機械通氣患者的壓力容積曲線

1、會計學(xué)1機械通氣患者的壓力容積曲線機械通氣患者的壓力容積曲線第1頁/共53頁第2頁/共53頁第3頁/共53頁Matamis D, Lemaire F, Harf A, et al: Total respiratory pressure volume curves in the adult respiratory distress syndrome. Chest 1984; 86: 58-66第4頁/共53頁Matamis D, Lemaire F, Harf A, et al: Total respiratory pressure volume curves in the adult resp

2、iratory distress syndrome. Chest 1984; 86: 58-66第5頁/共53頁n整個過程通常不超過90秒鐘Matamis D, Lemaire F, Harf A, et al: Total respiratory pressure volume curves in the adult respiratory distress syndrome. Chest 1984; 86: 58-66第6頁/共53頁Matamis D, Lemaire F, Harf A, et al: Total respiratory pressure volume curves i

3、n the adult respiratory distress syndrome. Chest 1984; 86: 58-66第7頁/共53頁Matamis D, Lemaire F, Harf A, et al: Total respiratory pressure volume curves in the adult respiratory distress syndrome. Chest 1984; 86: 58-66第8頁/共53頁CO2代償n注射器中氧氣的溫度和濕度影響測定結(jié)果n使用未經(jīng)加溫加濕的氣體導(dǎo)致曲線左移Lu Q, Rouby JJ. Measurement of pres

4、sure-volume curves in patients on mechanical ventilation: methods and significance. Crit Care 2000; 4: 91-100第9頁/共53頁Levy P, Similowski T, Corbeil C, et al: A method for studying the static volume-pressure curves of the respiratory system during mechanical ventilation. J Crit Care 1989, 4: 83-89第10頁

5、/共53頁Levy P, Similowski T, Corbeil C, et al: A method for studying the static volume-pressure curves of the respiratory system during mechanical ventilation. J Crit Care 1989, 4: 83-89第11頁/共53頁Levy P, Similowski T, Corbeil C, et al: A method for studying the static volume-pressure curves of the resp

6、iratory system during mechanical ventilation. J Crit Care 1989, 4: 83-89第12頁/共53頁Barberis L, Manno E, Guerin C. Effect of end-inspiratory pause duration on plateau pressure in mechanically ventilated patients. Intensive Care Med 2003; 29: 130-134第13頁/共53頁Barberis L, Manno E, Guerin C. Effect of end-

7、inspiratory pause duration on plateau pressure in mechanically ventilated patients. Intensive Care Med 2003; 29: 130-134第14頁/共53頁Barberis L, Manno E, Guerin C. Effect of end-inspiratory pause duration on plateau pressure in mechanically ventilated patients. Intensive Care Med 2003; 29: 130-134第15頁/共

8、53頁Takeuchi M, Sedeek KA, Schettino GPP, et al. Peak pressure during volume history and pressure-volume curve measurement affects analysis. Am J Respir Crit Care Med 2001; 164: 1225-1230 第16頁/共53頁Nishida T, Suchodolski K, Schettino GPP, et al. Peak volume history and peak pressure-volume curve press

9、ures independently affect the shape of the pressure-volume curve of the respiratory system. Crit Care Med 2004; 32: 1358-1364第17頁/共53頁Nishida T, Suchodolski K, Schettino GPP, et al. Peak volume history and peak pressure-volume curve pressures independently affect the shape of the pressure-volume cur

10、ve of the respiratory system. Crit Care Med 2004; 32: 1358-1364第18頁/共53頁Nishida T, Suchodolski K, Schettino GPP, et al. Peak volume history and peak pressure-volume curve pressures independently affect the shape of the pressure-volume curve of the respiratory system. Crit Care Med 2004; 32: 1358-136

11、4第19頁/共53頁Lu Q, Rouby JJ. Measurement of pressure-volume curves in patients on mechanical ventilation: methods and significance. Crit Care 2000; 4: 91-100第20頁/共53頁測定原理: 順應(yīng)性計算公式CompliancevolumepresssureCompliancevolume/timepresssure/time第21頁/共53頁測定原理: 順應(yīng)性計算公式ComplianceVpresssure/time若V(t)恒定則克服阻力的壓力差恒

12、定此時氣道壓力與呼吸系統(tǒng)順應(yīng)性呈負(fù)相關(guān)第22頁/共53頁高估UIP和LIP第23頁/共53頁第24頁/共53頁Mankikian B, Lemaire F, Benito S, et al: A new device for measurement of pulmonary pressure-volume curves in patients on mechanical ventilation. Crit Care Med 1983； 11: 897-901Servillo G, Svantesson C, Beydon L, et al: Pressurevolume curves in a

13、cute respiratory failure. Automated low flow inflation versus occlusion. Am J Respir Crit Care Med 1997, 155: 1629-163第25頁/共53頁減去克服氣道阻力所需壓力減去克服氣道阻力所需壓力進(jìn)一步降低吸氣流量進(jìn)一步降低吸氣流量Ptot = Ptrach + Pres(tube)Ptrach = Pel + Pres與吸氣阻斷法相比與吸氣阻斷法相比呼吸系統(tǒng)順應(yīng)性呼吸系統(tǒng)順應(yīng)性, UIP和和LIP均相同均相同Paw = Pressure + PelPressure = Flow x Ra

14、w當(dāng)吸氣流量0Pressure 0Paw Pel如何提高準(zhǔn)靜態(tài)PV曲線的準(zhǔn)確性Servillo G, Svantesson C, Beydon L, et al: Pressurevolume curves in acute respiratory failure. Automated low flow inflation versus occlusion. Am J Respir Crit Care Med 1997, 155: 1629-1636Lu Q, Vieira S, Richecoeur J, et al: A simple automated method for measur

15、ing pressure-volume curve during mechanical ventilation. Am J Respir Crit Care Med 1999, 159: 275-282第26頁/共53頁Jonson B, Richard JC, Straus C, et al: Pressurevolume curves and compliance in acute lung injury. Am J Respir Crit Care Med 1999, 159: 1172-1178第27頁/共53頁Krason S, Sndergaard S, Lundin S, Wik

16、lund J, Stenqvist O. Evaluation of pressure/volume loops based on intratracheal pressure measurements during dynamic conditions. Acta Anaesthesiol Scand 2000; 44: 571-577第28頁/共53頁減去克服氣道阻力所需壓力減去克服氣道阻力所需壓力進(jìn)一步降低吸氣流量進(jìn)一步降低吸氣流量Ptot = Ptrach + Pres(tube)Ptrach = Pel + Pres與吸氣阻斷法相比與吸氣阻斷法相比呼吸系統(tǒng)順應(yīng)性呼吸系統(tǒng)順應(yīng)性, UI

17、P和和LIP均相同均相同Paw = Pressure + PelPressure = Flow x Raw當(dāng)吸氣流量0Pressure 0Paw Pel如何提高準(zhǔn)靜態(tài)PV曲線的準(zhǔn)確性Servillo G, Svantesson C, Beydon L, et al: Pressurevolume curves in acute respiratory failure. Automated low flow inflation versus occlusion. Am J Respir Crit Care Med 1997, 155: 1629-1636Lu Q, Vieira S, Riche

18、coeur J, et al: A simple automated method for measuring pressure-volume curve during mechanical ventilation. Am J Respir Crit Care Med 1999, 159: 275-282第29頁/共53頁Lu Q, Vieira S, Richecoeur J, et al: A simple automated method for measuring pressure-volume curve during mechanical ventilation. Am J Res

19、pir Crit Care Med 1999, 159: 275-282VtFlow設(shè)置1500 mL3 lpm設(shè)置21500 mL9 lpm第30頁/共53頁Lu Q, Vieira S, Richecoeur J, et al: A simple automated method for measuring pressure-volume curve during mechanical ventilation. Am J Respir Crit Care Med 1999, 159: 275-282第31頁/共53頁Lu Q, Vieira S, Richecoeur J, et al:

20、A simple automated method for measuring pressure-volume curve during mechanical ventilation. Am J Respir Crit Care Med 1999, 159: 275-282第32頁/共53頁Lu Q, Vieira S, Richecoeur J, et al: A simple automated method for measuring pressure-volume curve during mechanical ventilation. Am J Respir Crit Care Me

21、d 1999, 159: 275-282第33頁/共53頁測定PV曲線Lu Q, Rouby JJ. Measurement of pressure-volume curves in patients on mechanical ventilation: methods and significance. Crit Care 2000; 4: 91-100第34頁/共53頁第35頁/共53頁/./PN%20689213_PV-Tool_WP_01-Validation_of_New_Method.pdfPiacentini E, Wy

22、socki M, Blanch L. A new automated method versus continuous positive airway pressure method for measuring pressure-volume curves in patients with acute lung injury. Intensive Care Med 2009; 35: 565-570Hamilton Galileo Gold采用的改良低流量法測定吸氣與呼氣PV曲線與CPAP方法相同與低流量法相同第36頁/共53頁Gama AM, Meyer EC, Gaudencio AM,

23、et al. Different low constant flows can equally determine the lower infection point in acute respiratory distress syndrome patients. Artif Organs 2001; 25: 882-889第37頁/共53頁Bensenor FE, Vieira JE, Auler JOC. Guidelines for inspiratory flow setting when measuring the pressure-volume relationship. Anes

24、th Analg 2003; 97: 145-150第38頁/共53頁Bensenor FE, Vieira JE, Auler JOC. Guidelines for inspiratory flow setting when measuring the pressure-volume relationship. Anesth Analg 2003; 97: 145-150第39頁/共53頁Bensenor FE, Vieira JE, Auler JOC. Guidelines for inspiratory flow setting when measuring the pressure

25、-volume relationship. Anesth Analg 2003; 97: 145-150第40頁/共53頁Bensenor FE, Vieira JE, Auler JOC. Guidelines for inspiratory flow setting when measuring the pressure-volume relationship. Anesth Analg 2003; 97: 145-150第41頁/共53頁Paw-Volume CurveLichtwarck-Aschoff M, Kessler V, Sjostrand UH, et al. Static

26、 versus dynamic respiratory mechanics for setting the ventilator. Br J Anaesth 2000; 85: 577-586第42頁/共53頁Vassiliou MP, Petri L, Amgdalou A, et al. Linear and nonlinear analysis of pressure and flow during mechanical ventilation. Intensive Care Med 2000; 26: 1057-1064第43頁/共53頁Mols G, Brandes I, Kessl

27、er V, et al. Volume-dependent compliance in ARDS: proposal of a new diagnostic concept. Intensive Care Med 10999; 25: 1084-1091第44頁/共53頁Lichtwarck-Aschoff M, Kessler V, Sjostrand UH, et al. Static versus dynamic respiratory mechanics for setting the ventilator. Br J Anaesth 2000; 85: 577-586第45頁/共53

28、頁第46頁/共53頁第47頁/共53頁Matamis D, Lemaire F, Harf A, et al: Total respiratory pressure volume curves in the adult respiratory distress syndrome. Chest 1984; 86: 58-66第48頁/共53頁Barberis L, Manno E, Guerin C. Effect of end-inspiratory pause duration on plateau pressure in mechanically ventilated patients. Intensive Care Med 2003; 29: 130-134第49頁/共53頁Nishida T, Suchodolski K, Schettino GPP, et al. Peak volume history and peak pressure-volume curve pressur