analysis of airway pressure, flow, and volume wav课件

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1、AnalysisofAirwayPressure,Flow,andVolumeWaveformsBobKacmarekMassachusettsGeneralHospital,HarvardMedicalSchool,Boston,Massachusettstimeflowinhalationexhalation0auto-PEEPnormalconstantflowrampflowpressurecontrolConstantflowvolumecontrolventilationPressurecontrolventi

2、lationPEEPPIPpressuretimeSlowrisetimePatienttriggerFastrisetimePEEPPIPPplatresistancepressureCompliancepressureauto-PEEPtotal-PEEPtimeVolumeleakinspiredtidalvolumeexpiredtidalvolumeA-Flowtrigger,B-PressureTriggerflowpressureflowtriggerbeginningofpatienteffortflowp

3、ressurepressuretriggerbeginningofpatienteffortABvolume(mL)pressure(cmH2O)flow(L/min)SpontaneousBreathingvolume(mL)pressure(cmH2O)flow(L/min)VA/CControlvolume(mL)pressure(cmH2O)flow(L/min)patient-triggeredbreathventilator-triggeredbreathVA/CAssisttimeflowDecelera

4、ting;inspiratorytimefixedrectangularDecelerating;fixedpeakflowvolume(mL)pressure(cmH2O)flow(L/min)flowtimefullramppartialramp50%ramp50%peakflow5L/minABtimepressureassistwindowSIMVvolume(mL)pressure(cmH2O)flow(L/min)spontaneousbreathmandatorybreathSIMVvolume(mL)p

5、ressure(cmH2O)flow(L/min)pressuresupportbreathmandatorybreathSIMVwithPSVPressurevsVolumeVentilationPressureVolumeTidalVolVariableConstantPIPConstantVariablePalvPConstantVariablePeakFlowVariableConstantvolume(mL)pressure(cmH2O)flow(L/min)triggerPSVPSVPSVPSVPSVPSVPS

6、VPSVPSVvolume(mL)pressure(cmH2O)flow(L/min)PA/CPA/CPA/CABPA/CVA/CMariniARRD1986;134:902FernandezARRCCM1999;159:710InspiratoryTimeInspontaneousbreathingpatients,ventilatorinspiratorytimeshouldequalpatientdesiredinspiratorytime.Spontaneousbreathing-inspiratorytime<1

7、.0seconds.Patientswithhighventilatorydemand,inspiratorytimemaybeasshortas0.5seconds.Pressuretargetedventilationbetterabletomatchpatientdemandthanvolumeventilation,patient-ventilatorsynchronyenhancedwithpressureventilationFabryChest1995:107:1387MacIntyreChest1990;9

8、7:1463MacIntyre,HoCheat1991;99:134CorrectRiseTimeInitialPressureshouldnotexceedsetlevelNoDelayinInitialIncreaseinPressureInitialPressureRiseshouldnotbeC