ИВЛ эксперт

Qaphela! Isicelo senzelwe ama-resuscitators. Uma ungeyena udokotela futhi usafuna ukuyisebenzisa, sicela uthintane nodokotela wakho ngaphambi kokusebenzisa uhlelo lokusebenza noma ukwenza izinqumo zezokwelapha.

Odokotela abaningi babhekana nokwelashwa kweziguli ezinamazinga ahlukene okuhluleka kokuphefumula okubuhlungu (ARF). Kodwa ukukhethwa kwendlela efanele futhi, ikakhulukazi, ukulungiswa ngesikhathi kwemingcele ye-invasive and non-invasive artificial lung ventilation (ALV) ngokuvamile kubangela ubunzima, ikakhulukazi kodokotela abasebasha. Ngeshwa, imishini yokuphefumula ebizayo, ngaphandle kokusetshenziswa kwayo ngobuchule, akusona isiqinisekiso sokuthuthukisa izinga lokufa kwe-ARF.

Emisebenzini yomtholampilo yamazwe ngamazwe, kuyisiko ukunquma izinga le-ARF ngenkomba ye-oxygenation (isilinganiso sokucindezela okuyingxenye ye-oxygen egazini le-arterial (PaO2) kuya engxenyeni yomoya-mpilo emoyeni ophefumulayo (FiO2)). Le nkomba iphinde ifakwe ezikalini eziningi zobunzima besimo sesiguli (SOFA, APACHE II-III, njll.). Kodwa ukukala i-PaO2 kubiza kakhulu, akutholakali kuzo zonke izibhedlela, futhi kuletha ukuhlupheka okwengeziwe ezigulini ngenxa yokuhlasela.

Ngo-2020-2021 yenza ucwaningo oluningi ezibhedlela ezinhlanu zemitholampilo eVolgograd, ezihlanganisa iziguli ze-1038 ezinokulimala okukhulu kwamaphaphu kanye nesifo sokuphefumula okunzima ngokumelene nesizinda se-viral and bacterial pneumonia. Imisebenzi emibili yahlelwa: okokuqala, ukuthuthukiswa kwendlela engavamile yokunquma inkomba ye-oxygenation (PaO2 / FiO2) nge-oxygen saturation (SpO2) futhi, okwesibili, ukunqunywa kwenqubo evamile yokulungisa imingcele ye-invasive and non-invasive. ukungena komoya ngomshini.

Lolu hlelo lubonisa imiphumela yalolu cwaningo. Ubudlelwano phakathi kwezinkomba ze-SpO2 ne-PaO2 banqunyelwe i-FiO2 ehlukahlukene kanye nezinhlobo zokusekelwa kokuphefumula. Iphinde isebenzise isimiso esijwayelekile sokwelashwa komoyampilo - ukusuka ekuhlaseleni kancane (imaski yobuso noma amakhala) kuye ezindleleni ezihlaselayo zokweseka ukuphefumula (ukungenisa komoya okungavamisile nokuhlaselayo). Lolu hlelo lukuvumela ukuthi ukhethe kuphela indlela ephumelela kakhulu yokusekelwa kokuphefumula, kodwa futhi, kuye ngokuthi isimo somtholampilo, funda ngesikhathi esifanele mayelana nesidingo sokulungisa imingcele eyinhloko ye-ventilation mechanical.

Bonke odokotela bayazi ukuthi izinga lokufa kweziguli ezine-ARF lithonywa kakhulu ukuba semthethweni kokuqala kanye nokuphela kokungena komoya ngemishini, futhi lolu hlelo lusiza ekwenzeni izinqumo ezinjalo.

Umphumela wezemfundo walolu hlelo nawo kufanele uqashelwe. Kuzosiza odokotela basebenzise ngokushesha futhi basebenzise imishini yokuphefumula ebizayo, ezoba nomthelela omuhle emiphumeleni yokwelashwa kweziguli ezine-ARF.

Imithombo elandelayo isetshenziswe ukudala uhlelo lokusebenza:
1. Brown SM, Grissom CK, Moss M, Rice TW, Schoenfeld D, Hou PC, Thompson BT, Brower RG; Abahlanganyeli Benethiwekhi ye-NIH/NHLBI PETAL. I-Nonlinear Imputation ye-Pao2/Fio2 Kusuka ku-Spo2/Fio2 Phakathi Kweziguli Ezine-Acute Respiratory Distress Syndrome. Isifuba. 2016 Aug;150(2):307-13. doi: 10.1016/j.chest.2016.01.003. Epub 2016 Jan 19. PMID: 26836924; I-PMCID: PMC4980543.
2. Bilan N, Dastranji A, Ghalehgolab Behbahani A. Ukuqhathaniswa kwesilinganiso se-spo2/fio2 kanye nesilinganiso se-pao2/fio2 ezigulini ezinokulimala okukhulu kwamaphaphu noma i-acute respiratory distress syndrome. J Cardiovasc Thorac Res. 2015;7(1):28-31. doi: 10.15171/jcvtr.2014.06. Epub 2015 Mar 29. PMID: 25859313; I-PMCID: PMC4378672.
3. U-Yoshida T, Takegawa R, Ogura H. [Isu lokungenisa umoya le-ARDS]. Nihon Rinsho. 2016 Feb;74(2):279-84. IsiJapane. PMID: 26915253.
4. Umlandeli E, u-Brodie D, uSlutsky AS. I-Acute Respiratory Distress Syndrome: Intuthuko Ekuxilongweni Nokwelashwa. JAMA. 2018 Feb 20;319(7):698-710. doi: 10.1001/jama.2017.21907. Inombolo yepholisi: 29466596.