Nkhani

"Mnzake wapezeka kuti ali ndi Covid ndipo adagonekedwa kuchipatala chapafupi," adatero membala wa gulu la WhatsApp masiku angapo apitawo.Membala wina adafunsa ngati ali pa makina opangira mpweya?Woyamba adayankha kuti anali pa 'Oxygen Therapy'.Munthu wina wachitatu anafuula kuti, “O!zimenezo si zoipa kwambiri.Amayi anga akhala akugwiritsa ntchito oxygen concentrator kwa zaka pafupifupi 2 tsopano.”Munthu wina wodziwa zambiri ananena kuti, “Sizili zofanana.Oxygen concentrator ndi Low Flow Oxygen Therapy ndipo zomwe zipatala zimagwiritsa ntchito kuchiza odwala omwe ali pachimake, ndi High Flow Oxygen therapy.

Wina aliyense ankadabwa, kodi pali kusiyana kotani pakati pa Ventilator ndi Oxygen therapy - High Flow or Low Flow?!

Aliyense amadziwa kukhala pa ventilator ndizovuta.Kodi kukhala pa chithandizo cha oxygen ndizovuta bwanji?

Therapy Oxygen vs Ventilation mu COVID19

Chithandizo cha okosijeni chakhala chodziwika bwino pochiza odwala a COVID19 m'miyezi yaposachedwa.Marichi-Meyi 2020 adakumana ndi mkangano wamisala kwa ma Ventilators ku India ndi padziko lonse lapansi.Maboma ndi anthu padziko lonse lapansi adaphunzira momwe COVID19 ingathandizire kutsika kwa mpweya m'thupi mwakachetechete.Zinadziwika kuti odwala ena omwe alibe mpweya anali ndi mpweya wabwino kapena ma SpO2 ochepetsedwa mpaka 50-60%, panthawi yomwe amafika ku Chipatala cha Emergency Room popanda kumva zambiri.

Kuchuluka kwa mpweya wabwino ndi 94-100%.Kuchuluka kwa okosijeni <94% kumatchedwa 'Hypoxia'.Hypoxia kapena Hypoxemia imatha kupangitsa kupuma movutikira ndikuyambitsa Kupsinjika Kwambiri Pakupuma.Aliyense ankaganiza kuti ma Ventilators ndiye yankho la odwala omwe ali ndi Covid19.Komabe, ziwerengero zaposachedwa zawonetsa kuti pafupifupi 14% yokha ya anthu omwe ali ndi COVID-19 omwe amakhala ndi matenda oopsa kwambiri ndipo amafunikira kugonekedwa m'chipatala ndi kuthandizidwa ndi okosijeni, ndi ena 5% okha omwe amafunikira kulandilidwa ku Intensive Care Unit ndi machiritso othandizira kuphatikiza ndi intubation and mpweya wabwino.

Mwanjira ina, 86% ya omwe adayezetsa kuti ali ndi COVID19 amakhala asymptomatic kapena amawonetsa zofatsa.

Anthuwa safuna chithandizo cha okosijeni kapena mpweya wabwino, koma 14% omwe atchulidwa pamwambapa amafunikira.WHO imalimbikitsa chithandizo chowonjezera cha okosijeni nthawi yomweyo kwa odwala omwe ali ndi vuto la kupuma, hypoxia/hypoxaemia kapena mantha.Cholinga cha chithandizo cha okosijeni ndikuti mulingo wawo wa oxygen ubwerere ku> 94%.

Zomwe muyenera kudziwa za High Flow Oxygen Therapy

Ngati inu kapena wokondedwa wanu muli m'gulu la 14% lomwe latchulidwa pamwambapa - mungafune kudziwa zambiri za chithandizo cha okosijeni.

Mungafune kudziwa momwe chithandizo cha okosijeni chimasiyanirana ndi mpweya wabwino.

Kodi zida zosiyanasiyana za okosijeni ndi makina operekera mpweya ndi ati?

Kodi zimagwira ntchito bwanji?Kodi zigawo zosiyanasiyana ndi ziti?

Kodi zidazi zimasiyana bwanji ndi luso lake?

Kodi amasiyana bwanji ndi ubwino ndi zoopsa zake?

Zizindikiro zake ndi ziti - Ndani amafunikira chithandizo cha okosijeni ndipo ndani amafunikira mpweya wabwino?

Werengani kuti mudziwe zambiri…

Kodi chothandizira okosijeni chimasiyana bwanji ndi chothandizira mpweya?

Kuti timvetsetse momwe chipangizo chothandizira okosijeni chimasiyana ndi chothandizira mpweya wabwino, choyamba tiyenera kumvetsetsa kusiyana pakati pa Mpweya Wopuma ndi Mpweya Wokwanira.

Mpweya wabwino vs oxygenation

Mpweya wabwino - Kupuma mpweya ndi ntchito yabwino, kupuma modzidzimutsa, kuphatikizapo kupuma ndi kupuma.Ngati wodwala sangathe kuchita izi payekha, akhoza kuikidwa pa makina opangira mpweya, omwe amawathandiza.

Mpweya wabwino ndi wofunikira pakusinthana kwa mpweya mwachitsanzo, kutumiza okosijeni kumapapu ndi kuchotsa mpweya woipa m'mapapo.Mpweya wa okosijeni ndi gawo loyamba la kusinthana kwa mpweya, mwachitsanzo, kutumiza mpweya kupita ku minofu.

Kusiyana pakati pa High Flow Oxygen therapy ndi Ventilator kwenikweni ndi motere.Thandizo la okosijeni limaphatikizapo kukupatsani mpweya wowonjezera - mapapo anu amagwirabe ntchito yotengera mpweya wochuluka wa okosijeni ndi kupuma mpweya wochuluka wa carbon-di-oxide.Mpweya wolowera mpweya sikuti umangokupatsani mpweya wowonjezera, umagwiranso ntchito m'mapapo anu - pumirani ndi kutuluka.

Ndani (Ndi wodwala wamtundu wanji) amafunikira chithandizo cha oxygen & yemwe amafunikira mpweya wabwino?

Kuti agwiritse ntchito chithandizo choyenera, munthu ayenera kudziwa ngati nkhaniyo ndi wodwalayo ili ndi mpweya woipa kapena mpweya wabwino.

Kulephera kupuma kumatha kuchitika chifukwa cha

vuto la oxygenation yomwe imabweretsa mpweya wochepa koma wabwinobwino - kuchepa kwa carbon dioxide.Zomwe zimatchedwanso hypoxaemic kupuma kulephera - izi zimachitika pamene mapapu satha kuyamwa mpweya mokwanira, makamaka chifukwa cha matenda oopsa a m'mapapo omwe amachititsa kuti madzi kapena sputum azikhala mu alveoli (Tizigawo tating'ono ta m'mapapo tomwe timasinthana ndi mpweya).Mpweya wa carbon dioxide ukhoza kukhala wabwinobwino kapena wotsika chifukwa wodwalayo amatha kupuma bwino.Wodwala yemwe ali ndi vuto loterolo - Hypoxaemia, nthawi zambiri amathandizidwa ndi okosijeni.

vuto la mpweya wabwino lomwe limayambitsa mpweya wochepa komanso kuchuluka kwa carbon dioxide.Zomwe zimatchedwanso hypercapnic kupuma kulephera - vutoli limayamba chifukwa cha kulephera kwa mpweya kwa wodwala kapena kupuma, zomwe zimapangitsa kuti mpweya wa carbon-di-oxide uunjike.Kuchuluka kwa CO2 ndiye kumawalepheretsa kupuma - mpweya wokwanira.Matendawa nthawi zambiri amafunikira thandizo la mpweya wabwino kuti athandizire odwala.

Chifukwa chiyani zida za Low Flow Oxygen Therapy sizokwanira pamilandu yovuta?

Zikavuta kwambiri chifukwa chiyani timafunikira chithandizo cha okosijeni wothamanga kwambiri m'malo mogwiritsa ntchito ma concentrator osavuta a okosijeni?

Minofu ya m’thupi lathu imafunika mpweya kuti ukhale ndi moyo.Kuperewera kwa okosijeni kapena hypoxia m'matumbo kwa nthawi yayitali (kupitilira mphindi 4) kungayambitse kuvulala koopsa pamapeto pake kumabweretsa kufa.Ngakhale kuti dokotala amatenga nthawi kuti awone zomwe zimayambitsa, kuwonjezereka kwa oxygen panthawiyi kungalepheretse imfa kapena kulemala.

Munthu wamkulu wabwinobwino amapuma 20-30 malita a mpweya pa mphindi imodzi pansi zolimbitsa ntchito mlingo.21% ya mpweya umene timapuma ndi mpweya, mwachitsanzo pafupifupi malita 4-6 / mphindi.FiO2 kapena kachigawo kakang'ono ka okosijeni wowuziridwa pankhaniyi ndi 21%.

Komabe, zikavuta kwambiri, kusungunuka kwa okosijeni m'magazi kumatha kukhala kotsika.Ngakhale pamene mpweya wouzira / wokoka mpweya uli 100%, mpweya wosungunuka ungapereke gawo limodzi mwa magawo atatu a mpweya wopuma.Chifukwa chake, njira imodzi yothanirana ndi hypoxia ya minofu ndikuwonjezera kagawo kakang'ono ka mpweya wouziridwa (Fio2) kuchokera ku 21%.Pazovuta zambiri, kuchuluka kwa okosijeni wa 60-100% kwakanthawi kochepa (ngakhale mpaka maola 48) kumatha kupulumutsa moyo mpaka chithandizo chapadera chiganizidwe ndikuperekedwa.

Kuyenerera kwa Zida Za Oxygen Otsika Pakusamalira Kwambiri

Machitidwe otsika otsika amakhala otsika kwambiri kuposa momwe amachitira mayendedwe olimbikitsa (Kuthamanga kwachizolowezi kumakhala pakati pa 20-30litres / mphindi monga tafotokozera pamwambapa).Mayendedwe otsika otsika monga ma concentrators okosijeni amatulutsa mayendedwe a 5-10 malita / m.Ngakhale kuti amapereka mpweya wa okosijeni mpaka 90%, popeza wodwalayo amafunika kutulutsa mpweya m'chipinda kuti apange kufunikira kokwanira koyendetsa mpweya - FiO2 yonse ikhoza kukhala yabwino kuposa 21% koma imakhala yosakwanira.Kuonjezera apo, pamayendedwe otsika a okosijeni (<5 l / min) kupuma kwakukulu kwa mpweya wa stale exhaled kumatha kuchitika chifukwa mpweya wotuluka sumatulutsidwa mokwanira kuchokera kumaso.Izi zimapangitsa kuti mpweya woipa wochuluka ukhale wochuluka komanso umachepetsanso kuwonjezereka kwa mpweya/oxygen.

Komanso pamene mpweya umaperekedwa pamtunda wa 1-4 l / min ndi chigoba kapena mphuno zamphuno, oropharynx kapena nasopharynx (airways) amapereka chinyezi chokwanira.Pakuthamanga kwapamwamba kapena pamene mpweya umaperekedwa mwachindunji ku trachea, chinyezi china chakunja chimafunika.Machitidwe otsika otsika alibe zida zochitira zimenezo.Kuphatikiza apo, FiO2 siyingakhazikitsidwe molondola mu LF.

Pazinthu zonse zotsika mpweya wa okosijeni sizingakhale zoyenera pazovuta za hypoxia.

Kuyenerera kwa Zida Zapamwamba za Oxygen Pakusamalira Kwambiri

Mayendedwe a High Flow ndi omwe amatha kufanana kapena kupitilira kuchuluka kwa mayendedwe olimbikitsa - mwachitsanzo 20-30 malita / mphindi.Makina othamanga kwambiri omwe akupezeka masiku ano amatha kutulutsa mitengo pakati pa 2-120 malita / mphindi ngati ma ventilators.FiO2 ikhoza kukhazikitsidwa molondola ndikuwunikidwa.FiO2 ikhoza kukhala pafupifupi 90-100%, popeza wodwala sayenera kupuma mpweya uliwonse wam'mlengalenga komanso kutaya mpweya ndikosavuta.Kupumulanso kwa gasi wotha ntchito si vuto chifukwa chigoba chimasunthidwa ndi kuchuluka kwakuyenda.Amawonjezeranso chitonthozo cha odwala posunga chinyezi ndi kutentha kokwanira mu gasi kuti azipaka mphuno.

Ponseponse, machitidwe othamanga kwambiri sangangowonjezera mpweya wa okosijeni monga momwe amafunikira pazovuta kwambiri, komanso amachepetsa ntchito ya kupuma, zomwe zimapangitsa kuti mapapu a odwala azivutika kwambiri.Chifukwa chake amayenererana bwino pazifukwa zowopsa za kupuma.

Kodi Zigawo za Mphuno Yapamwamba ya Nasal Cannula vs Ventilator ndi ziti?

Tawona kuti njira yochepetsera mpweya wa okosijeni (HFOT) ndiyofunika kwambiri pochiza matenda opumira kwambiri.Tiyeni tiwone momwe makina a High Flow (HF) amasiyanirana ndi mpweya wabwino.Kodi zigawo zosiyanasiyana za makina onsewa ndi ziti ndipo zimasiyana bwanji pakugwira ntchito kwawo?

Makina onsewa ayenera kulumikizidwa ku gwero la okosijeni m'chipatala monga mapaipi kapena silinda.Njira yoperekera mpweya wabwino kwambiri ndi yosavuta - yokhala ndi a

jenereta yotulutsa,

chosakaniza ndi mpweya wa oxygen,

mpweya wonyezimira,

moto chubu ndi

chipangizo chotumizira mwachitsanzo kanula wa m'mphuno.

Ventilator imagwira ntchito

Mpweya wolowera mpweya kumbali ina ndi wokulirapo.Sikuti ili ndi zigawo zonse za HFNC, ilinso ndi njira zopumira, zowongolera ndi zowunikira limodzi ndi ma alarm kuti azitha kuyendetsa bwino, kuwongolera, komanso mpweya wabwino kwa wodwalayo.

Zofunikira kwambiri pakukonza mpweya wabwino wamakina ndi:

Mpweya wabwino, (voliyumu, kuthamanga kapena kuwirikiza),

Makhalidwe (kuwongolera, kuthandizidwa, kuthandizira mpweya wabwino), ndi

Magawo opuma.Zofunikira zazikulu ndi kuchuluka kwa mafunde ndi kuchuluka kwa mphindi mumayendedwe a voliyumu, kuthamanga kwambiri (munjira zokakamiza), pafupipafupi kupuma, kupanikizika komaliza, nthawi yopumira, kuthamanga kwa mpweya, chiŵerengero cha kupuma kwa mpweya, nthawi yopuma, kukhudzika, kuthandizira. pressure, ndi expiratory trigger sensitivity etc.

Ma alarm - Kuti azindikire zovuta mu mpweya wabwino ndi kusintha kwa wodwalayo, ma alarm a mafunde ndi mphindi zochepa, kuthamanga kwapamwamba, kupuma kwafupipafupi, FiO2, ndi apnea zilipo.

Kuyerekeza koyambira kwa mpweya wabwino ndi HFNC

Kufananiza pakati pa Ventilator ndi HFNC

Kuyerekeza kwa HFNC ndi Ventilator

Mpweya wabwino vs HFNC - Ubwino ndi Zowopsa

Mpweya wabwino ukhoza kukhala Wosokoneza kapena Wosasokoneza.Ngati pali mpweya wabwino, chubu chimalowetsedwa kudzera pakamwa kupita m'mapapo kuti chithandizire mpweya wabwino.Madokotala amakonda kupewa intubation momwe angathere chifukwa cha zomwe zingawononge wodwalayo komanso zovuta kuzisamalira.

Intubation ngakhale sizowopsa payokha, imatha kuyambitsa

Kuvulala m'mapapo, trachea kapena mmero etc. ndi/kapena

Pakhoza kukhala chiwopsezo cha kuchuluka kwamadzimadzi,

Aspiration kapena

Matenda a m'mapapo.

Nonvasive mpweya wabwino

Mpweya wabwino wosasokoneza ndi njira yabwino kwambiri momwe mungathere.NIV imapereka chithandizo cha mpweya wodziwikiratu poyika mpweya wabwino m'mapapo kunja, kudzera mu chigoba cha kumaso chomwe chimagwiritsidwa ntchito nthawi zambiri cholumikizidwa ndi makina a chinyezi, chotenthetsera chinyontho kapena chotenthetsera kutentha ndi chinyezi, ndi chothandizira mpweya.Njira yomwe imagwiritsidwa ntchito kwambiri imaphatikiza mpweya wothandizira (PS) komanso mpweya wabwino wakumapeto kwa mpweya (PEEP), kapena kungoyika kupanikizika kosalekeza kwa airway (CPAP).Thandizo lopanikizika limakhala losiyana malinga ndi momwe wodwalayo akupumira kapena kunja ndi kupuma kwawo.

NIV imathandizira kusinthana kwa gasi ndikuchepetsa kulimbikira chifukwa cha kukakamizidwa kwabwino.Imatchedwa "osasokoneza" chifukwa imaperekedwa popanda intubation.Komabe, NIV ikhoza kuyambitsa kuchuluka kwa mafunde omwe amalimbikitsidwa ndi kukakamizidwa komanso zomwe zitha kukulitsa kuvulala komwe kunalipo kale m'mapapo.

Ubwino wa HFNC

Ubwino winanso wopereka mpweya wochuluka kudzera m'mphuno ndi kutulutsa mpweya wa mpweya mosalekeza ndikutulutsa mpweya wabwino wa CO2.Izi zimachepetsa ntchito ya kupuma kwa wodwalayo komanso kumapangitsa kuti mpweya ukhale wabwino.Kuphatikiza apo, chithandizo cha okosijeni chothamanga kwambiri chimatsimikizira FiO2 yapamwamba.HFNC imapereka chitonthozo chabwino kwa odwala kudzera mu mpweya wotenthedwa ndi wonyowa womwe umaperekedwa kudzera m'mphuno pafupipafupi.Kuthamanga kosalekeza kwa gasi mu dongosolo la HFNC kumapanga zovuta zosiyanasiyana mumayendedwe a mpweya malinga ndi kupuma kwa wodwalayo.Poyerekeza ndi mankhwala ochiritsira (Low Flow) okosijeni kapena mpweya wosasunthika, kugwiritsa ntchito mpweya wabwino wa okosijeni kungachepetse kufunikira kwa intubation.

Ubwino wa HFNC

Njira zothandizira odwala omwe ali ndi vuto la kupuma kwapang'onopang'ono cholinga chake ndi kupereka mpweya wokwanira.Pa nthawi yomweyo n`kofunika kusunga kapena kulimbikitsa wodwala m`mapapo ntchito popanda straining kupuma minofu.

Chifukwa chake HFOT ikhoza kuonedwa ngati njira yoyamba yoperekera mpweya kwa odwalawa.Komabe, kuti mupewe vuto lililonse chifukwa cha kuchedwa kwa mpweya / intubation, kuwunika nthawi zonse ndikofunikira.

Chidule cha zabwino ndi zoopsa za HFNC vs Ventilation

Ubwino motsutsana ndi chiwopsezo cha mpweya wabwino ndi HFNC

Kugwiritsa ntchito HFNC ndi ma ventilator pochiza COVID

Pafupifupi 15% ya milandu ya COVID19 akuti imafunikira chithandizo cha okosijeni ndipo ochepera 1/3 mwaiwo angafunike kupita kumalo opumira.Monga tanena kale opereka chithandizo chovuta amapewa kulowetsa momwe angathere.Thandizo la okosijeni limatengedwa ngati mzere woyamba wothandizira kupuma kwa milandu ya hypoxia.Kufuna kwa HFNC kotero kwakwera m'miyezi yaposachedwa.Mitundu yotchuka ya HFNC pamsika ndi Fisher & Paykel, Hamilton, Resmed, BMC etc.