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Mekanik ventilatorun etkinligini degerlendirmek icin pratikte hangi parametreler kullanilmali?

Mekanik ventilatorun etkinligini degerlendirmek icin pratikte hangi parametreler kullanilmali?. Turk Toraks Dernegi 11. Yillik Kongresi Antalya, Turkey April 2008. Gökhan M. Mutlu, M.D. Pulmonary and Critical Care Medicine Northwestern University Feinberg School of Medicine.

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Mekanik ventilatorun etkinligini degerlendirmek icin pratikte hangi parametreler kullanilmali?

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  1. Mekanik ventilatorun etkinligini degerlendirmek icin pratikte hangi parametreler kullanilmali? Turk ToraksDernegi 11. YillikKongresi Antalya, Turkey April 2008 Gökhan M. Mutlu, M.D. Pulmonary and Critical Care Medicine Northwestern University Feinberg School of Medicine Financial Disclosure: Nothing to disclose

  2. Mekanik ventilasyonda amac Solunum yetersizliginin tedavisi Oksijenasyon ve hiperkapninin duzeltilmesi Destek tedavi Solunum kaslarini destekleme Mekanik ventilasyona bagli komplikasyonlarin onlenmesi Barotravma (i.e., pnomotoraks, pnomomediastinum) Ventilatore bagli AC hasariCok organ sistem yetmezligi

  3. Mekanik ventilasyonda amac • Vital bulgular, AKG vehavayolubasinclarimonitorizeedilmeli 2. Kucuk VT 6 ml/kg- ALI/ARDS 6-8 ml/kg- obstruktif AC hastaliklari 3. Pplat < 30 cm H2O tutulmali 4. Oksijenasyonuduzeltmekamaciileyeterli PEEP uygulanmali 5. FiO2 < 0.6 tutulmali

  4. MV degerlendirilmesinde kullanilan parametreler Klinik Vital bulgular SpO2 Gaz degisimi Invaziv AKG (SaO2, PaO2, pH, PaCO2) Non-invaziv SpO2 VO2 ETCO2

  5. MV degerlendirilmesinde kullanilan parametreler Solunum sistemi mekanigi Paw (Ppik and Pplat) Kompliyans ve elastans Havayolu direnci Oto-PEEP P-V egrisi

  6. Solunumsistemimekaniginindegerlendirilmesi Resistance (Raw) Plateau Pressure Compliance (Csrs) Peak Pressure 30 Airway Pressure (cm H2O) 20 10 PEEP Time

  7. Havayolu basinclari Ppik =Presistif+ Pelastans + Pinertia Ppik = (Akim x Havayolu direnci) + (VT x Elastans) Ppik = (Akim x Havayolu direnci) + (VT x 1/kompliyans)

  8. PIPvsPplat PIP High Raw Normal PIP PPlat PPlat Paw (cm H2O) PIP PPlat Low Compliance Time (sec)

  9. Kompliyans ve havayolu direnci Kompliyans (statik)RS= ΔV/ΔP CRS= VT/Pplat-PEEP Normal degerler- 60-80 ml/cm H2O Ciddi derecede azalmis kompliyans <25 ml/cm H2O Havayolu direnci Sabit akim 60 L/dak (1L/san) PIP - Pplat cmH2O L/san Normal < 15 cmH2O/L/san

  10. Havayolu basinclari Parenkimal hastaliklar (Pnomoni, ALI, ARDS, pulmoner odem) ↑ Ppik ↑ Pplat ↓ Kompliyans Havayolu hastaliklari (KOAH, asthma) ↑ Ppik N Pplat ↑ Havayolu direnciOto-PEEP

  11. Normal Hasta Normal vs. Havayoluobstruksiyonu Inspirasyon Time (sec) Flow (L/min) } Ekspirasyon

  12. Oto-PEEPinolcumu Oto-PEEP Ekspirasyon Inspirasyon Paw (cm H2O) Total PEEP Uygulanan PEEP Ekspirasyon sonu akimin durdurulmasi Time (sec)

  13. Vaka 1 34 yasinda kadin, daha once herhangi hastaligi yok Sikayeti: balgamli oksuruk, ates ve plevral gogus agrisi Muayene: SS-34/min, SpO2 81%, BL krepitanlar Lab: WBC 21,000/mm3, 98% PMNs BUN 31, Crea 1.2

  14. Vaka 2 41 yasinda astimli erkek Sikayeti: Soluk yetmezligi ve hiriltili solunum- salbutamola yanit vermiyor Muayene: SS-37/min, SpO2 92%, AC seslerinde azalma, uzayan ekspirasyon donemi ve hirilti Labs: WBC 14,000/mm3, 84% PMNs, 11% eos AKG: 7.24/60/62

  15. ETCO2

  16. VT and PEEP

  17. Oksijenizasyon

  18. Effects of a 50%shunt on oxygenation 150 CxO2 = 1.39*HG*% sat + PO2*0.003 21% oxygen 100 15 20 CvO2=15 PvO2 = 45 SvO2 = 75% CcO2=20 PcO2 = 100 ScO2 = 98% 17.5 CaO2=17.5 PaO2 = 57 SaO2 = 87%

  19. Effects of 100% oxygen in 50% shunt 713 CxO2 = 1.39*Hgb*% sat + PO2*0.003 100% oxygen 650 15 22 CvO2=15 PvO2 = 45 SvO2 = 75% CcO2=22 PcO2 = 650 SaO2 = 100% 18.5 CaO2=18.5 PaO2 = 65 SaO2 = 92%

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