Amakuru

Hashize iminsi mike umwe mu bagize itsinda rya WhatsApp yagize ati: "Umuturanyi wanjye yagaragaye ko afite Covid kandi yinjiye mu bitaro biri hafi".Undi munyamuryango yabajije niba ari kuri ventilator?Umunyamuryango wa mbere yashubije ko yari kuri 'Oxygene Therapy'.Umunyamuryango wa gatatu yatontomye, agira ati: “Yoo!ibyo ntabwo ari bibi cyane.Mama amaze imyaka igera kuri 2 akoresha intumbero ya Oxygene. ”Undi munyamuryango uzi ubumenyi yagize ati: "Ntabwo ari kimwe.Oxygene yibanda cyane ni Ubuvuzi bwa Oxygene yo mu bwoko bwa Oxygene kandi ibyo ibitaro bifashisha mu kuvura abarwayi bakaze, ni uburyo bwo kuvura Oxygene yo mu bwoko bwa High Flow. ”

Abandi bose baribajije, ni irihe tandukaniro riri hagati yubuvuzi bwa Ventilator na Oxygene - Umuvuduko mwinshi cyangwa umuvuduko muke?!

Abantu bose bazi kuba kuri ventilator birakomeye.Ni kangahe kuba kuri ogisijeni ivura?

Ubuvuzi bwa Oxygene vs Ventilation muri COVID19

Ubuvuzi bwa Oxygene bwahindutse ijambo-mu kuvura abarwayi ba COVID19 mu mezi ashize.Werurwe-Gicurasi 2020 habaye umusazi kuri Ventilators mu Buhinde ndetse no ku isi yose.Guverinoma n'abantu ku isi bamenye uburyo COVID19 ishobora gutuma igabanuka rya ogisijeni mu mubiri bucece.Byagaragaye ko abarwayi bamwe badahumeka bafite ogisijene yuzuye cyangwa urugero rwa SpO2 rwaragabanutse kugera kuri 50-60%, mugihe bageze mucyumba cyihutirwa cy’ibitaro batumva ikindi kintu kinini.

Igipimo gisanzwe cya ogisijeni ni 94-100%.Kwiyongera kwa Oxygene <94% bisobanurwa ngo 'Hypoxia'.Hypoxia cyangwa Hypoxemia bishobora kuviramo guhumeka kandi biganisha ku bubabare bukabije bw'ubuhumekero.Buri wese yibwiraga ko Ventilator aricyo gisubizo kubarwayi ba Covid19.Nyamara, imibare iheruka kwerekana ko abantu bagera kuri 14% bonyine bafite indwara ya COVID-19 ari bo barwara indwara zidakabije kandi zikomeye kandi bisaba ko bajyanwa mu bitaro ndetse n’inkunga ya ogisijeni, hamwe na 5% bonyine bakeneye kwinjira mu ishami ryita ku barwayi bakomeye ndetse n’ubuvuzi bufasha harimo intubation na guhumeka.

Muyandi magambo, 86% byabapimwe neza kuri COVID19 baba badafite ibimenyetso cyangwa bagaragaza ibimenyetso byoroheje-bitagereranywa.

Aba bantu ntibakeneye kuvura ogisijeni cyangwa guhumeka, ariko 14% twavuze haruguru barabikeneye.OMS irasaba ubuvuzi bwa ogisijeni bwihuse kubarwayi bafite ibibazo byubuhumekero, hypoxia / hypoxaemia cyangwa ihungabana.Intego yo kuvura ogisijeni ni ukugarura urwego rwuzuye rwa ogisijeni kuri> 94%.

Ibyo ukeneye kumenya kubyerekeye Ubuvuzi Bwinshi bwa Oxygene

Mugihe wowe cyangwa uwo ukunda bibaye mubyiciro 14% byavuzwe haruguru - urashobora kumenya byinshi kubijyanye no kuvura ogisijeni.

Urashobora gushaka kumenya uburyo imiti ya ogisijeni itandukanye na ventilator.

Nibihe bikoresho bitandukanye bya ogisijeni na sisitemu zo gutanga?

Bakora bate?Ni ibihe bice bitandukanye?

Nigute ibyo bikoresho bitandukanye mubushobozi bwabo?

Nigute batandukanya inyungu zabo ningaruka zabo?

Ni ibihe bimenyetso - Ninde ukeneye kuvura ogisijeni kandi ninde ukeneye Ventilator?

Soma kugirango umenye byinshi…

Igikoresho cyo kuvura ogisijeni gitandukaniye he na ventilator?

Kugira ngo twumve uburyo igikoresho cyo kuvura ogisijeni gitandukanye na ventilator, tugomba mbere na mbere kumva itandukaniro riri hagati ya Ventilation na Oxygene.

Umuyaga vs ogisijeni

Guhumeka - Guhumeka nigikorwa cyo guhumeka bisanzwe, bidatinze, harimo inzira yo guhumeka no guhumeka.Niba umurwayi adashoboye gukora izi nzira wenyine, barashobora gushirwa kumuyaga, ubakorera.

Oxygene - Ventilation ningirakamaro muburyo bwo guhanahana gaze ni ukuvuga gutanga ogisijeni mu bihaha no kuvana karuboni ya dioxyde de mu bihaha.Oxygene ni igice cya mbere gusa cyo guhanahana gaze ni ukuvuga gutanga ogisijeni mu ngingo.

Itandukaniro hagati ya High Flow Oxygene ivura na Ventilator muri rusange ni ibi bikurikira.Ubuvuzi bwa Oxygene burimo kuguha gusa ogisijeni - ibihaha byawe biracyakora igikorwa cyo gufata umwuka ukungahaye kuri ogisijeni no guhumeka umwuka mwiza wa karuboni-di-oxyde.Umuyaga ntaguha gusa ogisijeni yongeyeho, ikora kandi akazi k'ibihaha byawe - guhumeka & hanze.

Ninde (Ni ubuhe bwoko bw'abarwayi) akeneye kuvura Oxygene & ninde ukeneye guhumeka?

Kugirango ushyire mubikorwa bikwiye, umuntu agomba kumenya niba ikibazo cyumurwayi ari ogisijeni nke cyangwa umwuka mubi.

Kunanirwa k'ubuhumekero bishobora kubaho kubera

ikibazo cya ogisijeni itera ogisijeni nkeya ariko isanzwe - urugero rwa dioxyde de carbone.Ikizwi kandi nka hypoxaemic kunanirwa guhumeka - ibi bibaho mugihe ibihaha bidashoboye kwinjiza ogisijene bihagije, mubisanzwe biterwa nindwara zikabije z ibihaha zitera amazi cyangwa spumum gufata alveoli (Inzira ntoya isa nisakoshi imeze nkibihaha ihanahana gaze).Dioxyde de Carbone irashobora kuba ibisanzwe cyangwa hasi kuko umurwayi abasha guhumeka neza.Umurwayi ufite ikibazo nk'iki - Hypoxaemia, muri rusange avurwa hakoreshejwe ogisijeni.

ikibazo cyo guhumeka gitera ogisijeni nkeya kimwe na gaze karuboni nyinshi.Ikizwi kandi nka hypercapnic kunanirwa guhumeka - iyi ndwara iterwa no kuba umurwayi adashobora guhumeka cyangwa guhumeka, bikaviramo kwirundanyiriza karuboni-di-oxyde.Kwiyegeranya kwa CO2 noneho bibabuza guhumeka-muri ogisijeni ihagije.Iyi miterere muri rusange isaba inkunga yumuyaga kugirango ivure abarwayi.

Ni ukubera iki ibikoresho bito bivura Oxygene yo kuvura bidahagije kubibazo bikaze?

Mubihe bikaze kuki dukeneye kuvura ogisijeni mwinshi aho gukoresha ingufu za ogisijeni yoroshye?

Uturemangingo two mu mubiri wacu dukenera ogisijeni kugirango tubeho.Ibura rya ogisijeni cyangwa hypoxia mu ngingo igihe kirekire (iminota irenga 4) bishobora gutera imvune ikomeye amaherezo iganisha ku rupfu.Mugihe umuganga ashobora gufata igihe kugirango asuzume ibitera, kongera itangwa rya ogisijeni hagati aho bishobora gukumira urupfu cyangwa ubumuga.

Umuntu mukuru usanzwe ahumeka muri litiro 20-30 z'umwuka kumunota murwego rwibikorwa biciriritse.21% byumwuka duhumeka-ni ogisijeni, ni ukuvuga hafi litiro 4-6 / umunota.FiO2 cyangwa agace ka ogisijeni yahumetswe muriki kibazo ni 21%.

Ariko, mubihe bikomeye, imbaraga za ogisijeni mumaraso zishobora kuba nke.Ndetse iyo umwuka wa ogisijeni wahumetswe / ushizwemo ni 100%, ogisijeni yashonze irashobora gutanga kimwe cya gatatu cyonyine cyo kuruhuka kwa ogisijeni.Kubwibyo, inzira imwe yo gukemura hypoxia tissue ni ukongera igice cya ogisijeni yahumetswe (Fio2) kuva kuri 21% bisanzwe.Mubihe byinshi bikaze, umwuka wa ogisijeni wahumetswe wa 60-100% mugihe gito (ndetse kugeza kumasaha 48) urashobora kurokora ubuzima kugeza igihe hashobora kuvurwa ubundi buryo bwihariye.

Birakwiriye Ibikoresho bito bya Oxygene yo Kwitonda cyane

Sisitemu yo gutemba ntoya ifite umuvuduko uri munsi yikigereranyo cyimyuka (Ubusanzwe guhumeka ni hagati ya 20-30litres / umunota nkuko byavuzwe haruguru).Sisitemu ntoya nka ogisijeni yibanze itanga umuvuduko wa litiro 5-10 / m.Nubwo zitanga umwuka wa ogisijeni kugeza kuri 90%, kubera ko umurwayi akeneye guhumeka umwuka wicyumba kugirango akemure ibyifuzo bisabwa - FiO2 muri rusange irashobora kuba nziza kurenza 21% ariko iracyari idahagije.Byongeye kandi, ku gipimo gito cya ogisijeni (<5 l / min) guhumeka gukomeye kwumwuka uhumeka bishobora kubaho kubera ko umwuka uhumeka udasohoka bihagije bivuye mumaso.Ibi bivamo kugumana cyane karuboni ya dioxyde kandi igabanya no gufata umwuka mwiza / ogisijeni.

Iyo kandi ogisijeni itanzwe ku kigero cya 1-4 l / min na mask cyangwa izuru, oropharynx cyangwa nasopharynx (inzira yumuyaga) itanga ubushuhe buhagije.Ku kigero cyo hejuru cyinshi cyangwa iyo ogisijeni itanzwe muri trachea, birakenewe ko hongerwaho ububobere bwo hanze.Sisitemu ntoya ntabwo ifite ibikoresho byo kubikora.Byongeye kandi, FiO2 ntishobora gushyirwaho neza muri LF.

Kuri sisitemu yo hasi ya ogisijeni ntishobora gukwirakwira mugihe gikabije cya hypoxia.

Birakwiriye Ibikoresho Byinshi bya Oxygene yo Kwita cyane

Sisitemu yo hejuru ya Flow nizo zishobora guhuza cyangwa kurenza igipimo cyo guhumeka - ni litiro 20-30 / umunota.Sisitemu yo hejuru ya Flow iboneka uyumunsi irashobora gutanga umuvuduko aho ariho hose hagati ya litiro 2-120 / umunota cyane nka ventilateur.FiO2 irashobora gushirwaho neza no gukurikiranwa.FiO2 irashobora kuba hafi 90-100%, kubera ko umurwayi adakeneye guhumeka ikirere icyo aricyo cyose kandi gutakaza gaze ni bike.Kuvugurura gaze yarangiye ntabwo ari ikibazo kuko mask ihindurwa nigipimo kinini.Bongera kandi ihumure ryumurwayi mukubungabunga ubushuhe nubushyuhe buhagije muri gaze kugirango basige amavuta yizuru.

Muri rusange, sisitemu yo hejuru ntishobora gusa guhindura ogisijeni nkuko bisabwa mugihe gikabije, ariko kandi igabanya akazi ko guhumeka, bigatuma imbaraga nke zihaha kubihaha byabarwayi.Kubwibyo, bikwiranye niyi ntego mubihe bikomeye byo guhumeka.

Nibihe bigize Ibice Byinshi Bitemba Amazuru Cannula vs Ventilator?

Twabonye ko byibuze sisitemu yo hejuru ya ogisijeni ivura (HFOT) isabwa kuvura indwara zikomeye zubuhumekero.Reka dusuzume uburyo sisitemu yo hejuru (HF) itandukanye na ventilator.Nibihe bintu bitandukanye bigize imashini zombi kandi bitandukaniye he mumikorere yabyo?

Imashini zombi zigomba guhuzwa nisoko ya ogisijeni mubitaro nkumuyoboro cyangwa silinderi.Sisitemu yo hejuru ya ogisijeni ivura sisitemu iroroshye - igizwe na a

amashanyarazi,

umwuka wa ogisijeni,

Ubushuhe,

Umuyoboro ushyushye kandi

igikoresho cyo gutanga urugero urugero urumogi.

Imikorere ya Ventilator

Umuyaga kurundi ruhande ni mwinshi.Ntabwo igizwe gusa nibice byose bigize HFNC, byongeye kandi ifite uburyo bwo guhumeka, kugenzura no kugenzura hamwe no gutabaza kugirango bikore neza, bigenzurwa, byoguhumeka neza kumurwayi.

Ibyingenzi byingenzi kuri gahunda muguhumeka ni:

Uburyo bwo guhumeka, (ingano, igitutu cyangwa bibiri),

Uburyo (kugenzurwa, gufashwa, gushyigikira umwuka), na

Ibipimo by'ubuhumekero.Ibipimo nyamukuru nubunini bwumunota nubunini bwumunota muburyo bwubunini, umuvuduko wimpanuka (muburyo bwumuvuduko), inshuro zubuhumekero, igitutu cyiza kirangirira, igihe cyo guhumeka, gutembera neza, guhumeka-kurangira, igihe cyo guhagarara, gukurura sensibilité, inkunga igitutu, na expiratory trigger sensitivite nibindi

Imenyesha - Kugirango umenye ibibazo biri muri ventilator nimpinduka kumurwayi, impuruza zingana numunota numunota, umuvuduko wimpanuka, inshuro zubuhumekero, FiO2, na apnea zirahari.

Ibice byibanze kugereranya umuyaga na HFNC

Kugereranya ibiranga hagati ya Ventilator na HFNC

Kugereranya ibiranga HFNC na Ventilator

Ventilation vs HFNC - Inyungu n'ingaruka

Guhumeka birashobora kuba Invasive cyangwa Ntibitera.Mugihe habaye umwuka uhumeka umuyoboro winjizwa mumunwa kugeza ibihaha kugirango ufashe guhumeka.Abaganga bakunda kwirinda intubation uko bishoboka kwose bitewe ningaruka zishobora guterwa umurwayi ningorane zo kubicunga.

Intubation nubwo idakomeye ubwayo, irashobora gutera

Gukomeretsa ibihaha, trachea cyangwa umuhogo nibindi na / cyangwa

Hashobora kubaho ibyago byo kwiyubaka,

Kwifuza cyangwa

Ibibazo by'ibihaha.

Guhumeka kudatera

Guhumeka kudatera ni uburyo bwatoranijwe uko bishoboka.NIV itanga ubufasha bwo guhumeka bidatinze ukoresheje igitutu cyiza mu bihaha hanze, binyuze mu masiki yo mu maso akunze gukoreshwa ahujwe na sisitemu yo guhumeka, ubushuhe bushyushye cyangwa guhinduranya ubushyuhe n’ubushuhe, hamwe na ventilator.Uburyo bukoreshwa cyane bukomatanya guhuza imbaraga (PS) guhumeka hiyongereyeho igitutu cyiza-kirangirire (PEEP), cyangwa ugashyiraho gusa igitutu cyiza cyumuyaga (CPAP).Inkunga yumuvuduko irahinduka ukurikije niba umurwayi ahumeka cyangwa hanze nimbaraga zabo zo guhumeka.

NIV itezimbere guhanahana gaze kandi igabanya imbaraga zubushakashatsi binyuze mumuvuduko mwiza.Yitwa "non-invasive" kuko itangwa nta intubation.NIV irashobora kuvamo umuvuduko mwinshi mwinshi utewe inkunga nigitutu kandi ibyo birashobora gukomeretsa ibikomere byihaha.

Ibyiza bya HFNC

Iyindi nyungu yo gutanga umwuka mwinshi wa ogisijeni unyuze mu mazuru ni ugukomeza gusohora inzira yo hejuru yumuyaga wapfuye ukoresheje CO2 neza.Ibi bigabanya akazi ko guhumeka umurwayi kandi bigatera okisijeni.Byongeye kandi, imiti myinshi ya ogisijeni ivura itanga FiO2 nyinshi.HFNC itanga ihumure ryumurwayi binyuze mumashanyarazi ashyushye kandi ashyushye atangwa binyuze mumazuru ku gipimo gihamye.Umuvuduko uhoraho wa gaze muri sisitemu ya HFNC itanga umuvuduko uhindagurika mumyuka ihumeka ukurikije imbaraga zumurwayi.Ugereranije nubuvuzi busanzwe (Low Flow) bwo kuvura ogisijeni cyangwa guhumeka neza, gukoresha imiti myinshi ya ogisijeni ivura bishobora kugabanya gukenera intubation.

Inyungu za HFNC

Ingamba zo kuvura abarwayi bafite uburwayi bukabije bwubuhumekero zigamije gutanga ogisijeni ihagije.Muri icyo gihe, ni ngombwa kubungabunga cyangwa gushimangira ibikorwa by’ibihaha by’umurwayi utiriwe unanura imitsi yubuhumekero.

HFOT rero ishobora gufatwa nkingamba ya mbere - umurongo wa ogisijeni muri aba barwayi.Ariko, kugirango wirinde ingaruka mbi ziterwa no gutinda guhumeka / intubation, guhora ukurikirana ni ngombwa.

Inshamake y'inyungu n'ingaruka za HFNC vs Ventilation

Inyungu vs ibyago kuri ventilator na HFNC

Gukoresha HFNC na ventilator mukuvura COVID

Hafi ya 15% by'indwara ya COVID19 bivugwa ko ikeneye kuvura ogisijeni kandi munsi ya 1/3 muri yo irashobora kwimukira mu mwuka.Nkuko byavuzwe haruguru abatanga ubuvuzi bukomeye birinda intubation kure hashoboka.Ubuvuzi bwa Oxygene bufatwa nkumurongo wambere wubufasha bwubuhumekero kubibazo bya hypoxia.Icyifuzo cya HFNC rero cyazamutse mu mezi ashize.Ibiranga ibyamamare bya HFNC ku isoko ni Fisher & Paykel, Hamilton, Resmed, BMC nibindi