Intensive care unit (ICU)-a damlo thawk harsatna nasa tak nei, doctor leh nursing staff-te’n uluk taka hmai hnuai lam an hawi lai i hmu tawh em? Engvangin nge hetiang hian an tih tih leh damlo tan a nuam lo ang em tih pawh i ngaihtuah tawh mai thei. Hei hi a takah chuan damlo nunna chhanhim thei tur enkawlna kawng pawimawh tak a ni. Vawiin hian he hmanraw bik, mi tam tak tana thil thar, mahse kum sawm tam tak chhung damdawi lama hman tawh hi kan sawi dawn a ni. Hei hi damdawi lamah chuan "Proning" an ti a.
Proning mai mai chu eng nge ni?
A awlsam zawngin, proning chu damlo supine (an hnungzang) chunga mu chu prone position (an pum chunga)-a chantir tihna a ni. Damdawi lam hawi chuan he mut dan hi ``Supine Position'' an ti a. ``Prone Position'' hi doctor-te chuan thawkna lama harsatna nasa tak nei damlote tanpui nan an hmang a, an taksaah oxygen tling tawk an dawng thei lo.
Hetiang method hi mechanical ventilation hmanga enkawl damlo tan hman a ni fo thin. He thumal hi COVID-19 hripui leng lai khan in lo hre tawh mai thei. Mahse thil thar a ni lo. Zirna hrang hrangah phei chuan thawkna lama natna khirh tak nei damlote tan he hmanrua hi hman hmasak a nih chuan thihna hlauhawmna nasa takin a tlahniam thei tih hmuhchhuah a ni.
He method hi eng condition chi hrang hrang atan nge hman a nih?
Proning method hi thawkna lama natna khirh tak nei, taksain oxygen a dawn tlem theihna hmuna ``Hypoxia`` state-a awmte tan hman a ni ber. Mahse, he hmanrua hi Acute Respiratory Distress Syndrome (ARDS) tih hming puin an hmang nasa ber a ni.
A awlsam zawngin, ARDS hi kan lung chhunga boruak bawm (alveoli) te tak te te chu tuiin a khat thinna a ni. Hei hian thawk a ti harsa hle. ARDS hi thawkna lama natna khirh tak tak, pneumonia leh COVID-19 te avanga harsatna lian tak a ni.
Engvangin nge i lu i herh hian oxygen level a san?
Hei hi a chhan chu a ngaihnawm khawp mai. A chhan ber chu kan taksa hi a symmetrical kim lo vang a ni. Proning hian thil pahnih a ti ber.
1. Lung a rit leh pressure tihhniam
Ngaihtuah teh, a chhan chu kan taksa hi kan rilru chhung lam aiin pawn lamah lung tissue tam zawk nei tura duan a ni. Kan hnungzang chunga kan mut hian kan thinlung leh pum chhung peng dangte rit chu kan lung chungah a tla nghal a ni. Tin, kan lung chhunga tui awmkhawm hian gravity vangin pawn lama air sacs te chu a press down bawk. Hei hian lung chhunga boruak a khat vek theihna tur hmun a tihtlem phah a ni.
Sponge rit phur ang mai a ni. I rit i lak chhuah chuan a lo hring chhuak tha hle a ni lawm ni? Chu chu hetah pawh hian a thleng mek a ni.
Mahse damlo pakhat chu hmai hnuai lam atanga kan hawitir chuan thinlung leh pum chhunga taksa peng hrang hrang rit zawng chu lung atanga hlain a rilru lam panin a kal thin. Tichuan, a hnunglam, lung tissue tam zawk chu a chhuak ta a ni. Chuvangin lung hi a zau zawk a, boruak tam zawk a la lut thei bawk.
2. Gas Exchange tha tak a ni
ARDS-ah chuan lung chhunga oxygen lut zat (ventilation) leh thisen chhunga oxygen lut zat (perfusion) te hi a inmil lo hle. Kan taksa dinhmun eng pawh ni se, lung hnunglam hian thisen a dawng tam ber a ni.
Tunah chuan en teh, damlo chu a hmai hnuai lam kan hawitir hian a sir khatah boruak tam zawk chu lung chhungah kan luh tir a ni. Kawng lehlamah chuan chu oxygen chu lung chhunga thisen tamna hmun lamah kan hruai a ni . Hei hian thawk dan a ti awlsam hle. A awlsam zawngin sawi ila, he hmanrua hian oxygen mamawh berna hmunah kan thawn thei a ni.
Engtin nge damlo chu i hmai hnuai lam i hawitir ang?
Hei hi mi pakhat emaw pahnih emaw tih theih a ni lo. Hei hi team effort ruahman fel tak a ni. Hetiang ti tur hian respiratory therapist, doctor leh nursing staff, mi 5-6 tal an thawk ho thin.
A hmasa ber chu damlo taksa nena inzawm tube leh wire zawng zawng (e.g., thawkna tube, saline tube, EKG) te chu a chhuah loh nan nghet taka dah a ni. Respiratory therapist chuan damlo kawr leh thawkna kawngkhar chu uluk takin a chelh a. Tichuan, chutih rual chuan thupek ang chiah chuan team pumpui chuan uluk takin damlo chu a sir lamah an hawitir a, pillow leh puan hmangin an herh kual a ni. Heng zawng zawng hi damlo tan harsatna a awm loh nan tih a ni.
A tlangpuiin damlo chu hetiang dinhmunah hian darkar 12 leh 18 inkar chhung an dah thin. Vawi tam tak chu session khatah darkar 16 tal hman a ni a, damlo chu a hmai hnuai lam hawiin a mu a, a hnunglam hawiin a inher a ni.
| Proning method hman thatna te | Hrilhfiahna awlsam tak |
|---|---|
| Oxygen level a sang chho zel | Thli tam zawk chu lungah a lut a, oxygen chu thisenah a lut tha zawk a ni. |
| Mucus awlsam zawka paih chhuah | Gravity hian lung chhunga mucus leh tui dang awmkhawmte chu awlsam taka a chhuah theih nan a pui thin. |
| Lung hnathawh thatna | Lung chhunga thisen kalna kawngte chu a inhawng a, chu chuan thinlung tan thisen pump a awlsam phah a ni. |
| Thihna rate tlahniam zel | Zirna hrang hrangah ARDS vei thihna rate nasa takin a tihhniam tih hmuhchhuah a ni. |
Hetiang hmanrua hian hlauhawmna a nei em?
Damdawi enkawlna dang ang bawkin, he tihnaah hian hlauhawmna engemaw zat a awm a ni. Mahse, heng thilte hi medical team tawnhriat ngah tak takte uluk taka enkawl a nih chuan heng hlauhawmnate hi tihziaawm theih a ni.
- Endotracheal tube chu accident- a lakchhuah a ni
- Venous catheter (saline ang chi) hloh:
- Thisen sang emaw thinlung chakna lama harsatna: (`Hemodynamic Instability`, `Arrhythmia`)
- Hun engemaw chen chu oxygen level tlahniam
- Thli kawng a tikhawlo
Proning method hmanga kum 5 aia tam experience nei damdawi inah chuan heng risk te hi a tlem hle.
Proning hi scientifically proven, thawkna lama harsatna nasa tak tuar mekte tan nunna chhanhim thei damdawi a ni tih hre reng ang che.
Thil engemaw takah chuan thawk lama harsatna nei lo damlote chu an doctor chuan hmai hnuai lam (`Awake Proning`) mu turin a fuih thin. Hei hian ventilator an mamawh loh phah thei a ni.
Take-Home Thuchah a ni
- Proning hi thawk lama harsatna nasa tak nei damlo chu hmai hnuai lam hawia enkawl a ni.
- Hei hian lung a pressure a tihziaawm bakah taksain oxygen tam zawk a hmuh theih nan a pui bawk.
- Hei hi ARDS (Acute Respiratory Distress Syndrome) a ni ber.Nunna chhanhimna damdawi, natna khirh tak tak, chutiang ang chite tana hman thin.
- Hei hi uluk takin an ti a, doctor trained team-in an ti a ni.
- I hmangaih tak chu damdawi inah hetiang enkawlna hi a dawng tih i hmuh chuan an dam lehna atana hmalakna pawimawh tak a ni tih hrethiam rawh. Thil ngaihtuah tur i neih chuan a enkawltu doctor nen inbia ang che.
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