7.19
Ventilation mécanique II: ventilation invasive
Les ventilateurs sont des équipements médicaux essentiels utilisés pour aider les patients souffrant de difficultés respiratoires. Leur fonction princ…
La ventilation invasive utilise un ventilateur mécanique relié à une sonde endotrachéale ou à une trachéotomie pour favoriser la respiration.
Un type courant est la ventilation à pression positive, qui gonfle les poumons en appliquant une pression positive sur les voies respiratoires, provoquant un afflux d’air et une expansion alvéolaire pendant l’inspiration. L’expiration se produit passivement.
La ventilation à pression positive est en outre classée comme suit :
Le premier est le ventilateur à cycle volumique. Il délivre un volume d’air prédéfini à chaque inspiration.
Le ventilateur s’éteint après avoir délivré ce volume, ce qui permet une expiration passive.
Ils fournissent des respirations constantes mais peuvent provoquer un barotraumatisme en raison d’une pression excessive.
Ensuite, un ventilateur à cycle de pression fournit un flux d’air jusqu’à ce qu’une pression prédéfinie soit atteinte, puis s’éteint pour une expiration passive.
Les changements dans la résistance des voies respiratoires ou la compliance pulmonaire peuvent affecter le volume d’air, entraînant des volumes courants incohérents et une ventilation potentiellement compromise.
Enfin, les ventilateurs à assistance oscillatoire à haute fréquence offrent des fréquences respiratoires exceptionnellement élevées tout en maintenant de faibles volumes courants et des pressions élevées des voies respiratoires.
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Q1: How does positive-pressure ventilation inflate the lungs?
Positive-pressure ventilation applies positive pressure directly to the airway, forcing air into the lungs and causing alveolar expansion during inspiration. After the preset volume or pressure is delivered, expiration occurs passively. This method requires an artificial invasive airway such as an endotracheal tube or tracheostomy to function effectively.
Q2: What is the difference between volume-cycled and pressure-cycled ventilators?
Volume-cycled ventilators deliver a preset air volume with each breath, ensuring consistent tidal volumes but risking barotrauma from excessive pressure. Pressure-cycled ventilators deliver airflow until a preset pressure is reached, but air volume varies with changes in airway resistance or lung compliance, potentially causing inconsistent ventilation and compromised breathing support.
Q3: When are high-frequency oscillatory ventilators used?
High-frequency oscillatory ventilators deliver exceptionally high respiratory rates while maintaining low tidal volumes and high airway pressures. They are used to open collapsed alveoli in conditions like atelectasis and acute respiratory distress syndrome, and are believed to protect lungs from pressure-related injury during mechanical support.
Q4: What are the main advantages and disadvantages of volume-cycled ventilators?
Volume-cycled ventilators provide consistent, predictable breaths with preset air volumes, making them reliable for maintaining adequate ventilation. However, they may cause barotrauma because excessive pressure is sometimes needed to deliver the programmed volume, potentially damaging lung tissue and causing complications.
Q5: How do pressure-cycled ventilators respond to changes in patient lung compliance?
Pressure-cycled ventilators cycle off when a preset pressure is reached, regardless of how much air has entered the lungs. If airway resistance increases or lung compliance decreases, less air enters before the pressure limit is reached, resulting in lower tidal volumes and potentially inadequate ventilation for the patient.
Q6: What airway access is required for invasive mechanical ventilation?
Invasive mechanical ventilation requires an artificial airway, typically an endotracheal tube placed through the mouth or nose, or a tracheostomy created surgically in the trachea. These invasive airways allow direct connection of the mechanical ventilator to deliver positive pressure ventilation and support breathing in critically ill patients.
Q7: How does passive exhalation work during mechanical ventilation?
During passive exhalation, the ventilator cycles off after delivering air, allowing the elastic recoil of the lungs and chest wall to naturally expel air without active machine assistance. This passive process occurs in all positive-pressure ventilation modes and relies on the patient's natural lung elasticity to complete the breathing cycle.