1、1會計學TaperGuard產(chǎn)品培訓解析產(chǎn)品培訓解析 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential2 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential3 |TaperGuard Evac漸進封閉錐形套囊技術(shù) Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confident

2、ial4 |IntubationShort Term IntubationRemoval of bacterial laden secretions.Modified airway device due to procedureProvide simple airwayModified airway device due to procedureProvide simple airway1997 - 20081980 - 1990 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential5

3、 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential6 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential7 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential8 | Covidien Respiratory & Monitoring Solu

4、tions | December 1, 2021 | Confidential9 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential10 |TaperGuardTaperGuard Evac減少誤吸減少誤吸分泌物管理分泌物管理 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential11 |higher risk of aspiration.nThe Evac lumen m

5、ay be hooked up to wall suction either continuous low or intermittent high, or a syringe may be used periodically to remove secretions from above the cuff.TaperGuard 提供兩種配置 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential12 |It is the unique tapered shape cuff that a

6、llows for this significant improvement in tracheal seal.The large cuff diameter of standard high volume, low pressure cuffs results in excess material that forms folds and channels that serve as a pathway for microaspiration of secretions into the lungs.The tapered shape cuff of the TaperGuard confi

7、guration allows the cuff diameter to match the trachea diameter at a certain point. At this point there is no excess material therefore no folds or channels common with standard high volume low pressure cuffs.By finding the right fit between the cuff external diameter and the trachea inner diameter

8、the TaperGuard cuff significantly reduces microaspiration by at least 85% compared to conventional high volume low pressure cuffs.TaperGuard是如何工作的？ Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential13 | Covidien Respiratory & Monitoring Solutions | December 1, 2021

9、 | Confidential14 |套囊近端套囊近端:Cuff diameter Tracheal diameter 封封閉帶閉帶:Cuff diameter = Tracheal diameter eliminating excess cuff material locallyMallinckrodt TaperGuard ETT Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential15 | Covidien Respiratory & Monitoring Solutio

10、ns | December 1, 2021 | Confidential16 |1- Nagelhout et al. Aspiration prophylaxis: is it time for changes in our practice? AANA Journal Aug 2003 vol71 no 4誤吸不一定會引發(fā)肺炎。誤吸不一定會引發(fā)肺炎。酸性物質(zhì)的吸入會嚴重損傷呼吸道，并不一定伴發(fā)肺部感染。酸性物質(zhì)的吸入會嚴重損傷呼吸道，并不一定伴發(fā)肺部感染。起初沒有肺部感染癥狀的患者隨著呼吸道損傷的加重及插管起初沒有肺部感染癥狀的患者隨著呼吸道損傷的加重及插管時間的延長，可能會逐漸發(fā)展成肺炎

11、時間的延長，可能會逐漸發(fā)展成肺炎 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential17 |n急性呼吸窘迫綜合癥急性呼吸窘迫綜合癥肌張力過高肌張力過高心動過緩心動過緩心臟停搏心臟停搏低氧血癥低氧血癥導(dǎo)致導(dǎo)致 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential18 | 對于呼吸道刺激物的自然反應(yīng)對于呼吸道刺激物的自然反應(yīng) 通過清除刺激物及分泌物來保護氣道通過清除刺激物及分泌物

12、來保護氣道 對于患者而言可能非常不舒服對于患者而言可能非常不舒服 可能會干擾睡眠和正常活動，也可能伴有眩暈，胸痛，呼吸困難可能會干擾睡眠和正常活動，也可能伴有眩暈，胸痛，呼吸困難。 導(dǎo)致胸廓內(nèi)壓增高導(dǎo)致胸廓內(nèi)壓增高: 外傷患者外傷患者 肋骨骨折肋骨骨折, 脊柱損傷脊柱損傷 手術(shù)患者手術(shù)患者 傷口疝傷口疝; 心胸手術(shù)患者心胸手術(shù)患者 手術(shù)患者手術(shù)患者 腹部手術(shù)腹部手術(shù)咳嗽咳嗽 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential19 | 對肺組織有嚴重損傷對肺組織有嚴重損傷 鹽酸引起肺泡

13、毛細血管損傷，從而導(dǎo)致肺水腫，影響肺部氣體交換。鹽酸引起肺泡毛細血管損傷，從而導(dǎo)致肺水腫，影響肺部氣體交換。 破壞肺泡中的血流空氣屏障破壞肺泡中的血流空氣屏障 導(dǎo)致低壓肺水腫導(dǎo)致低壓肺水腫 嚴重的通氣不平衡嚴重的通氣不平衡 低氧血癥和高碳酸血癥低氧血癥和高碳酸血癥 死腔永久性的增大死腔永久性的增大 急性呼吸窘迫綜合癥急性呼吸窘迫綜合癥 慢性肺限制性疾病慢性肺限制性疾病 ICU中胃內(nèi)容誤吸到氣管的發(fā)生率為中胃內(nèi)容誤吸到氣管的發(fā)生率為88.9%.胃酸吸入胃酸吸入 Covidien Respiratory & Monitoring Solutions | December 1, 2021 |

14、 Confidential20 | 吸入性肺炎是胃內(nèi)容物反流入氣道引起氣管支氣管樹產(chǎn)生化學性的損吸入性肺炎是胃內(nèi)容物反流入氣道引起氣管支氣管樹產(chǎn)生化學性的損傷。傷。 化學性肺炎化學性肺炎 Mendelsons syndrome 通常發(fā)生在意識狀態(tài)突然改變的患者通常發(fā)生在意識狀態(tài)突然改變的患者,包括：癲癇突發(fā)，腦血管意外（包括：癲癇突發(fā)，腦血管意外（CVA ）, 中樞神經(jīng)系統(tǒng)疾病，藥物中毒或者過量，顱腦外傷中樞神經(jīng)系統(tǒng)疾病，藥物中毒或者過量，顱腦外傷吸入性肺炎吸入性肺炎 Covidien Respiratory & Monitoring Solutions | December 1, 2

15、021 | Confidential21 | (/health/dci/Diseases/Ards/Ards_WhatIs.html)nARDS以肺部炎癥以及血管滲透性增高為特以肺部炎癥以及血管滲透性增高為特征征肺泡充滿體液肺泡充滿體液 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential22 |急診手術(shù)胃飽脹產(chǎn)科患者胃腸道梗阻糖尿病性胃麻痹裂空疝胃潰瘍困難氣道管理胃內(nèi)壓高食道下括約肌松弛反射功能受損顱腦外傷意識低下癲癇肥胖外傷惡心嘔吐全麻

16、嚴重低血壓，心臟停搏麻醉不充分頭低足高位腸脹氣1- Nagelhout et al. Aspiration prophylaxis: is it time for changes in our practice? AANA Journal Aug 2003 vol71 no 4 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential23 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confi

17、dential24 |肺不張肺不張肺炎肺炎肺萎縮肺萎縮 肺泡肺泡死腔增大死腔增大 呼吸作功浪費呼吸作功浪費低氧血癥低氧血癥/高碳酸血癥高碳酸血癥可能由誤吸引起可能由誤吸引起細菌或病毒引起的肺部感染細菌或病毒引起的肺部感染主要的發(fā)病機理是誤吸主要的發(fā)病機理是誤吸 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential25 |呼吸衰竭呼吸衰竭肺部疾病惡化肺部疾病惡化氣體交換不充分氣體交換不充分, 動脈氧分壓和二氧化碳分壓不在動脈氧分壓和二氧化碳分壓不在正常范圍正常范圍 (http:/en.w

18、/wiki/Respiratory_failure)囊性纖維化囊性纖維化慢性阻塞性肺疾病慢性阻塞性肺疾病肺氣腫肺氣腫 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential26 |肺不張肺不張肺炎肺炎呼吸衰竭呼吸衰竭肺部疾病惡化肺部疾病惡化指南指出最有可能導(dǎo)致術(shù)后肺指南指出最有可能導(dǎo)致術(shù)后肺部并發(fā)癥或者肺部疾病惡化的部并發(fā)癥或者肺部疾病惡化的原因來自于微量誤吸原因來自于微量誤吸 Covidien Respiratory & Monitoring Solut

19、ions | December 1, 2021 | Confidential27 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential28 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential29 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential30 |

20、 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential31 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential32 |There is opportunity to address an unmet need in the OR as it relates to aspiration an post-op pulmonary complications. Covidien

21、 Respiratory & Monitoring Solutions | December 1, 2021 | Confidential33 |套囊近端套囊近端:Cuff diameter Tracheal diameter 封封閉帶閉帶:Cuff diameter = Tracheal diameter eliminating excess cuff material locallyMallinckrodt TaperGuard ETT Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Conf

22、idential34 |n麻醉恢復(fù)室中的發(fā)熱麻醉恢復(fù)室中的發(fā)熱 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential35 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential36 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential37 | Covidien R

23、espiratory & Monitoring Solutions | December 1, 2021 | Confidential38 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential39 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential40 | Covidien Respiratory & Monitoring Solutions | De

24、cember 1, 2021 | Confidential41 | Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential42 |n獨特的錐形設(shè)計可以使套囊的直徑從近獨特的錐形設(shè)計可以使套囊的直徑從近端至遠端都契合氣管的直徑。端至遠端都契合氣管的直徑。 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential43 |通過降低圍手術(shù)期誤吸的發(fā)生，通過降低圍手術(shù)期誤吸的發(fā)生，Taperg

25、uardTaperguard導(dǎo)管可以潛在地減少誤吸相導(dǎo)管可以潛在地減少誤吸相關(guān)并發(fā)癥的發(fā)生，縮短麻醉蘇醒室的恢復(fù)時間，減少進入關(guān)并發(fā)癥的發(fā)生，縮短麻醉蘇醒室的恢復(fù)時間，減少進入ICUICU深切治療的深切治療的概率，減少藥物的使用以及術(shù)后發(fā)病率。概率，減少藥物的使用以及術(shù)后發(fā)病率。 Covidien Respiratory & Monitoring Solutions | December 1, 2021 | Confidential44 |需要進行氣管插管需要進行氣管插管的病人的病人插管時間插管時間24 hours(可能會去可能會去ICU)TaperGuard Evac我不在意是否會有微量誤我不在意是否會有微量誤吸吸Hi-Lo我不在意是否會有微量誤吸我不在意是否會有微量誤吸比較在意微量誤吸比較在意微量誤吸非常在意微量誤吸非常在意微量誤吸TaperGuardTaperGuar