1, connect the relevant equipment
Connect the ventilator pipeline, oxygen and power supply. The power-on sequence is air compressor, humidifier, host, and machine self-test. The order of shutting down the ventilator is coincidentally the opposite, i.e., shutting down the mainframe first, then the humidifier, the air compressor, and then shutting down the air supply.
2, choose breathing mode
(1) auxiliary/control mode (A/C): volume control mode, is commonly used in adult ventilation mode, can ensure ventilation; pressure control ventilation (PCV) commonly used in pediatrics, constant pressure, not easy to occur in the lungs of the air pressure injury.
(2) Synchronized Intermittent Command Ventilation (SIMV): the advantage is to ensure the ventilation volume, but also conducive to the exercise of respiratory muscles, is more commonly used, often used as a withdrawal of the machine before the excessive measures.
(3) Pressure Support Ventilation (PSV): after the patient's voluntary breathing triggers the ventilator, the ventilator gives the patient a certain pressure support to achieve the purpose of improving ventilation, which is a ventilator-assisted mode of voluntary ventilation, synchronization is good, and look at the use of SIMV with.
(4) Continuous positive airway pressure ventilation (CPAP): on the basis of the patient's spontaneous breathing, the ventilator gives a certain pressure in both inhalation and exhalation phases to make the alveoli open, applicable to the decline in lung compliance and atelectasis, obstructive sleep apnea syndrome.
(5) Positive end-expiratory pressure ventilation (PEEP): in the expiration still maintain a positive pressure in the airway, at a predetermined level of positive pressure, generally advocate the end positive pressure of 5-10cmH2O. because normal people at the end of expiration due to the vocal folds closed, also maintain a certain positive pressure, called physiological PEEP, generally between 1-3cm water column, mainly to maintain functional residual air volume and prevent alveolar atrophy. After the patient implemented tracheal intubation, this physiological protective effect is lost, so PEEP of 1-3 cmH2O can be used during mechanical ventilation, but it should not be too high to prevent causing pulmonary alveoli and pneumatic injuries, and this mode is mainly used in patients with ARDS and pulmonary edema.
3. Adjustment of related parameters
(1) When Pa02 is too low: increase the oxygen concentration, use PEEP appropriately, increase the ventilation per minute, and prolong the ventilation time.
(2) When PaO2 is too high: decrease oxygen concentration, gradually decrease PEEP, decrease ventilation per minute
(3) When PaCO2 is too high: increase respiratory rate, increase tidal volume, appropriately downwardly adjust the inhalation/exhalation ratio
(4) When PaCO2 is too low: decrease respiratory rate, decrease tidal volume, prolong expiration time, and upwardly adjust the inhalation/exhalation ratio
4, stop
The patient's ability to breathe and cough is restored, spontaneous respiration produces sufficient ventilation, and oxygen saturation is always maintained above 90%. Lung infection control, not much respiratory secretion, no serious pulmonary or systemic comorbidities, arterial blood gas analysis PAO2 is greater than 50MMHG, PACO2 is not significantly elevated, PH value is basically normal, you can carry out the shutdown.
What are the precautions for the use of ventilator
1, the first use of the ventilator should be turned on and off for the first time, to determine whether it can be correctly mastered on and off, and at the same time to check whether the machine can work properly. If there is any problem, contact the seller or manufacturer. The first time you use the ventilator, you may feel uncomfortable, but this is a normal phenomenon. You can do a few deep breaths, after a period of self-adjustment, the patient will gradually adapt to this new feeling.
2. Read the instruction manual in detail before use, and connect the ventilator, humidifier, and nasal or mouth-nose mask according to the diagrams in the manual.
3, before use to determine the humidifier has been added to the pure water or distilled water, and can not exceed the prescribed position.
4, in the use of the process of the patient to temporarily disengage from the machine, it is best to turn off the machine, remove the nose mask or nasal mask before leaving, and come back to wear the nose mask or nasal mask and then reopen the machine to use.
5. If using a nasal mask, try to keep your mouth closed during treatment. Air leakage from the mouth will result in reduced efficacy. If mouth leakage cannot be resolved, use an oro-nasal mask or use a jaw strap.
6. The ventilator is most effective when the mask is worn well and is comfortable. Air leaks can affect the effectiveness of therapy, so it is important to eliminate them. Before putting on the mask, wash your face to remove excess oils and grease, which will help you wear the mask better and prolong the life of the cushions.
7. During use, dryness of the nose, mouth and throat may occur, especially in winter. Often, the addition of a humidifier will eliminate these discomforts.
8, in the first few weeks of treatment, sneezing, runny nose, nasal congestion and other phenomena may occur. Often, the addition of a humidifier will solve these problems.
9. Most ventilators have a built-in power converter for 100-240V, 50-60Hz, enabling the ventilator to work worldwide. When traveling internationally, no special adjustments are needed, but a power plug converter may be required.
10, it is best to clean the mask once a day, every three days to clean the tube, cleaning methods can refer to the respirator manual annex disinfection method.
What are the basic parameters of the ventilator
1, oxygen concentration
Calculation formula: 21 + 4 * oxygen flow. Low concentration of oxygen (24-40%), for COPD patients; medium concentration of oxygen (40-60%) for hypoxia and carbon dioxide storage; high concentration of oxygen (more than 60%) for CO poisoning, cardiogenic shock and severe trauma after major surgery, inhalation of high concentration of oxygen should not exceed 1-2 days, otherwise it is easy to oxygen poisoning.
2, tidal volume
Generally set at 8-10ml/kg, for ARDS, pulmonary edema, pulmonary atelectasis and other patients with poor lung compliance can be set at 10-12ml/kg, the maximum can be used to 10-15/ml/kg.
3, respiratory rate
After the surgery, the patient should not inhale high concentration of oxygen for more than 1-2 days, otherwise it is easy to oxygen toxicity. p>3, respiratory rate
General selection of 8-14 times / min, if the withdrawal of the machine before the patient to gradually adapt to, can reduce the respiratory rate to 2-10 places / min.
4, inhalation/exhalation time ratio
Obstructive ventilation disorder inhalation: exhalation for 1:2-2.5, with slow frequency; restrictive ventilation disorder, inhalation: exhalation for 1:1.5, with faster frequency.
5. Pressure support
Set this parameter when using the pressure support ventilation mode, mild lesions in the lungs: 15-20 CMH2O; moderate lesions: 20-25 cmH2O; severe lesions: 25-30 CMH2O.