機械通氣患者的壓力容積曲線

1、會計學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一步降低吸氣流量進一步降低吸氣流量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當吸氣流量0Pressure 0Paw Pel如何提高準靜態(tài)PV曲線的準確性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一步降低吸氣流量進一步降低吸氣流量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當吸氣流量0Pressure 0Paw Pel如何提高準靜態(tài)PV曲線的準確性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