困難撤機(jī)經(jīng)驗(yàn)和思考課件

第二附屬醫(yī)院困難撤機(jī)我們還能做什么?鄭州大學(xué)第二附屬醫(yī)院重癥醫(yī)學(xué)科〔ICU)2019年10月24日開封第二附屬醫(yī)院1概況第二附屬醫(yī)院心約40%入住工CU的病人需機(jī)械通氣〔我國的比例可能更高)①;今其中困難撤機(jī)者占30%②;心美國每年有超10萬延遲撤機(jī)病人占有大量醫(yī)療資源:37%ICU資源③;心對社會(huì)及家庭造成巨大負(fù)擔(dān)emeainmeedintensivesoareseinternational20510概況2歐洲標(biāo)準(zhǔn)(2019)第二附屬醫(yī)院機(jī)械通氣患者經(jīng)歷的各個(gè)階段急性呼衰撤機(jī)篩查拔管再插管治療自主呼吸試驗(yàn)入院」出院Weaningfrommechanicalventilation.EurRespirJ.2019:29:1033-1056歐洲標(biāo)準(zhǔn)(2019)3歐洲標(biāo)準(zhǔn)(2019)第二附屬醫(yī)院ClassificationofpatientsaccordingtotheweaningprocessGroup/categoryDefinitionPatientswhoproceedfromntiationofweaningtosuccessfulextubationonthefirstalertwithoutoffDifficultweaningweaningandtetnreesBtaseocas7aonthefirstsBTloachevesuccessfulweaningProlongedweaningPatientswhofailatleastthreeweaningatemetsorrequire>7daysofweaning困難撤機(jī):需要3次自主呼吸試驗(yàn)〔SBT);或首次sBT后在7天內(nèi)成功撤機(jī)延遲撤機(jī):>3次自主呼吸試驗(yàn)〔SBT)失敗;或首次sBT后在7天仍未成功撤機(jī)oDWeaningfrommechanicalventilation.EurRespir].2019:29:1033-1056歐洲標(biāo)準(zhǔn)(2019)4第二附屬醫(yī)院撤機(jī)困難的原因第二附屬醫(yī)院5困難撤機(jī)經(jīng)驗(yàn)和思考課件6困難撤機(jī)經(jīng)驗(yàn)和思考課件7困難撤機(jī)經(jīng)驗(yàn)和思考課件8困難撤機(jī)經(jīng)驗(yàn)和思考課件9困難撤機(jī)經(jīng)驗(yàn)和思考課件10困難撤機(jī)經(jīng)驗(yàn)和思考課件11困難撤機(jī)經(jīng)驗(yàn)和思考課件12困難撤機(jī)經(jīng)驗(yàn)和思考課件13困難撤機(jī)經(jīng)驗(yàn)和思考課件14困難撤機(jī)經(jīng)驗(yàn)和思考課件15困難撤機(jī)經(jīng)驗(yàn)和思考課件16困難撤機(jī)經(jīng)驗(yàn)和思考課件17困難撤機(jī)經(jīng)驗(yàn)和思考課件18困難撤機(jī)經(jīng)驗(yàn)和思考課件19困難撤機(jī)經(jīng)驗(yàn)和思考課件20困難撤機(jī)經(jīng)驗(yàn)和思考課件21困難撤機(jī)經(jīng)驗(yàn)和思考課件22困難撤機(jī)經(jīng)驗(yàn)和思考課件23困難撤機(jī)經(jīng)驗(yàn)和思考課件24困難撤機(jī)經(jīng)驗(yàn)和思考課件25困難撤機(jī)經(jīng)驗(yàn)和思考課件26困難撤機(jī)經(jīng)驗(yàn)和思考課件27困難撤機(jī)經(jīng)驗(yàn)和思考課件28困難撤機(jī)經(jīng)驗(yàn)和思考課件29困難撤機(jī)經(jīng)驗(yàn)和思考課件30困難撤機(jī)經(jīng)驗(yàn)和思考課件31困難撤機(jī)經(jīng)驗(yàn)和思考課件32困難撤機(jī)經(jīng)驗(yàn)和思考課件33困難撤機(jī)經(jīng)驗(yàn)和思考課件34困難撤機(jī)經(jīng)驗(yàn)和思考課件35困難撤機(jī)經(jīng)驗(yàn)和思考課件36困難撤機(jī)經(jīng)驗(yàn)和思考課件37困難撤機(jī)經(jīng)驗(yàn)和思考課件38困難撤機(jī)經(jīng)驗(yàn)和思考課件39困難撤機(jī)經(jīng)驗(yàn)和思考課件40困難撤機(jī)經(jīng)驗(yàn)和思考課件41困難撤機(jī)經(jīng)驗(yàn)和思考課件42困難撤機(jī)經(jīng)驗(yàn)和思考課件43困難撤機(jī)經(jīng)驗(yàn)和思考課件44困難撤機(jī)經(jīng)驗(yàn)和思考課件45困難撤機(jī)經(jīng)驗(yàn)和思考課件46困難撤機(jī)經(jīng)驗(yàn)和思考課件47困難撤機(jī)經(jīng)驗(yàn)和思考課件48困難撤機(jī)經(jīng)驗(yàn)和思考課件49困難撤機(jī)經(jīng)驗(yàn)和思考課件50困難撤機(jī)經(jīng)驗(yàn)和思考課件51困難撤機(jī)經(jīng)驗(yàn)和思考課件52困難撤機(jī)經(jīng)驗(yàn)和思考課件53困難撤機(jī)經(jīng)驗(yàn)和思考課件54困難撤機(jī)經(jīng)驗(yàn)和思考課件55困難撤機(jī)經(jīng)驗(yàn)和思考課件56困難撤機(jī)經(jīng)驗(yàn)和思考課件57困難撤機(jī)經(jīng)驗(yàn)和思考課件58困難撤機(jī)經(jīng)驗(yàn)和思考課件59困難撤機(jī)經(jīng)驗(yàn)和思考課件60困難撤機(jī)經(jīng)驗(yàn)和思考課件61困難撤機(jī)經(jīng)驗(yàn)和思考課件62困難撤機(jī)經(jīng)驗(yàn)和思考課件63困難撤機(jī)經(jīng)驗(yàn)和思考課件64困難撤機(jī)經(jīng)驗(yàn)和思考課件65困難撤機(jī)經(jīng)驗(yàn)和思考課件66困難撤機(jī)經(jīng)驗(yàn)和思考課件67困難撤機(jī)經(jīng)驗(yàn)和思考課件68困難撤機(jī)