Izindaba

"Umakhelwane wami utholakale une-Covid-positive futhi ungeniswe esibhedlela esiseduze", kubika ilungu leqembu le-WhatsApp ezinsukwini ezimbalwa ezedlule.Elinye ilungu labuza ukuthi ngabe usemshinini wokuphefumula?Ilungu lokuqala liphendule ukuthi empeleni liku-'Oxygen Therapy'.Ilungu lesithathu langena lathi, “O!lokho akukubi kakhulu.Umama useneminyaka engu-2 esebenzisa i-Oxygen concentrator.”Elinye ilungu elinolwazi liphawule lathi, “Akufani.I-oxygen concentrator i-Low Flow Oxygen Therapy futhi lokho izibhedlela ezikusebenzisela ukwelapha iziguli ezibucayi, i-High Flow Oxygen therapy.

Wonke omunye umuntu wayezibuza ukuthi, yini ngempela umehluko phakathi kokwelashwa kwe-Ventilator kanye ne-Oxygen - Ukugeleza Okuphezulu noma Ukugeleza Okuphansi?!

Wonke umuntu uyazi ukuba kwi-ventilator kubucayi.Kubi kangakanani ukuba ekwelashweni komoyampilo?

I-Oxygen Therapy vs Ventilation ku-COVID19

Ukwelashwa nge-oxygen sekuphenduke igama elivamile ekwelapheni iziguli ze-COVID19 ezinyangeni ezisanda kwedlula.NgoMashi-Meyi 2020 kwaba nesiphithiphithi sohlanya sama-Ventilator eNdiya nakuwo wonke umhlaba.Ohulumeni kanye nabantu emhlabeni wonke bafunde ukuthi i-COVID19 ingaholela kanjani ekwehliseni ukugcwala komoyampilo emzimbeni buthule.Kwaqashelwa ukuthi ezinye iziguli eziphefumulayo zine-oxygen saturation noma amazinga e-SpO2 ancishisiwe aze afinyelele ngisho ku-50-60%, ngesikhathi zifika eGumbi Lezimo Eziphuthumayo Esibhedlela ngaphandle kokuzwa okunye.

Ibanga elijwayelekile lokugcwala komoyampilo lingama-94-100%.Ukugcwala komoyampilo <94% kuchazwa njenge-'Hypoxia'.I-Hypoxia noma i-Hypoxemia ingase ibangele ukuphefumula futhi iholele ekucindezelekeni okunamandla kokuphefumula.Wonke umuntu ikakhulukazi wayecabanga ukuthi ama-Ventilators ayimpendulo yeziguli ezibucayi ze-Covid19.Kodwa-ke, izibalo zakamuva zikhombisile ukuthi cishe bangu-14% kuphela abantu abane-COVID-19 ababa nezifo ezibucayi futhi badinga ukulaliswa esibhedlela kanye nomoya-mpilo, kanti futhi bangu-5% kuphela abadinga ukwamukelwa ePhikweni Lokunakekelwa Kwabagula Kakhulu kanye nokwelashwa okusekelayo okuhlanganisa nokufaka intubation kanye ne-oxygen. ukungena komoya.

Ngamanye amazwi ama-86% alabo abahlolelwe ukuthi bane-COVID19 asymptomatic noma bakhombisa izimpawu ezithambile kuya kwezimaphakathi.

Laba bantu abadingi ukwelashwa komoyampilo noma ukungeniswa komoya, kodwa u-14% oshiwo ngenhla uyakufuna.I-WHO incoma ukwelashwa komoyampilo owengeziwe ngokushesha ezigulini ezinokucindezeleka kokuphefumula, i-hypoxia/hypoxaemia noma ukushaqeka.Inhloso yokwelashwa komoyampilo ukuthola izinga labo lokugcwala komoyampilo libuyele ku->94%.

Odinga ukukwazi nge-High Flow Oxygen Therapy

Uma kwenzeka wena noma othandekayo wakho nisesigabeni esingu-14% okukhulunywe ngaso ngenhla - ungase ufune ukwazi okwengeziwe mayelana nokwelashwa komoyampilo.

Ungase ufune ukwazi ukuthi i-oxygen therapy ihluke kanjani kune-ventilator.

Yiziphi izinhlobo ezahlukene zemishini yomoya-mpilo kanye nezinhlelo zokudiliva?

Zisebenza kanjani?Yiziphi izingxenye ezihlukahlukene?

Ihluke kanjani le mishini ngamakhono azo?

Zihluke kanjani ngezinzuzo nezingozi zazo?

Yiziphi izinkomba - Ubani odinga ukwelashwa komoyampilo futhi ubani odinga i-Ventilator?

Funda ukuze ukwazi okwengeziwe…

Ingabe idivayisi yokwelapha komoya-mpilo ihluke kanjani kumshini wokuphefumula?

Ukuze siqonde ukuthi idivayisi yokwelapha i-oxygen ihluke kanjani kumshini wokuphefumula, kufanele siqale siqonde umehluko phakathi kokungenisa umoya kanye nokukhipha umoya.

Ukungenisa umoya vs oxygenation

I-Ventilation - Ukuphefumula kuwumsebenzi wokuphefumula okuvamile, okuzenzakalelayo, okuhlanganisa izinqubo zokuhogela kanye nokukhipha umoya.Uma isiguli singakwazi ukwenza lezi zinqubo ngokwaso, singafakwa kumshini wokuphefumula, owenzela sona.

I-Oxygenation - Ukungena komoya kubalulekile enqubweni yokushintshanisa igesi okungukuthi ukulethwa komoyampilo emaphashini kanye nokukhishwa kwe-carbon dioxide emaphashini.Ukukhipha umoya-mpilo kuyingxenye yokuqala kuphela yenqubo yokushintshisana ngegesi okungukuthi ukulethwa komoyampilo ezicutshini.

Umehluko phakathi kokwelashwa kwe-High Flow Oxygen kanye ne-Ventilator empeleni yilokhu okulandelayo.Ukwelashwa komoyampilo kuhilela ukukunikeza umoya-mpilo owengeziwe kuphela - iphaphu lakho lisawenza umsebenzi wokuthatha umoya onomoya-mpilo kanye nokuphefumula umoya ocebile we-carbon-di-oxide.I-ventilator ayigcini nje ngokukunika umoya-mpilo owengeziwe, futhi yenza umsebenzi wamaphaphu akho - phefumula futhi uphume.

Ubani (Hlobo luni lwesiguli) oludinga ukwelashwa nge-Oxygen futhi ubani odinga ukungena komoya?

Ukuze kusetshenziswe ukwelashwa okufanele, umuntu udinga ukunquma ukuthi inkinga ngesiguli iwukuba ne-oxygen empofu noma umoya ompofu.

Ukwehluleka Ukuphefumula kungenzeka ngenxa

inkinga ye-oxygenation eholela ku-oxygen ephansi kodwa evamile - amazinga aphansi e-carbon dioxide.Okwaziwa nangokuthi ukwehluleka ukuphefumula kwe-hypoxaemic - lokhu kwenzeka lapho amaphaphu engakwazi ukumunca umoya-mpilo ngokwanele, ngokuvamile ngenxa yezifo zamaphaphu ezinzima ezibangela ukuthi uketshezi noma isikhwehlela singene ku-alveoli (Izakhiwo ezincane zamaphaphu ezifana nesaka ezishintshana ngamagesi).Amazinga e-carbon dioxide angase abe avamile noma abe phansi njengoba isiguli sikwazi ukuphefumula kahle.Isiguli esinesimo esinjalo - i-Hypoxaemia, ngokuvamile selashwa ngokwelashwa komoyampilo.

inkinga yokuphefumula komoya ebangela umoya-mpilo omncane kanye namazinga aphezulu e-carbon dioxide.Kwaziwa nangokuthi ukwehluleka ukuphefumula kwe-hypercapnic - lesi simo sibangelwa ukungakwazi kwesiguli ukukhipha umoya noma ukuphefumula, okuholela ekunqwabeleni kwe-carbon-di-oxide.Ukunqwabelana kwe-CO2 bese kubavimbela ekuphefumuleni-okungenayo i-oxygen eyanele.Lesi simo ngokuvamile sidinga ukusekelwa kwe-ventilator ukwelapha iziguli.

Kungani amadivaysi e-Low Flow Oxygen Therapy enganele ezimweni ezibucayi?

Ezimweni ezinzima kungani sidinga ukwelashwa komoya-mpilo okugeleza okuphezulu kunokusebenzisa ama-concentrator alula we-oxygen?

Izicubu emizimbeni yethu zidinga umoya-mpilo ukuze ziphile.Ukushoda komoyampilo noma i-hypoxia ezicutshini isikhathi eside (ngaphezu kwemizuzu emi-4) kungabangela ukulimala okubi ekugcineni kuholele ekufeni.Nakuba udokotela engathatha isikhathi ukuhlola izimbangela eziyinhloko, ukwandisa ukulethwa komoyampilo okwamanje kungavimbela ukufa noma ukukhubazeka.

Umuntu omdala ojwayelekile uphefumula ngamalitha angama-20-30 omoya ngomzuzu ngaphansi kwezinga lomsebenzi omaphakathi.U-21% womoya esiwuphefumulayo uwumoya-mpilo, okungukuthi cishe amalitha ama-4-6 ngomzuzu.I-FiO2 noma ingxenye ye-oxygen ephefumulelwe kuleli cala ingama-21%.

Kodwa-ke, ezimeni ezinzima ukuncibilika komoyampilo egazini kungaba phansi.Noma ngabe ukugxilwa komoyampilo okuphefumulelwe/okuhogeliwe kungu-100%, i-oxygen encibilikisiwe ingase inikeze ingxenye eyodwa kwezintathu kuphela yezidingo ze-oxygen yezicubu eziphumulele.Ngakho-ke, enye indlela yokubhekana ne-tissue hypoxia ukukhulisa ingxenyana ye-oxygen ephefumulelwe (Fio2) kusuka ku-21 evamile.Ezimweni eziningi ezinzima, ukugxiliswa komoyampilo okuphefumulelwe okungu-60-100% isikhathi esifushane (ngisho namahora afinyelela kwangu-48) kungase kusindise ukuphila kuze kunqunywe ukwelashwa okuqondile okwengeziwe futhi kunikezwe.

Ukufaneleka Kwamadivayisi E-oksijeni Okugeleza Okuphansi Okunakekelwa Okubukhali

Amasistimu okugeleza okuphansi anokugeleza okuphansi kunezinga lokugeleza kokuphefumula (Ukugeleza okujwayelekile kokuphefumula kuphakathi kuka-20-30litres/umzuzu njengoba kushiwo ngenhla).Amasistimu okugeleza aphansi njengama-concentrator oksijini akhiqiza amazinga okugeleza angama-5-10 amalitha/m.Ngisho noma benikeza ukuhlushwa komoya-mpilo kuze kufike ku-90%, njengoba isiguli sidinga ukuhogela umoya wegumbi ukuze senze ibhalansi yokugeleza kokuphefumula kokuphefumula - i-FiO2 iyonke ingase ibe ngcono kune-21% kodwa inganele.Ukwengeza, kumazinga aphansi okugeleza komoyampilo (<5 l/min) ukuphefumula okubalulekile komoya okhishwe kudala kungase kwenzeke ngenxa yokuthi umoya okhishiwe awukhishwanga ngokwanele kumaski yobuso.Lokhu kubangela ukugcinwa okuphezulu kwe-carbon dioxide futhi kunciphisa ukutholakala okwengeziwe komoya/umoya-mpilo omusha.

Futhi lapho i-oksijeni ilethwa ngesilinganiso sokugeleza kwe-1-4 l/min nge-mask noma i-nasal prongs, i-oropharynx noma i-nasopharynx (imigwaqo yomoya) inikeza ukumswakama okwanele.Emazingeni aphezulu okugeleza noma lapho umoya-mpilo ulethwa ngokuqondile kuqhoqhoqho, umswakama owengeziwe wangaphandle uyadingeka.Amasistimu okugeleza aphansi awahlonyiselwe ukwenza kanjalo.Ukwengeza, i-FiO2 ayikwazi ukusethwa ngokunembile ku-LF.

Kuzo zonke izinhlelo zokugeleza okuphansi komoya-mpilo kungenzeka angazifanele izimo ezibucayi ze-hypoxia.

Ukufaneleka Kwamadivayisi Ageleza Kakhulu Oksijini Wokunakekelwa Okubukhali

Amasistimu okugeleza okuphezulu yilawo angakwazi ukuhambisana noma eqe izinga lokugeleza okuphefumulelwe - okungukuthi 20-30 amalitha/ngomzuzu.Amasistimu Okugeleza Okuphakeme atholakalayo namuhla angakwazi ukukhiqiza amazinga okugeleza noma yikuphi phakathi kwamalitha angu-2-120/ngomzuzu njengama-ventilators.I-FiO2 ingasethwa ngokunembile futhi iqashwe.I-FiO2 ingaba cishe ku-90-100%, njengoba isiguli singadingi ukuphefumula umoya osemkhathini futhi ukulahlekelwa igesi kuyinto encane.Ukuphefumula kabusha kwegesi ephelelwe yisikhathi akuyona inkinga ngoba imaski ikhishwa amazinga aphezulu okugeleza.Ziphinde zithuthukise ukunethezeka kwesiguli ngokugcina umswakama kanye nokushisa okwanele egesini ukuze kugcobe indawo yamakhala.

Sekukonke, izinhlelo zokugeleza okuphezulu azikwazi nje ukuthuthukisa umoya-mpilo njengoba kudingekile ezimweni ezinzima, kodwa futhi zinciphisa umsebenzi wokuphefumula, okubangela ubunzima obuncane kakhulu emaphashini esiguli.Ngakho-ke zifaneleka kahle kule njongo ezimweni ezinzima zokucindezeleka kokuphefumula.

Yiziphi Izingxenye Ze-High Flow Nasal Cannula vs Ventilator?

Sibonile ukuthi okungenani uhlelo lwe-high flow oxygen therapy (HFOT) luyadingeka ukuze kwelaphe izimo zokwehluleka ukuphefumula okukhulu.Ake sihlole ukuthi uhlelo lwe-High Flow (HF) luhluke kanjani kumshini wokungenisa umoya.Yiziphi izingxenye ezihlukahlukene zayo yomibili imishini futhi ihluke kanjani ekusebenzeni kwayo?

Yomibili le mishini idinga ukuxhunywa emthonjeni komoyampilo osesibhedlela njengepayipi noma isilinda.Isistimu yokwelapha komoya-mpilo egeleza kakhulu ilula - ehlanganisa a

ijeneretha yokugeleza,

i-blender ye-air-oxygen,

i-humidifier,

ishubhu evuthayo futhi

isisetshenziswa sokudiliva isb i-cannula yamakhala.

I-Ventilator iyasebenza

Ngakolunye uhlangothi i-ventilator ibanzi kakhulu.Ayiqukethe kuphela zonke izakhi ze-HFNC, futhi inezinhlelo zokuphefumula, zokulawula nokuqapha kanye nama-alamu ukuze enze umoya ophephile, olawulwayo, nohlelekayo wesiguli.

Imingcele ebaluleke kakhulu yokuhlela ekungeneni komoya ngomshini yile:

Imodi yokungenisa umoya, (ivolumu, ingcindezi noma okubili),

I-Moodality (elawulwayo, eyisizwayo, esekela ukungeniswa komoya), kanye

Imingcele yokuphefumula.Imingcele eyinhloko ivolumu ye-tidal kanye nevolumu yemizuzu ezindleleni zevolumu, ukucindezela okuphezulu (ezimweni zokucindezela), imvamisa yokuphefumula, ukucindezela kokuphefumula kokuphela, isikhathi sokuphefumula, ukugeleza kokuphefumula, isilinganiso sokuphefumula-kuya-kukuphelelwa umoya, isikhathi sokumisa isikhashana, ukuzwela kwe-trigger, ukusekelwa. ingcindezi, kanye nokuzwela kwe-trigger yokuphelelwa umoya njll.

Ama-alamu - Ukubona izinkinga kumshini wokuphefumula kanye nezinguquko esigulini, ama-alamu evolumu ye-tidal kanye nemizuzu, ukucindezela okuphezulu, imvamisa yokuphefumula, i-FiO2, ne-apnea ayatholakala.

Ukuqhathaniswa kwengxenye eyisisekelo ye-ventilator ne-HFNC

Isici sokuqhathanisa phakathi kwe-Ventilator ne-HFNC

Isici sokuqhathanisa i-HFNC ne-Ventilator

Ukungenisa umoya vs HFNC - Izinzuzo Nezingozi

Ukungenisa komoya kungase kube Okuhlaselayo noma Kungahlaseli.Uma kungena umoya odabukisayo ishubhu lifakwa ngomlomo liye emaphashini ukuze lisize ekungeneni komoya.Odokotela bathanda ukugwema ukungena ngaphakathi ngenxa yomphumela ongase ube yingozi esigulini kanye nobunzima ekuwulawuleni.

I-Intubation ngenkathi ingembi ngokwayo, ingabangela

Ukulimala emaphashini, uqhoqhoqho noma umphimbo njll. kanye/noma

Kungase kube nengozi yokwakheka kwe-Fluids,

Isifiso noma

Izinkinga zamaphaphu.

Ukungenisa komoya okungavamisile

Ukungenisa komoya okungahlaseli kuyinketho ekhethwayo ngangokunokwenzeka.I-NIV ihlinzeka ngosizo lokungena komoya okuzenzakalelayo ngokufaka ingcindezi eyakhayo emaphashini ngaphandle, ngokusebenzisa imaski yobuso evame ukusetshenziswa exhunywe ohlelweni lokuswakama, isifudumezi esishisayo noma isishintshi sokushisa nomswakama, kanye nomshini wokuphefumula.Imodi esetshenziswa kakhulu ihlanganisa ukwesekwa kwengcindezi (i-PS) ukungena komoya kanye ne-positive end-expiratory pressure (PEEP), noma imane ifake i-continuous positive airway pressure (CPAP).Ukusekelwa kwengcindezi kuyaguquguquka kuye ngokuthi isiguli siyaphefumula noma siyaphuma kanye nomzamo wokuphefumula.

I-NIV ithuthukisa ukushintshaniswa kwegesi futhi inciphisa umzamo wokuphefumula ngokusebenzisa ingcindezi enhle.Kubizwa ngokuthi “okungahlanyisi” ngoba ilethwa ngaphandle kwanoma iyiphi intubation.Kodwa-ke i-NIV ingase ibangele amavolomu aphezulu agqugquzelwe ukwesekwa kwengcindezi futhi okungase kube kubi kakhulu ukulimala kwamaphaphu okwakukhona ngaphambili.

Inzuzo ye-HFNC

Enye inzuzo yokuletha umoya-mpilo ogeleza kakhulu nge-cannula yamakhala iwukuba ukhiphe ngokuqhubekayo indawo efile yomzila womoya ophezulu ngokususa i-CO2 engcono.Lokhu kunciphisa umsebenzi wokuphefumula kwesiguli futhi kuthuthukisa umoya-mpilo.Ngaphezu kwalokho, ukwelashwa kwe-oksijeni okugeleza okuphezulu kuqinisekisa i-FiO2 ephezulu.I-HFNC ihlinzeka ngokunethezeka okuhle kwesiguli ngokugeleza kwegesi eshisayo neyomswakama elethwa ngamakhala ngenani eliqinile.Izinga lokugeleza njalo kwegesi ohlelweni lwe-HFNC lidala izingcindezi eziguquguqukayo emigwaqweni yomoya ngokuya ngomzamo wokuphefumula wesiguli.Uma kuqhathaniswa nokwelashwa kwe-oksijeni evamile (Ukugeleza Okuphansi) noma ukungena komoya okungavamisile, ukusetshenziswa kokwelashwa kwe-oksijeni okugeleza okuphezulu kunganciphisa isidingo sokungena.

Izinzuzo ze-HFNC

Amasu okwelapha isiguli esinesimo esibucayi sokuphefumula ahloselwe ukuhlinzeka nge-oxygenation eyanele.Ngesikhathi esifanayo kubalulekile ukulondoloza noma ukuqinisa umsebenzi wamaphaphu esiguli ngaphandle kokucindezela imisipha yokuphefumula.

Ngakho-ke i-HFOT ingase ibhekwe njengesu lomugqa wokuqala we-oxygenation kulezi ziguli.Kodwa-ke, ukuze ugweme noma yimuphi umonakalo ngenxa yokubambezeleka kokungena komoya/intuba, ukuqapha njalo kubalulekile.

Isifinyezo sezinzuzo nobungozi be-HFNC vs Ukungenisa umoya

Izinzuzo vs ingozi ye-ventilator ne-HFNC

Ukusetshenziswa kwe-HFNC nama-ventilators ekwelapheni i-COVID

Cishe i-15% yamacala e-COVID-19 alinganiselwa ukuthi adinga ukwelashwa komoyampilo futhi ngaphansi kancane kwe-1/3rd yawo kungadingeka ukuthi athuthele ekungeneni komoya.Njengoba kushiwo ngaphambili, abanakekeli ababucayi bagwema ukungena ngaphakathi ngangokunokwenzeka.Ukwelashwa komoyampilo kuthathwa njengomugqa wokuqala wokusekelwa kokuphefumula ezimweni ze-hypoxia.Ngakho-ke isidingo se-HFNC senyukile ezinyangeni ezisanda kwedlula.Izinhlobo ezidumile ze-HFNC emakethe yiFisher & Paykel, Hamilton, Resmed, BMC njll.