困難脫機(jī)和對(duì)策課件

困難脫機(jī)及對(duì)策青島市市立醫(yī)院ICU曲彥困難脫機(jī)及對(duì)策1提要口脫機(jī)參數(shù)有用嗎?口脫機(jī)指標(biāo)的篩選(Dailyscreen)口SBT的實(shí)施口困難脫機(jī)原因及對(duì)策提要2呼吸機(jī)的撤離在醫(yī)院里,撤機(jī)占了42的上機(jī)時(shí)間!EstebanaAliaiibanez],etal.Modesofmechanicalventilationandweaning:anationalsurveyofSpanishhospitalstheSpanishLungFailureCollaborativeGroup.Chest1994;106:1188-1193呼吸機(jī)的撤離3Weaning現(xiàn)代危重病醫(yī)學(xué)的定義:一旦確定病人有自主呼吸能力,應(yīng)盡早的、安全的、迅速的撤離機(jī)械通氣口快速撤機(jī):原無(wú)肺部疾患者,一般24內(nèi)脫機(jī)?？诶щy撤機(jī):Weaning4脫機(jī)參數(shù)的有用嗎?口過(guò)去的30余年66項(xiàng)脫機(jī)指標(biāo)應(yīng)用于臨床,多項(xiàng)RCT研究?？谟捎卺t(yī)生的問(wèn)題不能有效撤離機(jī)械通氣,使通氣時(shí)間增加2/3。Esteban(1994)chest106:1188-1193Esteban(2019)]AMA287:345-355口我們現(xiàn)有的指標(biāo)確定脫機(jī)成功陽(yáng)性率50%,陰性率67%oStroetz(2019)AmJRespirCritcareMed152:1034-1040脫機(jī)參數(shù)的有用嗎?5困難脫機(jī)和對(duì)策課件6困難脫機(jī)和對(duì)策課件7困難脫機(jī)和對(duì)策課件8困難脫機(jī)和對(duì)策課件9困難脫機(jī)和對(duì)策課件10困難脫機(jī)和對(duì)策課件11困難脫機(jī)和對(duì)策課件12困難脫機(jī)和對(duì)策課件13困難脫機(jī)和對(duì)策課件14困難脫機(jī)和對(duì)策課件15困難脫機(jī)和對(duì)策課件16困難脫機(jī)和對(duì)策課件17困難脫機(jī)和對(duì)策課件18困難脫機(jī)和對(duì)策課件19困難脫機(jī)和對(duì)策課件20困難脫機(jī)和對(duì)策課件21困難脫機(jī)和對(duì)策課件22困難脫機(jī)和對(duì)策課件23困難脫機(jī)和對(duì)策課件24困難脫機(jī)和對(duì)策課件25困難脫機(jī)和對(duì)策課件26困難脫機(jī)和對(duì)策課件27困難脫機(jī)和對(duì)策課件28困難脫機(jī)和對(duì)策課件29困難脫機(jī)和對(duì)策課件30困難脫機(jī)和對(duì)策課件31困難脫機(jī)和對(duì)策課件32困難脫機(jī)及對(duì)策青島市市立醫(yī)院ICU曲彥困難脫機(jī)及對(duì)策33提要口脫機(jī)參數(shù)有用嗎?口脫機(jī)指標(biāo)的篩選(Dailyscreen)口SBT的實(shí)施口困難脫機(jī)原因及對(duì)策提要34呼吸機(jī)的撤離在醫(yī)院里,撤機(jī)占了42的上機(jī)時(shí)間!EstebanaAliaiibanez],etal.Modesofmechanicalventilationandweaning:anationalsurveyofSpanishhospitalstheSpanishLungFailureCollaborativeGroup.Chest1994;106:1188-1193呼吸機(jī)的撤離35Weaning現(xiàn)代危重病醫(yī)學(xué)的定義:一旦確定病人有自主呼吸能力,應(yīng)盡早的、安全的、迅速的撤離機(jī)械通氣口快速撤機(jī):原無(wú)肺部疾患者,一般24內(nèi)脫機(jī)?？诶щy撤機(jī):Weaning36脫機(jī)參數(shù)的有用嗎?口過(guò)去的30余年66項(xiàng)脫機(jī)指標(biāo)應(yīng)用于臨床,多項(xiàng)RCT研究?？谟捎卺t(yī)生的問(wèn)題不能有效撤離機(jī)械通氣,使通氣時(shí)間增加2/3。Esteban(1994)chest106:1188-1193Esteban(2019)]AMA287:345-355口我們現(xiàn)有的指標(biāo)確定脫機(jī)成功陽(yáng)性率50%,陰性率67%oStroetz(2019)AmJRespirCritcareMed152:1034-1040脫機(jī)參數(shù)的有用嗎?37困難脫機(jī)和對(duì)策課件38困難脫機(jī)和對(duì)策課件39困難脫機(jī)和對(duì)策課件40困難脫機(jī)和對(duì)策課件41困難脫機(jī)和對(duì)策課件42困難脫機(jī)和對(duì)策課件43困難脫機(jī)和對(duì)策課件44困難脫機(jī)和對(duì)策課件45困難脫機(jī)和對(duì)策課件46困難脫機(jī)和對(duì)策課件47困難脫機(jī)和對(duì)策課件48困難脫機(jī)和對(duì)策課件49困難脫機(jī)和對(duì)策課件50困難脫機(jī)和對(duì)策課件51困難脫機(jī)和對(duì)策課件52困難脫機(jī)和對(duì)策課件53困難脫機(jī)和對(duì)策課件54困難脫機(jī)和對(duì)策課件55困難脫機(jī)和對(duì)策課件56困難脫機(jī)和