I-Capnography kwi-ventilatory practice: kutheni sifuna i-capnograph?

By UCristiano Antonino On Mar 24, 2023

Ukungenisa umoya kufuneka kwenziwe ngokuchanekileyo, ukubeka iliso okwaneleyo kuyimfuneko: i-capnographer idlala indima echanekileyo kule nto.

I-capnograph kwi-ventilation yomatshini wesigulane

Ukuba kuyimfuneko, umoya wokungenisa umoya kwi-prehospital kufuneka uqhutywe ngokuchanekileyo kunye nokubeka iliso elibanzi.

Akubalulekanga nje ukufumana isigulane esibhedlele, kodwa nokuqinisekisa ithuba eliphezulu lokubuyisela, okanye ubuncinci ukuba ungabandisi ubunzima bemeko yesigulane ngexesha lokuthutha kunye nokunyamekela.

Iintsuku ze-ventilators ezilula ezinoseto oluncinci (i-frequency-volume) yinto yakudala.

Uninzi lwezigulana ezifuna ukuphefumla ngoomatshini ziye zakugcina ukuphefumla okuzenzekelayo (i-bradypnoea kunye ne-hypoventilation), ephakathi 'kuluhlu' phakathi kwe-apnea epheleleyo kunye nokuphefumla okuzenzekelayo, apho ukuphefumla i-oxygen yanele.

I-ALV (i-Adaptive lung ventilation) ngokubanzi kufuneka ibe yi-normoventilation: i-hypoventilation kunye ne-hyperventilation zombini ziyingozi.

Umphumo wokungena komoya onganelanga kwizigulane ezine-pathology yengqondo ebukhali (i-stroke, i-head trauma, njl.) iyingozi kakhulu.

Utshaba olufihliweyo: i-hypocapnia kunye ne-hypercapnia

Kuyaziwa ukuba ukuphefumla (okanye i-ventilation mechanical) kuyimfuneko ukubonelela umzimba nge-oxygen O2 kunye nokususa i-carbon dioxide CO2.

Umonakalo wokungabikho kweoksijini ucacile: i-hypoxia kunye nokulimala kwengqondo.

Ukugqithisa kwe-O2 kunokonakalisa i-epithelium yeendlela zomoya kunye ne-alveoli yemiphunga, nangona kunjalo, xa usebenzisa i-oxygen concentration (FiO2) ye-50% okanye ngaphantsi, akuyi kubakho monakalo omkhulu kwi-'hyperoxygenation ': i-oksijeni engaxutywanga iya kususwa ngokulula. ngokuphefumla.

Ukukhutshwa kwe-CO2 akuxhomekanga ekubunjweni komxube onikeziweyo kwaye kunqunywe ngumzuzu wexabiso le-ventilation ye-MV (i-frequency, fx tidal volume, Vt); xa uphefumla utyebile okanye unzulu, kokukhona i-CO2 ikhutshwa.

Ngokunqongophala kwe-ventilation ('hypoventilation') - i-bradypnoea / ukuphefumula okuphezulu kwisigulane ngokwakhe okanye umoya we-mechanical 'lacks' hypercapnia (i-CO2 engaphezulu) iqhubela phambili emzimbeni, apho kukho ukwandiswa kwe-pathological yemikhumbi ye-cerebral, ukwanda kwe-intracranial uxinzelelo, i-cerebral edema kunye nomonakalo wayo wesibini.

Kodwa ngokuphefumla ngokugqithisileyo (i-tachypnoea kwisigulana okanye kwiiparamitha zokungenisa umoya ezigqithisileyo), i-hypocapnia ibonwa emzimbeni, apho kukho ukucutha kwemithambo ye-cerebral kunye ne-ischemia yamacandelo ayo, kwaye ngaloo ndlela nomonakalo wesibini wobuchopho, kunye ne-alkalosis yokuphefumla nayo iyanda. ubuqatha bemeko yomguli. Ngoko ke, umoya wokungena ngoomatshini akufanele ube 'yi-anti-hypoxic' kuphela, kodwa kwakhona 'i-normocapnic'.

Kukho iindlela zokubala ngokwethiyori iiparameters ze-ventilation mechanical, ezifana ne-formula kaDarbinyan (okanye ezinye ezihambelanayo), kodwa zibonisa kwaye zingenako ukuqwalasela imeko yesigulane, umzekelo.

Kutheni i-pulse oximeter ayanele

Ewe, i-pulse oximetry ibalulekile kwaye yenza isiseko sokujongwa kwe-ventilation, kodwa ukubeka iliso kwe-SpO2 akwanelanga, kukho iingxaki ezininzi ezifihliweyo, ukulinganiselwa okanye iingozi, ezizezi: Kwiimeko ezichazwe, ukusetyenziswa kwe-pulse oximeter kaninzi kuba yinto engenakwenzeka. .

- Xa usebenzisa i-oxygen concentrations ngaphezu kwe-30% (ngokuqhelekileyo i-FiO2 = i-50% okanye i-100% isetyenziswe nge-ventilation), imilinganiselo yokunciphisa umoya (izinga kunye nomthamo) inokwanela ukugcina "i-normoxia" njengoko inani le-O2 elihanjiswa ngesenzo sokuphefumula sanda. Ngoko ke, i-pulse oximeter ayiyi kubonisa i-hypoventilation efihliweyo kunye ne-hypercapnia.

– I-pulse oximeter ayibonisi i-hyperventilation eyingozi nangayiphi na indlela, amaxabiso ahlala e-SpO2 angama-99-100% aqinisekisa ngobuxoki ugqirha.

-I-pulse oximeter kunye nezalathi zokuzalisa zingasebenzi kakhulu, ngenxa yokubonelelwa kwe-O2 kwigazi elijikelezayo kunye nendawo efileyo ye-physiological yemiphunga, kunye nangenxa yokufundwa kwe-avareji kwithuba lexesha kwi-pulse oximeter ekhuselweyo. i-pulse yezothutho, xa kwenzeka isiganeko esiphuthumayo (ukuqhawulwa kwesekethe, ukungabikho kweeparamitha zomoya, njl.) n.) I-saturation ayinciphisi ngokukhawuleza, kanti impendulo ekhawulezayo evela kugqirha iyadingeka.

– I-pulse oximeter inika ukufundwa kwe-SpO2 engalunganga kwimeko ye-carbon monoxide (CO) yetyhefu ngenxa yokuba ukukhanya kwe-oxyhaemoglobin HbO2 kunye ne-carboxyhaemoglobin HbCO kuyafana, ukubeka iliso kule meko kulinganiselwe.

Ukusetyenziswa kwe-capnograph: i-capnometry kunye ne-capnography

Iinketho ezongezelelweyo zokubeka iliso ezisindisa ubomi besigulane.

Ukongezwa okuxabisekileyo kunye nokubalulekileyo ekulawuleni ukwanela kokungena komoya kumatshini ukulinganisa rhoqo i-CO2 yoxinaniso (EtCO2) emoyeni ophumayo (capnometry) kunye nokubonakaliswa kwegraphical ye-cyclicity ye-CO2 excretion (i-capnography).

Izinto eziluncedo ze-capnometry zezi:

-Izibonakaliso ezicacileyo kuyo nayiphi na imeko ye-haemodynamic, nangexesha le-CPR (kwixinzelelo lwegazi eliphantsi kakhulu, ukubeka iliso kwenziwa ngeendlela ezimbini: i-ECG kunye ne-EtCO2)

– Utshintsho olukhawulezileyo lwezalathi kuzo naziphi na iziganeko kunye nokutenxa, umz. xa isiphaluka sokuphefumla sivaliwe

-Uvavanyo lwesimo sokuqala sokuphefumula kwisigulane esifakwe ngaphakathi

-Imbonakalo yexesha lokwenyani ye-hypo- kunye ne-hyperventilation

Ezinye iimpawu ze-capnography zibanzi: ukuvinjelwa kwendlela yomoya kubonisiwe, iinzame zesigulane zokuphefumula ngokuzenzekelayo kunye nesidingo sokuqinisa i-anesthesia, i-cardiac oscillations kwitshati kunye ne-tachyarrhythmia, ukunyuka okunokwenzeka kokushisa komzimba kunye nokunyuka kwe-EtCO2 kunye nokunye okuninzi.

Iinjongo eziphambili zokusebenzisa i-capnograph kwinqanaba le-prehospital

Ukubeka iliso kwimpumelelo ye-tracheal intubation, ngakumbi kwiimeko zengxolo kunye nobunzima be-auscultation: inkqubo eqhelekileyo ye-cyclic CO2 excretion kunye ne-amplitude enhle ayinakuze isebenze ukuba ityhubhu ifakwe kwi-esophagus (nangona kunjalo, i-auscultation iyimfuneko yokulawula ukungena komoya kwezi zibini." imiphunga)

Ukubeka iliso ekubuyiselweni kokujikeleza ngokuzenzekelayo ngexesha le-CPR: imetabolism kunye nokuveliswa kwe-CO2 kwanda kakhulu kwi-organism 'evuselelwe', 'i-jump' ibonakala kwi-capnogram kwaye imbonakalo ayibi kakhulu ngokunyanzeliswa kwentliziyo (ngokungafaniyo nomqondiso we-ECG)

Ukulawulwa ngokubanzi kokungena komoya ngoomatshini, ngakumbi kwizigulane ezinomonakalo wobuchopho (i-stroke, ukulimala kwentloko, ukuxhuzula, njl.

Ukulinganisa "kwindlela ehamba phambili" (MAINSTREAM) kunye "kwi-lateral flow" (SIDESTREAM).

IiCapnographs zimbini iintlobo zobugcisa, xa ulinganisa i-EtCO2 'kwindlela engundoqo' i-adapter emfutshane enemingxuma esecaleni ibekwe phakathi kwetyhubhu ye-endotracheal kunye nesekethe, i-sensor e-U-shaped ibekwe kuyo, igesi edlulayo iskena kwaye izimisele. I-EtCO2 iyalinganiswa.

Xa kulinganiswa 'kwi-lateral flow', inxalenye encinci yerhasi ithathwa kwisekethe ngomngxuma okhethekileyo kwisekethe ngecompressor yokufunxa, ityiswa ngombhobho obhityileyo ukuya kumzimba wecapnograph, apho i-EtCO2 ilinganiswa.

Izinto ezininzi zichaphazela ukuchaneka komlinganiselo, njengokugxininiswa kwe-O2 kunye nomswakama kumxube kunye nobushushu bokulinganisa. Inzwa kufuneka ifudunyezwe kwaye ilinganiswe.

Ngaloo ndlela, umlinganiselo wecala ubonakala uchaneka ngakumbi, njengoko unciphisa impembelelo yale miba ephazamisayo ekusebenzeni, nangona kunjalo.

Ukuphatheka, iinguqulelo ezi-4 zecapnograph:

njengenxalenye yemonitha ecaleni kwebhedi
njengenxalenye yemisebenzi emininzi defibrillator
i-mini-nozzle kwisekethe ('isixhobo sikwinzwa, akukho cingo')
isixhobo esiphathwayo sepokotho ('isivamvo somzimba + ecingweni').

Ngokuqhelekileyo, xa kubhekiswa kwi-capnography, itshaneli yokubeka iliso ye-EtCO2 iqondwa njengenxalenye ye-monitor 'yebhedi' esebenzayo; kwi-ICU, ilungiswa ngokusisigxina kwi- izixhobo ishelufu.

Nangona i-monitor stand isuswa kwaye i-capnograph monitor inikwe amandla ngebhetri eyakhelwe-ngaphakathi, kusenzima ukuyisebenzisa xa ufudukela kwiflethi okanye phakathi kwesithuthi sokuhlangula kunye neyunithi yokunyamekela kakhulu, ngenxa yobunzima kunye nobukhulu befowuni. i-monitor case kunye nokungenakwenzeka kokuyinamathisela kwisigulane okanye kwi-stretcher engenamanzi, apho uthutho olusuka kwiflethi lwaluqhutyelwa kakhulu.

Kufuneka isixhobo esiphathwayo ngakumbi.

Ubunzima obufanayo bufunyanwa xa kusetyenziswa i-capnograph njengenxalenye ye-multifunctional defibrillator: ngelishwa, phantse zonke zisenobukhulu obukhulu kunye nobunzima, kwaye ngokwenene azivumeli, umzekelo, isixhobo esinjalo ukuba sibekwe ngokukhululekile kwindawo engangeni manzi. i-stretcher ecaleni kwesigulane xa usehla izinyuko ukusuka kumgangatho ophezulu; nangexesha lokusebenza, ukudideka kaninzi kwenzeka ngenani elikhulu leengcingo kwisixhobo.