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ID:20464264
大小:1.34 MB
页数:25页
时间:2018-10-10
《airway pressure release ventilation1.ppt课件》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、AirwayPressureReleaseVentilationAPRVreviewandindicationsinpaediatricsAPRVTerminologyHowitworksIndicationsAdvantages/disadvantagesReviewofpaediatricstudiesSet-up(paedspecific)WeaningDiscussionAPRVContinuouspositiveairwaypressurewithregular,briefreleasesinairwaypressuretofac
2、ilitatealveolarventilationandCO2removalTimetriggered,pressurelimited,timecycledmodeAllowingunrestrictedspon.BreathingthroughouttheventilatorycycleTerminologyPhigh=thebaselineairwaypressurelevel,Plow=airwaypressureresultingfromairwayrelease(PEEP)Timehigh=thelengthoftimethat
3、PhighismaintainedTimePEEP=timespentinairwayreleaseatPlowTheconstantairwaypressureatPhighfacilitatesalveolarrecruitmentandthereforeenhancesgasdiffusionThelongtimeatPhighallowsalveolarunitswithslowtimeconstantstoopenThetimedreleasesinpressureTPEEPallowsalveolargastobeexpelle
4、dvianaturallungrecoilnotwithrepetitiousopeningofalveoliHowdoesitwork?APRVwaveformIndicationsRecruitablelowcompliancelungdisordersLungdysfunctionsecondarytothoracicrestrictioni.e..obesity,acitesInadequateoxygenationwithFiO2>.60PIP>35cmH2Oand/orPEEP>10cmH2OLungprotectivestra
5、tegies(highPEEP,lowVt)arefailingCanbeusedwithotherinterventionsi.e..INOtherapy,pronepositioningAdvantagesSignificantlylowerpeakPawandimprovedoxygenationwhencomparedtoconventionalventilationRequireslowermin.vol.suggestingdecreaseddeadspaceventilationAvoidslowvolumelunginjur
6、ybyavoidingrepetitiousopeningofalveoliAdvantagesAllowsforspontaneousbreathingatallpointsintherespiratorycycleSpon.breathingtendstoimproveV/QmatchingDecreasedneedforsedationandneareliminatingneedforneuromuscularblockadeDisadvantagesVolumesaffectedbychangesincomplianceandres
7、istanceandthereforeclosemonitoringrequiredIntegratingnewtechnologyLimitedresearchandclinicalexperiencePaediatricStudiesStudiesinthepaediatricpopulationarefewandsmallSeveralareongoing3publishedMostevidenceisextrapolatedfromtheadultstudiesAirwaypressurereleaseventilationinpa
8、ediatricsSchultzT,etal.PediatricCritCareMed.2001jul;2(3):243-6aprospective,randomized,cro
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