Capnography i ka hana ventilatory: no ke aha mākou e pono ai i kahi capnograph?

By Cristiano Antonino On Mar 24, 2023

Pono e hoʻokō pono ʻia ka ea, pono ka nānā ʻana: he kuleana kūpono ka capnographer i kēia.

ʻO ka capnograph i ka mechanical ventilation o ka mea maʻi

Inā pono, pono e hoʻokō pono ʻia ka ea mechanical i ka manawa prehospital a me ka nānā ʻana.

He mea nui ʻaʻole wale ka lawe ʻana i ka mea maʻi i ka haukapila, akā no ka hōʻoia ʻana i kahi manawa kiʻekiʻe o ka hoʻihoʻi ʻana, a i ʻole ma ka liʻiliʻi ʻaʻole e hōʻeha i ke koʻikoʻi o ke kūlana o ka mea maʻi i ka wā o ka lawe ʻana a me ka mālama ʻana.

ʻO nā lā o nā ventilator maʻalahi me nā hoʻonohonoho liʻiliʻi (frequency-volume) kahi mea i hala.

ʻO ka hapa nui o nā poʻe maʻi e koi ana i ka hoʻoheheʻe mechanical ua mālama ʻia ka hanu kūlohelohe (bradypnoea a me ka hypoventilation), aia ma ka waena o ka 'pūnaewele' ma waena o ka apnea piha a me ka hanu ʻana, kahi e lawa ai ka inhalation oxygen.

ʻO ALV (Adaptive lung ventilation) ma ke ʻano he normoventilation: he mea ʻino ka hypoventilation a me ka hyperventilation.

ʻO ka hopena o ka pono ʻole o ka ea ma luna o nā poʻe maʻi me nā pathology lolo (stroke, trauma poʻo, a me nā mea ʻē aʻe).

ʻenemi huna: hypocapnia a me hypercapnia

Ua ʻike ʻia ʻo ka hanu ʻana (a i ʻole ka mechanical ventilation) e hoʻolako i ke kino me ka oxygen O2 a wehe i ke kalapona CO2.

ʻIke ʻia ka pōʻino o ka nele o ka oxygen: hypoxia a me ka lolo.

Hiki ke hoʻopōʻino i ka epithelium o nā alaloa a me ka alveoli o nā akemāmā i ka nui o O2, akā naʻe, i ka hoʻohana ʻana i ka ʻike oxygen (FiO2) o 50% a i ʻole ka liʻiliʻi, ʻaʻohe pōʻino nui mai ka 'hyperoxygenation': e hoʻoneʻe wale ʻia ka oxygen unssimilated. me ka exhalation.

ʻAʻole hilinaʻi ka hoʻokuʻu ʻana o CO2 i ke ʻano o ka hui ʻana i hāʻawi ʻia a hoʻoholo ʻia e ka waiwai hoʻoheheʻe minuke MV (frequency, fx tidal volume, Vt); ʻoi aku ka mānoanoa a hohonu paha o ka hanu, ʻoi aku ka nui o ka CO2 i hoʻokuʻu ʻia.

Me ka nele o ka ventilation ('hypoventilation') - bradypnoea/superficial hanu i loko o ka mea maʻi iā ia iho a i ʻole mechanical ventilation 'lacks' hypercapnia (ʻoi aku CO2) holomua i loko o ke kino, i loko o ka mea he pathological hoʻonui o ka cerebral moku, he mahuahua ma intracranial. ke kaumaha, ka edema cerebral a me kona poino lua.

Akā, me ka excessive ventilation (tachypnoea i loko o ka mea maʻi a excessive ventilation parameter), hypocapnia i malamaia i loko o ke kino, i loko o ka pathological narrowing o ka cerebral moku me ka ischemia o kona mau pauku, a pela no hoi lua lolo poino, a respiratory alkalosis no hoi aggravates. ke koʻikoʻi o ke kūlana o ka mea maʻi. No laila, ʻaʻole pono ka 'anti-hypoxic' wale nō ka ventila mechanical, akā ʻo ka 'normocapnic' pū kekahi.

Aia nā ʻano hana no ka helu ʻana i nā ʻāpana mechanical ventilation, e like me ke ʻano o Darbinyan (a i ʻole nā mea like ʻē aʻe), akā hōʻike lākou a ʻaʻole paha e noʻonoʻo i ke kūlana maoli o ka mea maʻi, no ka laʻana.

No ke aha ʻaʻole lawa ka pulse oximeter

ʻOiaʻiʻo, he mea nui ka pulse oximetry a lilo i kumu no ka nānā ʻana i ka ventilation, akā ʻaʻole lawa ka nānā ʻana o SpO2, aia kekahi mau pilikia huna, nā palena a i ʻole nā pōʻino, ʻo ia hoʻi: I nā kūlana i wehewehe ʻia, lilo pinepine ka hoʻohana ʻana i ka pulse oximeter. .

- I ka hoʻohana ʻana i ka oxygen concentration ma luna o 30% (ʻo ka mea maʻamau ʻo FiO2 = 50% a i ʻole 100% e hoʻohana ʻia me ka hoʻoheheʻe ʻana), ua lawa paha nā ʻāpana hoʻohaʻahaʻa hoʻohaʻahaʻa (rate a me ka leo) no ka mālama ʻana i ka "normoxia" i ka piʻi ʻana o ka nui o ka O2 i hāʻawi ʻia i kēlā me kēia hana hanu. No laila, ʻaʻole e hōʻike ka pulse oximeter i ka hypoventilation huna me hypercapnia.

- ʻAʻole hōʻike ka pulse oximeter i ka hyperventilation maikaʻi ma kekahi ʻano, ʻo nā helu SpO2 mau o 99-100% e hōʻoiaʻiʻo wahaheʻe i ke kauka.

- ʻAʻole inert ka pulse oximeter a me nā hōʻailona saturation, ma muli o ka hāʻawi ʻana o O2 i loko o ke koko e kahe ana a me ka wahi make physiological o nā akemāmā, a ma muli hoʻi o ka awelika o ka heluhelu ʻana i kahi manawa ma ka pulse oximeter-pale ʻia. transport pulse, i ka hopena o ka pilikia pilikia (kaapuni disconnection, nele o ka ventila parameters, etc.) n.) saturation 'aʻole e emi koke, akā, i ka wikiwiki pane mai ke kauka.

- Hāʻawi ka pulse oximeter i nā heluhelu SpO2 hewa i ka hihia o ka carbon monoxide (CO) poisoning ma muli o ka like ʻana o ka lawe māmā ʻana o ka oxyhaemoglobin HbO2 a me carboxyhaemoglobin HbCO, ua kaupalena ʻia ka nānā ʻana i kēia hihia.

Hoʻohana i ka capnograph: capnometry a me ka capnography

Nā koho mākaʻikaʻi hou e mālama i ke ola o ka mea maʻi.

ʻO kahi hoʻohui waiwai a koʻikoʻi i ka mana o ka lawa o ka mechanical ventilation ka ana mau o ka CO2 concentration (EtCO2) i ka ea exhaled (capnometry) a me kahi kiʻi kiʻi o ka cyclicity o CO2 excretion (capnography).

ʻO nā mea maikaʻi o ka capnometry:

- Hoʻomaʻemaʻe i nā hōʻailona ma nā mokuʻāina hemodynamic, ʻoiai i ka wā CPR (ma ke kahe koko haʻahaʻa haʻahaʻa, hana ʻia ka nānā ʻana ma o nā ala ʻelua: ECG a me EtCO2)

- Hoʻololi koke i nā hōʻailona no nā hanana a me nā haʻihaʻi, no ka laʻana i ka wā e hemo ai ke kaapuni hanu

- Ka loiloi o ke kūlana hanu mua i loko o kahi maʻi i hoʻopaʻa ʻia

- ʻO ka hiʻohiʻona manawa maoli o ka hypo- a me ka hyperventilation

ʻO nā hiʻohiʻona ʻē aʻe o ka capnography he nui: hōʻike ʻia ke ala ea, nā hoʻāʻo o ka mea maʻi e hanu spontaneously me ka pono e hoʻonui i ka anesthesia, nā oscillations cardiac ma ka pakuhi me ka tachyarrhythmia, hiki ke piʻi i ka mahana o ke kino me ka piʻi ʻana o EtCO2 a ʻoi aku.

ʻO nā pahuhopu nui o ka hoʻohana ʻana i kahi capnograph i ka manawa prehospital

Ka nānā ʻana i ka kūleʻa o ka intubation tracheal, ʻoi aku hoʻi i nā kūlana o ka walaʻau a me ka paʻakikī o ka auscultation: ʻaʻole e hana ka papahana maʻamau o ka cyclic CO2 excretion me ka amplitude maikaʻi inā hoʻokomo ʻia ka paipu i loko o ka esophagus (akā naʻe, pono ka auscultation e kāohi i ka ventila o nā mea ʻelua. māmā)

Ka nānā ʻana i ka hoʻihoʻi ʻana o ka holo ʻana i ka wā CPR: hoʻonui nui ʻia ka metabolism a me ka hoʻoulu ʻana o CO2 i ke kino 'resuscitated', ʻike ʻia kahi 'lele' ma ka capnogram a ʻaʻole i ʻoi aku ka maikaʻi o ka hiʻohiʻona me nā puʻuwai puʻuwai (ʻaʻole like me ka hōʻailona ECG)

ʻO ka mana maʻamau o ka mechanical ventilation, ʻoi loa i nā poʻe maʻi me ka pōʻino o ka lolo (stroke, ʻeha poʻo, convulsions, etc.)

Ana "ma ke kahe nui" (MAINSTREAM) a me "ma ke kahe lateral" (SIDESTREAM).

ʻO nā capnographs ʻelua ʻano ʻenehana, i ke ana ʻana iā EtCO2 'ma ke kahawai nui' kahi adapter pōkole me nā lua ʻaoʻao i kau ʻia ma waena o ka ʻōpū endotracheal a me ke kaapuni, ua kau ʻia kahi mea ʻike U-like ma luna, nānā ʻia ke kinoea hele a hoʻoholo ʻia. Ana ʻia ʻo EtCO2.

I ke ana 'ma ka lateral kahe', he wahi uuku o ke kinoea laweia mai ke kaapuni ma o ka kūikawā puka i loko o ke kaapuni e ka suction compressor, ua hanai ia ma o ka lahilahi paipu i loko o ke kino o ka capnograph, kahi e ana i ka EtCO2.

Hoʻololi kekahi mau mea i ka pololei o ke ana, e like me ke ʻano o ka O2 a me ka makū i loko o ka hui ʻana a me ke ana wela. Pono e hoʻomaʻamaʻa mua ʻia ka sensor a calibrated.

Ma kēia manaʻo, ʻoi aku ka pololei o ke ana ʻaoʻao ʻaoʻao, ʻoiai e hoʻemi ana i ka mana o kēia mau mea hoʻololi i ka hana, akā naʻe.

Portability, 4 mana o ka capnograph:

ma ke ʻano he ʻāpana o ka nānā ʻana i kahi moe
ma ke ʻano he ʻāpana o ka multifunctional defibrillator
he mini-nozzle ma ke kaapuni ('mea i loko o ka mea ʻike, ʻaʻohe uea')
he mea lawe lima ʻeke ('kino + sensor ma ka uea').

ʻO ka mea maʻamau, i ka wā e pili ana i ka capnography, ua hoʻomaopopo ʻia ke kahawai nānā ʻo EtCO2 ma ke ʻano he ʻāpana o ka monitor 'bedside' multifunctional; i ka ICU, ua paa mau ia ma ka pono holopapa.

ʻOiai hiki ke hoʻoneʻe ʻia ke kū kiaʻi a hoʻohana ʻia ka capnograph monitor e kahi pākaukau i kūkulu ʻia, paʻakikī nō ka hoʻohana ʻana i ka wā e neʻe ai i ka pā a i ʻole ma waena o ke kaʻa hoʻopakele a me ka ʻāpana mālama koʻikoʻi, ma muli o ke kaumaha a me ka nui o ka. e nānā i ka hihia a me ka hiki ʻole ke hoʻopili iā ia i ka mea maʻi a i ʻole i kahi kau wai wai, kahi i lawe nui ʻia ai ka lawe ʻana mai ka pā.

Pono ʻia kahi mea lawe lima ʻoi aku.

Loaʻa nā pilikia like i ka wā e hoʻohana ai i ka capnograph ma ke ʻano he ʻoihana defibrillator multifunctional: ʻo ka mea pōʻino, ʻaneʻane he nui ka nui a me ke kaumaha o lākou a pau, a ʻo ka ʻoiaʻiʻo, ʻaʻole e ʻae ʻia, no ka laʻana, e kau ʻia kēlā ʻano mea ma luna o kahi wai wai. kau ma ka ʻaoʻao o ka mea maʻi i ka iho ʻana i ke alapiʻi mai kahi papahele kiʻekiʻe; ʻoiai i ka wā o ka hana, ulu pinepine ka huikau me ka nui o nā uea i loko o ka hāmeʻa.