pb840呼吸机的使用_ppt课件

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1、,PB 840 呼吸机原理及特点,21世纪机型,全新的操作界面顶尖的气路设计完善的安全保障无限的升级潜力,PB 840 技术优势及特点,高效双电脑控制 顶尖气路设计 模块化设计 图形用户界面(GUI) 呼吸释放单元(BDU) 后备电源(BPS) 压缩泵(选件)(CU) 轻便台车 病人回路 (PC) 湿化器,PB 840 图形用户界面,简洁，直观的用户界面 双屏幕显示，不会影响 任何信息观察智能报警系统在台车支架上可以270度 旋转可以单独安装于合适位置延长电缆长达30英尺,PB 840 呼吸释放单元 (BDU),呼吸机核心 气路系统 电脑系统 电气系统 警报系统 供应电源 与图形用户界面通讯,

2、交流电压低或丢失时， 自动提供后备供电连接交流电时，自动充电 后备电源不提供压缩泵及 湿化器,PB 840 后备电源 (BPS),两个相似系统- 空气 - 氧气,Q1,Q2,PSOL1,PSOL2,流量控制子系统,PB840 气路系统工作原理,PB840 操作特性,逻辑化操作 (GUI) 理想体重设置(IBW) 呼吸模式(A/C，SIMV，Bi-Level,SPONT) 呼吸方式(VCV，PCV) 自主呼吸支持方式(PSV，TC) 工作参数，警报参数自动预设 窒息通气参数同时被预设 选择想观察的呼吸波形,呼吸机常规 按键在屏内， 操作钮在屏外 单次按键不影响送气 变更参数通过 触摸-旋转- 确

3、认 右下方屏幕的导引区帮助操作者完成操作过程,PB840 操作特性,PB840 操作特性,模式的设定,在设置中找到 SETUP 键位，按压,BiLevel的设定,旋转调节至显示?BiLevel 随后的通气方式将被固定为PC方式，不可变更 选择 spontaneous类型及触发类型 触压 Continue 键位,PB840 操作特性,彩色屏幕,并非单纯美观 彩色屏幕 自助菜单 全面安全性,PB840 操作特性,PB840 操作特性,智能呼吸释放 ABC,A - work to trigger B - flow acceleration percent (rise time) C - preven

4、ting pressure overshoot and sustaining the breath D - transition into expiration,Pressure,Time,A,B,C,D,新通气策略,首先，增强现有呼吸形式的灵活性 将适用面扩展至儿童、婴儿患者 改善PSV、 PCV 状态下人机同步性能 新智能通气能根据病人情况改变而自动调整,Pressure,A,C (PCV Only),D (PS Only),B,压力上升时间,PCV维持阶段,PCV吸气维持阶段，病人做功将引起对抗及压力上冲,40,PCIRC cmH2O,INSP,EXP,30,20,10,0,10,-20

5、,80,60,40,20,0,20,-80,40,60,0,4,8,12s,2,6,10,Spontaneous Efforts,Spontaneous Efforts,PCV W/O Active Valve,PCV with Active Valve,C,A,B,D,NPB 840 电脑呼吸机 独家专利设计 主动呼气阀,美国万灵科公司 Puritan Bennett 840呼吸机,吸气相实现主动性呼气,主动呼气阀,吸气时，根据设置压力呼气阀关闭 允许在压力持续阶段自主呼吸或咳嗽,40,PCIRC cmH2O,INSP,EXP,30,20,10,0,10,-20,80,60,40,20,0,

6、20,-80,40,60,0,4,8,12s,2,6,10,Spontaneous Efforts,Spontaneous Efforts,PCV W/O Active Valve,PCV with Active Valve,PB840 操作特性,主动呼气阀临床特性,呼气灵敏度,Pressure support breaths terminate when patient flow decelerates to a percentage of peak flow,40,PCIRC cmH2O,INSP,EXP,30,20,10,0,10,-20,80,60,40,20,0,20,-80,40,

7、60,0,4,8,12s,2,6,10,PS Termination Criteria,C,A,B,D,呼气灵敏度,Leaks can cause inability to terminate pressure support breaths, causing profound asynchrony I-times too long or too short can also cause asynchronous breathing,20% (Set),35% (Leak Rate),Flow,呼气灵敏度,ESENS allows adjustment of the termination c

8、riteria for pressure supported breaths sets the percent of peak flow that cycles the pressure support breath into exhalation especially helpful to match the patient抯 desired inspiratory time can improve synchrony between patient and ventilator,20% (Set),40% (Set),35% (Leak Rate),Flow,PB840 操作特性,Bi-L

9、EVEL 压力-时间曲线,PB840 操作特性,Bi-Level 呼吸方式的增强功能,Bi-Level 、 APRV存在于一种方式中 PSV 可以给病人在PEEPH 或PEEPL水平上的自主呼吸予支持PEEPH与PEEPL之间的相互转换由时间与病人共同决定对病人的每一次呼吸进行监测，并计算自主呼吸分钟通气量可以由操作者决定TH、TL或TH:TL 固定 全面监测自主呼吸容量，确定病人呼吸能力,PB840 操作特性,APRV 呼吸方式,Upper And Lower Inflection Points,0,20,40,60,20,40,-60,0.2,LITERS,0.4,0.6,Paw,cmH2

10、O,VT,Upper And Lower Inflection Points,Alveolar collapse,P,T,Lower inflection points are thought to be a point of critical opening pressure,Upper And Lower Inflection Points,Alveolar overdisention,Alveolar collapse,P,T,PV CURVE,PEEP = 5 cmH2O,Setting PEEP,PEEP = 12 cmH2O,PB840 操作特性,TC 气管插管自动补偿,Press

11、ure drop shows imposed work across ET-Tube when flow is present,What The Carina Sees,Circuit Pressure,Lower Carina Pressure,Paw,TC adds appropriate pressure to keep carina pressure at preset PEEP,Tubing Compensation - What The Carina Sees,Higher Circuit Pressure,No decreased Carina Pressure,Paw,TC C

12、ompared To PS,TC varies its output as flow demands change Pressure rises and falls more naturally,10,PCIRC cmH2O,INSP,EXP,7.5,5,2.5,0,-5,-10,80,60,40,20,0,20,-80,40,60,0,4,8,12s,2,6,10,Higher Flow,Higher Appropriate Support,Artificial Airways and WOB,Single greatest cause of imposed WOB is caused by

13、 the ET-Tube During inspiration lung pressure can be significantly lower than circuit pressure when flow is present PS is frequently used to overcome this imposed WOB, and when used in this manner has several shortcomings,PS Limitations For ET-Tube Compensation,PS may under-support the WOB early in

14、the inspiratory phase when flows are high As patients wake, sleep, become agitated etc, PS is unable to compensate for variable demands,10,PCIRC cmH2O,INSP,EXP,7.5,5,2.5,0,-5,-10,80,60,40,20,0,20,-80,40,60,0,4,8,12s,2,6,10,Higher Flow,Insufficient Support,What is Tube Compensation?,Not a mode, but a spontaneous breath type Accurately overcomes the imposed inspiratory WOB through an artificial airway Hybrid of PS (but more efficient at overcoming tube resistance) Controls the patients carinal pressure to a constant preset PEEP value during inspiration,