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1 95 年 療 類 療 理 ˍˍˍˍˍˍˍ 不 不 1 列 療 Tracheal gas insufflation 力 PEEP 2 列 療 Extracorporal membrane CO 2 removal Intravascular oxygenator Tracheal gas insufflation Inverse ratio ventilation 3 力 pressure support mode 利 列 不 力 不 靈 流 零 4 adaptive support ventilation, ASV 列 closed-loop ventilation Pressure regulated volume control SIMV + pressure support A/C mode Volume support 5 列 力 pressure control 量 volume limit 力 pressure cycle 流 square wave time trigger 6 列 permissive hypercapnia 糖尿 7 力 PIP 不 20 cmh 2 O 30 cmh 2 O 40 cmh 2 O 45 cmh 2 O 8 列 proportional assist ventilation PAV PAV time trigger PAV 力 resistance compliance 力 流 flow assist 量 volume assist 9 auto-peep 列 Static auto-peep 塞 路 Dynamic auto-peep 流 airway pressure Dynamic auto-peep 路 力 static auto-peep dynamic auto-peep 10 列 類 11 例 inverse ratio ventilation 列 ARDS 不 降 量 量 cardiac output 降 不 12 列 不 連 CPAP BiPAP proportional assist ventilation PAV

2 APRV airway pressure release ventilation PCIRV pressure controlled inverse ratio ventilation APRV PCIRV 更 狀 APRV PCIRV 力 APRV PCIRV 降 APRV PCIRV I : E >1 : 1 14 力 pressure support ventilation 行 流 square wave 流量 了 力 力 度 15 40% Venturi 流 10 L/min 20 L/min 27 L/min 40 L/min 50 L/min 16 列 異 carboxyhemoglobin 10% 17 COPD with aspiration pneumonia Servo-900 C 度 FiO 2 60% PEEP 4 cmh 2 O pressure control 20 cmh 2 O PH 7.44 PCO 2 55 PO 2 60 HCO 3 34 SaO 2 94% intake > output 600 ml RT 不 weaning 列 不 weaning CO 2 production Oxygenation High PEEP level Metabolic alkalosis 18 列 不 ARDS PEEP 流量降 易 量 降 19 列 PEEP ARDS 量 FRC 葉 流量 降 A-aDO 2 20 列 weaning 不 weaning PaO 2 > 60 mmhg FiO 2 < 35% 量 minute ventilation < 10 liter/min 力 maximal inspiratory pressure < -30 cmh 2 O 力 peak airway pressure < 35 cmh 2 O 21 列 力 pressure cycle Bird Mark 7 Puritan Bennett MA-1 Servo 900C Bear 列 狀 離 Hypocalcemia Hypophosphatemia Hypothyroidism 狀 不 Hyperglobulinemia 23 dead space breathingpapv PA 列 PA > Pv > Pa PA > Pa > Pv Pa > PA > Pv Pa > Pv > PA 24 列 療 humidity therapy cascade 量 MDI nebulizer small volume nebulizer 25 力 列 不 量 量 26 力 列 路漏 路

3 力 pressure control mode 列 不 力 airway pressure 流流 flow rate 數 28 square 流 列 Volume control Proportional assist ventilation 29 列 Assist-control A/C mode SIMV 30 ARDS FiO 2 80% FEEP 8 cmh 2 O tidal volume 6 ml/kg 力 plateau pressure 28 cmh 2 O SaO 2 83% 不 PEEP 量 tidal volume FiO 2 例 IRV 31 列 time trigger Proportional assist ventilation Volume support Servo 列 利 靈 度 expiratory trigger sensitivity 來 Time cycle Volume cycle Flow cycle Pressure cycle 33 列 不 Assist-control A/C mode SIMV 34 列 輪 turbine PB MA-1 Servo 900C T-Bird Bear Hamilton Galileo ASV 量 minute volume 度 力 量 tidal volume 36 數 time constant 99% 狀 漏 cuff leak test 漏 50 ml 110 ml 80 ml 90 ml 38 Respironics BiPAP 兩 漏 路 39 Drager Evita BiPAP 列 Inverse ratio ventilation SIMV Autoflow 40 列 不 dual control Pressure regulated volume control Adaptive support ventilation ASV SIMV + pressure support Volume support 41 Hamilton Galileo ASV 列 數 數 量 力 力 量 42 力 APRV 列 兩 不 度 力 pressure support volume control 連 CPAP 力 pressure control

4 sigh 列 atelectasis oxygenation 量 44 率 high frequency oscillation 力 mean airway pressure 量 tidal volume 流流 flow rate inspiratory time 45 率 high frequency oscillation 力 mean airway pressure 量 tidal volume 流流 flow rate inspiratory time 46 路 intrinsic PEEP 力 力 47 列 不 量 度 FiO 2 PEEP 例 IRV pressure support mode 48 列 力 dynamic compliance 力 plateau pressure 力 resistance 力 airway pressure 流流 力 力 度 49 列 力 neuromuscular drive Duty cycle Ti / Ttot Mean inspiratory flow Vt / Ti Inspiratory occlusion pressure P 0.1 Diaphragmatic pressure Pdi 50 列 -auto-peep 力降 度 力 力 elastic recoil 51 列 不 力 力 - 數 tension-time index > 0.15 量 52 列 力 Ptr (cm H2O) Ppeak Pi Pplat 力 plateau pressure alveolar pressure Pi P = Pi-Pplat, P 數 time constant 力 plateau pressure 力 static elastic recoil

5 利 PetCO 2 PaCO 2 dead space PaCO 2 -PetCO 2 / PaCO 2 PetCO 2 -PaCO 2 / PetCO 2 PaCO 2 -PetCO 2 / PetCO 2 PetCO 2 -PaCO 2 / PaCO 2 54 列 PEEP PEEP ARDS end-expiratory lung volume PEEP COPD end-expiratory lung volume PEEP O 2 content O 2 delivery PEEP 量 量 55 列 不良 trigger asynchrony 類 不 易 離 auto-peep 力 pressure trigger flow trigger 56 列 PEEP PEEP autopeep PEEP 不 autopeep PEEP total PEEP PEEP + autopeep PEEP autopeep 理 不 量 FRC 57 列 ARDS PEEP ARDS ARDS 來 Plateau pressure 不 35 cmh 2 O PEEP compliance curve 2 cmh 2 O Tracheal gas insufflation TGI CO 2 58 列 humidity aerosol humidity 狀 aerosol 理 粒 療 度 44 mg/l 59 Volume control Volume-assured pressure support Flow L/m Pressure cmh 2 O Volume ml Time(sec) 流 Decelerated flow Constant flow Sine wave flow Accelerated flow 61 CMV mode 550 ml 數 20/min PaCO 2 50 mmhg 若 PaCO 2 降 40 mmhg 數不 dead space 若 150 ml 800 ml 350 ml 650 ml 1250 ml

6 量 力 路漏 不 2 L/s L cm H 2 O -10 V & V T P AW 63 Volume control Volume-assured pressure support 64 A 2 L/s L cm H 2 O -20 Inspiration Expiration V & V T P AW Flow lpm Pressure (cmh 2 O) 4 Volume (cc) Time (seconds) Pressure augmentation inverse ratio ventilation PCIRV Volume-assured pressure support

7 Drager Evita Autoflow 流 Bear 1000 Pressure augmentation 力 Drager Evita BiPAP Servo 300 Volume support 量 66 力 pressure volume curve 念 low inflection point PMC = 24 cmh 2 O Volume (ml) LIP = 15 cmh 2 O Pressure (cmh 2 O) beginning of recruitment end of recruitment middle of recruitment closing pressure 力 pressure volume curve 念 high inflection point beginning of recruitment end of recruitment middle of recruitment closing pressure 68 Rapid shallow index 離 RR / Vt > 105 Vt / RR < 105 RR / Vt < 105 Vt / RR > 列 tracheal gas insufflation PEEP auto-peep barotrauma 力

8 COPD 療 不 度 SaO 2 95% 列 不 量 P 0.1 流 Vt/Ti PaCO 2 71 列 離 70% 離 21 50% 離 率 10~20% SIMV 離 力 T 離率 72 Adaptive support ventilation ASVprotective lung zone Tidal volume, respiratory rate Tidal volume, airway pressure Respiratory rate, airway pressure Airway pressure, flow rate 73 列 不 air compressor Hamilton Galilio gold Servo 300 T-bird Drager Evita 2 74 Drager Evita 列 volume control pressure control 列 力 peak airway pressure 力 plateau pressure mean airway pressure 理 75 塞 T-piece nasal CPAP CMV mode SIMV + pressure support 76 列 離 力 rapid shallow breathing index 數 PaO 2 /FiO 2 77 列 力 pressure control time cycle 力不 力 力 力 立 不 78 力 力量 Pimax 力量 Pemax mean airway pressure 力 plateau pressure 79 volume cycle 力不 力 流 80 spacer 列 量 量 類