PB840呼吸机的使用课件

1、PB 840 呼吸机原理及特点21世纪机型 全新的操作界面 顶尖的气路设计完善的安全保障 无限的升级潜力PB 840 技术优势及特点 高效双电脑控制顶尖气路设计模块化设计图形用户界面(GUI) 呼吸释放单元(BDU)后备电源(BPS)压缩泵(选件)(CU)轻便台车病人回路 (PC)湿化器PB 840 图形用户界面 简洁，直观的用户界面 双屏幕显示，不会影响 任何信息观察 智能报警系统 在台车支架上可以270度 旋转 可以单独安装于合适位置 延长电缆长达30英尺 PB 840 呼吸释放单元 (BDU)呼吸机核心气路系统电脑系统电气系统警报系统供应电源与图形用户界面通讯呼吸机开机时同时启动，无需独

2、立电源与开关外接空气源压力达到额定范围，自动停机BDU 随时监测其工作状态 PB 840 压缩泵(选件)PB840 气路系统工作原理顶尖气路设计低系统顺应性低系统泄漏低系统死腔高速响应PB840 操作特性逻辑化操作 (GUI)理想体重设置(IBW)呼吸模式(A/C，SIMV，Bi-Level,SPONT)呼吸方式(VCV，PCV)自主呼吸支持方式(PSV，TC)工作参数，警报参数自动预设窒息通气参数同时被预设选择想观察的呼吸波形呼吸机常规按键在屏内， 操作钮在屏外单次按键不影响送气 变更参数通过 触摸-旋转- 确认 右下方屏幕的导引区帮助操作者完成操作过程PB840 操作特性模式的设定在设置中

3、找到 SETUP 键位，按压MODESETUPAPNEASETUPALARMSETUPBiLevel的设定BiLevelPCModeMandatory TypeSpontaneous TypePSTrigger TypeV - TRIGCONTINUE旋转调节至显示?BiLevel随后的通气方式将被固定为PC方式，不可变更选择 spontaneous类型及触发类型触压 Continue 键位彩色屏幕并非单纯美观彩色屏幕自助菜单全面安全性PB840 操作特性PB840 操作特性智能呼吸释放 ABCA - work to triggerB - flow acceleration percent (

4、rise time) C - preventing pressure overshoot and sustaining the breathD - transition into expirationPressureTimeABCD新通气策略首先，增强现有呼吸形式的灵活性将适用面扩展至儿童、婴儿患者改善PSV、 PCV 状态下人机同步性能新智能通气能根据病人情况改变而自动调整PressureAC (PCV Only)D (PS Only)BA压力上升时间40PCIRCcmH2OINSPLminEXPPLOT SETUP302010 010-2080604020020-804060V.04812

5、s2610UNFREEZE RES = 5 RES = 20 RES = 50 cmH20/L/SEC cmH20/L/SEC cmH20/L/SECCABDNPB 840 电脑呼吸机独家专利设计 主动呼气阀美国万灵科公司 Puritan Bennett 840呼吸机吸气相实现主动性呼气主动呼气阀吸气时，根据设置压力呼气阀关闭允许在压力持续阶段自主呼吸或咳嗽40PCIRCcmH2OINSPLminEXP302010 010-2080604020020-804060V.04812s2610Spontaneous EffortsSpontaneous EffortsPCV W/O Active V

6、alvePCV with Active Valve呼气灵敏度Pressure support breaths terminate when patient flow decelerates to a percentage of peak flow 40PCIRCcmH2OINSPLminEXP302010 010-2080604020020-804060V.04812s2610PS Termination CriteriaCABD呼气灵敏度Leaks can cause inability to terminate pressure support breaths, causing profo

7、und asynchronyI-times too long or too short can also cause asynchronous breathing20% (Set)35% (Leak Rate)Flow呼气灵敏度ESENS allows adjustment of the termination criteria for pressure supported breathssets the percent of peak flow that cycles the pressure support breath into exhalationespecially helpful

8、to match the patient抯 desired inspiratory timecan improve synchrony between patient and ventilator20% (Set)40% (Set)35% (Leak Rate)FlowPB840 操作特性Bi-LEVEL 压力-时间曲线FSynchronized TransitionsSpontaneous BreathsPressure SupportPLPHPB840 操作特性Bi-Level 呼吸方式的增强功能 Bi-Level 、 APRV存在于一种方式中 PSV 可以给病人在PEEPH 或PEEPL

9、水平上的自主呼吸予支持 PEEPH与PEEPL之间的相互转换由时间与病人共同决定 对病人的每一次呼吸进行监测，并计算自主呼吸分钟通气量 可以由操作者决定TH、TL或TH:TL 固定全面监测自主呼吸容量，确定病人呼吸能力PB840 操作特性APRV 呼吸方式Spontaneous BreathsPTrelease?Upper And Lower Inflection Points02040602040-600.2LITERS0.40.6PawcmH2OVTUpper And Lower Inflection Points02040602040-600.2LITERS0.40.6PawcmH2OV

10、TAlveolar collapsePTLower inflection points are thought to be a point of critical opening pressureUpper And Lower Inflection Points02040602040-600.2LITERS0.40.6PawcmH2OVTAlveolar overdisentionAlveolar collapsePTPV CURVEPEEP = 5 cmH2OSetting PEEPPEEP = 12 cmH2OPB840 操作特性TC 气管插管自动补偿Pressure drop shows

11、 imposed work across ET-Tube when flow is presentWhat The Carina SeesCircuit PressureLower Carina PressurePawTC adds appropriate pressure to keep carina pressure at preset PEEPTubing Compensation - What The Carina SeesHigher Circuit PressureNo decreased Carina PressurePawTC Compared To PSTC varies i

12、ts output as flow demands changePressure rises and falls more naturally10PCIRCcmH2OINSPLminEXP7.5 5 2.5 0 -5-1080604020020-804060V.04812s2610Higher FlowHigher Appropriate SupportArtificial Airways and WOBSingle greatest cause of imposed WOB is caused by the ET-TubeDuring inspiration lung pressure ca

13、n be significantly lower than circuit pressure when flow is presentPS is frequently used to overcome this imposed WOB, and when used in this manner has several shortcomings PS Limitations For ET-Tube CompensationPS may under-support the WOB early in the inspiratory phase when flows are highAs patien

14、ts wake, sleep, become agitated etc, PS is unable to compensate for variable demands10PCIRCcmH2OINSPLminEXP7.5 5 2.5 0 -5-1080604020020-804060V.04812s2610Higher FlowInsufficient SupportWhat is Tube Compensation?Not a mode, but a spontaneous breath typeAccurately overcomes the imposed inspiratory WOB

15、 through an artificial airwayHybrid of PS (but more efficient at overcoming tube resistance)Controls the patients carinal pressure to a constant preset PEEP value during inspirationTC Potential Advantages SummaryEase of usemerely set the tube type and size, and % supportthe ventilator automatically

16、generates the correct supportLowest WOBcompared to CPAP or T-piece breathingImproved patient comfortAbility to track variable drivesPawLiterature ReviewTC provides an increase in respiratory comfort compared with IPS. The predominant cause for respiratory discomfort in the IPS mode seems to be lung overdistention.?Intensive Care Medicine 1997;23:1119 - 1124 Literature ReviewTC in contrast to PS, is a suitable mode to compensate for impo