1、.,1,壓力支持通氣壓力目標(biāo)/容量目標(biāo),解放軍總醫(yī)院呼吸病中心 解立新,.,2,Pulmonary and critical care medicine -a peculiarly American hybrid？,Tobin, MJ. Thorax 1999;54:286287,.,3,現(xiàn)代機械通氣的發(fā)展歷程,Current Anaesthesia 44(1):1-2,.,8,國內(nèi)RICU的情況,國內(nèi)目前主要有兩種情況：RICU（Respiratory ICU）：代表單位有301醫(yī)院、北京朝陽醫(yī)院等,.,9,國內(nèi)的情況,國內(nèi)目前主要有兩種情況： 綜合ICU：代表醫(yī)院有廣州醫(yī)學(xué)院第一附屬醫(yī)院等

2、,.,10,呼吸模式,控制模式 Controlled ventilation 2. 支持模式 Supported ventilation 3. 自主呼吸 Spontaneous breathing 4. 混合模式 Combined control and supported or spontaneous and supported ventilation,.,11,理想的壓力支持通氣,.,12,理想的支持通氣,VA, volume assist,Best Practice 174:894900,CDW: computer-driven weaning,.,46,Smart Care,Am J

3、Respir Crit Care Med. 2006; 174:894900,Weaning protocol: computer-driven vs. Physician controlled,.,47,Smart Care,Kaplan-Meier analysis of weaning time until successful extubation or death after inclusion for all included patients in each study group,Weaning protocol: computer-driven vs. Physician c

4、ontrolled,Am J Respir Crit Care Med. 2006; 174:894900,.,48,Smart Care,Am J Respir Crit Care Med. 2006; 174:894900,Conclusions: The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay, as compared with a physician-controlled weaning pro

5、cess,Weaning protoccol: computer-driven vs. Physician controlled,.,49,總結(jié),In the future, the ventilators will adapt themselves to the patient and not the reverse,Best Practice 174:894900,.,50,Current Status of Respiratory Critical Care,RICU: Respiratory Intensive Care Unit RICU : Respiratory Intermed

6、iate Care Unit RMU : Respiratory Monitoring Unit,Arch Bronconeumol. 2008;44(1):1-2,.,51,Definition of “RICUs”,Respiratory Intermediate Care units (RICUs) is an area for monitoring and treating patients with acute or exacerbated chronic respiratory failure caused primarily by a respiratory disease Ca

7、rdiorespiratory monitoring or treatment of respiratory failure with NIV Continuous monitoring of patients following thoracic surgery and of tracheostomized patients Treatment of critical patients whose weaning from invasive ventilation is difficult,Arch Bronconeumol. 2008;44(1):1-2,.,52,The Respirat

8、ory Medicine Status in ICU,Criteria adopted by the components of Task Force in order to define a respiratory intermediate care unit,Eur Respir J 2002; 20:1343-1350,.,53,The Respiratory Medicine Status in ICU,Definition of the three levels of care,Eur Respir J 2002; 20:1343-1350,.,54,RICU未來的發(fā)展方向,RICU應(yīng)向MICU（Medical Intensive Care Unit）發(fā)展，收 治對象應(yīng)涵蓋內(nèi)科各種合并感染的危重癥患者（不包括急性心肌梗塞患者，但是如果合并感染亦應(yīng)收治） 但是人才梯隊的建設(shè)也是當(dāng)務(wù)之急 Our Aim: Provide principal care for all patients in (medical) ICUs. -ATS Statemen