"Muvakidzani wangu aonekwa kuti ane Covid-positive uye akapinzwa muchipatara chiri pedyo", akadaro nhengo yeboka reWhatsApp mazuva mashoma apfuura.Imwe nhengo yakabvunza kana aive pamhepo inofefetera?Nhengo yekutanga yakapindura kuti aive pa'Oxygen Therapy'.Imwe nhengo yechitatu yakapinda, ichiti, “O!izvozvo hazvina kunyanya kuipa.Amai vangu vanga vachishandisa Oxygen concentrator kweanoda kusvika makore maviri ikozvino. "Imwe nhengo ine ruzivo yakati, “Hazvina kufanana.Oxygen concentrator is Low Flow Oxygen Therapy uye zviri kushandiswa nezvipatara kurapa varwere vakaoma, ndeye High Flow Oxygen therapy.
Wese munhu aishamisika, chii chaizvo chaive musiyano pakati peVentilator neOxygen therapy - Kuyerera Kwepamusoro kana Kuyerera Kwakaderera?!
Wese munhu anoziva kuve paventilator kwakakomba.Kuve pakurapa oxygen kwakakomba zvakadii?
Oxygen Therapy vs Ventilation muCOVID19
Oxygen therapy yave iyo buzz-izwi mukurapa varwere veCOVID19 mumwedzi ichangopfuura.Kurume-Chivabvu 2020 yakaona kupokana kunopenga kweVentilators muIndia nepasirese.Hurumende nevanhu pasi rese vakadzidza nezve nzira iyo COVID19 inogona kutungamira mukudzikira kweokisijeni mumuviri chinyararire.Zvakaonekwa kuti vamwe varwere vaifema vaive neokisijeni saturation kana SpO2 mazinga akaderedzwa kusvika kunyange 50-60%, panguva yavakasvika kuChipatara Emergency Room vasina kunzwa zvimwe zvakawanda.
Iyo yakajairika oxygen saturation range ndeye 94-100%.Oxygen saturation <94% inotsanangurwa se'Hypoxia'.Hypoxia kana Hypoxemia inogona kukonzera kufema uye kutungamirira kune Acute Respiratory Distress.Wese munhu ainyanya kufunga maVentilators yaive mhinduro yeacute Covid19 varwere.Nekudaro, nguva pfupi yadarika nhamba dzakaratidza kuti vangangosvika gumi neina muzana chete revanhu vane COVID-19 vanokura zviri pakati nepakati kusvika kuhurwere hwakakomba uye vanoda kuchipatara uye nerutsigiro rweokisijeni, paine imwe 5% chete vanotoda kupindirwa muIntensive Care Unit uye marapiro anotsigira anosanganisira intubation uye. kufefetedza.
Mune mamwe mazwi 86% yeavo vakaedza kuti COVID19 vangangove asymptomatic kana kuratidza zvinyoro-kusvika-zvine mwero zviratidzo.
Vanhu ava havadi kurapwa kweokisijeni kana kufefeterwa, asi 14% yataurwa pamusoro inodaro.WHO inokurudzira kuwedzera okisijeni kurapwa nekukurumidza kune varwere vane kufema kunetseka, hypoxia/hypoxaemia kana kuvhunduka.Chinangwa cheokisijeni kurapwa ndechekudzosa yavo oxygen saturation level kusvika> 94%.
Zvaunoda kuziva nezve High Flow Oxygen Therapy
Kana iwe kana mudiwa wako mukaitika kuti muri muchikamu che14% chataurwa pamusoro - ungangoda kuziva zvakawanda nezveokisijeni kurapwa.
Iwe unogona kuda kuziva kuti okisijeni kurapwa kwakasiyana sei neventilator.
Ndeapi akasiyana midziyo yeokisijeni uye masisitimu ekutumira?
Vanoshanda sei?Ndezvipi zvakasiyana-siyana zvinoumba?
Midziyo iyi yakasiyana sei mukugona kwayo?
Vanosiyana sei mukubatsira kwavo uye njodzi?
Ndezvipi zviratidzo - Ndiani anoda oxygen kurapwa uye ndiani anoda Ventilator?
Verenga kuti uzive zvimwe…
Chishandiso cheokisijeni chekurapa chakasiyana sei nemudziyo wekufemesa?
Kuti tinzwisise kuti mudziyo weokisijeni wekurapa wakasiyana sei nemhepo inofefetera, tinofanira kutanga tanzwisisa musiyano uripo pakati peVentilation neOxygenation.
Ventilation vs oxygenation
Ventilation - Kufemesa ibasa renguva dzose, kufema kwega, kusanganisira maitiro ekufema uye kufema.Kana murwere asingakwanisi kuita maitiro aya ega, anogona kuiswa pamhepo inofefetera, inovaitira.
Oxygenation - Kufefetedza kwakakosha pakuchinjana kwegasi kureva kuendeswa kweokisijeni kumapapu uye kubviswa kwecarbon dioxide mumapapu.Oxygenation inongova chikamu chekutanga chekuchinjana gasi kureva kuendeswa kweokisijeni kumatishu.
Musiyano uripo pakati peHigh Flow Oxygen therapy uye Ventilator mune essence ndeinotevera.Kurapa okisijeni kunosanganisira chete kukupa imwe okisijeni - mapapu ako achiri kuita basa rekutora mweya wakapfuma-okisijeni mukati uye kufema mweya wakapfuma wecarbon-di-oxide kunze.Yekufefetera haingope iwe yakawedzera okisijeni, inoitawo basa remapapu ako - femera mukati & kunze.
Ndiani (Rudzi rwemurwere) anoda Oxygen kurapwa & ndiani anoda kufefetedza?
Kuti ushandise kurapa kwakakodzera, munhu anoda kuona kana nyaya nemurwere ikushaya oxygenation kana kutadza kufema zvakanaka.
Kutadza kufema kunogona kuitika nekuda kwe
nyaya yeokisijeni inoguma neokisijeni yakaderera asi yakajairika - yakaderera mwero wecarbon dioxide.Iyo inozivikanwawo se hypoxaemic kufema kutadza kufema - izvi zvinoitika kana mapapu asingakwanise kutora mweya weokisijeni zvakaringana, kazhinji nekuda kwezvirwere zvemapapu zvinokonzeresa kuti mvura kana sputum ipinde mualveoli (Zvimiro zvidiki-sesac zvemapapu zvinochinjana magasi).Carbon dioxide mwero inogona kunge yakajairika kana kuti yakaderera sezvo murwere achikwanisa kufema zvakanaka.Murwere ane chirwere chakadaro - Hypoxaemia, kazhinji anorapwa neokisijeni therapy.
nyaya yekufemesa mweya inokonzera kuderera kweokisijeni pamwe nekuwanda kwekabhoni dhaikisaidhi.Iyo inozivikanwawo sekuti hypercapnic kufema kukundikana - chirwere ichi chinokonzerwa nekutadza kwemurwere kufema kana kufema-kunze, zvichikonzera kuunganidzwa kwecarbon-di-oxide.CO2 kuunganidzwa kunobva kwadzidzivirira kubva pakufema-mu oxygen yakakwana.Chimiro ichi chinowanzoda rutsigiro rwemhepo inofefetera kurapa varwere.
Sei Low Flow Oxygen Therapy zvishandiso zvisina kukwana kune acute kesi?
Muzviitiko zvakakomba nei tichida yakanyanya kuyerera okisijeni kurapwa pane kushandisa nyore okisijeni concentrators?
Matishu ari mumuviri wedu anoda oxygen kuti tirarame.Kushomeka kweokisijeni kana hypoxia mumatishu kwenguva yakareba (kupfuura maminetsi e4) kunogona kukonzera kukuvara kwakakomba kunozopedzisira kwakonzera kufa.Nepo chiremba achigona kutora nguva kuti aongorore zvikonzero, kuwedzera oxygen kuendeswa panguva iyi kunogona kudzivirira kufa kana kuremara.
Munhu mukuru anofema 20-30 litres emhepo paminiti pasi pechiito chine mwero chekuita.21% yemhepo yatinofema iokisijeni, kureva kuti 4-6 litres paminiti.Iyo FiO2 kana chikamu cheokisijeni yakafuridzirwa munyaya iyi i21%.
Zvisinei, mumamiriro ezvinhu akaoma, kunyungudika kweokisijeni muropa kunogona kunge kwakaderera.Kunyangwe kana iyo yakafemerwa/yakafemerwa mweya yeokisijeni iri 100%, okisijeni yakanyungudika inogona kupa chikamu chimwe chete muzvitatu chekuzorora kwetishu okisijeni zvinodiwa.Naizvozvo, imwe nzira yekugadzirisa tishu hypoxia ndeyekuwedzera chikamu cheokisijeni yakafuridzirwa (Fio2) kubva kune yakajairika 21%.Mumamiriro ezvinhu akanyanya kuoma, mweya weokisijeni wakafuridzirwa we60-100% kwenguva pfupi (kunyangwe kusvika maawa makumi mana nemasere) unogona kuponesa hupenyu kusvika kumwe kurapa kwakanyatso kusarudzwa nekupihwa.
Kukodzera kweLow Flow Oxygen Devices for Acute Care
Kuyerera kwakadzika masisitimu ane kuyerera kwakaderera pane kufemerwa kuyerera (Normal inspiratory flow is between 20-30litres/miniti sezvataurwa pamusoro).Low flow masisitimu akadai seokisijeni concentrators anogadzira kuyerera kwe5-10 litres/m.Kunyange zvazvo vachipa oxygen concentration inosvika kunyange 90%, sezvo murwere achida kufemera mukamuri mhepo kuti agadzirise kuenzana kufemerwa kuyerera kunodiwa - iyo yose FiO2 inogona kunge iri nani kupfuura 21% asi ichiri isina kukwana.Uyezve, pamwero wakaderera weokisijeni inoyerera (<5 l/min) kufema kwakakosha kwemweya wakareruka wakafemerwa kunogona kuitika nekuti mweya wakabuditswa hauna kugezwa zvakakwana kubva pachiso chemeso.Izvi zvinoguma nekuchengetwa kwepamusoro kwekabhoni dhaikisaidhi uye zvakare kunoderedza kuwedzera kutorwa kwemweya mutsva/okisijeni.
Uyewo kana okisijeni ichiendeswa pamwero wekuyerera kwe1-4 l/min nemasiki kana nasal prongs, oropharynx kana nasopharynx (airways) inopa humidification yakakwana.Pakuyerera kwemazinga epamusoro kana apo okisijeni inounzwa zvakananga kune trachea, kuwedzera kwekunze humidification kunodiwa.Low flow masisitimu haana kushongedzerwa kuita kudaro.Pamusoro pezvo, FiO2 haigone kuiswa nemazvo muLF.
Pamusoro pese yakaderera kuyerera okisijeni masisitimu anogona kunge asina kukodzera kune acute kesi dze hypoxia.
Kukodzera kweYakakwira Flow Oxygen Zvishandiso zveAcute Care
High Flow masisitimu ndeaya anogona kuenderana kana kudarika espiratory flow rate - kureva 20-30 litres/miniti.Yakakwira Flow masisitimu aripo nhasi anogona kuburitsa mitengo yekuyerera chero pakati pe2-120 litres/miniti zvakanyanya senge maventilator.FiO2 inogona kunyatsogadziriswa uye kuongororwa.FiO2 inogona kunge ingangoita 90-100%, sezvo murwere asingade kufema chero mweya wemuchadenga uye kurasikirwa kwegasi hakuna basa.Kufemazve kwegasi rakapera harisi dambudziko nekuti mask inoputirwa neiyo yakanyanya kuyerera mitengo.Ivo zvakare vanowedzera kunyaradzwa kwevarwere nekuchengetedza hunyoro uye kupisa kwakakwana mugasi kuzora mumhino.
Pakazere, masisitimu ekuyerera akakwira haangogone kuvandudza oxygenation sezvinodiwa mumamiriro ezvinhu akaomarara, asi zvakare kuderedza basa rekufema, zvichikonzera kuderera kwakanyanya kumapapu evarwere.Saka ivo vakanyatsokodzera chinangwa ichi mune acute kesi dzekufema kunetseka.
Ndezvipi Zvikamu zveYakakwira Kuyerera Nasal Cannula vs Ventilator?
Isu taona kuti inokwana yakanyanya kuyerera okisijeni therapy (HFOT) system inodiwa kurapa acute kufema kutadza kutadza.Ngationgororei kuti iyo Yepamusoro Flow (HF) system inosiyana sei neventilator.Ndezvipi zvakasiyana-siyana zvemichina yacho uye inosiyana sei mukushanda kwayo?
Michina yese iri miviri inoda kubatanidzwa kune okisijeni sosi muchipatara senge pombi kana silinda.A high-flow oxygen therapy system iri nyore - inosanganisira a
jenareta,
air-oxygen blender,
humidifier,
inopisa chubhu uye
mudziyo wekutumira semuenzaniso kanula yemumhino.
Ventilator inoshanda
A ventilator kune rumwe rutivi yakawedzera.Haisi chete ine zvikamu zvese zveHFNC, zvakare ine kufema, kutonga uye yekutarisa masisitimu pamwe nemaalarm ekuita yakachengeteka, inodzorwa, programmable ventilation yemurwere.
Iwo akanyanya kukosha ma paramita ekuronga mune mechanic ventilation ndeaya:
The ventilation mode, (vhoriyamu, kudzvanywa kana maviri),
Modality (inodzorwa, yakabatsirwa, inotsigira mhepo), uye
Zvimiro zvekufema.Iwo makuru ma paramita ndeye tidal volume uye miniti vhoriyamu muvhoriyamu modalities, peak pressure (mukumanikidza modalities), kufema frequency, positive end expiratory pressure, inspiratory time, inspiratory flow, inspiratory-to-expiratory ratio, nguva yekumbomira, trigger sensitivity, tsigiro. pressure, uye expiratory trigger sensitivity etc.
Alarms - Kuona matambudziko mumhepo inofefetera uye shanduko mumurwere, maalarm emvura uye miniti vhoriyamu, peak pressure, kufema frequency, FiO2, uye apnea zviripo.
Iyo yakakosha chikamu kuenzanisa yeventilator uye HFNC
Feature kuenzanisa pakati peVentilator neHFNC
Feature kuenzanisa HFNC uye Ventilator
Ventilation vs HFNC - Mabhenefiti uye Njodzi
Ventilation inogona kuva Invasive kana Non-invasive.Kana paine invasive ventilation chubhu inopinzwa nemumuromo kuenda kumapapu kubatsira mukufemesa.Vanachiremba vanofarira kudzivirira intubation zvakanyanya sezvinobvira nekuda kwekugona kukanganisa kukanganisa kumurwere uye kuomerwa mukuzvibata.
Intubation nepo isiri yakakomba pachayo, inogona kukonzera
Kukuvara kumapapu, trachea kana huro nezvimwewo uye/kana
Panogona kuve nenjodzi yeFluids kuvaka-up,
Aspiration kana
Matambudziko emumapapu.
Non-invasive ventilation
Non-invasive ventilation isarudzo inosarudzwa sezvinobvira.NIV inopa rubatsiro rwekufemesa kwega nekuisa kudzvanya kwakanaka mumapapu kunze, kuburikidza neanowanzo shandiswa mask kumeso akabatanidzwa kune humidification system, inopisa humidifier kana kupisa nehunyoro exchanger, uye mhepo inofefetera.Iyo inonyanya kushandiswa modhi inosanganisa tsigiro yerutsigiro (PS) kufefetedza pamwe neiyo yakanaka kupera-expiratory pressure (PEEP), kana kungoisa continuous positive airway pressure (CPAP).Tsigiro yekumanikidza inosiyana zvichienderana nekuti murwere ari kufema mukati kana kunze uye nekufema kwavo kuedza.
NIV inovandudza kuchinjana kwegasi uye inoderedza simba rekusimudzira kuburikidza nekumanikidza kwakanaka.Inonzi "isina-invasive" nekuti inounzwa pasina chero intubation.NIV inogona zvakadaro kukonzera kuwanda kwemvura inosimudzirwa nerutsigiro rwekumanikidza uye izvo zvinogona kuwedzera kukuvara kwemapapu kwagara kuripo.
Kubatsira kweHFNC
Imwe bhenefiti yekuunza yakakwira kuyerera kuburikidza nenasal cannula ndeyekuenderera mberi nekuburitsa kunze kwepamusoro pemhepo nzvimbo yakafa neCO2 clearance.Izvi zvinoderedza basa rekufema kumurwere uye kunatsiridza oxygenation.Mukuwedzera, kuyerera kwakanyanya kweokisijeni kurapwa kunovimbisa yakakwira FiO2.HFNC inopa kunyaradza kwemurwere kwakanaka kuburikidza nekudziya uye kunyoroveswa gasi kuyerera kunounzwa kuburikidza nemhino prongs pamwero wakatsiga.Kugara kuyerera kwegasi muHFNC system inoburitsa madhindindi akasiyana mumhepo inoenderana nekufema kwemurwere.Kuenzaniswa neyakajairwa (Low Flow) okisijeni therapy kana mhepo isina kuvharika, kushandiswa kwepamusoro kuyerera kweokisijeni therapy kunogona kuderedza kudiwa kweiyo intubation.
HFNC Benefits
Maitiro ekurapa murwere ane acute kufema mamiriro ane chinangwa chekupa yakakwana oxygenation.Panguva imwecheteyo zvakakosha kuchengetedza kana kusimbisa basa remapapu remurwere pasina kunetsa mhasuru dzekufema.
HFOT saka inogona kutariswa seyekutanga-mutsara zano reokisijeni muvarwere ava.Nekudaro, kudzivirira chero kukuvadzwa nekuda kwekunonoka kufefetera / intubation, kugara uchitarisa kwakakosha.
Pfupiso yemabhenefiti uye njodzi dzeHFNC vs Ventilation
Benefits vs njodzi yeventilator uye HFNC
Kushandiswa kweHFNC uye mavheiri mukurapa COVID
Vanosvika gumi neshanu muzana veCCIDID-19 nyaya dzinofungidzirwa kuti dzinoda kurapwa kweokisijeni uye isingasviki 1/3rd yavo inogona kuenda kumhepo.Sezvambotaurwa kare varapi vakakomba vanodzivirira intubation zvakanyanya sezvinobvira.Oxygen therapy inoonekwa seyekutanga mutsara wekufema kutsigira nyaya dze hypoxia.HFNC inoda saka yakakwira mumwedzi ichangopfuura.Mhando dzakakurumbira dzeHFNC pamusika ndiFisher & Paykel, Hamilton, Resmed, BMC nezvimwe.
Nguva yekutumira: Feb-03-2022