新机械通气

1、NEWER VENTILATORS,WHAT MAKES THEM DIFFERENT ? John Newhart CRTT. RCP.,PURITAN BENNETT MA-1,Puritan Bennett MA-1,First released August 1967. Simple to use Basic IMV system (non-sync). Bellows spirometer for exhaled gas measurement.,SIEMENS 900 C,SIEMENS 900 B/C,900 B available in the USA early 70s Time limited and minute volume preset. Patient or time cycled or SIMV. Expiratory flow monitoring.,BEAR I,Built in SIMV. Monitoring of tidal and minute volume. Pneumatically and electrically powered, el

2、ectrically controlled volume limited. Time or patient cycled, control or assist/control modes.,PURITAN BENNETT 7200,Released 1983 First widely accepted microprocessor controlled ventilator in USA. Software upgradable.,Newer Generation Ventilators,TRANSPORT VENTILATORS EARLY MODEL,PULMONETIC LTV 1000,PULMONETIC LTV,Compact lightweight 12.6 lbs. Ability to transport more critical patients. Internal battery. Volume Control, Pressure Control and Pressure Support. Volume and pressure alarms and monit

3、oring.,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 Design,Touch Screen Display can be mounted separately Breath Delivery Unit weighs only 40 lbs. can be mounted separately from cart,New Hardware,Proportional control valves Active Exhalation valves Battery backup Miniature blower,Proportional Control Valves,One or two valves

4、 (O2, Air, or both) proportionally open or close 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 System NPB 7200-840, DRAGER E2-4, SERVO 300,O2,AIR,To Patient,50 psig,50 psig,Each gas has its own solenoid, flow sensor and pressure regulator . Both valves controlled by microprocessor.,FLOW SENSOR,FLOW SENSOR,Single Proportional System Hamilton Veo

5、lar, Bird 6400-8400st,O2,AIR,To Patient,50 psig,50 psig,BLENDER,RESERVOIR,10-15 PSIG,Air and O2 are mixed in a blender, stored as a mixed gas in a reservoir then pass through a single proportional valve.,PROPORTIONAL VALVE,Pneumatics Chassis (PB 840),Blower with Intragral Digital Blender,O2,Pulmonetic LTV Turbine/Blender System,Blended gas to patient,Delivery Control Valve,Active Exhalation Valves,The inspiratory and expiratory valves are active during inspiration to maximize the reproducibility

6、 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 off of its seat adding to expiratory resistance and work of breathing.,Active Exhalation Valve,During inspiration, the valve is closed with the force of the insp pressure setting Allows coughing or spont breathing at upper

7、 pressure level by venting excess pressure and flow (PCV or BiLevel),Two Proportional Valve System With Active Exhalation Valve,O2,AIR,50 psig,50 psig,Air and O2 solenoids combined with active exhalation valve.,PATIENT,EXH,Microprocessor Control,Each 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 FUNCTION,During ea

8、ch breath, the ventilator switches through multiple 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 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 ye

9、ars would be impossible without computer control.,UPGRADABILITY,Older ventilators frequently required a complete factory overhaul to have one mode added. Upgrading 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 keypad.,Battery Back-Up,Is now standard on most ICU ventilators. Eliminates interruptions in ventilator function during flickers or short term failure in A/C power. Aids patient safety.,GUI Graphical User Interface,Touch screen technology. Becoming the norm for ICU ventilators. Replaces traditional knobs, buttons etc. Blends graphical displays with controls. Easy software upgrades. Gives additional information relative to setting changes.,Ease of Use - Software C

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