“Ungalokothi ungabaze ukuthi iqembu elincane lezakhamuzi ezicabangayo nezizinikele lingawushintsha umhlaba.Eqinisweni, iyona yodwa ekhona.”
Umgomo kaCureus uwukushintsha imodeli yakudala yokushicilelwa kwezokwelapha, lapho ukuthunyelwa kocwaningo kungase kubize, kube nzima, futhi kudle isikhathi.
Calula lesi sihloko ngokuthi: Kojima Y., Sendo R., Okayama N. et al.(Meyi 18, 2022) Isilinganiso se-oxygen ehogeliwe kumadivayisi agelezayo aphansi futhi aphezulu: isifundo sokulingisa.Ukwelapha 14(5): e25122.doi:10.7759/cureus.25122
Injongo: Ingxenye ye-oksijini ehogeliwe kufanele ilinganiswe lapho i-oxygen inikezwa isiguli, njengoba imele ukuhlushwa kwe-oksijini ye-alveolar, okubalulekile ngokombono we-physiology yokuphefumula.Ngakho-ke, inhloso yalolu cwaningo kwakuwukuqhathanisa ingxenye ye-oxygen ephefumulelwe etholwe ngamadivaysi ahlukene okulethwa kwe-oxygen.
Izindlela: Kusetshenziswe imodeli yokulingisa yokuphefumula okuzenzakalelayo.Linganisa ingxenye ye-oksijini ehogeliwe etholwa ngamakhala agelezayo aphansi naphezulu kanye namamaski omoya-mpilo alula.Ngemva kwamasekhondi angu-120 omoya-mpilo, ingxenye yomoya ohogeliwe ikalwa njalo ngomzuzwana ngamasekhondi angu-30.Kuthathwe izilinganiso ezintathu esimweni ngasinye.
IMIPHUMELA: Ukugeleza komoya kwehle ingxenye ye-oxygen ephefumulelwe e-intracheal kanye nokugxila kwe-oxygen e-extraoral lapho kusetshenziswa i-cannula yamakhala egeleza kancane, okuphakamisa ukuthi ukuphefumula kokuphelelwa umoya kwenzeke ngesikhathi sokuphefumula futhi kungase kuhlotshaniswe nokwanda kwengxenyana ye-oxygen ephefumulelwe e-intracheal.
Isiphetho.Ukuphefumula komoya-mpilo ngesikhathi sokukhipha umoya kungaholela ekwandeni kokuhlushwa komoyampilo endaweni efile ye-anatomical, okungase kuhlotshaniswe nokwanda kwenani le-oxygen ehogeliwe.Ukusebenzisa ukugeleza okuphezulu kwe-cannula yamakhala, iphesenti eliphezulu le-oxygen ephefumulayo lingatholakala ngisho nangesilinganiso sokugeleza kwe-10 L / min.Lapho kunqunywa inani eliphelele le-oxygen, kuyadingeka ukusetha izinga lokugeleza elifanele lesiguli kanye nezimo ezithile, kungakhathaliseki ukuthi inani lengxenye ye-oxygen ephefumulelwe.Uma usebenzisa ama-nasal prongs ageleza kancane kanye namamaski omoya-mpilo alula esimweni somtholampilo, kungaba nzima ukulinganisa ingxenye ye-oxygen ehogelwe.
Ukuphathwa komoya-mpilo phakathi nezigaba ezinzima nezingapheli zokuhluleka kokuphefumula kuyindlela evamile emithini yomtholampilo.Izindlela ezihlukahlukene zokuphatha umoya-mpilo zihlanganisa i-cannula, i-cannula yamakhala, i-oxygen mask, i-reservoir mask, i-venturi mask, kanye ne-high flow nasal cannula (HFNC) [1-5].Iphesenti le-oxygen emoyeni ohogeliwe (FiO2) iphesenti le-oxygen emoyeni ohogeliwe elibamba iqhaza ekushintshisaneni kwegesi ye-alveolar.Izinga le-oxygenation (isilinganiso se-P/F) isilinganiso sokucindezela kwengxenye ye-oxygen (PaO2) kuya ku-FiO2 egazini le-arterial.Nakuba inani lokuxilonga le-P / F isilinganiso lihlala liphikisana, liyinkomba esetshenziswa kabanzi ye-oxygenation ekusebenzeni komtholampilo [6-8].Ngakho-ke, kubalulekile ngokomtholampilo ukwazi inani le-FiO2 lapho unikeza isiguli umoya-mpilo.
Phakathi ne-intubation, i-FiO2 ingalinganiswa ngokunembile nge-monitor ye-oxygen ehlanganisa isifunda sokuphefumula umoya, kuyilapho i-oksijini ilawulwa nge-cannula yamakhala kanye ne-oxygen mask, kuphela "isilinganiso" se-FiO2 esisekelwe esikhathini sokuphefumula singalinganiswa.Lo “mphumela” isilinganiso sokutholakala komoyampilo kumthamo wamaza.Kodwa-ke, lokhu akubheki izici ezithile ngokombono we-physiology yokuphefumula.Ucwaningo lubonise ukuthi izilinganiso ze-FiO2 zingathonywa izici ezihlukahlukene [2,3].Nakuba ukuphathwa komoya-mpilo ngesikhathi sokukhipha umoya kungaholela ekwandeni kokuhlushwa kwe-oksijini ezindaweni ezifile ze-anatomical ezifana nomgodi womlomo, i-pharynx kanye ne-trachea, ayikho imibiko ngalolu daba ezincwadini zamanje.Kodwa-ke, abanye odokotela bakholelwa ukuthi ekusebenzeni lezi zici azibalulekile kangako nokuthi "izikolo" zanele ukunqoba izinkinga zomtholampilo.
Eminyakeni yamuva nje, i-HFNC idonse ukunakwa okukhethekile kwezokwelapha eziphuthumayo kanye nokunakekelwa okujulile [9].I-HFNC inikeza i-FiO2 ephezulu kanye nokugeleza kwe-oksijeni ngezinzuzo ezimbili eziyinhloko - ukukhukhula kwendawo efile ye-pharynx kanye nokunciphisa ukumelana ne-nasopharyngeal, okungafanele kunganakwa lapho kuchaza i-oksijeni [10,11].Ukwengeza, kungase kudingeke ukuthi kucatshangwe ukuthi inani le-FiO2 elilinganisiwe limelela ukuhlushwa kwe-oksijeni emigwaqweni yomoya noma i-alveoli, njengoba ukuhlushwa kwe-oksijeni ku-alveoli ngesikhathi sokuphefumula kubalulekile ngokwesilinganiso se-P / F.
Izindlela zokulethwa komoyampilo ngaphandle kwe-intubation zivame ukusetshenziswa emisebenzini yomtholampilo evamile.Ngakho-ke, kubalulekile ukuqoqa idatha eyengeziwe ku-FiO2 elinganiswa nalawa madivaysi okulethwa kwe-oksijini ukuze kuvinjwe ukudlula ngokweqile okungadingekile futhi uthole ukuqonda mayelana nokuphepha kokuphefumula ngesikhathi se-oxygeation.Nokho, ukukalwa kwe-FiO2 kuqhoqhoqho lomuntu kunzima.Abanye abacwaningi baye bazama ukulingisa i-FiO2 besebenzisa amamodeli okuphefumula okuzenzakalelayo [4,12,13].Ngakho-ke, kulolu cwaningo, sihlose ukukala i-FiO2 sisebenzisa imodeli elingisiwe yokuphefumula okuzenzakalelayo.
Lolu wucwaningo lokulinga olungadingi ukugunyazwa ngokwezimiso zokuziphatha ngoba alubandakanyi abantu.Ukuze silingise ukuphefumula okuzenzakalelayo, silungiselele imodeli yokuphefumula ezenzakalelayo ngokubhekisela kumodeli eyakhiwe ngu-Hsu et al.(Umdwebo 1) [12].Ama-Ventilator namaphaphu okuhlola (i-Dual Adult TTL; Grand Rapids, MI: Michigan Instruments, Inc.) avela emishinini yokubulala izinzwa (Fabius Plus; Lübeck, Germany: Draeger, Inc.) alungiselelwa ukulingisa ukuphefumula okuzenzakalelayo.Amadivaysi amabili axhunywe ngesandla ngamabhande ensimbi aqinile.Isivunguvungu esisodwa (uhlangothi lokushayela) lwephaphu lokuhlola luxhunywe kumshini wokuphefumula.Esinye isivunguvungu (uhlangothi lwe-passive) lwephaphu lokuhlola luxhunywe “Kumodeli Yokuphatha I-oksijeni”.Lapho nje umshini wokungenisa umoya unikeza igesi entsha ukuhlola amaphaphu (uhlangothi lokushayela), izifutho zivuvukala ngokudonsa ngenkani kwezinye izifutho (uhlangothi lwe-passive).Lokhu kunyakaza kuhogela igesi kuqhoqhoqho we-manikin, ngaleyo ndlela kulingisa ukuphefumula okuzenzakalelayo.
(a) imonitha komoyampilo, (b) i-dummy, (c) ukuhlola amaphaphu, (d) idivayisi yokubulala izinzwa, (e) imonitha komoyampilo, kanye (f) nomshini wokungenisa umoya kagesi.
Izilungiselelo ze-ventilator zazimi kanje: ivolumu ye-tidal 500 ml, izinga lokuphefumula i-10 breaths/min, inspiratory to expiratory ratio (inhalation/expiration ratio) 1:2 (isikhathi sokuphefumula = 1 s).Ocwaningweni, ukuthobelana kwephaphu lokuhlola kwakusethwe ku-0.5.
Imonitha ye-oxygen (i-MiniOx 3000; i-Pittsburgh, i-PA: I-American Medical Services Corporation) kanye ne-manikin (MW13; Kyoto, Japan: Kyoto Kagaku Co., Ltd.) zasetshenziselwa imodeli yokuphatha umoya-mpilo.I-oxygen ehlanzekile yajovwa ngamanani angu-1, 2, 3, 4 no-5 L/min futhi i-FiO2 yalinganiswa ngayinye.I-HFNC (i-MaxVenturi; i-Coleraine, i-Northern Ireland: i-Armstrong Medical), izingxube zomoya womoya-mpilo zazilawulwa ngamavolumu angu-10, 15, 20, 25, 30, 35, 40, 45, 50, 55, no-60 L, kanye ne-FiO2 kuhlolwa esimweni ngasinye.Ku-HFNC, ukuhlolwa kwenziwa ku-45%, 60% kanye no-90% wokugxila komoyampilo.
I-extraoral oxygen concentration (BSM-6301; Tokyo, Japan: Nihon Kohden Co.) ikalwa ngo-3 cm ngaphezu kwama-maxillary incisors nge-oxygen ehanjiswa nge-cannula yamakhala (Finefit; Osaka, Japan: Japan Medicalnext Co.) (Umfanekiso 1).) Intubation kusetshenziswa i-ventilator kagesi (HEF-33YR; Tokyo, Japan: Hitachi) ukuze ukhiphe umoya ekhanda le-manikin ukuze kuqedwe ukuphefumula okuphelelwa yisikhathi, futhi i-FiO2 ikalwa ngemva kwemizuzu engu-2.
Ngemuva kwemizuzwana engu-120 yokuchayeka kumoya-mpilo, i-FiO2 ikalwa umzuzwana ngamunye imizuzwana engu-30.Ventilate i-manikin nelabhorethri ngemva kokulinganisa ngakunye.I-FiO2 ikalwe izikhathi ezi-3 esimweni ngasinye.Ukuhlolwa kwaqala ngemva kokulinganiswa kwethuluzi ngalinye lokulinganisa.
Ngokwesiko, umoya-mpilo uhlolwa ngama-cannula ekhala ukuze i-FiO2 ilinganiswe.Indlela yokubala esetshenziswe kulokhu kuhlolwa iye yahluka kuye ngokuqukethwe ukuphefumula okuzenzakalelayo (Ithebula 1).Izikolo zibalwa ngokusekelwe ezimweni zokuphefumula ezibekwe kudivayisi ye-anesthesia (ivolumu ye-tidal: 500 ml, izinga lokuphefumula: ukuphefumula okungu-10/min, isilinganiso sokuphefumula esiphefumulayo {inhalation: isilinganiso sokuphefumula} = 1: 2).
"Amaphuzu" abalwa ngesilinganiso sokugeleza komoyampilo ngamunye.I-cannula yamakhala yasetshenziswa ukunikeza umoya-mpilo ku-LFNC.
Konke ukuhlaziya kwenziwa kusetshenziswa isofthiwe ye-Origin (Northampton, MA: OriginLab Corporation).Imiphumela ichazwa njengesilinganiso ± ukuchezuka okujwayelekile (SD) kwenani lokuhlola (N) [12].Sihlanganise yonke imiphumela ezindaweni ezimbili zamadesimali.
Ukuze ubale "amaphuzu", inani le-oksijini eliphefumulelwe emaphashini ngokuphefumula okukodwa lilingana nenani le-oxygen ngaphakathi kwe-cannula yamakhala, kanti enye ingaphandle komoya.Ngakho, ngesikhathi sokuphefumula se-2 s, i-oksijini ehanjiswa yi-cannula yamakhala ngamasekhondi angu-2 yi-1000/30 ml.Umthamo womoya-mpilo otholakala emoyeni wangaphandle wawungu-21% wevolumu ye-tidal (1000/30 ml).I-FiO2 yokugcina inani le-oxygen elethwa kumthamo we-tidal.Ngakho-ke, "isilinganiso" se-FiO2 singabalwa ngokuhlukanisa inani eliphelele le-oxygen elidliwe yivolumu ye-tidal.
Ngaphambi kwesilinganiso ngasinye, imonitha ye-oxygen ye-intracheal yalinganiswa ku-20.8% futhi i-extraoral oxygen monitor yalinganiswa ku-21%.Ithebula 1 libonisa amanani amaphakathi e-FiO2 LFNC ngezinga lokugeleza ngakunye.Lawa manani aphakeme izikhathi ezi-1.5-1.9 kunamanani “abaliwe” (Ithebula 1).Ukugcwala komoyampilo ngaphandle komlomo kuphakeme kunomoya wasendlini (21%).Inani elimaphakathi lehle ngaphambi kokwethulwa kokugeleza komoya okuvela kufeni kagesi.Lawa manani afana "namanani alinganiselwe".Ngokugeleza komoya, lapho ukuhlushwa komoyampilo ngaphandle komlomo kuseduze nomoya wegumbi, inani le-FiO2 kuqhoqhoqho liphakeme "kunenani elibaliwe" elingaphezu kuka-2 L/min.Ngokugeleza komoya noma ngaphandle, umehluko we-FiO2 wehla njengoba izinga lokugeleza landa (Umfanekiso 2).
Ithebula 2 libonisa amanani amaphakathi e-FiO2 ekugxilweni komoyampilo ngakunye kumaski womoya-mpilo olula (imaski yomoya-mpilo ye-Ecolite; Osaka, Japan: Japan Medicalnext Co., Ltd.).Lawa manani akhuphuka ngokwanda kokuhlushwa komoyampilo (Ithebula 2).Ngokusetshenziswa okufanayo kwe-oxygen, i-FiO2 ye-LFNK iphakeme kune-mask elula ye-oxygen.Ku-1-5 L/min, umehluko ku-FiO2 cishe u-11-24%.
Ithebula 3 libonisa amanani amaphakathi e-FiO2 e-HFNC ngezinga lokugeleza ngakunye nokugxiliswa komoyampilo.Lawa manani ayeseduze nokugxiliswa komoyampilo okuhlosiwe kungakhathaliseki ukuthi izinga lokugeleza laliphansi noma liphezulu (Ithebula 3).
Amanani e-Intracheal FiO2 ayephezulu kunamanani 'alinganiselwe' futhi amanani e-extraoral FiO2 ayephezulu kunomoya wegumbi lapho kusetshenziswa i-LFNC.Ukugeleza komoya kutholwe kwehlisa i-intracheal ne-extraoral FiO2.Le miphumela iphakamisa ukuthi ukuphefumula okuphelelwa yisikhathi kwenzeka ngesikhathi sokuphefumula kwe-LFNC.Ngokugeleza komoya noma ngaphandle, umehluko we-FiO2 uyehla njengoba izinga lokugeleza likhuphuka.Lo mphumela uphakamisa ukuthi enye into ingase ihlotshaniswe ne-FiO2 ephakeme kuqhoqhoqho.Ngaphezu kwalokho, baphinde babonisa ukuthi i-oxygenation ikhulisa ukuhlushwa komoya-mpilo endaweni efile ye-anatomical, okungenzeka kube ngenxa yokwanda kwe-FiO2 [2].Kuyamukelwa ngokuvamile ukuthi i-LFNC ayikubangeli ukuphefumula kabusha ekukhipheni umoya.Kulindeleke ukuthi lokhu kungase kuthinte kakhulu umehluko phakathi kwamanani akalwayo “nalinganiselwe” ama-cannula akhala.
Ngamazinga aphansi okugeleza kwe-1-5 L/min, i-FiO2 ye-mask ethafeni yayiphansi kunaleyo ye-cannula yamakhala, mhlawumbe ngenxa yokuthi ukuhlushwa komoya-mpilo akukhuli kalula lapho ingxenye yemaski iba indawo efile ye-anatomically.Ukugeleza komoyampilo kunciphisa ukuhlanjululwa komoya wegumbi futhi kuzinzise i-FiO2 ngaphezu kuka-5 L/min [12].Ngaphansi kwe-5 L/min, amanani aphansi e-FiO2 enzeka ngenxa yokuhlanjululwa komoya wegumbi kanye nokuphefumula kabusha kwesikhala esifile [12].Eqinisweni, ukunemba kwamamitha okugeleza komoya-mpilo kungahluka kakhulu.I-MiniOx 3000 isetshenziselwa ukuqapha ukugcwala komoyampilo, nokho idivayisi ayinakho ukulungiswa kwesikhashana okwanele ukukala izinguquko ekugxilweni komoyampilo okhishwa umoya (abakhiqizi bacacisa amasekhondi angu-20 ukumela impendulo engu-90%).Lokhu kudinga imonitha komoyampilo enempendulo yesikhathi esisheshayo.
Emisebenzini yangempela yomtholampilo, i-morphology ye-nasal cavity, i-oral cavity, ne-pharynx iyahlukahluka kumuntu nomuntu, futhi inani le-FiO2 lingase lihluke emiphumeleni etholwe kulolu cwaningo.Ngaphezu kwalokho, isimo sokuphefumula seziguli siyahluka, futhi ukusetshenziswa okuphezulu kwe-oxygen kuholela ekwakhiweni kwe-oxygen ephansi ekuphefumuleni kokuphefumula.Lezi zimo zingaholela ekwehleni kwamanani e-FiO2.Ngakho-ke, kunzima ukuhlola i-FiO2 enokwethenjelwa lapho usebenzisa i-LFNK kanye namaski oksijini alula ezimweni zangempela zomtholampilo.Kodwa-ke, lokhu kuhlola kuphakamisa ukuthi imiqondo yesikhala se-anatomical efile kanye nokuphefumula kokuphefumula okuphindaphindiwe kungase kuthonye i-FiO2.Njengoba kunikezwe lokhu kutholakala, i-FiO2 ingakhula kakhulu ngisho namazinga okugeleza aphansi, kuye ngezimo kunokuba "izilinganiso".
I-British Thoracic Society incoma ukuthi odokotela banikeze umoya-mpilo ngokuya ngebanga lokugcwala okuhlosiwe futhi baqaphe isiguli ukuze sigcine uhla lokugcwala okuhlosiwe [14].Nakuba “inani elibaliwe” le-FiO2 kulolu cwaningo laliphansi kakhulu, kungenzeka ukuzuza i-FiO2 yangempela ephakeme “kunenani elibaliwe” kuye ngesimo sesiguli.
Uma usebenzisa i-HFNC, inani le-FiO2 liseduze nokuhlushwa komoyampilo okusethiwe kungakhathaliseki izinga lokugeleza.Imiphumela yalolu cwaningo iphakamisa ukuthi amazinga aphezulu e-FiO2 angafinyelelwa ngisho nangesilinganiso sokugeleza kwe-10 L / min.Ucwaningo olufanayo alubonisi ushintsho ku-FiO2 phakathi kwe-10 ne-30 L [12,15].Izinga eliphezulu lokugeleza kwe-HFNC kubikwa ukuthi lisusa isidingo sokucabangela isikhala esifile se-anatomical [2,16].Indawo efile ye-anatomical ingase ikhishwe ngezinga lokugeleza komoyampilo elingaphezu kuka-10 L/min.Dysart et al.Kucatshangelwa ukuthi indlela eyinhloko yokusebenza ye-VPT ingase ibe ukukhukhula kwesikhala esifile se-nasopharyngeal cavity, ngaleyo ndlela kuncishiswe indawo efile ephelele futhi kwandise isilinganiso sokuphefumula okuncane (okungukuthi, umoya we-alveolar) [17].
Ucwaningo lwangaphambili lwe-HFNC lwasebenzisa i-catheter ukukala i-FiO2 ku-nasopharynx, kodwa i-FiO2 yayiphansi kunalokhu kuhlolwa [15,18-20].U-Ritchie et al.Kuye kwabikwa ukuthi inani elibaliwe le-FiO2 lisondela ku-0.60 njengoba izinga lokugeleza kwegesi likhuphuka ngaphezu kwe-30 L / min ngesikhathi sokuphefumula kwekhala [15].Empeleni, ama-HFNC adinga amazinga okugeleza angu-10-30 L/min noma ngaphezulu.Ngenxa yezakhiwo ze-HFNC, izimo emgodini wekhala zinomthelela omkhulu, futhi i-HFNC ivamise ukwenziwa kusebenze ngamazinga aphezulu okugeleza.Uma ukuphefumula kuba ngcono, ukwehla kwezinga lokugeleza kungase kudingeke, njengoba i-FiO2 ingase yanele.
Le miphumela isuselwe ekufaniseni futhi ayiphakamisi ukuthi imiphumela ye-FiO2 ingasetshenziswa ngokuqondile ezigulini zangempela.Kodwa-ke, ngokusekelwe kule miphumela, esimweni sokusebenzisa intubation noma amadivaysi ngaphandle kwe-HFNC, amanani we-FiO2 angalindelwa ukuthi ahluke kakhulu kuye ngezimo.Lapho unikeza umoya-mpilo nge-LFNC noma imaski ye-oksijini elula esimweni somtholampilo, ukwelashwa ngokuvamile kuhlolwa kuphela "inani le-peripheral arterial oxygen saturation" (SpO2) kusetshenziswa i-pulse oximeter.Ngokuthuthukiswa kwe-anemia, ukuphathwa okuqinile kwesiguli kunconywa, kungakhathaliseki ukuthi i-SpO2, i-PaO2 nokuqukethwe kwe-oksijini egazini le-arterial.Ngaphezu kwalokho, i-Downes et al.kanye noBeasley et al.Kuye kwaphakanyiswa ukuthi iziguli ezingazinzile zingase zibe sengozini ngenxa yokusetshenziswa kwe-prophylactic ye-oxygen therapy egxile kakhulu [21-24].Phakathi nezikhathi zokuwohloka komzimba, iziguli ezithola ukwelashwa kwe-oksijeni okugxilwe kakhulu zizoba nokufundwa kwe-pulse oximeter ephezulu, okungase kufihle ukwehla kancane kancane kwesilinganiso se-P / F futhi ngaleyo ndlela kungase kungaqapheli abasebenzi ngesikhathi esifanele, okuholela ekuwohlokeni okuzayo okudinga ukungenelela komshini.ukusekela.Ngaphambilini kwakucatshangwa ukuthi i-FiO2 ephezulu inikeza ukuvikelwa nokuphepha kweziguli, kodwa le mbono ayisebenzi esimweni somtholampilo [14].
Ngakho-ke, ukunakekelwa kufanele kuthathwe ngisho nalapho ubeka i-oksijini esikhathini se-perioperative noma ezigabeni zokuqala zokuhluleka kokuphefumula.Imiphumela yocwaningo ibonisa ukuthi izilinganiso ezinembile ze-FiO2 zingatholwa kuphela nge-intubation noma i-HFNC.Uma usebenzisa i-LFNC noma imaski ye-oxygen elula, i-oxygen ye-prophylactic kufanele inikezwe ukuvimbela ukucindezeleka kokuphefumula okuncane.Lawa madivayisi angase angafaneleki uma ukuhlolwa okubalulekile kwesimo sokuphefumula kuyadingeka, ikakhulukazi uma imiphumela ye-FiO2 ibalulekile.Ngisho nangamazinga okugeleza aphansi, i-FiO2 iyanda ngokugeleza komoyampilo futhi ingase ifihle ukwehluleka kokuphefumula.Ngaphezu kwalokho, ngisho nalapho usebenzisa i-SpO2 ekwelapheni kwangemva kokuhlinzwa, kuyafiseleka ukuthi kube nesilinganiso esiphansi sokugeleza ngangokunokwenzeka.Lokhu kuyadingeka ukuze kutholakale ngokushesha ukwehluleka kokuphefumula.Ukugeleza komoyampilo okuphezulu kwandisa ingozi yokwehluleka ukutholwa kusenesikhathi.Umthamo we-oxygen kufanele unqunywe ngemuva kokunquma ukuthi yiziphi izimpawu ezibalulekile ezithuthukisiwe ngokuphathwa komoya-mpilo.Ngokusekelwe emiphumeleni yalolu cwaningo kuphela, akukhuthazwa ukushintsha umqondo wokuphathwa kwe-oxygen.Kodwa-ke, sikholelwa ukuthi imibono emisha evezwe kulolu cwaningo kufanele ibhekwe ngokwezindlela ezisetshenziswa ekusebenzeni komtholampilo.Ukwengeza, lapho kunqunywa inani le-oxygen elinconywe yiziqondiso, kuyadingeka ukusetha ukugeleza okufanele kwesiguli, kungakhathaliseki ukuthi inani le-FiO2 lezilinganiso zokugeleza kokuphefumula okujwayelekile.
Siphakamisa ukuthi sicabangele kabusha umqondo we-FiO2, kucatshangelwa ububanzi bokwelashwa komoyampilo kanye nezimo zomtholampilo, njengoba i-FiO2 iyipharamitha ebaluleke kakhulu yokulawula ukuphathwa komoyampilo.Nokho, lolu cwaningo lunemikhawulo eminingana.Uma i-FiO2 ingalinganiswa kuqhoqhoqho lomuntu, inani elinembe kakhudlwana lingatholwa.Nokho, okwamanje kunzima ukwenza izilinganiso ezinjalo ngaphandle kokuhlasela.Ucwaningo olwengeziwe kusetshenziswa imishini yokulinganisa engahlaseli kufanele yenziwe esikhathini esizayo.
Kulolu cwaningo, silinganise i-FiO2 ye-intracheal sisebenzisa imodeli yokulingisa yokuphefumula ezenzakalelayo ye-LFNC, imaski ye-oxygen elula, ne-HFNC.Ukuphathwa komoyampilo ngesikhathi sokukhipha umoya kungaholela ekwandeni kokuhlushwa komoyampilo endaweni efile ye-anatomical, okungase kuhlotshaniswe nokwanda kwenani le-oxygen ehogeliwe.Nge-HFNC, ingxenye ephezulu ye-oxygen ehogeliwe ingatholakala ngisho nangesilinganiso sokugeleza esingu-10 l/min.Lapho kunqunywa inani eliphelele le-oxygen, kuyadingeka ukusungula izinga lokugeleza elifanele lesiguli kanye nezimo ezithile, hhayi kuphela kumanani wengxenye ye-oxygen ehogeliwe.Ukulinganisa iphesenti le-oksijini ehogelwe lapho usebenzisa i-LFNC kanye nemaski ye-oxygen elula esimweni somtholampilo kungaba inselele.
Idatha etholiwe ikhombisa ukuthi ukuphefumula okuphelelwa yisikhathi kuhlotshaniswa nokwanda kwe-FiO2 kuqhoqhoqho we-LFNC.Lapho kunqunywa inani le-oksijini elinconywe yiziqondiso, kuyadingeka ukusetha ukugeleza okufanele kwesiguli, kungakhathaliseki ukuthi inani le-FiO2 elilinganiswa kusetshenziswa ukugeleza kokuphefumula kwendabuko.
Izihloko Zomuntu: Bonke ababhali baqinisekisile ukuthi abekho abantu noma izicubu ezihilelekile kulolu cwaningo.Izihloko zezilwane: Bonke ababhali baqinisekisile ukuthi azikho izilwane noma izicubu ezihilelekile kulolu cwaningo.Ukungqubuzana Kwezintshisekelo: Ngokuhambisana nefomu le-ICMJE Lokudalula Okufanayo, bonke ababhali bamemezela lokhu okulandelayo: Ulwazi Lokukhokha/ Lwesevisi: Bonke ababhali bamemezela ukuthi abatholanga ukwesekwa kwezezimali kunoma iyiphi inhlangano ngomsebenzi othunyelwe.Ubudlelwano Bezezimali: Bonke ababhali bamemezela ukuthi okwamanje noma phakathi neminyaka emithathu edlule abanabo ubudlelwano bezezimali nanoma iyiphi inhlangano engase ibe nentshisekelo emsebenzini othunyelwe.Obunye Ubudlelwano: Bonke ababhali bamemezela ukuthi abukho obunye ubudlelwano noma imisebenzi engathinta umsebenzi othunyelwe.
Sithanda ukubonga uMnu. Toru Shida (IMI Co., Ltd, Kumamoto Customer Service Centre, Japan) ngosizo lwakhe ngalolu cwaningo.
Kojima Y., Sendo R., Okayama N. et al.(Meyi 18, 2022) Isilinganiso se-oxygen ehogeliwe kumadivayisi agelezayo aphansi futhi aphezulu: isifundo sokulingisa.Ukwelapha 14(5): e25122.doi:10.7759/cureus.25122
© Copyright 2022 Kojima et al.Lena indatshana yokufinyelela evulekile esatshalaliswa ngaphansi kwemigomo ye-Creative Commons Attribution License CC-BY 4.0.Ukusetshenziswa okungenamkhawulo, ukusatshalaliswa, kanye nokukhiqizwa kabusha kunoma iyiphi indlela kuvunyelwe, inqobo nje uma umlobi wangempela kanye nomthombo kwaziswa.
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(a) imonitha komoyampilo, (b) i-dummy, (c) ukuhlola amaphaphu, (d) idivayisi yokubulala izinzwa, (e) imonitha komoyampilo, kanye (f) nomshini wokungenisa umoya kagesi.
Izilungiselelo ze-ventilator zazimi kanje: ivolumu ye-tidal 500 ml, izinga lokuphefumula i-10 breaths/min, inspiratory to expiratory ratio (inhalation/expiration ratio) 1:2 (isikhathi sokuphefumula = 1 s).Ocwaningweni, ukuthobelana kwephaphu lokuhlola kwakusethwe ku-0.5.
"Amaphuzu" abalwa ngesilinganiso sokugeleza komoyampilo ngamunye.I-cannula yamakhala yasetshenziswa ukunikeza umoya-mpilo ku-LFNC.
I-Scholarly Impact Quotient™ (SIQ™) iyinqubo yethu eyingqayizivele yokuhlola ukubuyekezwa kontanga ngemva kokushicilela.Thola okwengeziwe lapha.
Lesi sixhumanisi sizokuyisa kuwebhusayithi yenkampani yangaphandle engaxhumene ne-Cureus, Inc. Sicela wazi ukuthi i-Cureus ayinasibopho sanoma yikuphi okuqukethwe noma imisebenzi equkethwe kozakwethu noma amasayithi axhumene naye.
I-Scholarly Impact Quotient™ (SIQ™) iyinqubo yethu eyingqayizivele yokuhlola ukubuyekezwa kontanga ngemva kokushicilela.I-SIQ™ ihlola ukubaluleka nekhwalithi yama-athikili isebenzisa ubuhlakani obuqoqiwe bomphakathi wonke we-Cureus.Bonke abasebenzisi ababhalisiwe bayakhuthazwa ukuthi bafake isandla ku-SIQ™ yanoma iyiphi i-athikili eshicilelwe.(Ababhali abakwazi ukulinganisa ama-athikili abo.)
Izilinganiso eziphezulu kufanele zibekelwe umsebenzi osuvele umusha ngempela emikhakheni yazo.Noma yiliphi inani elingaphezu kuka-5 kufanele libhekwe ngaphezu kwesilinganiso.Nakuba bonke abasebenzisi ababhalisiwe be-Cureus bangase balinganisele noma iyiphi i-athikili eshicilelwe, imibono yochwepheshe bendaba inesisindo esikhulu kakhulu kunaleyo yabangebona ochwepheshe.I-SIQ™ ye-athikili izovela eduze kwe-athikili ngemva kokuthi isikalwe kabili, futhi izobalwa kabusha ngemiphumela ngayinye eyengeziwe.
I-Scholarly Impact Quotient™ (SIQ™) iyinqubo yethu eyingqayizivele yokuhlola ukubuyekezwa kontanga ngemva kokushicilela.I-SIQ™ ihlola ukubaluleka nekhwalithi yama-athikili isebenzisa ubuhlakani obuqoqiwe bomphakathi wonke we-Cureus.Bonke abasebenzisi ababhalisiwe bayakhuthazwa ukuthi bafake isandla ku-SIQ™ yanoma iyiphi i-athikili eshicilelwe.(Ababhali abakwazi ukulinganisa ama-athikili abo.)
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