機械通氣的氣道濕化
在正常生理狀態下,吸入氣體通過上呼吸道加溫加濕作用達到BTPS狀態,即氣體溫度達到37℃, 絕對濕度44mgH2O/L,相對濕度100%。而在正壓通氣或建立人工氣道的情況下,呼吸機通過高壓或高流速輸送的氣體較為干燥,使上呼吸道生理性加溫加濕功能負擔加重,此時,使用呼吸濕化器提供足夠的濕化補償就顯得尤為必要。
上呼吸道可以提供吸入氣體75%的濕度。在進行有創機械通氣時,因人工氣道的建立,上呼吸道被旁路,不能對吸入氣體進行加溫加濕時,濕化器就需要補償丟失的這部分溫度和濕度。吸入氣體總的濕度需求是44mg/L,被旁路的75%氣道濕化功能需要濕化器進行補償,即0.75*44mg/L=33mg/L。因此,對有創通氣患者進行主動濕化達到理想BTPS狀態時,濕化器需要提供33-44mg/L 的濕度,對應的氣體溫度在34-41℃之間,相對濕度達100%來維持正常呼吸道的生理功能。
盡管呼吸濕化器可以保證Y型管處的氣體溫度達到41℃,依據ARRC指南建議Y型管處的最高氣體溫度是37℃,相對濕度是100%。ISO 組織認為:輸送的氣體溫度持續在41℃以上會對患者帶來潛在的熱損傷,并把43℃作為熱損傷的高溫報警臨界點。
在進行無創機械通氣時,盡管上呼吸道的生理濕化功能保留,由于漏氣通氣的特點,單位時間內經過連接界面處的氣流加大,使得患者上呼吸道水分丟失,導致上呼吸道濕化的負荷加重,黏膜濕度不足。此時,使用呼吸濕化器可顯著提升吸入氣體的溫度及濕度,增加患者的依從性和舒適度,從而提高無創通氣的成功率。
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