Ventilator Associated Pneumonia (VAP), yemwenso imatchedwa Ventilator Acquired Pneumonia, ndi chibayo chomwe chimapanga maola 48 kapena patapita mthupi. Chibayo chomwe chimayamba m'maola 48 oyambirira a nthawi ya wodwala pa mpweya wotsegula mpweya, kapena kupezeka pamene wodwalayo anaikidwa pa mpweya, sichimatengedwa ngati mpweya wothandizidwa chifukwa chibayo chinalipo asanayambe kugwiritsa ntchito mpweya.
Kuteteza Pentiumonia Yogwirizanitsidwa ndi Ventilator
Wodwala amatha kuteteza mpweya wotenga chibayo pogwiritsa ntchito chiwopsezo chabwino chisanachitike opaleshoni. Izi zikutanthawuza kusuta fodya asanayambe opaleshoni , kusamalira nkhani iliyonse ya mano yomwe ikhoza kupezeka ndikuchita bwino ukhondo. Kawirikawiri, kuyesetsa kukhala ndi thanzi labwino kwambiri mwa kudya bwino, kuchita masewera olimbitsa thupi ndikutsatira malangizo kuti kugwiritsa ntchito mankhwala kungathandize thanzi komanso kuchepetsa mavuto pambuyo pa opaleshoni.
Mwachitsanzo, opaleshoni yokhala ndi matenda a shuga omwe amayang'ana shuga awo nthawi zonse ndipo amatenga mankhwala awo moyenera adzakhala ndi thanzi labwino kuposa munthu wodwala shuga amene amanyalanyaza shuga awo. Kukhazikitsa thanzi lanu musanachite opaleshoni kungakuthandizeni kusintha zotsatira za opaleshoni yanu, kaya chibayo chikukula kapena ayi.
Kupewa
Mzipatala zakhala ndi ma protocol kuti zisawononge anthu odwala mpweya kuti asakhale ndi chibayo.
Mukhoza kumva omvera akuyankhula za "VAP protocol" kapena "VAP bundle" zomwe zikutanthawuza kuphatikizapo kupewa mu dongosolo la chisamaliro.
Mapulogalamu amachitiranso:
- Kusamalirana pakamwa nthawi zonse: Pakatha maola awiri kapena anayi pakamwa pakakhala bwino kutsuka kuti mabakiteriya asapitirire pakamwa ndi mmero.
- Kuika bedi ndi mutu wokwera kufika madigiri 30 mpaka 45: Odwala ena, sangalole kuti izi zichitike chifukwa cha kuvulala kapena matenda, koma omwe angathe kulekerera kuti mutu wawo ukhale wochepa sungathe kukhala ndi chibayo panthawi ya mpweya.
- Kambiranani mwamsanga momwe mungathere: Njira yabwino yopezera mpweya yomwe ikugwirizanitsidwa ndi chibayo sikuti ikhale pa mpweya wabwino. Kuchotsa mpweya wabwino ndi kulola wodwala kudzipumira yekha mwamsanga ndikofunika kuti apewe.
- Gwiritsani ntchito zipangizo zotayika kapena kupatsa zipangizo kwa wodwala kuti muteteze kuipitsidwa kwapakati pakati pa odwala.
- Muzimudwalitsa nthawi zonse: Kuonetsetsa kuti wodwalayo ali woyera, komanso kusamba tsiku ndi tsiku pogwiritsa ntchito khungu zoyenera kuyeretsa mabakiteriya pa khungu kungachepetse kusamutsidwa kwa mabakiteriya pakhungu kupita pakamwa ndi m'mapapo.
- Kuyeretsa m'manja mwamphamvu kukuyenera kuchitidwa musanakhudze mpweya wotulutsa mpweya wabwino, kupereka chithandizo cham'thupi kapena kuyamwa.
Ndani ali pangozi ya chibayo chophatikizidwa ndi mpweya
Anthu omwe ali ndi matenda akuluakulu a m'mapapu, monga COPD ndi mphumu zambiri zimatha kukhala ndi mpweya wotenga chibayo. Kupezeka kwa matenda a ubongo, monga kupwetekedwa kwa mutu kapena kubwezeretsedwa kwa matenda a ubongo, kumadziwikanso ndi chiwopsezo cha chibayo.
Osuta fodya ndi odwala omwe ali ndi matenda ambiri omwe ali ndi matenda ambiri amakhala pachiopsezo chachikulu kuposa wodwalayo.
Zowopsa Zowopsa
Kutsegula kwa nthawi yaitali : Pamene wodwala amakhalabe pa mpweya wotsekemera, amakhala ndi chiopsezo cha VAP, tsiku limodzi pa mpweya wabwino kuposa 4. Odwala ali pachiopsezo chachikulu pa masiku asanu oyambirira pa mpweya wabwino.
Kuwongolera: Wodwala amatha kupuma yekha ndiyeno nkubwezeretsedwa ndi kubwezeretsedwa pa mpweya wabwino pamene sangakwanitse kukwaniritsa zosowa zawo za mpweya.
Tracheostomy: Kutseguka kwapakati pa khosi, tracheostomy imapangidwira kuti zisawonongeke minofu yovuta ya mmero pakapita nthawi yaitali pa mpweya wabwino.
Kutsegula kotereku ndidzidzidzidzidzi koyambitsa matenda chifukwa imapereka njira yina kuti mabakiteriya alowe.
Kusintha kwamasinthasintha kawirikawiri: Izi ndi pamene zida zogwirizanitsa wodwala ndi mpweya zimasinthidwa.
Kapepala koyambira kumapeto kwambiri: Phukusi lomwe limalowa mummero wa wodwalayo limakhala lofewa pang'ono kuti lisatenge mpweya. Phukusi lopanda kulowetsedwa lidzapangitsa kuti mpweya uzitha, komabe adzalola kutsekedwa pamlomo kutsegula m'mapapu, omwe ndi chiopsezo chachikulu cha chibayo.
Kuwonetsa kosaoneka bwino: Ngati wodwala sangathe kukhala ndi m'kamwa ndi mmero pakutsogolo kwa chingwe choyambira bwino chochotseramo katemera, pali mwayi wapamwamba wopita m'mapapo.
Kutulutsira odwala kunja kwa ICU: Izi zimatanthauza kutengedwa, pa kama, kuti ayesedwe kapena ndondomeko, monga CT scan.
NG yogwiritsira ntchito: A nasogastric chubu ndi chubu yomwe imalowetsedwa m'mphuno ndipo imalowa m'mimba kuti imachotse madzi ndi kuyamwa kapena kulola kuyendetsa mankhwala, madzimadzi kapena kugwiritsira ntchito tizilombo m'mimba. Nthaŵi zina chubu yowonjezera ikhoza kuikidwa mofananamo koma imadyetsedwa kwambiri mu thirakiti la GI. Mtundu woterewu umatchedwa NJ tube (naso-jejeunal tube) komanso umakhala ndi chiopsezo chachikulu cha chibayo.
Chithandizo
Ngati n'kotheka, chikhalidwe ndi chidziwitso chimapezeka kuti adziwe mabakiteriya omwe amayambitsa matenda a chibayo. Ma antibayotiki, omwe amachititsa mitundu yambiri ya mabakiteriya, amaperekedwa makamaka pamene chibayo chimapezeka. Ngati zotsatira zokhudzidwa zimasonyeza kuti maantibayotiki ena akhoza kukhala othandiza kwambiri, ma antibiotic angasinthe pambuyo pake kuti apindule.
> Chitsime:
> Zowopsa kwa ICU Pneumonia Acquired. JAMA. > ftp://72.167.42.190/cardinal/pdf/Risk_factors_for_ICU_acquired_pneumonia_VAP_Cook_JAMA_052798.pdf
> Ventilator Associated > Chibayo mu ICU. Chisamaliro Chovuta. > http://www.ccforum.com/content/18/2/208