Ua maopopo anei iā kākou ke ʻano o ka extubation?

Ua kipa aku anei ʻoe i kekahi ma ka ʻāpana mālama koʻikoʻi (ICU)? A i ʻole ua wehewehe mai kekahi kauka iā ʻoe e pili ana i ke kaʻina hana o ka hanu ʻana i ka wā e hoʻomākaukau ana no ke ʻoki kino? ʻO kekahi o nā mea āu e lohe ai i ia mau manawa, ʻo ia ke kau nei lākou i kahi "ʻōmole hanu." No laila, e like me ke kau ʻana i kēia ʻōmole, ʻo ka wehe ʻana he hana koʻikoʻi loa ia a hoʻolālā ʻia. I ka lāʻau lapaʻau, ʻo ka wehe ʻana i kēlā ʻōmole ka mea a mākou e kapa nei he "extubation." I kēia lā, e kamaʻilio kākou e pili ana i kēia me ka maʻalahi, ma ke ʻano hiki iā ʻoe ke hoʻomaopopo.

ʻO ka mea mua, e nānā kākou he aha ka intubation?

Ma mua o ko mākou kamaʻilio ʻana e pili ana i ka extubation, e nānā pōkole kākou i ka intubation. I ka ʻōlelo maʻalahi, he mea kēia a ka hui lapaʻau e hana ai e hoʻopakele i kou ola ke pilikia ʻoe i ka hanu ʻana iā ʻoe iho no kekahi kumu. Hoʻokomo lākou i kahi paipu plastik palupalu, i kapa ʻia he endotracheal tube (ETT) , ma kou waha i loko o kou windpipe (ke ala ea nui).

E noʻonoʻo penei: ua like ko kākou mau māmā me ka ʻenekini o ke kaʻa. Pono lākou i ka ea mau (oxygen) e hana. E like me ka neʻe ʻole o ke kaʻa inā he kaʻa kaʻa, inā ua ālai ʻia kou ala ea a nāwaliwali paha kou hanu ʻana, ʻaʻole e hiki ka oxygen i kou mau māmā. I kēlā manawa, ua hoʻokomo ʻia kēia paipu, a ua hoʻopili ʻia kahi mīkini, kahi ventilator, iā ia, a ua hāʻawi ʻia iā ʻoe ka nui o ka oxygen āu e pono ai. Ua kapa ʻia kēia he intubation.

I kēia manawa, ua maopopo paha iā ʻoe ke ʻano o ka extubation . ʻO ia hoʻi, ke kaʻina hana o ka wehe pono ʻana i ka ʻōmole i kau ʻia ma hope o ka hilinaʻi ʻana o ka hui lapaʻau hiki iā ʻoe ke hanu maikaʻi iā ʻoe iho, me ke kōkua ʻole.

I nā hihia hea e hana ʻia ai ka extubation?

ʻAʻole kēia e hana i nā kānaka a pau i ka manawa like a i ʻole ma ke ʻano like. Aia ia i ke kumu i hoʻokomo ʻia ai ʻoe ma ka ʻōmole a me ke kūpaʻa o kou olakino.

Ma hope o ke ʻoki kino

Ke hana ʻia ʻoe i ke ʻoki kino nui, hoʻohiamoe loa ʻia ʻoe. Kāhea mākou ia he anesthesia laulā . Hoʻopau kēia mau lāʻau anesthetic i nā ʻiʻo e kaohi ana i kou hanu ʻana no kekahi manawa. I kēlā manawa, hoʻokomo nā kauka i kēia ʻōmole hanu e hōʻoia i ka loaʻa ʻana o ka nui kūpono o ka oxygen i loko o ke ʻoki kino.

Ma hope o ka pau ʻana o ke ʻoki kino, e wehe ke kime lapaʻau i ka ʻōmole ke pau nā hopena o ka lāʻau hoʻomake a hiki iā ʻoe ke hanu hou iā ʻoe iho. I ka hapanui o nā hihia, ua wehe ʻia ka ʻōmole i ka manawa e hoʻi hou ai ʻoe i ka ʻike. No laila, ʻaʻole paha ʻoe e hoʻomanaʻo iā ia. I kēia hihia, ua paʻa paha ka ʻōmole no ka manawa pōkole e like me hoʻokahi a ʻelua paha hola.

Ma muli o ka maʻi a i ʻole ka ulia pōpilikia

Ke hoʻokomo ʻia ke kanaka i loko o ka ʻōpū no ka mea ʻaʻole hiki iā lākou ke hanu ma muli o kahi ulia, kahi maʻi koʻikoʻi (e like me ka maʻi pneumonia), a i ʻole kekahi maʻi koʻikoʻi ʻē aʻe, ʻokoʻa iki ke kaʻina hana no ka wehe ʻana i ka ʻōpū. ʻO ka maʻamau, aia kēia kanaka i loko o ka hale mālama koʻikoʻi (ICU).

Ma mua o ka wehe ʻana i ka ʻōmole, pono nā kauka e hōʻoia hiki iā ʻoe ke hanu iā ʻoe iho. E hana lākou i kahi hoʻokolohua kūikawā no kēia. Ua kapa ʻia ʻo ia he Spontaneous Breathing Test (SBT) .

I kekahi manawa, ʻaʻole paha ʻoe e hala i kēia hoʻāʻo i ka manawa mua. Ua kapa ʻia kēia ʻo "weaning failure." He mea maʻamau kēia. Inā hana ʻia kēia, e kali ke kauka a hiki i kou maikaʻi iki ʻana a laila e hana hou i kēia hoʻāʻo i hoʻokahi a ʻelua paha lā.

He aha nā kumu nui no ka intubation?

No ka hana ʻana i kahi extubation, pono e hana mua ʻia kahi intubation. Eia kekahi mau kumu maʻamau no ia mea. E kau kākou i kēia mau mea i loko o kahi papa e like me kēia e hoʻomaopopo pono ai iā lākou.

He aha nā ʻanuʻu e pili ana i ke kaʻina hana extubation?

ʻAe, e nānā kākou pehea e wehe ai ke kauka a i ʻole ke kahu maʻi i aʻo ʻia i kēia ʻōmole. ʻAʻole kēia he mea hiki ke huki ʻia i waho i ka manawa hoʻokahi. Aia kekahi mau ʻanuʻu e hana ai.

1. Ke hoʻomākaukau ʻana i ka mea maʻi: ʻO ka mea mua, e hāpai ʻia ke poʻo o ka moena i luna. E lawe ʻia ʻoe i kahi kūlana noho. E kōkua kēia i ke kahe ʻana o ka ea i loko o nā māmā a hōʻemi i ka pilikia o nā mea e like me ke kō e komo ai i loko o nā māmā ma hope o ka wehe ʻia ʻana o ka ʻōmole.

2. Ka omo ʻana: ʻO ka mea aʻe, hoʻohana ʻia kahi mea hana kūikawā (mea omo) e wehe i nā mucus, nā lawai, a me nā mea pono ʻole ʻē aʻe mai kou waha, puʻu, a me ka paipu hanu. He mea nui loa kēia, no ka mea, inā ʻaʻole, hiki i kēia mau mea ke komo i loko o kou mau māmā ke wehe ʻia ka paipu.

3. Ke hoʻokuʻu nei i ka ʻōmole: Wehe pono ʻia ke kaula a i ʻole ka lipine e paʻa ana i ka ʻōmole i kou maka.

4. Ka hoʻokaʻawale ʻana mai ka mīkini hanu: Ua hoʻokaʻawale ʻia ka paipu mai ka mīkini hanu i hoʻopili ʻia ai.

5. Ke wehe ʻana i ka ʻōmole: ʻO kēia ka ʻāpana koʻikoʻi loa. Ke ʻōlelo aku nei ke kauka iā ʻoe e "hanu hohonu a ʻū."I kou wā e ʻū ai a i ʻole e hanu i waho, huki lākou i ka ʻōmole i waho me ka neʻe wikiwiki a mālie. Hana lākou i kēia i kou wā e ʻū ai, ka mea e wehe ai i kou mau kaula leo, e ʻae ana i ka ʻōmole e puka maʻalahi i waho. A hoʻokuke pū ka ʻū i nā mea āpau i loko o kou puʻu.

Ua ʻike anei ʻoe i ka wā e wehe ʻia ai ke ʻōmole?

He nīnau kēia a nā poʻe he nui. ʻO ka pane, i kekahi manawa ʻae, i kekahi manawa ʻaʻole.

• Ma hope o ke ʻoki kino: Wehe pinepine ʻia ka ʻōmole ma mua o kou hoʻi hou ʻana i ka ʻike, ʻoiai ʻoe e noho ana ma lalo o ka anesthesia. No laila, wehe ʻia ia ke ala ʻoe.
• Inā ʻoe i loko o ka ʻāpana mālama koʻikoʻi (ICU): E wehe ʻia ka ʻōmole i kou wā e ʻike ana, no ka mea, he mea nui iā ʻoe ke ʻike a hoʻolohe i ka mea i haʻi ʻia iā ʻoe (no ka laʻana, e ʻū i ka wā e ʻōlelo ʻia ai e "ʻū").

He aha ka mea e hana ma hope o ka extubation?

ʻAʻole manaʻo ka wehe ʻana i ka ʻōmole ua pau ka hana. He mea nui loa nā hola e hiki mai ana. E nānā pono loa ke kime lapaʻau iā ʻoe.

• Oxygen: I ka manawa pinepine, ma hope o ka wehe ʻia ʻana o ka ʻōmole, e hāʻawi ʻia ʻoe i kahi liʻiliʻi o ka oxygen ma o ka cannula nasal a i ʻole kahi pale oxygen e kōkua i kou kino e hoʻololi i ke kūlana hou.
• Nānā ʻana: Ke nānā mau ʻia nei kou pae oxygen koko (me ka pulse oximeter), ka helu o ka puʻuwai, a me ke koko.
• Kuke: Hiki ke hōʻiliʻili ka huʻa i loko o kou puʻu ma muli o ka paipu. No laila, e aʻo ʻia ʻoe e kuke pinepine e hoʻomaʻemaʻe iā ia. Inā pono, pono paha ʻoe e omo hou e hoʻomaʻemaʻe i kou puʻu.

Aia kekahi mau pilikia e hiki ke hana i ka wā o ka extubation?

E like me nā hana lapaʻau a pau, aia kekahi mau pilikia liʻiliʻi e pili ana i ka extubation. Akā e hoʻomanaʻo, ua mākaukau ka hui lapaʻau no kēia mau mea a pau.

He aha nā pōmaikaʻi o ka extubation?

• He hōʻailona o ka ho'ōla hou ʻana: ʻO ka pōmaikaʻi nui loa, hiki iā ʻoe ke hanu hou iā ʻoe iho. ʻO ia hoʻi, ke hoʻi nei kou mau māmā a me ke kino i ka maʻamau.
• Ka hiki ke ʻōlelo: ʻAʻole hiki iā ʻoe ke ʻōlelo i ka wā e kau ana ka ʻōmole. Ma hope o ka wehe ʻia ʻana, hiki iā ʻoe ke ʻōlelo hou i loko o ka manawa pōkole. ʻOiai paha e ʻeha kou puʻu i ka wā mua a e loli iki paha kou leo, e nalo aku kēia i loko o kekahi mau lā. (E nalo aku ia i loko o kekahi mau lā).
• Ka hiki ke ʻai a inu: Pēlā nō, ʻaʻole hiki iā ʻoe ke ʻai a inu paha ma ka waha i ka wā e waiho ana ka ʻōmole. Ke wehe ʻia ka ʻōmole a ua hōʻoia ʻia kou hiki ke ale (gag reflex), hiki iā ʻoe ke hoʻomaka hou i ka ʻai ʻana.
• Ke pale ʻana i nā pilikia lōʻihi: Aia kekahi mau pilikia e pili ana i ka loaʻa ʻana o kahi ʻōmole hanu no ka manawa lōʻihi (e.g., ka hana ʻole o ke kaula leo, ka maʻi pneumonia, ka tracheomalacia ). ʻO ke ʻano o ka extubation ua kaʻawale ʻoe mai kēlā mau pilikia.

Inā pono ʻoe a i ʻole kekahi o kou ʻohana e hana i kēia kaʻina hana, mai makaʻu a kānalua paha. E nīnau i kāu kauka i nā nīnau a hopohopo paha āu e loaʻa ai. E wehewehe lākou i nā mea āpau iā ʻoe.