1、SLE5000March 2006Slide 1CompetitionPlus some adult ventilators being used with infantsStephanieSensorMedic3100ASLE5000SLE2000HFOPremiumBasicinfantstarSLE4000Infant StarLife Pulse JetDraeger Babylog 8000l原理：通过鼓膜活塞，使空氧混合后的气体产生振荡，用小于生理潮气量和高于正常呼吸频率4倍以上的呼吸频率进行通气，吸气和呼气都是主动的。在高频通气过程中，气体的交换与常频通气的交换有所不同，由于气体
2、的高频振荡，通过摆动性对流搅拌作用、对流性扩散等使气体分子扩散效应增强。l越来越常用l特性描述; 频率范围3-20 Hz (180 900 bpm)其中B(3-20),STE(5-15),SL(?),S3100(3-15) 主动吸气和主动呼气 潮气量接近死腔量l氧合和通气的控制是互相独立的l氧合主要通过调节平均气道压PAW和FIO2来改善l通气主要通过 振幅(Delta-P) 和频率F来调节氧合氧合lMAP平均气道压1.FiO2氧浓度通气通气lAmplitude振幅lFrequency频率lTi%吸气时间百分比(对氧合有一定影响)INJURYINJURYCMV PIP 34 cmH2O PEE
3、P 9 cmH2OHFOV Amplitude 16 cmH2O Paw 20 cmH2OET 管管 湿化后的基湿化后的基础气流础气流 病人病人 CDP调节阀调节阀 鼓膜振荡鼓膜振荡 通过通过“超级超级CPAP 系统系统”提高功能残气量提高功能残气量Bias FlowNONO FlowSensorNOxDelno 1000Inlet iNOSLE5000March 2006Slide 18SLE5000 气路图Electronic blendingJets are driven through Piezo-activated regulators, which can respond in 2
4、mS and yet consumes only 1/20th the power of conventional solenoid valvesO2AirSimplified view. Safety bypass valves and monitoring not shownMay 2005Slide 19SLE5000 在HFO中主动呼气阻断阀阻断阀脉冲波形湿化后震荡湿化后震荡STEPHANIE气路原理图：V0MAPVoszimpedance tube(high impedance for fosc )stenosis for MAP(high resistance for spont.
5、 breathing) humidifierHFOV only in combination with CPAP活塞活塞V0活塞HFOV Strategy If CO2 retention persists, decreasing cuff pressure to allow gas to escape around the ET tube will move the fresh gas supply from the wye connector to the tip of the ET tubel机器将采取变化的此参数l通常, 它提供了新鲜气体气流和制造MAP（平均气道压）l越小的病人需要越
6、小的气流量，反之亦然。l改变改变CO2：主要主要调振幅调振幅l开始可设振幅于开始可设振幅于50% 。逐步递增见胸壁。逐步递增见胸壁明显振荡明显振荡 （维持（维持CO2 40-50mmHg）Results 4 ET-tube dependencyDelta V(ml)10 20 30 40 50 60 70 80Pressure at the Y-piece (cm water)3.53.02.51412108642l改变改变CO2：次要调频率次要调频率l频率：胎龄小频率：胎龄小 频率快，调低频率可降低频率快，调低频率可降低CO2Frequency dependencyDelta V (ml)
7、6 7 8 9 10 11 12 13 14 15Frequency (Hz)87654321l改善氧合改善氧合 调节调节MAP 及及FiO2l除气漏外原则采用高容量及低除气漏外原则采用高容量及低FiO2策略策略l气漏气漏 低容量低容量(MAP)高高FiO2策略策略l注意：高频使用之前一定要保证病人肺的张开，否则注意：高频使用之前一定要保证病人肺的张开，否则易引起气压损伤。易引起气压损伤。SLESTEPHANIE或或BABYLOG要要使用比较高的使用比较高的PEEP（MAP）以防止肺泡塌陷。）以防止肺泡塌陷。May 2005Slide 35SLE infant ventilators hist
8、ory 30 years ventilation experience 25 years as ventilator manufacturer 6,000+ SLE infant ventilators in use Newborn250 first with patient triggered ventilation SLE2000 introduced a valveless technology, and integral oxygen measurement system SLE2000HFO introduced active exhalation technology, to se
9、t new standards of gas flow in HFO mode SLE2000HFO+ introduced oscillation for larger infants and paediatrics SLE4000/5000 further introduced extensive integrated monitoring, in a more contemporary styling and user interface1981198519901995199920022003SLE5000 Infant Ventilatorl抢救性抢救性HFOV：MAP高于高于CMV时
10、时2-5cmH2Ol预防性预防性HFOV：根据肺部疾病：根据肺部疾病 一般一般MAP自自8cmH2O开始，顺应性差时自开始，顺应性差时自10cmH2O开始开始l递增递增MAP：每次：每次1cmH2O间隔间隔5分钟递增一次，分钟递增一次，直至直至FiO2 0.4l上机上机1-2h摄胸片，维持右肺底于摄胸片，维持右肺底于8-9肋水平。病肋水平。病情不稳定情不稳定6h后重复胸片后重复胸片l右肺底于右肺底于10肋时，下调肋时，下调MAP。RDS时要求肺透时要求肺透亮度改善亮度改善lFiO2 0.3氧合稳定，可递减氧合稳定，可递减MAP。（需。（需FiO2 0.3示示MAP下降太快）下降太快） 低低PO
11、2时考虑时考虑l气管插管漏气，管内及接口处积水气管插管漏气，管内及接口处积水l注意胸廓振动度（气道阻塞？）注意胸廓振动度（气道阻塞？）l气漏可疑（双肺振动对称否？透光试验，气漏可疑（双肺振动对称否？透光试验，立即摄胸片）立即摄胸片）l肺未复张肺未复张 提高提高MAP，重复摄片，重复摄片l肺扩张过度肺扩张过度 血压测定，下调血压测定，下调MAPl气管插管漏气，并发气胸气管插管漏气，并发气胸l低通气，肺复张不充分，胸廓震荡小，增加振低通气，肺复张不充分，胸廓震荡小，增加振幅幅,MAPl疑肺过度充气，胸部疑肺过度充气，胸部X光检查光检查l无上述问题无上述问题 下调频率（因肺、气道阻力下降，下调频率（
12、因肺、气道阻力下降，VT 、CO2排除排除 ）lHomogenous lung diseases 70-80%lInhomogeneous lung diseases 50-79%lAir leaks 63-80% lPPHN 39-69%lCDH 22-27%l气管插管漏气气管插管漏气,需更改大一号插管需更改大一号插管l持续监护持续监护SPO2，或经皮，或经皮PO2，CO2，间隙测血，间隙测血压压lHFOV应用前摄胸片，用后应用前摄胸片，用后1-2h重复胸片重复胸片lHFOV应用时应维持血压及灌注正常应用时应维持血压及灌注正常 （必要时补充容量及用正性肌力药）（必要时补充容量及用正性肌力药）
13、l用低顺应性呼吸机管路用低顺应性呼吸机管路l可用镇静剂，但不推荐用肌松剂可用镇静剂，但不推荐用肌松剂l胸壁振荡运动减弱时，疑胸壁振荡运动减弱时，疑ETT阻塞，应吸痰，阻塞，应吸痰，吸痰后短时提高吸痰后短时提高MAP 3-5cmH2O 七、不同高频呼吸机的比较预设振幅的总潮气量预设振幅的总潮气量 (MAP=15 mbar)02040608010012005101520Pset mbarV1osz mlI/E=50% MAP=15 mbar tube=3,5 mm020406080100120246810121416Pset mbarV1osz mlI/E=50% MAP=15 mbar tube
14、=3,0 mm020406080100120024681012Pset mbarV1osz mlI/E=50% MAP=15 mbar tube=2,5 mm00.511.5200.20.40.60.81SLESensormedicsSteph. oldSteph. newInfant StarBabylog预设振幅的总潮气量预设振幅的总潮气量(MAP=25 mbar)02040608010012005101520Pset mbarV1osz mlI/E=50% MAP=25 mbar tube=3,5 mm020406080100120246810121416Pset mbarV1osz m
15、lI/E=50% MAP=25 mbar tube=3,0 mm020406080100120024681012Pset mbarV1osz mlI/E=50% MAP=25 mbar tube=2,5 mm00.511.5200.20.40.60.81SLESensormedicsSteph. oldSteph. newInfant StarBabylog预设振幅的顺应压力预设振幅的顺应压力(MAP=15 mbar)020406080100120024681012Pset mbarPCosz mbarI/E=50% MAP=15 mbar tube=3,5 mm020406080100120
16、24681012141618Pset mbarPCosz mbarI/E=50% MAP=15 mbar tube=3,0 mm02040608010012024681012Pset mbarPCosz mbarI/E=50% MAP=15 mbar tube=2,5 mm00.511.5200.20.40.60.81SLESensormedicsSteph. oldSteph. newInfant StarBabylog预设振幅的顺应压力预设振幅的顺应压力 (MAP=25 mbar)020406080100120024681012Pset mbarPCosz mbarI/E=50% MAP=
17、25 mbar tube=3,5 mm02040608010012024681012141618Pset mbarPCosz mbarI/E=50% MAP=25 mbar tube=3,0 mm02040608010012024681012Pset mbarPCosz mbarI/E=50% MAP=25 mbar tube=2,5 mm00.511.5200.20.40.60.81SLESensormedicsSteph. oldSteph. newInfant StarBabylog预设振幅的噪音对比预设振幅的噪音对比 (MAP=15 mbar)020406080100120404550
18、556065Pset mbarNoise dBI/E=50% MAP=15 mbar tube=3,5 mm020406080100120404550556065Pset mbarNoise dBI/E=50% MAP=15 mbar tube=3,0 mm020406080100120404550556065Pset mbarNoise dBI/E=50% MAP=15 mbar tube=2,5 mm00.511.5200.20.40.60.81SLESensormedicsSteph. oldSteph. newInfant StarBabylog预设振幅的噪音对比预设振幅的噪音对比 (
19、MAP=25 mbar)020406080100120404550556065Pset mbarNoise dBI/E=50% MAP=25 mbar tube=3,5 mm020406080100120404550556065Pset mbarNoise dBI/E=50% MAP=25 mbar tube=3,0 mm020406080100120404550556065Pset mbarNoise dBI/E=50% MAP=25 mbar tube=2,5 mm00.511.5200.20.40.60.81SLESensormedicsSteph. oldSteph. newInfan
20、t StarBabylog噪音对比操作潮气量噪音对比操作潮气量 (MAP=15 mbar)05101520404550556065V1osz mlNoise dBI/E=50% MAP=15 mbar tube=3,5 mm246810121416404550556065V1osz mlNoise dBI/E=50% MAP=15 mbar tube=3,0 mm024681012404550556065V1osz mlNoise dBI/E=50% MAP=15 mbar tube=2,5 mm00.511.5200.20.40.60.81SLESensormedicsSteph. oldSteph. newInfant StarBabylog
