Ukungenisa umoya ngamaphaphu akuyona nje inqubo edingwa yisiguli: kulo nyaka iCovid-19 ikwenze kwaba yisibonelo sokuthi ukungenelela kwezempilo okusindisiwe kushintshile kanjani futhi kungakanani

Impela ngonyaka owodwa edlule, ingxenye enkulu ye- i-ambulensi ukuhanjiswa kwakubandakanya iziguli ezihlukumezekile, kanye nokuhanjiswa kwangaphakathi nasezibhedlela.

Namuhla, umoya omncane wamaphaphu udlala indima, futhi kubalulekile ukujwayelana nayo, noma ngabe kufushane nje.

Yebo, uyini umoya omncane wamaphaphu? Iyiphi indima edlalwa umoya wokuphefumula empilweni yansuku zonke yomhlengi noma wezokunakekelwa kwempilo?

I-pulmonary, yokufakelwa noma yokungenisa imishini ithatha indawo noma isekele umsebenzi wemisipha ekhuthazayo, iqinisekise ivolumu eyanele yegesi emaphashini.

Kuyinqubo eyenziwe ngomshini, ezenzekelayo futhi enesigqi, elawulwa yizikhungo eziphakeme lapho, ngemisipha yamathambo yesifinyezo sokuphumula nokuphumula, isisu nezimbambo, kukhuthazwa ukushintshaniswa komoya ku-alveoli.

Ngesikhathi sokuhogela, ingcindezi ye-intra-alveolar iba mbi kancane uma iqhathaniswa nengcindezi yasemkhathini (-1mmHg), futhi lokhu kubangela ukuba umoya ungene ngaphakathi ezindleleni zomoya.

Ngakolunye uhlangothi, ngesikhathi sokuphefumula okujwayelekile ingcindezi ye-intra-alveolar ikhuphukela ku-1mmHg ezungeze, idale umoya uphumele ngaphandle.

Umshini owenza lo msebenzi ubizwa ngokuthi i-lung ventilator noma i-mechanical ventilator noma i-ventilator yokufakelwa.

I-lung ventilator ingena esikhundleni sohlelo lokuphefumula imisebenzi yemishini iphelele noma ingxenye yayo lapho uhlelo lokuphefumula lungakwazi ukwenza umsebenzi walo lodwa ngenxa yesifo, ukuhlukumezeka, ukukhubazeka okuzelwe noma imithi (isib. Izinzwa ngesikhathi sokuhlinzwa).

I-ventilator ingafaka insufflate yohlobo oluthile lwegesi emaphashini iwavumele ukuthi akhiphe imvamisa eyaziwayo nengcindezi efanele.

Ukuze uhambise inani elidingekayo le-oxygen esigulini futhi ususe isikhutha esikhiqizwayo, umshini wokuphefumula kufanele akwazi:

- insufflate inani elilawulwayo lemixube yomoya noma yegesi emaphashini;

- misa insufflation;

- vumela amagesi akhishiwe ukuba abaleke;

- Phinda umsebenzi ngokuqhubekayo.

Ngokuphambene nokuphefumula kwemvelo, ekungeneni komoya okufakelwayo ngokusebenzisa umshini wokuphefumula wamaphaphu, ingcindezi ayiveli nje kuphela ezindleleni zomoya ezingenhla kepha futhi nangaphakathi.

Ukuze kunwetshwe amaphaphu nezimbambo, umshini wokuphefumula kufanele athumele umoya ekucindezelekeni: amaphaphu ahlala esengaphansi kwengcindezi yasemkhathini, noma kungekho ukugeleza.

Ukungenisa umoya ngemishini, ngokuba sengcindezelweni enhle, kuholela ekwandeni kokushintshana ngokuphefumula, lapho kuvulwa kabusha izindawo ezingenawo umoya kahle, kepha ngesikhathi esifanayo kungaholela ekulimaleni kohlelo lokuphefumula (i-barotrauma).

Ukuphefumula ngomshini kusetshenziswa ezimweni ze:

- izifo ezinzima zamaphaphu

- i-apnea ehambisana nokuboshwa kokuphefumula (nakho kusuka ekudakweni);

- i-asthma enamandla futhi enamandla;

- i-acidosis ebucayi noma engapheli yokuphefumula;

- i-hypoxemia elinganiselayo / eqinile;

- umsebenzi wokuphefumula ngokweqile;

- ukukhubazeka kwe-diaphragm ngenxa ye-Guillain-Barré syndrome, i-Myasthenia Gravis, izinkinga ezinzima ze-muscular dystrophy noma i-amyotrophic lateral sclerosis, Umgogodla ukulimala kwentambo, noma umphumela wokubulala izinzwa noma iziphumlisi zemisipha;

- umsebenzi owandisiwe wemisipha yokuphefumula, okufakazelwa yi-tachypnoea eyeqile, ukungena kabusha okungaphezulu kokungena ngaphakathi kanye nokunyakaza okukhulu kodonga lwesisu;

- i-hypotension nokwethuka, njengasekucingeni kwenhliziyo noma i-sepsis.

Ukungenisa umoya ngamaphaphu, izinhlobo zama-ventilator wamaphaphu

Kunezinhlobo ezahlukahlukene zemishini yokuphefumula:

- ingcindezi engemihle yokuphefumula ngomshini

- ingcindezi enhle umshini wokuphefumula osebenzayo

- ukunakekelwa okunamandla noma ukuphefumula okungaphansi kokunakekelwa okungaphansi (noma ezokuthutha eziphuthumayo / zezokwelapha eziphuthumayo)

- umshini wokungenisa umoya wokunakekelwa okungajwayelekile noma ukunakekelwa okungaphansi (noma ezokuthutha eziphuthumayo / zezokwelapha eziphuthumayo)

Ngaphezu kwalokho, imishini yokuphefumula ihlukaniswe yaba:

- Ukuphefumula Okungenayo

- Ukuphefumula Okungangenisi

Ingcindezi engeyinhle yokuphefumula / yokufakelwa

Ingcindezi engeyinhle yokungenisa umoya imelela isizukulwane sokuqala semishini yokuphefumula yamaphaphu, eyaziwa nangokuthi amaphaphu ensimbi.

Iphaphu lensimbi, ngamafuphi, likhiqiza nje umshini wokuphefumula orekhodwe ezimweni ezijwayelekile lapho i-myopathy noma i-neuropathy ikwenza kungabi khona umsebenzi owanele wemisipha yezimbambo.

Izinhlelo zokucindezela ezingezinhle zisasetshenziswa, ikakhulukazi ezigulini ezinemisipha enganele ye-thoracic cage, njengakwipoliyomyelitis.

Ingcindezi evumayo imishini yokuphefumula / yokufakelwa (engahlaseli)

Lezi zinsimbi zenzelwe ukuphefumula okungangenisi umoya, kufaka phakathi ekhaya ekwelapheni ukuphefumula kokulala okungavimbeli.

I-ventilator isebenza ngokuxubana kwegesi engaxinene (imvamisa umoya ne-oxygen) ekucindezelekeni okuhle ezindleleni zomoya zesiguli.

Ama-ventilator asekhaya (umthombo wamandla we-electromechanical)

I-piston noma ipompo yokubuyisela emuva: Iqoqa amagesi noma ingaphansi kwengcindezi ephansi, uwaxube bese uwafaka kumjikelezo wangaphandle ngesikhathi sesigaba sokukhuthaza.

Akusebenzi kangako ukukhokhela ukuvuza

I-Turbine: Idonsa amagesi, iyacindezela bese ithumela esigulini nge-valve yendlela eyodwa yokukhuthaza.

Bangakwazi ukulawula ingcindezi ngokugeleza nokulethwa kwevolumu.

Ama-ventilator asekhaya (ephendulwa ngogesi onengcindezi ephansi):

1.I-CPAP ne-autoCPAP

1. Izinga eliphindwe kabili

3. Pressovolumetric

1.I-CPAP ne-autoCPAP (hhayi imodi yokungenisa umoya kepha uhlobo lomshini wokuphefumula)

- zisetshenziselwa ukwelashwa kokuphazamiseka kokulala;

- I-CPAP inikeza izinga elinqunyelwe kusengaphambili lokucindezela okulinganayo okuhle kuzo zombili izigaba zokuphefumula okuvimbela ukuwa komoya;

- i-self CPAP iletha ingcindezi enhle kuzo zombili izigaba zokuphefumula ngokuya ngezidingo zesiguli ngaleso sikhathi (ibanga lokucindezela lisethelwe).

2. Izinga eliphindwe kabili

- umshini wokungenisa umoya ongahlaseli onikela ngamazinga okucindezela amabili: i-IPAP (ingcindezi enhle esigabeni esikhuthazayo) ne-EPAP (ingcindezi enhle esigabeni sokuphefumula);

- ungavumeli ukuqapha kwemingcele yokuphefumula;

- zisetshenziselwa ukwelashwa kwezifo zokulala;

- lapho i-CPAP ingalungisi i-apnea kanye / noma i-apnea enamandla noma i-hypoxemia ehambisanayo.

3. Ama-Pressuvolumetric ventilators

Lokhu kuvumela ukusetshenziswa kwezingcindezi noma izindlela zokufaka umoya omncane. Zihlukaniswa yisifunda esisetshenzisiwe.

Ukungenisa umoya ngamaphaphu ekunakekelweni okunamandla (umthombo wamandla womoya)

Lung ama-ventilators ingasebenza kuzo zombili izindlela ezihlasela futhi ezingezona ezihlasela zokuphefumula, ezimbalwa zezici eziyinhloko yilezi:

- Basebenza ngegesi enomfutho ophakeme (4 BAR)

- Nikeza ukuzinza kwe-FiO2

- Baqinisekisa ukulethwa kwevolumu noma ngabe kwenzeka impedance ephezulu (isiguli esikhuluphele)

I-FiO2 ingxenyenamba ehogelwayo ye-O2. Yisiqubulo esisetshenziswe kwezokwelapha ukukhombisa i-% ye-oxygen (O2) ehogelwe yisiguli.

I-FiO2 ivezwa njengenombolo ephakathi kuka-0 no-1 noma njengephesenti. I-FiO2 emoyeni esemkhathini ingu-0.21 (21%).

I-ventilator yamaphaphu iqukethe amabhlogo ayisisekelo asebenzayo alandelayo

- i-generator yengcindezi ekwaziyo ukukhiqiza i-gradient yengcindezi phakathi kwendawo yangaphandle yengcindezi yomkhathi kanye ne-alveoli, enquma inani lokugeleza kwegesi okungafinyeleli esigulini.

Lo msebenzi utholakala ngokukhiqiza amandla asetshenziswa kwizifutho eziqukethe ingxube yegesi enganciphisi, noma ngokunciphisa ingcindezi yamagesi yohlelo olungaguquki ngochungechunge lwama-valve we-cascade;

- uhlelo lokulinganisa ivolumu yamanje (VT);

- uchungechunge lwamadivayisi wesikhathi somjikelezo wokuphefumula okuthi, ngokuvula ngokufanelekile nokuvala ama-valve alawula ukugeleza okukhuthazayo nokuphefumulayo, avumele ukuguquka kusuka ekuphefumulelweni kuye ekuphelelweni isikhathi futhi okuphambene nalokho;

- isifunda sesiguli, esiqukethe zonke izingxenye ezixhuma umshini wokuphefumula nohlelo lokuphefumula lwesiguli. Kungaba nemijikelezo evulekile (ngaphandle kokuphefumula kabusha), okuthi lapho umoya ngamunye ukhipha amagesi aphefumulelwe iye ngaphandle, noma amasekethe avaliwe anezincibilikisi ze-CO2 lapho kutholakala khona igesi ekhishwe yisiguli ngemuva kokumunca kwe-CO2;

- Izinto eziphikisayo ezibandakanya wonke amapayipi afakwe phakathi kwe-generator yengcindezi enhle kanye nesistimu yokuphefumula yesiguli ekhiqiza ukumelana nokuthuthuka kwegesi kuzo.

Ukungenisa umoya ngamaphaphu: ukuthi umshini wokuphefumula usebenza kanjani

Ama-ventilator emaphashini anikela ngezindlela ezahlukahlukene zokusebenza ezizoshintshwa ngokuya ngezidingo ezithile zesiguli.

Isimo esibalulekile lapho abezokwelapha bakhetha khona imodeli yokungenisa umoya yikhono lesiguli lokuphefumula ngokuzimela.

Imodi elawulwayo ikhethwa lapho isiguli singenawo umsebenzi wokuphefumula okuzenzekelayo futhi sidinga ukuthi udokotela alungise izikhathi zokusebenza (isikhathi sokuphefumulelwa, isikhathi sokuphelelwa yisikhathi, isikhathi sokuphumula, imvamisa yokukhuthaza) kwiphaneli yokulawula i-lung ventilator.

Kunamathuba amabili wokungeniswa komoya okulawulwayo: ukugeleza komoya okuqhubekayo nokungena komoya kwengcindezi njalo, kuya ngobungako obukhethiwe (ukugeleza noma ukucindezela) njengepharamitha yokulawula uhlelo lokungenisa umoya.

Imodi esiziwe isetshenziselwa ubunzima bokuphefumula iziguli ezisakwazi ukuqala isigaba sokukhuthaza.

Umshini wokuphefumula wamaphaphu kufanele azi ngomzamo wesiguli wokukhuthaza nokulekelela ekwenzeni lokho.

Ekugcineni, imodi evumelanisiwe iqukethe isigaba sokuqala lapho isiguli sithola khona umoya ngokuthumela ivolumu ethile yomoya emaphashini ngesikhathi esichazwe ngaphambilini, ngendlela elawulwa njalo yokuhamba; lokhu kulandelwa yisikhathi sokuphefumula okuzenzakalelayo uma isiguli sikuthole ukusebenza kohlelo lokuphefumula, noma isikhathi sokungenisa umoya esisizayo uma kuba nobunzima obuqhubekayo.

Funda futhi: 

Ukuphefumula okwenziwa ngesandla, Izinto ezi-5 okufanele uzigcine engqondweni

I-New Lungs Ventilator Ukusiza iziguli ze-COVID-19 Emazweni amaningi Asathuthuka, Olunye uphawu Lmpendulo Yezwe Kuyi-Virus

Iziguli ze-COVID-19: Ngabe i-Initered Nitric oxide Ngesikhathi Sokuphefumula Kwemishini Inikeza Izinzuzo?

I-FDA ivuma i-Recarbio Ukwelapha I-Pneumonia Ebangelwa Yibacteria Ebangelwa Yisibhedlela

Funda Isigaba Sase-Italy

Source:

I-Ventilatore Polmonare Stephan ® EVE IN per terapia intensiva e trasporto intra-ospedaliero

Ama-Approfondimenti tecnici nell'articolo dedicatedato EMD 112