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95 年療類療理 1 4301 8 1 ˍˍˍˍˍˍˍ 不 80 1.25 2 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

8 2 13 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 1000 22 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

8 3 27 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 300 32 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 1000 35 Hamilton Galileo ASV 量 minute volume 度力量 tidal volume 36 數 time constant 99% 狀 1 3 4 5 37 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

8 4 43 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) 60 50 40 30 20 10 0 Ppeak Pi Pplat 0 2 4 6 8 10 力 plateau pressure alveolar pressure Pi P = Pi-Pplat, P 數 time constant 力 plateau pressure 力 static elastic recoil

8 5 53 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) 60 59 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

8 6 62 量力路漏不 2 L/s 2 0.8 L -0.2 30 cm H 2 O -10 V & V T P AW 63 Volume control Volume-assured pressure support 64 A 2 L/s 2 0.8 L -0.5 60 cm H 2 O -20 Inspiration Expiration V & V T P AW Flow lpm -40 4 14 Pressure (cmh 2 O) 4 Volume (cc) 14 4 14 Time (seconds) Pressure augmentation inverse ratio ventilation PCIRV Volume-assured pressure support

65 4301 8 7 2 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 1200 1000 PMC = 24 cmh 2 O Volume (ml) 800 600 400 200 0 LIP = 15 cmh 2 O 0 10 20 30 40 Pressure (cmh 2 O) beginning of recruitment end of recruitment middle of recruitment closing pressure 67 66 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 > 105 69 列 tracheal gas insufflation PEEP auto-peep barotrauma 力

8 8 70 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