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BiPAP ® S/T-D30

BiPAP ® S/T-D30. 聯杏股份有限公司 呼吸治療師 黃瓊娟. BiPAP 定義. BiPAP (Bilevel Positive Airway Pressure) 非侵入雙向正壓通氣 NPPV 的明日之星 IPAP 吸氣正相氣道壓力 EPAP 吐氣正相氣道壓力 壓力支持型 (pressure support) 呼吸器： 經由面罩作換氣呼吸，適合開刀房、恢復室 、急診、病房及居家長期使用. 動作原理. BIPAP 藉由電氣驅動的風扇及電磁閥來調整吸氣及吐氣壓力. 應用在下列狀況：.

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BiPAP ® S/T-D30

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  1. BiPAP®S/T-D30 聯杏股份有限公司 呼吸治療師 黃瓊娟

  2. BiPAP定義 • BiPAP (Bilevel Positive Airway Pressure) • 非侵入雙向正壓通氣NPPV的明日之星 • IPAP 吸氣正相氣道壓力 • EPAP 吐氣正相氣道壓力 • 壓力支持型(pressure support)呼吸器： 經由面罩作換氣呼吸，適合開刀房、恢復室 、急診、病房及居家長期使用

  3. 動作原理 • BIPAP藉由電氣驅動的風扇及電磁閥來調整吸氣及吐氣壓力.

  4. 應用在下列狀況： • 1. Post surgical - cardiac, general　開刀後之病人 • 2. Alveolar Hypoventilation　換氣不足之病人 • 3. Ventilatory muscle fatigue　肌肉衰竭者 • 4. Hypoxemia　低血氧症者 • 5. Post extubation　拔管後之病患 • 6. Intubation refused　拒絕插管之病患 • 7. C-Spine injury(Patient Must Have Spontaneous Respirations) • 8. End-Stage disease　末期病患 • 9. Upper airway obstruction　上呼吸道阻塞者

  5. BIPAP提供的呼吸模式 IPAP=Inspiratory Positive Airway Pressure: 吸氣正相壓力 EPAP=Expiratory Positive Airway Pressure: 吐氣正相壓力 BPM=Breath per min：每分鐘的呼吸次數 %IPAP Time：一次呼吸cycle中IPAP所佔的時間比例

  6. 機器特色：Auto-Trak SensitivityTM • Leak Tolerance漏氣補償系統 • 漏氣補償最大60L/min • Sensitivity • Trigger Variables • CYCLE to EPAP

  7. Trigger VariablesAuto-Trak SensitivityTM PRESSURE FLOW Volume Trigger Shape Volume Trigger= 病人吸氣累積 6 cc 的volume 時即可驅動機器 打IPAP Shape Signal = 病人在EPAP時 flow碰到shape電子訊號時即 可驅動機器打IPAP

  8. Airway Pressure Monitor (APM)

  9. Cycle to EPAPAuto-Trak SensitivityTM Maximum 3.0 Sec IPAP Time=最大吸氣時間3秒自動轉吐氣 • Shape Signal=病人在IPAP時flow碰到shape電子訊號時即 • 可驅動機器打EPAP SET=Spontaneous Expiratory Threshold

  10. BIPAP操作 • 主機

  11. DCP 控制面板

  12. APM氣道壓力監視器

  13. High Pressure(IPAP+5) 成因:病人咳嗽. Low Pressure(IPAP~EPAP之間) 成因1: disconnect 成因2:病人在S Mode下沒有吸氣(Apnea) Low Pressure Delay 設定警報延遲時間 調整APM---警報系統設定

  14. IPAP參數設定 • 調整IPAP給病人呼吸壓力支持 Pressure Support • PS = IPAP – EPAP • 改善呼吸 • 增加 Tidal Volume • 減少 CO2

  15. EPAP參數設定 • EPAP = PEEP • 增加 肺餘容積 FRC • 改善氧化作用 • 減少 Auto-PEEP • 暢通上呼吸道 Upper airway

  16. %IPAP Time (吸氣時間/cycle time) • 正常值: 25 – 50% • %IPAP Time換算 I:E比 • 50%→1:1 • 33%→1:2 • 25%→1:3 • 20%→1:4

  17. Mask Fitting Golden Rule: All Noses Are Not Created Equal!

  18. 面罩帶法

  19. Interface Selection (continued) • Respironics Total™ face mask • Full face mask • Nasal mask • Mouthpiece • Mouth breather • Claustrophobia • Anxiety • Long-term NPPV

  20. COMFORT SERIESTM NASAL MASKS

  21. Comfort Series of Masks Simplicity Simply the Smallest and Lightest • Simple to fit • Easy to assemble • Superior patient comfort Contour DeluxeSetting the Comfort Standard Profile  The Ultimate in Comfort

  22. Comfort Series of Masks

  23. COMFORT CLASSIC NASAL MASK Where Comfort Lives

  24. Comfort Classic • Superior comfort and durability • Pillowy cushion reduces pressure around the nose • Built-in “silent” exhalation device • Two mask sizes • Dual-size gel spacer • Built-in Comfort Flap and support ring • One-size Deluxe Headgear Respironics, Inc. 1998

  25. Comfort Classic

  26. Comfort Classic Nasal Mask Fitting Landmarks a. Sides of nostrils b. Bridge of nose zone c. Below the nose tip, above the lip

  27. Interface Selection (continued) • Respironics Total™ face mask • Full face mask • Nasal mask • Mouthpiece • Need for immediate ventilation • Mouth breather • Claustrophobia • Facial abnormalities • Eye irritation • Lack of dentures • Anxiety

  28. Comfort Classic Nasal Mask Fitting 1. Begin with sizing gauge Integrated sizing gauge on package: • Allows for quick and easy fitting. • Cuts down on mask waste by letting you determine the right mask size before you open the bag. • Check landmarks • Choose the smallest mask that fits without pinching or obstructing the nostrils 4. Try the mask on with the unit at the prescribed pressure to ensure proper fit

  29. A Properly Fitted Mask... • Should gently contour tothe tip of the nose • Does not contact the bridge of the nose • Sits at an angle on the nose • Allows for slight arch in tubing • Is not tight

  30. MASK COMFORTand CARE TIPS

  31. Mask Comfort and Care Tips • Let new patient become familiar with mask • Spacer fills the gap between mask and forehead, reduces pressure at bridge of nose • Choose smallest mask size that is snug but does not pinch the nostrils • Cushion should not be crushed against face • Headgear should be secure but not tight • Tight fit is not necessary for effective therapy • Eliminate air leaks into eyes

  32. Mask Comfort and Care Tips • Always make final adjustments to mask and headgear with unit on at prescribed pressure. • Mark headgear straps with permanent marker • Remove mask by pulling over head or use the quick release clip • Do not block exhalation port • Loop tubing over the headboard to reduce the pull on face • Place the tubing under theblanket to warm the air

  33. Mask Comfort Care and Tips • Every day, patients should • Wash their face thoroughly before using mask • Wash mask in hot soapy water. No moisturizers or lotions (disassembly not necessary) • Air dry • Irritation to skin • Soak in hot soapy water for one hour to remove any irritants • If irritation persists, try different mask material

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