(Ventilator)

Ventilator
- 2 ( ,
2546)
( , 2551)
1. negative pressure ventilator (NPV)

2. Positive pressure ventilator (PPV)

power
transmission drive mechanism

(output control valve)

(Pneumatic drive)
ventilator Bird mark 7

electric power
Bennett MA I,Servo 900, Emerson 3 PV

 (mixed power)

1.
ventilator settings
Mode , VT, RR, % O2, PIF, I: E PEEP
2. alarm system

; O2

; low P. alarm ; high P. alarm

secretion block pneumothorax;
VT
;
3. , (humidifier) nebulizer

4. (monitoring of patient data
patient information) graphics waveforms

1. (mode of ventilation)

A/C (assist / control)
10 -12 /

25 /
overdrive
(CMV)
/

total support partial

support
IMV SIMV (synchronous intermittent mandatory
ventilation) PS (pressure support)

2.
VT (Tidal volume) 6 8 . /.

500 . 20 .
500 . compliance compressible loss
24 . / . VT 500 .
VT 500 +
(40-80) .
3.
10 12 /
I:
E 1: 2 ( : )
insufflation time + plateau dead
space


apnea back up
4.
O2 100%
50% O2
O2 Pa O2 60 80 . Sa O2 90 95 %
O2 hypoxic drive
, COPD calibrate O2 sensor

5.
(PIF) peak inspiratory
flow rate
(VT) (square waveform)
/
20 / , I: E
~ 1:2, VT ~ 0.5
1 60 / 20 = 3
: = 1: 2
1 VT = 0.5
60 VT = 30 /
Compressible loss = 80 . = 0.08
= 0.5 + 0.08 = 0.58
1 = 0.58 x 60
PIF = 34.8


PIF 40 60 /
6.
PEEP FRC, , shunt (
Pa O2 ) 2

3 5 . static compliance (CS = VT /
(Ppla PEEP ) best PEEP COPD
FRC PEEP
7.
nebulizer
32 34 1 2
30 ./ Wick humidifier

8.

alarm
O2 < / >
10%
T
low PIP alarm ( PIP 10 . )

high PIP alarm ( PIP + 10 . )

loss of PEEP ( 3 . )
expired VT ( / 20% )
RR ( < 8 10 > 30 35 / )
apnea alarm > 15
ventilator failure
9.
(sensitivity breath
triggering)
autocycling

( 0 PEEP 0.5 2 . )
pressure sensing
(-5) .

flow sensing constant flow

2 / flow sensor
patient wye
(calibrated)

1. ,
, ,
(cyanosis)

 , Sp O2

2. oxygenation FiO2 0.21 SpO2 97 % PaO2
80 100 . COPD
FiO2 carbon monoxide
poisoning cardiogenic shock PaO2 125 .

3. (ventilation) PaCO2 < 35 >
50 . (hyperventilation)
(hypoventilation) permissive hypercapnea pH
7.25 COPD
4. parameters
4.1 Tidal volume (VT) 5 7 . /. VT




4.2 minute ventilation (VE) 1
= VT x RR 4 8 / 10 /
ventilatory demand
4.3 Vital capacity (VC)

 60 80 . /. 10 . /.

4.4 Peak airway pressure (PAP)
2
elastic recoil
Ppla
4.5 Plateau pressure (Ppla)

elastic recoil
inspiratory hold occluding expiratory port
2 4.8
PAP Ppla secretion mucous block
bronchospasm PAP Ppla 2
acute congestive heart failure ARDS pneumothorax
4.6 mean airway pressure (MAP)
MAP 30 .
Barotraumas cardiac output
4.7 positive end expiratory pressure (PEEP)


+10, +7, +5 . PEEP mean airway pressure
4.8 Auto PEEP




Auto PEEP ( )
-2, -3 Auto PEEP +5
, +5 -3 . Auto PEEP
Auto PEEP flow
time waveform expiratory flow base line zero flow
inspiratory flow total PEEP end expiratory hold occluded
expiratory port technique auto PEEP = total PEEP set PEEP auto
PEEP
VT inspiratory flow

expiratory time set external PEEP
work of breathing auto PEEP
set external PEEP +12 auto
PEEP +10 total PEEP = +12 . water falls theory set

4.9 (lung compliance) 2 CS
(State compliance) CD
(dynamic compliance)

) CS = VT / (Ppla PEEP) 80
100 . / . CD = VT / (PAP PEEP) 60 80 . / .

4.10 (airway resistance = Raw) non

Elastic component Raw = 2 3 . / / ( flow 1 /
)
8 . / / Raw = (PAP Ppla) / flow


(Patient-ventilator
asynchrony)
ventilator graphic waveform

waveform graphic




ambu bag + 100 % O2 +
PEEP
accessory muscles
paradoxical breathing respiratory alternans alarm

inspiratory
flow auto PEEP


respiratory drive demand flow rate
trigger sensitivity
flow triggering pressure triggering / external PEEP counter
balance auto PEEP 80% auto PEEP 6 .
external PEEP 5 . Trigger sensitivity -2 .

3 . ( 1 . 6 - 5 = 1) auto
PEEP 2 . 2 . ) / cycle dys synchrony
patient ventilator inspiratory time expiratory
trigger sensitivity
4
1.
2.
3.
4.

(weaning)







1.


( weaning protocol
1 )

1
1)
2) 90/60-140/90 mmHg ( BP dopamine <5
/./)
3) Oxygen saturation>95% FiO2 0.5 PaCO2/FiO2
150
4) Tidal volumne >5 ml/kg
5) electrolyte Ca,Mg,PO4 72 .
6) sedative
7) PEEP 5 cmH2O

8)
()

2

2
Rapid Shallow Breathing Index (RSBI) 1 RSBI<105
disconnect bird 1
1) / ()
2) Minute Ventilation
3) Tidal volumne (Lite)
4) RSBI / Tidal volumne
RSBI
105
1

3
Spontaneous Breathing Trial (SBT) 120 on T-piece O2 flow 8
LPM
15-30
wean
1) RR>35/min
5
2) Oxygen saturation <90%
3) HR>140/min 20/min Baseline

4) Systolic blood pressure >180 < 90 mmHg

5)
6)
7)

1
gag reflex / GCS 9

extubation Warm Saline nebulizer 1 hr. On O2 mask with
bag 6-10
LPM Oxygen saturation>95% monitor V/S O2 sat 24 .
2.

(Perry)
(Viderman)

1
-
- (Panic)
- (Psychosis)
2



-
-
-
3
-
-


1.

2.



1.
2.

1.



2.

1.1 T-piece (tracheostomy
mask)
1.2 Ambu
1.3
1.4
1.5
1.6 20-40
1.
weaning protocol
1
2.
5.


6.