PB呼吸机呼吸模式解析

1、1会计学PB呼吸机呼吸模式解析呼吸机呼吸模式解析u辅助/控制(A/C)模式u同步间隙指令通气(SIMV)模式u自主呼吸(SPON)模式u双水平通气（BILEVEL）模式新模式VV+ (VC+ VS+)TC (Tube Compensation)PAV (proportional assist ventilation)TimePressure控制模式通气（控制模式通气（ CMV）-VC预设预设 VT容量切换容量切换取决于取决于CL & RawFlowL/mPressurecm H2OVolumemL预设峰流速预设峰流速 时间触发时间触发 流速限定流速限定 容量切换容量切换吸气相吸气相呼气

2、相呼气相CMV (PVC)PressureFlowVolume(L/min)(ml)CycledSet PC level 时间触发时间触发 压力限定压力限定 时间切换时间切换(cm H2O)Assisted Mode (VC)FlowL/mPressurecm H2OVolumemLPreset VTVolume Cycling 病人触发病人触发 流速限定流速限定 容量切换容量切换 SIMV(VC)自主呼吸自主呼吸流速流速L/m压力压力cm H2O容量容量mL压力压力流速流速容量容量SIMV Mode (PV)自主呼吸自主呼吸(cm H2O)(ml)(L/min)PCV（压力控制模式）压力控制

3、模式）适应症适应症:ARDS单侧肺组织病变单侧肺组织病变限制性肺疾病限制性肺疾病肺部外伤。肺部外伤。PCV（压力控制模式）压力控制模式）PRESSUREI-timeFLOWPresure constantTimePressure病人触发的强制通气病人作功自主呼吸u缺点l如果设定频率或潮气量太低，对病人的支持就会不足设定呼吸机频率设定呼吸机频率1010次次/ /分分 呼吸机的实际 工作频率患者呼吸频率A-CMVSIMV0520PSVTime (sec)流速流速L/m压力压力cm H2O容量容量mL设置压力设置压力病人触发，流速切换，压力限制病人触发，流速切换，压力限制流速切换10cmTimePr

4、essure压力压力流速流速容量容量SIMV (PV)+ PSPS BreathSet PS levelTime (sec)时间切换时间切换流速切换流速切换(cm H2O)(L/min)(ml)SIMV(VC)+PSFlowPressureVolume(L/min)(cm H2O)(ml)Set PS levelPS BreathFlow-cycled肺顺应性肺顺应性: 压力压力-容量曲线容量曲线02040602040-600.2LITERS0.40.6PawcmH2OVTL.I.PU.I.PUse P-V curve as a guide to set the appropriate lev

5、el of PEEPInflection PointsPressure (cm H2O)Volume (mL)Upper Inflection PointLower Inflection PointCPAPCPAP levelFlowL/mPressurecm H2OVolumemL10 cm H2O PEEPTime5 cm H2O PEEP有关，使用起来其他方式会更加轻松、熟练。PVC)(PEEPPVCPlatTstat)(PEEPPVCPeakTdynFlowPressureInspExhPCV - Volume 400 mlVCV - Volume 400 ml方波的流速曲线显示压力呈

6、直线上升，气道压力较高。定容通气与定压通气的比较定容通气与定压通气的比较 FlowPressureInspExhPCV - Volume 400 mlVCV - Volume 400 ml肺内压的升高与气道压相似（容量不变，肺的顺应性不变，则肺内压不变）定容通气与定压通气的比较定容通气与定压通气的比较肺内压肺内压FlowPressureInspExh定容通气与定压通气的比较定容通气与定压通气的比较减速气流容量通气的压力波形与方波PCV的压力波形相近。VCV - Volume 400 mlPCV - Volume 400 mlFlowPressureInspExh定容通气与定压通气的比较定容通气

7、与定压通气的比较 对顺应性和病人需求增加时的反应对顺应性和病人需求增加时的反应VCV - Volume 容量通气时可能会导致 容量通气时 是顺应性增高的反映定容通气与定压通气的比较定容通气与定压通气的比较 对顺应性和病人需求增加时的反应对顺应性和病人需求增加时的反应FlowPressureInspExhVCV - Volume 定压通气时压力保持恒定。容量和流量不断变化以维持同步。PCV - Volume 300 - C顺应性（compliance）V容量变化P压力变化PVC)(PEEPPVCPlatTstat)(PEEPPVCPeakTdynPressureTimeABCDPressureA

8、C (PCV Only)D (PS Only)BAPressureAC (PCV Only)D (PS Only)BATransient overshootPressure reliefFAP = 1% FAP = 50% FAP = 100%Transient overshootPressure reliefTransient overshootPressure reliefFAP = 1% FAP = 50% FAP = 100%Transient overshootPressure relief40PCIRCcmH2OINSPLminEXPPLOT SETUP302010 010-208

9、0604020020-804060V.04812s2610UNFREEZE RES = 5 RES = 20 RES = 50 cmH20/L/SEC cmH20/L/SEC cmH20/L/SECCABD40PCIRCcmH2OINSPLminEXPPLOT SETUP302010 010-2080604020020-804060V.04812s2610UNFREEZE RES = 5 RES = 20 RES = 50 cmH20/L/SEC cmH20/L/SEC cmH20/L/SECCABD提供“较大的潮气量及平缓辅助压力上升”相关。CABDCABD40PCIRCcmH2OINSPL

10、minEXP302010 010-2080604020020-804060V.04812s2610Spontaneous EffortsSpontaneous EffortsPCV W/O Active ValvePCV with Active ValveCABDOK, OK, OK. Everyone just calm down and well try this thing one more time40PCIRCcmH2OINSPLminEXP302010 010-2080604020020-804060V.04812s2610Spontaneous EffortsSpontaneou

11、s EffortsPCV W/O Active ValvePCV with Active Valve1PB 840 电脑呼吸机独家专利设计 主动呼气阀PB840 操作特性操作特性主动呼气阀临床特性40PCIRCcmH2OINSPLminEXP302010 010-2080604020020-804060V.04812s2610PS Termination CriteriaCABDnFAP 目标流速)Preset ESENSPatient FlowIncreased ESENS呼气作功并导致患者与呼吸机不同步20% (Set)35% (Leak Rate)Flow20% (Set)40% (Se

12、t)35% (Leak Rate)FlowVT吸气峰流速5%20%40%目标流速nExpiratory sensitivitynHumidification typenDisconnect sensitivitynO2 sensor enable/disable1000 mLAvailable DSENS range: 20-95%70% Loss 95% LossAvailable DSENS range: 20-95%u压力触发u流量触发 X XBaseline TriggerPatient effortPressure-2 cm H2ODelivered flowReturned flowNo patient effortDelivered flowLess flow returned All inspiratory efforts recognizedTimePressureSIMV(V