Ventilator humidification problem
Heating and humidification: the best effect, the water temperature in the tank is 50-70 degrees Celsius, the standard tube length is 1.25 meters, the gas temperature at the outlet is 30-35 degrees Celsius, and the humidity is 98-99%. Only humidified water can be used for the humidification solution. Nebulizer: low temperature and high irritation. The patient is more difficult to accept. Direct instillation in the trachea: especially in the airway. When there is obstruction in the airway, repeated backing and sucking after instillation can often relieve poor ventilation. Specific methods: Adults instill 2 ml of 0.45-0.9 saline every 20-40 minutes, or drip at a rate of 4-6 drops / min, the total amount is greater than 200 ml / day, children instill every 3-30-30 minutes 3- 10 drops, with airway secretions thin, can be smoothly attracted, no flaws. Artificial nose.
Oxygen absorption concentration (FiO2): The general machine oxygen concentration can be adjusted from 21 to 100%. It is necessary to correct hypoxemia and prevent oxygen poisoning. Generally, it should not exceed 0.5~0.6. If it exceeds 0.6, it should be less than 24 hours. Objective: To achieve an arterial blood PaO2 greater than 60 mm Hg (8.0 Kpa) with the lowest oxygen uptake concentration. If the purpura can not be relieved after oxygen is given, PEEP can be added. 1.0 oxygen can be used during resuscitation, without regard to oxygen poisoning.
Set the alarm range: airway pressure upper and lower limit alarm (usually 30% above and below the set value), air source pressure alarm, and other alarms. Unexpected problems: A resuscitator or other simple artificial air bag should be provided next to the ventilator. The joint between the air bag and the endotracheal tube should also be prepared. Take care to prevent tubing, tube blockage, ventilator malfunction, air supply and power failure.
Common comorbidities: stress damage, circulatory disorders, respiratory infections, atelectasis, larynx, tracheal injuries. Evacuation of the ventilator: Gradually reduce the oxygen concentration, PEEP gradually reduced to 3~4 cm water column, change IPPV to IMV (or SIMV) or pressure support, gradually reduce IMV or support pressure, and finally transition to CPAP or completely evacuate the ventilator The whole process needs to closely observe the analysis of breathing and blood gas. Extubation indication: spontaneous breathing and coughing, swallowing function is good, blood gas analysis results are basically normal, no laryngeal obstruction, can be considered extubation. The tracheal intubation can be pulled out at one time, and the tracheotomy can be gradually removed through the replacement of the thin tube, the semi-blocking tube, and the whole tube blocking sequence.