성인간호학 실습 사전학습보고서 (외과계중환자실 실습 전 숙지하면 좋은 자료)

문서 내 토픽

• 1. ACMV mode

  기계가 호흡을 100% 조절하고 통제하는 방식으로 목표 환기량 또는 목표 압력을 달성하는 것이 보장되지만 자발 호흡이 있는 환자에게 적용 시 환자와 기계와의 충돌을 일으킬 수 있다.

• 2. VCV mode

  1회 환기량을 설정하고 이를 전달하는 방식으로 폐의 변화(기도저항, 폐유순도)에 관계없이 설정된 환기량만을 전달하는데 목적을 두지만 baro-trauma(압력과 관련된 외상)의 위험이 있다.

• 3. PCV mode

  설정된 기도내압이 흡기 목표인 환기 양식이며 설정된 압력(P control)에 도달하기 전까지 흡기를 유도하고 도달한 뒤로는 호기로 전환한다. 흡기압 조절로 폐포의 과팽창과 폐 손상을 예방할 수 있지만 일정한 환기량을 보장할 수 없다.

• 4. SIMV mode

  기계호흡+자가 호흡의 형태이며 환자가 숨을 쉬는 것이 감지되는 경우, 기계는 이와 맞추어 환기를 시도한다. 그렇지 않은 경우에는 설정된 값으로 기계호흡을 전달한다. 환자의 자발 호흡 시도에 맞추어 기계가 호흡을 시작하기 때문에, ACMV mode의 단점으로 지적되는 "환자의 fighting 위험성"을 보완할 수 있으며 평균기도내압을 낮추고 호흡근육 훈련이 가능하고 호흡횟수를 줄여가며 환자의 호흡능력을 증강 시키는 연습을 하게 된다. 그러나 아직 자발호흡이 약한 환자의 경우, 호흡횟수 불안정으로 인해 SpO2 저하 및 PCO2 정체가 있을 수 있으며 호흡성 산증 유발 가능성이 있다.

• 5. PSV mode

  자발호흡 100%로 이루어지며, 기계는 환자의 자발 호흡에 맞추어 setting된 흡기압 까지만 환기를 보조한다.

• 6. CPAP mode

  자발호흡 100%로 이루어지며 지속적 양압 환기법이다. 자발 호흡 하에 흡기, 호기 모두 양압이 적용되며, PS mode와 거의 유사하다. 환기는 스스로에 의해서 유지된다. 환자와 ventilator의 마찰을 줄여 편안함을 줄 수 있으며, 자발 호흡능력 증강 연습 시 가장 적절한 모드 중에 하나이지만 자발 호흡이 없거나 불규칙한 호흡에서는 사용할 수 없다.

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• 1. ACMV mode

  ACMV (Assist Control Mechanical Ventilation) mode is a commonly used ventilation mode in mechanical ventilation. In this mode, the ventilator delivers a preset tidal volume (VT) with each breath, regardless of the patient's respiratory effort. The ventilator will deliver a breath whenever the patient triggers the ventilator, and if the patient fails to trigger a breath, the ventilator will deliver a breath at the preset respiratory rate. This mode is suitable for patients who are unable to initiate their own breathing or have weak respiratory muscles. The advantage of ACMV mode is that it provides consistent and reliable ventilation, ensuring the patient receives the necessary tidal volume and respiratory rate. However, it may not be suitable for patients who have some respiratory effort, as the ventilator may not synchronize well with the patient's breathing pattern, potentially leading to patient-ventilator asynchrony. Overall, ACMV mode is a reliable and widely used ventilation mode, but it requires careful monitoring and adjustment to ensure optimal patient-ventilator synchrony and gas exchange.

• 2. VCV mode

  VCV (Volume Control Ventilation) mode is a ventilation mode in which the ventilator delivers a preset tidal volume (VT) to the patient with each breath. In this mode, the ventilator maintains a constant flow rate and adjusts the inspiratory time to deliver the desired tidal volume. The advantage of VCV mode is that it provides a consistent and predictable tidal volume, which can be beneficial for patients with stable respiratory mechanics. However, it may not be as responsive to changes in the patient's respiratory effort or compliance, as the ventilator maintains a constant flow rate regardless of the patient's respiratory pattern. This can potentially lead to patient-ventilator asynchrony, especially in patients with variable respiratory mechanics or high respiratory drive. VCV mode is commonly used in patients who require precise control over tidal volume, such as those with acute respiratory distress syndrome (ARDS) or other conditions where maintaining a specific tidal volume is crucial. Overall, VCV mode is a reliable and widely used ventilation mode, but it requires careful monitoring and adjustment to ensure optimal patient-ventilator synchrony and gas exchange.

• 3. PCV mode

  PCV (Pressure Control Ventilation) mode is a ventilation mode in which the ventilator delivers a preset inspiratory pressure (Pinsp) to the patient with each breath. In this mode, the ventilator adjusts the flow rate to maintain the desired inspiratory pressure, and the tidal volume (VT) is determined by the patient's respiratory mechanics and the set inspiratory pressure. The advantage of PCV mode is that it can be more responsive to changes in the patient's respiratory mechanics, as the ventilator adjusts the flow rate to maintain the desired pressure. This can be beneficial for patients with variable respiratory compliance or resistance, as it can help to minimize patient-ventilator asynchrony. However, the tidal volume in PCV mode can be more variable, which may require closer monitoring to ensure adequate gas exchange. PCV mode is commonly used in patients with acute respiratory failure, such as ARDS, where maintaining a specific inspiratory pressure is important to prevent further lung injury. Overall, PCV mode is a versatile ventilation mode that can be useful in patients with variable respiratory mechanics, but it requires careful monitoring and adjustment to ensure optimal patient-ventilator synchrony and gas exchange.

• 4. SIMV mode

  SIMV (Synchronized Intermittent Mandatory Ventilation) mode is a ventilation mode that combines mandatory breaths delivered by the ventilator with spontaneous breaths taken by the patient. In this mode, the ventilator delivers a preset number of mandatory breaths per minute, and the patient is allowed to take spontaneous breaths in between the mandatory breaths. The advantage of SIMV mode is that it allows the patient to participate in their own breathing, which can help to maintain respiratory muscle tone and improve patient-ventilator synchrony. This mode can be particularly useful for patients who are transitioning from full ventilatory support to spontaneous breathing, as it allows them to gradually take on more of the work of breathing. However, SIMV mode may require more monitoring and adjustment to ensure that the patient is receiving adequate ventilation and gas exchange, as the tidal volume and respiratory rate can be more variable. Overall, SIMV mode is a useful ventilation mode for patients who are able to take some spontaneous breaths, but it requires careful monitoring and adjustment to ensure optimal patient-ventilator synchrony and gas exchange.

• 5. PSV mode

  PSV (Pressure Support Ventilation) mode is a ventilation mode in which the ventilator provides a preset level of inspiratory pressure support to assist the patient's spontaneous breathing efforts. In this mode, the ventilator detects the patient's inspiratory effort and provides a predetermined level of pressure support to augment the patient's own respiratory effort. The advantage of PSV mode is that it allows the patient to take the lead in their own breathing, which can help to maintain respiratory muscle tone and improve patient-ventilator synchrony. This mode is particularly useful for patients who are weaning from mechanical ventilation or have some respiratory effort, as it can help to gradually transition the patient to spontaneous breathing. However, PSV mode requires careful monitoring and adjustment to ensure that the patient is receiving adequate ventilation and gas exchange, as the tidal volume and respiratory rate can be more variable. Overall, PSV mode is a useful ventilation mode for patients who are able to take some spontaneous breaths, but it requires careful monitoring and adjustment to ensure optimal patient-ventilator synchrony and gas exchange.

• 6. CPAP mode

  CPAP (Continuous Positive Airway Pressure) mode is a ventilation mode in which the ventilator provides a constant positive pressure throughout the respiratory cycle, without delivering any mandatory breaths. In this mode, the patient is responsible for initiating and maintaining their own breathing efforts, and the ventilator simply provides a continuous positive pressure to keep the airways open and facilitate spontaneous breathing. The advantage of CPAP mode is that it allows the patient to take the lead in their own breathing, which can help to maintain respiratory muscle tone and improve patient-ventilator synchrony. This mode is particularly useful for patients with obstructive sleep apnea or other conditions where maintaining airway patency is important. However, CPAP mode requires the patient to have sufficient respiratory effort and may not be suitable for patients who are unable to initiate or maintain their own breathing. Overall, CPAP mode is a useful ventilation mode for patients who are able to take spontaneous breaths and require positive airway pressure, but it requires careful monitoring and adjustment to ensure optimal patient-ventilator synchrony and gas exchange.