PB840呼吸機的使用課件

1、PB 840 呼吸機原理及特點21世紀機型 全新的操作界面 頂尖的氣路設(shè)計完善的安全保障 無限的升級潛力PB 840 技術(shù)優(yōu)勢及特點 高效雙電腦控制頂尖氣路設(shè)計模塊化設(shè)計圖形用戶界面(GUI) 呼吸釋放單元(BDU)后備電源(BPS)壓縮泵(選件)(CU)輕便臺車病人回路 (PC)濕化器PB 840 圖形用戶界面 簡潔，直觀的用戶界面 雙屏幕顯示，不會影響 任何信息觀察 智能報警系統(tǒng) 在臺車支架上可以270度 旋轉(zhuǎn) 可以單獨安裝于合適位置 延長電纜長達30英尺 PB 840 呼吸釋放單元 (BDU)呼吸機核心氣路系統(tǒng)電腦系統(tǒng)電氣系統(tǒng)警報系統(tǒng)供應(yīng)電源與圖形用戶界面通訊呼吸機開機時同時啟動，無需獨

2、立電源與開關(guān)外接空氣源壓力達到額定范圍，自動停機BDU 隨時監(jiān)測其工作狀態(tài) PB 840 壓縮泵(選件)PB840 氣路系統(tǒng)工作原理頂尖氣路設(shè)計低系統(tǒng)順應(yīng)性低系統(tǒng)泄漏低系統(tǒng)死腔高速響應(yīng)PB840 操作特性邏輯化操作 (GUI)理想體重設(shè)置(IBW)呼吸模式(A/C，SIMV，Bi-Level,SPONT)呼吸方式(VCV，PCV)自主呼吸支持方式(PSV，TC)工作參數(shù)，警報參數(shù)自動預(yù)設(shè)窒息通氣參數(shù)同時被預(yù)設(shè)選擇想觀察的呼吸波形呼吸機常規(guī)按鍵在屏內(nèi)， 操作鈕在屏外單次按鍵不影響送氣 變更參數(shù)通過 觸摸-旋轉(zhuǎn)- 確認 右下方屏幕的導(dǎo)引區(qū)幫助操作者完成操作過程PB840 操作特性模式的設(shè)定在設(shè)置中

3、找到 SETUP 鍵位，按壓MODESETUPAPNEASETUPALARMSETUPBiLevel的設(shè)定BiLevelPCModeMandatory TypeSpontaneous TypePSTrigger TypeV - TRIGCONTINUE旋轉(zhuǎn)調(diào)節(jié)至顯示?BiLevel隨后的通氣方式將被固定為PC方式，不可變更選擇 spontaneous類型及觸發(fā)類型觸壓 Continue 鍵位彩色屏幕并非單純美觀彩色屏幕自助菜單全面安全性PB840 操作特性PB840 操作特性智能呼吸釋放 ABCA - work to triggerB - flow acceleration percent (

4、rise time) C - preventing pressure overshoot and sustaining the breathD - transition into expirationPressureTimeABCD新通氣策略首先，增強現(xiàn)有呼吸形式的靈活性將適用面擴展至兒童、嬰兒患者改善PSV、 PCV 狀態(tài)下人機同步性能新智能通氣能根據(jù)病人情況改變而自動調(diào)整PressureAC (PCV Only)D (PS Only)BA壓力上升時間40PCIRCcmH2OINSPLminEXPPLOT SETUP302010 010-2080604020020-804060V.04812

5、s2610UNFREEZE RES = 5 RES = 20 RES = 50 cmH20/L/SEC cmH20/L/SEC cmH20/L/SECCABDNPB 840 電腦呼吸機獨家專利設(shè)計 主動呼氣閥美國萬靈科公司 Puritan Bennett 840呼吸機吸氣相實現(xiàn)主動性呼氣主動呼氣閥吸氣時，根據(jù)設(shè)置壓力呼氣閥關(guān)閉允許在壓力持續(xù)階段自主呼吸或咳嗽40PCIRCcmH2OINSPLminEXP302010 010-2080604020020-804060V.04812s2610Spontaneous EffortsSpontaneous EffortsPCV W/O Active V

6、alvePCV with Active Valve呼氣靈敏度Pressure support breaths terminate when patient flow decelerates to a percentage of peak flow 40PCIRCcmH2OINSPLminEXP302010 010-2080604020020-804060V.04812s2610PS Termination CriteriaCABD呼氣靈敏度Leaks can cause inability to terminate pressure support breaths, causing profo

7、und asynchronyI-times too long or too short can also cause asynchronous breathing20% (Set)35% (Leak Rate)Flow呼氣靈敏度ESENS allows adjustment of the termination criteria for pressure supported breathssets the percent of peak flow that cycles the pressure support breath into exhalationespecially helpful

8、to match the patient抯 desired inspiratory timecan improve synchrony between patient and ventilator20% (Set)40% (Set)35% (Leak Rate)FlowPB840 操作特性Bi-LEVEL 壓力-時間曲線FSynchronized TransitionsSpontaneous BreathsPressure SupportPLPHPB840 操作特性Bi-Level 呼吸方式的增強功能 Bi-Level 、 APRV存在于一種方式中 PSV 可以給病人在PEEPH 或PEEPL

9、水平上的自主呼吸予支持 PEEPH與PEEPL之間的相互轉(zhuǎn)換由時間與病人共同決定 對病人的每一次呼吸進行監(jiān)測，并計算自主呼吸分鐘通氣量 可以由操作者決定TH、TL或TH:TL 固定全面監(jiān)測自主呼吸容量，確定病人呼吸能力PB840 操作特性APRV 呼吸方式Spontaneous BreathsPTrelease?Upper And Lower Inflection Points02040602040-600.2LITERS0.40.6PawcmH2OVTUpper And Lower Inflection Points02040602040-600.2LITERS0.40.6PawcmH2OV

10、TAlveolar collapsePTLower inflection points are thought to be a point of critical opening pressureUpper And Lower Inflection Points02040602040-600.2LITERS0.40.6PawcmH2OVTAlveolar overdisentionAlveolar collapsePTPV CURVEPEEP = 5 cmH2OSetting PEEPPEEP = 12 cmH2OPB840 操作特性TC 氣管插管自動補償Pressure drop shows

11、 imposed work across ET-Tube when flow is presentWhat The Carina SeesCircuit PressureLower Carina PressurePawTC adds appropriate pressure to keep carina pressure at preset PEEPTubing Compensation - What The Carina SeesHigher Circuit PressureNo decreased Carina PressurePawTC Compared To PSTC varies i

12、ts output as flow demands changePressure rises and falls more naturally10PCIRCcmH2OINSPLminEXP7.5 5 2.5 0 -5-1080604020020-804060V.04812s2610Higher FlowHigher Appropriate SupportArtificial Airways and WOBSingle greatest cause of imposed WOB is caused by the ET-TubeDuring inspiration lung pressure ca

13、n be significantly lower than circuit pressure when flow is presentPS is frequently used to overcome this imposed WOB, and when used in this manner has several shortcomings PS Limitations For ET-Tube CompensationPS may under-support the WOB early in the inspiratory phase when flows are highAs patien

14、ts wake, sleep, become agitated etc, PS is unable to compensate for variable demands10PCIRCcmH2OINSPLminEXP7.5 5 2.5 0 -5-1080604020020-804060V.04812s2610Higher FlowInsufficient SupportWhat is Tube Compensation?Not a mode, but a spontaneous breath typeAccurately overcomes the imposed inspiratory WOB

15、 through an artificial airwayHybrid of PS (but more efficient at overcoming tube resistance)Controls the patients carinal pressure to a constant preset PEEP value during inspirationTC Potential Advantages SummaryEase of usemerely set the tube type and size, and % supportthe ventilator automatically

16、generates the correct supportLowest WOBcompared to CPAP or T-piece breathingImproved patient comfortAbility to track variable drivesPawLiterature ReviewTC provides an increase in respiratory comfort compared with IPS. The predominant cause for respiratory discomfort in the IPS mode seems to be lung overdistention.?Intensive Care Medicine 1997;23:1119 - 1124 Literature ReviewTC in contrast to PS, is a suitable mode to compensate for impo