Endotracheal intubation (ETI) muvana inotenda isingawanzo uye yedu yekutanga kupasa yekubudirira mwero inogona chaizvo kuita nekumwe kugadzirisa

Izvo zvakaoma kuenzanisa kushanda kweakasiyana-siyana epamberi nzira dzekufamba nendege muvana.

Iko kune zvinehunhu hunhu, hongu, asi zvakare zvakaratidza misiyano mumazera uye mune ingangoita aetiology yekusungwa.

Iko kune kazhinji nguva yekutaura neboka revatambi vakanyanya uye nekuita hurongwa hwakavakirwa panzira yakanaka yemumhepo yeiyo yakapihwa mamiriro.

Saizvozvowo, iyo yekushandira yemitambo, imba yevakawanda muyedzo yemumhepo, inzvimbo yakatosiyana.

Tichatarisa epamberi nzira yemhepo muzviitiko zvemoyo / kufema kusungwa.

Iva nehanya pane pachagara paine mutsauko wenguva uye hunyanzvi hwakaiswa pakati pekunze-kwechipatara kusungwa kwemoyo (OHCA) kuenda kuchipatara kusungwa kwemoyo (IHCA).

Kune mashoma zvidzidzo chaiwo achifananidza epamberi nzira dzendege kurapwa kunoshandiswa panguva yemoyo yekusungwa manejimendi muvana.

Kune zvimwe zvirinani zvidzidzo zvakapoterera kushandiswa kwesupraglottic airways (SGAs) muvana. Zvizhinji zveizvi zvidzidzo zvekucherechedza.

ILCOR parizvino inokurudzira endotracheal intubation (ETI) senzira yakanaka yekugadzirisa nzira yemhepo panguva yekumutsiridza

Ivo zvakare vanotaura kuti supraglottic airways ndiyo inogamuchirwa nzira kune yakajairwa bhegi-vharuvhu-mask kufefetedza (BVM).

Kune mashoma mashoma emakiriniki miedzo muvana pane izvo zvinokurudzirwa izvi zvakavakirwa (uye zvirokwazvo hapana chakaomarara dhizaini mumakore apfuura makumi maviri).

Nekuda kwekushayikwa kweuchapupu, ivo vakapa chidzidzo sechikamu chePediatric Life Support Task Force.

Lavonas et al. (2018) yakaita ongororo yakarongeka uye meta-ongororo pamashandisirwo epamberi penzira dzepamhepo (ETI vs SGA), zvichienzaniswa neBVM yoga, yekumutsidzira vana mukusungwa kwemoyo. Zvidzidzo gumi nemana chete zvakaratidzwa.

12 yeaya aikodzera kuiswa mune meta-ongororo.

Vakanga vachinyanya kutarisa OHCA. Paive nenjodzi huru yekusarudzika uye saka huwandu hwese hweuchapupu hwaive mune yakaderera kusvika pasi zvakanyanya.

Iyo yakakosha mhedzisiro chiyero kwaive kupona kusvika kuchipatara kuburitswa neakanaka mhedzisiro mhedzisiro.

Ongororo iyi yakaratidza kuti ese ETI neSGA anga asiri pamusoro peBVM.

Saka ikozvino, ngativhurei mamwe emabhuku ari pamusoro pekushandiswa kwesupraglottic airway zvishandiso. Izvi zvinowanzoenderana nezvidzidzo zvevakuru.

Iyo yakanaka mweya wekushandisa

• … Iri nyore kumisikidza uye kuisa nechero ani saka hazvina basa kuti chimiro chechikwata ndechei
• … Inokurumidza kumisa uye nekukurumidza kuisa. Izvi zvinoderedza iyo nguva inotorwa kubva kune mamwe akakosha mabasa uye ichibvumira iyo-yakakosha 'bandwidth'
• … Inobvumira mukana wakaderera wekusuwa
• … Inopa chisimbiso chakasimba kubvumira kumanikidzwa kwepamhepo kana zvichidikanwa
• … Yakasimba zvekuti murwere haakwanise kuruma kuburikidza nayo uye nekuzvicherera oxygen yavo
• … Inopa sarudzo yekudzora dumbu kuburikidza nemudziyo mumwe chete
• … Ine njodzi shoma yekukanganisa kuitisa njodzi kana kurasikirwa nendege kana yaiswa

Kana izvi zvichinzwika zvakanyanya kunaka kuti zvive zvechokwadi, ndizvo. Hapana mudziyo mumwe unobatanidza zvese izvi zvakakosha maficha.

Izvi zvinotisiya isu tichifunga izvo zvinonyanya kukodzera kumurwere ari pamberi pedu.

Izvo zvakaoma kwazvo kuenzanisa maSGA nema endotracheal machubhu (ETT).

ETT 'inotsanangudza nzira yemumhepo' inopa chengetedzo kubva kushuwiro.

Izvi hazvireve kuti maSGA ndiwo 'mashoma' sarudzo.

SGA ichiri 'yepamberi nzira yemhepo' uye inoshanda kupfuura kushandisa bhegi-vharuvhu-masiki maitiro.

Izvo zvakakosha kuti urangarire kuti yepamberi nzira yemumhepo ine zvayakanakira nezvayakaipira.

Ipo ivo vachigona kuvandudza mukana wevarwere wekupona nehutano hwakanaka kupora, panogona kunge paine kusangana kunosangana.

Iyo sainzi iri kumashure kwesupraglottic airways

Saka sainzi inoti chii? Kune mashoma miedzo muvana asi kwave kuine akati wandei seminal mapepa akaburitswa pane epamberi nzira yemumhepo muvakuru. Kunyangwe isina hukama chaihwo nevana, ivo vanokwidza mamwe anonakidza mapoinzi ekuenzanisa pakati pemidziyo.

Iyi multicentre, sumbu yakasarudzika kuyedzwa, yakaitiswa nevarapi veparamedics mana amburenzi mabasa muEngland. Iyo yakafananidza supraglottic zvishandiso kune tracheal intubation mune vanhu vakuru varwere vane OHCA vachitarisa mhedzisiro yavo pane inoshanda neurological mhedzisiro.

Ichi chidzidzo chete chaisanganisira varwere vanopfuura makore gumi nemasere.

Havana kuwana musiyano wakakura musiyano mune 30-zuva mhedzisiro (iyo yekutanga mhedzisiro chiyero) kana muhupenyu hwekupona, mwero wekudzokazve, kushuvira kana ROSC (yechipiri mhedzisiro).

Paive nemusiyano wakakosha pakuverengera kana zvasvika pakubudirira kwemhepo yekufema.

Supraglottic airways inoda kuyedza kushoma, asi mashandisiro avo anotungamira kune yakawedzera mikana yekurasikirwa kwenzira yakasimbiswa yemhepo.

Saka izvi zvinorevei? Iko kunetseka kukuru uko kunosungwa kwakatenderedza kana uchikurukura maSGA ndiyo njodzi yakakwira yekuda. Dai pakanga pasina mutsauko panjodzi, zvaizochinja pfungwa dzako?

Iyi yaive multicentre, yakasarudzika kiriniki kuyedzwa muFrance neBelgium ichitarisa OHCA pamusoro pemakore maviri-gore. Zvakare chidzidzo ichi chakanyoresa vanhu vakuru vanopfuura makore gumi nemasere.

Vakatarisa kusiri kushomeka kweBVM vs ETI zvine chekuita nezvekupona nemhedzisiro inokanganisa mhedzisiro mumazuva makumi maviri nemasere.

Mapoka ekupindura aive nemutyairi weamburenzi, mukoti uye chiremba wechimbichimbi.

Chiyero cheROSC chaive chakakura kwazvo muboka reETI asi pakanga pasina mutsauko mukupona kwekuburitsa.

Pakazara, mhedzisiro yekudzidza yanga isinganzwisisike chero nzira.

Kana kupona pakuburitsa zvisina kukanganiswa, isu tese tinofanirwa kunge tichishandisa nguva kudzidzisa uye kuchengetedza kugona kana endotracheal intubation inongochengeterwa chete kune avo vanozviita nguva dzose mumabasa avo ezuva?

Iyi sango-yakasarudzika, yakawanda crossover dhizaini yakaitwa neveparamedics / EMS kumatanho makumi maviri nemasere.

Yakatarisa kune vanhu vakuru varwere vanogamuchira laryngeal tube kana endotracheal intubation uye kupona pamaawa makumi manomwe nemaviri.

Zvekare, ivo chete vaisanganisira vakuru pamusoro pegumi nesere vasina-kutyisa moyo kusungwa.

Vakawana 'mwero asi wakakosha' kuvandudzwa kwekupona muboka reLMA uye izvi zvakabatana neyero yakakwira yeROSC.

Nehurombo, uyu muedzo waisanganisira yakawanda ingangoita kusarudzika uye dhizaini yekudzidza inogona kunge isina kusimba zvakakwana kutsigira danho remusiyano.

Iyo yekupona mwero inogona kutsanangurwa neyekutanga-kupasa kubudirira uye shoma nguva yakashandiswa 'kubva pachipfuva' panguva yekutanga kumutsidzira? Hapana kudzidza kwakakwana. Gara uchizviongorora pachako uye wotarisa kana mhedzisiro yekudzidza ichishanda kune veko nharaunda uye neyako maitiro usati wachinja chero chinhu.

Mibvunzo yakawanda kupfuura mhinduro

Mushure mekuverenga sainzi (uye ndokumbirawo endai mutore zvakadzama mumapepa aya mozvionera mega), ngatitorei mimwe mibvunzo.

SGAs zviri nyore kwazvo iwe unogona kungozvipinza mukati nekuita!

Kwete Kuwana iyo SGA mukati inongova nhanho yekutanga. Kunyangwe ipapo, iwe unofanirwa kuve neshuwa kuti watora saizi yakakodzera uye kuongororwa kuyerwa. SGAs dzinowanzoita kuti dzibudiswe uye zvinotungamira mukurasikirwa kusingatarisirwi kwemhepo. Kazhinji, isu hatisi sevangwaru nezvekuvachengetedza sezvatinofanirwa kuve. Zvakanakisa, shandisa chubhu tai kuti uichengetedze munzvimbo uye kutarisa chinzvimbo (maererano nemazino). Mamwe maSGA ane tambo nhema pane shaft iyo inofanirwa kuenderana neiyo incisors (chenjera izvi zvinogona kungovapo mumatanho akakura). Kungofanana neETT, zvinoda kuti iwe utarise mweya wakaringana kuburikidza neyeuscultation, ETCO2 uye nekuteerera kubuda kuri pachena.

Hazvina kunaka kana paine kuvuza pakutanga sezvo gel richaumba sezvo richipisa

Kwete. Hapano humbowo hunoratidza chimiro chei-gels (kazhinji aya varapi vemuenzaniso varikureva pachiitiko ichi) vanozoumba mukati meiyo gokora. Vatsvagiri vakaedza kupisa izvo zvinhu uye hapana shanduko yehuwandu mukudonha. Kana iwe uine chakakosha kudonha, funga zvakare kumisikidza, kuchinjira kunze kune imwe saizi yakakura kana kushandisa imwe modhi. Iwe unogona kuwana kudonha kudiki kunonyangarika nekufamba kwenguva. Nekufamba kwenguva, iyo yemhepo ino jiggles kutenderera uye inogara zvirinani.

Iwe unofanirwa kugara uchidzvinyirira mudumbu kana iwe ukaisa muLMA

Pamwe. Izvi hazviwanzo kuwanikwa mune nhungamiro sezvo zvichionekwa seyakawanda nzira yekugadzirisa zvakanaka. Zvinogona kutora nguva nezviwanikwa kubva kune mamwe mabasa akakosha (senge kupfuudzwa kwechifuva, kupinda kweIV, kufefetedza kwakaringana) asi kana iwe uine zviwanikwa zvekuita zvakadaro, pasina kukanganisa hwaro hwekumutsiridzwa kwekuchengetwa kwakanaka, saka iri sarudzo yakanaka kana kufefetedza haina kunyatsoita sezvingaite. Izvi zvinonyanya kukosha muvana. Isu tinoziva kuti ivo vari panjodzi yakakwira yekuparadzaniswa nedhayaphragmatic kubva kune yakanyanyisa kufefetedza mweya kuitira kuti kuiswa kwekutanga kwe nasogastric chubhu kunogona kunyatso kugadzirisa zvinhu.

Laryngoscopy inofanirwa kushandiswa pamberi peese kuiswa kweSGA

Pamwe. Dzimwe nzvimbo dzakatanga kuraira laryngoscopy nekuti ivo vapotsa kuvharirwa nemutumbi wekunze, kana kubvumira kukweva zvirinani uye kugadzirisa nzira yekuisa. Pane kupokana kuti SGA inogona kugara zvirinani kana ikaiswa nerubatsiro rwe laryngoscope sezvo, mune dzinoverengeka kesi, haina kuiswa zvakadzama zvakakwana. Laryngoscopy hunyanzvi hwakaoma, hunotora chiito chenguva dzose uye hunouya nematambudziko aro (kukuvara kumuromo / mazino, nguva yekuwedzera inotorwa, hunyanzvi hwepamusoro hunodiwa).

Pane imwe chete yaiswa, SGAs inogona kushandiswa pamwe chete nekuenderera mberi kwechifukidzo chechifu

Pamwe. Izvi zvinonyatsoda kutariswa pane kesi-ne-kesi hwaro. SGAs inzira yepamusoro yemhepo uye inogona kushandiswa nekuenderera mberi kwechifuva kumanikidza kuwedzera cerebral perfusion dzvinyiriro. Zviri kumukiriniki wega kuti aongorore uye osarudza kana rutsigiro rwemhepo irworwo rwavari kupa rwakakwana panguva yekumanikidza kuri kushanda. Mumamiriro ezvinhu apo kusungwa kuri kwechipiri kune hypoxia (sekusungwa kwakawanda kwevana) zvinogona kuve nyore, uye zvichinyanya kubatsira, kuenderera uine 30: 2 kana 15: 2 ratio kuve nechokwadi chekuti mafashama emvura ari kusvika pamapapu. Zvimwe zvidzidzo zvakaratidza musiyano mudiki tichienzanisa iyo 30: 2 nzira yekuenderera mberi nemhepo.

Verenga Uyewo:

Successfull Intubation Dzidzira NaSuccinylcholine Kurwisana neRocuronium

Tracheostomy Munguva Yekutenderera Mu COVID-19 Varwere: Ongororo Pazvino Zvekuchipatara Kudzidzira

Tracheal Intubation: Rini, Sei Uye Sei Kugadzira Yakagadzirwa YeMhepo YeMurwere

Source:

NaJessica Rogers - Usakanganwa mabhuru