Elisee350中文操作培训.ppt

Waking people up to sleep© ResMedElisée产品特点产品特点卓越性能－源于科技卓越性能－源于科技© ResMed患者适用范围患者适用范围• •ICU / CCU ICU / CCU 呼吸机呼吸机呼吸机呼吸机• •压力压力压力压力 & & 容量控制呼吸机容量控制呼吸机容量控制呼吸机容量控制呼吸机• •有创有创有创有创 & & 无创呼吸机无创呼吸机无创呼吸机无创呼吸机• •单单单单 & & 双呼吸回路系统双呼吸回路系统双呼吸回路系统双呼吸回路系统• •成人成人成人成人 & & 儿童呼吸机儿童呼吸机儿童呼吸机儿童呼吸机 （适合体重（适合体重5 5 kg kg以上儿童、呼吸回路直径以上儿童、呼吸回路直径 Ø 15 Ø 15 毫米、最低容量控制通气时毫米、最低容量控制通气时潮气量潮气量 : 50 ml: 50 ml、最大呼吸频率、最大呼吸频率 : 80 : 80 次次 / / 分）分）© ResMed 简洁直观操作的界面简洁直观操作的界面l l无需任何按钮无需任何按钮------全触摸式操作全触摸式操作l l图形文字对照图形文字对照------极易操作使用极易操作使用l l通气程序预设通气程序预设------快速启动快速启动l l具备模式、参数、报警、监测各自具备模式、参数、报警、监测各自独立的设定页面。

独立的设定页面 © ResMed 整体化气路结构整体化气路结构• •坚固的整体、一体化的气路结构坚固的整体、一体化的气路结构------坚固耐用，故障率低坚固耐用，故障率低• •------紧凑的气路机械死腔最小，反应最快，呼吸同紧凑的气路机械死腔最小，反应最快，呼吸同步性更好步性更好• •------气路系统的顺应性更小，呼吸机的压力气路系统的顺应性更小，呼吸机的压力/ /流量流量/ /容量输出更精确容量输出更精确• •------一体化设计融合了当今工业设计、制造和工艺一体化设计融合了当今工业设计、制造和工艺最新技术最新技术© ResMed超强的供气能力超强的供气能力• •第三代航空智能涡轮供气系统第三代航空智能涡轮供气系统第三代航空智能涡轮供气系统第三代航空智能涡轮供气系统 ------超长使用寿命超长使用寿命 --- ---超强供气流速，在超强供气流速，在6060厘米水柱时最高供气流厘米水柱时最高供气流速可达速可达300300升升/ /分 --- ---体积小、噪音低、惯性及功耗极低体积小、噪音低、惯性及功耗极低 --- ---能够瞬间准确调节供气流速，与患者自主呼能够瞬间准确调节供气流速，与患者自主呼吸匹配，最大程度缩短吸气及呼气的反应时吸匹配，最大程度缩短吸气及呼气的反应时间间。

• •成比例三项主动呼气阀技术成比例三项主动呼气阀技术成比例三项主动呼气阀技术成比例三项主动呼气阀技术 © ResMed“人－机协调性人－机协调性”触发技术触发技术• •具备三种触发判断方式：具备三种触发判断方式：具备三种触发判断方式：具备三种触发判断方式：压力、流速、能量转移，先进的吸气触压力、流速、能量转移，先进的吸气触发技术，保证了优异的人－机同步性发技术，保证了优异的人－机同步性/ /协调性，降低了病人的吸气协调性，降低了病人的吸气做功做功• •吸气触发调节：吸气触发调节：吸气触发调节：吸气触发调节：• •动态压力触发技术动态压力触发技术• •动态流量触发技术动态流量触发技术• •“ “能量转移触发能量转移触发” ”技术，呼吸机自动跟踪调节吸气触发水平，即使在大量漏气时也能保证吸技术，呼吸机自动跟踪调节吸气触发水平，即使在大量漏气时也能保证吸气同步性气同步性• •呼气触发调节：呼气触发调节：呼气触发调节：呼气触发调节：• •呼气灵敏度手动调节范围呼气灵敏度手动调节范围10-90%10-90%峰流速，保证呼气同步性，减少提前或延后终止呼吸，避峰流速，保证呼气同步性，减少提前或延后终止呼吸，避免再次触发呼吸机，或减少肺动态过度充气和免再次触发呼吸机，或减少肺动态过度充气和AutoPEEPAutoPEEP产生。

产生• •自动呼气触发功能：具备先进的呼气触发敏感度（自动呼气触发功能：具备先进的呼气触发敏感度（ETSETS））自动调节功能自动调节功能© ResMed自动能量转移触发－原理示意图自动能量转移触发－原理示意图• •优点：自动能量转移技术能有效减少患者的呼吸做功优点：自动能量转移技术能有效减少患者的呼吸做功优点：自动能量转移技术能有效减少患者的呼吸做功优点：自动能量转移技术能有效减少患者的呼吸做功2020％© ResMed对患者波形的控制对患者波形的控制•方波或递增波：方波或递增波：具备气道压力上升斜率调节功能，适应不同病人自主呼吸的吸气用力的需求，保证了病人舒适性和同步性•减速波形：减速波形：© ResMed全面、完善、实用的呼吸方式和通气模式全面、完善、实用的呼吸方式和通气模式• •通通通通气气气气模模模模式式式式预预预预先先先先设设设设定定定定功功功功能能能能：：：：EliseeElisee呼呼吸吸机机提提供供将将临临床床常常用用的的通通气气模模式式、、通通气气参参数数、、报报警警范范围围、、监监测测等等所所有有参参数数预预先先存存储储，，极极大大的的提提高高了了临临床床对呼吸机快速简便的使用要求对呼吸机快速简便的使用要求• •压力控制呼吸模式：压力控制呼吸模式：压力控制呼吸模式：压力控制呼吸模式：辅助辅助/ /控制通气（控制通气（A/CA/C）、）、同步间歇指令通气同步间歇指令通气（（SIMVSIMV）、）、压力支持通气（压力支持通气（PSVPSV）、）、持续气道正压通气（持续气道正压通气（CPAPCPAP））• •容量控制呼吸模式：容量控制呼吸模式：容量控制呼吸模式：容量控制呼吸模式：辅助辅助/ /控制通气（控制通气（A/CA/C）、）、同步间歇指令通气同步间歇指令通气（（SIMVSIMV）、）、窒息后备通气。

窒息后备通气• •压力容量双控制呼吸模式：压力容量双控制呼吸模式：压力容量双控制呼吸模式：压力容量双控制呼吸模式：该模式结合了压力控制通气和容量控制通该模式结合了压力控制通气和容量控制通气的优点，设定最低潮气量目标和最高压力水平，呼吸机根据前次呼气的优点，设定最低潮气量目标和最高压力水平，呼吸机根据前次呼吸实际潮气量和设定的潮气量目标的差异，自动调节输出压力水平，吸实际潮气量和设定的潮气量目标的差异，自动调节输出压力水平，尽量达到设定的潮气量目标尽量达到设定的潮气量目标Elisee Elisee 呼吸机还可以在压力支持条件下呼吸机还可以在压力支持条件下在同一次呼吸中保证潮气量，称为压力支持容量保证在同一次呼吸中保证潮气量，称为压力支持容量保证( (Ps-Vt)Ps-Vt)• •无创呼吸方式：无创呼吸方式：无创呼吸方式：无创呼吸方式：全面兼容各种无创通气模式，具备超强的自动漏气补全面兼容各种无创通气模式，具备超强的自动漏气补偿能力，您无需更换设备即可实现有创偿能力，您无需更换设备即可实现有创/ /无创通气的自由切换无创通气的自由切换© ResMed窒息后备保障功能窒息后备保障功能• •窒窒窒窒息息息息后后后后备备备备通通通通气气气气：：：：可可可可精精细细预预先先设设定定在在病病人人窒窒息息触触发发后后，，EliseeElisee呼呼吸吸机机将将采采用用何何种种通通气气方方式式。

具具备备：：容容量量/ /压压力力通通气气模模式式、、容容量量水水平平/ /压压力力水水平平、、窒窒息息时时间间、、窒息恢复、窒息报警等内容可选窒息恢复、窒息报警等内容可选• •阻力、顺应性自动补偿：阻力、顺应性自动补偿：阻力、顺应性自动补偿：阻力、顺应性自动补偿：• •BTPS BTPS 校正校正校正校正 : : 气体温度和压力校正气体温度和压力校正气体温度和压力校正气体温度和压力校正– –当呼吸机启用该功能后进行自动的校正当呼吸机启用该功能后进行自动的校正– –仅限于测量呼出潮气量仅限于测量呼出潮气量 (Vte)(Vte)– –If BTPS = NO If BTPS = NO  ATPD (Ambient Temperature Pressure & Dryness)ATPD (Ambient Temperature Pressure & Dryness)© ResMed肺部复张工具肺部复张工具• •什么是肺复张策略（什么是肺复张策略（什么是肺复张策略（什么是肺复张策略（What is a recruitment maneuverWhat is a recruitment maneuver））））? ?Periodic increase of insufflation pressure beyond the tele-inspiratory pressure released during the Periodic increase of insufflation pressure beyond the tele-inspiratory pressure released during the conventional ventilation cyclesconventional ventilation cycles•肺复张的目标（肺复张的目标（What is the aim of a maneuver recruitment）） ? To avoid atelectasy : sagging of air cells•那些病人需要适用该项功能（那些病人需要适用该项功能（For which patients ））?–For neuromuscular patients which air cells could easily collapse–Not for COPD patients or all obstructive patients !!•同常规的叹息功能比较有什么优势同常规的叹息功能比较有什么优势?–Pressure control. Indeed, in case of a sigh, a volume parameter is set up. Therefore the pressure is not controlled. In order to avoid barautroma, An HP alarm must be adjusted–Long opening of air cells© ResMedElisee 呼吸报警设定、呼吸监测界面呼吸报警设定、呼吸监测界面－－－－病人数据监测、存储、回顾、分析病人数据监测、存储、回顾、分析1.1.压力波形、流速波形、容量压力波形、流速波形、容量波形，两种向量环等波形，两种向量环等动态波动态波形显示形显示。

2.2.2020多项实时呼吸力学监测，多项实时呼吸力学监测，并可根据需要随意组合并可根据需要随意组合3.3.配置先进的参数及波形分析配置先进的参数及波形分析工具，可提供，波形冻结分工具，可提供，波形冻结分析，历史波形回顾，波形存析，历史波形回顾，波形存储打印等丰富应用工具，为储打印等丰富应用工具，为临床诊断及确定治疗方案提临床诊断及确定治疗方案提供丰富参考依据供丰富参考依据 © ResMed报警设定报警设定• •报警设定范围广泛报警设定范围广泛• •提供当前患者实际通气数值－为临床设定提供依据提供当前患者实际通气数值－为临床设定提供依据© ResMed呼吸力学监测呼吸力学监测－－15英寸彩色触摸屏幕英寸彩色触摸屏幕 It’s as easy as …实时实时数据数据监测区域监测区域当前当前设置设置状态状态显示显示区域区域实时实时波形、波形、向量环向量环监监测显示区测显示区域域分析分析工具工具区域区域© ResMed技术维护菜单技术维护菜单• •技术维护菜单使得日常维护工作更为简单容易技术维护菜单使得日常维护工作更为简单容易技术维护菜单使得日常维护工作更为简单容易技术维护菜单使得日常维护工作更为简单容易 : :– –调整呼吸机的传感器调整呼吸机的传感器– –调整供气的传感器调整供气的传感器不需要拆卸设备不需要拆卸设备 ! 同时按压下按钮同时按压下按钮 和和© ResMed外观、重量、电源外观、重量、电源• •尺寸尺寸尺寸尺寸 : : 290 x 250 x 130 290 x 250 x 130 毫米毫米• •重量重量重量重量 : :– –4,5 kg,4,5 kg, ventilator only with internal batteryventilator only with internal battery– –0,4 kg,0,4 kg, mains supply pack mains supply pack– –1,1 kg, external battery pack1,1 kg, external battery pack• •电源电源电源电源 : :– –可外接直流电源可外接直流电源– –内置电池内置电池 : : 不低于不低于4 4小时小时 – –外置电池外置电池 : :不低于不低于4 4小时小时 ( (选配件选配件) )Ventilation performances are preserved during the whole time of discharge© ResMed扩展升级功能（扩展升级功能（Optional））• •5 5个通气预设程序（标准个通气预设程序（标准2 2个）个）• •雾化吸入雾化吸入• •2 2分钟纯氧吸入分钟纯氧吸入• •P0.I P0.I 、阻力及顺应性测量、阻力及顺应性测量• •吸气保持、呼气保持、手动通气吸气保持、呼气保持、手动通气Waking people up to sleep© ResMedElisée操作培训操作培训© ResMed产品介绍目录产品介绍目录呼吸的介绍呼吸回路的连接启动/关闭呼吸机通气模式通气参数报警管理FiO2通气观测技术维护菜单呼吸力学通气方式的选择雾化吸入© ResMed成比例三项主动呼气阀 (双回路)送气端口 触摸屏幕呼吸机描述呼吸机描述主电源 / 外接电源状态指示灯报警销音按钮蓝牙信号指示灯内置 / 外置电池状态指示灯© ResMed呼吸机描述呼吸机描述氧电池« 开 / 关 » 按钮远程报警控制接口信号输出端口低压氧源空气入口空气入口雾化端口高压氧源12-28V外接直流电源基座© ResMed呼吸回路连接呼吸回路连接• •连接单连接单/ /双肢呼吸回路双肢呼吸回路• •只需通过卡扣，即可轻松连接只需通过卡扣，即可轻松连接/ /拆卸拆卸卡扣基准点•在进行手动测试时，能自动探测到呼吸回路连接的方式。

不需任何工具不需任何工具 !© ResMed呼吸回路连接呼吸回路连接• •2 2种呼气阀可供选择种呼气阀可供选择 : :– –« « 单回路单回路 » » 呼气阀上集合了外接呼气阀控制端口及近端压力传感管端口呼气阀上集合了外接呼气阀控制端口及近端压力传感管端口外接呼气阀控制端口近端压力传感线端口病人呼吸回路(直径Ø 22 mm)© ResMed呼吸回路连接呼吸回路连接• •2 2种呼气阀可供选择种呼气阀可供选择 : :– – « « 双回路双回路 » » 成比例三项主动呼气阀上集成了多项传感及控制部分，允许连接成比例三项主动呼气阀上集成了多项传感及控制部分，允许连接双肢呼吸回路双肢呼吸回路. .患者呼气口吸气管路 (标准直径Ø 22 mm)呼气管路(标准直径Ø 22 mm)© ResMed呼吸机的启动呼吸机的启动• •通过按压按右侧通过按压按右侧 按钮启动设备按钮启动设备• •随即出现以下欢迎使用界面随即出现以下欢迎使用界面 : :显示最新的检测结果选择预先设定模式选择设定新模式选择先前使用的模式© ResMed呼吸机的关闭呼吸机的关闭• •通过按压按右侧通过按压按右侧 按钮关闭设备按钮关闭设备• •依据当前所处的不同状态依据当前所处的不同状态, , 会出现以下两种界面中的一个会出现以下两种界面中的一个 : :• •确认想要关闭呼吸机确认想要关闭呼吸机正在通气正在通气未启动通气未启动通气© ResMed手动测试手动测试• •通过做手动测试可以通过做手动测试可以通过做手动测试可以通过做手动测试可以 : :– –探测当前患者使用的呼吸回路的类型探测当前患者使用的呼吸回路的类型– –探测当前呼吸回路的阻力探测当前呼吸回路的阻力 / / 顺应性数值顺应性数值• •何时需要做手动测试何时需要做手动测试何时需要做手动测试何时需要做手动测试 ? ?– –新的患者使用前新的患者使用前– –通气程序改变通气程序改变– –呼吸回路改变呼吸回路改变– –在增加在增加 / / 减少附件后减少附件后 ( (如：湿化器、过滤器如：湿化器、过滤器 …)…)• •测试前准备测试前准备测试前准备测试前准备 : :– –连接好通气时所需所有附件连接好通气时所需所有附件– –将呼吸机同患者之间断开将呼吸机同患者之间断开如未通过测试如未通过测试, 请通知技术服务机构请通知技术服务机构© ResMed手动测试手动测试• •3 3 个测量阶段个测量阶段个测量阶段个测量阶段 : :– –传感器便宜校准传感器便宜校准 (O(O2 2, pressure …), pressure …)– –吸气回路阻力校准吸气回路阻力校准– –呼气回路阻力呼气回路阻力 ( (如使用双回路如使用双回路), ), 顺应性及顺应性及 OO2 2 传感器校准传感器校准© ResMed通气方式选择通气方式选择n 5 个预设通气程序n 存储了通气所需调整所有参数 :- 通气模式- 患者类型- 通气参数- 报警设置区别对待患者区别对待患者 白天白天/夜间夜间 的通气的通气需求需求 !减少对医护人员的培训工作减少对医护人员的培训工作 !© ResMed通气方式选择通气方式选择© ResMed新模式设定新模式设定• •按压按压 “ “New patient”New patient”按钮，进入新通气模式设定程序按钮，进入新通气模式设定程序• •随即，出现如下患者类型选择界面随即，出现如下患者类型选择界面: :Each element of the configuration is reminded on the screen thanks to an icon © ResMed新模式设定新模式设定• •一旦，确认了患者通气类型后一旦，确认了患者通气类型后, , 随即会出现通气模式选择确认界面随即会出现通气模式选择确认界面: :压力模式压力模式容量模式容量模式双控制模式双控制模式•通气模式确认后, 随后出现参数设定界面© ResMed通气模式通气模式 : P(A)CV• •P(A)CV = P(A)CV = 辅助辅助辅助辅助/ /控制通气模式（压力控制）控制通气模式（压力控制）控制通气模式（压力控制）控制通气模式（压力控制）The ventilator delivers cycles characterized by a fixed insufflation's time and pressure The ventilator delivers cycles characterized by a fixed insufflation's time and pressure parameterparameter– –PCVPCV = cycles are released by the ventilator, insufflation does not depend on = cycles are released by the ventilator, insufflation does not depend on patient’s effort. A frequency should be adjusted.patient’s effort. A frequency should be adjusted.– –PACVPACV = inspiration can be released by the patient (trigger) = inspiration can be released by the patient (trigger)– –The change from PCV to PACV mode depends on inspiratory triggers The change from PCV to PACV mode depends on inspiratory triggers adjustmentadjustment•In P(A)CV mode, the user can set recruitment cycles More about recruitment :© ResMed通气模式通气模式 : P(A)CV• •On P(A)CV mode, the parameters to set are :On P(A)CV mode, the parameters to set are :§ §FiOFiO2 2§ §Inspiratory PressureInspiratory Pressure§ §Positive End Expiratory Pressure (PEEP)Positive End Expiratory Pressure (PEEP)§ §FrequencyFrequency§ §Inspiratory timeInspiratory time§ §Flow or Pressure Inspiratory trigger in Invasive ventilationFlow or Pressure Inspiratory trigger in Invasive ventilation§ §Inspiratory trigger in NIVInspiratory trigger in NIV§ §Inspiratory slopeInspiratory slope•可设置使用可设置使用“肺复张肺复张”参数参数 :§Recruitment period§Recruitment duration§Recruitment pressure or© ResMed通气模式通气模式 : P(A)CV• •临床治疗应用临床治疗应用 : :As the pressure is controlled, P(A)CV mode is particularly As the pressure is controlled, P(A)CV mode is particularly recommended if there is a risk of barautroma or lung infection that recommended if there is a risk of barautroma or lung infection that could obstruct respiratory tract (inhalation pneumopathy)could obstruct respiratory tract (inhalation pneumopathy)As the end of inspiratory time is imposed on the patient, the P(A)CV As the end of inspiratory time is imposed on the patient, the P(A)CV mode could sometimes be uncomfortable because it is not very mode could sometimes be uncomfortable because it is not very adapted to the patient’s needsadapted to the patient’s needsThis mode is recommended at the beginning of weaning to facilitate This mode is recommended at the beginning of weaning to facilitate the adaptation of the patient to the ventilator the adaptation of the patient to the ventilator © ResMed通气模式通气模式 : (A)CV• •(A)CV = (A)CV = 辅助辅助辅助辅助/ /控制通气模式（容量控制）控制通气模式（容量控制）控制通气模式（容量控制）控制通气模式（容量控制）The ventilator delivers cycles characterized by a fixed insufflation's time and volume The ventilator delivers cycles characterized by a fixed insufflation's time and volume parameterparameter– –CVCV = cycles are released by the ventilator, insufflation does not depend on = cycles are released by the ventilator, insufflation does not depend on patient’s effort. A frequency should be adjusted.patient’s effort. A frequency should be adjusted.– –ACVACV = inspiration can be released by the patient (trigger) = inspiration can be released by the patient (trigger)– –The change from CV to ACV mode depends on inspiratory triggers adjustmentThe change from CV to ACV mode depends on inspiratory triggers adjustment•In (A)CV mode, the user can set recruitment cyclesMore about recruitment :© ResMed通气模式通气模式 : (A)CV• •On (A)CV mode, the parameters to set are :On (A)CV mode, the parameters to set are :§ §FiOFiO2 2§ §Tidal VolumeTidal Volume§ §Positive End Expiratory Pressure (PEEP)Positive End Expiratory Pressure (PEEP)§ §FrequencyFrequency§ §Inspiratory time Inspiratory time oror I/E ratio I/E ratio oror Maxi flowMaxi flow§ §Flow or Pressure Inspiratory trigger in Invasive ventilationFlow or Pressure Inspiratory trigger in Invasive ventilation§ §Inspiratory trigger in NIVInspiratory trigger in NIV§ §Flow shapeFlow shape§ §Plateau timePlateau timeor•Recruitment parameters may be set up :§Recruitment period§Recruitment duration§Recruitment pressure © ResMed通气模式通气模式 : (A)CV• •临床治疗应用临床治疗应用 : :The CV mode is recommended when it is better the device totally The CV mode is recommended when it is better the device totally substitutes itself for the patient ventilationsubstitutes itself for the patient ventilationThe ACV mode is particularly recommended for patients whose The ACV mode is particularly recommended for patients whose ventilation needs could be changed (volume control). It helps to ventilation needs could be changed (volume control). It helps to adapt the patient to the ventilator.adapt the patient to the ventilator.The setting of volume and frequency alarms is very important in The setting of volume and frequency alarms is very important in order to avoid hyperventilation risks (exaggerated patient’s demand) order to avoid hyperventilation risks (exaggerated patient’s demand) © ResMed通气模式通气模式 : PSIMV• •PSIMV = PSIMV = 同步间歇指令通气（压力控制）同步间歇指令通气（压力控制）同步间歇指令通气（压力控制）同步间歇指令通气（压力控制）This ventilation mode allows to alternate pressure assisted controlled ventilation and This ventilation mode allows to alternate pressure assisted controlled ventilation and Pressure Support (PS) cycles initiated by the patientPressure Support (PS) cycles initiated by the patient•When the PSIMV mode is selected, an access to “Pressure Support” adjustment is available from the first screen of parameters adjustmentSuited for weaning and in case of sedation decreasing !© ResMed通气模式通气模式 : PSIMV• •On PSIMV mode, the parameters to set are :On PSIMV mode, the parameters to set are :§ §FiOFiO2 2§ §Inspiratory pressureInspiratory pressure§ §Positive End Expiratory Pressure (PEEP)Positive End Expiratory Pressure (PEEP)§ §FrequencyFrequency§ §Inspiratory timeInspiratory time§ §Inspiratory slopeInspiratory slope•The adjustable parameters of Pressure Support are :§Pressure Support§Inspiratory slope§Flow or Pressure Inspiratory trigger in Invasive ventilation§Inspiratory trigger in NIV§Expiratory trigger§Maximum inspiratory timeor© ResMed通气模式通气模式 : PSIMV• •临床治疗应用临床治疗应用 : :The PSIMV mode allows a good distribution of work between the The PSIMV mode allows a good distribution of work between the device and the patientdevice and the patient It is ideal for weaning and in case of sedation decreasing (gradual It is ideal for weaning and in case of sedation decreasing (gradual return of patient’s ventilation autonomy)return of patient’s ventilation autonomy)It is particularly recommended for treatment of chronic respiratory It is particularly recommended for treatment of chronic respiratory insufficienciesinsufficiencies© ResMed通气模式通气模式 : SIMV• •SIMV =SIMV =同步间歇指令通气（容量控制）同步间歇指令通气（容量控制）同步间歇指令通气（容量控制）同步间歇指令通气（容量控制）This ventilation mode allows to alternate flow assisted controlled ventilation and This ventilation mode allows to alternate flow assisted controlled ventilation and Pressure Support (PS) cycles initiated by the patientPressure Support (PS) cycles initiated by the patient•When the SIMV mode is selected, an access to “Pressure Support” adjustment is available from the first screen of parameters adjustment© ResMed通气模式通气模式 : SIMV• •On SIMV mode, the parameters to set are :On SIMV mode, the parameters to set are :§ §FiOFiO2 2§ §Tidal VolumeTidal Volume§ §Positive End Expiratory Pressure (PEEP)Positive End Expiratory Pressure (PEEP)§ §FrequencyFrequency§ §Inspiratory timeInspiratory time oror I/E ratioI/E ratio oror Maxi flowMaxi flow§ §Flow shapeFlow shape§ §Plateau TimePlateau Time•The adjustable parameters of Pressure Support are :§Pressure Support§Inspiratory slope§Flow or Pressure Inspiratory trigger in Invasive ventilation§Inspiratory trigger in NIV§Expiratory trigger§Maximum inspiratory timeor© ResMed通气模式通气模式 : SIMV• •临床治疗应用临床治疗应用 : :The SIMV mode allows a good distribution of work between the device and The SIMV mode allows a good distribution of work between the device and the patientthe patientIt is ideal for weaning and in case of sedation decreasing (gradual return It is ideal for weaning and in case of sedation decreasing (gradual return of patient’s ventilation autonomy)of patient’s ventilation autonomy)It is particularly recommended for treatment of chronic respiratory It is particularly recommended for treatment of chronic respiratory insufficienciesinsufficiencies© ResMed通气模式通气模式 : PS• •PS = PS = 压力支持通气（压力控制）压力支持通气（压力控制）压力支持通气（压力控制）压力支持通气（压力控制）This mode is a pressure mode assisting the patient’s spontaneous breathingThis mode is a pressure mode assisting the patient’s spontaneous breathing•Principle :The beginning and the end of the inspiratory cycle are initiated by the patient. However, Elisée 350 is provided with a minimum frequency parameter : if the number of patient initiated breaths is lower than Fmini, the ventilator releases support breaths.© ResMed通气模式通气模式 : PS• •PS mode also allows to set an apnea time at the end of which the ventilator switches to backup PS mode also allows to set an apnea time at the end of which the ventilator switches to backup apnea ventilation if the patient does not initiate a breathapnea ventilation if the patient does not initiate a breath• •Apnea ventilation setting is only available when “Fmini = NO”Apnea ventilation setting is only available when “Fmini = NO”• •If the patient initiates a breath afterwards, ventilation switches back to Pressure SupportIf the patient initiates a breath afterwards, ventilation switches back to Pressure SupportApnea ventilation in pressureApnea ventilation in volumeApnea ventilation = Exclusive to Elisée 350 !© ResMed通气模式通气模式 : PS• •On PS mode, the parameters to set are :On PS mode, the parameters to set are :§ §FiOFiO2 2§ §Pressure Support Pressure Support § §Positive End Expiratory Pressure (PEEP)Positive End Expiratory Pressure (PEEP)§ §Inspiratory slopeInspiratory slope§ §Leak Alarm thresholdLeak Alarm threshold§ §Flow or Pressure Inspiratory trigger in Invasive ventilationFlow or Pressure Inspiratory trigger in Invasive ventilation§ §Inspiratory trigger in NIVInspiratory trigger in NIV§ §Expiratory trigger Expiratory trigger § §Maximum inspiratory timeMaximum inspiratory timeor© ResMed通气模式通气模式 : PS• •The adjustable parameters of Pressure Support The adjustable parameters of Pressure Support in pressurein pressure are : are :§ §Apnea TimeApnea Time§ §Inspiratory Pressure Inspiratory Pressure § §FrequencyFrequency§ §Inspiratory time Inspiratory time •The adjustable parameters of Pressure Support in volume are :§Apnea Time§Tidal Volume §Frequency§Inspiratory time or I/E ratio or Maxi flow© ResMed通气模式通气模式 : PS• •临床治疗应用临床治疗应用 : :Because of its functioning, the PS mode allows to help and reduce Because of its functioning, the PS mode allows to help and reduce the work of respiratory musclesthe work of respiratory muscles Therefore, it is recommended for postoperative ventilation Therefore, it is recommended for postoperative ventilation rehabilitation and in physiotherapyrehabilitation and in physiotherapyIt is also recommended for weaningIt is also recommended for weaning© ResMed通气模式通气模式 : PS.VT• •PS-VPS-VT T = = 压力支持＋潮气量保证双模式通气（压力支持＋潮气量保证双模式通气（压力支持＋潮气量保证双模式通气（压力支持＋潮气量保证双模式通气（Pressure Support with Pressure Support with guaranteed tidal volumeguaranteed tidal volume））））This ventilation mode is described as a dual mode : it requires setting a This ventilation mode is described as a dual mode : it requires setting a pressure support and a target tidal volume that must be reached for each cyclepressure support and a target tidal volume that must be reached for each cycle•Principle :The delivered cycle starts in PS ventilation. Every 10 minutes, Elisée 350 calculates if the tidal volume parameter can be delivered, according to the already supplied Vt and the remaining inspiratory time–If the calculation foresees that Vt parameter can be reached, then Elisée 350 stands in Pressure Support for the rest of the cycle–Otherwise, if the calculation concludes that Vt parameter will not be reached in PS, then Elisée 350 insufflates the remaining volume while maintaining a constant flow until volume parameter is reached© ResMed通气模式通气模式 : PS.VT• •PS.VPS.VT T mode also allows to set an apnea time at the end of which the ventilator switches to apnea mode also allows to set an apnea time at the end of which the ventilator switches to apnea ventilation if the patient has not breathedventilation if the patient has not breathed• •Apnea ventilation setting is only available when Fmini = NOApnea ventilation setting is only available when Fmini = NO• •If the patient initiates a breath afterwards, ventilation switches back to pressure supportIf the patient initiates a breath afterwards, ventilation switches back to pressure supportApnea ventilation = Exclusive to Elisée 350 !Apnea ventilation in pressureApnea ventilation in volume© ResMed通气模式通气模式 : PS.VT• •On PS.VOn PS.VT T mode, the parameters to set are : mode, the parameters to set are :§ §Pressure SupportPressure Support§ §Positive End Expiratory Pressure (PEEP)Positive End Expiratory Pressure (PEEP)§ §Tidal VolumeTidal Volume§ §Leak Alarm threshold Leak Alarm threshold § §Flow or Pressure Inspiratory trigger in Invasive ventilationFlow or Pressure Inspiratory trigger in Invasive ventilation§ §Inspiratory trigger in NIV Inspiratory trigger in NIV § §Expiratory trigger Expiratory trigger § §Maximum inspiratory timeMaximum inspiratory timeor© ResMed通气模式通气模式 : PS.VT• •The adjustable parameters of Pressure Support The adjustable parameters of Pressure Support in pressurein pressure are : are :§ §Apnea timeApnea time§ §Inspiratory pressure Inspiratory pressure § §FrequencyFrequency§ §Inspiratory time Inspiratory time •The adjustable parameters of Pressure Support in volume are :§Apnea time§Tidal Volume§Frequency§Inspiratory time or I/E ratio or Maxi flow© ResMed通气模式通气模式 : PS.VT• •临床治疗应用临床治疗应用 : : PS.VPS.VT T 模式模式 : :§ §安全的容量控制模式安全的容量控制模式§ §舒适的压力控制模式舒适的压力控制模式The PS.VThe PS.VT T mode is particularly recommended for patients whose mode is particularly recommended for patients whose physiological characteristics (resistance …) are likely to changephysiological characteristics (resistance …) are likely to changeIt is recommended for patients who are in weaning test of a respiratory It is recommended for patients who are in weaning test of a respiratory insufficiencyinsufficiency© ResMed通气模式通气模式 : CPAP• •CPAP = CPAP = 持续气道正压通气持续气道正压通气The patient can breathe spontaneously thanks to a PEEP levelThe patient can breathe spontaneously thanks to a PEEP levelThe device counters the depression caused by the inspiration with a The device counters the depression caused by the inspiration with a flow increase. During expiration, a back pressure on the exhalation flow increase. During expiration, a back pressure on the exhalation valve maintains the expiratory pressure at the pressure level set by the valve maintains the expiratory pressure at the pressure level set by the useruser• •在在 CPAP CPAP 模式模式, , 仅可设置的参数仅可设置的参数 : :§ §持续压力的水平持续压力的水平© ResMed通气模式通气模式 : CPAP• •临床治疗临床治疗 应用应用: :§ §阻塞性睡眠呼吸暂停（阻塞性睡眠呼吸暂停（Obstructive Apnea Sleep syndromeObstructive Apnea Sleep syndrome））§ §肺动脉瓣狭窄（肺动脉瓣狭窄（Pulmonary oedemaPulmonary oedema））© ResMed通气参数定义通气参数定义• •Pressure Support (cmHPressure Support (cmH2 2O) :O) :在患者吸气循环中呼吸机在在患者吸气循环中呼吸机在PEEPPEEP压力之上，额外给予的一个压力水平压力之上，额外给予的一个压力水平•Maxi flow (l/min) :呼吸机给患者供气时所能提供的最大吸气流速，在容量控制通气中会直接影响到所需吸气时间的长短•Flow shape :仅在容量控制模式中有效,可以患者吸气项进行持续递增或递减流速•Frequency (cycles/min) :一分钟内所呼吸总的次数•Inspiratory slope :仅在压力控制模式中有效, 其意义为要达到设定的目标压力值而所需要花费的时间© ResMed通气参数定义通气参数定义•Positive End Expiratory Pressure (cmH2O) :由呼吸机维持的，患者在呼气循环期间持续保持的一个正压力•Inspiratory Pressure (cmH2O) :患者在辅助/控制呼吸循环中的吸气项时，呼吸机提供的一个高于PEEP的压力值•I/E ratio (1/x) :在1次呼吸中，吸气所用时间和呼气所用时间之间的比值•Apnea Time (s) :仅在自主呼吸模式下有效, 其表示为一段时间区间之后，如呼吸机未探测到患者的呼吸循环，患者可能出了现窒息的状况。

© ResMed通气参数定义通气参数定义•Inspiratory Time (s) :从吸气流速而时间区间Time space between the beginning of inspiratory flow and the beginning of expiratory flow•Maximum Inspiratory Time (s) :呼吸机向患者输入气体所需最长时间区间，设定潮气量达到与否•Expiratory Trigger :达到一个规定的界定值时，引起的呼气循环. 定义为最大峰值流速的% 或自动触发标准•Inspiratory Trigger :达到一个规定的界定值时，引起的吸气循环. 触发的方式有 :§流速触发（Flow trigger）§压力触发（Pressure trigger）§在无创通气中的触发（Non invasive trigger）© ResMed通气参数定义通气参数定义•Tidal Volume (ml) :吸气或呼气时间内患者所吸入或呼出的气体容量•FiO2 (%) :患者吸入气体内氧气所占的百分比•Plateau time (s) :Time during which insufflation is maintained nil at the patient level© ResMed参数设置参数设置• •要设置某项参数时要设置某项参数时, , 只需按压下相对应的图标只需按压下相对应的图标• •随即弹出增减调节按钮随即弹出增减调节按钮 和和 • •调整至需要使用的数值后调整至需要使用的数值后, , 按压按压 按钮进行确认修改按钮进行确认修改提示但前通气模式提示但前患者状态返回至模式设定界面 确认后进入报警设置界面按压“start ventilation”开始通气其它参数设定界面© ResMed扩展特点扩展特点• •进入扩展特点设置界面进入扩展特点设置界面 : :© ResMed扩展特点扩展特点•BTPS 校正校正 : 气体温度和压力校正气体温度和压力校正–当呼吸机启用该功能后进行自动的校正–仅限于测量呼出潮气量 (Vte)–If BTPS = NO  ATPD (Ambient Temperature Pressure & Dryness)•RC 自动测量自动测量–患者肺部力学情况 :每隔 15 分钟自动测量阻力和顺应性–仅有限于在有创通气的ACV 模式© ResMed扩展特点扩展特点•多种氧源多种氧源 – 高压高压 / 低压氧源低压氧源–更好的适合各种供氧条件•可在可在Ti, maximum flow 或或 I/E 中选择使用查看方式中选择使用查看方式:–仅限于在 ACV 模式 !© ResMed报警管理报警管理• •Two Two independentindependent systems to trigger audible alarms systems to trigger audible alarms– –1 voice synthesis1 voice synthesis§ §Adjustable volume Adjustable volume § §Controlled by the main microprocessorControlled by the main microprocessor– –1 buzzer controlled by :1 buzzer controlled by :§ §The main microprocessorThe main microprocessor§ §The alarm microprocessorThe alarm microprocessor§ §An hardware independent system supplied by an extra batteryAn hardware independent system supplied by an extra battery© ResMed通气报警通气报警• •需要设置报警参数时，可通过按压需要设置报警参数时，可通过按压 按钮直接进入呼吸机报警设置界面按钮直接进入呼吸机报警设置界面• •随即出现如图参数随即出现如图参数 : : 报警参数的调节方式和通气参数调节方式是一样的！报警参数的调节方式和通气参数调节方式是一样的！© ResMedFiO2• •低压供氧低压供氧低压供氧低压供氧§ §供气口压力不超过供气口压力不超过 400 kPa400 kPa§ §氧气供给方式氧气供给方式 : :- - An oxygen bottle equipped with a rotameter and pressure reducerAn oxygen bottle equipped with a rotameter and pressure reducer- An O- An O2 2 concentrator concentrator- An O- An O2 2 wall-gas supply equipped with a rotameter wall-gas supply equipped with a rotameter§ Elisée 350 automatically manages FiO2 value according to FiO2 parameter© ResMedFiO2• •高压氧源高压氧源高压氧源高压氧源§ §供气口压力范围为供气口压力范围为240 kPa 240 kPa 至至 700 kPa700 kPa之间之间§ §供氧方式供氧方式 : :- - 墙壁供氧墙壁供氧- - 带减压调节装置的氧气瓶带减压调节装置的氧气瓶§ Elisée 350 automatically manages FiO2 value according to FiO2 parameter© ResMedFiO2•2分钟纯氧功能（分钟纯氧功能（O2 100 %））- 按压 图标按钮后可获得两分钟的纯氧通气 - 在使用高压供氧方式时，该功能有效 低压供氧低压供氧高压供氧高压供氧© ResMedFiO2• •空气和氧气的混合过程是在气体输入涡轮之前完成的。

空气和氧气的混合过程是在气体输入涡轮之前完成的空气和氧气的混合过程是在气体输入涡轮之前完成的空气和氧气的混合过程是在气体输入涡轮之前完成的• •依靠成比例阀门对依靠成比例阀门对依靠成比例阀门对依靠成比例阀门对flow-byflow-by进行精确控制进行精确控制进行精确控制进行精确控制 (proportional valve)(proportional valve)Elisée 150 Elisée 150 能自动调节能自动调节 flow-by flow-by 水平，通过吸入气体流速和流速触发值水平，通过吸入气体流速和流速触发值O2Flow-by with oxygen+/- Inspiratory flow+/- Flow trigger +/- Flow-by© ResMedFiO2• •图形图形图形图形 : :Inspi.Expi.流速曲线O2 concentration at level patientSAIME systemOther systemAn important oxygen peak can be delivered at the very beginning of the inspiration phase where the flow is the most important减少对氧气的消耗减少对氧气的消耗© ResMed通气观察通气观察• •When the ventilation begins, a screen that allows to control on ventilation curves When the ventilation begins, a screen that allows to control on ventilation curves automatically appears automatically appears • •From that screen, the user can have a look at the ventilation thanks to the From that screen, the user can have a look at the ventilation thanks to the following elements :following elements :Bargraph of instantaneous pressurePressure curve Flow curve Ventilation measuresTrigger© ResMed通气观察通气观察•By pressing on one of the 4 displayed measures at the bottom of the screen, you have direct access to the measures screen §Choice between 11 measures§Real time display of the values © ResMed通气观察通气观察•From curves screen, the evolution of measures can be frozen by pressing one of the curves•Press on any point of the curves to display the corresponding value•Possibility to determine value between two points© ResMed治疗控制治疗控制 : 事件回放事件回放•The journal of events registers :§The whole of alarms release / stop§Every act made on the ventilator :§Start / Stop of the ventilation§Start / Stop of the ventilator§Change of the ventilation parameters value§Start / Stop of the alarms§Change of the alarms threshold© ResMed呼吸力学测量选项呼吸力学测量选项•通气时可选择使用多种呼吸力学测量工具•使用的有效性要依据所处在的通气方式或通气模式•用户可以通过在曲线监测屏幕下，通过翻页找到相关需要的测量工具P0.1胸腔闭合压力胸腔闭合压力 雾化功能雾化功能吸气保持吸气保持呼气保持呼气保持手动通气手动通气阻力阻力 / 顺应性顺应性© ResMed呼吸力学测量选项呼吸力学测量选项•吸气保持功能吸气保持功能- It is carried out at the end of the inspiratory cycle when the tidal volume is delivered.- A nil flow is manually maintained.- The pause cannot exceed 5 seconds. After this time, an exhalation cycle is automatically released.- This option is available only in invasive ACV modeMaximum pressure valuePlateau pressure value Resistance value© ResMed呼吸力学测量选项呼吸力学测量选项•呼气保持功能呼气保持功能- It is carried out at the end of the exhalation cycle.- During the pause, the circuit is obstructed.- The pause cannot exceed 12 seconds. After this time, an inspiratory cycle is automatically released.- This option is available only in invasive ACV modePositive End Expiratory PressureIntrinsic Positive End expiratory Pressure © ResMed呼吸力学测量选项呼吸力学测量选项•手动呼吸手动呼吸- 按压下该图标后, 将增加一次呼吸循环- 除了 CPAP 模式外，在所有的通气模式中都有效•P0.1- Measurement are carried out when the patient initiates a breath. The depression generated by the patient’s inspiratory effort is measured 0.1 second after the trigger release.- 该项功能仅在有创通气模式中有效 © ResMed雾化功能（雾化功能（Nebulization））•Connecting a nebulizer to the ventilator allows users to dispense medicines to the patient through HP oxygen. •Adjustable nebulization parameters are :§Duration§Flow •The nebulizer input is located at the rear of the device•The input is a 100 % oxygen input at a maximum pressure of 200 kPa for a 20 l/min flow © ResMed雾化功能（雾化功能（Nebulization））• •To accede to nebulization option :To accede to nebulization option :• •To start nebulization :To start nebulization :© ResMed技术维护菜单技术维护菜单• •技术维护菜单使得日常维护工作更为简单容易技术维护菜单使得日常维护工作更为简单容易技术维护菜单使得日常维护工作更为简单容易技术维护菜单使得日常维护工作更为简单容易 : :– –调整呼吸机的传感器调整呼吸机的传感器– –调整供气的传感器调整供气的传感器不需要拆卸设备不需要拆卸设备 ! 同时按压下按钮同时按压下按钮 和和© ResMed肺部复张工具肺部复张工具• •什么是肺复张策略（什么是肺复张策略（什么是肺复张策略（什么是肺复张策略（What is a recruitment maneuverWhat is a recruitment maneuver））））? ?Periodic increase of insufflation pressure beyond the tele-inspiratory pressure released during the Periodic increase of insufflation pressure beyond the tele-inspiratory pressure released during the conventional ventilation cyclesconventional ventilation cycles•肺复张的目标（肺复张的目标（What is the aim of a maneuver recruitment）） ? To avoid atelectasy : sagging of air cells•那些病人需要适用该项功能（那些病人需要适用该项功能（For which patients ））?–For neuromuscular patients which air cells could easily collapse–Not for COPD patients or all obstructive patients !!•同常规的叹息功能比较有什么优势同常规的叹息功能比较有什么优势?–Pressure control. Indeed, in case of a sigh, a volume parameter is set up. Therefore the pressure is not controlled. In order to avoid barautroma, An HP alarm must be adjusted–Long opening of air cells。