Introduction: Ventilator is a kind of medical equipment that can play a vital role in preventing and treating respiratory failure, reducing complications, saving and prolonging patients' lives. How to use the ventilator? What are the precautions for using a ventilator? The following to see how to use the ventilator and precautions.
Humans and animals have to breathe countless times a day, and breathing is the main element to maintain the human body, people have also liked the breathing, but when some patients are critically ill, they can not help themselves to breathe, this time the medical staff will be inserted into the respiratory machine for them, friends know how to use it? Do you know how to use it? How do you adjust it? Please follow me to recognize the following: the use of ventilators, how to adjust the ventilator.
The use of the ventilator precautions
a. Contraindications:
There are no absolute contraindications. Pulmonary alveoli, pneumothorax, hypovolemic shock, myocardial infarction and other diseases should be applied to reduce the ventilation pressure and increase the frequency.
Second, the basic type of ventilator and performance:
1, fixed-volume ventilator: inhalation into expiration is based on the pre-conditioning of the tidal volume and switch.
2, fixed-pressure ventilator: inhalation into expiration is switched according to the pre-set pressure peak. (Unlike pressure-limiting, pressure-limiting is that airway pressure reaches a certain value and continues to send air and does not switch)
3, timed-type ventilator: inhalation converted to expiration is determined by the time parameter (inhalation time). Since the eighties, the emergence of timed, pressure-limited, constant-flow type ventilator. This type of ventilator retains the characteristics of the timed type and the constant volume type that can still ensure ventilation when airway resistance increases and lung compliance decreases, and has the advantage of not easily causing pneumatic injuries due to the restriction of pressure peaks, the inspiratory time, expiratory time, inspiratory-to-expiratory ratio, the size of the inspiratory platform, and the size of the oxygen concentration can be adjusted, and at the same time, it can also provide ventilation modes such as IMV (Intermittent Command Ventilation), CPAP (Continuous Positive Airway Pressure Ventilation
Three, the adjustment of the working parameters of the ventilator:
Four parameters: tidal volume, pressure, flow, time (including respiratory frequency, inhalation and exhalation ratio).
1, tidal volume: tidal output must be greater than the human physiological tidal volume, physiological tidal volume of 6 ~ 10 ml / kg, while the tidal output of the ventilator can be up to 10 ~ 15 ml / kg, often 1 ~ 2 times the physiological tidal volume. It should also be further adjusted according to chest rise and fall, auscultation of air intake in both lungs, reference to pressure diaphragm, and blood gas analysis.
2, inhalation and exhalation frequency: close to the physiological respiratory rate. Newborns 40 ~ 50 times / min, infants 30 ~ 40 times / min, older children 20 ~ 30 times / min, adults 16 ~ 20 times / min. Tidal volume * respiratory rate = ventilation per minute
3, inhalation and exhalation ratio: generally 1:1.5~2, obstructive ventilation disorder can be adjusted to 1:3 or longer expiration time, restrictive ventilation disorder can be adjusted to 1:1.
4, pressure: generally refers to the peak airway pressure (PIP), when the lungs are normal in terms of compliance, the peak inspiratory pressure is generally 10~20 cm water column, lungs Mild lesions: 20~25 cm water column; moderate: 25~30 mm water column; severe: more than 30 cm water column, up to 60 cm water column or more in RDS and pulmonary hemorrhage. However, it is usually below 30, and neonates are 5 centimeters of water column lower than the above pressures.
5, PEEP using IPPV children generally give PEEP 2 ~ 3 cm water column is in line with the physiological situation, when the serious gas exchange disorder (RDS, pulmonary edema, pulmonary hemorrhage) need to increase PEEP, generally in 4 ~ 10 cm water column, the condition of the serious can be up to 15 or even more than 20 cm water column. When the oxygen concentration exceeds 60% (FiO2 greater than 0.6), if the partial pressure of arterial oxygen is still lower than 80 mm Hg, PEEP should be increased until the partial pressure of arterial oxygen exceeds 80 mm Hg.Each increase or decrease of 1~2 mm water column of PEEP will have a great impact on blood oxygen, and this impact can be seen in a few minutes, and the reduction of PEEP should be carried out gradually, and pay attention to monitor the blood oxygen PEEP values can be read from the end-expiratory position of the pressure diaphragm pointer. (It is better to have a special display)
6, flow rate: at least twice the amount of ventilation per minute, generally 4 to 10 liters / minute.
Fourth, according to the blood gas analysis further adjustment:
First of all, we need to check whether the airway is open, the ` position of the tracheal tube, the two lungs into the air is good, the ventilator whether the normal delivery of air, whether there is no air leakage.
Adjustment methods:
1, PaO2 is too low: (1) increase the concentration of oxygen inhalation (2) increase the value of PEEP (3) such as insufficient ventilation can be increased per minute ventilation, prolonged inhalation time, end of inhalation stay, etc..
2, PaO2 is too high: (1) reduce the oxygen concentration (2) gradually reduce the PEEP value.
3, PaCO2 is too high: (1) increase the respiratory frequency (2) increase the tidal volume: fixed-volume type can be directly adjusted, fixed-pressure type to increase the pre-conditioning pressure, timed-type to increase the flow rate and improve the pressure limit.
4, PaCO2 is too low: (1) slow down the respiratory rate. Can simultaneously extend the expiratory and inspiratory time, but should be to extend the expiratory time, otherwise it will have the opposite effect. If necessary, it can be changed to IMV mode. (2) Reduce the tidal volume: fixed-volume type can be directly adjusted, fixed-pressure type can reduce the pre-adjustment pressure, timed type can reduce the flow rate and lower the pressure limit.
V. Humidification:
Warming humidification: the best effect.
1, the first time you use
The first time you use the ventilator may feel uncomfortable, but this is a normal phenomenon. You can take a few deep breaths, and after a period of self-adjustment, the patient will gradually adapt to this new feeling.
2. Getting up
If you need to get up during the night, remove the mask and turn off the ventilator. To continue sleeping, put the mask back on and turn the ventilator on.
3. Mouth leakage
If you are using a nasal mask, try to keep your mouth closed during treatment. Air leakage from the mouth can lead to reduced efficacy. If mouth leakage cannot be resolved, use an oro-nasal mask or use a jaw strap.
4. Mask Wearing
The ventilator works best when the mask is well worn and comfortable. It is important to eliminate air leaks, as they can affect the effectiveness of the therapy. Before putting on the mask, wash your face to remove excess oils, as this will help you to wear the mask better and prolong the life of the mask cushion.
5. Dryness
During use, dryness of the nose, mouth and throat may occur, which is more pronounced in winter. Often, the addition of a humidifier will eliminate these discomforts.
6. Nasal irritation
In the first few weeks of treatment, sneezing, runny nose and nasal congestion may occur. Often, the addition of a humidifier will solve these problems.
7. International travel
Most ventilators have a built-in power converter for 100-240V, 50-60Hz, which allows the ventilator to work worldwide. When traveling internationally, no special adjustments are needed, but a power plug converter may be required.
Precautions for the use of the ventilator1. When using the ventilator for the first time, you should first turn it on and off once to determine whether you can grasp the switch correctly, and check whether the machine can work normally. If there is a problem, contact the seller or manufacturer in time.
2. Read the instruction manual in detail before use, and connect the ventilator, humidifier, nose mask or mouth-nose mask according to the instruction manual.
3. Put on the nose mask or mouth-nose mask, and adjust the elasticity of the headband. The elasticity of the headband is generally appropriate to the mask on the corresponding part of the patient without pressure, but not too loose to avoid air leakage.
4, to determine the humidifier has been added pure water or distilled water, and can not exceed the prescribed position.
5, start the ventilator, feel the ventilator work whether there is anomaly, such as no abnormality can be assured that the use.
6, 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 a good nose mask or nasal mask and then reopen the use.
7, every day after use, be sure to turn off the machine and then cut off the power.
8. It is best to clean the mask once a day and the tubing once every three days. The cleaning method can be referred to the respirator accessories disinfection method.
9, every day to replace the water in the humidifier, in order not to exceed the water level line is appropriate.