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1、高频振荡通气(HFOV) High Frequency Oscillatory Ventilation,詹庆元2004年7月9日,高频通气（HFV）的分类,高频正压（HFPPV） 高频喷射（HFJV） 高频射流阻断（HFFI） 高频振荡通气（HFOV）,HFOV工作原理,ET Tube,BIAS Flow,Patient,CDP Adjust Valve,Oscillator,Increase FRC with a “super CPAP system”,HFOV呼吸机构造,振荡发生装置 侧枝气流、吸呼气管路和控制阀 加温湿化装置 电路控制系统和控制面板,振荡发生装置,由活塞泵和隔膜产生振荡
2、317Hz 压力变化幅度（P）：每次振荡所产生的压力变化 振荡容量（stroke volume）：活塞运动引起的容积变化，每次接近或小于解剖死腔 主动呼气：活塞前后方向的振荡分别产生正压或负压方波，吸气为正，呼气为负 平均气道压（MAP） ：P叠加于侧枝气流发生的基础气道压，P值的变化在一定程度影响MAP,侧枝气流、病人管路和呼气阀,经空氧混合器调节后的侧枝气流，由气体流量计调节后输入吸气管道，使气体可以充分湿化 吸气与呼吸管路 气体经呼气阀排至外界环境，呼气阀的开口大小可决定平均气道压的高低,加温湿化器,吸气管路内有电阻丝，使来自于湿化罐的气体继续加热，在吸气管路内不存在凝结水，防止振荡波衰
3、减 注意加水,HFOV改善氧合及减少肺损伤的机理,提高肺容积，改善V/Q比 HFOV肺泡压为CMV 1/51/15 VT较CMV低，吸呼相的压力差小 避免了高氧对肺组织的毒性作用,When Do You Consider HFOV?,The EARLIER the better FiO2 0.6-0.8 for 24 hours mPaw 24 PEEP 10-15 P/F Ratio than CMV Set Amplitude for Visual WIGGLE to thigh Hertz 6 I Time % 33 Bias Flow 40 to 60 lpmRecruitment m
4、aneuver Cuff leak,HFOV的监测,物理体征： 自主呼吸：强弱、节律 胸部振动幅度：效果与副作用（痰多，气胸，插管位置） 肺容量：胸廓周径，肝脏在右侧肋下的位置，腹胀和腹围 心功能：心率、血压和周围末梢循环状态，心脏听诊 胸片：判断肺容量，要求膈肌位于第8-9后肋水平 动脉血气分析 持续经皮氧饱和度和二氧化碳监测,Chest X-rays,Stopping the piston, or re-positioning the head to shoot an appropriate film is not necessary. Do not remove the patient
5、from HFOV and manually ventilate to shoot the film. The purpose of the x-ray is to verify the lung volume that the HFOV is producing. A physician, nurse, or therapist should be at bedside to assure the patency of the airway and the patients position.,Suctioning,Indications: Decreased or absent CWF D
6、ecrease in saturation Increase in PaCO2 Using a closed system helps minimize the de-recruitment. When the patient is disconnected from the HFOV they de-recruit lung volume.,Auscultation: Breath sounds,Identifying the normal “breath “ sounds is difficult since HFOV is not ventilation with a bulk flow
7、 of gas through the airway.,Auscultation: Heart Sounds,Stop the piston (the patient is now on CPAP) Listen to the heart sounds Re-start the piston Removing the patient from the ventilator may result in loss of lung volume.,Transition to CMV Ventilation,FiO2 50% Paw 25 ABGs stable Resolution of lung pathology,
