医、技学院(华盛顿医疗手册培训-重症监护).pptVIP

Problems and Complications Worsening respiratory distress NOTE alarm, Vt, airway pressure Disconnected ventilator circuit Ventilate manually Suction if manual ventilation is difficult Check vital sign and rapid physical examination Ventilator is never used again unless making sure it’s working properly Problems and Complications High PIP Pneumothorax, hemothorax, or hydropneumothorax Airway occlusion Bronchospasm Increased accumulation of condensate in the ventilator circuit tubing Main-stem intubation Worsening pulmonary edema Development of gas trapping with auto-PEEP Problems and Complications Loss of Vt Leakage: circuit, tube or patient Asynchronous Breathing Unmet respiratory demands Inappropriate setting of ventilation Patients’ condition worsening Hypotension Due to positive inspiratory pressure Increase preload Administration of dobutamine Problems and Complications Auto-PEEP Gas trapped of pts due to airway diseases or inadequate expiratory time Adjust ventilation parameter, increase PEEP Barotrauma or Volutrauma Associated with high PIP, PEEP, or Pplat subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, pneumopericardium, air embolism, and pneumothorax Maybe life-threatening Reduce inspiratory pressure Problems and Complications Positive fluid balance Cardiac arrhythmias Aspiration Ventilator-Associated Pneumonia (VAP) Upper gastrointestinal hemorrhage Acid-base complications Oxygen toxicity Weaning from Mechanical Ventilation Gradual withdrawal of mechanical ventilatory support, depending on the condition of the patient and on the status of the cardiovascular and respiratory systems Methods SIMV T-tube PSV Protocol-guided weaning is safe and successful Extubation Should be performed early in the day Patient educated about the necessity of extubation, the need of cough, and the possibility of reintubation Extubated after the cuff is deflated completely Encourage the patient for cough and deep breathing, and vital sign should be monitered Extuba