Mechanical Ventilation ventilation Pa CO 2 respiration Pa

기계적 환기 Mechanical Ventilation

호흡 및 환기 부전의 정의 • 환기 (ventilation) : 가스 이동 - Pa. CO 2 • 호흡 (respiration) : 가스 교환 - Pa. O 2 • 환기 부전 (ventilatory failure) : Pa. CO 2 > 50 mm. Hg • 호흡 부전 (respiratory failure) : - Pa. O 2 < 60 mm. Hg, Pa. CO 2 > 50 mm. Hg (in room air) - Pa. O 2 < 70 mm. Hg (mask) - Pa. O 2 < 200 mm. Hg (100% O 2) - A-a. DO 2 > 450 mm. Hg (100% O 2)

동맥내 산소화 • PAO 2 6 Fi. O 2 , Pa. O 2 5 Fi. O 2 • Alveolar air equation PAO 2 = (PB -PH O) Fi. O 2 - PACO 2 /R 2 = (760 -47) Fi. O 2 - Pa. CO 2 /0. 8 • Oxygen content (Ca. O 2) = (Sa. O 2 * Hgb * 1. 34)+0. 003 Pa. O 2 • Oxygen transport = Oxygen content * cardiac output • Oxyhemoglobin dissociation curve - 30 -60 -90 rule (Sp. O 2 -Pa. O 2 )

PEEP 효과

Steps of Ventilator Commitment 1. Establish the airway& manually support ventilation 2. Cardiovascular stabilization 3. Establish appropriate monitors and base lines 4. Establish ventilatory pattern (FVS / PVS ? ) 5. Connection to the ventilator

호흡 보조 전 호흡 보조 (full ventilatory support, FVS) 부분 호흡 보조 (partial ventilatory support, PVS) 호흡일 전적으로 기계 기계와 환자가 담당 방법 A/CMV, IMV/SIMV / SIMV, PSV 심박출량 억제 FVS보다 덜 하다 뇨량, 신혈류량 억제 FVS보다 덜 하다 호흡근 정상 유지 FVS보다 좋다. 진정제 등 약물 사용 Ix 많다 적다 with nervous system dysfunction with severe lung disease with severe cardiac disease in first 12 h ( 임상적 안정, 진단, 감시장치) ㅡ FVS 또는 PVS * 4 center study : FVS : PVS = 20 : 80

FVS /PVS 설정 1. FVS : A/CMV, IMS/SIMV - VT 10 -15 ml/kg , RR: 8 -12 /분 , 흡기 유속: 0. 5 -1. 5초, I: E= 1: 2 - 1: 4 - narcotics (morphine), sedatives (midazolam, propofol), paralyzing agents - Fi. O 2 : high low (0. 1 -0. 2 씩) * 원하는 Fi. O 2 = Aa. DO 2*(필요한 Pa. O 2 / 713) - PEEP 5 - 30 cm. H 2 O * COPD환자: smaller tidal volume, more rapid rate 2. PVS : IMV/SIMV, PSV IMV / SIMV - VT: 10 -15 ml/kg , RR: 2 -7회/분, 흡기 유속 : 0. 5 -1. 5 초 - 진정제 또는 진통제 투여, - RR < 4 : CPAP 5 cm. H 20 첨가 PSV - 압력 20 cm. H 20 시작 : RR < 20회, 3 - 5 cm. H 20씩 조정 - 진정제 또는 진통제 투여, - 압력 제한 < 10 cm. H 20: CPAP 5 cm. H 20 첨가

PEEP 설정 • 일반적 원칙 - 10 -30 cm. H 20 ( 5 cm. H 20 증감) - PEEP response ? (Pa. O 2, 폐유순도, 션트) - fluid administration, inotropic support, pressor agent - change Fi. O 2 - end point: least PEEP (Fi. O 2 to 0. 4, Pa. O 2 >60 torr , adequate CO & Ca. O 2 ) • FVS plus PEEP - Fi. O 2 최소화 - PPV 감소 (자발 호흡 유도) - PEEP치 감소 • PVS plus PEEP - Fi. O 2 0. 4 까지 - 환기 보조를 감소 - PEEP치 감소 (least PEEP)

Servo Ventilator 900 C

증례 • 34 years-old woman, car accident, multiple Fx of leg & pelvis traction, after 36 h : tachypneic, tachcardiac, agitated, urine: (+) for fat content Time (min) 0 10 15 15 10 SBP RR VT 110 36 300 110 110 20 150 120 18 250 Ventilator Spon. CMV CMV SIMV SIMV ETV Rate PEEP Fi. O 2 Pa. CO 2 Pa. O 2 0. 6 33 35 900 8 10 900 8 15 900 4 20 0. 6 32 38 0. 6 33 41 0. 6 33 55 0. 6 29 90 0. 6 33 110 0. 5 33 64 0. 5 35 95 0. 4 34 68

새로운 환기법 1. Conventional ventilator : open lung concepts: 2. Airway pressure release ventilation (APRV) 3. Proportional assist ventilation (PAV) 4. Mandatory minute ventilation (MMV) 5. High frequency ventilation (HFV) 6. Independent lung ventilation (ILV) 7. Intratracheal pulmonary ventilation (ITPV) 8. Liquid ventilation : perfluorochemical (PFCs) * Extracorporeal lung support (ECLS): ECMO, ECCO 2 R, IVOX

Open Lung Approach • Purpose: preventilator-induced complication • A suggested strategy - Tidal volume : 5 -7 ml/kg - PEEP : 8 -12 cm. H 2 O - Recruitment maneuver: : inspiratory pause 10 -20 sec at 30 -35 cm. H 2 O (inverse ratio ventilation) : periodic 12 ml/kg (initially and after circuit disconnect) - Airway pressure : plateau pressure < 35 cm. Hc. O - Pa. CO 2: 50 -80 mm. Hg (permissive hypercarbia)

Independent Lung Ventilation (ILV) • Synchronized IVL - same RR, different VT, PEEP, insp. flow • Asynchronized IVL - different RR, VT, PEEP, insp. flow • One lung ventilation • Double lumen tube • Indications - thoracic surgery, BPF selective airway protection lung disease

ECMO

IVOX

The Newport HT 50 VENTILATOR 기본setting & 사용mannual 열린중앙병원 3병동

개요 • • 구성 Setting 기본 작동법 Alarm시 management