1. Wear a mask and connect to a ventilator
1) Put on a mask, connect the mask to the oxygen delivery tube (oxygen flow rate 2-5L/min), fix the mask with the strap, and place it in a comfortable position.
2) Turn on the BiPAP ventilator (S or S/T), adjust the inspiratory pressure (IPAP) to 8cmH2O, PEEP2cmH2O.
3) Connect the ventilator tubing to the mask.
4) Adjust the tension of the lace, so that the mask just does not leak air.
2. Adjust the parameters to suit the pathophysiology of the patient
1) The respiratory rate is slightly lower than that of the patient, and the IPAP is gradually increased from 8 or 10 cmH2O to 2 or 4 cmH2O until the patient's appropriate
Pressure (tidal volume, respiratory ratio, loss of auxiliary respiratory muscle activity, coordination of chest and abdomen).
2) Adjust the oxygen inhalation flow or oxygen inhalation concentration (FiO2) until the oxygen saturation (SPO2) reaches 90-95%.
3) Monitor frequency rhythm, IPAP, Vt, PEEP and SPO2. After 20 minutes of stabilization, blood gas analysis was performed. According to the results,
Adjust various parameters.
4) Strengthen oral care, remove secretions and vomit in time, and prevent suffocation.
1. Before using the ventilator, use the simulated lung to check whether the ventilator can operate normally and whether there is air leakage in the pipeline.
2. Change it every week, clean the inhaled air filter, and replace the ventilator pipe and connection regularly.
3. Do not connect the mask to the ventilator first, and then fix the mask. At this time, the BiPAP ventilator will cause a large amount of air leakage.
Air leakage compensation, the inspiratory flow increases sharply to 100~150L/min, the airflow hits the face, but still cannot reach the preset pressure, and it continues
Inhale state. The airflow is too large to switch to exhalation, and the patient can't breathe, which is unbearable.
4. If the mask leaks a lot, the airflow is too large, and the actual tidal volume is not large, which is not conducive to the discharge of CO2 and makes it difficult to breathe.
5. In the case of bronchospasm, the inhalation pipeline is connected to a nebulizer or a jet nebulizer for quantitative or atomized inhalation of bronchodilators (β2
agonists and cholinergic blockers, glucocorticoids) for mechanical ventilation to maintain airway patency.
6. Before using the ventilator, it is best to use a simple respirator to follow the patient's frequency to assist breathing with a higher oxygen concentration, and gradually increase the tide.
Gas volume, improve patient PaO2, CO2 retention and pH. To understand its respiratory pathophysiology, to preset the ventilator ventilation mode
formula and various parameters (PImax, VT, f, PEEP, I/E and FiO2).
7. Put on the ventilator, monitor the patient's breathing and circulation, and adjust the parameters one by one. Until the patient has no auxiliary respiratory muscle activity, chest and abdomen
Respiratory coordination, respiratory rate, rhythm and pulse rate stable blood pressure. Under the set PSV, PEEP and FiO2 conditions, VT, PEEP and FiO2
f and SPO2 (90-95%) did not change significantly. After 20 minutes, measure the arterial blood gas analysis, and then make appropriate adjustments according to the results.
In the future, it depends on the changes of the condition, so that individualized effective mechanical ventilation can be achieved.
8. When medical staff give the patient mechanical ventilation with a mask for the first time, it is generally necessary to adhere to the observation for 0.5h to 2h, or even 4 to 6h.
After the patient adapts, they can leave, but close follow-up is still required.