Dai Cuong Thong Khi AP Luc Duong

I CNG V
MY TH
(THNG KH P LC DNG)
ThS.BS. NG THANH TUN

TK. HI SC NGOI - BV NHI NG 1
Ci no l my th ?
dangthanhtuan65@gmail.com 03/2014
Phn loi my th
My th p lc m:
Phi thp (iron lung)
My th p lc dng:
Hu ht my th hin ti
My th p lc va dng va m
HFOV (high frequency oscillation ventilation)
i cng v thng kh p lc dng
H hp = Thng kh + Trao i kh
Respiration = Ventilation + Oxygenation
My th ECMO
(Ventilator) (Extra corporal
membrane oxygenation)
IPPV = Intermittent positive pressure ventilation

S thng kh
= di chuyn kh vo / ra phi trong 1 chu k h hp
Mun di chuyn kh phi c s chnh lch p lc.
Di chuyn: Ni p lc cao ni p lc thp
T th (th bnh thng):
Chnh lch p lc m:
0
Patm = 0 > Palv > Pip
(-)
p
e = expiration
Negative pressure gradient
t NH LUT: P.V = k
i = inspiration V P
Th my (TKALD)
Chnh lch p lc dng:

(+)
Paw > Palv > Pip > Patm = 0
p
i
e
0
0
t
Positive pressure gradient
Giai on th ra: th ng
(+)
NH LUT: P.V = k VP
ng th nhn to
Th my xm nhp: invasive
NKQ
M KQ
Th my khng xm nhp: non-invasive
Mask mi ming
Mask mi
Binasal prong/cannula
NH HNG CA TH MY
TRN CC C QUAN
Tc ng ca TKALD trn phi
Ng c
Barotrauma O2: FiO2 > con sn
Xp phi
Volutrauma 60% trong PQ-phi
> 48h
gim
trn kh
ARDS, thng kh,
mng phi sinh non,
f gng
trung ROP PIP cao,
m, lm
tht: do ( PaO2) FiO2 cao
hm khng
Ppeak
i
Bin chng th my
Trn kh mng phi con sn ph qun phi

Tc ng ca TKALD trn V/Q
NmM NGnA
THAY VI V/Q
THj Tk NHIN
NmM NGnA
THoNG KHp qP
ckC DNG
Thng kh
Tti mu
Tc ng ca TKALD trn tim
Tc ng trn tim:
P ng th cao gim cung lng tim & h HA
(do cn tr mu TM ngoi bin v tim)
Tc ng trn tim gim nu dng mPaw thp
Khi bt buc dng mPaw cao c th cn truyn

dch v thuc vn mch
Gim cung lng tim
Th my
p lc dng trong lng ngc

Ht vo: PIP
Th ra: PEEP
Cn tr mu TM v tim
Gim cung lng tim
Sc dangthanhtuan65@gmail.com 03/2014
Cc yu t nh hng ln mPaw
mPaw = K(PIP-PEEP)(I/I+E) + PEEP
Ppeak
P
cmH2O
Pi
PEEP
T
Ti sec
Tc ng trn thn
lu lng ntc tiu do tti mu thn thf
pht do cung lng tim
C th plasma ADH & atrial natriuretic peptide
Ph, cao HA v qu ti dch do:
lu lng ntc tiu
truyn dch qu l
gim lng ntc mt khng nhn bit ng h
hp do s dng bnh lm hm
Tc ng trn ng tiu ha
Chtng bng do kh vo d dy, rut:

Phng nga VP ht nm u cao, sonde d dy giai
on u, nui n qua sonde nh gigt chm
Stress ulcer & XHTH lun gp trong SHH nng v

phi d phng thng quy:
? antacid / anti H2 / fc ch bm proton / sucralfate)
pH acid dch v tng nguy c VPBV
Tc ng trn thn kinh
p lc ni sg do mPaw cao:
Chn thng ni sg, ph no:
hn ch PIP v PEEP cao
Ti khng qu di v khng ci pause
Tng thng kh PaCO2 co mch no gim p

lc ni sg
Tc ng trn dinh dng
Dinh dng thiu:

Teo c h hp
Tng nguy c VPBV
Dinh dng qu mfc:

Tng chuyn ha tng sinh CO2 cn phi tng
thng kh pht
CC YU T TI PHVI
NH HNG N TH MY
RESISTANCE (Sc cn ng th R)
n: c nh cia kh
Poiseuilles law l: chiu di ng
r: bn knh ng
Sfc cn ng th R
1
ng knh PQ Sfc cn 16 ln R 4
Nguyn nhn R:
r
t NKQ
gng m
Hen, VTPQ,
COPD
dangthanhtuan65@gmail.com
S gim p lc ng th t my th n ph nang
do cc tr khng trn ng th
R R
VENTIcATOR Alveolar
PRESSURE Pressure
R
R
AIRWAYS
R CIRCUIT
ET tube
Ppeak - Pplateau
Resistance =
Flow
peak
peak
plateau plateau
COMPLIANCE ( gin n C)
Lung springs
Nguyn nhn C:
RDS, ARDS, VP lan ta (siu vi), ngt ntc
Xp phi, TDMP, TKMP, chtng bng, TPPM
COMPLIANCE ( gin n C)
peak Volume
Compliance =
plateau Pplateau - PEEP
peak
plateau
PEEP
R v C trn h h hp
CHEST
cUNG
R:C R:C R:C R:C

ETT AIRWAY
CIRCUIT
C
R:
RESISTANCE V COMPcIANCE TRN NG Ho HP

Time constant (Hng s thi gian)
Cng thfc: = R x C
l thi gian di chuyn th ng cia 63% th
ch kh lu thng
Time constant (Hng s thi gian)
Bnh l tc nghn ng th: R
Vy =RxC
Ko di Te trnh by kh
Bnh l tn thng ph nang: C

Vy =RxC
Phi xp nhanh t PEEP trnh xp phi
PHN LOI BNH L H HP
R v C bnh thng R tng C gim

Chn thng sg no Vim tiu PQ B. mng trong
Vim no MN Hen suyn Vim phi virus
Ng c thuc ngi Bnh phi tc Ngt ntc
Wernidg - Hoffmann nghn mn tnh Ph phi cp
Hi chfng GBarre ARDS
Nhc c Ch.thng
ngc

Dai Cuong Thong Khi AP Luc Duong

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I CNG V

ThS.BS. NG THANH TUN

IPPV = Intermittent positive pressure ventilation

Chnh lch p lc dng:

Trn kh mng phi con sn ph qun phi

Tc ng trn tim gim nu dng mPaw thp

Khi bt buc dng mPaw cao c th cn truyn

p lc dng trong lng ngc

Gim cung lng tim

Chtng bng do kh vo d dy, rut:

Stress ulcer & XHTH lun gp trong SHH nng v

Tng thng kh PaCO2 co mch no gim p

Dinh dng thiu:

Tng nguy c VPBV

Dinh dng qu mfc:

R:C R:C R:C R:C

RESISTANCE V COMPcIANCE TRN NG Ho HP

Bnh l tn thng ph nang: C

R v C bnh thng R tng C gim

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