X TR BO NG

TRN MY PB 840

ThS.BS.ng Thanh Tun

Khoa Hi sc Ngoi
BV Nhi ng 1
 BO NG MY TH
Cc bo ng my th trn my PB840:
p lc ng th cao (PCIRC)
Tn s th cao (fTOT)

Th tch pht th ra tng cng cao/thp (VE TOT)

Th tch kh lu thng th ra (my) cao/thp (VTE

MAND)
Th tch kh lu thng th ra (t th) cao/thp (VTE

SPONT)
Nng oxy cao/thp

Ngun kh: air/oxy khng

Ngng th dangthanhtuan65@gmail.com 04/2015

S pht trin ca bo ng my th

C in:
n hoc cc gi tr mu
m thanh bo ng (chi tai)

Ci thin:
Cho bit thng s bo ng
m thanh bo ng nh ting nhc

Hin i:
Thng bo thng s bo ng
Nguyn nhn c th

Cch x tr bo ng
dangthanhtuan65@gmail.com 04/2015
 MC BO NG

Ti khn cp !!!
Khn cp !!
t khn cp !
Khng bo ng

04/2015 dangthanhtuan65@gmail.com
 Mc bo ng
Mc Tn hiu Tn hiu Cch xa bo ng
khn cp n m thanh
Cao: nguy Mc u Khi ht tnh trng bo ng: m
him, cn tin cao thanh bo ng tt, n chuyn
x tr ngay t nhp nhy sang sng.
T ng vo s bo ng.
n alarm reset v b.thng
Trung bnh: Vng, Mc u Khi ht tnh trng bo ng, tn hiu
cn x tr nhp tin trung n v m thanh t tt.
nhanh nhy bnh T ng vo s bo ng.
Thp: cn Vng, Mc u Khi ht tnh trng bo ng, tn hiu
ch trn sng tin thp n v m thanh t tt.
lm sng T ng vo s bo ng.
B.thng: Xanh, Khng Khng
khng c sng
bo ng dangthanhtuan65@gmail.com 04/2015
Ci t bo ng trn my PB840

dangthanhtuan65@gmail.com 04/2015
Ci t gii hn bo ng
Cc gii hn bo ng:
High Pressure = peak + 10 (< 40 cmH2O)
Low Pressure = PEEP + 5 cmH2O

F tot = f ci t + 10 - 20

High Minute volume = 120% VE

Low Minute volume = 80% VE

High Tidal volume = 120% VT

Low Tidal volume = 80% VT

FiO2 = 5 7 % FiO2 ci t

dangthanhtuan65@gmail.com 04/2015
Bo ng
Thng bo chnh VTE MAND
Phn tch 2 of last 4 mand breaths < set limit.
Gi Check for leaks, changes in patients R & C.

dangthanhtuan65@gmail.com 04/2015
Nguyn tc x tr bo ng
Xem bnh nhn:
Tm ti: tch ngay khi my, bp bng vi oxy
100%, tm nguyn nhn x tr ngay
Cn hng: n nt silence tm nguyn nhn.

Cnh bo mu n nhp nhy:

:nguy him, cn x tr ngay
Vng: cn x tr, nu khng s nguy him

Nt xa bo ng:
Nt silence: tt m thanh bo ng trong 2 pht
Nt alarm reset: xa biu hin bo ng c
dangthanhtuan65@gmail.com 04/2015
 Nt Alarm Reset khng tc dng i vi cc
bo ng sau:

AC POWER LOSS LOW AC POWER

COMPRESSOR INOPERATIVE LOW BATTERY
DEVICE ALERT NO AIR SUPPLY
O2 SENSOR NO O2 SUPPLY
INOPERATIVE BATTERY PROCEDURE ERROR

dangthanhtuan65@gmail.com 04/2015
CC BO NG
TRN MY PB840
 Bo ng vn hnh my chung

Device Test my c vn Xem BN

alert Nu my h phi
thay my khc
Procedure BN gn vo my Bp bng v ch
error trc khi my khi my startup hon
ng hon ton. ton
Safety ventilation.
Circuit B dy h, st ch Xem li BN
disconnect ni hoc tut NKQ Ni li ch b h
04/2015 dangthanhtuan65@gmail.com
 Bo ng ngun cung cp in

AC Mt ngun in, Cm li in
power my hot ng Thay cu ch
loss nh pin st Chun b bp bng
Low AC in ngun Xem ch cm in,
power gim p < 80%. cu ch, v ngun
in
Low Ngun pin st Cm in hoc thay
battery gn ht (2 pht) ngun pin st
Loss of C AC v pin Tm ngun in thay
power u yu th
04/2015 dangthanhtuan65@gmail.com
 Bo ng ngun cung cp kh
No air Mt ngun air, my Xem BN
supply vn hnh vi O2 Xem ngun air
100% hoc ngng Tm ngun air
(nu cng ht O2), thay th
van an ton m
No O2 Mt ngun O2, my Xem BN
supply vn hnh vi air Xem ngun O2
21% hoc ngng Tm ngun O2
thay th
O2 sensor O2 sensor b h n 100% O2 CAL
04/2015
Thay O2 sensor
dangthanhtuan65@gmail.com
Bo ng gas supply
No air supply:
Cha cm in air compressor
Cha bt cng tc air compressor

Cha chun v p sut (50psi) v m (wet)

Air tng khng p sut (mc p sut ci trn

regulator, v tr outlet cui ngun)
No O2 supply:
Bnhoxy ht
Ngun oxy tng ht, p sut khng (50psi)

dangthanhtuan65@gmail.com 04/2015
 Bo ng ngun cung cp kh

O2% O2 cung cp > 7% Xem li ngun O2

so vi O2 ci t v air.
CAL O2 sensor
O2% O2 cung cp < 7% Xem li ngun O2
so vi O2 ci t v air.
CAL O2 sensor

04/2015 dangthanhtuan65@gmail.com
Bo ng nng oxy

Nng oxy cao:

Gim p sut kh nn
Tng p sut oxy

Nng oxy thp:

Tng p sut kh nn
Gim p sut oxy

H oxygen cell

dangthanhtuan65@gmail.com 04/2015
 Cc bo ng lm sng

f TOT Tng nhp th Xem BN v cc

ton phn thng s
Inspiration Thi gian ht vo Xem BN v thng
too long qu di s ci. (Rise time
v ESENS)
PCIRC PCIRC > P limit. Xem BN, ng
Occlusion ng v NKQ

04/2015 dangthanhtuan65@gmail.com
Bo ng p sut cao OCCLUSION

Nguyn nhn X tr
1. Gp ng my th Chnh li v tr
2. BN cn ng, gp NKQ Chnh li v tr
3. Nght m Ht m, VLTL
4. BN chng my An thn, dn c
5. Bnh l tc nghn R ? Dn ph qun
6. Xp phi VLTL, t th, m
7. ng NKQ su Chnh li v tr
8. TKMP
04/2015 Chc ht, dn lu
dangthanhtuan65@gmail.com
Bo ng p lc cao

Tc nghn do ng NKQ:
Gp ng khi BN xoay u
BN cn ng NKQ

ng NKQ b gp trong vng hu hng (ng

NKQ mm + BN gp c)
ng NKQ b airway vo

Bt u ng NKQ do cc m cng

dangthanhtuan65@gmail.com 04/2015
 Bo ng p lc cao
Xp phi:
Do cc m lm tc PQ gc hoc mt nhnh PQ
thy, phn thy.
Ng.nhn: khng m, t xoay tr ht m.

Triu chng: r khi xp hon ton 1 phi:

1 bn ngc thp, Khong gian sn hp
G c, Nghe ph m: gim/khng nghe
X quang xc nh thy/phn thy b xp

X tr: ht m, ni soi PQ ly nt m

dangthanhtuan65@gmail.com 04/2015
 Bo ng p lc cao
ng NKQ vo su:
Thng vo su bn (P), phi (T) b xp

Cch pht hin:

Phn cn li NKQ bn ngoi: ngn
Triu chng xp phi (T)
X quang: xp phi (T) + ng NKQ vo bn (P)
X tr: rt bt NKQ ra
Phim X quang ngc thng: d
Phim k thut s: kh c lng chiu di

dangthanhtuan65@gmail.com 04/2015
Bo ng p lc cao

Trn kh mng phi:

BN vt v, tm ti t ngt
Khm:
Ngc nh cao
Khong gian sn rng
G vang
Nghe gim hoc mt ph m
X quang: trn kh

X tr: chc ht dn lu

dangthanhtuan65@gmail.com 04/2015
Kim lun v trocar

dangthanhtuan65@gmail.com 04/2015
Cc bo ng lm sng

Apnea BN ngng th Xem BN

ngn hoc t th Xem cc thng s
yu. My chuyn ci t
Apnea ventilation

VTE MAND VT th ra BN ca Xem BN, ng

nhp my < mc ng v NKQ (tht
ci t thot). o C v R
VTE SPONT VT th ra BN ca Xem BN v cc
nhp t th < mc thng s
04/2015
ci tdangthanhtuan65@gmail.com
Bo ng VE/VT thp LEAKAGE

Nguyn nhn X tr

H h thng ng Chnh li cho ng

ng NKQ nh, x t li NKQ ln hn 0,5

Bo ng p sut cao X tr bo ng

BN t th yu trong cc i mode hoc thng s

mode h tr khc
R ?, C ? trong mode PC Tng PIP thch hp
04/2015 dangthanhtuan65@gmail.com
Cc ni d b h/x

dangthanhtuan65@gmail.com 04/2015
 Cc bo ng lm sng
.
VE TOT Th tch pht th Xem BN v cc
. ra < mc ci t thng s ci t
.
VE TOT Th tch pht th Xem BN v cc
ra > mc ci t thng s ci t
Compliance Th tch nn b Xem BN v thay
limit VT tr nh hng BN b ng my th
ph hp
Severe ng ng my Xem BN v thay
occlusion th b nght b ng khc
04/2015 dangthanhtuan65@gmail.com
 Bo ng th tch pht cao

Nguyn nhn X tr
BN t th tt Thay i mode, thng s

Self-triggering Gim trigger n khi va

mt self-triggering
Ci thin R, C trong Gim PIP
mode PC
Nghn mng flow Ngm ra li mng
transducer (Servo900C)
04/2015 dangthanhtuan65@gmail.com
Bo ng ngng th
Nguyn nhn:
Cithi gian bo ng: 10, 15, 20, 30 giy
BN ang mode h tr: SIMV, PS

My t chuyn sang Apnea ventilation

X tr:

Chuyn li mode control, A/C hoc

Tng tn s SIMV

dangthanhtuan65@gmail.com 04/2015
Bo ng ngun pin st
Gn ht ngun pin st
My ngng hot ng khi cp in
Cm in li cho h thng
St pin chu k nu khng s dng (1 ngy st
/1 tun khng s dng)
Thay pin nu pin chai

dangthanhtuan65@gmail.com 04/2015