(Mechanical Ventilator in Patients with COPD)

, .. () *

(chronic obstructive
pulmonary disease; COPD)

(ventilation-perfusion mismatch)

(acute exacerbation)


(accessory muscle)

(abdominal paradox) 120 /
(
, 2553)
(oxygen saturation; SaO 2 )
90%
(PaO 2 ) 60 .
(PaCO2) 45-60 .
pH 7.36 /

(purulent sputum)
(GOLD Executive Committee, 2010)



(oxygen cannula)
1-2 /
(FiO2) 0.4-0.6

88-92%

(dynamic hyperinflation)

3 ( , 2548)

1.
(minute ventilation)
(tidal volume)

(permissive
hypercapnia)

2. (expiratory
time)
(inspiratory flow)
(end inspiratory pause)

3. (airway
resistance)

22 2 - 2554

PAGE

80


1.
(NPPV)

(NPPV)

(noninvasive ventilation; NIV)

(respiratory acidosis)
80-85%
(GOLD Executive Committee, 2006)

(IPPV)


(gastric distention)
(aspiration)

(barotraumas)

( , 2551)

(minute ventilation)
PaCO2 pH

(noninvasive
positive pressure ventilator; NPPV)
(invasive positive
pressure ventilator; IPPV)

NPPV
NPPV

2
(NPPV)
(IPPV)

NPPV
NPPV
(tachypnea)

(obstructive sleep apnea;

OSA)

Journal of Phrapokklao Nursing College Vol.22 No.2 March - August 2011

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81

 NPPV (mask)

(chin strap)







(full face mask)
(helmet)


(mouthpieces)


(nasal pillows)


2.




3. (ventilator tubing)
(humidifier)
NPPV

NPPV

NPPV

NPPV
NPPV

(claustrophobia)


(facial deformity)
PaCO2

NPPV NPPV
NPPV

NPPV 2
(critical care ventilator)

(bilevel positive airway pressure; BiPAP)

NPPV

1. (mask)
NPPV 2
(nasal mask)
(oronasal mask)
(inner lip)


2/3

(air leak)

22 2 - 2554

PAGE

82


NPPV
(mode)

4

1. bilevel positive airway pressure
(BiPAP) (inspiratory
positive airway pressure; IPAP)
(expiratory positive airway
pressure; EPAP) IPAP EPAP

2. continuous positive airway
pressure (CPAP) IPAP EPAP

3. spontaneous time mode
BiPAP CPAP

4. volume control ventilation
pressure control ventilation

6-8 .


2-3 . 15 .
20-25 .
(
, 2553)
2-4 .

2-3 .

(pressure support)

PaCO2

pressure rise time (PRT)

pressure rise time




pressure rise time
pressure rise time
0.3-0.5


45
NPPV
6-8 .

2-4 .

NPPV
NPPV
(monitor) (alarming system)





NPPV

NPPV
NPPV

Journal of Phrapokklao Nursing College Vol.22 No.2 March - August 2011

PAGE

83

 30 1 1-2
NPPV

(abdominal paradox)

24

(volume controlled)

(constant flow)

(pressure controlled)

(decelerated flow)





(peak pressure)

2.
6-8 ./.

- (plateau pressure)

NPPV

2.
(IPPV)
IPPV


NPPV

IPPV
IPPV

1.

(controlled ventilation)
( , 2548)

22 2 - 2554

PAGE

84



(thoracoabdominal paradox) (
40 /)
pH 7.25 PaCO2
45 . PaO2 60 .

35 .
15 .

60 /
8-10 /

1.0
90% PaO2
60 .
0.6
(oxygen toxicity)

(
, 2548)

1.

2.

pH 7.30 PaCO2 50 .
95%
PaCO2

(peak inspiratory pressure; PIP)

(peak alveolar pressure)

Journal of Phrapokklao Nursing College Vol.22 No.2 March - August 2011

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85


(auto-positive end expiratory pressure; autoPEEP/ intrinsic PEEP)

(dead space)


(inspiratory valve)

6-10 ./.

(inspiratory :
expiratory ratio; I : E) > 1 : 3
(work of breathing)

(external positive end expiratory pressure;
external PEEP) 3-5 .
10 .




3. (patientventilator asynchrony)

4. (ventilatory
demand)

5.
(gas exchange)






(hypercarbia)

6.

(venous
return)

(forced expiration) inferior vena

cava

22 2 - 2554

PAGE

86

(hypotension)

. (2553).



.. 2553. :

.
. (2548). Mechanical Ventilation

in Obstructive Lung Disease.

. Diasters: Roles of

Critical Care. :

.
. (2551).

.

. .

: .
. (2553). Noninvasive

Positive Pressure Ventilation.

. .

: .

(ventilator weaning)




PaCO2

(pressure support ventilation)

(synchronous intermittent
mandatory ventilation; SIMV)

Journal of Phrapokklao Nursing College Vol.22 No.2 March - August 2011

PAGE

87

GOLD Executive Committee. (2006). Global Strategy

for the Diagnosis, Management, and

Prevention of Chronic Obstructive

Pulmonary Disease. Retrieved July 18, 2011,

from http://www.goldcopd.org/Guidelines/

guidelines-global-strategy-for-diagnosis
management-2006.html

GOLD Executive Committee. (2010). Pocket Guide

to COPD Diagnosis, Management and

Prevention. Retrieved July 18, 2011, from

http://www.goldcopd.org/guidelines-pocket
guide-to-copd-diagnosis.html

22 2 - 2554

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88