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1、NEWER VENTILATORSWHAT MAKES THEM DIFFERENT ?John Newhart CRTT. RCP.PURITAN BENNETT MA-1Puritan Bennett MA-1First released August 1967.Simple to useBasic IMV system (non-sync).Bellows spirometer for exhaled gas measurement.SIEMENS 900 CSIEMENS 900 B/C900 B available in the USA early 70s.Time limited
2、and minute volume preset.Patient or time cycled or SIMV.Expiratory flow monitoring.BEAR IBuilt in SIMV.Monitoring of tidal and minute volume.Pneumatically and electrically powered, electrically controlled volume limited.Time or patient cycled, control or assist/control modes.PURITAN BENNETT 7200Rele
3、ased 1983First widely accepted microprocessor controlled ventilator in USA.Software upgradable. Newer Generation VentilatorsTRANSPORT VENTILATORSEARLY MODELPULMONETIC LTV 1000PULMONETIC LTVCompact lightweight 12.6 lbs. Ability to transport more critical patients.Internal battery.Volume Control, Pres
4、sure Control and Pressure Support.Volume and pressure alarms and monitoring.Changes in Ventilators Include.More sophisticated hardware.More compact size.Multiple high speed microprocessors.Backup battery systems.Graphical User Interface (GUI).An ever expanding list of modalities.Modular DesignuTouch
5、 Screen Displaycan be mounted separatelyuBreath Delivery Unitweighs only 40 lbs. can be mounted separately from cartNew HardwareProportional control valvesActive Exhalation valvesBattery backupMiniature blowerProportional Control ValvesOne or two valves (O2, Air, or both) proportionally open or clos
6、e to control the flow of gas to the patient circuit.Responsible for FIO2, Flow rate, Flow waveform. Microprocessor controlled.Each valve is controllable from 1,000-4,000 steps.Two Proportional Valve SystemNPB 7200-840, DRAGER E2-4, SERVO 300O2AIRTo Patient50 psig50 psigEach gas has its own solenoid,
7、 flow sensor and pressure regulator . Both valves controlled by microprocessor.FLOW SENSORFLOW SENSORSingle Proportional SystemHamilton Veolar, Bird 6400-8400st O2AIRTo Patient50 psig50 psigBLENDERRESERVOIR10-15 PSIGAir and O2 are mixed in a blender, stored as a mixed gas in a reservoir then pass th
8、rough a single proportional valve.PROPORTIONAL VALVEPneumatics Chassis (PB 840)Blower with Intragral Digital BlenderO2Pulmonetic LTV Turbine/Blender SystemBlended gas to patientDelivery Control ValveActive Exhalation ValvesThe inspiratory and expiratory valves are active during inspiration to maximi
9、ze the reproducibility of inspiratory and expiratory events.These valves are critical in newer modes such as APRV, BiLevel, and ATC.With an active exhalation valve, the ventilator moves the exhalation valve off of its seat during exhalation. With a non-active valve the patient must push the valve of
10、f of its seat adding to expiratory resistance and work of breathing.Active Exhalation ValveDuring inspiration, the valve is closed with the force of the insp pressure setting Allows coughing or spont breathing at upper pressure level by venting excess pressure and flow (PCV or BiLevel)40PCIRCcmH2OIN
11、SPLminEXP302010 010-2080604020020-804060V.04812s2610Spontaneous EffortsSpontaneous EffortsPCV W/O Active ValvePCV with Active ValveTwo Proportional Valve System With Active Exhalation ValveO2AIR50 psig50 psigAir and O2 solenoids combined with active exhalation valve.PATIENTEXHMicroprocessor ControlE
12、ach new generation of ventilator incorporates faster processors.Multiple high speed processors improve the ventilators response to the patients needs.Faster processors make more information available to the clinician.MICROPROCESSOR FUNCTIONDuring each breath, the ventilator switches through multiple
13、 algorythims. These determine sensing of patient breath, rise rate of breath, criteria for patient termination of breath at various points during the breath, and ventilator initiated termination of breath.Monitored data as well as data needed for ventilator function are constantly being processed in
14、 the background.Most calculations done by the ventilator are never seen by the user.Most modes of ventilation that have come out in the last 15 years would be impossible without computer control.UPGRADABILITYOlder ventilators frequently required a complete factory overhaul to have one mode added.Upg
15、rading newer ventilators is usually accomplished by software upgrade. This may be done by changing out the chip set or uploading software from a PC. Adding options/modes typically involves changing a chip that accesses specific options included in the software, or entering a code number through a ke
16、ypad. Battery Back-UpIs now standard on most ICU ventilators.Eliminates interruptions in ventilator function during flickers or short term failure in A/C power.Aids patient safety.GUIGraphical User InterfaceTouch screen technology.Becoming the norm for ICU ventilators.Replaces traditional knobs, but
17、tons etc.Blends graphical displays with controls.Easy software upgrades.Gives additional information relative to setting changes.Ease of Use - Software Controlled ScreensOnly current modes and settings are displayed (ease of use)Information can appear as needed to help make decisions easier and safe
18、rAutomatic Tube CompensationOvercomes the resistance to flow created by an endotracheal tube or tracheostomy tube.Gives the patient the sensation that they are not intubated.Most important during spontaneous breaths.May provide a calculated tracheal pressure curve on the graphics display (E4).Can be
19、 used to “train” the respiratory muscles.ET. Tube Resistance During Breath TypesMandatory breaths from the ventilator easily overcome the resistance of an ET. tube.Spontaneous breaths are more difficult as a result of breathing through a relatively small orifice.ATC Function During InspirationDuring
20、 inspiration , the ventilator increases pressure at the top of the ET. tube proportionate to the inspiratory flow rate.Function of ATC during ExhalationDuring expiration the circuit pressure is decreased below the PEEP level. The tracheal pressure is held constant at the selected PEEP level. This de
21、creases the work of expiration. The circuit pressure is calculated from the expiratory flowrate. ATC with Paw and Ptrach waveforms displayedPressure CalculationUsing the flow measured by the ventilator, the difference in pressure at any given time can be calculated by the following equation:Pressure
22、 = Rtube Coef. X Flow2, where tube resistance R is itself dependent on the flow.Difference Between ATC and PSPS is a user set, fixed pressure that remains constant throughout the inspiratory phase irrespective of the patients flow rate.ATC is a user set level of compensation (1-100%). The driving pr
23、essure will vary according to the E.T. tube size set, compensation level and inspiratory flow rate.CONCLUSIONVentilator DesignThe design of ventilators depends increasingly on the use of microprocessor control and software.The hardware in ventilators is being continuously miniaturized.Move towards v
24、entilator designs that will ventilate infants through adults.CONCLUSIONModes of VentilationModes and hardware that minimize the overall work of breathing. Modes that make “decisions” based on both input from the therapist and patient monitoring.Interfaces that display more graphical and numerical information.“Smart Alarms” that look for combinations and severity of thresholds. The alarm indicates by sound and/or graphics the seriousness of the condition.
