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1、Editors:Singer,Mervyn;Webb,AndrewR.Title:OxfordHandbookofCriticalCare,2ndEditionCopyright©1997,2005M.SingerandA.R.WebbOvid:OxfordHandbookofCriticalCarefile:///C:/Documents%20and%20Settings/MVP/Application%20Data/Mozilla/Firefox/Profiles/2...Ovid:OxfordHandbookofCriticalCareEditors:Sin
2、ger,Mervyn;Webb,AndrewR.Title:OxfordHandbookofCriticalCare,2ndEditionCopyright©1997,2005M.SingerandA.R.Webb,1997,2005.PublishedintheUnitedStatesbyOxfordUniversityPressInc>TableofContents>RespiratoryTherapyTechniquesRespiratoryTherapyTechniquesOxygentherapyAllcriticallyillpatientsshoul
3、dreceiveadditionalinspiredoxygenona‘morenotlessisbest’philosophy.PrinciplesHighflow,highconcentrationoxygenshouldbegiventoanyacutelydyspnoeicorhypoxaemicpatientuntilaccuratetitrationcanbeperformedusingarterialbloodgasanalysis.Ingeneral,maintainSaO2>90%,thoughpreferably>95%.Compromises
4、mayneedtobemadeduringacuteonchronichypoxaemicrespiratoryfailure,orprolongedsevereARDS,whenlowervaluesmaysufficeprovidedtissueoxygendeliveryismaintained.AllpatientsplacedonmechanicalventilationshouldinitiallyreceiveahighFIO2untilaccuratetitrationisperformedusingarterialbloodgasanalysis
5、.ApartfrompatientsreceivinghyperbaricO2therapy(e.g.forcarbonmonoxidepoisoning,divingaccidents),thereisnoneedtomaintainsupranormallevelsofPaO2.CautionsAsmallproportionofpatientsinchronicTypeII(hypoxaemic,hypercapnic)respiratoryfailurewilldevelopapnoeaiftheircentralhypoxicdriveisremoved
6、bysupplementaloxygen.However,thisisseldom(ifever)abruptandaperiodofdeteriorationandincreasingdrowsinesswillalertmedicalandnursingstafftoconsidereither(i)FIO2reductionifoverallconditionallows,(ii)non-invasiveorinvasivemechanicalventilationiffatiguingor(iii)useofrespiratorystimulantssuc
7、hasdoxepram.Thecorollaryisthatclosesupervisionandmonitoringisnecessaryinallcriticallyillpatients.Anormalpulseoximetryreadingmayobscuredeterioratinggasexchangeandprogressivehypercapnia.Oxygentoxicityisdescribedinanimalmodels.Normalvolunteerswillbecomesymptomaticafterseveralhoursofbreat
8、hingp
