(精选)Ventilator Review教学课件.ppt

Ventilator Alarms Oxygen (FiO2) 5% above and below set FiO2 Auto PEEP Air trapping related to airway obstruction, rapid RR, long inspiratory times, insufficient expiratory time. Seen with auto peep maneuver and flow vs. time wave form. Reducing Auto PEEP Reduce airway obstruction through bronchodilators/steroids. Increase expiratory time Decrease RR Increase inspiratory flow rate Decrease tidal volume Decrease inspiratory time Weaning If the patient is to be weaned… Perform weaning parameters. This may be done through the ventilator on most modern vents. If you are to do a VC or MIP, the patient is typically on CPAP mode without PEEP and minimal PSV if any. Assess VC, MIP, MEP several times for reproducibility While weaning note vital signs, RSBI, Vte, RR, SpO2… If patient fatigues to the point that their vitals decline, you should place them back on previous mode/settings You may get a ABG after a short time frame while weaning to assess effectiveness Weaning can be done numerous ways…SBT, CPAP trials, to Bipap… Nov 2006 Kishore P. Critical Care Conference Compliance changes Static vs dynamic Know formula and causes for each Static: use inspiratory hold to assess plateau, increasing plat=decreasing static compliance. Assess by looking at press-vol loop Caused by ARDS, pulm edema, atelectasis, pneumothorax, obesity… Dynamic: Decreased with increases in RAW Adequate Plateau Time -20 1 2 3 4 5 6 30 SEC Paw cmH2O Plateau Time Compliance Trend static and dynamic compliance Decreasing static compliance= changing to lung protective strategies, low volumes/high rates and peep, APRV, HFV… Decreasing Dynamic compliance = suction, bronchodilator, bite block, heated humidity… Nov 2006 Kishore P. Critical Care Conference Management Options – Inspiratory Time Principle of Use Increase in inspiratory time (TI) causes increase in Increase in aids in maintaining integrity of alveoli and recruiting atelectatic alveoli Associated with improvement in Associated with