病人與呼吸器交互作用與機械通氣技術的新發展

Patient-ventilator Interactions and Technological Development in Mechanical Ventilation

謝慧觀(Huei-Guan Shie) ； 林蕙鈴(Hui-Ling Lin)

《呼吸治療》 10卷1期 (2011/01) Pp. 91-104

https://doi.org/10.6269/JRT.2011.10.1.08

摘要

隨著密閉式呼吸迴路與機械通氣新模式上市，對加護病房重症病人照護而言，這些新的通氣模式在未來將扮演更重要的角色，採用進階的密閉式呼吸迴路的醫療自動調控系統，例如順應性支持模式(adaptive support ventilation ASV)可增進病人自動化持續性照護計畫。比例式輔助通氣(Proportional assist ventilation, PAV)與神經調控呼吸輔助神經調控呼吸輔助(Neurally adjusted ventilatory assist, NAVA)這兩種通氣模式，能針對病人呼吸用力的程度給予比例式的呼吸輔助，以改善呼吸器與病人同步作用，而在實驗室研究階段的雜亂式通氣支持模式，可以不受吸氣用力程度的影響，增加呼吸型態的變異度，這些模式可改善呼吸器與病人之交互作用與治療結果，可部分解決未來加護病房降低成本而導致臨床照護人力短缺的問題，減少機械通氣的時間，人員的工作負荷，這些改變創造了機械通氣的新世代。

並列摘要

New modes of mechanical ventilation with advanced closed loops are now available, and in the future these could assume a greater role in supporting critically ill patients in intensive care units for several reasons. A few systems that automate the medical reasoning with advanced closed-loops, such as adaptive support ventilation, have the potential to improve knowledge transfer by continuously implementing automated protocols. Two modes of ventilation-proportional assist ventilation and neurally adjusted ventilatory assist-deliver assisted ventilation proportional to the patient's effort, improving patient-ventilator synchrony. Also, A new noisy pressure support ventilation mode studied in laboratory, noisy PS is able to increase the variability of the respiratory pattern independent of the inspiratory effort. Moreover, they may improve patient-ventilator interactions and outcomes, and provide a partial solution to the forecast clinician shortages by reducing ICU-related costs, time spent on mechanical ventilation, and staff workload. A new era of mechanical ventilation should emerge with these systems.