jjmmuamuaoRssid su 123 RSU i0 ummunRum 7

mmu : naimuR ventilator Tuucia:0 U HUROSilsriDu Hsaujuuarlsbi progress

Lhofi:
u u u . _
Rauumis asROiuaoRU
VI VI
as wean , indication , alarm cnun a . lRaau ucihuao AA
VI

IunsiumauuRiiRa:auuiRRuIu UsnuuHsatJsu ventilator cnuauuoIoa:R:

I VI

pnciau : oiauuua w.u . nuuuo intern ( Fiau 7 anilUimsu )

aa RSU > rh round uciaiou
1. R ET tube iuasa:Is
ROiuanirhlhS ( RJsmau portable CXR RDU ) DR cuff
pressure UsiiDuROumRaoIaciasuJrh

: Fia cuff pressure laiTuinu 25 mmHg (lumo practical ianJs:UlfU 20-

30 cmH 2 O) luaomnmm capillary pressure naruril 25 mmHg > Rfinaonmu
auaaociamsinR tracheal mucosal necrosis
2. Rsaasiomu - R secretion lUauuasiUch (anquuu aiauanai VAP maoisu

ui an loose iiaiuilsmaium aiaa:aafio volume overload) breath sound iQu

uolo RuIumub uwusnuiRsaouu ( UnR mubith UaRun-naoun , mubaan
^
UaRiiWu-naouWu )
- Rtnlu ventilator circuit ROD miJiua: (TRUIQWPRSO corrugated tube) Minth
aan iwsiruilu ventilator niuannu arrnlhRuIuu patient-ventilator
>
^ v

dyssynchrony IR iwsirlil (condensate) niua: arlllURO trigger inspiratory valve

mlhRuIumufoisolR
- RWasudsan ( umiJui , tnsn ) luilsriRurunuauaonu ventilator cialUu
1) lu - mu IhS:5o VAP (ventilator associated pneumonia) IORDU
2) RR - rhisouu uiJamma:uQrypnuoos:uumub > uio sw. a:ij nurse
note Msa ventilator chart ciiomn idu urns record 02 sat , tidal volume, PIP
ImaiuiRROu VI
3) Intake/ output (I/ O) balance - iOutb:iciUcTlRfyuin ni intake > output 01117
Chninuuna: leak UnUotTi nilmJacilluao mlh respiratory parameter 01107
iilauuuilao
3. Portable CXR RbiiUauuuUaoItJiJinuatjauioT'5 > anOu guide Muni'S
tBu ventilator
4. ABG > tb:lRuayn oxygenation (PF ratio), ventilation, acid base >
iQu guide luni'Sil'SU ventilator
5. Q lung compliance UUUR 51D7 > amaci5 compliance = delta V/ delta P
VCV mode m tidal volume lanon
^compliance
c ih'SU
^ mJablUoRRUU
i
set > PIP mJaai
ni

PIP aouu uUabl compliance

aciao

RUU > ni aciao

uUabiUaciuu
cTlhSu PCV mode m set inspired pressure lanon > ni VTE (exhaled tidal
volume) iwuuu uUabl compliance null uUabiUacinuu > ni VTE aciao
uUabl compliance aciao uUabiUaciuu
uayai ao compliance no:uiuidouIuni5Llsu ventilator cialU
^
6. walcuauauiociu
u
mnuiuiUbu ventilator In unnoaUio
l) PF ratio nuunbunu (H50 02 sat nuunbunu) aiamm an Fi02 ao iwaaci
^
lamainn oxygen toxicity > anInna:U5:uinj 0.1-0.2 (nnOu ARDS aiaa:
aciaona: 0.05-0.1)

: Iuni5iaonaci5:haio Fi 02 ua: PEEP biaranarfefiauuu fttobi setting Inu

rialmnn side effect uinnbi > n^ fu Fi02 mnnbiM50 iriinu 0.6 IHWUIUIU
aci Fi02 riau > n^ru Fi02 uaunbi 0.6 teuan PEEP Iciuaci PEEP In 2-4
cmH20 ciaau

- PF ratio uuaonbiinu (nsa 02 sat uuaonbiinu) aianimsiwu Fi02 uu ua:Ih

uaonioiaanau idu ni5?d PEEP lun'sruniOu bilateral alveolar infiltration
: nmiRuIuuuum fhwu Fi02 iQu l.o Idriau
:n
^ruiQu bilateral alveolar infiltration IhW3l5fUl step PEEP uu > 5:RU
w.u. nlduuu incremental PEEP Idriau (step na: 2-3 du.ui nn 5-15 uin) >
n^runluIhO aiam prone position PfSa alveolar recruitment maneuver IR (IM
uanw staff R 3 U)
2) Ventilation + acid-base > U5:iRunanadn pH ni pH ayluinruriR cnao
wala IuRaoIdiRud5uiR 5 ao Idai PaC02 H5a HC03 ariQuimlhdncnu
idu pH 7.39, PaC02 18, HC03 12 > auioulucnaolljlj u tidal volume H53 RR
^
lia:muldaci5 (PaC02)l x MV1 = (PaC02) 2 x MV2 iwaiwu PaC02 > IW51:
nnwu PaC02 aznilh pH aRaonun
- nnQu metabolic acidosis : [Run pH < 7.20 (< 7.25) minute
ventilation uuld TRUU U tidal volume uu iriinaiui n accept PIP IQ an unci a:
^ ^
mode > rh PIP ifiuuaa TtfiVimsiwu RR
- n^ruiQu PaC02 RO ua:u respiratory acidosis nluu auto-PEEP Hanm^nold
Ralmwu minute ventilation TRU3:IWU tidal volume H50 RR nlcrf (RR maximun
luinu 35/ min) n^ruuluacn^ (PaC02)l x MV1 = (PaC02)2 x MV2
: 5:aom5luaci5u Tu ARDS luaoam tidal volume lu ARDS ainnanncilan 6-8
u u

mL/kg aoluaiui niwu tidal volume uif

(luinu 35/ min)
^ ^ Tcf > moUrjuRuniOumsiwu RR

- n^ruiilu PaC02 RO nu respiratory acidosis nu auto-PEEP (0107 IHR flow-

time curve ai nan end of expiration 3iIuiiR:nnuu) > IminTuaiihCiuao
auto-PEEP uu (wuui H53 diuretics nuaauciaiihci) mni5d5U ventilator IRU
aci tidal volume, iwu E-time, aR RR > niluliia nld sedation Id
- miOu PaC02 on ua:iQu respiratory alkalosis ua:RuIumul3RiuiR 5 aoaR7
(idu Ruludu M5 au neuromuscular disease) IiidSu minute ventilation TRUIU
aR 5 (PaC02)l x MV1 = ( PaC02) 2 x MV2 > iRuariaondsuillu TV H53 RR n
IR
- rriRuIdiOu PaC02 cfn dounu respiratory alkalosis urichRuIumubluimiRsao
rBadimubtlonyi RR n set B > n^ruumubaon^ (PaC02)i x MVi =
(PaC02)2 x MV2 iwrumsafl minute ventilation armlhRuIdmubtSoduIUan

:n
^ruuMnauIURbi mTiJRuIumubmn:hiR 5ao Ra cnaomanncn (disconnect -
uu bag - suction - Wo lung 3 U5:lRU - crep - wheez - decrease breath
sound) iaaaiuiqa:B nunlUcnuuu niluiaaarb nlh sedation Id

> mnoORnRuBaim^RUU hemodynamic stable waauR 05 Id Fi02 uau

l

nbm airfinu 0.4 (staff uiorhuld Fi02 < 0.5), Pa02/Fi02 > 200 > teu
^
RRnoi50 o weaning amiR
^aodoumublR > IhaiBai RuIuoynuiR oodoa
^
rnubuuiiri ilhd TamanannR VAP aoumuuiriiuu uaim
^ ntn VAP (ventilator
'

associated pneumonia) uu luaun ua:3 uaJaaom5nuiuin7 iRUiawnm

- -
X X
^Id
antibiotics uarOocnaoiwdrynuidOROuion

a ^U aRncnoo^rao
l 1

1. rmiwu tidal volume u limit uuayn PIP uaoucia: mode (uao VCV lailuinu
35 du.ui uao PCV lailuinu 30 du.m)
2. nil pHiOuRin iRrijIum5iJ5uiR 50o rh pH ayluinrurinuau^ulR lucnaolddo
^
nu tidal volume rBa respiratory rate (Inrnbaou uaaiRuaanui!!!!!!!!)
3. aai5 (PaC02)l x MVI = (PaC02)2 x MV2 Idlum tBu PaC02 iQWirn
^ ^runRuId
mubcnuiR > niRuIuIuI(7imubanuiR 500 InauaR ^ulRiau
^ aoimuu u

4. nT5i0 i parameter setting Giol(naoriauuu IhROl parameter setting Gvolhum

"

ImnR side effect umnbi luioiROuuaoriau

5. n5ruRuIuuLlrypnhiabmh5 aIijauwu 5 nuiR 5 ao adiuaiiciduiBuiR ao In
rnm^maiiuciLianinluaiihcnuuiauo admaouoimldnum ABG
^
l l
>
aodoumublR Inmni^ wean nun adnJaauInRuIdld
6. rnnoaoin wean iR
i

odaumabmu
^ risk VAP daom inR
iR 50 7 IWTIUWLI ^