Absolute Basics of Mechanical Ventilation.ppt
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1、Absolute Basics of Mechanical Ventilation,Dr David HowellConsultant in Intensive Care, Respiratory and Acute Medicine,Aims and Objectives,Define Positive Pressure Mechanical VentilationExplain Continuous Mandatory Ventilation (CMV)Explain Synchronised Mandatory Ventilation (SIMV)Explain Pressure Sup
2、port Ventilation (PSV)Explain Basic Ventilator SettingsNot a Talk on Physiology of Mechanical Ventilation,What you Encounter,Positive Pressure Mechanical Ventilator,Lots of Monitors and Knobs to Turn,Some are More Complicated than Others,Weaning Screen/standard protocol,Long Term Weaning/Individual
3、plan,Weaning,Non-Invasive Ventilation,Non-invasive support,Tracheostomy,Intubation,Extubation Decannulation,Standard Ventilation,Advanced Ventilation,Invasive support,Optimising the Pt for weaning,Prone Position,Nitric Oxide,Suctioning,Humidification,NIV is defined as ventilatory support provided vi
4、a a tight fitting mask or similar interface as opposed to invasive support, which is provided via a laryngeal mask, endotracheal tube or tracheostomy tube.Tight fitting masks deliver can CPAP, BIPAP or NIV via the mechanical ventilator.,NIV vs. Invasive Mechanical Ventilation,The work of breathing u
5、sually accounts for 5% of oxygen consumption (V02). In the critically ill patient this may rise to 30%.Invasive mechanical ventilation eliminates the metabolic cost of breathing.,Indications for Mechanical Ventilation,Inadequate oxygenation (not corrected by supplemental O2 by mask).Inadequate venti
6、lation (increased PaCO2).Retention of pulmonary secretions (bronchial toilet). Airway protection (obtunded patient, depressed gag reflex).,Indications for Mechanical Ventilation,Intubation,1 Airway: oral Guedel airway to lift tongue off posterior pharynx to facilitate mask ventilation during pre-int
7、ubation phase. 2 Liquids: stop feed and aspirate ng tube. 3 Suction: extremely important to avoid pulmonary aspiration. 4 Oxygen: preoxygenate patient and ensure a source of O2 with a delivery mechanism (ambu-bag and mask) is available.,Bare Essentials for Intubation ALSOBLEED,5 Bougie: to facilitat
8、e tube insertion in more difficult airway. 6 Laryngoscope: have a long and short blade available. 7 Endotracheal tube: for average adult, cuffed oral endotracheal tube 7.0 for women and 8.0 for men. 8 End tidal CO2: to confirm correct position of tube. 9 Drugs: an induction agent, muscle relaxant, s
9、edative are usually required.,Bare Essentials for Intubation ALSOBLEED,Principles of Mechanical Ventilation,ET tube Ventilator Tubing Major Airways,Alveoli,PEEP,Positive pressure ventilation involves delivering a mechanically generated breath to get O2 in and CO2 out.Gas is pumped in during inspirat
10、ion (Ti) and the patient passively expires during expiration (Te).The sum of Ti and Te is the respiratory cycle or breath.,Principles of Mechanical Ventilation,Flow,Pressure,Principles of Mechanical Ventilation,Ti,Te,Ti,Te,In the fully ventilated patient, positive pressure breaths are delivered eith
11、er as preset volume or pressure continuous mandatory breaths (CMV) breaths.The mechanical ventilator triggers the breath and switches from inspiration to expiration when the preset volume, pressure (or time) is achieved/delivered.During CMV the patient takes no spontaneous breaths.CMV is usually use
12、d in theatre and in very unwell ICU patients.,Principles of Mechanical Ventilation,Principles of Mechanical Ventilation,Volume control,Tidal volume is presetUsually 500 mlsAirway Pressure is Variable,Pressure control,Inspiratory Pressure is presetUsually 15-20 cm H20Tidal Volume is Variable,Mandator
13、y breaths are delivered during inspiration, to generate a tidal volume (Vt), at a set rate (f), the quotient of which is the minute volume (MV). Minute Volume = Tidal Volume x frequencyIn volume control ventilation, an inspiratory flow rate is also set.The ratio of the time spent in inspiration:expi
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