airway pressure release ventilation1.ppt课件

《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