I-Ventilator Associated Pneumonia (VAP), eyaziwa nangokuthi i-Ventilator Acquired Pneumonia, i-pneumonia eqala amahora angu-48 noma ngaphezulu ngemva kokuba isiguli sivuliwe . I-pneumonia eqala emahoreni angu-48 esikhathi sesiguli esiveni, noma ekhona lapho isiguli sifakwe ku-ventilator, ingabhekwa njengesivini-ehambisana ngoba i-pneumonia yayivele ngaphambi kokuba i-ventilator isetshenziswe.
Ukuvimbela i-Ventilator Associated Pneumonia
Isiguli singasiza ekuvimbeleni i-ventilator ithole i-pneumonia ngokwenza ngcono impilo ngaphambi kokuhlinzwa. Lokhu kusho ukubhema ngaphambi kokuhlinzwa , ukunakekelwa kwanoma yiziphi izinkinga zamazinyo ezingase zikhona futhi zenze kahle ukuhlanzeka komlomo. Ngokuvamile, ukwenza umzamo wokuba nempilo engcono kakhulu ngokudla kahle, ukuzivocavoca nokulandela imiyalo yokusetshenziswa kwemithi kungathuthukisa impilo futhi kuvimbele ukucindezeleka ngemuva kokuhlinzwa.
Isibonelo, ukwelashwa kwesifo sikashukela ohlola ushukela wegazi njalo futhi ukuthatha imithi yabo ngendlela efanele kuyoba nempilo engcono kunesifo sikashukela esishaya ushukela wegazi. Ukwenza ngcono impilo yakho ngaphambi kokuhlinza kuzosiza kuphela ukuthuthukisa umphumela wakho wokuhlinzwa, kungakhathaliseki ukuthi i-pneumonia iqala noma cha.
Ukuvimbela
Izibhedlela ziye zakha izinhlelo zokuvimbela iziguli ezixhomeke ekuqhumeni umoya ukuba zingathuthuki i-pneumonia.
Ungase uzwe abanakekeli bekhuluma "nge-VAP protocol" noma "i-VAP bundle" okusho ukuhlanganisa ukuvimbela ohlelweni lokunakekelwa.
Amaprotheni ngokuvamile ahlanganisa:
- Ukunakekelwa komlomo njalo: Wonke amahora amabili kuya kwangu-4 umlomo kufanele uhlanzwe ngokuphelele ukuvimbela amabhaktheriya ukuba angene emlonyeni nasemphinjeni.
- Ukubeka umbhede ngekhanda eliphakanyisiwe kuya ku-30 kuya ku-45 degrees: Ezinye iziguli, angeke zibekezelele lesi sikhundla ngenxa yokulimala noma ukugula, kodwa labo abangakwazi ukubekezelela ukuthi ikhanda labo liphakeme ngeke libe nomthelela omkhulu wokuthuthukisa i-pneumonia ngenkathi ku-ventilator.
- Phuma ngokushesha ngangokunokwenzeka: Indlela engcono kakhulu yokuvimbela i-pentiumonia ehambisana ne-ventilator akumele ibe se-ventilator. Ukususa ithubhu lokuphefumula nokuvumela isiguli ukuphefumula ngokwabo ngokushesha kungukhiye wokuvimbela.
- Sebenzisa imishini elahlwe noma unikeze imishini kwisiguli ngasinye ukuvimbela ukungcola okuphakathi kwamagciwane.
- Bhalisa isiguli njalo: Ukugcina isiguli sihlanzekile, kanye nokugeza kwansuku zonke kusetshenziswa izihlanzi ezifanelekile ezikhungweni ezikwazi ukunciphisa amabhaktheriya esikhumbeni kunganciphisa ukudluliselwa kwamagciwane kusuka esikhumbeni kuya emlonyeni nasemaphapheni.
- Ukuhlanza izandla ngokucindezelayo kufanele kwenziwe ngaphambi kokuthinta ishubhu se-ventilator, ukunikeza ukunakekelwa komlomo noma ukusondeza.
Ubani Osemngciphekweni We-Pneumonia Ehlanganiswa Ne-Ventilator
Abantu abanezifo ezingapheli zamapayipi, njenge-COPD ne-asthma kungenzeka ukuthi bathuthukise umoya we-pneumonia. Ukutholakala kwengxabano yezinzwa, njengokuhlukunyezwa kwekhanda noma ukubuyisela emuva kwe-neurosurgery, kuyindawo eyaziwa engozini ye-pneumonia.
Ababhemayo kanye neziguli ezinezimo eziningi ezingapheli nazo ziyingozi kakhulu kunesiguli esivamile.
Izingozi Ezivamile Zengozi
Ukukhulumisana isikhathi eside : Uma isiguli sigcina isikhathi eside ku-ventile, kuphakama ingozi ye-VAP, usuku olulandelayo ku-ventili lungcono kunezingu-4. Iziguli zisengozini enkulu kakhulu ezinsukwini eziyisihlanu zokuqala ngeventilator.
Ukubukeka: Isiguli siphelelwe amandla ukuphefumula sodwa bese sibheka kabusha futhi sibuyiswe ku-ventilator uma singakwazi ukuhlangabezana nezidingo zabo oksijini ngokuphumelelayo.
I-tracheostomy: Ukuvula okuvuliwe okwenziwe entanyeni, i-tracheostomy yenzelwa ukuvimbela ukulimala kwamathiski amancane emqaleni ngenkathi isikhathi eside ku-ventilator.
Lokhu kuvulwa kuyingozi eyaziwayo yokutheleleka njengoba inikeza enye indlela yokuthi amabhaktheriya angene.
Izinguquko zesifunda ezivamile: Lokhu yisikhathi lapho izibhubhu ezixhuma isiguli ku-ventilator ziguqulwa.
Ukucindezela komfutho wokugcina we-cups is low kakhulu: I-tube engena emgodleni wesiguli isuke igcwele umoya ngokunciphisa ukuvimbela umoya ukuba ungadli. I-tube engaphansi kokuvuthwa izovumela umoya ukuba ugeleke, kodwa futhi uzovumela ukuthi imfihlo yomlomo ingene emaphashini, okuyinhloko enkulu engozini ye-pneumonia.
Ukunciphisa okuncane okuncane: Uma isiguli singakwazi ukuhlala endaweni yomlomo nomphimbo phambi komgudu wokugcina we-tubotracheal ukususa imfihlo, kunethuba eliphakeme lemfihlo yokungena emaphashini.
Ukuthutha kwesineke ngaphandle kwe-ICU: Lokhu kusho ukuthathwa, embhedeni, ukuhlolwa noma inqubo, njenge-CT scan.
I-tube ye-NG isendaweni: I-tube nasogastric iyishubhu efaka emphunjini futhi iphinde ibe sesiswini sokukhipha uketshezi ngokukhipha noma ukuvumela ukuphathwa kwemithi, uketshezi noma ukondla i-tube ngaphakathi esiswini. Ngezinye izikhathi ithubhu elide lingeniswa ngendlela efanayo kodwa londliwe ngokujulile kumapheshana we-GI. Lolu hlobo lwebhayisikili ngokuvamile olubizwa ngokuthi i-NJ tube (tube naso-jejeunal) nalo lize lengozi yokunyuka kwe-pneumonia.
Ukwelapha
Uma kunokwenzeka, isiko lokuhlunga nokuzwela kutholakala ukuthola amabhaktheriya abangela ukutheleleka kwe-pneumonia. Ama-antibiotic avulekile, aphatha izinhlobo ezahlukene zebhaktheriya, ngokuvamile anikelwa uma kutholakala ukuthi i-pneumonia iyatholakala. Uma imiphumela yozwela ibonisa ukuthi enye imithi elwa namagciwane ingase iphumelele kangcono, imithi elwa namagciwane ingashintshwa ngokuhamba kwesikhathi ukuze ibe nemiphumela ethuthukisiwe.
> Umthombo:
> Izingozi ze-ICU Pneumonia. I-JAMA. > ftp://72.167.42.190/cardinal/pdf/Risk_factors_for_ICU_acquired_pneumonia_VAP_Cook_JAMA_052798.pdf
> I-Ventilator Associated > I-Pneumonia e-ICU. Ukunakekelwa Okubalulekile. > http://www.ccforum.com/content/18/2/208