ʻO ka maʻi maʻi respiratory respiratory koʻikoʻi

ʻO ka maʻi ahulau respiratory respiratory (ARDS) kahi kūlana maʻi hoʻoweliweli ola e pale ai i ka nui o ka oxygen mai ke kiʻi ʻana i nā akemāmā a i loko o ke koko. Hiki i nā pēpē ke loaʻa i ka maʻi palaho hanu.

Hiki ke kumu ʻia ka ARDS e kekahi ʻeha kū pololei a i ʻole ʻole i ka hū. ʻO nā kumu maʻamau ka:

• ʻO ka luaʻi hanu i loko o nā māmā (makemake)
• E hoʻokomo i nā kemika
• Ke kuʻi ʻōpū
• Pulumonia
• Hoʻoweliweli Septic (maʻi i loko o ke kino)
• Trauma

Aia i ka nui o ka oxygen i loko o ke koko a i ka wā o ka hanu ʻana, ua hoʻokaʻawale ʻia ka nui o ka ARDS ma ke ʻano:

• Mild
• Kānāwai
• Kaha

Alakaʻi ʻo ARDS i ke kūkulu ʻia ʻana o ka wai i nā ʻeke lewa (alveoli). Pale kēia wai i ka lawa o ka oxygen mai ka hele ʻana i ke kahe o ke koko.

Hoʻonui ka māmā i nā māmā a paʻakikī hoʻi. Hoʻoiho kēia i ka māmā e hiki ke hoʻonui. Hiki ke haʻahaʻa haʻahaʻa ke kiʻekiʻe o ka oxygen i loko o ke koko, ʻoiai inā loaʻa i ke kanaka ka oxygen mai kahi mīkini hanu (ventilator) ma o ka hanu hanu (tube endotracheal).

Hana pinepine ʻia ʻo ARDS me ka holo pono ʻole o nā ʻōnaehana ʻē aʻe, e like me ke ake a me nā puʻupaʻa. ʻO ka puhi paka ʻana a me ka hoʻohana nui ʻana i ka waiʻona i mau kumu pilikia no kona ulu ʻana.

Hoʻolālā maʻamau nā ʻōuli ma waena o 24 a 48 mau hola o ka ʻeha a maʻi paha. ʻO ka manawa pinepine, maʻi nui ka poʻe me ARDS ʻaʻole hiki iā lākou ke hoʻopiʻi i nā ʻōuli. Hiki i nā ʻōuli ke hoʻokomo i kekahi o kēia mau mea:

• Pokole o ka hanu
• Puʻuwai wikiwiki
• Ke koko haʻahaʻa a me ka maikaʻi ʻole o ka ʻōpū
• Hanu wikiwiki

Ke hoʻolohe nei i ka umauma me kahi stethoscope (auscultation) e hōʻike ai i nā kani o ka hanu maʻamau, e like me nā māwae, a he mau hōʻailona paha ia o ka wai i nā akemāmā. ʻO ka pinepine, haʻahaʻa ke koko. ʻIke pinepine ʻia ʻo Cyanosis (ʻili polū, lehelehe, a me nā kui kuʻi ma o ka nele o ka oxygen i nā aʻa.

Hoʻohana ʻia nā hoʻokolohua e kuhikuhi ai i ka ARDS:

• Ke kinoea koko arterial
• Nā ho'āʻo koko, me CBC (helu piha ke koko) a me nā chemistries o ke koko
• Nā moʻomeheu koko a me ka mimi
• ʻO Bronchoscopy i kekahi poʻe
• Pākuʻi x-ray a i ʻole CT scan
• ʻO nā moʻomeheu Sputum a me ke kālailai
• Nā hoʻāʻo ʻana no nā maʻi hiki ʻole

Pono paha kahi echocardiogram e kāpae i ka maikaʻi ʻole o ka puʻuwai, i like ke ʻano me ARDS ma kahi umauma x-ray.

Pono e mālama pinepine ʻia ʻo ARDS i kahi keʻena mālama nui (ICU).

ʻO ka pahuhopu o ka mālama ʻana e hāʻawi i ke kākoʻo hanu a mālama i ke kumu o ARDS. Pili paha kēia i nā lāʻau e mālama ai i nā maʻi, hōʻemi i ka mumū, a hemo i ka wai mai nā akemāmā.

Hoʻohana ʻia kahi ventilator e hāʻawi i nā koina kiʻekiʻe o ka oxygen a me ke kaomi maikaʻi i nā akemāne i hōʻino ʻia. Pono pinepine ka poʻe i ka sedated me nā lāʻau. I ka wā o ka mālama ʻana, hana nā mea mālama ola i kēlā me kēia hana e pale aku i nā māmā mai nā pohō hou aʻe. Kākoʻo nui ʻia ka mālama ʻana a hiki i ka hōʻā hou ʻana o nā māmā.

I kekahi manawa, hana ʻia kahi lapaʻau i kapa ʻia ka oxygenation membrane extracorporeal (ECMO). I ka wā o ka ECMO, kānana ʻia ke koko ma o ka mīkini e hāʻawi i ka oxygen a hemo i ka carbon dioxide.

Nui nā lālā ʻohana o ka poʻe me ARDS i lalo o ke koʻikoʻi koʻikoʻi. Hiki iā lākou ke hōʻoluʻolu pinepine i kēia koʻikoʻi ma ke komo ʻana i nā pūʻulu kākoʻo kahi e māhele like ai nā lālā i nā ʻike a me nā pilikia.

Ma kahi o ka hapakolu o ka poʻe me ARDS i make i ka maʻi. ʻO ka poʻe e noho pinepine nei e hoʻi i ka hapa nui o kā lākou hana maʻamau o ka lung, akā he nui ka poʻe i mau ka ʻino mau (maʻamau maʻamau).

He nui ka poʻe i ola i ka ARDS i ka nalo ʻana o ka hoʻomanaʻo a i ʻole nā ​​pilikia maikaʻi o ke ola ma hope o ko lākou ola hou ʻana. Loaʻa kēia i ka hōʻino o ka lolo i hana ʻia inā ʻaʻole holo pono nā māmā a ʻaʻole lawa ka oxygen i ka lolo. Hiki i kekahi poʻe ke loaʻa i ke koʻikoʻi post-traumatic ma hope o ke ola ʻana iā ARDS.

ʻO nā pilikia i hopena ʻia mai ARDS a i ʻole kāna mālama ʻana me:

• Hoka o nā ʻōnaehana nui
• ʻO ka hōʻino ʻia o ka puʻu, e like me ka hāhā o ka hāhā (i kapa ʻia hoʻi ʻo pneumothorax) ma muli o ka hōʻeha mai ka mīkini hanu e pono ai e mālama i ka maʻi
• Pulmonary fibrosis (scarring of the lung)
• ʻO pneumonia e pili ana i ka Ventilator

Hana pinepine ʻia ʻo ARDS i kekahi manawa maʻi ʻē aʻe, no ka mea ua paʻa ke kanaka i ka haukapila. I kekahi mau hihia, loaʻa i kahi kanaka olakino ka maʻi puʻupuʻu nui e ʻoi aku ka maikaʻi a lilo i ARDS. Inā pilikia ʻoe i ka hanu ʻana, kāhea i kāu helu pilikia kūloko (e like me 911) a i ʻole hele i ka lumi pilikia.

ʻO ka edema pulmonary noncardiogenic; ʻO ka edema pulmonary hoʻonui-permeability; KANAKA; ʻEha pūpū nui

• ʻO ke anuanu a me ka maʻi palū - he aha e nīnau aku ai i kāu kauka - makua
• ʻO ke anuanu a me ka maʻi palū - he aha kāu e noi aku ai i kāu kauka - keiki
• Ke kuni kāu pēpē a pēpē paha

• Lungs
• ʻŌnaehana hanu

ʻO Lee WL, Slutsky AS. ʻO ka maikaʻi ʻole o ka hanu hypoxemic a me ARDS. I: Broaddus VC, Mason RJ, Ernst JD, et al, eds. ʻO Murray a me Nadel's Textbook of Respiratory Medicine. ʻElua huaʻōlelo Piladelapia, PA: Elsevier Saunders; 2016: chap 100.

Matthay MA, Ware LB. Holo hanu koʻikoʻi. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 96.

ʻO Seigel TA. Mīkini hoʻokomo ea a me ke kākoʻo ventilatory noninvasive. I: Nā paia RM, Hockberger RS, Gausche-Hill M, nā ʻaoʻao. ʻO Rosen's Emergency Medicine: Nā Manaʻo Manaʻo a me ka hana lapaʻau. 9th ed. Piladelapia, PA: Elsevier; 2018: chap 2.