人机不同步.ppt

郭凤梅东南大学附属中大医院重症医学科人机不同步 关注呼吸机设置1.人机不同步l 概念：机械通气与患者自主呼吸不同步的现象l 分类：吸气触发 吸气呼气切换 吸气潮气量2.Asynchrony during non-invasive ventilation6 ICUS60 acute respiratory failure patientsEMGdi was measuredIntensive Care Med,2009;35(5):840-6.44%患者存在严重人机不同步3.Time asynchrony during invasive MVPats 62 ACV和PSV MV24h监测食道压力、流速压力波形30分钟内无效触发、双触发的次数不同步指数不同步事件次数/患者所有吸气努力次数24患者人机不同步指数10%(严重人机不同步)Thille AW,Intensive Care Med 2006;32:151515224.Asynchrony-ventilation induced lung injury N Engl J Med,2010;363:1107-1116.5.Consequence of asynchrony N Engl J Med,2010;363:1176-11806.N Engl J Med,2010;363:1176-11807.Consequence of asynchrony 机械通气机械通气大于大于7天天气管气管切开率切开率病死率病死率0%20%40%60%80%100%Asynchronyindex10%Asynchronyindex10%*p0.05Thille AW,Intensive Care Med 2006;32:15151522n镇静、肌松剂使用增多n改变自主呼吸形式n机械通气时间延长8.分 类 吸气触发：吸气呼气切换：吸气潮气量：10.Auto triggerPossible ReasonspatientCardiogenic oscillatorsVentilatorLower triggeringCircuit leaksWater in circuit11.Ventilator waveformsTrigger asynchronylIneffective effortThille AW,Clinical Pulmonary Medicine 2007;14:350-35912.触发延迟Am J Respir Crit Care Med 2005;172:1283128913.-1cmH2O14.-2cmH2O15.-3cmH2O-3cmH2O16.Double triggernPossible ReasonsnpatientnStrong and prolonged inspiratory effortnVentilatorReduce mechanical inflation timeALI patient with ACV17.Flow asynchrony pressure trace is dished outCritical Care Nurse.2009;29:41-55.Intensive Care Med.2006;32:3447.18.Cycle-off asynchronyCritical Care Nurse.2009;29:41-55.lpremature terminationldelayed termination19.Thank you for your attention!20.