316.2 🩺 國考版

316.2.1 高頻考點

316.2.1.1 Modes of Ventilation

  • VCV, PCV (control modes)
  • PSV (weaning + comfort)
  • SIMV (mixed)
  • APRV (refractory hypoxia)
  • CPAP, BiPAP (NIV)

316.2.1.2 Lung-Protective (ARDSnet)

  • Vt 6 mL/kg PBW
  • Plateau < 30
  • PEEP per table
  • Driving pressure < 15

316.2.1.3 Sedation Strategy

  • Target light sedation
  • ABCDEF bundle
  • SAT + SBT daily
  • Dexmedetomidine (MENDS-2) less delirium
  • Avoid prolonged midazolam

316.2.1.4 Weaning Failure Causes

  • Persistent respiratory failure
  • Diaphragm weakness (ICUAW)
  • Cardiac dysfunction
  • Anxiety
  • Secretions
  • Upper airway issues

316.2.1.5 VAP

  • Hospital-acquired pneumonia > 48 h MV
  • Pseudomonas, MRSA, Acinetobacter common
  • Empiric → narrow per cultures
  • 7-day typical

316.2.1.6 NIV Indications

  • COPD exacerbation pH < 7.35 (Class I)
  • Cardiogenic pulmonary edema
  • Immunocompromised hypoxemic RF
  • Post-extubation high-risk

316.2.1.7 HFNC

  • FLORALI (2015): comparable to NIV; ↓ reintubation
  • Awake proning combo for COVID

316.2.1.8 Tracheostomy

  • Prolonged MV > 14 days
  • Earlier vs later timing controversial
  • TracMan 2013: no mortality benefit early

316.2.1.9 Key Trials

  • ARMA / ARDSnet (2000): lung-protective ventilation
  • PROSEVA (2013): prone positioning
  • MENDS-2 (2024): dexmedetomidine = propofol; less delirium
  • TracMan (2013): early vs late trach — neutral
  • FLORALI (2015): HFNC vs mask O2/NIV
  • OPERA (2020): HFNC for post-extubation

316.2.2 易混淆比范

Mode Patient Trigger Variable Use
VCV Set or patient Vt set, P variable Standard, ARDS
PCV Set or patient P set, Vt variable Severe lung disease
PSV Patient only P support Weaning, comfort
SIMV Mixed Mixed Less common
APRV Spontaneous + brief releases High continuous P Refractory hypoxia

316.2.3 Special Topics

316.2.3.1 Auto-PEEP Assessment

  • Expiratory hold maneuver
  • Measures total PEEP
  • Auto-PEEP = total PEEP - applied PEEP
  • Asthma, COPD, severe obstruction

316.2.3.2 Plateau Pressure

  • End-inspiratory hold
  • Reflects alveolar pressure
  • < 30 cm H2O target
  • Higher = injury risk

316.2.3.3 Compliance Calculation

  • Vt / (Plateau - PEEP)
  • Normal 50-80 mL/cm H2O
  • ARDS reduced to 20-40

316.2.3.4 Permissive Hypercapnia

  • Allowed in ARDS to ↓ Vt
  • pH > 7.20 generally OK
  • CV monitoring
  • Sedation may need adjustment