机械通气在micu的应用及护理一ppt课件.pptVIP

吸气流速根据系统顺应性和粘性阻力的变化而改变；有利于时间常数大的肺泡单位充气，改善通气/血流比 * * * * * * * * * * The cause of the high airway pressure may also be obstruction in the ventilatory circuit. This is most commonly due to water pooling in the circuit or to a filter that is filled with water. Note that the obstruction is often in the expiratory limb of the circuit which results increased PEEP and hence airway pressure[paw12] * * * * * * If a patient desaturates while on a mechanical ventilator it is important to consider both patient causes and equipment causes. Increase the inspired oxygen concentration to 100% and quickly check that the patient’s chest is still moving before going on to a more detailed examination. If the chest is not moving it may be a problem with the ventilator but this is unusual. In this situation the patient will be easy to ventilate manually. If the chest is not moving and the patient is not easy to ventilate then the problem is similar to a high airway pressure problem. More commonly the chest is still moving. A detailed examination of the chest should be carried out looking in particular for endobronchial intubation, pneumothorax, collapse, pulmonary oedema and bronchospasm. In addition patient ventilator dysynchrony may result in desaturation. * 机械通气时的报警 高压报警 低压报警 窒息报警 氧浓度报警 低通气报警 对呼吸机报警的反应 手法通气 通气阻力 呼吸机或管路漏气 气管插管套囊漏气 正常 过低 低压报警 气道低压报警 ? 漏气 呼吸机内部 吸气回路 Y管与气管插管连接处 气管插管套囊周围 支气管胸膜瘘 测温线 ?呼吸机工作异常 ?患者吸气力量过强 漏气时的表现 Volume (ml) Time (sec) Air Leak 对呼吸机报警的反应 一旦怀疑呼吸机工作异常或气管插管是否通畅 应将患者脱离呼吸机, 并用纯氧进行手法通气 机械通气时的报警 高压报警 低压报警 窒息报警 氧浓度报警 低通气报警 机械通气时的报警 高压报警 低压报警 窒息报警 氧浓度报警 低通气报警 机械通气时的报警 高压报警 低压报警 窒息报警 氧浓度报警 低通气报警 机械通气时患者-氧合下降 ? 氧源故障 ? 单侧插管 ? 意外拔管/脱机 ? 呼吸机故障 ? 导致低氧性呼吸功能衰竭的所有原因 肺栓塞 气胸 氧合下降 胸廓运动? 调FiO2=1.0 人工通气 通气容易? 呼吸机故障 ETT/患者问题气道阻力升高 或顺应性降低 体格检查 特别注意: 单侧插管气胸 肺不张 肺水肿 支气管痉挛 治疗病因? 调整呼吸机设置 Yes No 检查设置 与功能 Yes No 机械通气时患者-呼吸频率过快 机械通气并发症及其防治 通气不足 通气过度 心输出量下降，低血压 肺气压伤 其他器官的并发症 院内获得性感染 常见原因：气道分泌物潴留或通气管道漏气；呼吸机与自发呼吸矛盾。多因潮气量小呼吸频