Capnography mune ventilatory tsika: nei tichida capnograph?

By Cristiano Antonino On 24 Sea, 2023

Kufefetera kunofanirwa kuitwa nemazvo, kutarisisa kwakakwana kunodiwa: iyo capnographer inoita basa chairo mune izvi.

Iyo capnograph mu mechanical ventilation yemurwere

Kana zvichidikanwa, mechanical ventilation mu prehospital phase inofanira kuitwa nemazvo uye nekutarisa kwakazara.

Izvo zvakakosha kwete kungoendesa murwere kuchipatara, asiwo kuve nechokwadi chepamusoro mukana wekupora, kana kuti kwete kuti uwedzere kuomarara kwemamiriro emurwere panguva yekutakura uye kutarisirwa.

Mazuva emagetsi akareruka ane mashoma marongero (frequency-vhoriyamu) chinhu chekare.

Varwere vazhinji vanoda kufefeterwa nemuchina vakachengetedza kufema kwega kwega (bradypnoea uye hypoventilation), iyo iri pakati pe'pakati' pakati peapnea yakakwana uye kufema kwega, uko kufemerwa kweokisijeni kunokwana.

ALV (Adaptive lung ventilation) kazhinji inofanira kuva normoventilation: hypoventilation uye hyperventilation zvose zvinokuvadza.

Mhedzisiro yekusakwana kwemhepo kune varwere vane acute brain pathology (stroke, kushungurudza musoro, nezvimwewo) inonyanya kukuvadza.

Akavanzika muvengi: hypocapnia uye hypercapnia

Zvinonyatsozivikanwa kuti kufema (kana mechanical ventilation) kwakakosha kupa muviri neokisijeni O2 uye kubvisa carbon dioxide CO2.

Kukuvadzwa kwekushaikwa kweokisijeni kuri pachena: hypoxia uye kukuvara kwehuropi.

Kuwedzera O2 kunogona kukuvadza epithelium yemhepo uye alveoli yemapapu, zvisinei, kana uchishandisa oxygen concentration (FiO2) ye50% kana pasi, hapazovi nekukuvadzwa kukuru kubva ku'hyperoxygenation': iyo isina kusimirwa okisijeni inongobviswa. nekufema.

CO2 excretion haina kutsamira pakuumbwa kwemusanganiswa wakapihwa uye inotarirwa neminiti yemhepo kukosha kweMV (frequency, fx tidal volume, Vt); iyo yakawedzera kana kudzika kufema, iyo CO2 yakawanda inobuda.

Nekushaikwa kwemhepo ('hypoventilation') - bradypnoea / kufema kwepamusoro mumurwere pachake kana mechanical ventilation 'inoshaya' hypercapnia (yakawandisa CO2) inofambira mberi mumuviri, umo mune pathological kuwedzera kwemidziyo yeuropi, kuwedzera intracranial. kumanikidzwa, cerebral edema uye kukuvara kwayo kwechipiri.

Asi nemhepo yakawandisa (tachypnoea mumurwere kana yakawandisa mhepo paramita), hypocapnia inoonekwa mumuviri, umo mune pathological kuderera kwemidziyo yeuropi ine ischaemia yezvikamu zvayo, uye nekudaro zvakare kukuvara kwechipiri kwehuropi, uye kufema alkalosis kunowedzerawo. kuoma kwehutano hwemurwere. Nokudaro, mechanical ventilation haifaniri kungova 'anti-hypoxic' chete, asiwo 'normocapnic'.

Kune nzira dzekuverengera kuverengera ma mechanical ventilation parameters, senge Darbinyan's formula (kana mamwe anowirirana), asi iwo anoratidza uye anogona kusafunga nezve mamiriro chaiwo omurwere, semuenzaniso.

Nei pulse oximeter isina kukwana

Ehe, pulse oximetry yakakosha uye inoumba hwaro hwekutarisa mhepo, asi SpO2 monitoring haina kukwana, kune akati wandei matambudziko akavanzika, zvisingakwanisi kana njodzi, zvinoti: Mumamiriro ezvinhu anotsanangurwa, kushandiswa kwepulse oximeter kunowanzo kuve kusingagoneke. .

- Paunenge uchishandisa kuwedzera kweokisijeni pamusoro pe30% (kazhinji FiO2 = 50% kana 100% inoshandiswa nemhepo), kuderedzwa kwemhepo yemhepo parameters (chiyero uye vhoriyamu) inogona kukwana kuchengetedza "normoxia" sezvo chiyero cheO2 chinounzwa pachiito chekufema chinowedzera. Naizvozvo, iyo pulse oximeter hairatidze yakavanzika hypoventilation ne hypercapnia.

- Iyo pulse oximeter haina kuratidza inokuvadza hyperventilation chero nzira, nguva dzose SpO2 tsika dze99-100% nhema simbisa chiremba.

-Iyo pulse oximeter uye zviratidzo zvekuzara zvakanyanya inert, nekuda kwekupihwa kweO2 muropa rinotenderera uye nzvimbo yakafa yemapapu, pamwe nekuda kweavhareji yekuverenga kwekufamba kwenguva pane pulse oximeter yakachengetedzwa. kutakura pulse, muchiitiko chechiitiko chekukurumidzira (kubviswa kwedunhu, kusava nemagetsi emhepo, nezvimwewo) n.) Kuzadza hakudzike pakarepo, asi kukurumidza kupindura kubva kuna chiremba kunodiwa.

– The pulse oximeter inopa zvisizvo SpO2 kuverenga kana carbon monoxide (CO) chepfu nemhaka yokuti chiedza kutorwa oxyhaemoglobin HbO2 uye carboxyhaemoglobin HbCO zvakafanana, monitoring munyaya iyi shoma.

Kushandiswa kweiyo capnograph: capnometry uye capnography

Dzimwe sarudzo dzekutarisa dzinoponesa hupenyu hwemurwere.

Kuwedzera kwakakosha uye kwakakosha pakutonga kwekukwana kwe mechanical ventilation ndiyo chiyero chinoramba chiripo che CO2 concentration (EtCO2) mumhepo inoputika (capnometry) uye mufananidzo wakajeka we cyclicity ye CO2 excretion (capnography).

Zvakanakira capnometry ndezvi:

-Zviratidzo zvakajeka mune chero hemodynamic state, kunyangwe panguva yeCPR (payakanyanya kuderera kweropa, kutarisisa kunoitwa kuburikidza nematanho maviri: ECG uye EtCO2)

-Kuchinja kwekukurumidza kwezviratidzo kune chero zviitiko uye kutsauka, semuenzaniso kana dunhu rekufema rabviswa

-Kuongorora kwekutanga kufema chimiro mumurwere ane intubated

-Chaiyo-nguva yekuona ye hypo- uye hyperventilation

Zvimwe zvinyorwa zvecapnography zvakakura: kuvharwa kwemhepo kunoratidzwa, kuedza kwemurwere kufema pakarepo nechido chekudzika anesthesia, cardiac oscillations pane chati ine tachyarrhythmia, kukwira kunokwanisika kwekushisa kwemuviri nekuwedzera kweEtCO2 nezvimwe zvakawanda.

Zvinangwa zvikuru zvekushandisa capnograph muchikamu cheprehospital

Kuongorora kubudirira kwetracheal intubation, kunyanya mumamiriro eruzha uye kuoma kwe auscultation: iyo yakajairwa chirongwa checyclic CO2 excretion ine yakanaka amplitude haizomboshanda kana chubhu ikaiswa mugurokuro (zvisinei, auscultation inofanirwa kudzora mhepo yezviviri izvi. mapapu)

Kuongorora kudzoreredzwa kwekutenderera kwechikafu panguva yeCPR: metabolism uye CO2 kugadzirwa kunowedzera zvakanyanya mu 'resuscitated' organism, 'kusvetuka' kunoonekwa pane capnogram uye iyo yekuona haina kuipa nekumanikidza kwemoyo (kusiyana nechiratidzo cheECG)

Kudzora kwemechanic ventilation, kunyanya muvarwere vane kukuvara kwehuropi (sitiroko, kukuvara kwemusoro, kugwinha, nezvimwewo)

Kuyera "mukuyerera kukuru" (MAINSTREAM) uye "mu lateral kuyerera" (SIDESTREAM).

Capnographs ndeyemhando mbiri dzehunyanzvi, pakuyera EtCO2 'murukova rukuru' ipfupi adapta ine maburi eparutivi inoiswa pakati peendotracheal chubhu uye sedunhu, iyo U-shaped sensor inoiswa pairi, iyo inopfuura gasi inoongororwa uye yakatemwa. EtCO2 inoyerwa.

Pakuyera 'mu lateral kuyerera', chikamu chidiki chegasi chinotorwa kubva kudunhu kuburikidza negomba rakakosha mudunhu neiyo suction compressor, inodyiswa kuburikidza nechubhu yakatetepa kupinda mumuviri wecapnograph, uko iyo EtCO2 inoyerwa.

Zvinhu zvakati wandei zvinopesvedzera kurongeka kwechiyero, sekusangana kweO2 uye mwando mumusanganiswa uye tembiricha yekuyera. Iyo sensor inofanira kunge yakagara ichipisa uye yakagadziriswa.

Mupfungwa iyi, chiyero chemumativi chinoratidzika kunge chakanyatsojeka, sezvo chichideredza kukanganiswa kwezvinhu izvi zvinokanganisa mukuita, zvisinei.

Portability, 4 shanduro dzecapnograph:

sechikamu chemonitor yepadivi pemubhedha
sechikamu chemabasa akawanda defibrillator
mini-nozzle padunhu ('mudziyo uri mu sensor, hapana waya')
mudziyo unotakurika wehomwe ('muviri + sensor pawaya').

Kazhinji, kana tichitaura nezve capnography, iyo EtCO2 yekutarisa chiteshi inonzwisiswa sechikamu cheakawanda anoshanda 'padivi pemubhedha' monitor; muICU, inogadziriswa zvachose pane midziyo pasherufu.

Kunyangwe iyo yekumira yekutarisa ichibviswa uye iyo capnograph yekutarisa inofambiswa nebhatiri rakavakirwa-mukati, zvichiri kunetsa kuishandisa kana uchienda kufurati kana pakati pemota yekununura uye yekuchengetera unit, nekuda kwehuremu uye saizi ye tarisa kesi uye kusakwanisa kuisungirira kumurwere kana kune isina mvura inotambanudza, iyo kutakura kubva pafurati kwainyanya kuitwa.

Chiridzwa chinotakurika zvakanyanya chinodiwa.

Matambudziko akafanana anosangana nawo kana uchishandisa capnograph sechikamu chehunyanzvi multifunctional defibrillator: zvinosuruvarisa kuti vanenge vese vachiri nehukuru hukuru uye uremu, uye muchokwadi havabvumire, semuenzaniso, mudziyo wakadaro kuti uiswe zvakanaka pamvura isingapindi mvura. stretcher pedyo nemurwere paanoburuka masitepisi kubva pauriri hwepamusoro; kunyange panguva yekushanda, kuvhiringidzika kunowanzoitika nenhamba huru yewaya muchigadzirwa.