Emergency Live | Manual Ventilation, 5 Things to Keep in Mind image 2

Ukuphathwa kwe-Ventilator: ukufaka umoya wesiguli

By UCristiano Antonino On Feb 24, 2023

I-invasive mechanical ventilation iwukungenelela okuvame ukusetshenziswa ezigulini ezigula kakhulu ezidinga ukwesekwa kokuphefumula noma ukuvikelwa kwendlela yokuphefumula.

I-ventilator ivumela ukushintshaniswa kwegesi ukuthi kunakekelwe ngenkathi ezinye izindlela zokwelapha zinikezwa ukuthuthukisa izimo zomtholampilo

Lo msebenzi ubuyekeza izinkomba, ukuphikisana, ukuphathwa, kanye nezinkinga ezingase zibe khona zokungena komoya okungenasidingo futhi ugcizelela ukubaluleka kwethimba labachwepheshe ekulawuleni ukunakekelwa kweziguli ezidinga ukwesekwa kwe-ventilatory.

Isidingo sokungena komoya ngomshini singenye yezimbangela ezivame kakhulu zokwamukelwa e-ICU.[1][2][3]

IZIQINISEKISO, IZIBHODI ZOMPHINI, IZIHLALO ZOKUPHUMA AMALUNGA: IMIKHIQIZO YE-SPENCER E-DOUBLE BOOTH KU-EXPO EZIPHUTHUMAYO

Kubalulekile ukuqonda amagama athile ayisisekelo ukuze uqonde ukungena komoya ngomshini

Ukuphefumula: Ukushintshana komoya phakathi kwamaphaphu nomoya (okuzungezile noma okunikezwa umshini wokungenisa umoya), ngamanye amazwi, kuyinqubo yokuhambisa umoya ungene noma uphume emaphashini.

Umphumela wayo obaluleke kakhulu ukukhishwa kwe-carbon dioxide (CO2) emzimbeni, hhayi ukwanda kokuqukethwe komoyampilo egazini.

Ezilungiselelweni zomtholampilo, ukungena komoya omncane kukalwa njengokungenisa komoya okuncane, kubalwa njengesilinganiso sokuphefumula (RR) izikhathi zevolumu ye-tidal (Vt).

Esigulini esinomshini wokungenisa umoya, okuqukethwe kwe-CO2 egazini kungashintshwa ngokushintsha umthamo wamaza noma izinga lokuphefumula.

I-Oxygenation: Ukungenelela okunikeza ukwanda kokulethwa komoyampilo emaphashini kanjalo nokujikeleza.

Esigulini esinomshini wokungenisa umoya, lokhu kungafezwa ngokukhulisa ingxenyana ye-oxygen ephefumulelwe (FiO 2%) noma ukucindezela okuhle kokuphela kokuphelelwa umoya (PEEP).

I-PEEP: Ukucindezela okuhle okusele endleleni yokuphefumula ekupheleni komjikelezo wokuphefumula (ukuphela kokuphelelwa yisikhathi) kukhulu kunokucindezela komkhathi ezigulini eziphefumulayo ngemishini.

Ukuze uthole incazelo ephelele yokusetshenziswa kwe-PEEP, bheka isihloko esithi “Positive End-Expiratory Pressure (PEEP)” kumareferensi ezincwadi ekugcineni kwalesi sihloko.

Ivolumu ye-Tidal: Ivolumu yomoya ingena iphuma emaphashini emjikelezweni ngamunye wokuphefumula.

I-FiO2: Iphesenti le-oxygen engxubeni yomoya elethwa esigulini.

Ukugeleza: Linganisa ngamalitha ngomzuzu lapho i-ventilator ikhipha khona ukuphefumula.

Ukuhambisana: Ukushintsha kwevolumu kuhlukaniswe ukushintsha kwengcindezi. Ku-physiology yokuphefumula, ukuthobela ngokuphelele kuyinhlanganisela yokuthobela udonga lwamaphaphu nesifuba, njengoba lezi zici ezimbili azikwazi ukuhlukaniswa esigulini.

Ngenxa yokuthi ukungena komoya ngemishini kuvumela udokotela ukuthi aguqule umoya wesiguli kanye nempilo nempilo, idlala indima ebalulekile ekuhlulekeni kokuphefumula okunamandla kwe-hypoxic kanye ne-hypercapnic kanye ne-acidosis enzima noma i-alkalosis ye-metabolic.[4][5]

I-Physiology ye-ventilation yemishini

Ukungena komoya ngemishini kunemiphumela eminingana kumishini yamaphaphu.

I-Physiology yokuphefumula evamile isebenza njengesistimu yokucindezela okubi.

Lapho i-diaphragm iphonseka phansi ngesikhathi sokuphefumulelwa, ingcindezi engalungile ikhiqizwa emgodini we-pleural, wona, odala ukucindezela okungalungile emigwaqweni yomoya edonsa umoya emaphashini.

Le ngcindezi efanayo ye-intrathoracic negative yehlisa ingcindezi ye-atrial yangakwesokudla (RA) futhi ikhiqize umphumela wokumunca ku-inferior vena cava (IVC), okwandisa ukubuya kwe-venous.

Ukusetshenziswa kwe-ventilation ye-pressure positive kushintsha le physiology.

Ukucindezela okuhle okukhiqizwa yi-ventilator kudluliselwa ku-airway ephezulu futhi ekugcineni ku-alveoli; lokhu, futhi, kudluliselwa endaweni ye-alveolar kanye ne-thoracic cavity, okwenza ukucindezela okuhle (noma okungenani ukucindezela okuphansi okungalungile) endaweni ye-pleural.

Ukwenyuka kwengcindezi ye-RA kanye nokuncipha kokubuya kwe-venous kudala ukwehla kokulayisha kuqala.

Lokhu kunomthelela okabili wokunciphisa ukuphuma kwenhliziyo: igazi elincane ku-ventricle engakwesokudla kusho ukuthi igazi elincane lifinyelela ku-ventricle yesokunxele futhi igazi elincane lingampontshwa, linciphise ukuphuma kwenhliziyo.

Ukulayisha kuqala okuphansi kusho ukuthi inhliziyo isebenza endaweni engasebenzi kahle kakhulu ejikeni lokusheshisa, ikhiqize umsebenzi ongasebenzi kahle futhi inciphise nakakhulu ukuphuma kwenhliziyo, okuzophumela ekwehleni komfutho wegazi omaphakathi (MAP) uma ingekho impendulo enxephezelayo ngokukhuphuka. i-systemic vascular resistance (SVR).

Lokhu ukucatshangelwa okubaluleke kakhulu ezigulini ezingase zingakwazi ukwandisa i-SVR, njengeziguli ezinokushaqeka kokusabalalisa (i-septic, neurogenic, noma i-anaphylactic).

Ngakolunye uhlangothi, umfutho omuhle wokungenisa umoya ngomshini unganciphisa kakhulu umsebenzi wokuphefumula.

Lokhu-ke, kunciphisa ukugeleza kwegazi emisipheni yokuphefumula futhi kusakabe kabusha ezingxenyeni ezibucayi kakhulu.

Ukunciphisa umsebenzi wemisipha yokuphefumula futhi kunciphisa ukukhiqizwa kwe-CO2 kanye ne-lactate kule misipha, okusiza ukuthuthukisa i-acidosis.

Imiphumela yokucindezela okuhle komoya wokungena kwemishini ekubuyeni kwe-venous ingaba wusizo ezigulini ezine-cardiogenic pulmonary edema.

Kulezi ziguli ezinomthamo omningi, ukunciphisa ukubuya kwe-venous kuzonciphisa ngokuqondile inani le-edema yamaphaphu elikhiqizwe, kunciphise ukuphuma kwenhliziyo efanele.

Ngasikhathi sinye, ukuncipha kokubuya kwe-venous kungase kuthuthukise ukweqisa kwe-ventricular yesokunxele, kubeke endaweni enenzuzo eyengeziwe kwijika lika-Frank-Starling futhi ngokunokwenzeka kuthuthukise ukuphuma kwenhliziyo.

Ukuphathwa ngendlela efanele kokungena komoya ngomshini nakho kudinga ukuqonda ukucindezelwa kwamaphaphu nokuhambisana namaphaphu.

Ukuthobela amaphaphu okuvamile cishe ku-100 ml/cmH20.

Lokhu kusho ukuthi ephashini elivamile, ukuphathwa kwe-500 ml yomoya ngomoya omuhle kuzonyusa umfutho we-alveolar ngo-5 cm H2O.

Ngokuphambene, ukuphathwa kwengcindezi enhle engu-5 cm H2O kuzodala ukwanda kwevolumu yamaphaphu ka-500 mL.

Lapho usebenza namaphaphu angavamile, ukuthobelana kungase kube phezulu kakhulu noma kube phansi kakhulu.

Noma yisiphi isifo esibhubhisa i-parenchyma yamaphaphu, njenge-emphysema, sizokwandisa ukuthobela umthetho, kuyilapho noma yisiphi isifo esidala amaphaphu aqinile (i-Ards, inyumoniya, i-pulmonary edema, pulmonary fibrosis) izokwehlisa ukuthotshelwa kwamaphaphu.

Inkinga ngamaphaphu aqinile ukuthi ukunyuka okuncane kwevolumu kungabangela ukwanda okukhulu kwengcindezi futhi kubangele i-barotrauma.

Lokhu kudala inkinga ezigulini ezine-hypercapnia noma i-acidosis, njengoba umoya omncane ungase udinge ukwenyuswa ukuze kulungiswe lezi zinkinga.

Ukwenyuka kwezinga lokuphefumula kungalawula lokhu kukhuphuka kokungena komoya omncane, kodwa uma lokhu kungenzeki, ukwanda komthamo wamaza kungakhuphula izingcindezi ze-plateau kudale i-barotrauma.

Kunezingcindezi ezimbili ezibalulekile ohlelweni okufanele uzikhumbule lapho ufaka umoya wesiguli ngomshini:

Umfutho ophakeme umfutho ofinyelelwa ngesikhathi sokuphefumula lapho umoya uphushelwa emaphashini futhi kuyisilinganiso sokumelana komoya.
Ingcindezi ye-Plateau ingcindezi emile efinyelelwe ekugcineni kokuphefumulelwa okugcwele. Ukuze kukale umfutho we-plateau, kumele kumiswe isikhashana kumshini wokungenisa umoya ukuze kuvunyelwe ingcindezi ukuthi ilingane ngesistimu. Ukucindezela kwe-Plateau isilinganiso somfutho we-alveolar nokuhambisana namaphaphu. Ukucindezela okujwayelekile kwethafa kungaphansi kuka-30 cm H20, kuyilapho ukucindezela okuphezulu kungenza i-barotrauma.

Izinkomba zokungena komoya ngomshini

Isibonakaliso esivame kakhulu sokungeniswa kanye nokungena komoya ngemishini kusesimweni sokwehluleka ukuphefumula okukhulu, kungaba yi-hypoxic noma i-hypercapnic.

Ezinye izinkomba ezibalulekile ukuncipha kwezinga lokuphaphama ngenxa yokungakwazi ukuvikela indlela yokuphefumula, ukucindezeleka kokuphefumula okuye kwahluleka ukuphefumula kahle, izimo ze-hemoptysis enkulu, i-angioedema enzima, nanoma yisiphi isimo sokuphazamiseka kwendlela yokuphefumula njengokushiswa komzila womoya, ukuboshwa kwenhliziyo, nokushaqeka.

Izinkomba ezijwayelekile zokungena komoya ngomshini ukuhlinzwa kanye nokuphazamiseka kwe-neuromuscular.

Izimo

Akukho ukuphikisana okuqondile ekungeneni komoya ngemishini, njengoba kuyisinyathelo esisindisa ukuphila esigulini esigula kakhulu, futhi zonke iziguli kufanele zinikezwe ithuba lokuzuza kukho uma kunesidingo.

Okuwukuphela kokuphikisana okuphelele ekungeneni komoya ngomshini uma kuphambene nesifiso esishiwo sesiguli sezinyathelo zokwenziwa zokusekela ukuphila.

Okuwukuphela kokuphikisana okuhlobene iwukuba uma kungena komoya okungavamisile kutholakala futhi ukusetshenziswa kwawo kulindeleke ukuxazulula isidingo sokungena komoya ngemishini.

Lokhu kufanele kuqalwe kuqala, njengoba kunezinkinga ezimbalwa kunokungena komoya ngomshini.

Izinyathelo ezimbalwa kufanele zithathwe ukuze kuqalwe ukungena komoya ngomshini

Kuyadingeka ukuqinisekisa ukubekwa okulungile kweshubhu le-endotracheal.

Lokhu kungenziwa nge-end-tidal capnography noma ngenhlanganisela yemiphumela yomtholampilo neye-radiological.

Kuyadingeka ukuqinisekisa ukwesekwa okwanele kwenhliziyo nemithambo yegazi ngoketshezi noma ama-vasopressors, njengoba kuboniswe ecaleni ngalinye.

Qinisekisa ukuthi i-sedation eyanele kanye ne-analgesia iyatholakala.

Ishubhu lepulasitiki emphinjeni wesiguli libuhlungu futhi alikhululekile, futhi uma isiguli singahlaliseki noma silwa neshubhu noma umoya, kuyoba nzima kakhulu ukulawula imingcele ehlukene yokukhipha umoya nomoya-mpilo.

Izindlela zokungenisa umoya

Ngemva kokufaka isiguli futhi usixhume kumshini wokuphefumula, yisikhathi sokukhetha ukuthi iyiphi imodi yokufaka umoya ozoyisebenzisa.

Ukuze lokhu kwenziwe ngokungaguquki ukuze kuzuze isiguli, kudingeka kuqondwe izimiso ezimbalwa.

Njengoba kushiwo ngaphambili, ukuhambisana nokuguqulwa kwevolumu ehlukaniswe ukushintsha kwengcindezi.

Lapho ufaka umoya wesiguli ngomshini, ungakhetha ukuthi i-ventilator izokunikeza kanjani ukuphefumula.

I-ventilator ingasethwa ukuthi ilethe inani elinqunywe kusengaphambili levolumu noma inani elinqunywe kusengaphambili lokucindezela, futhi kukudokotela ukuthi anqume ukuthi yikuphi okuzuzisa kakhulu esigulini.

Lapho sikhetha ukulethwa kwe-ventilator, sikhetha ukuthi yikuphi okuzoba ukuhluka okuncikile futhi okuzoba okuhlukile okuzimele kuzibalo zokuthobela amaphaphu.

Uma sikhetha ukuqalisa isiguli ekungeneni komoya olawulwa ivolumu, i-ventilator izohlale iletha inani elifanayo levolumu (ukuguquguquka okuzimele), kuyilapho ingcindezi ekhiqizwayo izoncika ekuthobeleni.

Uma ukuthobela kungalungile, ingcindezi izoba phezulu futhi i-barotrauma ingenzeka.

Ngakolunye uhlangothi, uma sinquma ukuqala isiguli ekungeneni komoya olawulwa yingcindezi, i-ventilator izohlale iletha ingcindezi efanayo phakathi nomjikelezo wokuphefumula.

Kodwa-ke, umthamo wokuzulazula uzoncika ekuthobeleni amaphaphu, futhi ezimeni lapho ukuthobela kushintsha khona njalo (njengakwisifuba somoya), lokhu kuzodala amavolumu angathembekile futhi kungase kubangele hypercapnia noma hyperventilation.

Ngemuva kokukhetha imodi yokuphefumula (ngokucindezela noma ivolumu), udokotela kufanele anqume ukuthi iyiphi imodi yokufaka umoya ozoyisebenzisa.

Lokhu kusho ukukhetha ukuthi i-ventilator izosiza yini konke ukuphefumula kwesiguli, okunye ukuphefumula kwesiguli, noma cha, kanye nokuthi umshini wokuphefumula uzowukhipha yini umoya ngisho noma isiguli singaziphefumuleli sodwa.

Eminye imingcele okufanele icatshangelwe izinga lokulethwa kokuphefumula (ukugeleza), i-waveform yokugeleza (i-waveform eyehlayo ilingisa ukuphefumula komzimba futhi ikhululeke kakhudlwana esigulini, kuyilapho amagagasi ayisikwele, lapho ukugeleza kulethwa khona ngenani eliphakeme kulo lonke ugqozi, azikhululekile esigulini kodwa zinikeza izikhathi zokuhogela ngokushesha), kanye nezinga okulethwa ngalo ukuphefumula.

Yonke le mingcele kufanele ilungiswe ukuze kuzuzwe ukunethezeka kwesiguli, amagesi egazi afiswayo, futhi kugwenywe ukuvaleka komoya.

Kunezindlela ezimbalwa zokungenisa umoya ezihluka kancane ukusuka kwelinye. Kulesi sibuyekezo sizogxila ezindleleni zokungenisa umoya ezivame kakhulu kanye nokusetshenziswa kwazo emtholampilo.

Izindlela zokungenisa komoya zifaka phakathi isilawuli sokusiza (AC), ukwesekwa kwengcindezi (PS), ukuvuthwa kwe-intermittent mandatory ventilation (SIMV) okuvunyelanisiwe, kanye ne-airway pressure release release (APRV).

Ukungenisa umoya okusizwayo (AC)

Ukulawulwa kokusiza yilapho umshini wokuphefumula usiza isiguli ngokunikeza ukwesekwa kokuphefumula ngakunye isiguli esikuthathayo (lena ingxenye yokusiza), kuyilapho umshini wokuphefumula unamandla okulawula izinga lokuphefumula uma wehla ngaphansi kwezinga elimisiwe (ingxenye yokulawula).

Ekulawulweni kokusiza, uma imvamisa isethelwe ku-12 futhi isiguli siphefumula ku-18, i-ventilator izosiza ngokuphefumula okungu-18, kodwa uma imvamisa yehla iye ku-8, i-ventilator izolawula izinga lokuphefumula futhi ithathe umoya oyi-12. ngomzuzu.

Ekungeneni komsizi wokulawula, ukuphefumula kungalethwa ngevolumu noma ngengcindezi

Lokhu kubizwa ngokuthi umoya olawulwa ngevolumu noma umoya olawulwa ngomfutho.

Ukuze sikugcine kulula futhi siqonde ukuthi njengoba ukungenisa umoya ngokuvamile kuyindaba ebaluleke kakhulu kunokucindezela nokulawulwa kwevolumu kusetshenziswa kakhulu kunokulawula ukucindezela, engxenyeni esele yalokhu kubuyekezwa sizosebenzisa igama elithi "ukulawula ivolumu" ngokushintshana lapho sikhuluma ngokulawula ukusiza.

Ukulawulwa kokusiza (ukulawula ivolumu) kuyindlela yokuzikhethela esetshenziswa kuma-ICU amaningi e-United States ngoba kulula ukuyisebenzisa.

Izilungiselelo ezine (izinga lokuphefumula, ivolumu ye-tidal, i-FiO2, ne-PEEP) zingalungiswa kalula kumshini wokuphefumula. Umthamo olethwa i-ventilator ekuphefumuleni ngakunye ekulawuleni okusizwayo uzohlala ufana, kungakhathaliseki umoya oqaliswe isiguli noma umshini wokuphefumula kanye nokuhambisana, ukuphakama noma ukucindezela kwethafa emaphashini.

Ukuphefumula ngakunye kungahle kubekwe isikhathi (uma izinga lokuphefumula kwesiguli liphansi kunesimo somshini wokuphefumula, umshini uzoletha ukuphefumula ngesikhathi esimisiwe) noma ucushwe isiguli, uma kwenzeka isiguli siqala ukuphefumula ngokwaso.

Lokhu kwenza ukulawula okusizayo kube imodi enethezeke kakhulu yesiguli, njengoba yonke imizamo yaso izokwengezwa umshini wokuphefumula.

Ngemva kokwenza izinguquko kumshini wokungenisa umoya noma ngemva kokuqala isiguli ekungeneni komoya ngomshini, amagesi egazi emithanjeni kufanele ahlolwe ngokucophelela futhi kulandelwe ukugcwala komoya-mpilo kumonitha ukuze kunqunywe ukuthi ngabe kukhona yini okunye okudingeka kwenziwe kumshini wokuphefumula.

Izinzuzo zemodi ye-AC wukunethezeka okwengeziwe, ukulungiswa kalula kwe-acidosis/alkalosis yokuphefumula, kanye nomsebenzi ophansi wokuphefumula kwesiguli.

Ukungalungi kuhlanganisa iqiniso lokuthi njengoba lokhu kuyimodi yomjikelezo wevolumu, ukucindezela akukwazi ukulawulwa ngokuqondile, okungabangela i-barotrauma, isiguli singase sithuthukise i-hyperventilation nge-stacking yokuphefumula, i-autoPEEP, ne-alkalosis yokuphefumula.

Ukuze uthole incazelo ephelele yokulawula okusizwayo, bheka isihloko esithi “Ventilation, Assisted Control” [6], engxenyeni ethi Izikhombo ZeBhayibheli ekupheleni kwalesi sihloko.

Ukungenisa umoya okugunyaziwe okungaphakathi okuhambisanayo (i-SIMV)

I-SIMV ingenye indlela yokungenisa umoya esetshenziswa njalo, nakuba ukusetshenziswa kwayo sekungasasebenzi ngenxa yomthamo wamaza othembekile kancane kanye nokuntuleka kwemiphumela engcono kune-AC.

“Ukuvumelanisa” kusho ukuthi umshini wokungenisa umoya uvumelanisa ukulethwa kokuphefumula kwawo emizamweni yesiguli. “Izikhawu” kusho ukuthi akuwona wonke ukuphefumula okusekelwa ngempela futhi “ukungenisa umoya okuyimpoqo” kusho ukuthi, njengasendabeni ye-CA, kukhethwa ifrikhwensi enqunywe kusengaphambili futhi umshini wokuphefumula uletha lokhu kuphefumula okuyisibopho njalo ngomzuzu kungakhathaliseki ukuthi isiguli sizama kangakanani ukuphefumula.

Ukuphefumula okuphoqelekile kungaqalwa isiguli noma isikhathi uma i-RR yesiguli ihamba kancane kune-RR ye-ventilator (njengasesimweni se-CA).

Umehluko ovela ku-AC ukuthi ku-SIMV umshini wokungenisa umoya uzoletha kuphela ukuphefumula okusethelwe ukukuletha i-frequency; noma yikuphi ukuphefumula okuthathwe isiguli ngaphezu kwalesi simiso ngeke kuthole ivolumu yomsindo noma ukusekelwa okugcwele kokucindezela.

Lokhu kusho ukuthi ngokuphefumula ngakunye okuphuzwa isiguli ngaphezu kwe-RR ebekiwe, ivolumu yomsindo olethwa isiguli izoncika kuphela ekuthotshelweni kwephaphu lesiguli kanye nomzamo.

Lokhu kuye kwahlongozwa njengendlela “yokuqeqesha” i-diaphragm ukuze kugcinwe ithoni yemisipha futhi kukhishwe iziguli kumshini wokuphefumula ngokushesha.

Kodwa-ke, izifundo eziningi azizange zibonise inzuzo ye-SIMV. Ngaphezu kwalokho, i-SIMV ikhiqiza umsebenzi wokuphefumula owengeziwe kune-AC, enomthelela omubi emiphumeleni futhi idale ukukhathala kokuphefumula.

Umthetho ojwayelekile wesithupha okufanele ulandelwe ukuthi isiguli sizokhishwa emshinini wokuphefumula lapho sesilungile, futhi ayikho indlela ethile yokukhipha umoya ezokwenza kusheshe.

Okwamanje, kungcono kakhulu ukugcina isiguli sinethezekile ngangokunokwenzeka, futhi i-SIMV ingase ingabi imodi engcono kakhulu yokufeza lokhu.

I-Pressure Support Ventilation (PSV)

I-PSV imodi yokungenisa umoya ethembele ngokuphelele ekuphefumuleni okwenziwe isiguli.

Njengoba igama liphakamisa, imodi yokungenisa umoya eqhutshwa ukucindezela.

Kule modi, konke ukuphefumula kuqaliswa yisiguli, njengoba umshini wokuphefumula ongenalo izinga lokusekela, ngakho ukuphefumula ngakunye kufanele kuqalwe isiguli. Kule modi, i-ventilator iyashintsha isuka kwenye ingcindezi iye kwenye (PEEP kanye nengcindezi yokusekela).

I-PEEP ingcindezi esele ekupheleni kokukhipha umoya, kuyilapho ukusekelwa kwengcindezi kuyingcindezi engaphezu kwe-PEEP ezosetshenziswa isisetshenziswa sokuphefumula ngesikhathi sokuphefumula ngakunye ukuze sibambe umoya.

Lokhu kusho ukuthi uma isiguli sisethwe ku-PSV 10/5, sizothola i-5 cm H2O ye-PEEP futhi ngesikhathi sokuphefumulelwa sizothola i-15 cm H2O yokusekelwa (i-10 PS ngaphezu kwe-PEEP).

Ngenxa yokuthi awekho ama-backup frequency, le modi ayikwazi ukusetshenziswa ezigulini ezilahlekelwe ukwazi, ukushaqeka noma ukuboshwa kwenhliziyo.

Umthamo wamanje uncike kuphela ekusebenzeni kwesiguli nokuthobela amaphaphu.

I-PSV ivamise ukusetshenziselwa ukulumula emshinini wokuphefumula, njengoba imane ikhulise imizamo yokuphefumula yesiguli ngaphandle kokuhlinzeka ngevolumu enqunyiwe noma izinga lokuphefumula.

Ububi obuyinhloko be-PSV ukungathembeki komthamo wamaza, okungadala ukugcinwa kwe-CO2 kanye ne-acidosis, kanye nomsebenzi ophezulu wokuphefumula ongaholela ekukhathaleni kokuphefumula.

Ukuze kuxazululwe le nkinga, kwadalwa i-algorithm entsha ye-PSV, ebizwa ngokuthi i-volume-supported ventilation (VSV).

I-VSV imodi efana ne-PSV, kodwa kule modi ivolumu yamanje isetshenziswa njengokulawula impendulo, ngokuthi ukusekelwa komshini wokucindezela okunikezwa isiguli kuhlala kulungiswa ngokuvumelana nevolumu yamanje. Kulesi silungiselelo, uma ivolumu ye-tidal yehla, umshini wokungenisa umoya uzokwandisa ukusekela kokucindezela ukuze unciphise ivolumu ye-tidal, kuyilapho uma ivolumu ye-tidal ikhuphuka ukusekelwa kokucindezela kuzokwehla ukuze kugcinwe ivolumu ye-tidal eduze nomzuzu wokuphefumula ofunekayo.

Obunye ubufakazi buphakamisa ukuthi ukusetshenziswa kwe-VSV kungase kunciphise isikhathi esisizwayo sokungenisa umoya, isikhathi sokulunyulwa ngokuphelele kanye nesikhathi esiphelele se-T-piece, kanye nokunciphisa isidingo sokulaliswa.

I-Airway pressure release release (APRV)

Njengoba igama liphakamisa, kumodi ye-APRV, i-ventilator ihambisa ingcindezi ephezulu njalo emgwaqeni womoya, okuqinisekisa ukuthi i-oxygenation, kanye nokukhipha umoya kwenziwa ngokukhulula le ngcindezi.

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Le modi isanda kuthola ukuthandwa njengenye indlela yeziguli ezine-ARDS okunzima ukuzitholela i-oxygen, lapho ezinye izindlela zokungenisa umoya zihluleka ukufeza imigomo yazo.

I-APRV ichazwe njengomfutho womoya oqhubekayo (CPAP) onesigaba sokukhululwa kwezikhawu.

Lokhu kusho ukuthi i-ventilator isebenzisa ukucindezela okuphezulu okuqhubekayo (P high) isikhathi esimisiwe (T high) bese iyayikhulula, ngokuvamile ibuyela ku-zero (P low) isikhathi esifushane kakhulu (T low).

Umqondo walokhu ukuthi ngesikhathi se-T high (ehlanganisa i-80% -95% yomjikelezo), kukhona ukuqashwa njalo kwe-alveolar, okuthuthukisa i-oxygenation ngoba isikhathi esigcinwe ekucindezelweni okuphezulu side kakhulu kunezinye izinhlobo zokuphefumula (isu elivulekile lamaphaphu). ).

Lokhu kunciphisa ukukhuphuka kwamandla emali okuphindaphindayo kanye nokwehla kwamandla emali kwamaphaphu okwenzeka ngezinye izindlela zokungenisa umoya, okuvimbela ukulimala kwamaphaphu okubangelwa umoya.

Ngalesi sikhathi (T high) isiguli sikhululekile ukuphefumula ngokuzenzakalelayo (okusenza sikhululeke), kodwa sizodonsa umthamo ophansi wamagagasi ngoba ukukhipha umoya ngokumelene nokucindezela okunjalo kunzima kakhulu. Khona-ke, lapho kufinyelelwa ku-T high, ingcindezi ku-ventilator yehlela ku-P low (imvamisa inguziro).

Umoya ube usukhishwa emgwaqeni womoya, okuvumela ukushaywa umoya kuze kube yilapho kufinyelelwa u-T low bese umshini wokungenisa umoya ukhipha omunye umoya.

Ukuze uvimbele ukuwohloka komzila womoya phakathi nalesi sikhathi, i-T ephansi isethwe isikhashana, ngokuvamile imizuzwana engu-0.4-0.8.

Kulokhu, lapho umfutho we-ventilator usethelwe ku-zero, ukunwebeka kwamaphaphu kuphushela umoya ngaphandle, kodwa isikhathi asiside ngokwanele ukukhipha wonke umoya emaphashini, ngakho umfutho we-alveolar nowomzila womoya awufinyeleli ku-zero. futhi ukuwohloka komzila womoya akwenzeki.

Lesi sikhathi sivame ukusetha ukuze i-T ephansi iphele lapho ukugeleza kokukhipha umoya kwehla ku-50% wokugeleza kokuqala.

Ngakho-ke, ukungena komoya ngomzuzu ngamunye kuzoncika ekuncipheni kuka-T kanye nevolumu yesiguli ngesikhathi sokuphakama kuka-T

Izinkomba zokusetshenziswa kwe-APRV:

I-ARDS inzima ukufaka umoya-mpilo nge-AC
Ukulimala kwamaphaphu acute
I-postoperative atelectasis.

Izinzuzo ze-APRV:

I-APRV iyindlela enhle yokungenisa umoya ovikela amaphaphu.

Ikhono lokusetha i-P ephezulu lisho ukuthi opharetha unokulawula phezu kwengcindezi ye-plateau, enganciphisa kakhulu isigameko se-barotrauma.

Njengoba isiguli siqala imizamo yaso yokuphefumula, kukhona ukusatshalaliswa kwegesi okungcono ngenxa yomdlalo ongcono we-V/Q.

Umfutho ophakeme njalo usho ukwanda kokuqashwa (isu elivulekile lamaphaphu).

I-APRV ingathuthukisa umoya-mpilo ezigulini ezine-ARDS okunzima ukuzifaka umoya-mpilo nge-AC.

I-APRV ingase inciphise isidingo se-sedation kanye ne-neuromuscular blocking agents, njengoba isiguli singase sikhululeke kakhulu uma siqhathaniswa nezinye izindlela.

Izinzuzo kanye nama-contraindications:

Ngenxa yokuthi ukuphefumula okuzenzakalelayo kuyisici esibalulekile se-APRV, akulungile ezigulini ezilaliswe kakhulu.

Ayikho idatha ngokusetshenziswa kwe-APRV ezinkingeni ze-neuromuscular noma izifo zamaphaphu ezivimbelayo, futhi ukusetshenziswa kwayo kufanele kugwenywe kulezi zibalo zeziguli.

Ngokwethiyori, umfutho ongapheli we-intrathoracic ungadala umfutho ophakeme we-pulmonary artery kanye nokushutheka kwe-intracardiac kubi ezigulini ezine-Eisenmenger's physiology.

Kudingeka ukucabanga okuqinile komtholampilo lapho kukhethwa i-APRV njengendlela yokungenisa umoya ngaphezu kwezindlela ezivamile ezifana ne-AC.

Ulwazi olwengeziwe ngemininingwane yezindlela ezihlukene zokungenisa umoya kanye nokuhlelwa kwazo kungatholakala ezihlokweni zemodi ethile yokungenisa umoya ngayinye.

Ukusetshenziswa kwe-ventilator

Ukulungiselelwa kokuqala kwe-ventilator kungahluka kakhulu kuye ngokuthi imbangela ye-intubation kanye nenjongo yalokhu kubuyekezwa.

Nokho, kunezinye izilungiselelo eziyisisekelo ezimweni eziningi.

Imodi yokuphefumula ejwayeleke kakhulu okufanele isetshenziswe esigulini esisanda kufakwa imodi ye-AC.

Imodi ye-AC inikeza ukunethezeka okuhle nokulawula okulula kwamanye amapharamitha abaluleke kakhulu okuphila.

Iqala nge-FiO2 ka-100% futhi yehle iqondiswa i-pulse oximetry noma i-ABG, njengoba kufanele.

Ukungena komoya okuphansi kwamanzi kuye kwaboniswa njengokuvikela amaphaphu hhayi kuphela ku-ARDS kodwa nakwezinye izinhlobo zezifo.

Ukuqala isiguli ngevolumu ephansi ye-tidal (6 kuya ku-8 mL/Kg isisindo somzimba esifanele) kunciphisa izehlakalo zokulimala kwamaphaphu okubangelwa umoya-mpilo (VILI).

Ngaso sonke isikhathi sebenzisa isu lokuvikela amaphaphu, njengoba amanzi aphezulu anenzuzo encane futhi andise ingcindezi ye-shear ku-alveoli futhi angase abangele ukulimala kwamaphaphu.

I-RR yokuqala kufanele ikhululeke esigulini: i-10-12 bpm yanele.

I-caveat ebaluleke kakhulu ithinta iziguli ezine-acidosis enzima ye-metabolic.

Kulezi ziguli, ukungena komoya ngomzuzu kufanele okungenani kufane komoya wangaphambi kokufaka, njengoba kungenjalo i-acidosis iba yimbi futhi ingase ibangele izinkinga ezifana nokuboshwa kwenhliziyo.

Ukugeleza kufanele kuqaliswe ku-60 L/min noma ngaphezulu ukuze kugwenywe i-autoPEEP

Qala nge-PEEP ephansi engu-5 cm H2O futhi wandise ngokuvumelana nokubekezelela kwesiguli emgomweni wokukhipha umoya-mpilo.

Nakisisa umfutho wegazi kanye nokunethezeka kwesiguli.

I-ABG kufanele itholwe emizuzwini engama-30 ngemuva kokufakwa kwe-intubation futhi izilungiselelo ze-ventilator kufanele zilungiswe ngokuya ngemiphumela ye-ABG.

Izingcindezi eziphakeme kanye nethafa kufanele zihlolwe kumshini wokuphefumula ukuze kuqinisekiswe ukuthi azikho izinkinga ngokumelana nomgwaqo womoya noma ukucindezela kwe-alveolar ukuvimbela ukulimala kwamaphaphu okubangelwa umoya.

Ukunakwa kufanele kukhokhwe kumajika evolumu kusibonisi se-ventilator, njengoba ukufundwa okubonisa ukuthi ijika alibuyeli kuqanda lapho kukhishwa umoya kubonisa ukuhosha okungaphelele kanye nokuthuthukiswa kwe-auto-PEEP; ngakho-ke, ukulungiswa kufanele kwenziwe kumshini wokuphefumula ngokushesha.[7][8]

Ukuxazulula inkinga nge-Ventilator

Ngokuyiqonda kahle imiqondo okuxoxwe ngayo, ukuphatha izinkinga ze-ventilator kanye nokuxazulula izinkinga kufanele kube imvelo yesibili.

Izilungiso ezivame kakhulu okufanele zenziwe ekungeneni komoya zihlanganisa i-hypoxemia ne-hypercapnia noma i-hyperventilation:

I-Hypoxia: umoya-mpilo uncike ku-FiO2 ne-PEEP (i-T ephezulu kanye ne-P ephezulu ye-APRV).

Ukulungisa i-hypoxia, ukwandisa noma iyiphi yalezi zinhlaka kufanele kwandise umoya-mpilo.

Ukunakwa okukhethekile kufanele kukhokhwe emiphumeleni emibi engenzeka yokwanda kwe-PEEP, engabangela i-barotrauma ne-hypotension.

Ukwandisa i-FiO2 akukhona ngaphandle kokukhathazeka, njengoba i-FiO2 ephakeme ingabangela ukulimala kwe-oxidative ku-alveoli.

Esinye isici esibalulekile sokuphathwa kokuqukethwe komoyampilo ukubeka umgomo we-oxygenation.

Ngokuvamile, kunenzuzo encane ukugcina ukugcwala komoya-mpilo ngaphezu kwama-92-94%, ngaphandle, isibonelo, ezimweni ze-carbon monoxide poisoning.

Ukwehla okungazelelwe kokugcwala komoyampilo komoyampilo kufanele kubangele izinsolo zokungahambi kahle kweshubhu, i-pulmonary embolism, i-pneumothorax, i-pulmonary edema, i-atelectasis, noma ukuthuthukiswa kwamapulaki amafinyila.

I-Hypercapnia: Ukuze ushintshe okuqukethwe kwe-CO2 yegazi, umoya we-alveolar kufanele ushintshwe.

Lokhu kungenziwa ngokushintsha ivolumu ye-tidal noma izinga lokuphefumula (i-T ephansi kanye ne-P ephansi ku-APRV).

Ukwenyusa izinga noma ivolumu ye-tidal, kanye nokwenyuka kwe-T low, kwandisa umoya futhi kunciphisa i-CO2.

Kufanele kuqashelwe ngokukhula kwemvamisa, njengoba kuzophinde kwandise indawo efile futhi kungase kungasebenzi kahle njengomthamo wamaza.

Uma ukhuphula ivolumu noma imvamisa, ukunakwa okukhethekile kufanele kukhokhwe ku-flow-volume loop ukuze kugwenywe ukuthuthukiswa kwe-auto-PEEP.

Izingcindezi eziphezulu: Izingcindezi ezimbili zibalulekile ohlelweni: ukucindezela okuphezulu nokucindezela kwethafa.

Ukucindezela okuphezulu kuyisilinganiso sokumelana nomgwaqo womoya kanye nokuhambisana nokuhambisana neshubhu nesihlahla se-bronchial.

Izingcindezi ze-Plateau zibonisa umfutho we-alveolar kanjalo nokuhambisana namaphaphu.

Uma kukhona ukwanda kokucindezela okukhulu, isinyathelo sokuqala ukuthatha ikhefu elikhuthazayo bese uhlola ithafa.

Ukucindezela okuphezulu okuphezulu kanye nokucindezela okujwayelekile kwethafa: ukumelana nomgwaqo omkhulu womoya kanye nokuhambisana okuvamile

Izimbangela ezingenzeka: (1) Twisted ET tube-Isixazululo ukuqaqa ishubhu; sebenzisa i-bite lock uma isiguli siluma ishubhu, (2) I-Mucus plug-Isixazululo ukulangazela isiguli, (3) I-Bronchospasm-Ikhambi liwukusebenzisa ama-bronchodilator.

Ukuphakama okuphezulu kanye nethafa eliphakeme: Izinkinga zokuthobela umthetho

Izimbangela ezingaba khona zifaka:

Main trunk intubation-Isixazululo ukuhoxisa ishubhu ye-ET. Ukuze uthole ukuxilongwa, uzothola isiguli esinomsindo wokuphefumula okuhlangene kanye nephaphu elihlangene (i-atelectatic lung).
I-Pneumothorax: Ukuxilongwa kuzokwenziwa ngokulalela imisindo yokuphefumula ngokuhlanganyela kanye nokuthola iphaphu eliphikisana ne-hyperresonant. Ezigulini ezifakwe intuba, ukubekwa kweshubhu esifubeni kubalulekile, njengoba ukucindezela okuhle kuzolimaza i-pneumothorax kuphela.
I-Atelectasis: Ukuphathwa kokuqala kuqukethe ukushaywa kwesifuba kanye nokuqondisa abantu. I-bronchoscopy ingasetshenziswa ezimweni eziphikisayo.
I-edema yamaphaphu: i-Diuresis, inotropes, i-PEEP ephakeme.
I-ARDS: Sebenzisa ivolumu ephansi ye-tidal kanye nomoya ophezulu we-PEEP.
I-Dynamic hyperinflation noma i-auto-PEEP: inqubo lapho omunye womoya ohogeliwe ungakhishelwanga ngokugcwele ekupheleni komjikelezo wokuphefumula.
Ukunqwabelana komoya ovalelekile kwandisa izingcindezi zamaphaphu futhi kubangela i-barotrauma ne-hypotension.
Isiguli kuzoba nzima ukuthi sikhiphe umoya.
Ukuze uvimbele futhi uxazulule i-PEEP, isikhathi esanele kufanele sivunyelwe ukuze umoya uphume emaphashini ngesikhathi sokukhipha umoya.

Umgomo ekuphathweni ukwehlisa isilinganiso sokuphefumula/sokuphelelwa yisikhathi; lokhu kungafezwa ngokunciphisa izinga lokuphefumula, ukwehlisa umthamo wokuphefumula (ivolumu ephezulu izodinga isikhathi eside ukushiya amaphaphu), nokwandisa ukugeleza kokuphefumula (uma umoya ulethwa ngokushesha, isikhathi sokuphefumula siba sifushane futhi isikhathi sokuphelelwa umoya sizoba isikhathi eside kunoma yiliphi izinga lokuphefumula).

Umphumela ofanayo ungafinyelelwa ngokusebenzisa i-waveform yesikwele ngokugeleza kokuphefumula; lokhu kusho ukuthi singakwazi ukusetha i-ventilator ukuletha konke ukugeleza kusukela ekuqaleni kuya ekupheleni kokuphefumulelwa.

Ezinye izindlela ezingase zisetshenziswe ukuqinisekisa ukulaliswa okwanele ukuze kuvinjwe i-hyperventilation yesiguli kanye nokusetshenziswa kwama-bronchodilator nama-steroid ukuze kuncishiswe ukuvinjwa kwendlela yokuphefumula.

Uma i-auto-PEEP inzima futhi idala i-hypotension, ukunqamula isiguli kumshini wokuphefumula nokuvumela wonke umoya ukuba ukhishwe kungase kube isinyathelo esisindisa ukuphila.

Ukuze uthole incazelo ephelele yokuphathwa kwe-auto-PEEP, bona i-athikili enesihloko esithi “Positive End-Expiratory Pressure (PEEP).”

Enye inkinga evamile okuhlangatshezwana nayo ezigulini ezidonsa umoya ngomshini i-dyssynchrony yesiguli-ye-ventilator, evame ukubizwa ngokuthi “umzabalazo wokungenisa umoya.”

Izimbangela ezibalulekile zihlanganisa i-hypoxia, i-self-PEEP, ukwehluleka ukuhlangabezana nezidingo zokuphefumula kwesiguli noma zokuphefumula umoya, ubuhlungu, nokungakhululeki.

Ngemva kokukhipha izimbangela ezibalulekile ezifana ne-pneumothorax noma i-atelectasis, cabangela induduzo yesiguli futhi uqinisekise ukuphumula okwanele kanye ne-analgesia.

Cabangela ukushintsha imodi yokukhipha umoya, njengoba ezinye iziguli zingase zisabele kangcono ezindleleni ezihlukene zokungenisa umoya.

Ukunakwa okukhethekile kufanele kukhokhwe kuzilungiselelo zokungenisa umoya ngaphansi kwezimo ezilandelayo:

I-COPD iyisimo esikhethekile, njengoba amaphaphu e-COPD ahlanzekile enokuthobela okuphezulu, okubangela ukuthambekela okuphezulu kokuvinjwa kokuhamba komoya okuguquguqukayo ngenxa yokuwa komgwaqo womoya kanye nokungena komoya, okwenza iziguli ze-COPD zithambekele kakhulu ekuthuthukiseni i-auto-PEEP. Ukusebenzisa isu lokuvikela lokungena komoya ngokugeleza okuphezulu nezinga lokuphefumula eliphansi kungasiza ukuvimbela i-PEEP. Esinye isici esibalulekile okufanele sicatshangelwe ekuhlulekeni kokuphefumula okungapheli kwe-hypercapnic (ngenxa ye-COPD noma esinye isizathu) ukuthi akudingekile ukulungisa i-CO2 ukuyibuyisela esimweni esijwayelekile, njengoba lezi ziguli zivame ukuba nesinxephezelo se-metabolic ngezinkinga zazo zokuphefumula. Uma isiguli sifakwe umoya kumazinga avamile we-CO2, i-bicarbonate yaso iyancipha futhi, lapho ikhishwa, ingena ngokushesha ku-acidosis yokuphefumula ngoba izinso azikwazi ukuphendula ngokushesha njengamaphaphu kanye ne-CO2 ibuyela kusisekelo, okubangela ukwehluleka ukuphefumula nokubuyisela kabusha. Ukuze ugweme lokhu, okuqondiwe kwe-CO2 kufanele kunqunywe ngokusekelwe ku-pH kanye nesisekelo esaziwayo noma esibaliwe ngaphambilini.
I-asthma: Njenge-COPD, iziguli ezine-asthma zijwayele kakhulu ukungena emoyeni, nakuba isizathu sihlukile nge-pathophysiologically. Ku-asthma, ukungena komoya kubangelwa ukuvuvukala, i-bronchospasm nama-mucus plugs, hhayi ukugoqa kwendlela yokuphefumula. Isu lokuvimbela i-PEEP lifana nalelo elisetshenziswa ku-COPD.
I-Cardiogenic pulmonary edema: i-PEEP ephakeme inganciphisa ukubuya kwe-venous futhi isize ukuxazulula i-edema yamaphaphu, futhi ikhuthaze ukuphuma kwenhliziyo. Ukukhathazeka kufanele kube ukuqinisekisa ukuthi isiguli sidonsa amanzi ngokwanele ngaphambi kokusikhipha, njengoba ukususwa komfutho omuhle kungase kubangele i-edema entsha yamaphaphu.
I-ARDS wuhlobo lwe-noncardiogenic pulmonary edema. Isu lamaphaphu avulekile ane-PEEP ephezulu kanye nomthamo ophansi wamagagasi kukhonjisiwe ukuthuthukisa ukufa.
I-pulmonary embolism yisimo esinzima. Lezi ziguli zincike kakhulu ekulayisheni kwangaphambilini ngenxa yokwenyuka okukhulu komfutho we-atrial ongakwesokudla. Ukufakwa kwalezi ziguli kuzonyusa ingcindezi ye-RA futhi kunciphise ukubuya kwe-venous, ngengozi yokwethuka. Uma ingekho indlela yokugwema intubation, kufanele kuqashelwe umfutho wegazi kanye nokuphathwa kwe-vasopressor kufanele kuqalwe ngokushesha.
I-acidosis emsulwa eqinile iyinkinga. Lapho ufaka lezi ziguli ngama-intubation, kufanele kubhekwe kakhulu umoya wazo wangaphambi kokufaka umoya omncane. Uma lokhu kungena komoya kunganikezwa lapho usekelo lwemishini luqalwa, i-pH izokwehla ngokuqhubekayo, okungase kubangele ukuboshwa kwenhliziyo.

Izikhombo ze-Bibliographic

Metersky ML, Kalil AC. Ukuphathwa Kwenyumoniya Ehlobene Ne-Ventilator: Izinkombandlela. UClin Chest Med. I-2018 Dec;39(4):797-808. [I-PubMed]
Chomton M, Brossier D, Sauthier M, Vallières E, Dubois J, Emeriaud G, Jouvet P. Ventilator-Associated Pneumonia kanye Nezehlakalo Ekunakekelweni Okunzulu Kwezingane: Ucwaningo Lwesikhungo Esisodwa. I-Pediatr Crit Care Med. I-2018 Dec;19(12):1106-1113. [I-PubMed]
U-Vandana Kalwaje E, u-Rello J. Ukuphathwa kwe-pneumonia ehambisana ne-ventilator: Isidingo sendlela yomuntu siqu. Isazi Rev Anti Infect Ther. I-2018 Aug;16(8):641-653. [I-PubMed]
Jansson MM, Syrjälä HP, Talman K, Meriläinen MH, Ala-Kokko TI. Ulwazi lwabahlengikazi abanakekelo olubucayi mayelana, ukubambelela, kanye nezithiyo ezibhekene nenqwaba yemishini yokuphefumula eqondene nesikhungo. Ngingu-J Ukulawulwa Kokutheleleka. I-2018 Sep;46(9):1051-1056. [I-PubMed]
I-Piraino T, Fan E. I-hypoxemia eyingozi kakhulu esongela ukuphila ngesikhathi sokungenisa umoya ngomshini. I-Curr Opin Crit Care. I-2017 Dec;23(6):541-548. [I-PubMed]
Mora Carpio AL, Mora JI. StatPearls [I-inthanethi]. I-StatPearls Publishing; I-Treasure Island (FL): Apr 28, 2022. Ukulawulwa Kokusiza Kokungenisa umoya. [I-PubMed]
I-Kumar ST, Yassin A, Bhowmick T, Dixit D. Izincomo Ezivela Kumihlahlandlela Yango-2016 Yokuphathwa Kwabantu Abadala Ngenyumoniya Etholwe Esibhedlela Noma I-Ventilator-Associated. P T. I-2017 Dec;42(12):767-772. [Isihloko samahhala se-PMC] [I-PubMed]
Del Sorbo L, Goligher EC, McAuley DF, Rubenfeld GD, Brochard LJ, Gattinoni L, Slutsky AS, Fan E. Mechanical Ventilation in Adults with Acute Respiratory Distress Syndrome. Isifinyezo sobufakazi bokuhlola bomhlahlandlela wokusebenza komtholampilo. U-Ann Am Thorac Soc. I-2017 Oct;14(Isengezo_4):S261-S270. [I-PubMed]
I-Chao CM, i-Lai CC, i-Chan KS, i-Cheng KC, i-Ho CH, i-Chen CM, i-Chou W. Ukungenelela kwemikhakha eminingi kanye nokuthuthukiswa kwekhwalithi okuqhubekayo ukunciphisa ukukhishwa okungahleliwe kumayunithi okunakekela abantu abadala: Isipiliyoni seminyaka engu-15. Imithi (Baltimore). I-2017 Jul;96(27):e6877. [Isihloko samahhala se-PMC] [I-PubMed]
I-Badnjevic A, i-Gurbeta L, i-Jimenez ER, i-Iadanza E. Ukuhlolwa kwama-ventilators ayimishini nama-incubator ezinsana ezikhungweni zezempilo. Ukunakekelwa kwezempilo kweTechnol. I-2017;25(2):237-250. [I-PubMed]