teevramaina swaasakosha baadha syndrome yokka pathophysiology

acute respiratory distress syndrome yokka pathophysiologylo gunde vaiphalyam (cardiogenic kaani pulmonary edema) dwara vivarinchabadani oopiritittulalo dravam perukupovadam untundi. idhi saadhaaranamgaa oopiritittulaku teevramaina gaayam valla prerepinchabadutundi, dheeni phalitamgaa oopiritittulalo kesanaalikalatoe oxygen mariyu carbon dioxide vanti vaayuvula maarpidiki kaaranamayye oopiritittula suukshma gaali sanchulu varadalu vastaayi. ard laloe adanapu saadhaarana kanugonna vaatilo oopiritittula pakshika patanam (atellectasis) mariyu raktamlo takkuva sthaayi oxygen (hypoxemia) unnaayi. clinical syndrome pneumonia, isinophilic pneumonia, cryptogenic organizing pneumonia, acute fibrinus organizing pneumonia mariyu diffuse alviolar damage (dodd) vanti rogalakshana phalitaalato mudipadi untundi. veetilo, saadhaaranamgaa ardsto sambandham unna pathology dodd, idhi oopiritittula kanajaalam yokka vyaapinchina vaapu dwara vargeekarinchabadutundi. kanajaalaaniki prerepinche avamaanaaniki saadhaaranamgaa sthaanika epithelial mariyu endothelial kanaala dwara sravinche rasayana sankethaalu mariyu itara inflammatory madhyavartula prarambha vidudalaku daariteestundi.
neutrophils mariyu konni tii-lymphocytelu twaragaa errabadina oopiritittula kanajaalamloki valasapothayi mariyu drugvishayam yokka vistaranaku dohadam chestaayi. vilakshanhamaina hystological pradarsanalo alviolar godalalo vyaapinchina alviolar nashtam mariyu hyline pora erpadatam untaayi. trigger mechanisms puurtigaa ardham kaanappatikee, iteevali parisoedhanalu vaapu mariyu yaantrika ottidi yokka paatranu pariseelinchaayi.
vaapu.
sepsis valla kalige vaapu, endothelial sell disfunction, kesanaalikala nundi dravam leekejeeki kaaranamavutundi mariyu oopiritittula nundi dravam yokka paarudalanu balaheenaparustundi. eee dasalo perigina prerepita praanavaayuvu saandrata tarachugaa avasaram avutundi, mariyu roganirodhaka kanaalalo 'swaasakosha visphotanam' nuu sulabhataram cheyavachu. dviteeya dasalo, endothelial kana panicheyakapovadam valla kanaalu mariyu inflammatory exudate alvioliloki pravesistaayi. eee pulmonary edema kesanalikaloni raktaanni gaali sanchulalooni sthalam nundi vaeru chese pora yokka mandaanni penchutundi, idhi raktaanni cherukovadaniki oxygen vyaapti chendaalsina dooraanni penchutundi. idhi gyaas maarpidini balaheenaparustundi mariyu hypoxiacu daariteestundi, swaasakriyanu penchutundi mariyu chivariki oopiritittula gaali sanchula macchalanu prerepistundi.
oopiritittulalo dravam perukupovadam mariyu rakam II neumocytela dwara surfuctant utpatti taggadam valla mottam gaali sanchulu kuulipoevachchu ledhaa puurtigaa dravam nindipovacchu. eee "vayuvu nashtam" ard laloe kudi nundi edama shantku marinta dohadam chestundi. saampradaaya kudi nundi edama shunt anedi ekkuva oxygen kosam oopiritittula kesanaalikalaku prayaninchakunda gunde yokka kudi vaipu nundi edama vaipuku raktam pravahinchadaanni suuchistumdi (udhaa.zii., patent foramen ovello chuusinatlugaa). kaddiilloo, oopiritittula lopala kudi nundi edamaku oopiritittula shunting jarugutundi, endukante gunde kudi vaipu nundi kontha raktam kesanalikalaloki pravesistundi, ivi dravam mariyu kaddiila nundi sidhilaalatoe nindina debbatinna gaali sanchulatho vaayuvunu marpidi cheyalevu. alviolilo kramamga takkuva vayuvu unnanduna, alviolar kesanaalikala gundaa pravahinche raktam kramamga takkuva oxygenated avutundi, phalitamgaa oopiritittula lopala bhaareega kunchinchukupotundi. gaali sanchulu mariyu chinna vayumaargaala patanam saadhaarana vayuvu marpidi prakriyaloo jokyam chesukuntundi. 100% prerepita oxygentho yaantrika ventilation unnappatikee 60 mmhg (8 kPA) yokka oka pa thoo rogulanu chudatam saadhaaranam.
antarleena vyaadhi yokka swabhaavam mariyu itara kaarakaalanu batti vayuvu nashtam vividha namuunaalanu anusarinchavacchu. ivi saadhaaranamgaa oopiritittula diguva lobsku, vaati venuka bhagalalo pampinhee cheyabadataayi mariyu avi dadapuga prarambha vyaadhi sokina praantaaniki anugunamgaa untaayi. sepsis ledhaa gaayam-prerita dandulalo, chorabaatlu saadhaaranamgaa marinta paacheega mariyu vyaapistaayi. prushtha mariyu besal vibhagalu ellappuduu ekkuvagaa prabhaavitamavutaayi, conny pampinhee inca takkuva sajaateeyamgaa untundi. vayuvu kolpovadam valla oopiritittula yaantrika lakshanaalalo mukhyamaina maarpulu kooda sambhavistaayi, ivi yaantrikamgaa ventilated rogulalo vaapu vistarana mariyu ardsku purogati prakriyaloo praadhamikamainavi.
yaantrika ottidi.
vayuvu kolpovadam mariyu antarleena vyaadhi purogamistunna koddi, chivari alala parimaanam jeevitaaniki anukuulamgaa laeni sthaayiki perugutundi. anduvalla, swaasa (swaasakosha kandaraalu) vaari paniki maddatu ichhe baadhyata kaligina kandaraala upasamanam kosam mariyu prabhaavita vyakti yokka vayumaargaanni rakshinchadaaniki yaantrika ventilation praarambhinchabadutundi. ayithe, yaantrika ventilation anedi abhivruddhi ledhaa ards yokka adhokaranam pramaada karakamga undavacchu. endotracial intubationtho invasive ventilation nundi utpannamayye antu samasyalatho paatu, positive-presure ventilation neerugaa ards samayamlo oopiritittula yantraamgaanni maarustundi. eee paddhatulanu upayoginchinappudu, phalitamgaa barotrama dwara adhika maranaalu sambhavistaayi.
sambhavistaayi, amato "mariyu itarulu."takkuva alala parimaanaalatoe (" "v" "t) (6 ml·g−1) ventilation unna rogula phalitamlo gananeeyamaina merugudalanu choopinche oka kaagitaanni prachurinchindi". nih spaansar chesina 2000 adhyayanamlo eee phalitam nirdhaarinchabadindi. rendu adhyayanalu aneka kaaranaala valla vistrutamgaa vimarsinchabaddaayi, mariyu rachayitalu takkuva-valume ventilationtho prayogaalu chesina modativaaru kaadu, conny vaaru yaantrika ventilation mariyu ardla madhya sambandham gurinchi avagahana penchaaru.
eee rakamaina ottidi ventilator dwara utpatti cheyabadina transpulmonary pressure (gradient) ("p" l) ledhaa, daani chakriya vaividhyaala dwara vartistundani bhaavistunnaaru. takkuva "v" t thoo ventilation unna vyaktulalo pondina merugaina phalitaanni takkuva "p" l yokka prayojanakaramaina prabhaavamgaa ardham chesukovacchu.
alviolar uparitalampai "p" l nii vartimpajese vidhanam alvioli bahirgatamayye kotha ottidini nirnayistundi. ards saadhaaranamgaa gaganatalam yokka vaividhyamaina taggimpu, mariyu anduvalla adhe "v" t vadda adhika "p" l vaipu dhorani, mariyu "takkuva" vyaadhigrasta unitlapy "adhika" ottidi vaipu dhorani kaligi untundi. vyaadhi yokka vividha dasalalo alvioli yokka vaividhyata avi bahirgatamayye gurutvakarshana pravanata mariyu vaati gundaa raktam pravahinche vividha perfusion ottidi dwara marinta perugutundi.
ard laloe alvioli yokka vividha yaantrika lakshanaalanu alviolar sammati × nirodhakata yokka utpatti ayina vividha "samaya sthiraamkaalu" kaligi unnatlu ardham chesukovacchu. nemmadigaa unde alviolini peep upayoginchi "terichi unchutaaru" anie chebutaaru, idhi aadhunika ventilatorla yokka lakshanam, idhi mottam swaasakosha chakram antataa saanukuula vayumarga peedanam nirvahistundi. adhika sagatu ottidi chakram-wide vyaadhigrasta alvioli patanaanni nemmadistundi, conny dheenini "p" l/peethabhoomi peedanam loe sambandhita ettuku vyatiraekamgaa baruvu veyali. kotta ventilatory vidhanalu kuulipooyina alviolini "recruit" cheyagala saamarthyam kosam sagatu vayumarga ottidini penchadaaniki prayatnistaayi, adhe samayamlo vayuvu gala unitla tarachugaa teravadam mariyu moosiveyadam valla kalige kotha ottidini taggistaayi.
ottidi suuchika.
yaantrika ventilation anedi alvioli yokka adhika dravyolbanaanni prerepinchadam dwara mariyu/ledhaa tarachugaa teravadam mariyu moosiveyadam dwara kotha ottidini penchadam dwara ards unnavaarilo taapajanaka pratispandananu marinta digajaarchavacchu. sthiramaina-pravaaha parimaanam sahaya-niyantrana yaantrika ventilation samayamlo baseline ventilatory namuunaanu marchakunda ottidi suuchika kolustaaru. preranaatmaka pravaham yokka sthiramaina bhaganni gurtinchadam (eff) taranga roopam eee krindi shakti sameekaranamlo vayumarga peedanam (paav) taranga roopam yokka sambandhita bhaagaaniki saripotundihi
paav = a × tb + c
ikkada ottidi suuchika gunakam b vakrarekha aakaraanni vivaristundi. ottidi suuchika viluva 1 kii daggaragaa unte sthiramaina sammati, viluva 1 kante takkuvagaa unte prerana samayamlo perugutunna sammati mariyu viluva 1 kante ekkuvagaa unte taggutunna sammati. eee krindi niyamaalato ottidi suuchika dwara maarganirdesam cheyabadina vyuuhaanni roopondinchandih
ordnet protokaaltho ventilated phokal ards unna rogulalo alviolar hyperinflation anedi ottidi suuchika kolata aadhaaramgaa peep settingku saareeraka vidhanam dwara tagginchabadutundi.
purogati.
antarleena vyaadhi ledhaa haanikaramaina karakanni tholaginchakapothe, oopiritittulu ardslo vidudala chese inflammatory madhyavartula parimaanam systemic inflammatory response syndrome (crs) ledhaa oopiritittula sankramana unte sepsisku daariteeyavachchu. shock ledhaa multiple orgaon disfunction syndrome vaipu parinaamam sepsis yokka pathophysiologyki saaruupya maargaalanu anusaristundi. idhi ards yokka pradhana samasya ayina balaheenamaina oxygenationku, alaage respiratory acidosisku daariteestundi. ard laloe respiratory acidosis tarachugaa permitive hyper capnia vanti ventilation technicla valla sambhavistundi, ivi ard laloe ventilator-prerita oopiritittula gayanni parimitam cheyadaaniki prayatnistaayi. phalitamgaa teevramaina sepsis ledhaa surse yokka 'endothelial vyaadhi' oopiritittula panicheyakapovadam valla marinta digajaarutundi, idhi kanaalaku oxygen pampineeni marinta balaheenaparustundi.

