I chhungte emaw, i thiante emaw zinga pakhat ICU (intensive care unit)-a a awm laiin doctor-te'n, "Damlo chu kan pronate dawn" an tih hi i hre tawh em? A nih loh leh COVID-19 hripui leng laia ‘proning’ tih thumal hman fo thin kha i hre reng mai thei. Hei hi mi tam tak tan chuan thil thar a ni thei a, mahse a takah chuan doctor-te’n thawk lama harsatna nasa tak nei damlote nunna chhanhimna atana an hman thin, hmanraw pawimawh tak leh hun rei tak atanga lo awm tawh a ni. Chuvangin, vawiinah hian a zawng zawng hi a awlsam em em a, i hriatthiam theih tur angin kan sawi dawn a ni.
A awlsam zawngin ‘Proning’ tih hi eng nge ni?
Proning hi thil awlsam tak a ni. Khum chunga supine position-a awm damlo chu prone position-a chantir a ni. Mut turin kan pum chungah kan inher ang mai a ni. Mahse hei hi kan tih mai mai a ni lo va, damdawi in pakhata medical staff ten uluk tak leh tumruh taka an tih thin a ni.
Hei hi thawk lama harsatna nasa tak nei damlote tan tih a ni fo thin , a bik takin mechanical ventilation hmangtute tan. Hei hian damlo taksaah oxygen a thlen tamna a tipung a ni.
COVID-19 hripui leng lai khan lar ni mah se, hei hi thil thar a ni lo. Doctor-te chuan kum sawm tam tak chhung chu he hmanrua hi an lo hmang tawh a ni. Research pawhin thawkna lama natna khirh tak nei damlo ventilator hmanga awmte pronation hmasa hian thihna nasa takin a tihtlem thei tih a tarlang bawk
He method hi eng damdawi lam dinhmun atan nge hman a nih?
Proning method hi taksain oxygen a hmuh tlem (hypoxia) hmuna thawkna lama natna khirh tak nei damlote tanpui nan hman a ni ber. Heng zinga a tam ber chu Acute Respiratory Distress Syndrome (ARDS) a ni.
A awlsam zawngin, ARDS chu kan lung chhunga boruak bawm te tak te, alveoli-a tui awmkhawmna a ni. Tui hip lut a, a gap te khar thei sponge angin ngaihtuah rawh. Heng air sacs te hi tuiin a khat chuan boruak hipna tur hmun a awm tawh lo. Hei hi dinhmun pawi tak a ni. ARDS hi pneumonia leh COVID-19 ang chi natna khirh tak angin a awm thei a ni.
Engvangin nge i pum i herh hian oxygenation a tha zawk?
Hei hi a pawimawh ber a ni. Engtin nge i pum chunga i inher hian oxygen level a san? Hei hi chhan lian tak pahnih a awm a. A chhan chu kan taksa hi a symmetrical loh vang a ni.
1. Lung a rit leh pressure tihhniam (Improved Ventilation) .
Kan taksa pianzia avang hian kan rilru aiin kan hnungzangah lung tissue kan nei tam zawk.Kan hnungzang chunga kan mut hian kan thinlung leh pum chhung peng dangte rit zawng chu kan lung chungah direct-in a tla a. Tin, ARDS ang dinhmunah chuan lung chhunga tui awmkhawm hian pawn lama boruak bawmte chu gravity vangin pressure a siam bawk. Hei hian lungte boruak a khat kim theihna a ti tlem a ni.
I rilruah rit tak i nei a, thawk harsa i tih angin han mitthla teh. Chutiang bawk chu i lungah pawh a thleng thin.
Amaherawhchu, damlo chu a pum (prone position)-a an han turn chuan thinlung leh taksa peng dangte rit chu lungah a tla lo va, a rilru ruh chungah a tla zawk a ni. Tin, lung chhunga tui awmte chu lung hmun te tak te, hmalam lung area-ah a khawlkhawm bawk. Hei hian hnungzang lama lung area lian tak chu a chhuah zalen a ni. Tichuan , chu hmunah chuan boruak chu a lut ṭha thei a, chu chuan lung chu a theihna sang ber thlengin a tizau thei a ni.
2. Lung chhunga gas exchange efficiency tihchangtlun
ARDS ang dinhmunah chuan lung chhunga boruak lut zat (ventilation) leh thisen chhunga oxygen lut zat (perfusion) te hi a inmil lo hle. Mi hrisel takah chuan heng thil kalphung pahnih hi a inzawm tha hle.
Kan dinhmun eng pawhah kan lung hnunglam hian hmalam aiin thisen a dawng tam zawk. Tunah chuan damlo pakhat chu an pum chungah an hawitir a nih chuan eng nge thleng tih han ngaihtuah teh.
- Point hmasa ber ang chuan pawn lam lung chamber te chu a inhawng tha hle a, boruak a khat bawk.
- Thil pahnihna chu hnungzang boruak a khatna hmun pawh hian thisen supply tha ber a nei bawk.
A awlsam zawngin, oxygen tamna hmunah chuan thisen kal pawh a tha hle. Thil mamawhna hmun dik taka thawn chhuah ang mai a ni. Hei hian thawk dan a ti awlsam hle.
| Damlo dinhmun | Lung hi engtin nge a awm? |
|---|---|
| Supine-ah a awm a | Lung leh taksa peng hrang hrang rit lutuk avangin lung hi a compress a ni. Thli hian lung hnunglam a thlen harsa hle. |
| Bawkkhup | Chu chu taksa peng hrang hrangte rit zawng chu rilru lam pan chuan a zalen ta a ni. Posterior lung chamber lian tak takte chu a inhawng tha hle a, boruak a khat bawk. |
Engtin nge damdawi inah damlo chu i `prone` thin?
Hei hi ruahmanna fel tak leh uluk taka tih a ni. Vawi khata mi pakhat i turn over mai ang a ni lo. Doctor, nurse leh thawkna lama thawktu team-te thawhhona a tel a ni. Hei hi a thleng tlangpui chu a ni:
- Pakhatnaah chuan damlo nena inzawm tube leh wire zawng zawng (entir nan, saline tube, ventilator tube, ECG wire) te chu a lo chhuak lo emaw, a inzawm loh nan emaw uluk takin an dah vek a ni.
- Respiratory therapist chuan damlo lu leh hmuiah endotracheal tube chu him takin a chelh a.
- Tichuan team dangte chuan damlo hnuaiah sheet dahin, damlo chungah pillow leh sheet dang dahin damlo chu an buatsaih thin.
- Tichuan, mi zawng zawng inzawmkhawm chuan, a rualin, signal pek angin, damlo chu khum sir khatah an hawitir a, chutah chuan a sir lehlamah an hawi leh a.
- Chutih lai chuan pipe leh wire zawng zawng chu a hmunah a awm em tih kan enfiah leh thin.
- A tawpah chuan damlo chu a pum chungah an dah vek a, a hmaa an dah tawh pillow-ah chuan nuam takin an dah a ni. Lu leh kawr atan pawh pillow dah a ni a, chu chuan hmun nuam tak a siam thei a ni.
Hei hi damdawi in hrang hrangah a inang lo deuh thei a, a chang chuan hemi atan hian hmanraw bik hman a ni bawk.
Eng chen nge hetiang hian ka dah ang?
Damlo thenkhat oxygen level chu darkar khat lek chhungin a tha chho tan thin. Mahse, dam rei tak a awm theih nân, doctor-te chuan damlo chu darkar 12 aṭanga 18 chhûng chu proning position-ah an dah ṭhîn . Damlo dinhmun a ṭhat chuan ni khatah darkar 16 tal chu hetiang dinhmunah hian an dah a, chutah chuan hun dang zawng chu supine position-ah an inthlak leh ṭhin.
Proning hian eng hlauhawmna leh hlawkna nge a neih?
Damdawi lam thil dang ang bawkin, proning hian hlauhawmna engemaw zat a keng tel a, mahse a hlawkna chuan chu hlauhawmna chu a tluk phah hle.
| Hlawkpuina | Risk a awm thei |
|---|---|
| Thisen oxygen level nasa takin a tisang. | Damlo turn laiin endotracheal tube chu accidental dislodgement a ni. |
| Lung atanga mucus ang chi secretion paih chhuah a awlsam phah. | Saline pe chhuak thei venous catheter dislodged. |
| Lung chhunga thisen kalna kawng a hawng a, thinlung hnathawh a tichak bawk. | Thisen sang emaw heartbeat lama harsatna nei. |
| Ventilator atanga rang taka lakchhuah theihna a tipung. | Thli kawng a tikhawlo. |
| ARDS na tak nei damlote thihna a tihziaawm tih finfiah a ni. | Vunah pressure sores a awm theihna. |
Heng hlauhawmnate tihtlem nan hian doctor leh nursing staff te hian ruahmanna fel tak siamin team angin an thawk ho thin. Hetiang hlauhawmna hi a hniam zawk hle a, a bik takin he thila tawnhriat nei damdawi inah chuan a hniam zawk hle.
`Awake Proning` tih hi eng nge ni?
He thu hi nang pawhin i hre tawh mai thei. Awake proning chu damlo hriatna nei, ventilator nena inzawm lo chu an pum chungah an inher tura hriattirna a ni. Hei hi natna khirh lo zawkah tih a ni a, ventilator hman ngai lohna tura tih a ni.
Mahse hei hi a pawimawh hle. Hei hi mahni chauha tih theih a ni lo. I doctor-in damlo dinhmun uluk taka a enfiah a, a rawt phawt chuan i ti tur a ni. Chuti chung pawh chuan, chu dinhmunah chuan him taka i inthlak theih dan tur chu medical staff-te chuan an pui ang che.
Damdawi in, a bik takin intensive care unit-a kan hmangaih tak, dinhmun khirh takah hmuh chu thil hlauhawm leh lungchhiatthlak tak a ni. Wire, tube leh beeping machine zawng zawng nen chuan a buaithlak thei hle. Doctor-te thil tih \henkhat chu kan hrethiam lo mai thei. Proning hi doctor-te’n damlo nunna chhanhimna atana an hmanraw pawimawh tak pakhat chauh a ni. Enkawlna zawng zawng hi 100% a hlawk vek lo nain, zirchianna atanga a lan dan chuan proning hi thawkna lama natna khirh tak nei damlote nunna chhanhimna leh an dam chakna kawng tha tak a ni.
Take-Home Thuchah a ni
- Proning chu thawkna lama natna khirh tak nei damlo chu an pum chungah an chantir a, taksaa oxygen level tihsan a ni.
- Hei hi ARDS ang chi natna khirh tak tak tan hman a ni ber a, a bik takin ventilator hmanga enkawl damlote tan hman a ni.
- Lung chunga pressure tihziaawmna leh boruak luhna hmunah thisen supply tha tak pein hna a thawk a ni.
- Proning hi damdawi inah hian trained medical team ten ruahmanna fel tak leh uluk taka an tih thin a ni.
- Risk engemaw zat awm mahse, proning hian natna khirh tak takah damlo thihna rate nasa takin a tihziaawm tih finfiah a ni.
- In lamah emaw damdawi inah emaw damdawi lam thurawn tel lovin "Awake Proning" hi tih tum ngai suh. Doctor rawn hmasa phawt ang che.
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