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WS392-2012

Chinese Standard: 'WS392-2012'
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BASIC DATA
Standard ID WS 392-2012 (WS392-2012)
Description (Translated English) Clinical application of ventilator
Sector / Industry Health Industry Standard
Classification of Chinese Standard C05
Classification of International Standard 11.020
Word Count Estimation 20,274
Quoted Standard GB 9706.28; WS 310
Drafting Organization Huazhong University of Science and Technology, Union Hospital, Tongji Medical College,
Administrative Organization ?PRC Ministry of Health
Regulation (derived from) ?Health-Communication (2012) 15; Industry Standard Filing Announcement 2012 No.10 (Total No.154)
Summary This standard specifies the use of personnel and unit ventilator basic requirements. Clinical application process, monitoring indicators. Scope ventilator, the ventilator classification and methods of use. Nursing principles. Ventilator during treatment s

WS 392-2012
Clinical application of ventilator
ICS 11.020
C 05
People's Republic of China Health Industry Standard
Clinical application of ventilator
2012-09-04 released
2013-04-01 Implementation
Published by the Ministry of Health of the People's Republic of China
1 Scope
This standard specifies the basic requirements of the ventilator users and units, the clinical application process, monitoring indicators, the scope of application of the ventilator, and the classification of the ventilator.
And methods of use, nursing principles, application specifications of sedatives, analgesics, and muscle relaxants during ventilator treatment, and ventilator-related complications.
This standard is applicable to the clinical application of ventilators by medical personnel at various medical institutions at various levels throughout the country.
2 Normative references
The following documents are essential for the application of this document. For dated references, only the dated version applies to this document.
For undated references, the latest version (including all amendments) applies to this document.
GB 9706.2 8 Medical electrical equipment Part 2. Particular requirements for ventilator safety. Therapeutic ventilator
WS 3 1 0 Hospital Disinfection Supply Center
3 terms and definitions
The following terms and definitions apply to this document.
3.1
Ventilator
Life support device capable of improving respiratory function, reducing respiratory energy consumption and saving heart reserve capacity.
3.3
Noninvasive positive pressure ventilation
Connect the patient with the mechanical ventilation mode by nasal or face mask.
3.4
Artificial airway
Temporary gas passages created by catheters through nasal, oral or tracheotomy 3
3.5
Volume-controlled ventilation, VCV
The ventilator achieves ventilation with a preset ventilation volume.
3.6
Pressure-controlled ventilation, PCV
The ventilator achieves ventilation with a preset airway pressure.
3.7
Controlled ventilation; CV
The ventilator completely replaces the patient's spontaneous breathing, providing all the work of breathing.
3.8
Assisted ventilation
Rely on the patient's inhalation effort to trigger the ventilator's inspiratory valve to achieve communication
3.10
Respiratory rale
Number of breaths per minute.
3.11
Breathing ratio, I. E
The ratio of inspiratory time to expiratory time.
3.12
Inspiratory flow rate
Gas volume passing through a certain point per unit time.
3.13
Trigger sensitivity
Can trigger ventilator-assisted ventilation, changes in pressure or flow rate in the tube caused by patient's spontaneous breathing.
3.14
Positive end-expiratory pressure; PEEP
A ventilation-assisted method to make the airway pressure higher than atmospheric pressure by artificial measures (such as a device that restricts air flow at the exhalation end) during the expiratory phase.
4 Basic requirements for ventilator users
Practitioners or registered nurses who meet the following requirements are eligible to use a ventilator.
a) Grasp the pathophysiology of respiratory system, respiratory physiology, and respiratory failure;
b) Grasp the working principle, performance characteristics and commonly used mechanical ventilation modes and parameter settings of the breathing scabs used;
c) Grasp the clinical significance and determination methods of commonly used breathing and circulation monitoring indicators;
d) master the routine maintenance and disinfection methods of the ventilator used;
c) Can judge the working status of the ventilator used and deal with it accordingly.
5 Basic requirements for units using ventilator
The unit using the ventilator should have the following conditions.
a) Have personnel who meet the requirements of Chapter 4
b) monitoring equipment with vital signs;
c) Conditions for monitoring commonly used respiratory indicators;
d) have oxygen source and sputum suction equipment;
c) have rescue equipment and personnel;
f) Have basic maintenance and disinfection capabilities of the ventilator;
g) Power supply facilities and technical conditions in accordance with GB 9706.28.
6 Using the ventilator
Procedure F should be used for ventilator use.
a) determine if the patient has indications for mechanical ventilation;
b) determine whether the patient has relative contraindications to mechanical ventilation and perform necessary treatments;
c) The informed consent should be signed before using the ventilator;
d) check before using the ventilator;
e) choose to use non-invasive ventilation or invasive ventilation;
f) determine the initial mechanical ventilation mode;
g) determining initial mechanical ventilation parameters;
h) determine alarm limits and airway pressure safety values;
i) adjust the temperature and humidifier temperature;
j) adjust the backup ventilation mode and parameter settings;
k) After using the ventilator, adjust the ventilator mode and parameters according to the patient's condition and changes in monitoring indicators
l) Dynamically monitor the changes in the patient's respiratory function and start to assess the possibility of weaning early.
7 Monitoring indicators during the use of the ventilator
The following indicators should be routinely monitored during the use of the ventilator.
a) vital signs;
b) conventional oxygenation indicators;
c) conventional indicators of respiratory mechanics;
d) Basic hemodynamic indicators.
8 Application of ventilator
Patients with severe and/or ventilatory dysfunction due to various causes.
9 classification of ventilator and clinical application method
9.1 Mechanical ventilation
9.1.1 Purpose of mechanical ventilation
The purposes of mechanical ventilation include.
-Improve alveolar ventilation and correct acute respiratory acidosis;
-Correct hypoxemia and improve tissue oxygenation;
-Reduce respiratory power consumption and relieve respiratory muscle fatigue;-Prevent atelectasis;
Ensure the safe use of sedative and muscle relaxants;
Stabilize the chest wall.
9.1.2 Application of mechanical ventilation
Ventilation and/or oxygenation dysfunction caused by any disease.
9.1.3 Relative contraindications for mechanical ventilation
There is no absolute contraindication for mechanical ventilation ill. • Relative contraindication iO inch exists in column K, Long said using.
-Pneumothorax and mediastinal emphysema without drainage;
-Bullae and lung cysts;
-Severe burns of the respiratory tract;
Severe pulmonary hemorrhage;
Tracheo-esophageal fistula.
9.1.4 Establishment of artificial airways
9.1.4.1 Purpose of establishing an artificial airway
Keep the airway unobstructed, prevent aspiration, strengthen the removal of respiratory secretions and ensure the effective implementation of mechanical ventilation.
9.1.4.2 Methods of establishing artificial airways
Methods to build artificial airways include.
Oral tracheal intubation;
Nasal tracheal intubation;
Tracheotomy
Retrograde tracheal intubation.
9.1.5 Basic pattern classification of mechanical ventilation
9.1.5.1 Classification by constant volume and constant pressure ventilation
9.1.5.1.1 Constant volume ventilation or volume controlled ventilation (VCV)
9.1.5.1.1.1 Ventilation principle. After the ventilator has reached the preset volume, it stops venting, and passively exhales based on the elastic retraction of the lungs and thorax.
9.1.5.1.1.2 Common modes. volume controlled ventilation (VC), volume assisted-controlled ventilation (A/C), intermittent command ventilation (IMV), and synchronization
Intermittent instruction ventilation (SIMV), etc.
9.1.5.1.2 Constant-pressure ventilation or pressure-K ventilation (PCV)
9.1.5.1.2.1 Principle of ventilation. The ventilator delivers air to a preset pressure and the inspiratory phase maintains the pressure level. The tidal volume is determined by the airway pressure and
The difference in PEEP and inspiratory time are determined and are affected by the respiratory system obstruction and airway resistance.
9.1.5.1.2.2 Common modes. pressure-controlled ventilation (PCV), pressure-assisted control ventilation (P-ACV), pressure control-synchronous intermittent command
Ventilation (PC-SIMV), pressure support ventilation (PSV), etc.
9.1.5.2 Classification by control and assisted ventilation
9.1.5.2.1 Controlled ventilation (CV)
Principle of ventilation. The ventilator completely replaces the patient's spontaneous breathing, and the ventilator provides all breathing work.
9.1.5.2.2 Assisted ventilation (AV)
Principle of ventilation. rely on the patient's inhalation effort to trigger the ventilator's inspiratory valve to achieve ventilation. When spontaneous breathing is present,
Force reduction (pressure trigger) or air flow (flow rate trigger) changes trigger ventilator aspiration, according to a preset tidal volume (constant volume) or inspiration pressure
(Constant pressure) The gas is delivered, and the work of breathing is performed jointly by the patient and the ventilator.
9.1.6 Common Mode
9.1.6.1 Auxiliary controlled ventilation (A-CV)
Principle of ventilation. the combination of assisted ventilation (AV) and controlled ventilation mode. When the patient's spontaneous breathing frequency is lower than the preset frequency
Or when the patient's inspiratory effort cannot trigger the ventilator to ventilate, the ventilator will perform positive pressure ventilation with the set tidal volume and ventilation frequency, that is CV;
When the patient's inspiration can trigger the ventilator, ventilation is performed at a frequency higher than a preset frequency, that is, AV.
Available parameters.
a) Volume switching AC. trigger sensitivity, tidal volume, ventilation frequency, inspiratory ratio or inspiratory time, positive end-expiratory pressure;
1)) Pressure switching AC. trigger sensitivity, pressure level, ventilation frequency, positive end expiratory pressure.
9.1.6.2 Simultaneous intermittent command ventilation (SIMV)
Ventilation principle. It is a breathing mode combining spontaneous breathing and controlled ventilation. In the trigger window, the patient can trigger and synchronize with the spontaneous breathing.
Allow positive pressure ventilation, trigger the window to allow the patient to breathe spontaneously between the two commanded ventilations, and the commanded breathing is a preset volume (V-SIMV) or
Aspirated in the form of set pressure (P-SIMV).
Available parameters.
a) V-SIMV. trigger sensitivity, tidal volume, intermittent ventilation frequency, inspiratory ratio or inspiratory time, positive end-expiratory pressure;
b) P-S1MV. trigger sensitivity, pressure level, intermittent ventilation frequency, inspiratory ratio or inspiratory time, positive end-expiratory pressure.
9.1.6.3 Pressure Support Ventilation (PSV)
Ventilation principle. mechanical ventilation mode triggered by the patient, pressure target, and flow switching, that is, the patient triggers ventilation, breathing frequency, tidal volume and
Inhalation and exhalation ratio. When the airway pressure reaches a preset pressure support level and the inspiratory flow rate drops below a certain threshold level, the inhalation is switched to exhalation.
Available parameters. trigger sensitivity, inspiratory pressure, flow rate switching percentage, positive end expiratory pressure.
9.1.6.4 Continuous Positive Airway Pressure (CPAP)
Principle of ventilation. In spontaneous breathing conditions, the airway maintains positive pressure throughout the breathing cycle (during inspiration and expiration),
The patient completes all work of breathing.
Available parameters. continuous positive airway pressure or positive end expiratory pressure.
9.1.6.5 Biphasic Positive Airway Pressure (BIPAP)
Ventilation principle. Two different levels of continuous positive air pressure are given to switch between high and low pressure at regular intervals, and their high
Pressure time, low pressure time, high pressure level, low pressure level can be adjusted individually.
Parameters that can be set. high pressure level, low pressure level, high pressure time, low earth time or〕? Gas frequency.
9.1.6.6 Proportional assisted ventilation (PAV)
Principle of ventilation. Partial ventilation support mode. The ventilator's air output is proportional to the patient's voluntary exhalation work.
Available parameters. flow assist, volume assist, pressure assist, positive end expiratory pressure.
9.1.6.7 Pressure-controlled volume controlled ventilation (PRVCV)
Ventilation principle. auxiliary or controlled ventilation mode with constant air supply pressure and constant tidal volume. Exhale within the scheduled ventilation time
Inhale at a constant inspiratory pressure. If there is a gap between the tidal volume and the preset tidal volume, the inspiratory pressure will be slightly increased or decreased during the next breath.
To ensure that the preset tidal volume is given away.
Parameters that can be set. trigger sensitivity, ventilation frequency, tide, inhalation, exhalation
9.1.6.8 High Frequency Oscillation Ventilation (HFOV)
Ventilation principle. Application of tidal gas less than or equal to anatomical dead space. A. Bidirectional pressure changes with relatively high frequency vibrations.
And achieve effective gas exchange.
9.1.7 Setting of mechanical ventilation parameters
9.1.7.2 Respiration rate
9.1.7.3 Inspiratory flow rate
9.1.7.4 Inspiratory time or inspiratory ratio (I. E)
9.1.7.5 Trigger sensitivity
9.1.7.6 Inhaled oxygen concentration
Adjust at any time according to the patient's condition and changes in monitoring indicators.
9.1.7.7 Positive end-expiratory pressure (PEEP)
9.1.8 Method and timing of mechanical ventilation withdrawal
9.1.8.1 Weaning method for mechanical ventilation
9.1.8.2 Assessment indicators for weaning with mechanical ventilation
Refer to Appendix VIII for the evaluation indicators of mechanical ventilation withdrawal.
9.2 Noninvasive Positive Pressure Ventilation
9.2.1 Application scope of non-invasive positive pressure ventilation
Non-invasive positive pressure ventilation is suitable for mild to moderate chronic or acute respiratory failure caused by various systemic diseases.
9.2.2 Contraindications for Noninvasive Positive Pressure Ventilation
9.2.2.1 Impaired consciousness.
9.2.2.2 Breathing is weak or stopped, and heartbeat is stopped.
9.2.2.3 Inability to clean airways or a high risk of aspiration.
9.2.2.4 Severe organ insufficiency.
9.2.2.5 Undrained pneumothorax or mediastinal emphysema.
9.2.2.6 Severe abdominal distension and intestinal obstruction.
9.2.2.7 Upper airway or maxillofacial injury, postoperative deformity, upper respiratory tract obstruction.
9.2.2.8 Cannot cooperate with NPPV or nasal (face) mask.
9.2.2.9 Recent esophagus, gastrointestinal surgery or bleeding.
9.2.2.10 Other.
9.2.3 Common non-invasive positive pressure ventilation methods
9.2.3.1 Respirator-mask with oxygen
It is suitable for pressurized oxygen during preparation of ventilator-mask (or nasal mask) before mechanical ventilation, and can also be used for pressurized ventilation before tracheal intubation.
oxygen. The breathing sac is connected to a mask, which covers the mouth and nose, and is pressurized under leak-proof conditions.
9.2.3.2 Connecting a ventilator through a nasal or face mask
Explain the patient about% invasive positive pressure ventilation, adjust the patient's position to a semi-recumbent position (30 ° ~ 45 °), select and try on the appropriate
Nasal mask or face mask, start sigh machine, parameter initialization, nasal mask or face mask is connected with ventilator through tube for mechanical ventilation. Depending on the condition
And monitoring indicators to adjust the number of non-invasive positive pressure ventilation, and evaluate the efficacy to determine whether to continue or terminate non-invasive mechanical ventilation, while strengthening adjuvant therapy
(Wetting, fogging, etc.).
9.2.4 Mode selection of non-invasive positive pressure ventilation
9.2.4.1 Continuous Positive Airway Pressure (CPAP)
Ventilation principle. Under the condition of spontaneous breathing, the airway within the entire breathing cycle (inspiratory and broken gas) maintains a constant preset pressure.
Available parameters. CPAP level, positive end expiratory pressure.
9.2.4.2 Bi-level positive pressure ventilation (BIPAP)
Ventilation principle. In each case of tidal breathing, according to the set parameters, the ventilator gives the patient different levels of inspiratory and tritium phases.
Positive airway pressure.
Parameters that can be set. inspiratory pressure, expiratory pressure, breathing frequency, peak inspiratory flow, inspiratory time, and trigger sensitivity.
9.2.5 Noninvasive Positive Pressure Ventilation Weaning Procedure
Refer to Appendix 13 for the non-invasive positive pressure ventilation procedure.
Related standard:   WS 399-2012  WS/T 389-2012
Related PDF sample:   WS/T 367-2012  WS/T 326.4-2010
   
 
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