机械通气时人机对抗的原因分析及护理对策

机械通气的目的是保持患者的通气量，改善换气功能，维持生命所需的动脉血氧浓度，人机对抗是机械通气中最为常见的并发症之一，若不及 时发现和处理，不仅影响患者氧疗的效果，同时可造成进一步的肺损伤。现将1998年1月－1999年12月ICU机械通气中人机对抗原因及护理措施介绍如下。     

机械通气时人机对抗的护理

机械通气已广泛应用于治疗各种急慢性呼吸衰竭 ,在呼吸支持治疗上发挥着非常重要的作用。机械通气作为病人自主呼吸的替代或辅助 ,是一种非生理状态的呼吸方式 ,病人又处于严重的病理状态下 ,呼吸功能异常 ,经常会发生患者与呼吸机之间的不协调 ,即人机对抗 ,这是机械通气的一种严重并发症 ,不但达不到治疗目的 ,反而增加氧耗 ,加重循环负担 ,加重呼吸衰竭 ,甚至导致休克和窒息。因此 ,及时发现人机对抗的表现 ,采取适当的措施 ,对于保证机械通气治疗的成功具有重要意义[1] 。本文总结重症监护室中 30例行机械通气患者发生人机对抗的各种原…     

机械通气时人机对抗的原因分析及处理

人机对抗是机械通气中最为常见的并发症之一,其危害是使每分通气量(MV)和潮气量(TV)下降,呼吸功增加,氧耗增加,使缺氧加重并形成恶性循环,还可使循环负荷增加,心肌缺血缺氧,诱发急性左心衰等,严重时危及生命.为此,对本科2004年6月～2006年6月40例气管插管或气管切开行机械通气时人机对抗的原因进行分析并探讨其处理策略.     

机械通气患者出现人机对抗时的护理

机械通气是危重患者呼吸支持治疗的一种重要手段,目的在于改善呼吸功能和纠正低氧血症.人机对抗是机械通气中最常见的并发症之一,不仅严重影响呼吸机治疗的效果,也可使患者的呼吸做功和氧耗量增加,还可致酸碱平衡和内环境紊乱,不利于患者康复.本院对这类患者应用肌松药进行处理并加强护理,获得了满意效果,总结如下.     

机械通气时人机对抗的原因及处理

机械通气的目的是保证患者的通气量、改善换气功能、维持生命所需的动脉血氧浓度。机械通气本身在治疗的同时也存在着可能发生的多种并发症，人机对抗是机械通气中最为常见的并发症之一，可造成进一步的肺损伤。本文回顾了自１９９５年１月～１９９６年１２月本科机械通气...     

异丙酚解除机械通气过程中人机对抗的护理

1997年1月～1998年6月,对5例经鼻气管插管行机械通气的患者,采用微量泵持续注入异丙酚解除机械通气过程中人机对抗,收到良好效果,停药后患者苏醒快,无恶心、呕吐等消化道不良反应。笔者强调在用药过程中使用监护仪监测患者生命体征、动脉血氧饱和度和呼气末二氧化碳,备好抢救物品,保持呼吸道通畅,做好基础护理。     

急诊ICU机械通气患者人机对抗原因分析及处理

目的 分析急诊ICU机械通气患者人机对抗的原因并探讨其处理策略,指导临床治疗.方法 对2003年6月～2005年12月间急诊ICU 85例气管插管或气管切开机械通气患者人机对抗的原因及处理进行回顾性调查.结果 因缺氧诱发自主呼吸过快导致人机对抗最多见,占44.50%.不能耐受气管插管,气管导管过深或脱出,气囊破裂,管道漏气以及气管内分泌过多,参数设计不当等为机械通气时人机对抗的常见原因.结论 发生人机对抗应尽快查找原因,及时处理,才能保证有效的通气,减少并发症的出现.     

ICU病人机械通气时人机对抗的病因分析及处理策略

人机对抗是机械通气中最为常见的并发症之一,其危害是使每分钟通气量(MV)和潮气量(TV)下降、呼吸做功增加、氧耗增加、使缺氧加重并形成恶性循环,另外,使循环负荷增加、心肌缺血缺氧、诱发急性左心衰等,严重时危及生命.为此,本文对我科2003-08～2004-02间40例气管插管或气管切开机械通气时人机对抗的原因进行分析并探讨其处理策略.     

机械通气人机对抗时应用镇静肌松剂的护理

通过对17例行机械通气患者发生人机对抗时行镇静肌松剂的护理分析,认为确定人机对抗的发生,掌握人机对抗的诱发因素,明确应用镇静肌松剂的指征,及掌握应用镇静肌松剂时应注意的问题至关重要。在护理措施上应做好以下几个点:(1)寻求最佳给药方法;(2)临床护理监测;(3)保持气道通畅;(4)预防褥疮;(5)做好心理护理。     

Patient-ventilator asynchrony during assisted mechanical ventilation

Objective The incidence, pathophysiology, and consequences of patient-ventilator asynchrony are poorly known. We assessed the incidence of patient-ventilator asynchrony during assisted mechanical ventilation and we identified associated factors.Methods Sixty-two consecutive patients requiring mechanical ventilation for more than 24 h were included prospectively as soon as they triggered all ventilator breaths: assist-control ventilation (ACV) in 11 and pressure-support ventilation (PSV) in 51.Measurements Gross asynchrony detected visually on 30-min recordings of flow and airway pressure was quantified using an asynchrony index.Results Fifteen patients (24%) had an asynchrony index greater than 10% of respiratory efforts. Ineffective triggering and double-triggering were the two main asynchrony patterns. Asynchrony existed during both ACV and PSV, with a median number of episodes per patient of 72 (range 13–215) vs. 16 (4–47) in 30 min, respectively (p = 0.04). Double-triggering was more common during ACV than during PSV, but no difference was found for ineffective triggering. Ineffective triggering was associated with a less sensitive inspiratory trigger, higher level of pressure support (15 cmH₂O, IQR 12–16, vs. 17.5, IQR 16–20), higher tidal volume, and higher pH. A high incidence of asynchrony was also associated with a longer duration of mechanical ventilation (7.5 days, IQR 3–20, vs. 25.5, IQR 9.5–42.5).Conclusions One-fourth of patients exhibit a high incidence of asynchrony during assisted ventilation. Such a high incidence is associated with a prolonged duration of mechanical ventilation. Patients with frequent ineffective triggering may receive excessive levels of ventilatory support.B.C. is supported by the Instituto de Salud Carlos III (expedient CM04/00096, Ministerio de Sanidad) and the Instituto de Recerca Hospital de la Santa Creu i Sant Pau     

Reduction of patient-ventilator asynchrony by reducing tidal volume during pressure-support ventilation

OBJECTIVE: To identify ventilatory setting adjustments that improve patient-ventilator synchrony during pressure-support ventilation in ventilator-dependent patients by reducing ineffective triggering events without decreasing tolerance. DESIGN AND SETTING: Prospective physiological study in a 13-bed medical intensive care unit in a university hospital. PATIENTS AND PARTICIPANTS: Twelve intubated patients with more than 10% of ineffective breaths while receiving pressure-support ventilation. INTERVENTIONS: Flow, airway-pressure, esophageal-pressure, and gastric-pressure signals were used to measure patient inspiratory effort. To decrease ineffective triggering the following ventilator setting adjustments were randomly adjusted: pressure support reduction, insufflation time reduction, and change in end-expiratory pressure. MEASUREMENTS AND RESULTS: Reducing pressure support from 20.0[Symbol: see text]cm H(2)O (IQR 19.5-20) to 13.0 (12.0-14.0) reduced tidal volume [10.2[Symbol: see text]ml/kg predicted body weight (7.2-11.5) to 5.9 (4.9-6.7)] and minimized ineffective triggering events [45% of respiratory efforts (36-52) to 0% (0-7)], completely abolishing ineffective triggering in two-thirds of patients. The ventilator respiratory rate increased due to unmasked wasted efforts, with no changes in patient respiratory rate [26.5[Symbol: see text]breaths/min (23.1-31.9) vs. 29.4 (24.6-34.5)], patient effort, or arterial PCO(2). Shortening the insufflation time reduced ineffective triggering events and patient effort, while applying positive end-expiratory pressure had no influence on asynchrony. CONCLUSIONS: Markedly reducing pressure support or inspiratory duration to reach a tidal volume of about 6[Symbol: see text]ml/kg predicted body weight eliminated ineffective triggering in two-thirds of patients with weaning difficulties and a high percentage of ineffective efforts without inducing excessive work of breathing or modifying patient respiratory rate.     

机械通气病人的需求及护理进展

综述了机械通气病人的需求,提出护士应做好基础护理、人工气道的护理、感染的预防及护理、营养支持、疼痛的护理,满足病人的生理需求;做好呼吸机的监测,满足病人安全需求;做好与病人的沟通和心理护理,满足其爱和归属及尊重的需求。     

机械通气病人的管理及护理进展

从人工气道的湿化、呼吸道分泌物的吸引、呼吸管道的管理以及机械通气时病人出现的不良心理和行为方面对机械通气病人的护理进行了综述。     

集束化护理干预在急诊重症监护病房机械通气病人护理中的应用

[目的]探讨集束化护理干预在急诊重症监护病房(EICU)机械通气病人护理中的应用。[方法]采用方便抽样方法,将296例EICU机械通气病人分为观察组134例和对照组162例,观察组采用集束化护理干预,对照组采用常规护理。病人转出EICU时评价效果。[结果]观察组病人意外脱管率、肺部感染率、病死率低于对照组(P<0.05);观察组病人住院费用、机械通气时间、住EICU时间少于对照组(P<0.05)。[结论]对EICU机械通气病人采用集束化护理干预,可降低相关并发症的发生率、病死率,减轻病人的经济负担,有益于医患双方。     

Patient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger

Objective: Air leaks around the mask are very likely to occur during noninvasive ventilation, in particular when prolonged ventilatory treatment is required. It has been suggested that leaks from the mask may impair the expiratory trigger cycling mechanism when inspiratory pressure support ventilation (PSV) is used. The aim of this study was to compare the short-term effect of two different expiratory cycling mechanisms (time-cycled vs flow-cycled) during noninvasive inspiratory pressure support ventilation (NIPSV) on patient-ventilator synchronisation in severe hypoxemic respiratory failure. Study population: Six patients with acute lung injury (ALI) due to acquired immunodeficiency syndrome (AIDS)-related opportunistic pneumonia were enrolled in the protocol. Intervention: Each subject was first studied during spontaneous breathing with a Venturi oxygen mask (SB) and successively submitted to a randomly assigned 20 ′ conventional flow-cycling (NIPSVfc) or time-cycling inspiratory pressure support ventilation (NIPSVtc). The pre-set parameters were: inspiratory pressure of 10 cm H₂O, PEEP of 5 cm H₂O for the same inspired oxygen fraction as during SB. A tight fit of the mask was avoided in order to facilitate air leaks around the mask. The esophageal pressure time product (PTPes) and tidal swings (ΔPes) were measured to evaluate the patient's respiratory effort. A subjective “comfort score” and the difference between patient and machine respiratory rate [ΔRR(p-v)], calculated on esophageal and airway pressure curves, were used as indices of patient-machine interaction. Results: Air leaks through the mask occurred in five out of six patients. The values of PEEPi (< 1.9 cm H₂0) excluded significant expiratory muscle activity. NIPSVtc significantly reduced PTPes, ΔPes, and ΔRR(p-v) when compared to NIPSVfc [230 ± 41 (SE) vs 376 ± 72 cm H₂O · s · min^–1 ; 8 ± 2 vs 13 ± 2 cm H₂O; 1 ± 1 vs 9 ± 2 br · min^–1; respectively] with a concomitant significant improvement of the “comfort score”. Conclusions: In the presence of air leaks a time-cycled expiratory trigger provides a better patient-machine interaction than a flow-cycled expiratory trigger during NIPSV. Received: 5 June 1998 Accepted: 24 February 1999     

Patient-ventilator synchrony during pressure-targeted versus flow-targeted small tidal volume assisted ventilation

PURPOSE: Low tidal volume (V(T)) delivered by flow-targeted breaths reduces ventilator-induced lung injury but may increase patient breathing effort because of limited flow. We hypothesized that a variable-flow, pressure-targeted breath would improve breathing effort versus a fixed flow-targeted breath. MATERIALS AND METHODS: We compared pressure assist-control ventilation and volume assist-control ventilation (VACV) in 12 patients with acute respiratory failure receiving 6 to 8 mL/kg V(T). Backup frequency, V(T), inspiratory time, applied positive end-expiratory pressure and fraction of inspired oxygen were held constant. Patient breathing effort was assessed by airway pressure (Paw) drop below baseline 0.1 second after the breath initiation (P(0.1)), the maximal Paw drop during the triggering phase (Ptr), the magnitude of ventilator work during flow delivery, and the presence of an active expiratory effort during cycling and air trapping judged by the magnitude of residual flow at end-expiration. RESULTS: Compared with VACV, pressure assist-control ventilation decreased P(0.1), Ptr (by 25% and 16%, respectively), and evidence for trapped gas but not ventilator work during flow delivery or cycle dys-synchrony. Peak inspiratory flow was comparable between the 2 modes. CONCLUSIONS: In patients receiving small V(T) VACV with increased breathing effort, variable-flow, pressure-targeted ventilation may provide more comfort by decreasing respiratory drive during the triggering phase.     

44例新生儿机械通气辅助治疗的护理

目的 探讨新生儿机械通气的相关护理。方法 介绍44例机械通气辅助治疗的护理：体位、病情观察、气管插管的管理、呼吸道管理、拔管护理、基础护理。结果 44例患儿中除家属放弃9例，死亡4例，31例顺利脱机并治愈出院。本组病例中有6例呼吸机相关性肺炎，发生率18．6％。结论 有效地减少呼吸机相关性肺炎，缩短了上机时间，减轻了患儿的痛苦和家长的经济负担，更提高了患儿的成活率与生命质量。     

机械通气患者的脱机（附85例分析）

分析了８５例机械通气患者恢复时的脱机过程。列举２例脱机困难者的处理。讨论了脱机患者的病理生理改变，脱机标准的掌握和营养支持与脱机的关系。认为脱机时机的掌握，脱机过程的调节，以及必要的营养支持有益于顺利脱机。     

机械通气患者及家属的心理反应与护理

目的：了解机械通气治疗患者及家属的心理反应和心理需求。方法：以问卷方法调查神志清楚的28例及128位患者及家属的心理反应。结果：28例患者中,忧郁占92．8％,多疑占85．7％,脆弱占100％;敌对占82．1％,易怒占96．4％,偏激占93．8％,120位家属中,忧郁占90．8％,多疑占81．6％,敌对占80％脆弱占97．5％,易怒占93．3％,偏激占82．5％,其余项目无明显差异;心理需求调查中,患者需要陪护占100％,健康教育需要占92％,减少费用为75％、临终关怀为67．8％,而家属对陪护的需求为83．3％,减少费用为77．7％、临终关怀为90．8％外,其余项目无差异性。结论：机械通气患者在治疗期间心理反应、心理需求基本上与家属一致,需对患者和家属进行心理护理。