“Ungaze uthandabuze ukuba iqaqobana labemi abacingayo nabazinikeleyo linokutshintsha ihlabathi.Enyanisweni, yiyo yodwa ekhoyo.”
Umsebenzi kaCureus kukutshintsha imodeli yexesha elide yokupapashwa kwezonyango, apho ukuhanjiswa kophando kunokubiza kakhulu, kuyinkimbinkimbi, kwaye kuthatha ixesha.
Caphula eli nqaku njenge: Kojima Y., Sendo R., Okayama N. et al.(ngoMeyi 18, 2022) Umlinganiselo we-oksijini ephefumleyo kwizixhobo ezisezantsi nezihambayo eziphezulu: isifundo sokulinganisa.Unyango 14(5): e25122.doi:10.7759/cureus.25122
Injongo: Iqhekeza le-oksijini edibeneyo kufuneka ilinganiswe xa i-oksijini inikwa isigulane, kuba imele i-alveolar oxygen concentration, ebalulekileyo kwimbono ye-physiology yokuphefumula.Ngoko ke, injongo yolu phononongo yayikukuthelekisa umlinganiselo weoksijini efunyenweyo efunyenwe ngezixhobo ezahlukeneyo zokuhambisa ioksijini.
Iindlela: Kusetyenziswe imodeli yokulinganisa ukuphefumla okuzenzekelayo.Linganisa umlinganiselo weoksijini erholeyo efunyenwe ngeempumlo ezisezantsi neziphezulu kunye neemaski ezilula zeoksijini.Emva kwe-120 ye-oxygen, iqhezu lomoya ophefumlelweyo lilinganiswe rhoqo ngesekhondi kwi-30.Imilinganiselo emithathu yathathwa kwimeko nganye.
IZIPHUMO: Ukuhamba komoya kunciphise i-intracheal ephefumlelweyo ye-oxygen fraction kunye ne-extraoral oxygen concentration xa usebenzisa i-low-flow nasal cannula, ebonisa ukuba ukuphefumula kokuphefumula kwenzeka ngexesha lokuphefumula kwaye kunokudibaniswa nokunyuka kwe-intracheal ephefumlelweyo ye-oxygen fraction.
Ukuqukumbela.Ukuphefumla ioksijini ngexesha lokuphefumla kunokukhokelela ekwandeni koxinzelelo lweoksijini kwindawo efileyo ye-anatomical, enokuthi idityaniswe nokunyuka komyinge we-oxygen efakwe ngaphakathi.Ukusebenzisa i-cannula ephezulu ye-nasal, ipesenti ephezulu ye-oxygen e-inhaled inokufumaneka nakwizinga lokuhamba kwe-10 L / min.Xa umisela inani elifanelekileyo le-oksijeni, kuyimfuneko ukuseta isantya esifanelekileyo sokuhamba kwesigulane kunye neemeko ezithile, kungakhathaliseki ukuba ixabiso leqhezu le-oksijini edibeneyo.Xa usebenzisa i-low-flow nasal prongs kunye ne-oxygen masks elula kwindawo yeklinikhi, kunokuba nzima ukuqikelela umlinganiselo we-oksijini efakwe ngaphakathi.
Ukulawulwa kwe-oksijeni ngexesha lezigaba ezinzima kunye nezingapheliyo zokungaphumeleli kokuphefumula yinkqubo eqhelekileyo kwiyeza zonyango.Iindlela ezahlukeneyo zolawulo lwe-oxygen ziquka i-cannula, i-nasal cannula, i-oxygen mask, i-mask ye-reservoir, i-venturi mask, kunye ne-high flow nasal cannula (HFNC) [1-5].Ipesenteji ye-oksijini kwi-air inhaled (FiO2) yipesenti ye-oksijini kwi-air inhaled ethatha inxaxheba ekutshintshisweni kwegesi ye-alveolar.Iqondo le-oxygenation (i-P / F ratio) ngumlinganiselo woxinzelelo lwe-oksijini (PaO2) ukuya kwi-FiO2 kwi-arterial blood.Nangona ixabiso lokuxilonga lomlinganiselo we-P / F lihlala liphikisana, liyisalathisi esisetyenziswa ngokubanzi se-oksijini ekusebenzeni kweklinikhi [6-8].Ngoko ke, kubalulekile ngokweklinikhi ukwazi ixabiso le-FiO2 xa unika i-oxygen kwisigulane.
Ngethuba lokungena, i-FiO2 inokulinganiswa ngokuchanekileyo nge-monitor ye-oksijeni ebandakanya isiphaluka somoya, ngelixa i-oksijini ilawulwa nge-cannula ye-nasal kunye ne-oxygen mask, kuphela "uqikelelo" lwe-FiO2 olusekelwe kwixesha lokuphefumula lunokulinganiswa.Eli "nqaku" ngumlinganiselo wobonelelo lweoksijini ukuya kumthamo wamaza.Nangona kunjalo, oku akuthatheli ngqalelo ezinye izinto ukusuka kwindawo yokujonga i-physiology yokuphefumla.Izifundo zibonise ukuba imilinganiselo ye-FiO2 inokuphenjelelwa zizinto ezahlukeneyo [2,3].Nangona ukulawulwa kwe-oksijini ngexesha lokuphefumula kunokukhokelela ekunyuseni kwe-oksijini ye-oksijeni kwiindawo ezifileyo ze-anatomical ezifana nomlomo womlomo, i-pharynx kunye ne-trachea, akukho ngxelo kulo mbandela kwiincwadi zangoku.Nangona kunjalo, abanye oogqirha bakholelwa ukuba ekusebenzeni ezi zinto azibalulekanga kangako kwaye "amanqaku" anele ukoyisa iingxaki zeklinikhi.
Kwiminyaka yakutshanje, i-HFNC iye yatsala ingqalelo ekhethekileyo kunyango olungxamisekileyo kunye nokhathalelo olunzulu [9].I-HFNC inikezela nge-FiO2 ephezulu kunye nokuhamba kwe-oksijeni kunye neenzuzo ezimbini eziphambili - ukutshitshiswa kwendawo efileyo ye-pharynx kunye nokunciphisa ukuchasana kwe-nasopharyngeal, okungafanele kuhoywe xa kuchaza i-oksijeni [10,11].Ukongezelela, kunokuba yimfuneko ukucinga ukuba ixabiso elilinganisiweyo le-FiO2 limele i-oxygen concentration kwi-airways okanye i-alveoli, ekubeni i-oxygen concentration kwi-alveoli ngexesha lokuphefumlelwa ibalulekile ngokwe-P / F ratio.
Iindlela zokuhambisa ioksijini ngaphandle kwe-intubation zihlala zisetyenziswa kwiinkqubo zesiqhelo zeklinikhi.Ngoko ke, kubalulekile ukuqokelela idatha engaphezulu kwi-FiO2 elinganiswe nezi zixhobo zokuhambisa i-oksijini ukwenzela ukukhusela ukugqithisa okungadingekile kunye nokufumana ingqiqo malunga nokhuseleko lokuphefumula ngexesha lokuphefumula.Nangona kunjalo, ukulinganiswa kwe-FiO2 kwi-trachea yomntu kunzima.Abanye abaphandi baye bazama ukulinganisa i-FiO2 ngokusebenzisa iimodeli zokuphefumla ngokuzenzekelayo [4,12,13].Ke ngoko, kolu phononongo, sijonge ukulinganisa iFiO2 sisebenzisa imodeli efanisiweyo yokuphefumla okuzenzekelayo.
Olu luphononongo lokulinga olungadingi mvume yeenqobo ezisesikweni kuba alubandakanyi abantu.Ukulinganisa ukuphefumla okuzenzekelayo, silungiselele imodeli yokuphefumla ezenzekelayo ngokubhekiselele kumzekelo ophuhliswe nguHsu et al.(Umfanekiso 1) [12].Ii-Ventilators kunye nemiphunga yokuvavanya (i-Dual Adult TTL; i-Grand Rapids, i-MI: i-Michigan Instruments, i-Inc.) evela kwizixhobo ze-anesthesia (i-Fabius Plus; i-Lübeck, i-Jamani: i-Draeger, i-Inc.) yayilungiselelwe ukulinganisa ukuphefumla ngokuzenzekelayo.Ezi zixhobo zimbini zixhunywe ngesandla ngeentambo zetsimbi eziqinileyo.Umvulo omnye (kwicala lokuqhuba) lomphunga wovavanyo uqhagamshelwe kwisixhobo sokungenisa umoya.Eminye imivumbo (icala lokugqitha) lovavanyo lwemiphunga iqhagamshelwe “kwiModeli yoLawulo lweOksijini”.Ngokukhawuleza ukuba i-ventilator ibonelele ngegesi entsha yokuvavanya imiphunga (icala lokuqhuba), i-bellows ivuthelwa ngokutsalwa ngenkani kweminye imivumbo (icala lokwenziwa).Le ntshukumo itsala igesi kuqhoqhoqho lwemanikin, ngaloo ndlela ilinganisa ukuphefumla okuzenzekelayo.
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Izicwangciso ze-ventilator zimi ngolu hlobo lulandelayo: umthamo we-tidal 500 ml, izinga lokuphefumula i-10 breaths / min, inspiratory to expiratory ratio (inhalation / expiration ratio) 1: 2 (ixesha lokuphefumula = 1 s).Kwimifuniselo, ukuthotyelwa komphunga wovavanyo kwakusetelwe ku-0.5.
Imonitha ye-oksijini (i-MiniOx 3000; i-Pittsburgh, i-PA: i-American Medical Services Corporation) kunye ne-manikin (MW13; i-Kyoto, e-Japan: i-Kyoto Kagaku Co., Ltd.) yasetyenziselwa imodeli yokulawula i-oksijini.I-oksijeni ecocekileyo yafakwa kumazinga e-1, 2, 3, 4 kunye ne-5 L / min kunye ne-FiO2 yalinganiswa nganye.I-HFNC (i-MaxVenturi; i-Coleraine, i-Northern Ireland: i-Armstrong Medical), imixube ye-oxygen-air yayilawulwa kwimiqulu ye-10, 15, 20, 25, 30, 35, 40, 45, 50, 55, kunye ne-60 L, kunye ne-FiO2 ihlolwe kwimeko nganye.Kwi-HFNC, iimvavanyo zenziwa kwi-45%, i-60% kunye ne-90% ye-oxygen concentrations.
Uxinzelelo lwe-oxygen eyongezelelweyo (BSM-6301; eTokyo, eJapan: i-Nihon Kohden Co.) yalinganiselwa kwi-3 cm ngaphezu kwe-maxillary incisors kunye ne-oksijini ehanjiswa nge-nasal cannula (Finefit; Osaka, Japan: Japan Medicalnext Co.) (Umfanekiso 1).) Intubation usebenzisa i-ventilator yombane (HEF-33YR; Tokyo, Japan: Hitachi) ukuvuthela umoya ngaphandle kwentloko ye-manikin ukuphelisa ukuphefumla emva kokuphefumula, kwaye i-FiO2 yalinganiswa imizuzu emi-2 kamva.
Emva kwemizuzwana ye-120 yokuvezwa kwe-oksijeni, i-FiO2 yalinganiswa nganye yesibini imizuzwana ye-30.Ventilate imanikin kunye nelebhu emva komlinganiselo ngamnye.I-FiO2 yalinganiswa amaxesha e-3 kwimeko nganye.Uvavanyo lwaqala emva kokulinganisa isixhobo ngasinye sokulinganisa.
Ngokwesiko, i-oksijeni ihlolwe ngeempumlo ze-cannulas ukwenzela ukuba i-FiO2 inokulinganiswa.Indlela yokubala esetyenziswe kolu vavanyo yahluka ngokuxhomekeke kumxholo wokuphefumla okuzenzekelayo (Itheyibhile 1).Amanqaku abalwa ngokusekelwe kwiimeko zokuphefumula ezibekwe kwisixhobo se-anesthesia (umthamo we-tidal: 500 ml, izinga lokuphefumula: i-10 breaths / min, inspiratory to expiratory ratio {inhalation: exhalation ratio} = 1: 2).
"Amanqaku" abalwa kwinqanaba ngalinye lokuhamba kwe-oxygen.I-cannula yempumlo yayisetyenziselwa ukulawula i-oxygen kwi-LFNC.
Lonke uhlalutyo lwenziwa kusetyenziswa isoftware yeMvelaphi (Northampton, MA: OriginLab Corporation).Iziphumo zichazwa njengentsingiselo ± ukutenxa okusemgangathweni (SD) kwenani leemvavanyo (N) [12].Sisondeze zonke iziphumo kwiindawo ezimbini zedesimali.
Ukubala "amanqaku", isixa se-oksijini ephefumulelwe emiphungeni ngokuphefumula omnye silingana nomlinganiselo we-oksijini ngaphakathi kwe-cannula ye-nasal, kwaye enye ingaphandle emoyeni.Ngaloo ndlela, ngexesha lokuphefumula kwe-2 s, i-oksijini ehanjiswa yi-nasal cannula kwi-2 s yi-1000 / 30 ml.Umthamo we-oksijeni ofunyenwe emoyeni wangaphandle wawuyi-21% yomthamo we-tidal (1000 / 30 ml).I-FiO2 yokugqibela yimali ye-oksijini ehanjiswe kumthamo we-tidal volume.Ngoko ke, "uqikelelo" lwe-FiO2 lunokubalwa ngokwahlula inani elipheleleyo le-oksijini esetyenziswe ngumthamo we-tidal.
Ngaphambi komlinganiselo ngamnye, i-monitor ye-intracheal ye-oksijini ilinganiswe kwi-20.8% kwaye i-monitor ye-oksijini ye-extraoral ilinganiswe kwi-21%.Itheyibhile yoku-1 ibonisa amaxabiso aphakathi kwe-FiO2 LFNC kwinqanaba lokuhamba ngalinye.La maxabiso angamaxesha angama-1.5-1.9 aphezulu kunamaxabiso “abaliweyo” (Itheyibhile 1).Ukuxinwa kweoksijini ngaphandle komlomo kuphezulu kunomoya wangaphakathi (21%).Umyinge wexabiso lehla ngaphambi kokungeniswa kokuhamba komoya ovela kwifeni yombane.La maxabiso ayafana "namaxabiso aqikelelweyo".Ngokuhamba komoya, xa i-oxygen concentration ngaphandle komlomo isondele kumoya wegumbi, ixabiso le-FiO2 kwi-trachea liphezulu "kwixabiso elibaliweyo" elingaphezu kwe-2 L / min.Ngaphandle okanye ngaphandle kokuhamba komoya, umehluko we-FiO2 wehla njengoko izinga lokuhamba landa (Umfanekiso 2).
Itheyibhile yesi-2 ibonisa amaxabiso aphakathi kwe-FiO2 kwindawo nganye yoxinaniso lweoksijini kwimaski yeoksijini elula (i-Ecolite oxygen mask; Osaka, Japan: Japan Medicalnext Co., Ltd.).Ezi xabiso zonyuka ngokunyuka koxinzelelo lweoksijini (Itheyibhile 2).Ngokusetyenziswa okufanayo kwe-oksijeni, i-FiO2 ye-LFNK iphezulu kune-mask ye-oxygen elula.Kwi-1-5 L / min, umehluko kwi-FiO2 malunga ne-11-24%.
Itheyibhile 3 ibonisa i-avareji ye-FiO2 amaxabiso e-HFNC kwinqanaba ngalinye lokuhamba kunye noxinzelelo lwe-oxygen.Ezi xabiso zazikufutshane nokugxininiswa kwe-oksijeni ekujoliswe kuyo kungakhathaliseki ukuba izinga lokuhamba liphantsi okanye liphezulu (Itheyibhile 3).
Amaxabiso e-Intratracheal FiO2 ayephezulu kunexabiso 'eliqikelelweyo' kwaye amaxabiso angaphezulu e-FiO2 ayephezulu kunomoya wegumbi xa usebenzisa i-LFNC.Ukuhamba komoya kufunyenwe ukunciphisa i-intracheal kunye ne-extraoral FiO2.Ezi ziphumo zibonisa ukuba ukuphefumla kokuphelelwa umoya kwenzeka ngexesha lokuphefumla kwe-LFNC.Ngokuhamba komoya okanye ngaphandle, umahluko weFiO2 uyancipha njengoko izinga lokuhamba linyuka.Esi siphumo sibonisa ukuba enye into inokudibaniswa ne-FiO2 ephakamileyo kwi-trachea.Ukongezelela, baphinde babonisa ukuba i-oxygenation yandisa i-oksijini yoxinaniso kwindawo efileyo ye-anatomical, enokuthi ibe ngenxa yokunyuka kwe-FiO2 [2].Kuyamkelwa ngokubanzi ukuba i-LFNC ayibangeli ukuphefumla kwakhona ekuphumeni.Kulindeleke ukuba oku kunokuchaphazela kakhulu umahluko phakathi komlinganiselo kunye "noqikelelo" lwamaxabiso eempumlo cannulas.
Kwizinga eliphantsi lokuhamba kwe-1-5 L / min, i-FiO2 ye-mask ecacileyo yayingaphantsi kune-cannula ye-nasal, mhlawumbi ngenxa yokuba i-oksijeni yoxinaniso ayinyuki lula xa inxalenye ye-mask iba yindawo efile ye-anatomically.Ukuhamba kwe-oksijeni kunciphisa ukuhlanjululwa komoya wegumbi kunye nokuzinzisa i-FiO2 ngaphezu kwe-5 L / min [12].Ngaphantsi kwe-5 L/min, amaxabiso aphantsi e-FiO2 ayenzeka ngenxa yokuhlanjululwa komoya wegumbi kunye nokuphefumla kwakhona kwendawo efileyo [12].Enyanisweni, ukuchaneka kweemitha zokuhamba kwe-oxygen kunokwahluka kakhulu.I-MiniOx 3000 isetyenziselwa ukubeka iliso kwi-oxygen concentration, nangona kunjalo isixhobo asinaso isisombululo esaneleyo sexeshana ukulinganisa utshintsho kwi-exhaled oxygen concentration (abavelisi bachaza imizuzwana ye-20 ukumela impendulo ye-90%).Oku kufuna i-oxygen monitor kunye nempendulo yexesha elikhawulezayo.
Kwinkqubo yokwenyani yeklinikhi, i-morphology ye-nasal cavity, umlomo womlomo, kunye ne-pharynx iyahluka ukusuka kumntu ukuya kumntu, kwaye ixabiso le-FiO2 linokwahluka kwiziphumo ezifunyenwe kolu cwaningo.Ukongezelela, imeko yokuphefumula yezigulane iyahluka, kwaye ukusetyenziswa kwe-oksijini ephezulu kukhokelela kumxholo ophantsi we-oksijini ekuphefumuleni kokuphefumula.Ezi meko zingakhokelela ekunciphiseni amaxabiso e-FiO2.Ngoko ke, kunzima ukuvavanya i-FiO2 ethembekileyo xa usebenzisa i-LFNK kunye ne-oxygen masks elula kwiimeko zangempela zeklinikhi.Nangona kunjalo, olu vavanyo lucebisa ukuba iikhonsepthi zendawo efileyo ye-anatomical kunye nokuphefumla okuphindaphindiweyo kokuphefumula kunokuchaphazela i-FiO2.Ukunikezelwa koku kufunyanwa, i-FiO2 inokunyusa kakhulu nakwizinga eliphantsi lokuhamba, kuxhomekeke kwiimeko kunokuba "uqikelelo".
I-British Thoracic Society incoma ukuba oogqirha bachaze i-oksijini ngokoluhlu olujoliswe kuyo kwaye ibeke iliso kwisigulane ukugcina uluhlu olujoliswe kuyo [14].Nangona "ixabiso elibaliweyo" le-FiO2 kolu phononongo laliphantsi kakhulu, kunokwenzeka ukufezekisa i-FiO2 yangempela ephezulu kune "ixabiso elibaliweyo" kuxhomekeke kwimeko yesigulane.
Xa usebenzisa i-HFNC, ixabiso le-FiO2 lisondele kwi-concentration ye-oksijeni esetyenzisiweyo kungakhathaliseki ukuba yinqanaba lokuhamba.Iziphumo zolu pho nonongo zibonisa ukuba amanqanaba aphezulu e-FiO2 anokufezekiswa nakwizinga lokuhamba kwe-10 L / min.Izifundo ezifanayo zibonise ukuba akukho tshintsho kwi-FiO2 phakathi kwe-10 kunye ne-30 L [12,15].Izinga lokuhamba okuphezulu kwe-HFNC kubikwa ukuba kupheliswe isidingo sokuqwalasela indawo efileyo ye-anatomical [2,16].Indawo efileyo ye-anatomical inokukhutshelwa ngaphandle kwinqanaba le-oxygen ehamba ngaphezu kwe-10 L / min.Dysart et al.Kucatshangelwa ukuba indlela ephambili yokusebenza kwe-VPT inokuba kukugungxulwa kwendawo efileyo ye-nasopharyngeal cavity, ngaloo ndlela kuncitshiswe indawo yonke yokufa kunye nokwandisa umlinganiselo wokungena komoya (okt, i-alveolar ventilation) [17].
Uphononongo lwangaphambili lwe-HFNC lusebenzise i-catheter ukulinganisa i-FiO2 kwi-nasopharynx, kodwa i-FiO2 yayingaphantsi kolu vavanyo [15,18-20].URitchie et al.Kuye kwaxelwa ukuba ixabiso elibaliweyo le-FiO2 lisondela kwi-0.60 njengoko izinga lokuhamba kwegesi landa ngaphezu kwe-30 L / min ngexesha lokuphefumula kwempumlo [15].Enyanisweni, ii-HFNC zifuna amazinga okuhamba kwe-10-30 L / min okanye ngaphezulu.Ngenxa yeepropathi ze-HFNC, iimeko kwindawo yempumlo zinefuthe elibalulekileyo, kwaye i-HFNC ihlala isebenze kumazinga aphezulu okuhamba.Ukuba ukuphefumla kuphucula, ukuhla kwesantya sokuhamba kunokufuneka kwakhona, njengoko i-FiO2 inokwanela.
Ezi ziphumo zisekelwe kukulinganisa kwaye azicebisi ukuba iziphumo ze-FiO2 zinokusetyenziswa ngokuthe ngqo kwizigulane zangempela.Nangona kunjalo, ngokusekwe kwezi ziphumo, kwimeko ye-intubation okanye izixhobo ngaphandle kwe-HFNC, amaxabiso e-FiO2 anokulindeleka ukuba ahluke kakhulu ngokuxhomekeke kwiimeko.Xa ulawula i-oksijini nge-LFNC okanye i-mask ye-oxygen elula kwindawo yekliniki, unyango luvame ukuhlolwa kuphela "nge-peripheral arterial oxygen saturation" (SpO2) ixabiso usebenzisa i-pulse oximeter.Ngokuphuhliswa kwe-anemia, ulawulo oluqinileyo lwesigulane lunconywa, kungakhathaliseki ukuba i-SpO2, i-PaO2 kunye nomxholo we-oksijini kwi-arterial blood.Ukongeza, Downes et al.kunye noBeasley et al.Kuye kwacetyiswa ukuba izigulane ezingazinzanga ngokwenene zinokuba sengozini ngenxa yokusetyenziswa kweprophylactic yonyango olugxininisiweyo lwe-oxygen [21-24].Ngexesha lokuwohloka komzimba, izigulane ezifumana unyango lwe-oksijini olugxininiswe kakhulu luya kuba nokufundwa kwe-pulse oximeter ephezulu, enokuthi ifihle ukuhla kancinci kumlinganiselo we-P / F kwaye ngoko ke ayinakulumkisa abasebenzi ngexesha elifanelekileyo, okukhokelela ekuwohlokeni okuzayo okudinga ukungenelela ngoomatshini.inkxaso.Ngaphambili kwakucatshangelwa ukuba i-FiO2 ephezulu inika ukhuseleko kunye nokhuseleko kwizigulane, kodwa le ngcamango ayisebenzi kwisimo seklinikhi [14].
Ngoko ke, kufuneka kuthathwe unonophelo nangona ubeka i-oksijini kwixesha le-perioperative okanye kwiinqanaba zokuqala zokungaphumeleli kokuphefumula.Iziphumo zophando zibonisa ukuba imilinganiselo ye-FiO2 echanekileyo inokufumaneka kuphela nge-intubation okanye i-HFNC.Xa usebenzisa i-LFNC okanye i-mask ye-oxygen elula, i-oksijini ye-prophylactic kufuneka inikezelwe ukukhusela ukuphefumula okufutshane.Ezi zixhobo zisenokungafaneleki xa kufuneka uvavanyo olubalulekileyo lwesimo sokuphefumula, ngakumbi xa iziphumo ze-FiO2 zibalulekile.Nokuba kumazinga aphantsi okuhamba, i-FiO2 yonyuka ngokuhamba kweoksijini kwaye inokufihla ukungaphumeleli kokuphefumla.Ukongeza, naxa usebenzisa i-SpO2 yonyango lwasemva kokuhlinzwa, kuyinqweneleka ukuba ube nesantya esiphantsi sokuhamba ngokusemandleni.Oku kuyimfuneko ekubonweni kwangaphambili kokungaphumeleli kokuphefumula.Ukuhamba kweoksijini ephezulu kwandisa umngcipheko wokungaphumeleli kokufunyanwa kwangoko.Umthamo we-oksijeni kufuneka unqunywe emva kokumisela ukuba zeziphi iimpawu ezibalulekileyo eziphuculweyo kunye nokulawulwa kwe-oxygen.Ngokusekelwe kwiziphumo zolu cwaningo kuphela, akukhuthazwa ukuba utshintshe ingcamango yokulawula i-oxygen.Nangona kunjalo, sikholelwa ukuba iingcamango ezintsha ezichazwe kolu phononongo kufuneka ziqwalaselwe ngokwemigaqo yeendlela ezisetyenziswa kwiklinikhi.Ukongezelela, xa umisela inani le-oksijini ekhuthazwa yizikhokelo, kuyimfuneko ukuseta ukuhamba okufanelekileyo kwesigulane, kungakhathaliseki ukuba ixabiso le-FiO2 lemilinganiselo yokuhamba kokuphefumula okuqhelekileyo.
Sicebisa ukuba siphinde siqwalasele ingcamango ye-FiO2, ngokuqwalasela ububanzi bonyango lwe-oksijini kunye neemeko zeklinikhi, kuba i-FiO2 iyipharamitha eyimfuneko yokulawula ukulawulwa kwe-oksijini.Nangona kunjalo, olu phononongo lunemida emininzi.Ukuba i-FiO2 inokulinganiswa kwi-trachea yomntu, ixabiso elichanekileyo linokufumaneka.Nangona kunjalo, okwangoku kunzima ukwenza imilinganiselo enjalo ngaphandle kokuphazamisa.Uphando olongezelelweyo olusebenzisa izixhobo zokulinganisa ezingahlaseliyo kufuneka lwenziwe kwixesha elizayo.
Kolu phononongo, silinganise i-intracheal FiO2 sisebenzisa imodeli yokulinganisa yokuphefumula ye-LFNC ezenzekelayo, imaski ye-oxygen elula, kunye ne-HFNC.Ukulawulwa kwe-oksijini ngexesha lokukhupha umoya kunokukhokelela ekwandeni koxinzelelo lwe-oksijini kwindawo efileyo ye-anatomical, enokuthi idibaniswe nokunyuka kwenani le-oxygen efakwe ngaphakathi.Nge-HFNC, umlinganiselo ophezulu we-oxygen e-inhaled unokufumaneka nakwizinga lokuhamba kwe-10 l / min.Xa kumiselwa umlinganiselo ofanelekileyo weoksijini, kuyimfuneko ukuseka isantya sokuqukuqela esifanelekileyo kwisigulana kunye neemeko ezithile, kungaxhomekekanga kuphela kumaxabiso eqhezu le-oksijini efakwe ngaphakathi.Ukuqikelela ipesenti ye-oxygen efakwe xa usebenzisa i-LFNC kunye ne-mask ye-oksijini elula kwimeko yeklinikhi ingaba ngumngeni.
Idatha efunyenweyo ibonisa ukuba ukuphefumla kokuphelelwa umoya kuhambelana nokunyuka kwe-FiO2 kwi-trachea ye-LFNC.Xa umisela inani le-oksijini ekhuthazwa yizikhokelo, kuyimfuneko ukuseta ukuhamba okufanelekileyo kwesigulane, kungakhathaliseki ukuba ixabiso le-FiO2 elilinganiswe kusetyenziswa ukuhamba kwendabuko yokuphefumula.
Izifundo zabantu: Bonke ababhali baqinisekisile ukuba akukho bantu okanye izicubu ezibandakanyekayo kolu cwaningo.Izifundo zezilwanyana: Bonke ababhali baqinisekisile ukuba akukho zilwanyana okanye izicubu ezibandakanyekayo kolu cwaningo.Ukungqubuzana koMdla: Ngokuhambelana neFom ye-ICMJE yokuDala i-Uniform, bonke ababhali bavakalisa oku kulandelayo: Intlawulo / iNgcaciso yeNkonzo: Bonke ababhali bavakalisa ukuba abazange bafumane inkxaso yezemali kuyo nayiphi na inhlangano yomsebenzi ongenisiweyo.Ubudlelwane bezeMali: Bonke ababhali bavakalisa ukuba okwangoku okanye kwiminyaka emithathu edlulileyo banobudlelwane bezemali kunye nawo nawuphi na umbutho onokuba nomdla kumsebenzi ongenisiweyo.Olunye uBudlelwane: Bonke ababhali bavakalisa ukuba akukho budlelwane obunye okanye imisebenzi enokuchaphazela umsebenzi ongenisiweyo.
Sithanda ukubulela uMnu. Toru Shida (IMI Co., Ltd, iZiko leNkonzo yabaThengi baseKumamoto, eJapan) ngoncedo lwakhe ngolu phando.
Kojima Y., Sendo R., Okayama N. et al.(ngoMeyi 18, 2022) Umlinganiselo we-oksijini ephefumleyo kwizixhobo ezisezantsi nezihambayo eziphezulu: isifundo sokulinganisa.Unyango 14(5): e25122.doi:10.7759/cureus.25122
© Copyright 2022 Kojima et al.Eli linqaku elivulekileyo lokufikelela lihanjiswe phantsi kwemigaqo ye-Creative Commons Attribution License CC-BY 4.0.Ukusetyenziswa okungenamkhawulo, ukuhanjiswa, kunye nokuveliswa kwakhona kuyo nayiphi na indlela kuvunyelwe, ngaphandle kokuba umbhali wokuqala kunye nomthombo banikwe ikhredithi.
Eli linqaku elivulekileyo lokufikelela lisasazwe phantsi kweLayisensi ye-Creative Commons Attribution, evumela ukusetyenziswa okungathintelwanga, ukuhanjiswa, kunye nokuveliswa kwakhona kuyo nayiphi na indlela, ngaphandle kokuba umbhali kunye nomthombo banikwe ikhredithi.
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Izicwangciso ze-ventilator zimi ngolu hlobo lulandelayo: umthamo we-tidal 500 ml, izinga lokuphefumula i-10 breaths / min, inspiratory to expiratory ratio (inhalation / expiration ratio) 1: 2 (ixesha lokuphefumula = 1 s).Kwimifuniselo, ukuthotyelwa komphunga wovavanyo kwakusetelwe ku-0.5.
"Amanqaku" abalwa kwinqanaba ngalinye lokuhamba kwe-oxygen.I-cannula yempumlo yayisetyenziselwa ukulawula i-oxygen kwi-LFNC.
I-Scholarly Impact Quotient™ (SIQ™) yinkqubo yethu yovavanyo olulodwa emva kokushicilela koontanga.Fumana ngakumbi apha.
Eli khonkco lizakukusa kwiwebhusayithi yomntu wesithathu enganxulumananga neCureus, Inc. Nceda uqaphele ukuba iCureus ayinaxanduva lwawo nawuphi na umxholo okanye imisebenzi equlethwe kumaqabane ethu okanye iisayithi ezinxulumeneyo.
I-Scholarly Impact Quotient™ (SIQ™) yinkqubo yethu yovavanyo olulodwa emva kokushicilela koontanga.I-SIQ™ ivavanya ukubaluleka kunye nomgangatho wamanqaku kusetyenziswa ubulumko obuhlangeneyo balo lonke uluntu lwaseCureus.Bonke abasebenzisi ababhalisiweyo bayakhuthazwa ukuba bafake isandla kwi-SIQ™ yalo naliphi na inqaku elipapashiweyo.(Ababhali abanako ukukala amanqaku abo.)
Amanqaku aphezulu kufuneka agcinelwe umsebenzi ovelisa into entsha kwiinkalo zawo.Naliphi na ixabiso elingaphezulu kwe-5 kufuneka lithathelwe ingqalelo ngaphezu komndilili.Ngelixa bonke abasebenzisi ababhalisiweyo beCureus banokukala naliphi na inqaku elipapashiweyo, izimvo zeengcali zemiba zinobunzima obuninzi kunezo zabangezongcali.I-SIQ™ yenqaku iya kuvela ecaleni kwenqaku emva kokuba irethiwe kabini, kwaye iya kubalwa kwakhona ngenqaku ngalinye elongezelelweyo.
I-Scholarly Impact Quotient™ (SIQ™) yinkqubo yethu yovavanyo olulodwa emva kokushicilela koontanga.I-SIQ™ ivavanya ukubaluleka kunye nomgangatho wamanqaku kusetyenziswa ubulumko obuhlangeneyo balo lonke uluntu lwaseCureus.Bonke abasebenzisi ababhalisiweyo bayakhuthazwa ukuba bafake isandla kwi-SIQ™ yalo naliphi na inqaku elipapashiweyo.(Ababhali abanako ukukala amanqaku abo.)
Nceda uqaphele ukuba ngokwenza oko uyavuma ukongezwa kuluhlu lwethu lokuposa lwesigidimi seendaba zenyanga.