Ventilator-humidification Problem

Heating and humidification: the effect is the best, the water temperature in the tank is 50-70 degrees Celsius, the standard tube is 1.25 meters long, the gas temperature at the outlet is 30-35 degrees Celsius, and the humidity is 98-99%. Use only distilled water for the humidification solution. Nebulizer: low temperature and great irritation. Patients are more difficult to accept. Intratracheal instillation: Especially when the airway is blocked with sputum scab, repeated patting of the back and sputum suction after instillation can often relieve poor ventilation. Specific method: Adults instill 2ml of 0.45-0.9 saline every 20-40 minutes, or at a rate of 4-6 drops / min, the total amount is greater than 200ml / day, and children 3--3 every 20-30 minutes 10 drops, preferably with thin airway secretions, smooth suction, and no sputum scab. Artificial nose. slightly. Oxygen absorption concentration (FiO2): the general machine oxygen concentration can be adjusted from 21 to 100%. Both 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 make arterial blood PaO2 greater than 60 mm Hg (8.0 Kpa) with the lowest oxygen concentration. If cyanosis cannot be relieved after oxygen administration, PEEP can be added. 1.0 oxygen can be used during resuscitation, without considering oxygen poisoning.

Set alarm range: airway pressure upper and lower limit alarm (generally 30% above and below the set value), air source pressure alarm, other alarms. Unexpected problem: Resuscitator or other simple artificial balloon should be provided near the ventilator, and the joint between the balloon and the tracheal tube should also be prepared. Pay attention to prevent disconnection, blockage, ventilator failure, air supply and power failure.

Common comorbidities: pressure injuries, circulatory disorders, respiratory tract infections, atelectasis, larynx, and tracheal injuries. The evacuation of the ventilator: gradually reduce the oxygen concentration, PEEP gradually drops 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 requires close observation of breathing and blood gas analysis. Indications for extubation: spontaneous breathing and coughing are strong, swallowing function is good, blood gas analysis results are basically normal, and there is no laryngeal obstruction. Extubation may be considered. The tracheal intubation can be pulled out once, and the tracheotomy can be gradually pulled out through the sequence of changing the thin tube, semi-blocking tube, and full-blocking tube.