1、Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Classification of Respiratory FailureFig. 68-2Fig. 68-4Fig. 68-5Fig. 66-17Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Stages of Edema Formation in Stages of Edema
2、 Formation in ARDSARDSA A, Normal alveolus and , Normal alveolus and pulmonary capillary pulmonary capillary B B, Interstitial edema , Interstitial edema occurs with increased occurs with increased flow of fluid into the flow of fluid into the interstitial space interstitial space C C, Alveolar edem
3、a , Alveolar edema occurs when the fluid occurs when the fluid crosses the bloodcrosses the blood- -gas gas barrierbarrierFig. 68Fig. 68- -8 8*Causes (see notes)DIFFUSE lung injury(SIRS or MODS)Damage to alveolar capillary membranePulmonary capillary leakInterstitial & alveolar edemaInactivation of
4、surfactantAlveolar atalectasisCOMetabolic acidosisCOSevere & refractory hypoxemiaHypoventilationHypercapneaRespiratory AcidosisHyperventilationHypocapneaRespiratory AlkalosisSHUNTINGStiff lungsFig. 68-10The Auscultation Assistant - Breath SoundsABG reviewProne positioning With position change to pro
5、ne, previously nondependent air-filled alveoli become dependent, perfusion becomes greater to air-filled alveoli opposed to previously fluid-filled dependent alveoli, thereby improving ventilation-perfusion matching.Fig. 68-12Fig. 66-22SETTING FUNCTION USUAL PARAMETERS Respiratory Rate (RR) Number o
6、f breaths delivered by the ventilator per minute Usually 4-20 breaths per minute Tidal Volume (VT) Volume of gas delivered during each ventilator breath Usually 5-15 cc/kg Fractional Inspired Oxygen (FIO2) Amount of oxygen delivered by ventilator to patient 21% to 100%; usually set to keep PaO2 60 m
7、mHg or SaO2 90% Inspiratory:Expiratory (I:E) Ratio Length of inspiration compared to length of expiration Usually 1:2 or 1:1.5 unless inverse ratio ventilation is required Pressure Limit Maximum amount of pressure the ventilator can use to deliver breath 10-20 cm H2O above peak inspiratory pressure;
8、 maximum is 35 cm H2O respiratory muscles. Low Pressure AlarmsCircuit leaks Airway leaks Chest tube leaks Patient disconnection High Pressure AlarmsPatient coughing Secretions or mucus in the airway Patient biting tube Airway problems Reduced lung compliance (eg. pneumothorax) Patient fighting the v
9、entilator Accumulation of water in the circuit Kinking in the circuit ECMO- Blood drains by gravity from the patient through a tube (catheter) placed in a large neck vein. This blood passes through a plastic pouch, or bladder, and then in pumped through the membrane oxygenator that serves as an artificial lung, putting oxygen into the blood and removing carbon dioxide. The blood then passes through a heat exchanger that maintains the blood at normal body temperature. Finally, the blood reenters the body through a large catheter placed in an artery in the neck.
