版權(quán)說明：本文檔由用戶提供并上傳，收益歸屬內(nèi)容提供方，若內(nèi)容存在侵權(quán)，請(qǐng)進(jìn)行舉報(bào)或認(rèn)領(lǐng)
文檔簡(jiǎn)介
NEWERVENTILATORSWHATMAKESTHEMDIFFERENT?JohnNewhartCRTT.RCP.NEWERVENTILATORSWHATMAKESTH1PURITANBENNETTMA-1PURITANBENNETTMA-12PuritanBennettMA-1FirstreleasedAugust1967.SimpletouseBasicIMVsystem(non-sync).Bellowsspirometerforexhaledgasmeasurement.PuritanBennettMA-1Firstrele3SIEMENS900CSIEMENS900C4SIEMENS900B/C900BavailableintheUSAearly70’s..Timelimitedandminutevolumepreset.PatientortimecycledorSIMV.Expiratoryflowmonitoring.SIEMENS900B/C900Bavailable5BEARIBuiltinSIMV.Monitoringoftidalandminutevolume.Pneumaticallyandelectricallypowered,electricallycontrolledvolumelimited.Timeorpatientcycled,controlorassist/controlmodes.BEARIBuiltinSIMV.6PURITANBENNETT7200Released1983FirstwidelyacceptedmicroprocessorcontrolledventilatorinUSA.Softwareupgradable.PURITANBENNETT7200Released17NewerGenerationVentilatorsNewerGenerationVentilators8TRANSPORTVENTILATORS
EARLYMODELTRANSPORTVENTILATORS
EARLYMO9PULMONETICLTV1000PULMONETICLTV100010PULMONETICLTVCompactlightweight12.6lbs.Abilitytotransportmorecriticalpatients.Internalbattery.VolumeControl,PressureControlandPressureSupport.Volumeandpressurealarmsandmonitoring.PULMONETICLTVCompactlightwei11ChangesinVentilatorsInclude...Moresophisticatedhardware.Morecompactsize.Multiplehighspeedmicroprocessors.Backupbatterysystems. GraphicalUserInterface(GUI).Aneverexpandinglistofmodalities.ChangesinVentilatorsInclude12ModularDesignTouchScreenDisplaycanbemountedseparately
BreathDeliveryUnitweighsonly40lbs.canbemountedseparatelyfromcartModularDesignTouchScreenDis13NewHardwareProportionalcontrolvalvesActiveExhalationvalvesBatterybackupMiniatureblowerNewHardwareProportionalcontr14ProportionalControlValvesOneortwovalves(O2,Air,orboth)proportionallyopenorclosetocontroltheflowofgastothepatientcircuit.ResponsibleforFIO2,Flowrate,Flowwaveform.Microprocessorcontrolled.Eachvalveiscontrollablefrom1,000-4,000steps.ProportionalControlValvesOne15TwoProportionalValveSystem
NPB7200-840,DRAGERE2-4,SERVO300O2AIRToPatient50psig50psigEachgashasitsownsolenoid,flowsensorandpressureregulator.Bothvalvescontrolledbymicroprocessor.FLOWSENSORFLOWSENSORTwoProportionalValveSystem
16SingleProportionalSystem
HamiltonVeolar,Bird6400-8400st
O2AIRToPatient50psig50psigBLENDERRESERVOIR10-15PSIGAirandO2aremixedinablender,storedasamixedgasinareservoirthenpassthroughasingleproportionalvalve.PROPORTIONALVALVESingleProportionalSystem
Ham17PneumaticsChassis(PB840)PneumaticsChassis(PB840)18BlowerwithIntragralDigitalBlenderO2PulmoneticLTVTurbine/BlenderSystemBlendedgastopatientDeliveryControlValveBlowerwithIntragralDigital19ActiveExhalationValvesTheinspiratoryandexpiratoryvalvesareactiveduringinspirationtomaximizethereproducibilityofinspiratoryandexpiratoryevents.ThesevalvesarecriticalinnewermodessuchasAPRV,BiLevel,andATC.Withanactiveexhalationvalve,theventilatormovestheexhalationvalveoffofitsseatduringexhalation.Withanon-activevalvethepatientmustpushthevalveoffofits’seataddingtoexpiratoryresistanceandworkofbreathing.ActiveExhalationValvesThein20ActiveExhalationValveDuringinspiration,thevalveisclosedwiththeforceoftheinsppressuresetting
Allowscoughingorspontbreathingatupperpressurelevelbyventing
excesspressureandflow(PCVorBiLevel)
40PCIRC
cmH2OINSPLminEXP302010010-2080604020020-804060V.04812s2610SpontaneousEffortsSpontaneousEffortsPCVW/OActiveValvePCVwithActiveValveActiveExhalationValveDuring21TwoProportionalValveSystemWithActiveExhalationValve
O2AIR50psig50psigAirandO2solenoidscombinedwithactiveexhalationvalve.PATIENTEXHTwoProportionalValveSystem22MicroprocessorControlEachnewgenerationofventilatorincorporatesfasterprocessors.Multiplehighspeedprocessorsimprovetheventilatorsresponsetothepatientsneeds.Fasterprocessorsmakemoreinformationavailabletotheclinician.MicroprocessorControl23MICROPROCESSORFUNCTIONDuringeachbreath,theventilatorswitchesthroughmultiplealgorythims.Thesedeterminesensingofpatientbreath,riserateofbreath,criteriaforpatientterminationofbreathatvariouspointsduringthebreath,andventilatorinitiatedterminationofbreath.Monitoreddataaswellasdataneededforventilatorfunctionareconstantlybeingprocessedinthebackground.Mostcalculationsdonebytheventilatorareneverseenbytheuser.Mostmodesofventilationthathavecomeoutinthelast15yearswouldbeimpossiblewithoutcomputercontrol.MICROPROCESSORFUNCTIONDuring24UPGRADABILITYOlderventilatorsfrequentlyrequiredacompletefactoryoverhaultohaveonemodeadded.Upgradingnewerventilatorsisusuallyaccomplishedbysoftwareupgrade.ThismaybedonebychangingoutthechipsetoruploadingsoftwarefromaPC.Addingoptions/modestypicallyinvolveschangingachipthataccessesspecificoptionsincludedinthesoftware,orenteringacodenumberthroughakeypad.UPGRADABILITYOlderventilators25BatteryBack-UpIsnowstandardonmostICUventilators.EliminatesinterruptionsinventilatorfunctionduringflickersorshorttermfailureinA/Cpower.Aidspatientsafety.BatteryBack-UpIsnowstandard26GUI
GraphicalUserInterfaceTouchscreentechnology.BecomingthenormforICUventilators.Replacestraditionalknobs,buttonsetc.Blendsgraphicaldisplayswithcontrols.Easysoftwareupgrades.Givesadditionalinformationrelativetosettingchanges.GUI
GraphicalUserInterfaceTo27EaseofUse-SoftwareControlledScreensOnlycurrentmodesandsettingsaredisplayed(easeofuse)
Informationcanappearasneededtohelpmake
decisionseasierandsaferEaseofUse-SoftwareControl28AutomaticTubeCompensationOvercomestheresistancetoflowcreatedbyanendotrachealtubeortracheostomytube.Givesthepatientthesensationthattheyarenotintubated.Mostimportantduringspontaneousbreaths.Mayprovideacalculatedtrachealpressurecurveonthegraphicsdisplay(E4).Canbeusedto“train”therespiratorymuscles.AutomaticTubeCompensationOve29ET.TubeResistanceDuringBreathTypesMandatorybreathsfromtheventilatoreasilyovercometheresistanceofanET.tube.Spontaneousbreathsaremoredifficultasaresultofbreathingthrougharelativelysmallorifice.ET.TubeResistanceDuringBre30ATCFunctionDuringInspirationDuringinspiration,theventilatorincreasespressureatthetopoftheET.tubeproportionatetotheinspiratoryflowrate.ATCFunctionDuringInspiratio31FunctionofATCduringExhalationDuringexpirationthecircuitpressureisdecreasedbelowthePEEPlevel.ThetrachealpressureisheldconstantattheselectedPEEPlevel.Thisdecreasestheworkofexpiration.Thecircuitpressureiscalculatedfromtheexpiratoryflowrate.FunctionofATCduringExhalat32ATCwithPawandPtrachwaveformsdisplayedATCwithPawandPtrachwavefo33PressureCalculationUsingtheflowmeasuredbytheventilator,thedifferenceinpressureatanygiventimecanbecalculatedbythefollowingequation:Pressure=RtubeCoef.XFlow2,wheretuberesistanceRisitselfdependentontheflow.PressureCalculationUsingthe34DifferenceBetweenATCandPSPSisauserset,fixedpressurethatremainsconstantthroughouttheinspiratoryphaseirrespectiveofthepatientsflowrate.ATCisausersetlevelofcompensation(1-100%).ThedrivingpressurewillvaryaccordingtotheE.T.tubesizeset,compensationlevelandinspiratoryflowrate.DifferenceBetweenATCandPSP35CONCLUSION
VentilatorDesignThedesignofventilatorsdependsincreasinglyontheuseofmicroprocessorcontrolandsoftware.Thehardwareinventilatorsisbeingcontinuouslyminiaturized.Movetowardsventilatordesignsthatwillventilateinfantsthroughadults.CONCLUSION
VentilatorDesignTh36CONCLUSION
ModesofVentilationModesandhardwarethatminimizetheoverallworkofbreathing.Modesthatmake“decisions”basedonbothinputfromthetherapistandpatientmonitoring.Interfacesthatdisplaymoregraphicalandnumericalinformation.“SmartAlarms”thatlookforcombinationsandseverityofthresholds.Thealarmindicatesbysoundand/orgraphicstheseriousnessofthecondition.CONCLUSION
ModesofVentilatio37NEWERVENTILATORSWHATMAKESTHEMDIFFERENT?JohnNewhartCRTT.RCP.NEWERVENTILATORSWHATMAKESTH38PURITANBENNETTMA-1PURITANBENNETTMA-139PuritanBennettMA-1FirstreleasedAugust1967.SimpletouseBasicIMVsystem(non-sync).Bellowsspirometerforexhaledgasmeasurement.PuritanBennettMA-1Firstrele40SIEMENS900CSIEMENS900C41SIEMENS900B/C900BavailableintheUSAearly70’s..Timelimitedandminutevolumepreset.PatientortimecycledorSIMV.Expiratoryflowmonitoring.SIEMENS900B/C900Bavailable42BEARIBuiltinSIMV.Monitoringoftidalandminutevolume.Pneumaticallyandelectricallypowered,electricallycontrolledvolumelimited.Timeorpatientcycled,controlorassist/controlmodes.BEARIBuiltinSIMV.43PURITANBENNETT7200Released1983FirstwidelyacceptedmicroprocessorcontrolledventilatorinUSA.Softwareupgradable.PURITANBENNETT7200Released144NewerGenerationVentilatorsNewerGenerationVentilators45TRANSPORTVENTILATORS
EARLYMODELTRANSPORTVENTILATORS
EARLYMO46PULMONETICLTV1000PULMONETICLTV100047PULMONETICLTVCompactlightweight12.6lbs.Abilitytotransportmorecriticalpatients.Internalbattery.VolumeControl,PressureControlandPressureSupport.Volumeandpressurealarmsandmonitoring.PULMONETICLTVCompactlightwei48ChangesinVentilatorsInclude...Moresophisticatedhardware.Morecompactsize.Multiplehighspeedmicroprocessors.Backupbatterysystems. GraphicalUserInterface(GUI).Aneverexpandinglistofmodalities.ChangesinVentilatorsInclude49ModularDesignTouchScreenDisplaycanbemountedseparately
BreathDeliveryUnitweighsonly40lbs.canbemountedseparatelyfromcartModularDesignTouchScreenDis50NewHardwareProportionalcontrolvalvesActiveExhalationvalvesBatterybackupMiniatureblowerNewHardwareProportionalcontr51ProportionalControlValvesOneortwovalves(O2,Air,orboth)proportionallyopenorclosetocontroltheflowofgastothepatientcircuit.ResponsibleforFIO2,Flowrate,Flowwaveform.Microprocessorcontrolled.Eachvalveiscontrollablefrom1,000-4,000steps.ProportionalControlValvesOne52TwoProportionalValveSystem
NPB7200-840,DRAGERE2-4,SERVO300O2AIRToPatient50psig50psigEachgashasitsownsolenoid,flowsensorandpressureregulator.Bothvalvescontrolledbymicroprocessor.FLOWSENSORFLOWSENSORTwoProportionalValveSystem
53SingleProportionalSystem
HamiltonVeolar,Bird6400-8400st
O2AIRToPatient50psig50psigBLENDERRESERVOIR10-15PSIGAirandO2aremixedinablender,storedasamixedgasinareservoirthenpassthroughasingleproportionalvalve.PROPORTIONALVALVESingleProportionalSystem
Ham54PneumaticsChassis(PB840)PneumaticsChassis(PB840)55BlowerwithIntragralDigitalBlenderO2PulmoneticLTVTurbine/BlenderSystemBlendedgastopatientDeliveryControlValveBlowerwithIntragralDigital56ActiveExhalationValvesTheinspiratoryandexpiratoryvalvesareactiveduringinspirationtomaximizethereproducibilityofinspiratoryandexpiratoryevents.ThesevalvesarecriticalinnewermodessuchasAPRV,BiLevel,andATC.Withanactiveexhalationvalve,theventilatormovestheexhalationvalveoffofitsseatduringexhalation.Withanon-activevalvethepatientmustpushthevalveoffofits’seataddingtoexpiratoryresistanceandworkofbreathing.ActiveExhalationValvesThein57ActiveExhalationValveDuringinspiration,thevalveisclosedwiththeforceoftheinsppressuresetting
Allowscoughingorspontbreathingatupperpressurelevelbyventing
excesspressureandflow(PCVorBiLevel)
40PCIRC
cmH2OINSPLminEXP302010010-2080604020020-804060V.04812s2610SpontaneousEffortsSpontaneousEffortsPCVW/OActiveValvePCVwithActiveValveActiveExhalationValveDuring58TwoProportionalValveSystemWithActiveExhalationValve
O2AIR50psig50psigAirandO2solenoidscombinedwithactiveexhalationvalve.PATIENTEXHTwoProportionalValveSystem59MicroprocessorControlEachnewgenerationofventilatorincorporatesfasterprocessors.Multiplehighspeedprocessorsimprovetheventilatorsresponsetothepatientsneeds.Fasterprocessorsmakemoreinformationavailabletotheclinician.MicroprocessorControl60MICROPROCESSORFUNCTIONDuringeachbreath,theventilatorswitchesthroughmultiplealgorythims.Thesedeterminesensingofpatientbreath,riserateofbreath,criteriaforpatientterminationofbreathatvariouspointsduringthebreath,andventilatorinitiatedterminationofbreath.Monitoreddataaswellasdataneededforventilatorfunctionareconstantlybeingprocessedinthebackground.Mostcalculationsdonebytheventilatorareneverseenbytheuser.Mostmodesofventilationthathavecomeoutinthelast15yearswouldbeimpossiblewithoutcomputercontrol.MICROPROCESSORFUNCTIONDuring61UPGRADABILITYOlderventilatorsfrequentlyrequiredacompletefactoryoverhaultohaveonemodeadded.Upgradingnewerventilatorsisusuallyaccomplishedbysoftwareupgrade.ThismaybedonebychangingoutthechipsetoruploadingsoftwarefromaPC.Addingoptions/modestypicallyinvolveschangingachipthataccessesspecificoptionsincludedinthesoftware,orenteringacodenumberthroughakeypad.UPGRADABILITYOlderventilators62BatteryBack-UpIsnowstandardonmostICUventilators.EliminatesinterruptionsinventilatorfunctionduringflickersorshorttermfailureinA/Cpower.Aidspatientsafety.BatteryBack-UpIsnowstandard63GUI
GraphicalUserInterfaceTouchscreentechnology.BecomingthenormforICUventilators.Replacestraditionalknobs,buttonsetc.Blendsgraphicaldisplayswithcontrols.Easysoftwareupgrades.Givesadditionalinformationrelativetosettingchanges.GUI
GraphicalUserInterfaceTo64EaseofUse-SoftwareControlledScreensOnlycurrentmodesandsettingsaredisplayed(easeofuse)
Informationcanappearasneededtohelpmake
decisionseasierandsaferEaseofUse-SoftwareControl65AutomaticTubeCompensationOvercomestheresistancetoflowcreatedbyanendotrachealtubeortracheostomytube.Givesthepatientthesensationthattheyarenotintubated.Mostimportantduringspontaneousbreaths.Mayprovideacalculatedtrachealpressurecurveonthegraphicsdisplay(E4).Canbeusedto“train”therespiratorymuscles.AutomaticTubeCompensationOve66ET.TubeResistanceDuringBreathTypesMandatorybreathsfromtheventilatoreasilyovercometheresistanceofanET.tube.Spontaneousbreathsaremoredifficultasaresultofbreathingthrougharelativelysmallorifice.ET.TubeResistanceDuringBre67ATCFunctionDuringInspirationDuringinspiration,theventilatorincreasespressureatthetopoftheET.tubeproportionatetotheinspiratoryflowrate.ATCFunctionDuringInspiratio68FunctionofA
溫馨提示
- 1. 本站所有資源如無(wú)特殊說明，都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請(qǐng)下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等，如果需要附件，請(qǐng)聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
- 3. 本站RAR壓縮包中若帶圖紙，網(wǎng)頁(yè)內(nèi)容里面會(huì)有圖紙預(yù)覽，若沒有圖紙預(yù)覽就沒有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 人人文庫(kù)網(wǎng)僅提供信息存儲(chǔ)空間，僅對(duì)用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理，對(duì)用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯，并不能對(duì)任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容，請(qǐng)與我們聯(lián)系，我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶因使用這些下載資源對(duì)自己和他人造成任何形式的傷害或損失。
最新文檔
- 新提拔任職表態(tài)發(fā)言稿
- 三農(nóng)村居民生態(tài)文明意識(shí)培養(yǎng)手冊(cè)
- 2023-2024學(xué)年西師大版（2013）小學(xué)信息技術(shù)六年級(jí)下冊(cè) 第五單元活動(dòng)1 有趣的動(dòng)畫舞臺(tái)（教學(xué)設(shè)計(jì)）
- 11 我們當(dāng)?shù)氐娘L(fēng)俗 教學(xué)設(shè)計(jì)-2023-2024學(xué)年道德與法治四年級(jí)下冊(cè)統(tǒng)編版
- 4 公民的基本權(quán)利和義務(wù)（教學(xué)設(shè)計(jì)）-2024-2025學(xué)年統(tǒng)編版道德與法治六年級(jí)上冊(cè)
- 化妝品生產(chǎn)質(zhì)量控制預(yù)案
- 農(nóng)業(yè)生態(tài)保護(hù)行動(dòng)計(jì)劃指南
- 11 蟋蟀的住宅教學(xué)設(shè)計(jì)-2024-2025學(xué)年四年級(jí)上冊(cè)語(yǔ)文統(tǒng)編版
- DB3715-T 24-2022 黨政機(jī)關(guān)綠色食堂建設(shè)指南
- DB3710-T 175-2022 商品和服務(wù)明碼標(biāo)價(jià)規(guī)范 第5部分：停車場(chǎng)服務(wù)
- 焊接專業(yè)英語(yǔ)詞典
- 糖尿病健康教育及飲食指導(dǎo)
- PFMEA模板完整版文檔
- 三無(wú)曲線(有緩)繩正法撥道自動(dòng)計(jì)算表
- 《母雞》課件 王崧舟 千課萬(wàn)人 （圖片版不可編輯）
- 臨床三基考試題庫(kù)臨床醫(yī)師三基考試題庫(kù)
- 商貿(mào)公司企業(yè)范文
- 第一章《原子結(jié)構(gòu)與性質(zhì)》測(cè)試卷-高二化學(xué)人教版（2019）選擇性必修2
- 《茯苓功效研究（論文）》
- YY/T 1761-2021透析管路消毒液
- GB/T 38330-2019光伏發(fā)電站逆變器檢修維護(hù)規(guī)程
評(píng)論
0/150
提交評(píng)論