Ventilator Department of Pediatrics Chosun University Hospital Min Seon Choi, M.D.
기계환기의 목적 저산소상태 해소 진행하는 호흡산증 해소 호흡작업량 경감
Oxygen delivery system Nasal cannula, nasal prong Mask Hood Endotracheal tube or tracheostomy tube adaptor
Conventional ventilation Absolute indications: failure to initiate or sustain spontaneous breathing Persistent bradycardia despite bag-mask ventilation Presence of major airway or pulmonary malformation Sudden respiratory or cardiac collapse with apnea/bradycardia
Conventional ventilation Relative indications: High likelihood of subsequent respiratory failure Surfactant administration Impaired pulmonary gas exchange Worsening apnea unresponsive to other measures Need to maintain airway patency Need to control CO2 elimination
Five different ways to increase mean airway pressure (MAP) Inspiratory flow rate ↑ PIP ↑ Prolong the I-time without changing the rate PEEP ↑ Ventilatory rate ↑by reducing expiratory time without changing I-time
Comparison of ventilator modes according to the ventilator parameters ModePEEPPIPTiRRTiming of inspiration During apneic episode IMVFixed No change SIMVFixed variableIMV ACFixed variable Backup ventilation PSVFixedSupport pressure variable Backup ventilation PAVFixedvariable Backup ventilation
Ventilator 종류별 사용 mode Servo-I (Maquet Inc., Bridgewater, NJ, USA) SIMV(PC)+PSV PRVC (Pressure regulated volume control)+PSV NAVA, NIV-NAVA Babylog, VN500 (Drager Medical GmbH, Lubeck, Germany) SIMV(PC)+PSV SIMV(VG)+PSV HFOV, Volume Guarantee-HFOV
Ventilator 종류별 사용 mode Sophie (Stephan Biomedical, Gackenbach, Germany) SIMV(PC)+PSV 기류센서에서 실시간으로 측정되는 호기 환기량 에 따라 설정 목표 용량에 맞도록 다음 호흡의 최 고 흡기압을 조절하는 방식 Assist/Control HFOV SNIPPV
Ventilator 종류별 사용 mode Puritan Bennett (PB) 840 (Covidien inc., USA): SIMV (PC or VC)+ PSV, A/C mode Humming V (Metran Co., Ltd., Japan): HFOV Calliopea (Metran Co., Ltd., Japan): HFOV
Sophie
문제 상황 1) leak ( 리크 )
문제 상황 2) 튜브 발관 / 꺾임
문제 상황 3) 회로내 물 고임
Position of the tube tip Correct position: mid trachea, midway between vocal cord and carina, at the level of clavicle