Samenvatting – EPA ICV 2 – Stabiele Beademing
Inhoudsopgave
Leerdoelen.................................................................................................................................................... 9
Basis beademen – Webinar.......................................................................................................................... 11
Fysiologie............................................................................................................................................................11
Compliance.........................................................................................................................................................11
Longvolumia.......................................................................................................................................................12
Soorten longvolumes:....................................................................................................................................12
Dode ruimte ventilatie (anatomisch).................................................................................................................13
Dode ruimte ventilatie (pathologisch)...............................................................................................................13
Shunting.............................................................................................................................................................13
Beademing en de hemodynamiek......................................................................................................................14
, Beademing en schade........................................................................................................................................14
Volume gecontroleerd beademen......................................................................................................................14
Druk gecontroleerd beademen..........................................................................................................................14
Instellingen beademingsmachine.......................................................................................................................15
Verschillen tussen gecontroleerde en ondersteunende beademing..................................................................15
Druk-ondersteunende beademing.....................................................................................................................16
Samenvatting beademingsvormen....................................................................................................................16
Gecontroleerde beademing:.........................................................................................................................16
Ondersteunende beademing:........................................................................................................................16
Meetwaarden beademing..................................................................................................................................16
etCO2 bewaking.................................................................................................................................................17
Samenvattend m.b.t omlaag brengen CO2........................................................................................................17
Gecontroleerde beademing:.........................................................................................................................17
Ondersteunende beademing:........................................................................................................................17
Venticare – Boekje - Beademing................................................................................................................... 18
Hoofdstuk 1: De normale ademhaling...............................................................................................................18
Ademhalingsspieren......................................................................................................................................18
Diffusie...........................................................................................................................................................18
Perfusie..........................................................................................................................................................18
Longvolumes..................................................................................................................................................19
Hoofdstuk 2: Fysiologie van beademen.............................................................................................................19
Weerstand/ Resistance..................................................................................................................................19
Elasticiteit / Compliance................................................................................................................................20
Surfactant......................................................................................................................................................20
Hoofdstuk 3: De gasuitwisseling........................................................................................................................21
Twee typen respiratoire insufficiëntie...........................................................................................................21
Kooldioxide en Hypercapnie..........................................................................................................................21
Behandelen van hypercapnie........................................................................................................................22
Zuurstof en hypoxemie..................................................................................................................................23
Behandelen van hypoxemie..........................................................................................................................24
Hoofdstuk 4: Indeling van de beademing, wie triggert en stuurt?....................................................................25
Wie of wat start en eindigt de inspiratie?.....................................................................................................25
Controlbeademing.........................................................................................................................................25
Supportbeademing........................................................................................................................................26
Control- of supportbeademing? Hoe zie je het verschil................................................................................26
Hoofdstuk 5: Indeling van de beademing, druk of volume gecontroleerd?.......................................................27
Expiratie en inspiratie....................................................................................................................................27
Druk gecontroleerde beademing...................................................................................................................27
Modi die worden gebruik bij druk gecontroleerde beademing....................................................................29
Volume gecontroleerde beademing...................................................................................................................30
Modi die gebruik maken van volume gecontroleerde beademing...............................................................31
Volumesupport..............................................................................................................................................31
Hoofdstuk 6: Indeling van de beademing, wat is het doel?...............................................................................32
Verschillende beademingsdoelen.................................................................................................................32
Kenmerken en eigenschappen van bekende beademingsmodi....................................................................32
Hoofdstuk 7: Beademing in de praktijk..............................................................................................................33
Patiënten met gezonde longen.....................................................................................................................33
Patiënten met COPD of Astma......................................................................................................................33
, Patiënten met ARDS (Acute Respiratory Distress Syndrome).......................................................................35
Samenvattend................................................................................................................................................36
Hoofdstuk 8: Recruteren....................................................................................................................................37
Inleiding.........................................................................................................................................................37
Open long.......................................................................................................................................................37
Recruteren.....................................................................................................................................................37
Methodes.......................................................................................................................................................37
Voorzorgen....................................................................................................................................................38
Hoofdstuk 9: Weanen.........................................................................................................................................39
Inleiding.........................................................................................................................................................39
Afbouwen.......................................................................................................................................................40
Spontaneous breathing trial..........................................................................................................................40
Rapid Shallow breathing index (RSBI)............................................................................................................41
ABC voor difficult-to-wean............................................................................................................................41
Hoofdstuk 10: De kunstmatige luchtweg...........................................................................................................42
Tube...............................................................................................................................................................42
De tracheacanule...........................................................................................................................................43
Assisteren bij intubatie..................................................................................................................................43
Hoofdstuk 11: Beademingsinstellingen..............................................................................................................43
Expiratory trigger sensitivity..........................................................................................................................43
Zucht..............................................................................................................................................................44
Drukstijgtijd....................................................................................................................................................44
I:E-ratio..........................................................................................................................................................45
Triggergevoeligheid.......................................................................................................................................45
Pauzetijd........................................................................................................................................................47
Hoofdstuk 12: Patiënt-ventilator-synchronie.....................................................................................................47
Modus-dyssynchronie....................................................................................................................................47
Trigger- en cyclingfouten...............................................................................................................................48
Samenvattend................................................................................................................................................49
Hoofdstuk 13: Specifieke metingen....................................................................................................................49
Inspiration hold / expiration hold..................................................................................................................49
Compliantie....................................................................................................................................................50
Hoofdstuk 14: Specifieke verpleegkundige aspecten.........................................................................................50
Maatregelen om een VAP te voorkomen......................................................................................................50
Endotracheaal uitzuigen................................................................................................................................51
Powerpoint 1 – Respiratoire insufficiëntie.................................................................................................... 51
Anatomie en fysiologie.......................................................................................................................................51
Regulatie ademhaling........................................................................................................................................51
Inspiratie (inademing)........................................................................................................................................52
Expiratie (uitademing)........................................................................................................................................52
Drukken met betrekking tot de ademhaling......................................................................................................53
Werking slijmvliezen bij de luchtwegen:............................................................................................................54
Respiratoire insufficiëntie...................................................................................................................................54
Soorten zuurstoftherapie...................................................................................................................................54
Verschil tussen hypoxie en hypoxemie...............................................................................................................54
Oorzaken van een bedreigde luchtweg..............................................................................................................55
Compliance/ elasticiteit......................................................................................................................................56
, Resistance/ Weerstand......................................................................................................................................56
Surfactant...........................................................................................................................................................56
Respiratoire insufficiëntie...................................................................................................................................57
Hypoxemie.....................................................................................................................................................57
Hypercapnie...................................................................................................................................................57
Hypoventilatie................................................................................................................................................57
Ventilatie- perfusie mismatch.......................................................................................................................57
.......................................................................................................................................................................58
Rechts-links shunt..........................................................................................................................................58
Symptomen verhoogd CO2................................................................................................................................58
Symptomen verlaagd O2....................................................................................................................................58
Ademarbeid........................................................................................................................................................58
Verhoogde ademarbeid, hoe zie je dit?........................................................................................................58
PowerPoint 2 – Luchtwegmanagement farmacologie...................................................................................59
Intubatie bij de acute patiënt.............................................................................................................................59
Intubatie.............................................................................................................................................................59
Redenen van intubatie...................................................................................................................................59
Gevolgen van intubatie..................................................................................................................................59
Luchtweg algoritme...........................................................................................................................................60
Positie voor intubatie.........................................................................................................................................60
Inschatting moeilijke luchtweg...........................................................................................................................61
OBESE.............................................................................................................................................................61
LEMON-law....................................................................................................................................................61
MACOCHA-Score............................................................................................................................................62
Stappenplan intubatie........................................................................................................................................62
Medicatie intubatie.......................................................................................................................................63
Post intubatie medicatie................................................................................................................................63
Invloed van positieve druk op de hemodynamiek..............................................................................................63
CVD en positieve druk........................................................................................................................................64
PowerPoint 3 – Beademing Basics 1............................................................................................................. 64
Wat doen ventilatoren?.....................................................................................................................................64
Doel van beademen............................................................................................................................................64
Anesthesie.....................................................................................................................................................64
Intensive care.................................................................................................................................................64
Soorten beademingmodussen............................................................................................................................65
Ventilatie circuit.................................................................................................................................................65
Classificatie volgens chatburn............................................................................................................................65
Hoofdgroepen beademing.................................................................................................................................66
Invasief...........................................................................................................................................................66
Non-invasief...................................................................................................................................................67
Volume gecontroleerde beademing...................................................................................................................67
Wat stel je in? Wat bewaak je?.....................................................................................................................67
Flow/volume gecontroleerd..........................................................................................................................67
Druk/flow.......................................................................................................................................................68
Druk gecontroleerde beademing.......................................................................................................................68
Inhoudsopgave
Leerdoelen.................................................................................................................................................... 9
Basis beademen – Webinar.......................................................................................................................... 11
Fysiologie............................................................................................................................................................11
Compliance.........................................................................................................................................................11
Longvolumia.......................................................................................................................................................12
Soorten longvolumes:....................................................................................................................................12
Dode ruimte ventilatie (anatomisch).................................................................................................................13
Dode ruimte ventilatie (pathologisch)...............................................................................................................13
Shunting.............................................................................................................................................................13
Beademing en de hemodynamiek......................................................................................................................14
, Beademing en schade........................................................................................................................................14
Volume gecontroleerd beademen......................................................................................................................14
Druk gecontroleerd beademen..........................................................................................................................14
Instellingen beademingsmachine.......................................................................................................................15
Verschillen tussen gecontroleerde en ondersteunende beademing..................................................................15
Druk-ondersteunende beademing.....................................................................................................................16
Samenvatting beademingsvormen....................................................................................................................16
Gecontroleerde beademing:.........................................................................................................................16
Ondersteunende beademing:........................................................................................................................16
Meetwaarden beademing..................................................................................................................................16
etCO2 bewaking.................................................................................................................................................17
Samenvattend m.b.t omlaag brengen CO2........................................................................................................17
Gecontroleerde beademing:.........................................................................................................................17
Ondersteunende beademing:........................................................................................................................17
Venticare – Boekje - Beademing................................................................................................................... 18
Hoofdstuk 1: De normale ademhaling...............................................................................................................18
Ademhalingsspieren......................................................................................................................................18
Diffusie...........................................................................................................................................................18
Perfusie..........................................................................................................................................................18
Longvolumes..................................................................................................................................................19
Hoofdstuk 2: Fysiologie van beademen.............................................................................................................19
Weerstand/ Resistance..................................................................................................................................19
Elasticiteit / Compliance................................................................................................................................20
Surfactant......................................................................................................................................................20
Hoofdstuk 3: De gasuitwisseling........................................................................................................................21
Twee typen respiratoire insufficiëntie...........................................................................................................21
Kooldioxide en Hypercapnie..........................................................................................................................21
Behandelen van hypercapnie........................................................................................................................22
Zuurstof en hypoxemie..................................................................................................................................23
Behandelen van hypoxemie..........................................................................................................................24
Hoofdstuk 4: Indeling van de beademing, wie triggert en stuurt?....................................................................25
Wie of wat start en eindigt de inspiratie?.....................................................................................................25
Controlbeademing.........................................................................................................................................25
Supportbeademing........................................................................................................................................26
Control- of supportbeademing? Hoe zie je het verschil................................................................................26
Hoofdstuk 5: Indeling van de beademing, druk of volume gecontroleerd?.......................................................27
Expiratie en inspiratie....................................................................................................................................27
Druk gecontroleerde beademing...................................................................................................................27
Modi die worden gebruik bij druk gecontroleerde beademing....................................................................29
Volume gecontroleerde beademing...................................................................................................................30
Modi die gebruik maken van volume gecontroleerde beademing...............................................................31
Volumesupport..............................................................................................................................................31
Hoofdstuk 6: Indeling van de beademing, wat is het doel?...............................................................................32
Verschillende beademingsdoelen.................................................................................................................32
Kenmerken en eigenschappen van bekende beademingsmodi....................................................................32
Hoofdstuk 7: Beademing in de praktijk..............................................................................................................33
Patiënten met gezonde longen.....................................................................................................................33
Patiënten met COPD of Astma......................................................................................................................33
, Patiënten met ARDS (Acute Respiratory Distress Syndrome).......................................................................35
Samenvattend................................................................................................................................................36
Hoofdstuk 8: Recruteren....................................................................................................................................37
Inleiding.........................................................................................................................................................37
Open long.......................................................................................................................................................37
Recruteren.....................................................................................................................................................37
Methodes.......................................................................................................................................................37
Voorzorgen....................................................................................................................................................38
Hoofdstuk 9: Weanen.........................................................................................................................................39
Inleiding.........................................................................................................................................................39
Afbouwen.......................................................................................................................................................40
Spontaneous breathing trial..........................................................................................................................40
Rapid Shallow breathing index (RSBI)............................................................................................................41
ABC voor difficult-to-wean............................................................................................................................41
Hoofdstuk 10: De kunstmatige luchtweg...........................................................................................................42
Tube...............................................................................................................................................................42
De tracheacanule...........................................................................................................................................43
Assisteren bij intubatie..................................................................................................................................43
Hoofdstuk 11: Beademingsinstellingen..............................................................................................................43
Expiratory trigger sensitivity..........................................................................................................................43
Zucht..............................................................................................................................................................44
Drukstijgtijd....................................................................................................................................................44
I:E-ratio..........................................................................................................................................................45
Triggergevoeligheid.......................................................................................................................................45
Pauzetijd........................................................................................................................................................47
Hoofdstuk 12: Patiënt-ventilator-synchronie.....................................................................................................47
Modus-dyssynchronie....................................................................................................................................47
Trigger- en cyclingfouten...............................................................................................................................48
Samenvattend................................................................................................................................................49
Hoofdstuk 13: Specifieke metingen....................................................................................................................49
Inspiration hold / expiration hold..................................................................................................................49
Compliantie....................................................................................................................................................50
Hoofdstuk 14: Specifieke verpleegkundige aspecten.........................................................................................50
Maatregelen om een VAP te voorkomen......................................................................................................50
Endotracheaal uitzuigen................................................................................................................................51
Powerpoint 1 – Respiratoire insufficiëntie.................................................................................................... 51
Anatomie en fysiologie.......................................................................................................................................51
Regulatie ademhaling........................................................................................................................................51
Inspiratie (inademing)........................................................................................................................................52
Expiratie (uitademing)........................................................................................................................................52
Drukken met betrekking tot de ademhaling......................................................................................................53
Werking slijmvliezen bij de luchtwegen:............................................................................................................54
Respiratoire insufficiëntie...................................................................................................................................54
Soorten zuurstoftherapie...................................................................................................................................54
Verschil tussen hypoxie en hypoxemie...............................................................................................................54
Oorzaken van een bedreigde luchtweg..............................................................................................................55
Compliance/ elasticiteit......................................................................................................................................56
, Resistance/ Weerstand......................................................................................................................................56
Surfactant...........................................................................................................................................................56
Respiratoire insufficiëntie...................................................................................................................................57
Hypoxemie.....................................................................................................................................................57
Hypercapnie...................................................................................................................................................57
Hypoventilatie................................................................................................................................................57
Ventilatie- perfusie mismatch.......................................................................................................................57
.......................................................................................................................................................................58
Rechts-links shunt..........................................................................................................................................58
Symptomen verhoogd CO2................................................................................................................................58
Symptomen verlaagd O2....................................................................................................................................58
Ademarbeid........................................................................................................................................................58
Verhoogde ademarbeid, hoe zie je dit?........................................................................................................58
PowerPoint 2 – Luchtwegmanagement farmacologie...................................................................................59
Intubatie bij de acute patiënt.............................................................................................................................59
Intubatie.............................................................................................................................................................59
Redenen van intubatie...................................................................................................................................59
Gevolgen van intubatie..................................................................................................................................59
Luchtweg algoritme...........................................................................................................................................60
Positie voor intubatie.........................................................................................................................................60
Inschatting moeilijke luchtweg...........................................................................................................................61
OBESE.............................................................................................................................................................61
LEMON-law....................................................................................................................................................61
MACOCHA-Score............................................................................................................................................62
Stappenplan intubatie........................................................................................................................................62
Medicatie intubatie.......................................................................................................................................63
Post intubatie medicatie................................................................................................................................63
Invloed van positieve druk op de hemodynamiek..............................................................................................63
CVD en positieve druk........................................................................................................................................64
PowerPoint 3 – Beademing Basics 1............................................................................................................. 64
Wat doen ventilatoren?.....................................................................................................................................64
Doel van beademen............................................................................................................................................64
Anesthesie.....................................................................................................................................................64
Intensive care.................................................................................................................................................64
Soorten beademingmodussen............................................................................................................................65
Ventilatie circuit.................................................................................................................................................65
Classificatie volgens chatburn............................................................................................................................65
Hoofdgroepen beademing.................................................................................................................................66
Invasief...........................................................................................................................................................66
Non-invasief...................................................................................................................................................67
Volume gecontroleerde beademing...................................................................................................................67
Wat stel je in? Wat bewaak je?.....................................................................................................................67
Flow/volume gecontroleerd..........................................................................................................................67
Druk/flow.......................................................................................................................................................68
Druk gecontroleerde beademing.......................................................................................................................68
