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EFFECT OF NURSING ACTIVITIES ON OXYGEN SATURATION IN
MECHANICAL VENTILATED CHILDREN
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D
Effect of Nursing Activity on Oxygen Saturation
Thesis Title
in
Mechanical
Ventilated Children
Name
Sermsri Santati
Degree
Master of Nursing ( Pediatrics
Thesis
)
Supervisory Committee
Jariya Wittayasooporn . B.Sc. ( Nursing ) , M.S. ( Nursing
)
Aroonwan Preutthipan . M.D. , Board of Pediatrics. , Subboard in
Pediatric Pulmonology and Critical Care
t
Yuwadee Luecha. B.Sc. (Nursing
Date of . Graduation
11 March B.E.
2539 ( 1996
),
M.Ed. , Ed.D.
)
ABSTRACT
Critically
ill children
especially those
who need mechanical
ventilatory
support are most sensitive to the change of oxygenation. To determine whether common
nursing cares in the PICU could effect the oxygen status of this vulnerable group of patients,
a descriptive research was conducted concerning 4 activities ; weighing , suctioning , bed
bath and lV access or blood drawing. Patients' baseline parameters
oxygenation
I
,
muscle relaxant and or sedative drug and the duration
; age ,
patient's
of each activity
that
could predict the change in oxygenation were also evaluated, Patients were classified into 3
groups by using their oxygenation
( PaO2lFiO, ) prior the time activity were done to
grade
the severities ; normal oxygenation , moderate abnormal oxygenation and severe abnormal
oxygenation. Serial arterial orygen saturation ( SpO, ) measured by pulse oximetry ( Nellcor@
N - 200 ; Hayward
, California )were manually rEcorded every 15 sec. while those 4 activities
were routinely performing in the PICU, Ramathibodi Hospital during December 1, 1994 March 31
lt
,
1995.
Among 174 observations , we found that all activities did cause reduction
in SpOr. The patients with sEvere abnormal oxygenation as classified by PaO,
ton
I Vo demonstrated
I FiOrl
2gg
the maximum reduction in SpOr, Weighing and suctioning caused
-_:
-_..--/
il
r!
maximum reduction in SpO, ( mean SpO, reduction
=
14.52
*
Z.gS
%o
and 14.26+7.29
respectively ). Regression analysis revealed that patients' baseline oxygenation ( PaO,
/
olo
FiO2
)
and the duration of activities performed until SpO, fell to the lowest level could predict the
severity
of desaturation occurring in all activities. Age was an additional important
factor
predicting the degree of desaturation caused by weighing; the younger the patient, the lower
the SpOr,
t
These data suggest that common nursing cares in the PICU all can cause
desaturation in mechanical ventilated children. Appropriate nursing techniques and equipment
particularly for weighing and suctioning should be emphasized
of desaturation.
f,
0
to prevent detrimental effect
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2594
, e{nn't 4Qr?ruTafin
2533
,
Hodge 1991
, Tolles & Stone 1990 )
dTraiufisnatudu 1 rdu nraarurlr nral:lderufftlfiuau nr#rr5Turin
i
ri
/
e
f,
I
.
oll
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n f,
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51
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tufyFtuiltJnonRfl na0nqufin:flulilsqEJylNrJantyyluF|onl?tilnflu
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fi
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1991
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t
)
z. nradr airurda ortr}i.r rffurdo nr doeluila n (
a. n1?mnt:ldeufrrt ( Gas Exchange
)
Perf
usion
)
t
4. n13d{ai'luoonAtqu ( Oxygen Transport
) 60 n?vucunl?di.on.ur.stsror
1. n1??yll1so1n1fi ( Ventilation
a.ln1fiq'lnur?fl1n.rfi0ou
1 frnriruviantfiuurflls tdLri :-lrn nryn no nria.rtdes
unonnrlur!
unonarJFro
)
unooraileiaf.r
oufirq.rnu
To,erdq.rnr.rdoqjdcurirt:rot:loor
( dependent part ) sydnn.jrq.rnufioqjr{euuuto.l:Jarr ( non - dependent part } ttriFr't1u
d
o
|
nilnltl[U:lOn
J
--
tt
|
d
|
( intrapulmonary pressure ) flO{q.inililOFJd']Ud'l.lqyillnn0l til€.lil1q1n9lA
ra.rua.r6.rqnm.ilnndfiriarf,a:laor d'.rriulude.reo{n1?u1fl'lsrff'luriavo,F{svfin.rsEJrE,
I
d
v
rr
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frerar q.rnrufi aqjdeurirrlo.iila nsJlnn.jrdcuuu
d'ruait(
(
6r[s
a{yvGS
dependent part )
dunlesudi
fl o.rr1.rna.rfi oqi
svdn'jrr{cudu 1 tri"jTqnrnnriunvoqituvirduu6ovi'ruoufinrru
2534 : 35
,
Bulter 1992 : 99 , Chan & Jensen 1992 :449
z, nred.rilruldonl:}i.rrfiurn'oordofl1u:Jon (
Perfusion
|
t rdurdaorfid.ltrl
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te
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|
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dependent part
16
t
o
)
dependent part
) urnn."jrr{cuilu ( non-
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(
( ventilation
o
or
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t rvitlu ( Bulter
utri fi n mdt ai r u 6 o ordut:Ia
1992 : gs ,
dr{'a {uvrlaqufi?
s s v fi fi rpi n m
2534
:36
|
3. n1?unnl:ldeufrrt ( Gas Exchange ] m.rnltlsvlirnreunnt:ldeufi1t
oanfi rquernornrfi r{r(narunrdonrunyilrrorff'rtnrfuoutnoontgd'oonq1nnrvrd[doFl
oeir.rfirJrvfiyr6nrn q.rnuriuurffo.rtfriunreevulEJolnlfitmvfinrac{{tlrura'ont:laeir.r
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d'.rrluqvunulffir:londcuuuqyfinrauanuldsuffrtfioer tdo.rsrntflurlcufifi
n1?tvulflarnrnrurnn.iT finmrkrdoordru ( Ventilation inexcess of perfusion
)
unv:lan
d"Ju6i'r.r qvfi nreunnr:ldeuffT qsJrnn"j'r rdarqrnrfluu?lcrufifinrar{tairurdonil1il1n
n'j't
( perfusion inexcess of ventilation
)
dtrrnortl*a*d
t
I
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r
cvfr
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nreunn uldEluffrqlfifioen'jrq.rnur{cufi fl 6anailulJln
t
drur :
Butler 1992 : 99.
I
4, n1?d{ailuoonAtsu ( oxygen
Transport
alr
) uurefi'l gueunl?vlf1{n1El
tnrflesuutuariewo.ilnfin rir6oorfifinr,:rilr{u{uro.raant'rqu4tt:JtT.:rdatfiadru:lnret
,3.
& i
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n11rJ1rJnlruo1u,'l?n1sturrnuayfisydu16onfifinrorur{u{usatoanfireunnn'ldndutil
tiS:lOnr (Shapiro, et
1992
)
.!
qotnnlnnT
al
1979. , Epstein & Henning 1993., Sexton 1990' , Tander & Hazinski
, &
a
r
t,
-.P^^.
rr{.1ilruoanqtsulun1u :lavnaufinfl
a.r r.Eurruoanfirqudc{.l1firdordo ( oxysen delivery
il
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-
Doz
)
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:l?rrruoanBtqu
vtt
fi ulottitdu t€iedn r{uoqirYu:i?urru 6o
aonfilquluunoordootuor{
(
orfi
4udoroanernfctq
arterial oxygen
( body surface area ) rir:Jnfiilesu1tu
ltagn'J1tJtlltJflUflO.:
600
content
fin66na /
t
Torest{un'ududfiota.:irtnrfl
urfi / rt1fl.itilnr
:lnfi:l?rurru
3' 4
oonfilsufic{slfirdarfiosnrnfiun.ir:l?urruaonfiueudrqnfrosnm:lrvrurru
( Epstien 1993 : 331
)
4.2
Gurruoanfiteufittnffa.lnre
( oxygen Demand
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T
rvir
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)
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(
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r.V-!
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n
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r
"1
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t
4.3 :J?urruoonQrquddadolfr
(
oxysen consumption - Vo2 )
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urfi x
AelsJttDlfloir.levu'itnetrul{rufrusa{oonBrsu'[uunoorrdoorrrrr{unyunonrdondr
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=
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T
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s
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oondtsud{rinsvilutA'ludn:lceevavinqn eioruvirhirfinnteyndataonElqufi.luurEJfi.r
nllvfifioonfirquturdontrjrfie.iv'lo ( Brunner & Suddarth
q.l J<
unreQE i6r,lf,.l
,
e4
I v
nra't'Ft ncr il6 ru d'csa.loon?
6o
ts
1982 : 169
utuilna
n 16o
or
) arruran:leyrfiutfr
unr.l
nerrudrurr-esalaan?rqulurlaoorrfiaouorrsa.r{rJeerr6nevavinqndlfir#osdrer
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tu n r eri r.l r us a.l fi'nts
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mrda{d.rfluretsriousvfulnrfi{:JceroytilarruranrJf,ud'ntff
34
vi
I
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tt'a
,
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ritd'e duvrTasuA? 2ffi4 :87 |
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6r,rJroau'
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nelNtAaulfltfifluo{scytunleuretstfiurnt{nrcrrud'uqt
td
I
o
It
c
41
4
v
uun^.nd..sriatfirfi nnre
9/
v6t
ttl6flutnla.i'[udrunred'].i1uflo.r?vuuuqu14aurdonr s'ruevnl?rffuflo.rric'ls
O
I
d
y
rCd6l
Fr16'lUylnnuil'tytue
t
F
[qnnn{ uttJliltn0nm4usn0onqlnue [qnn6r.t
nntnnreunnrrldeufrrq
( Szaflarski & Chan 1989 : 449
)
c or4
viT
tr16onr
$nviltJnn?vvtuFl0
*
z.
druiufrrlrefifinnrErqntlnrtilon 6e{'e duvrlequfi? ( 2534 :37 |
aBurehivterufirprnrufinr:-lnfifirfludlrl,rqlro.inretfinrnmsndotoanBtsuu?anralrldeu
u:-l
nrevdu
nr'rT
ud
N
fioso{oo nfi tsu'luuno
or
tdo
or
uor'116
+
dn:*ruv6o
z.t. {:Jeefifinraevurea"ln1fifiafl ( Hypoventilation ) uilrflfi{ {rJcufifi
nrorufin:lnfidr,irtfinrcr:rrlrruranlunreurertenna{ nT eunnr:ldetufrrtlurvffuq.lnu
( atveotar gas exchange )
titoqjlurnruvirlnfi {:Jcenvuru'[s{ril?ouraln#u
1
firl?rurna
tunmurfl'lqnna{ ( tidal volume ) firtqrvur:l?rutruffrt'[utdonrsvnu'irfi rrrr:ld'uto.l
I
frltoonirsu'[uunaorrdaoruor.rdr (paor)$nvn"J1Nduff'rrnrf:.routnraonltriluuaoor
rdoordr ( paco, )
4t
rinnrlu{rJnutenrnrmvruilavrqrm lenrevuu:lavarnrosndrrurdo
nretffSuerrfiusuror
2.2 nnq6nnantunr:{ruairusorfrrtfior:lnfi ( Ditfusion defects ) lflu
nrcrrufior:lnfifirfin'dufirtnrorrda:loor lirt#finreuurd'eto.rrurftrfiurdaorluq.lnrum.lilaor
( atveolar
drlfi
- capiltary membrane t lirtr1nr#ruairuso.loon6rsuttlei.ilfiurdaorfiottfflcnreltn
rfi ornrc
ylrda.roa nB rsulds yfl ulA"tufr:jradoqjtunm v:la oru't
tuavsvuan nrrvfifirftdrrtu:loor
u ( Pu
t
o .{
O94
/6t
)
h r.J(r
.Uigtv
a
)
ul.t1flfi{flflrG
d
I
h r:i
dnllrvrvrl tlrrnoFlFl.lilCIonslnue [s ttJtJ ton']d ltttil00n{tsuslnilon tuo{q1n uJiln']t
rv:.r1floln.rnfi:larrr{rurlu dtorurfio,durfis.rurtdcuga.udorlopr
rlaprrry'lu( Atelectasis t
Diseases
l:nrintqfinreuriritfio ( Congenital
Heart
)
z.q,
rlaor ( Ventilation
trinru
rdu l?lrrudfinrrv
fiuuot'[u:loo ( consolidation t ra?ofiner6fiR11\ttu:r ra or5'd lon
( ARDS - Adult Respiratory Distress Syndrome t
I
monary Edema
( Pulmonary Fibrosis )
2,3, ,Jnslnnradnsostfiurdoordilru:lofl ( Shunt Effect
ttl
do
t
/
K
adlutot
nr
c
r
ru
fi
or
Perfusion Abnormatity
:J n fi
la.r n r mvu'r
fl o 1 n.l
Ft
un s n md.r il r u rd a nrhj ei.r
) tflunrcufior:Jnfidnur-iaafi4n tfinqrnnrtru
4arvra"irrnreryurfl a1n1 fl unynrad.r airu6a ort:}i.r:lo
4
or
dv
rd
fl{o1qsy:JFl.t ttniln1?
?vu1fla1n1ntfiofln'jrnrec{{ai''rurdanr firrfluruT nnufi.r1orfitilfinreevurflorn1fltnfl ?lflrG
cdtd4art-j-f
r{n1ilRqvt:lurluuNnlenngo.inl??yu1Elo1n1fl
( shunt Effect ) 1r?orilutl:Juvriln1??vu1Er
e
01 n1 fl il1 nn"ir nrag{.i
ilru6a
( Dead Space Ventilation )
3,
qvduuuunlrtvulgornT rt'[ur{rudnrrl
frlff
e uXenr
fr:j
v{fl 1ec{n'rv{fi
or
rictsln
e ror,{ r
vt
f,
or
fi fi
r
nr,:
ru
fi n r es ot
n
r avi
rt r us o.r n ffr rdo
a.r
ri'cls r myocardiat function ) finrcrruunndstturdotnelils{lsJltnlunrefluficrdorirudanrt:l
'l
'
& |
|
|
-o d.ls-- {- d- (. oxygen delivery ,4
) 6.$vt1
r6fl{r{cuoir{"lgo.rfl{n.lerfiorfiN:l?ultuoonfitsufr"lfiffuuilalila
tfi
rfi orayd'u
nm
ru6
ru
o
d'rsa.ioo nA rsutuunoor
160 n
rn{n na{u?a
tfi ornrevvldo.laonQ
tsutu
unoatdanLrorttfiquueln,jrrduriu ( Epstein & Hennins 1993 : 332 )
l}
4.
{:Jc erdoqjiunrn
o
i {
oe
e
"[faondrsufrqyufrrrdur.nnoqiudc
ri n q nfi .r ufis vtri fi fl EJrBs{nrvlfl r{il0 n
n'tr:r fia{ nm
virtrlfintrduduriirnruliloanAr^udaottfrdndru^,
nm6.raonBlsutilt{ tude{dsvrfinfinraran,{nlruollrlauuutritffaan?rqu{u dsriatrl
rfinrneorunrrfins{{,Jnnevnurionntnso.rnred.raanf rqul:l'[frunvGsJlruoanfirsufitdarda
t
5l ,[
Q
619 4
| 6lra
"t{
furio"turfrrrayduncril6Nd'eso.roonf reunoartufr:jcenrcrlnqn
(
Epstein
& Henning
1993
: 336
)
Ld
to:lc{duunvFufi.i
neirc"j'r {:-lcerdaqilula{flEnurnfi'd'nrnreldilso.t
nrcrruffarnrenT elfroanBlqufi.r govo lneranrvlu{rJcuinqmr,adtairdordffo.rtffrnrdo.rdcer
urerleunvfinre6e6onra?ofinmfiorrdo svfi:l?ilrruoanfilqudrdordot{ rd:.rdufu b0 G0
%o
{{n.j1:lnfi f.rt:ln'itiurl?:nruoan?rsudrdordat{fl.rfinrelfi:.rfit
ic,'
frurnr r6uunrs
ud{
6l
u
( multiple trauma ) nrnvfionrsrnnrefi
or
100
o/olu{:Jce
ldounr{:hertdtraff
I
s.
Yo
v
I
lu{:Jeurad.ralT
rdu
{:jcetuaverinqndffott{l#o{drararetqqvffcaru4zun'[rrfinrru
v 5l
I
v
.
V
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o o
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a
r
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€
4
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r
d
2'
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oonfl[qu tuunoF]tnoFtttn{nnn{u?0iln1cvTt?o{oon{tsu tuuaontnont[n.tuogne''lryilea
dtr{rn?o.rdceuretsdfi:lcgurnr.r:Jaor unvraiefiflrpilrvn.rfcls vrcnfiurfit]rgur'[ufiru
tl
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v
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t
at
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, 4VlVq.----le^9a=^
d
' Y..ulV
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nrcyndo.roonfirquunnriT
a
o
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nrerlfr
or
ffi fi qnaarunenilrnR-ilnrenneao'uncrildilFl-rfl aman?tquluunant6ao
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,
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tr
o q|tv.
d
cl
V.tl-
I
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d
c
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,ir,f,tv
nlalilnflurJlUytuou nrrf.lritarin nrenhnnvtmrtfrc n''l?EFtt6:J1rv n1?tqlvt6oor nre
e
I
tt ttii, Ct
o
a
4
9,
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n{$NU,'t{nqn?rilsy rN rFtrilunl?rfiNne1Nffo{nratfioonfi
rdu n.r..urL n1?nAnnvunr.rd'nff:Jner nr#trSt,lrin nmrildeu
rurififiaravrNdoru
et tA
rsusottfioldolnrflna.i
o cr 1,
d
4
v 9,it
a
d
rer-.-.--,-d-.-ot-.--
fir:lfruou
t'{EJ''lu1ns1riluno{Nn1ffinil?o?\nnnvuFr.rn0H:lrrEltl\otUnfluvtl{.ltuiln1ttv{tJ
A
v\
frnnaaertor{:Jctr
5l
4
-Lunredn::nflo{
d
tuad $nv
d-
nilv (Baele, et al 1982:515 )1\u?1
fisnmudv{enurn:Jfrffitr1{rJcarflu:-lrvittrn6'u tdu nrenhnrrrunrtd'c{:Jcsunvnl?o1u
vl
(
rirqyrirhldrnerru6rufieflo{oanAtsutuunoBrrn'arrrir
t,
|
5
|
6l
6l
mixed venous blood
oxygen
t
1 unyrfluntannn.rodrtacort6ctu:l?trrufirurn
d.lnntnnranorn.l
J
& Jao
,
a
,e'
d
I
6Q' a
r.d
61il1?nSyA6il1fl [nS1niln1f ty{t,tn1t t{oonq tsu?lo{nnleJtuoililnsn?e8J f,.itotldFluunv
saturation ) nnn{ tnr:-ioe
Huf,.i ( Epstein &
I
Hennins 1993 :
ggr t lfioGure1fid'nrsudu'i. n.tdfifi^ntelrsvdrlfi
& -Ya c, i
3 J ,
,
I
r 4
IUOtflAn1.i 'l flA.i?'l.ln'lEltlt'|iln1?trJ''lrJA1fu011l1?il1n1U tl.lUUS{nO{tyliln1? LlrntQflUil0.l
i I ora
4 t
&
,
&
I o
a
oh
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$nvc{.$
rd?il'lrlfinre6.r roloonArquslnrdon roru.nndutrirfis{v{ariuFre''rNffo{n1?fla.r
dtd
tuo[Elo
d.rfi
nT
erjevrurruriu.ir'lufl ruvdfi nlroon rird'r'[unu:l
n fi
svfi nrerfi runre'[{
urfi unv:l?il1rurdoo,dt:lldernffrrurdo
fievrfiildufis zs rvir qrn 3,6 AA / too niru / urfi rflu go dd I roo nir I urfi do#o
lflu
oonArsuslnrfi:J 2bo dd I urfi
sooo dd
I
rad.rto.r:-lBr.nrurdaorfirfi:rqnrirt:.Jti'tun1?uJ'rrJalruolrrlrnlalurdardo dtaiutuff:Jner
q1y'ln1s{fiunv
lnmu ( Szaflaski
& cohen 1989 : Mg
-
450 ) nriT
c"jr {:Jcufifinurinnrn
u
tu:Jo or {rJ c ud fi o. o ro da.ro o n? rs
rff:le wri fi rhlud a.r ffor u6o {:J e r fi fi aR 1 e yn f .i?y:r u
r
d
I
a
e,,n uv A
d s.
h, J
,J
uquteEJutnun $.lFr.lvt nlftuaguvrl0lqqyiltJnnoRlevoonqtqugo.tflueg [n tua.iqlnnl?
t
rnrdoutr,lcraSonrer:Jdeuvirsyriotfirfinnrnr:itl.is{ruqnririuavu.irrdrrdeunl??yu'rso1n1rl
v
gt 4
J,
ll re
,
rTudut6oorfrilrul:Jtitq{nruso.t:lon ( ventilation
/ perfusion imbalance
)
I
fi.1
trurmylqu
+
tfltl ( chan & Jensen
: a+g t fi'[#ruqtJnn?{fiuunvrdrurfiu.jT nrauldeuvirsvfirJn
1992
(
lnrsna{tioncrilfrunrfltu:Jonr
t
intrapulmonary pressure
d{svd{runnevnurianrcy
oanfirsusa{dr{nrs run..ndnT ar:JdErurf,offrunvnraorurh{rJcaeftorsriatfilfinRlev
unr?ansrnnmrutfiu ( cotd stress t drtris{QunreuqilqcuuqfisasdrrnrErfinra:lfuc{nrfllore
n.rdun.arrJ1,.ln1rUo1r.*uod.d,
drd o
Y
-
J
v
",
Fl.tuutgans{s1t:JuvtsvFto.t
rfiotrlrfirrnrerruSounnunun'crruffoudqrprdat:J
qv
a
I
X
lfloon{tsutT{ilil1nflu
a
r
e e a
!,
rro
[tlJtngenilnunqn??ilvlno [utn0l
nerrut6u:lnnr rdu nranacsul.ror.il{ n1?rs1v160a firiahlrfiornrerrufio.rnrat{oonArsu
urodrtdrudrudurdurdflefi'u
+
1orfluarlrvtufrrlcardnfi'.rqvffo.rduqrnnrcrru16uilenunv
oiaffrunranms launtnd unv nruv ( Hensley , et al 6rt1il
-
4bo
I
& Cohen 1989 : 449
Szaflaski
v{u"iln0rrudr.rficgoraanfirqutuunanrdonuoxd.r{prlorenretfrnd'noon?firnaf
(.pulse oximeter ) 61sJ1?nnnn.rtddrn'jr
ua vtr{ n r e n c u1:Jt fr fi c ra ri.rTpr
d
taiu
flfls1n zo
soz" tu{:J,)EJ 12
ererfitffSunmair
etil 16"[fi s r n n u
fi s n eeru fi fi
n oio n r
ar
etffo
o
nfi
rs uTn
er
a{
n
rd
u
n
r
nl
n
or
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T
oo n n n
ca
iroJr4
tnrTo.rd,rErlr"re"[stfror,iueru6aqormuuy uonq''lnsylflunrenornrclutffri{ugo.raonBrqu'[u
6t
-
v n
v
I o
|
f,
ailurelst{rto.r{:Jcruficludn.rfiqorrc{r.Juyfifi.ruflunra6.rrolo1n1filu:looroanilrdndce
f,3
firnreqotmruuyfi
srnnmfinrnsio.luunrtilg''lxl ( McMichan , 1984 ) y{u.jlsyd"lruranrirtrX
-lv
( mixed venous blood oxygen saturation
rvffunrmudrufftgotoanfitquluuaaorrdonrdr
t
nnn{q1n
7lo/o nst:JdT4ortfifu:lavrurru
4Oo/o
)
d$iu.jrriauffr.$Nlnunvrfludunytsl
runor.lfi.r'irfinrrtffoon?tquluevd'udq.rurinre qur{taonBrsutfiurirdarfiarir.lltrirfiflsila
lun
da
T .r
, 3
vr.l n
fi
l' r
n
r e rfi
ru
n
r atu n n^fl u? os
I dea
rn^
o n ua
I
yn
1 ? [rJ 1,J
n'r rus oo,du
tts'
a
rd
d uu. n
a
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T-
:JeerrA'e.ition''l?nnn{qo.revdunrcrrudr.rd'cto.roonfilqutuuaon16onttn{oqjuffc udofinra
rdilnersJffornre'lffoonfirqwa{rdordosT
j
td
,
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A tr
onr
tl,totgo
f,
d
e fr s v fr n
lr r
d
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t
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u "i r t n r
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r
1
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ufi
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trirTu
'
no tutnnnletrl6flurt:la.ravd'unr'nsJ6ild"r?o.roonBrsu'[uunonrdonun{quritl#
tfinrnrcvndataonBtsuluuaoorrdooruorrtfr u6ourn{:jceril'nrcvfldo.roqjrdcfinrillensy
*
c oed
&
t14 uo 1 n']?quu?.i il1 nfl
vt1
il
tc
I r
A v
-..f__e__d--Ca!
ilq q-e d u fr il fl n n es il u ei o nir n m u 6 ru frr s o
m
o n ? r q u"[ u un o
or r 6
oou
et
s
a1aq
tIn{enr.r 6r uorq arqqvlil
unontdanun.ltunT
cv:lnfi
uoiurntfiornT
fi
r,r
nlorEJ
na{ liu nir no r u6
ru
dcso.roo nfi rqutu
cvinqnr{utlJ.irqrnaruaElorfintrnynu.ir
trinrruren:liud'ctffdrvirflr,lqjrdorfinrnroyfiecfiu ( Hazinski i992 :1
rdn
| '[unmynresror
aanEtsu tAnsvtfinnrcvvtdotoanfitqutuunaprrdonuor.rtfrquur.ln'j,r nraquninmniou
{r.l dr ur
n
u. n^.
ndrio doblrfi
n
ncr
e.r
fi eurstfi ri'uo{ee vdr drglfir.n
uranuentfior dnrrnonrioufiruunr rmvdntdn (
Mackenzie , et al 1989 :
lnrfl
178
fiayuudrdac{artrar!
z
)
Cordero and
n
Tnrs
rqnr y'ludn
Hon 1971 cited
in
rduo^lnrdnrdnqyfinflrinsrumnoirtqrndnTrruiaff[urg
eyuunr'a
rvuuursts tunrenuenrfiorunvtudnrdn
rffolfiprnrcyoonireuann.r
risarfionT fuouloroanlqrflr,dr.r4tdu ir.rnrElso.irdnsyy{ererilrolsfllnflnrerdar:J?rurru
so.lnrut{roanurinvnF.l ( tidal volume )
urud.rrrfltsl6cdu
[nyil?,]{onfisyfi6ilGy,{na
clrsrurnriorundlrf,irnv:lrvfrnBnrn'[un1ru1e'[qlffraonuoinsnri.r rroirdo.rsrna?mornar.r
andumnrir.rnrnfflraqj 6.rrirtrinrar,lre'[srdorfiil:lBurrunerd,roon'[uuoinynrFt
vplume
)
udorfio'nravnmur€Jleqnnortdtridrvirr6nln
ney:irnruunvdTnre.rqn,irflorsruy
rarfltetfr1 virtrnTqufi:Janqv?grflfi0sufi.idTn,r.td4o,firatruvurfllsffi1
fiofln'irlutdnlnrrnrfflrarLj
nrcrruaooruqju ( compliant )
dr
( tidal
( apposition zone
)
uun^.nddTnrr.runyarftil?c{onso.rnranuayrdnrdnqyfi
r,ir'lrinradnffetfrrunvoofl ( outward and inward recoit
)
tffr3oe d.ln.r^r^mrunrrumntunrednrd',rr{1uund svdrlfiil?u.*ruo^uduan'ooqjtu
dannrelud{s1nn''lfl,t1eltqoonufiild ( Functionat Residual Capacity - FRc t riaern'jrtu
fftrtu
s{eudlna.isvFe{d'etuuueuouillndr'[findrrurdadoqjtuana,j,r.rdTnrr.r
( intercostar
)
trirtrmansvn'{lfi:looresred'ctfiurnrvirdprna 6.rr,irtfirfluffo.{rrTn'[un,r*dru
.-4--<q-.r---- (
d ^' F
v^
,
'
tuoytludoran
thoracic cross - sectional area ) rfrolfrr.r:l?r.nrun:.rtfrr'[urrrinyrrf.ltfi
muscle
( Hershenson 1992
i
I
1992: go )
:28 - 4G t
dt ur.rnd'lcd uny nilv
( Maxwelt , et al cited in Hershenson
vru'ir rflofitudo.rrroornd.r,fi'udur.ur.q r{cu lsoedraudu uay nily
( Hershenson 1992 ; 30 ) ttnv lolriuta{ unynruy ( openshaw , et al cited in Hershenson
to
t
:
1gs2
(
60
) lru"ir
nTar:Jdfluuil^or,rodl^rod.rul.u.rorirtrirdnra,
t rvirfflr,lr$rdaarq:Jevrurru 2
tidal volume
Zinman cited in Hershenson 1gg2 |
nrire.ir
fl
alqlfr:Gilrrunil
rYnrfisf Ltay ?uuruu ( Gauttier &
nrcrruut{.rua.rso.rnfrrelrdalunrauret'[sqyrdil
#r^ii6ft^aruri'url?rrruru,rnelo.rndrsJdrfirdudurdan{nT eTndu unyney:i.rnruqyyirtru
I g (Watchoko,
et al cited in Hershenson 1992 )
ras. if,
[FttFt:Jytt]Joo'lqt113J?u
avuurl'otq
I
uof.rnel'O rury ruru
*
(
rm vu na
or
ldo
nr fft
n
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t'
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fiqnerru
a-nfl n1?a on{rfl alt Fi1 n'11 Nd u DYrqasao n?tq ulurana
fu
run
n
tda
rir{sa{ rirnmru6rud'cto.loon? lquturanarudr r urod^
ro^.d oi.^orilrdufrcarotoonfi tsu'[uunoor tdo n un.ln nn{sufi
t
nlosaanirqu
o o nQ rq
(
t
oxygenation
us or {rJ o a ri o ud
n
r fdr.nJfr
ffi
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fi q n eeil il e r u r
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-v
ffu { rio, )lusruvriu rniuflu
-
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{rJceddfi'd'nrT
dcusotnir
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tfifu t rio, )turruniu
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fu ( Fio, )lusruvfiu
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or
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a
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ayu"jrsnreqn rdNuvunrufrtnraqor rdruuvrdSs :lrvnouficfl
fi snaailEiasJ6o
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rfi
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rio flu navua
nrmqrvrdonlorfll{ril nfi nnmri'n
o
i
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qgr?
4
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aur rdu16o or
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n
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a
( syri n ge
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'l
und
2
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r rQ {EJ n F.i d lfl u
n
n
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n
r*r n r a ul d fl u utl n r av d'u
nc
r ud
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d'ce o{ a o
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-
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or
rror.r
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- nrarJfr ffi fi s narilnerrur nf iT rfl utunreq un {:.lce rd nfi ffo{tr{ rerdo{dce
1r'rEJ
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-
nr.Jril dufiuf,avra'jT
r
orq fiu nrer:ldsuu:l
n.r ri
r nrcr rud ru firflo.roo nQ rqu
o4
tuunontnonttn.i
-
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ll
rrjdsuu:la.:
nir nreru6:r d'cfl o.roonA
-
t
n.r1
rsu'[uuno
or
rdo n Lrrr.r
nmrlayffi urrleyaanA rautudl.inla
n
r a:l ey ffi un r c yvr dar o o nB rs
dv
ila N or2somo nitq ulurano
t
o
uln fl tfr',{'n aao n? fi rn o
f
rda n uors
ut uu n a or ud o or upr r rfl ufl n d'a fi d r d'rg fl s {fl u fi r fi
6r - ,3a
a
,
-j
( oxygenation ifi{1frfl'rfforffunrasud.raonfi
rflufrc:J.rdfr{nlevoon8lsuqosdl{n1tJ
rsu
nr
c
r
d
r.r
d'c
eJ
o
{ o o n A ra
)
( oxysen transport )
qrnoonfitqudrare'[sr{Tl:Imvrirl:J{rrnrir.rl rdorirt:J1fftuq].r?un1?
Lrrlrrnlru Toraaonfirsudsurfut:1l#lrnur.rnaa,aldomlusyriluliltA'lu
t, nznruoqjtunnrnrur
oxysen
I
( ptama t
tfioqj,irucurdnrioervir irurson
qruraqfi
ovvJ
37
c ( Klaus & Fanaroff
1986
z d'n:sruy6o
6en.ir ddTn,rfoonfirqu ( dissotved
t6o fioonfirsil 0,3 un. tuvrnre{eJ1
: 172 I
100
u^, d
ri'{firfi0{srnn0''rrJ6''lrulrnlunraaynrs
so{oonAtqutu16onfinirfiofl ilBmil?a{oanAroufioqj'lug:litarnranynlslu nnrarur6.l
t
hrdtvl
u^trq-
o.lfl .in1g
1rl tlIa{110FI0 ac13J Fl0{n1ffl
3yFtU00nq tquvlnvalfl 0fJ
:layffiuoonr.rTtug:Jro.lnirnr"Jrilduso{oonAlsuluunaott6on$n{
tul\n1nil1n1il1?n
( Pao2 t
fiuriefltflu
NrJ.rhovr
2. aqjacrufi'udTrulnnfiu ( hemostobin ) tunlerrdooruoxlug:Jso.loan8filru
lnnfiu ( oxyhemoglobin ) firfi,irucururnfi.r 95 61il1?n{Uoon?rqulfr 1,34 iln. fiqruraqfi 37"C
t
:
Klausand Fanaroff '1986
172
|
(
97o/o Torer:lnfi
dlr.rlnnflu 1 nftl
Hoffman and Manzetti 1gg2
: 33
,
xviluoonfirqudru.rriudtr.rTnnfiudntnan:levffiuaonlr
t6'lugr.Jaorrirnmru6ru6'cso{oanArsuluunonr60nun{(sao2tdtrfludorr{cuso.l
oonfi rqufi fiTrulnnfi u{utfis?{
Fio
nelilqoo
nA
tsugo.ldlr.rTnnfi
lnnfiunuren{u1fi1firufi t fiilri'rsrflur:lofnupi'(
u
il?rurruoonfirqufiEXu
Hoffman and Manzetti 1992 :441
I
uta
rdnulfi'ir
.
RirncrruGurTemmonBrqulurdonunr
ve
i
nir
o
rrcu
(7o)
= rjfurruaonfrrquddhrlnafiu{uldi?.r x too
nruloonB tnuto.rdlruXnnfi u
d'uilayFi''l ne''rrJ6ru d'eraroanB
lsutuunan
t6o n Ln{fi nrcrrudrur{u:i'
d
nuLotErsJou,rtJltflautflunarrlsvfinerrud:c{ufriu ( oxyhemoglobin dissociation curve ) d'.1
n1v{fi
2
I
7o SaO"
100
Pao, (nmHs)
'15
{n
25
PO2 (mmHg)
a
4'r il
.l
yltJ'l
d
2
:
nfl
?'{
u6 n.i Frcr il ffr.n{urf'qataa nfi dTruTn nfi
Fazan 1985 :36
ntunrc y:l nfi
n
t
q1nnfl$lit6{Fr.ine"rilfrNrfuf,qro.rnirnrcrrud'uunynirnr']rildud'csroroonfirqu
614drltvatf,hrrl
luunon[nonuot.i svn ueltSJoFtlFt']lNFlljoonfrrqur:ldeulilnirnrcrru6ud'c1o{oonalqutu
4
t.{
ll
lli tgt
|
tv
t.J
|
|
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r
oz
I
4J
I
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e
I
acu[Ft.it?tJtv{tJflnvxiafl'lud?.iGilffuga.lr{,]uTfi.luaytfiruurntudmnnl.0unyann.isutfioil
vru'[unoufira r{culfufiniou{rtyrusJ1n60 dc.rdnirnrcreJd'uoonBrsuturanon60nun.r
aqjevr,a"jrt
60-100 rJil,:lroyr dcrddre,rrru6rud'rso.roonBusutuunanrdanun.llr-ldflu
rAd?tr'l
$Un{til€l.ilanuoElryr']riu 6os"ln eg fi.i 97.5o/o lFanan 1985 :gO t c{cu1fi{s{']ufi{u 6o
'
v
4
3i
, d,
a
o
,
^
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|}
nc1il d'uoanf rqu'[ur,rno
n rdonLror{
urlderutil rfifl{
oon8tsur:Jdeuuiln{hlilln ( Kersten 1989 : 47
)
rdnfioesvdrtfidrncrudufiosa.r
rdo{srnrirnelilfiuLtnyni, nr.Jrildild'n
v
fl
o.iaonA tsutuuno
-
n18J',]?n
o9z r
I
n
6o
n
vv6lqv
un{fi n1?r:ldeuu:Jn.i nrLrrTuff rfl rir n{d
q
r
61
4
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Ft.tuutuusqilu
<' - o
T.tQn
i
v
I
i
v
tnEltft?a{lFlft'tFt,t'tila:Jne
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Itieq
aiU
,s,
4
tr i
m runsilvr lil no{n1?rq1v[no n ry:.JeEJ
f Iq q-e d fi 6
il6 n a oi a ri r n cr ru 6 ru qr r s o {ra o n a r q ul
fi fl s
{g u n r e o ei T r fi d rhi
ne
u
ra
na
l :J 6 1 r.r''r an tu
n
or r d
a
or
u
or
s
r e{u r{ue vra,j
oonfitqut:ldflulild.idr'[rinmv,lunpr{nelildsJfiuf,toroonfidlr.rlnnfru
l
dissociation curve
) m6outrlnr.r{uu?oscrernffiuilnfi
a
d
i.l , | &
6
oo
0ondtsuluuaontdonun{fiNri"llfi"tr1:l
n{ tsu tiluao n lno n un{ilN Ft"l [yt"t n:l
rdooruorrileyru.lru 27 NN,:Jaoyr r
T .r
(
dTru Tn n
fi u
riu
oxyhemogtobin
ddnfilfinirnrcrru6'rufrora.r
q vtff nir prcr u d'uao nB tsuluuno
50 7o ( P5g ) sv-[nri"lne']:Jdu01
nr
ffioqruuqfi 32"q. pH7.4l rflufr'rfrnfiu
fls{erfi fi 6ilGnntrinmv{
Lrc{
Fr.iFrclNdrJfiufsaraanfi dlruTnafi urndautrlfi
,4
d'.rfr lKersten 1989:146-149, r1n6 4cea[ujvrv,2534:39
'
I
1, nrare,doul:Jm1.ise1 ( Right shift
)
) n.r,^duuoorne'rdt:lvr1{se1Lr6n.l
fi.rnr,rrualNrentunre{ufrisoroonQrsuuayATNtnnfiunnn.i dtfi:ieytfltrilude.ifi
dTLrTnnflusv:laiosaon?rqutfirYuldaufia fls4'flfidrtfin?''ryl16Fr.iFrnrruffr.n{ufta{aan
adooadttl
qlg HJ tnnuutnnoiltuynssr'rr
tfiuri
28
a
A
I
dutt
t. n1f tv'l3Jn1ttr,l1 r,,ln1fu011r1? tfl U tJ tll
4
2.
R1e
3, Rrcr
yn
ru
1?
ct'4.{dr:g
t:l un ?n n f .ill o.i tn 0 n 3J n e 1 il tuun f n tTl ull
ffusa.r ffrq nrrfiautproo ntt rilulda
a. :l?rurru z,g-tnr'loc{tdn3lqaftan (
rdr.r{u ldu'[unT"rvndasaonfirqu dor svfi
z. n.r,^drut:lvrr{{Te
2,3 -
dfi6
nr
(
u
Paco2
1
4odu
2,3-Diphosphoglycerate 2,3-DPG
rfiru{u
( Left shift ) nralnrdomo.rna-rv,ltrlnr.rfrre Lldn.r
firncrruarmanlunre{ud'ciro{oonElsuuavdT:rtnnfiulfidfi.rdudtfirlevTetflunrasud.t
D
oonQrsulunranraonQrqut:}irrdordodeurit 1 uritunT .rma.r{ruffrrflud'J{fio{:l6iae
oonErsul#rTurdordos{n'rnydsyvi'rtrldtrulnnfiu:lcianaonfirqutrirdordatfrfiaen{virtfi
,dcd.o. r.onfi lqu16 fleteddrhlnery,l uM{ n{ nmr.rdr.n{uf,ro.raanQdlruTnafi urnrdoul:l
{re tffuri
t. o..rdfin''n[eJ1rJa1ruo11i1?nnn{tdunrerqruraqfidr ( Hypothermia
)
z. nrnvrflurir.r
3.
,
s.
ncru duto.r frrq nrrfuouloroo ntg ri'lulda n ( P aco2
dXrilnnfiuno.rd'ceiou ( Fetat hemoglobin
2,3 -
dfi6
1
h
rld.i
)
nnra.r
o. flrtnn$uourJouuonttri' t carbon monoxide - co )torefiffrtnr$uau
rlouuontqoinrmen{ud'criudlrutnnfiulfirurnn'iroanfirsu
$
fidlr.rlnnflu ( carboxyhemogtobin : Hbco
fioen{
nerv,lfi
t
zt
o ryir nnrEJrflunrfuan
virtrffdTrulnafiu:laiotraanirsut#rdardolfi
qvunrdaufit:lvn{{re
4o SaO,
100
PaO, (nunHC)
75
-iremp
DPG
+
50
PCO2I PH+
25
Po2
a
(mHC)
d^rvvrado<rai,oihrv
n1ilvr
3
nfl?{$dn.iFtelildrjv\tu61l0{oonfl8lil[nnuuil!nFr n1?tnnou[:Jyt1.t{1Ei$ny
fle,ls1nn1?dfirl.d'uoil.r 1 nJdeuu:Jn.:t:l ( Hoffman and Manzetri
1gg2 :
M2,
I
29
tl
qv^O49te4ott44
l
uonq1nnc1iloilr|0flo.300nttsil [uunontnonLtn{une fl{ililsqflouan
q v Ae
v
d !
tt'
i
q
v
,
ot-y-----,r
i
&v-. ^
unletfls{sfizirdrgunvildcurilso{o{flun"reyaonatqu$a.idr.rnrflEs:Js{fllu6iril6nuil
dcuffi.ndurf'riu ilevnou fi're
t,
:l?rurrutdoorfi6udoroons''rnfi'ctqtu
z.
evd'udtuTnafi uturdonr
3,
t urfi
ncrrud'ugasaan?tsu'[uunaorldonrur].t
(
t cardiac output
partial pressure
)
of
arterial
oxygen - PaO2 l
t
4, :l?rurruoon?rqufildardel{
d.r ri r :l n fi g o.r uri n
( 0xysen consumption
vfls {rJ un ort16"[un. t.'o d t
ilssfl
nir:lnF
)
( oxysen consumption )
ne1il61ru1?ntunratuc(.loon8rsu ( oxygen transport
600 -
:Grurruoon8reufildordol{
3
:l?mru6oorfiqudoroanqrnfc'[stu
t urfi
(cardiac output
dhrlnnfiu
( oxygen saturation - SaO2
looo dd I urfi
- 4AAl urfi / fiTanffr.r
) 4- 8 6ne/urfi
12 -10 n5ru / lafihme
nrcrrudrufr'rso.:aanfilquluunonr6oRrunrr
t
)
> 0,90
)
nrcrild'uso.roonQlqutuunonrdonun{
( partial pressure of aterial oxygen - PaO2
oo -
100 uru.rleavr
|
-trra*-dare
nrmsfi
1 udn.idllnnqo{usqflils.rilnoion1,rvoanAtsuflo.rfl{n1€r
a
dnr :
Ahrens 1993 :
ur ns vrdsua
ru
193.
nraq vtff d'.rd
nrerur{soon6rqu
=
il?rurrurdonrdqudn
oonq, nfi'ctqlu
t urfi
x
drucuso.roonfrrquxl0
( orygen content
)
30
t
,irucuqo.roo
'
nE
tqulunev
,iru.Juso.losnBrqu
=
un
6o
ultAer
n g{il
n''la
Btr.rTnafiu x 1.34 x nretrd'rud'rqrotoon8tquluranan16oorttors
(
d.rni,r r,s+
ot ( oxygen content )
0.003
x
ncrrud'ugosaanfr tquluunoortdonsor.:
qv
)
6odr6rlndoonQreunvqn{ulortrdtrrlnnfiu uavnir 0,003 6odrfil{:levrfiu
(
'ilaan?rsu6lrJlrn$ud.ltdr.nnrvirtorfine''lild'uoonfitqu?fuvtiu
I
*
rfi
ulfi.jr
n'''rd dordus ytdiuoo nE rsurfi
Ahrens 1993
e{v,rau?otri ilrvn
:
194
r e uann vduaqi
)
riu
FrclrJ6''rrJ1?nsosrintsfinv4udnrrdonuny,irucuoonfirsufifioqjturdoorrrort dturnGrurru
z{
i
d
vet h ra{
,J
|
,
c
6l
,
&
tq
y
9
'
lraqjfiqvfiutTu,iruru
rdoorfi4udorqrnrintqlrJilnrarildeuu:ln.:nrsdtairuaon?tnudru
a a nQ
lqulu
16o n d fi o qltu rd a
or
ay d'udTruTn n fi u un y n c
r ilrd il d'cir a{ oa nfi tq utuu
ao
nr
t6 o
or
;a.rsyrflufln{afidr d'rgfisvfi zunFiadruouoanB rsuturdoprrurnn"irrirn,rrud'uso.r
aonBrsutuunonrrdanuflt ( Ahrens 1993 : 194
)
d'.rnreTsd
z
unor.ltrirfiu'ir n.lenn
n.rrasd1allnnfiuunynrcrudrud'csrosoonQrqu'[uunontdonunrtqvfizunriodrucuoan?tqu
( oxygen content ) rurnn.jrnr?ana.$flo.iFlcrrud'ugo.loonfitqu'[uuaant6ofrLtor.i
of
Effect
PO2 ( mmHg
t
*
a
PO2 , Hb, and SaO2
r
d
2
un
H6 1g7o
)
SaO2 ( 7o )
CaO2 | Vol 7o )
100
15
98
20.0
75
15
94
19.3
50
15
84
17.0
100
10
98
13.4
100
5
98
6.9
A decrease in Hb
orT aT
,
on 02 Content t CaOZ t *-
has a oreater
effect on 02 content than a decrease in
ortlfi rfi uncu frifiufso.r ncr
u
PO2
d'uso{oo nA [quluuao
or
rdo n $n\:
dtulnnfiu u r^..udufioro.raonfiuquluunanrdanuo,.rdfioianirucuaanQrsuturdoFl
d
vl
lJ1 :
Kacmarek 1992 : 107:
31
t
nrerJfr u?fi qnr?ililenuT add'rrfl ulunrag un {rJrer rHn dd'o.rld r #ardreu'lslq
un s r,r n qo { fi q n ae r.r d n es n u oia as oTu n m il d il n-r fl a {aa n i t q ul u un a n td a rr u or
rfl urn6a.i fi adl{airuiu
rdro^. n r#a{d.r eurels
tt?t
d
| d
o h,il
tFtttJtl^lEt.iy{o
[Frta.tu?olrlEl ts
dr
i
<
.i,lz.{
v
|
{:Jcufikinrmanule.rts
6t9t
do
alt
[uutFt?o.t3ioyl tfltllo:l?yyt.iten'] tlruT'tyrEJHqL[nil [on16u1
ntu4usouffkrflrgurfirfluffuna4uvknT ar6u:hutfu d{orssvrflulensorevuuurelero.r
d
ra5a
dl o i
!a
rijulrndufr
N arn
v
'
" "r&
nrevrr.rrusoravur:urelsl#fllunffurur(nrer:J
rio
t : 343 t
t
n
fi1fr
fi?{Er
ftrlutusr*rdfrtlourdntfriunmtdr#o.rdeeure'lqr1u
I
flerrur
a
fi,ir lflufiq yffo.r lflrfi n nrilolnl?unvo''ln''r?Lrd n{gotnratfi ornrcvnda.rqas
.rlnffiorunrffa.rquntri{:jcutfrffuncrruilnarrfi'et flatri'u
oonfirsuluuaoorrdonrrmr.radT
A
o
{
.
dv
I
lrrufi{'nrq:Jaymniradnrfiadrslfia{ecvrir.r 1 aa.retnrEJdra{16
dummsfrarqsyrfrndu
o v Auicr.,
d
d.rnreyrrufirfr'[nrrflu:Jnfitueyra"j'r.rfits(rn?a{deflur€Jls $nvaonreffn:*rrfio urih:lrgrar
4 o
1r?o
i.t
q
q
, 3r
,t
rd
a $vt q
9t
t:l qytuu
LFt01:Jruu']$nvnc1ilno{n1tflo.i{ueg tunqilue{1u turuN
I u I
[?FtyttlJuc{1tu4no
ncrunrfirend.rrTu
'^l
1
:r
l
.
tffuri ( 0?6l r,fuf,iind , 2b3o :211 ;6et'e duilteqrifi? , 2834 :343
,tarA
r6fl.rnon1?ilqyrnnR1cyflda.ifla{oonA
)
tsilunvn1rtvlr1fl arnrafitrid
ruvt{rnr?a{do erur EJls
z,
fi 1o
nr
n rfi ornm v
unantouq r n nral{rnr?odneuT
- R1e v uyr?nffaud rfi orqr
t
J'l''l 0 v
3,
n
1fr
uri
nl?lff nel ru d'uua n ( positive pressu re )
ttfl ?nfroud rfi orqrnoa nE
tqu ( oxygen toxicity
- nlevLrm?n{oufi
rfi
orqrnnretr{viouno nnil no
- R''levttu?nfioud
rfi
orqrnnrefi
ne1 il c{1rJ1?n'[un1as{n
sls
16
nr
)
rda
ilrryoo nq1 nil1{ lAuil1gls
nn
n.i drou. n
nra'[r{viaranannrJFro rir'trinratotrifi:leyfin6nrn finres{h{16{tJrrvr]1n{u *nvtfriu
ncrrudulrirfie{Tlo
2t
,r
4
4.
6 e'i
s
n
Fi
onr
e
rfi n d'un
U'n,ir fior nram,da
v
d
h rol/
vanl
urJnnnnilu?reilqNn?yqnn1.3'l
e rm v rfi rrn r c vn t{ot a o nB rs ufl
uluc rdo.rq, n ffor'[d rnr?otdcfl urfl
nn1il tuo unvfl 1ljo1junu tfl a $J tlrlrlg
e
fl
6l
tq
I
d
c OZC
I
d
ilv
q n td
sJ
1,
v
ts u6atr1Elr
v
g,
n
nre
C
F|']utn?a{ il1 tu tn g{ F|on1?N tniluvFt.t Fl't{ ti
32
e
tu:rruyfi'ldrrrdo{d']eurEJtq flEJ1u1nne?nan,lrinoqjtstsJo'irfi.iufi{:jcanr
tfisunrd,reru6onraurelsTnenrfl{rnr6o{d.JEru'retq
vr
tto{oon8tsu
d'.1:l?e.nnego{o''1n1fi ( tidal volume
)
finT
n-liur:lofirurirrcrurffr.r{u
unvuatfiuto.wr?odcttrareltsfisv
dos'[firueJrrnrufiu{:Jrfl urinynunrruuarunraffntnso.lunvreioqjrnrua uri{:.1ce.rfifilonrn
rfiornreyneo.rso.roonfi rsuu6on'rr?y:rlflolnlnfitrinorfieNtdnnoortenl rfluoqln{:Jcer
tdu
orssyfin,'rcyuvren{aud.rorsqyrfindulfiadrrnevri'uri'u
n.tdfin.tqnrrYuluviovn.l
t
Guurelsstnrnruuydiofinteuortn6tsorunonrdil (Bronchospasm
I
rirtrXoanfirsuhi
c{,rrJ,'lenr.irun.rt:leT.naaoFrnsJunyq.inild"ru:lnrfltff u?ooreqvufiorqrnnraavulsolnlFl
er6'uq.:nrunprfioeas (atveotar hypoventitation
)
rdo.rornfrrJretfffuarnlfldfiil?u1n?
nrcrrud'utrirfifl{flo nrru4fivruiloado finm*,rmtntqr
u
I
v vtt
d
v
-
d
v
t
dT
L[nv
florrrrSotdrnr'r1sJ{utrinfivr
r- d-
I
a
{anauqntn?a.ruqnaonslnF|eHil?El 61aunnil Nn''l??eu?t?ruilallnonnilno notnou
it
I
A
v
r{rila ordr.luil.l
d
I
'
nraE nrarjusroulo
i
orn
or
rh.Jn{ ( o?c{1 r{ufiind 2$6 : zlt
I
d
e
nuilotqr n:la n ilfl er6nnrn
, pntiinri tcfldmr
2834
4 {
tfr
rudu
:373
ar nresorlenr
| d.na,nfleruratil
'[rinrarflraydrunyufifuoriT.rri'uvic.rfi fiorsriolfirfiornrevv'tdo.rsatoonBlnuoeirtguue.r
nurfluua4lfi{:Jcerdadintfi lnaranrr'[u{rlcufitfiSuernarflnfirrurdo u?anruouudu
gt,
I
h r
'
&
v
{:Jcerhinruranmrdaulucrfiod'refrcla{td uonqrnilnrels{viouaanailnouavnretd
Mrda.:dceurslqfid.rutur!lflurnr?otdceruretsltuul{uetd'uunn ( positive pressure
veatitator
I
)
dnornrrtrffrt:llur,lnonnuunv:Joortor{:JnuTprflilruil'r.iviouaonnNnodunra
evada
{rrffuflerEnTaivrersa{nrauretsuur:lnfiqo.r{:Jca
d{svdr'[firfiprnr,]reJd'unuluila'r.r
ondc.rmtltsdl$nyarnrnnlsuanfieytunr{lunonnruuny:loor
t 6d'e d'uilTasfffi
2534:3ff1 , 0?61 rdufi{nd 2ffi6: 199, Rarey & Yoursey 1981 :208 ):.laynouriuvia
ilnoaarJnadtattfn'u6Ueerfisurnrdnn.jrviaur.r16urarets6.rriotr1rfiorua.rfirurfiiudu
n''l?
rv:r1flo1n1nrdtrflut:Jtffhidlvirrdarfierufiuilnfi d'.rriuflEJrulnnetntsufindtnr,r'uJ
eird'rgtarnrerflrev{.runvfinrnrruo.n.tdnrilnfitu{rlcafitdrn6o{dcfluTsteaEj,t.l'lnfifFl
lrrEloEirFn'jT hi,,{rrflurfla.rnrn{:jQfltfffunred?flrildoTnsnretr{rFria.rdQEJurfl'lnaqjude
q-l'4c4
nqn??Nilqynnlcn{nno
t
t,
fiornreJqorriufinffrgrgrrudnrirt
1 l6uri
d'nernreduso.ni'c1q d'nfl
uavdn:*uynmurerlq nrcrud'uTafin d.rrilud'crj.ruundrt.d'rp urnfiornrefin:Jnfi fi
+
W
t
d
dd
e, u-flrfir6
nleyy{do{fl0{oonArqu'[uuaon[6onun{ loretuevevurand'me-rnreduso.rtictsu6cdu
dnqarSe unyncrrudur6oo,4tdu eyflyriailrornTeuaairdqvaora{ fc'[esvrffufirn.i
nrnrrud'utnfinqsnnn{ dcunreurertsqyfinrerrl6eurila{ fiodttlu^tFrclrJu?{fl4{n1?
urfllq
ToreqyuretqlScduunyffrurnrdor tffnffrr.rrdodcgurflts
a
rurndu (sexton
,
Hazinski
, 1989 :414 ,
6us{
(
accessory muscle
)
TtlGuln , 2530 :294 - 292 )lnfla.lssv
fiornrruqorrTufindrgrgrrudnrirt 1 uar{rd4n 1s - so
urfi ra?o4n
r
fi.1
z
dctu.l fidu
fr'us{nrv{ornrano.r{:jee'irn{fiil5o1il ( Bradley, 1987 : 55 }
I
druiuornraLdflr (
cyanosis
)
ulnv{elluraqvfinrornl?unvo1n1?LtnFt.l
so{ nrerdsc nr il:l nr s fi o :l nrs rfir ?r.r?l:-lr n tfl ud'cua nnre vlraotsotoa nfi tqutuuno Fl
ii
6t v
4
st
4 Av a lr r
'----.+
ruo{q''lno1n1?nqvu?1n{JuJonl'lvT'l?0.1
r6ian un{Lme sytilu6rurulruflT{yrfl1tnxJ
l:l
a
Y a
<i
3
d
I a
d
|
' ---.y
-q-?.-q---f--roanfirqufufinnrruquuer loreilnfiarnrerdecnarqrr5r.r:Jnngtriuiurfrorirn'nuduto.t
ao44l|--aeI
b0 fi6rruna:laon
oonfrrsuluunon[donrmraornrruda:leyrurru
q
4
o
d
|
q
I
uavnlnelNouneio.t
t--.y--y-.----
--
V
--^,
H] LFI
{.tuu01Fr0ufl1.l0uFrff]El u1n?{u1u1a-\-i'1
oon{tsuluua0n[6ioFrttFt.t:J?yN1tu 850/o
frrrnmuiuurnytfinredcflrudofiufiocir.rfi:Jev6vrinrn
d.o..nr.nfioHu.*rcvnea.r
aanBlqutuunoor16ooruor{syrn?n{qutrinrrurantrlnreurfftntfifr:JceornrdadintA'lufi4n
a{rufunrafinnrrufrrgrgrrunr.rfiruevuuuleJleLmvuaant6ondu
1
rdu
nra{ornntrud'uluunontdoordrnnr.l ( central venous pressue - cVP ) nrritprervr,i'ff'rq1u
f
4{
v
y6
'
t6on nra{nnoruor-u'lu:loor
5l
( pulmonary wedge pressure
d v ttgt I
d
dt A
o
tr
) nm{Brrnrrudrudrga.loon?tsu
6t 6l
V t
a
AV
tilun0n tn0n un{. ( 02 saturation ) r'lilU [oe1 [:JUd{s1 t:lu tunl?E ttnHilc€lsvavcnqnilno.l
ts{mrSatdceulsts torsranrvtumsfi frtncrrudu:Grurnmo{o1n1fl uavfiu ( pEEp } flo.l
i
q Aov-
I
vn
hr6r
-j
rrrTo.ldofl1r1u"tefr"trirTuff:jnertflururorfiry rfiorflravftrJnn?vvmrioavuurietqtr1uritq
.irnmvixruto{ri'ntsfiarair.r{rflc{''rruran4udorrdonl:lrdero{EJ,rrr{curir{
tfrrfie{vlo
( Divertie , et al
, 1983 :72 |
1 totdrrnru
nnonsuzunnavnurioevuu$nnr:ldeufrT
q uri
nraqvqor:iufinavevrenrvirrriurvirk rlufi{uoqifius{nrilornrato.r{:Jcu urnornraro.r{
:Jcuguuarunvtripr.rfi nre{prrjoanfo{ufir...y,{rrflustta5:-r{rJea
:
rpirruvdfiri.rrfludnn
rfiercrTuaqj,jrqvvirLiaeerir rvir'[orunynre{nfrceri6uuutpr6.r u,rruryaarrTu{:Jcerdfiornra
hrJ,gJda4JoctrcztCl
quuetunrtrinrtfitraairfl rf,o.rsrnnre{aur.r46flerurnni'rrlluda.r:lnormrSo{dreurEJlq
aonornfr':{:-1,:stflrlylmntdqyvirt#nirfiortrl qrnnmflntnqot torrcoffi unynily
37875
\ -r oLrqo ba*
v
I
( Divertie , et al i983 ) rda.r nraradnldeNnreriahlrfionrQvnrosso.ioon?rqu'luunoorrdapr
u
.!i
|
6l
A
v
|
UFl.iflilyennllAAgne']lJFlUgO.lUnOntnonUn{ [U:JOn
of Aggravated
Hypoxemia During Measurement
t lorEllfiilrnrefin:*r1u{:jes
Pressure in ARDS
6l
9/r
of
ervrdvtqv,f,v
q
d
I
$tu']''l
dt
Itn
O
(
Avoidance
Mean Pulmonary Artery Wedge
)
,irucu so r.udfi
tunl?enn1lsagne13Jnufla.t
uaonLdanunrtturlaor ( mean pulmonary artery wedge pressure
I
[O.O''l?.Fl,t0d,
ro,a1f.A.toc{, (ARDS
n1cyn1?u1g tsnNtuneofll.itoetilflnultny?utt?.i
tl
dd
turyil?A
d
4
t
d
dcutrarlv{El'lu1asvffa.i
e
v
v
ilantFt?o.uegu1glqaonq']nryil']Elt:lutenlulu 15 - 30 eulyttl^to?Ft Ltaytosuntvvl{cFl
i
hru r J
t
|
|
I
d
f,-
e
'
tsuytrJFlslnun0n
tnFtlvtFt.tyt tJn:J?''lnRe1
3Jn1?nnn.igo.i?gFtuFtclSJotJFl??la.io0n{
&l
d
LnoFl
rirn.rilrnsrn?vd'u za vo n{1:jfi{?yd'u 10 vo Ll6yr4d'tqrnk{mr?o.rdeeurelqudesvffo{t{
r:rnrfi.r b - 10 urfi
W (n1y{d4
6.rqynrruranr,iT trlevd'uFrxlsJailficaa{oonarsundudu{avd'ulfir.r
)
]lme ( Min.
)
I
mr{ d
I
4
q
urt n{ n?1
ild
vi
ru
dceurslsoonnrn {:-lca
dNT :
Divertie , et
d'cro.roa nf rqutuuno
i
e
I
i
rfr oi'or nir rqdEJ
al
1983
n rda
or
drd r:idfl uu:Jn{trlt ruv:l
d
a
ncru rr'mo{uno
or
16o n
un{tu:Jo
n
or
rnrdo.r
Fl
:
rdurdfl'rrTun''refin:s.rso{uruntN{1u'lufl n.rt.
t
ge+ rdornre{nrilrrmrJ
dr.rd"rsa.ioonfirquturdoorodr.roiordortu{ricufifin,,rrilrds{{.r ( continuous measurement
t
of blood oxygen saturation
in
the high risk patient )(McMichan 1984
:. 55 ) nu'irlunre{ornrcrud'usotunopndoorrloetuiloFr
qrnunrdo.rdeaulertqdfifiu ( pEEp ) u,ru so
iurfi
drttu
Bradley, 1987
truydflerurn:Jnnr{:Jceoon
avd'ur,'rrudlrd'Qro.idbrtnnfiutu
t
c
4
Itn
v
r
h rA
F
unoa6ondTro{{:-lcelnnn{slnrvd'u bg% n.rlrlfirevdu:lBrrru
6t ta.f
|
ozzn
v
9t
6|9
a
d'rsurfllsfififiutriff:Jcuudc fia{tffrnnrfr.r
so{ETeJTn nfi un d'u
(nT'r y:l n fi
( n1v'tvt
5
GJ
so u1fi
30o/o urnvrfiotr{rnr?o.r
c o,
4
u
'
6.rnrurandalfiev,frunlr:16ufic
)
t
Time ( Min.
n1 il
.rl-lvdaoaodoj
fi 5
lld
Fr{
9/l
4
|
oonsln tn?o{1eElu1fl
ryu?fl
drur :
ne1ilailnofl o{s til [nnuu ruuno
McMichan 1984
drrtu
O
4
tq tfl
v
I
n rno
ot
d
nln t:ldauu:ln.rtrls ruy:la
v
4
fd
I
It u
v
4
r
f,
v
l
Q
O
O
I
Bradley 1987 : 55.
v 6l
svfiost:ldfluvirror{ucErflruvilsvennerrunr'u
!
|
rl
oennl tsnfl n?lilFrulto.tunon tnontJog txrlJaFl
uonslnd slnn.l?frn:ellufin.rdelri'udso.ruruntr.rtru
9
)
a 6v,
o
d
---luunonrdonFllnal.i( cvP
n
6
-
)
flu.j,l
d
n1?d
i
v
u?anrefisyi'Fl
o
,
( supine ) uyirfu uon
Fl?'rsJduso.0unon6on,Joertu:-lontora{rrtfi{:Jceuou'[uviru.r1€J
srnsvvirt#tfinrnrennrn.iflo.i?yd'!FtcT r.rdr.rd'csardta.rlnnfiuufrn ei{rflunreruncunl?
uouudusarffrinariatrirfinrn'nillil4?rdu1a?uncudonradr{1uflo.r?ylruulats
!my
vlsrurafrffosl{r'rnrniou{r.rrurntunrerildeuvirhirTu{:J,rstdoinunvnd'ut:luoufl.rvir
,oi.r4
3 nrjru ( Bradley 1987 : go t tffr,irnr?yloao.t{nncrrud'u1u
unon6ond'lnn1{ ( Central venous pressure ) unynelsJd'ugatrrnanrdooriloetu:lorl
:Jnfr fr.lfrn1tfin:flflo.rrinQ{e
(
I
pulmonary capillary wedge pressure
t
tu{:Jcetenunaortdaorricts ( coronary disease
v{u"j1
tlifin'rrsJL$rnri'NociT tfirita{rd'rpvntnfifiavra"jT rnreinrnird.lnrirn'[uviruoulr,tl€J
('supine
) mvun{ff1etu?oser
( left r,lie right taterat decubitus
)
)
syrfiutfi.irlunr:inuny
fiornrrupirnrcrrurrJduuu:ln.ru1.roEi1.i ltErlulnqyfford'nfiunretrf,nrequrn'lri[usJ'ryc{Nffu
gtq
t,q
I
g.
d
cl
rct
f,
I
4
ryUea$nnvflcrFr''ltJdRlv{o1n1fluo.rry:lcfler?ilrrr{NlnuoEJrnEl.i [nunyor; tuntavvrn{t4ui0
36
l
3 i
a 16rz
uonqlnurFt?o.tlJoyt t{{'tgttnv6voen 6.ltri,itrfluffo.lrirtrhfinnlffun']udonnrn
i
i
e'n
a1n1ffi { n.ifi rar{:Jna fi rfl ufi .rfi rirqvrirrur'H
hr
rrJ
2.
n1?E
unlfinr
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61
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nrrt{dtavuunrarTurnuuvfid lorenflrurndlru.r?ntfin1:dceru6off:JoutA"lu
dn:sruv
1) nratrincrru{u ( Humidity ) Tnenletfiornrnu6ooan?rquairurirfi
eyru€.rrflutarfir{vrrtrhuraratnror{:-lcendro..nn.rvir.rruslq{tun{n
duo{rT:.rerd'u
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s1nfl1{r6urare'[qt6"Tnfl{rs ( tmte 1981 : 183 ] uun..nd^otrf,usvvir'lr1lfiarlnrrr6u
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6
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d
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2834
: 13G I
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da n,rrilduuuue,iudqruuqfi 37 a.rArlqaldtld ( shapiro , et al ,
rar{.r nrnu 4 ruq ruraq fi tfioqjlunou
,
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I
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nd ff.o
n.r
1983 :
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rdotrihlrfi ndunera oio {:jca
( Hoffman & Maszkiewicz 1987 : 43
|
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6??rJFtl ( 26
a.rrtltnrdsa
)
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37
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Vt
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too
:b4)
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: 172 | 41 nelsJdudfiqruraqfi 97 o.trt1
syfizuavir'lfiavuunref,urfiorfionuaynmdrsru
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so.rsun{rrfi :leyfi vr6nrnrurnn"it nratfinnrruduuuu6rrN Fr1
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Ackerman
, Lombard-Garner
]
2
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2532: bb-bo
,
( watker
shapiro
,
)
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tulntdnsJln naaaqjtuff'rq unnriro..n^o.udufiaqjtunnrnTr.rrnqnu6otor]r nyao.nlrfi
tfisrnrFfio{rirnvaatrir ( Nebutizer ) arqfisurnrir.r 1 riu urirurordfinrcrrua{rd'rptunra
v4Y'hr
?n:fl Flo nyoo.rulgutordrn.ir +o trlnreaunrtl I :lrynruflei {uvra , zlgg: 299 )
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4
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'Uvc4rdrroeoY
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g fi.i Z trunreou Ft1iln1nu n1?il1nyoo.tul
1 nrrurnrS.dqnqt
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&
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uo ns1 niln yoo.tul ruu6{
d:rfin rnruuyfi
t.:-lrys{rflflci
urX.r
{un:
'[u
n
1978
: 182 |
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neyFl
unel
n0fl
3Ja6
1
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zsgg : 304 ) uny6,'rrJlrntolnuuyaanlfr.ircrdu
ani
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fiin r{ru
r.r yi a u n a n n il n otn e n
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uofrYntrinrtrendrt:lffrueiarYutamavtdrurn{u ( Hantey , et at 1978 : 124 ) dunflflqrn
38
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)
b Ltav to fin66na tu
virnrauano{r:JieurfieurJaflo{n1?ugloo,drundouofiin'irucu
ztt
1987 : 533
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|
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2.2
nT
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(
vibration
s
rfl
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o
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drainage
)
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percusion
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vt
t
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I
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fl r.r
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urrd
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ui6nrefi or f,s ua.ilfiil ric.t
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l
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o
o- f, - A
yr1n1?'rqEr Lnfl enu
[?€.i d'.rneirctfi
rri
- tufl A,A:g74 rrunhu (
Mettein
, 1974 t tfiiiTnrafrnmQinleevurEJ
r cystic fibrosis t d.rfi:lryrarrdtrerTunltvil.i''rulto.lsun{nr
d
v I d
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rnruravtu{:j.lednfintylTildn
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n1??vulflrdurru^rduRrcrunurianraoondrdtnretu{:jca:levunvrdtfid
t
cat$avnilv ( Wong , et al ,
fla
1983
t
filffdrnradnm{:Jeer ds{fintv{1:Jrqd (
Fibrosis
)
,irunu
position
)
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-
13
rdurdercrTu
nenrsrnu.irdnarnraayurertdsJuvluviTrionyir (
nrdruruof uavdnhnr ( Palmer
and sellick
t
Cystic
head-down
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, 1953 t tdlirnmfrntnvru.ir
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v
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'trl
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lfrrirnradnm{:Jcerdnfi
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q
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I
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rdoorurrs
(
Pao2
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) unyrirrrerudurarrrrfuouloroantqd I e"co2 ) norntud.lsrntdnra
:-lfrffifinnrel.rd'tnairctunrafinunqotnoffitrluunvtu?iltefl (
Gormezano
tfir,irnraflntnnretrlnT enrildr:ioryrl.in?e{onXorsnT ed'nviruuurir.r
&
Brathwaite
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t
orflrsfiEi 31
q
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)
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( mean Pao2 ) d{nirraduga{nr't'lud'uoonfitsutu
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o v
r
dd
aeir.lfirifldrdrgrnr.lnfifi fi.lMnrir{qrnnrefinmto.r ldruof Ltnvnilv (
1980:320
?1u
i
d c dt tr |
o
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( intermittent positive pressure breathing
unanrrdonrun',rtuurfid
)
Finner,
et
al,
) drtdfinmnrauanr:ldfluoonBrqutu6nuantfirr zo nru dtfiflrgur arf d
ro6 ( respiratory distress syndrome - RDS t dtffottfrfunrrdnsludonreure'lqTorflnratfr
rrrdo{dcsurflts lntlnreirnrnyr,frirpr,:rrud'uoonfirsu'luunoor16ooruottuurfifi
ett,'
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t
s
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e
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t
rsu ddu
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r
nrefinmd.rnairc qvululfi.itrndrfiorsrnnratfi
lA6rV
nra:Jfr:jEnrfln1y{yr1.ryr??.ion ( Chest physical therapy
vir
) rrri{rJca d.rrlavnouffcsn'la{Fl
n.l?rnr1yilon u^rn.rdunylfiou rioryd'urrcrrudurotoonfi rqutuuaoorrdooruor.rsy
hiarnrf,iluffru,du{uu^r^r^o lore6(culunid:leT nnruntuurtnorn.rfnsvrfluunfi'.rrfir,du
turfi'ufiud'rnT
nnra:Jfr:ififisneeilfftn6ire
fi'tnavnuriaevd'unrerrud'urataanBrqutu
unoorrdoounr urrirad'.rqrnddlN'l?n?y:r1€rrdrilryoontffd{u nlmyulEJornrrtlu:lanuny
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g. rrcrrud'uaufi'lfftunmqpr raruuvkinreaufi u t t o fi nh rrunnlmnludn
Fr
unv t+o finhu.rnnJaom'luff[raru
( gittins & Stokes 1987
4, erul Fmo.r61€J€r'l{
A
n
: 1147 |
rnruuvrrrefi rffuair queTnnr.r :lavrur
4utinnr.rnrstuviaunonrnilno ( Riegal & Forshee , 1985 : 516
b. k{nrr
t
u'rr
q
or rc{
ru#{so{ #uilr
)
eJuvlus rurfi {rJnuurerts r{"r un vtilrir nr
aq
nrtur ruvfi
'[s{dreer{r{1l:l'[uvioranonnrJFro [il?'lvsvEFrolnldunvoonBrsuoonsrnvionr.:16u
ilre'[s r,irtrlfi nrcyndaroonQ
o. tri
nr
o
uquuayufl
unrevirnre rdaqvrr.r 6uuretn
e6.r d 1 Er Er''l{ A n rn u
r rdu^oo ruv
E
Fr
rd
tJ 1,
v
.
7. rvsvrcnldtfftun.rqnrrs{:Juvtiln,mlfiu 10 fu tz ,:'urfi ffrqorfinria
fiuuru 1b
fu 30 Qurfi orndrhi{:Jcerfi{rrineeiltfi d.o..no.rvlrt{a.roonQreu
odr.lguua.: ( Luckman & Sorensen , 1980 I 1258
)
8, frr,irrfluffotqnrd&Jrisr,!^.u^io nrcal#{:Jcu1frrfnoeir.rfiael s urfi
unytfiiuaanE lsurioun''r?Qn 16lJrrynF.r riot:l
9.
lnre qer
n
nrdutv,lfi
(
Laryngospasm
ur
fl
o
"[q
y
C,
fr
Fi
o
flu
t;',rls
)
a
oo
CJO
srruyfi virn''lrq n rc{ r.r1ry syffa.idt rn n rrny:iufi
nE rq
ffrvruir fi nrerffusa{ firlqfi n:l n
fi
n{tucynrarffuqo{fiels
fi nreu
or
rnirsa{ n rior fi
fl .r
svffo{uqnn1?AnM{rurayri'ufi nffaruriurirnra?er're:loorficuqtdrr
u
rir n uo r n r afi n :l n fi ffor fll
Er.i 1
u
rry,r yr
Ei
il
r-llcyLtyrrnfrouslnn''t?QFt 16N!tyyll.tyiouno nail no
ud'unrerriofr:Jcatfr fitiraeir.i
n1?En rdNuydrhXrfi nnrcyuyrenfroud rfl
vltlttvdgrAvio
lilqnffa.rnrsJudnnl? mrufi{mu.nufr{d'umflefrrfiprs.rnnr?EnrdsJlryyrr.rviolanonnruno
r
4
Co 699n
d 4a ritv
e']quut.{n{evnuflvt1
tlr{ileataflx'rn
2t
[Fl
unonnilnotu{:jner tfiuri tHatfield and
v
,
Raushuber, 1984:568 - 569
1. n1?v?\do{aon6rqulurdon$n{
t
ls
n1evuil?n{auil6''rnruslnnl?EFtt6tJlryytl.tyto
( hypoxemia )
)
{:J"refiiunr:dnflnre
ure'[qfiQflln?o{dcfllr''letseyfincrufior:Jnfirfiflefiun1rure'[noqjudc
r,tre'[qlfrro.n,lSoraT
Eltstfftrirfie{no
)
F1e1ud'uu'Jn ( positive pressure
nrfllfiSuoonB tsurfi
e{ilo
do
kinrruT en
nlrde€rulErtqficernrdo{dceurelqqvdcEJt##.i
unyoonQtsun,trilr{ru{u6.lduuri{:-1cu rdodrEJtfid"t.t
ffiasvdrnraqn raruvrfio.r:lnnrvioro.r mr?a.rdeEJu"rslsoonqrn
{oriostosvio?rnonnruno{:.ler Rrdcsrudafi{ 2 oeirrqrnrnr?a{dcrlr,r'rutn6.rqnd'noant:l
o
f,6
uvv
d
o
' Xvu
luavra'ir.rfi{rjeerfititrarer'ls
ro.itff:ir.rqvurflts rorornr rt'[urla.rfitfi nrc'ril r{il{uso.r
oo n? rsuoir
r{rtil
n'ird rpretffiu
dcu{rJcedtil nr urenurs'lqlff ro{q yhitfifuoo nfi ueutu
.2,
dctfi
nersJr{il{uso{oonfirsu'lxlyrl.irAuulerlo{rlcer6.rana.rqrn16il :leynauriunre
Vv
Entfiililvnesncriln'uaussqntola''ln1filuy1{rAuurets6.rfioonSusuaanrurn$oulrTu
rnaJuvficfl rfluzuntrlnrc'rrur{ru{uso{oon?lsu'[uynrrAuurfltqnndrnttildn ,rn..nd
fre
t
nruqortnruuvto.rtisrTorrcr.ru?oqorYuu.n.n..no.uu.nrtsyr{1liluyrufiarnrnfiqnEn
oanrurdnffcet prmrur{:r{uso.raonfirqulunrsrhuurer'lnunrtuqrnru6rdrmurn rdofi
tl
r
@-
4
I
l49t
A
o
d
J
o
nltunnLUnfluun6?vue"r.3tl{nilLtnvunantnons{ tnoon{tsu tutnonn1 unyolstnnR''rey
ndaroa nfi rsuturdo
n
Ut
v
.t
n
un.r{utfi
m rfi nr n r o yn
J
tFl o?gevn1fl tuou
'l
o o n ? rs
d
!,
utu 6 a n lmr t fi ar ntrX lfi or n 1 eu or ff"J I
v
olntt
a
ruao
4c
o,
rd o r, vr'
h
v
( patent ductus arteriosus t
eirlfigrrrrn'oott:lrdw ( necrotizing
) uavnrrtfinnrerrutrjnr4atunraunnr:ldeu$ffd?yu.j''l{unon6oorunvq.lnru
( Intra pulmonary shunting
!|
t
unyunontnonfliloFt n1o1n1?quu?{olqu1 t:Jqnleylnon tunnrl
qrnfc'[qffrutcrt:lfrru{rs
enterocolitis
eo
)
43
I
2.
trlrrcr
i
rud
ru
ri'clq rffufi orrlnfi I dysrhythmia ) nlaqn M{3luvn't.ldaunonaruno orqvi"r
d'era.raa
ulul6a
nB lq
tr r
A
Ll?nytne"ltJoilF|ego{oont [qu
.
e
i
u rav&
nr
uox n n n{ un v tfi
J
5l d
or
tutnonun{nnn1n{
I
r
nranr;{uu?tr
a
svt,l9{a Luuc
e
d
ruu ao
qr,e.6t y
or
n
rulff
g
turve v
,&
tqno{vl1.i1u3J''lnflu
2.
q
e.6l 4
u100n{tsutll Llrtuotgoflo.3?']{n']Elo€11.tlilg.w\o on?1n1ttnu1o.lue
J
tTlo
ts'
4
unnl
[sq{t?eflu
aon?rquturdonuor.rnndrnsrurn unyndtrrdorictqtfffuoan?lquhirfiEJ.iilo svvirt##c
tsrfiufiru6orffufior:lnfitff drufunraner{u:Gleruuaonn:rFro lorerri'ct:lqvrfluzunhifi
icea
nlaryrtilnl?yr'r.i1ilfla.iryuufirunrrsfifl (Sympathetic activity t d{svdrh1rf'Jlsrffur6c uri
i
tuurenurnrfior n1?n?y{uu?[oiluaannNnoo1slfinnr"Jvfctsrffu{rr,l6ori'etsraqnrffu16
, Frankel , et al
(.Cordero and Hon 1971
1975 cited in Mackenzie, et al
ltl
rflurduflrflurJaslnnltfi rfiu:lavnril'l1rin
3.
( Vagus nerve
178
)
ti
) qnntv{u
d'u6o ordr ( rrypotension ) R1?vFr't''ltJd'ur6o
nrcrer
, 1989:
or
drd
tfi
or{uqrnnre
qnrc{:Jlrv rflurunsrnrfiurlavnril'lT finqnnav{u u6aqrnnrefirictqrffu{T uonslndtu
riruvqormruuyrislflunrrfnrqctnr??yu1flo''rn''rFl nretr,lnnd'uso.itdonNleiqri'els $nv
oorA
4
d
e6l
J
d
e.{
?t
;
4
vrr"[f:JiruT rurdonrfroonsrnfi'clsnnn{frce nrcrruor'utdoo16.rnndrn.r n1?Entc{tJlrv6spr']e
t{rrnrtfi#ud4or
4.
I
:lo
ot
uv'lu ( lung collapse ) nrrtfiarettur orlur! qn tr{ulrvvn.rviounonnru
nraff:Jcerfin dtfiranan aNeulnr6n syvirtfiornlfiqlnnlsuonhjnrruranr{rt:lvroruvru
I
01n1 fi ilqn
.C
o
noonil1 [u?rilyqn
168Jlry
he 4 6
,
tFt s{ [n nnle viloFt
|
6e.,
16onlffs{re
.
a
A
ot
rdNuvfl ur
orfi
9t \
viounaornrumaorsrirlfirfinrnrefi nrr{atd s
.
rn
4
fi
nr
4
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n
fl ornryn uny:l1nsilsrfl
r eq
nr
tn
ru
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.Jogal
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I
pr
ffi
c
o
tunl?E
4
n [c{ 3J1rvs{ ne?
u
lururvnrufiuviouno ornr no {:Jcs 6neretfiu
5. nrafiru{otunrt6uurertq
lfr
, &
$Tllrlru
tfl tun']f
q n t6
.n utri1fifl
ura{rr
rfl
o.r
uffu
( bacterial contamination
t
nT
qn
) nltqntdsJlrvvtl.l
6cflflu6o
ffo.:
illry
h
t8J
I
6
yo'] tl
fiun mn aye r EJ r{ar o.i n u rottrJ ( {:j
c
e ld u tri
s{
e sr
4
I
,dc.o
6, tgouunonnNqnillala
( mucosal damage
.{d
a 4
J
)
tunl?E0ltneJilvvll.ivlo
e-.,-,-.6r-,a2t .4ts tFr tua.$s']nut.SEFl
unonailno ilnNnlenaonLtnyiltaonoanslntgo:Jyt1.ltFrulr1fl
'
ia,
a
i
c
o
.4t-.------.r-24^^^t^.4-qyt
rnrurayfifiriarfioqvrrsGuulstqsruydrnreqonailuvunvtfluaT tuFltlifinrafiorrf,old.iT e
firfinrarirnrflaEir.triorfietriat:l nvrirtrJ{nrerfiorldordafllet
( granulation tissue ) LtdY
?tnonasJfiuunut6
7.
e
ne.ttid'u'[u6ilo{q.i ( increased intracranial pressure t rlnfinratraal6gu
16oordnr.ro.rtor{rJcerrdn Tprflraflryilranqvtcrionrel:ldeurt:ln':flo.tFrc1:Jd'urdaoraqiufrc
6.rdrlfirfian1cvne1Nd'ulunilo.i
n,l?En16NrryrirhhfiornrerildflurL:Ja{flo.rFrc1ud'urfioor
4rtfi unyfiuucTriudqyrfinnreyrdaoroonlunr.rorlfriredce
{:Jcardnnr!ilfl6{finrrril
rdehlFionratfi nnrnvnerild'u'[uc{tJotq.ln'jrnajrudu ( Mackenzie 1 989 : 1 79
g. nrarTu M{sJuyq1n FioNryn rfi rur
q
nr
rnrur:-ioa 1 rirhlfi
1o n1 d tfi n
(paroxysmal cough )(Allen 1988:+z
lfifiorn,euadoflr6u orqdq?unarqndlne.rri'ntff
urfidr.r{ur
nev{ulnan,
riorurynqn
a
nltq or duta.lur{ Guuretq,fiiu{u
g. nratauontuflonrenreuq:J
n.rduoronraunnfilnrnTfiu
n{u duo..n
)
(
D.r.r,
i9B2 :
tzz
)
viT
) nrelonru{u'lrifi
( cathechotamine ) dTtrhGuT ruXnfinoonqrnri'etq'[uufi.t
Bodai 1987 : 43 , warsh , et ar 1989 : 104
)
*
10. unonnruund'c (broncho-constriction , bronchospasm
4
au ncuu3a
lt
6l a
|
^
nranav{uvn{ 6uurelqlne
ne{ilo€r
1
ca
"&
qffi nreniEuaqj
)
tdo.lsrnnra
i
tv
riuaver v uc nrfr au
ncu
d.i
1,1i0?vtlv[CnlvlqntdilUv ( Demers 1982 : 172 |
11, f,rprarvrrtfrru6nts ( Bodai 1987 : 43 ) rirtrirfinrnrcrundcunvncra.r
Qnnrftca nlrfinmso.rLnJFrnonuon
nu.ir fiffrjcarfitr.r5aenv
6r,G{
tl,tlJn'1?EFlt6tJl4v ( McDonald cited in Siskind 1989 : 480 )
s
fierailSuunsffosnre
3
Uonslnil
v
I
rnvn'rr:JQnnrYsnnfinrerrudr.n{ufri':rnrarfinrrlrputictsrffufinr:-lnfirirh?rfinornrafinr:lnfi
Q
q
d
hv r
z'
ytilutFtuagtulroHil?El
(Glasser, et al 1978 : 1007 )
n
v
el{nU0lFl'l'1SJnne
45
t
'
n1?Anr6ru1ryr,ir'[rXrfiornrcyumenfiaurir.rld.lnrirc d'.lriunraqorrntr,ar6.l
c 6r , Y
o I a
E ^
:-^^^.^^-y- -^^l^...a
ne?il1mJailne,tilq1luuryt1uu uouruo? ( Bonner 1985 : t39 ) drUU'tUdnnmilevNU
-X
n']?Ettt6Nlrv n.iu
r.
tffOurde{rdtJuvriinn?1n u?otdelfin:lnfiso{n1?u1sts
2. {:Joufffi n"jrfi mruuv urnrfro.r nrr'[rlqnr
3, ne1ild'l$ro.i tnrda.ldQsurflte
rl
4.
{rJcu navdu neve{rfl
fi
rfi
il{u
or n1?Ltd n{R'te v?\to{aa nB tquqr
fiarnrata finrer:ldeudnsruvn"rararettqu?afio1n1?tdfle
n''l ? E Fr [c{ N lr yn r.r
vi o
u n o n n N n o ?i'r'[rX rfi
or
(
n tct Nuvq n
siskind 1988 : 4ll8
n r c v rrvr an
fru
)
{o ud rfl udu n er etd
unler:hynledtnairerurufic 6rfifrnu'[qrirnrefrn:s'lt{nn1?r:ldfluu:ln{drfio,duqrnn1?EFr
rn
ru
u
ynr.ryiouao
nn
il no fiurur
tFrtftJ
n
dtaiutu{rJce
u6 n
unvnilv ( Kerem , et al
2s nu
flrgurrateyuuyrl{[Auurstq,irucu
fi
{nu'[s fr nmt{u nrerere tfi uri
1990
: 95-99 )
frnmtu{rjcsdn fifi
avu"jrtnretri'lrfioonSrsuriouunvud'.rqor
te{eJuv nrrhXoonfitnudouqnrtdNt v( presuction oxygenation ) n''ltsEllailoorriouqor
LdtJlry
t
(
presuction hyperinflation
)
Ltnvn"lfllEl''lUfJOOrfld'.lqOttdsJlrv
hyperinftation) nu,jrnretil'lrloonfilsuriauunyudtAnmilu
d'cta.laan8tqu turdorruor.r
I
Pao2
(
postsuction
virtr1nirnrcrruffuuavnnru6ru
& sao2 ) nordrntaejrtfiriarirdryflNc{fifi nretrl
oon?rsuriauEFtrc{Nuynrruranflarfunreynda.roonBtsulu6aoruntqlnnl?EFl16mavtfi
unynlrrerler:.Joorrad'.rqnrdililyd,retridrnmr.rd'uu^r^.audufroso.iaanfiusulu6onttn.r
vtr,ot{
nnuqnl:Jnnrrelu
qvrud unvnrilu ( Durand , et al 1989 : 506 - sro t tfifin:rnrenldsuu:Jat
f,-
{
o
vo
|
,
'
frtfrordutuevuuti'r"[sunv:Jone''rnnr?EnrdmryynsyiaunonnNnotuyrl?nfirfiorriourit,lun
fififlrprarte{?vuuvrl.rtFurarfl'lq 16 ?'lrJ lnfllfrvioduJe;fi:*$urdol{r"[unraEn16ilr,ry
e
(
suction adaptor
l
lunreqnr,rlurndurfinrde.inm:Jnnr#asdneure'[eoonnrn{:Jce
rdotriltf;ufi ornr"Jvrl?o.ioonA [qulutdo
n uor.r
trnyRleynlfuoutoroonttrid'.rarracr.rqo,
t6{eJrrv urifiti.lllu.irpirnrcrud'uoonfirquturdonL[n{nnn{ 12,i o/o '[usruyvinr,]rrud'u
46
s
dudu
rrrfuoutnroontqd { pco2 t
q.tv" d
,"du gayo rirnntud'utunuollfi:ldv
t urfiudtqntnillrv
117o/o
unvd z
aonfirsulutdonrurrt ( Pao2 t eTtnrtdrn'jrrdufi.l
ud.lqorulruuv nirpr'lr:Jd'u
10,30/o
qyu1ulfr,jrflrgrardrd'rpslnn''lrA
tfiuri
uTfi
rirn't.lsJd'ur6oorrfiu{u
n
rc{rJurmrtviouna nnil natu{rjeu 16n
n1?nnn{flo.myd'uoonErsu'[u16oF,dor.^^rd.^.rsulfinnrcvnda.loonfirqul6
nmyyrdo.roonQrqufidurtflsn\?1yqydrtrifiarnl?uc{ntqa.lavuurit.l
t
t iavffl dunleelm?2$1
1,
:113
:Je
nr
fi
.
ayuuileyarndcunnr.r rdodrtnredNfiFcrilt{ufiusotaonQtqulu
a:*v ntveun?v'na
#uflurrunduurn qvfiatnranavffunavrh€l
triffd
fie il?oralr
n
or s{
fi
tA"tud
4
n
2. eyuurl',r'[qrnyunonr6oor ndrruldari']tsevfinrer,irmuldudutdttt
q
&
al'v
i
|
|
rt saa nE rqu lririu lilo rfi a rir.l 1 so{er{
oonQusu
nrs
Ft?''l tJ nu Lau
nn n n1n.tsulr't tsuq n tnu
g. ayuuilrflts
GJ
4
luuos rirge urolrqnulEr
rc{il0 l6urarironu?tcrufintq
nrcynearoonfitsu (
rfi
hypoxemia
)
ssvirttitfinrnte
ildu fi nret{nfrtr rdad'JeuT etsilrndu uau
6r Vlgt
rs
rFt
nrcvuuenfroudu
I
q
d l4rt
,-d
yrrXulfr.iT'[unrc vuen
vllaa.l
[itgotnro^^-^..-.!^
n
nav{unreurets vilt#fi dmmnreurflls
di
q
( hypoxemia t syfifi'c'lsrffur6cra?orfiutrid:iT
oaAI-qvtv
t
tudr.lnred'{d
)
ldooraorn.l ssvir'[filfinntaruncurian,
dourndet
1
o
iz
r unrgocir{
I
6Jt
,
rdu nredricts rfiufi nilnfi nrcrrud'utdaor
t
I
|
tu
mrunyncrrud'utunruo.r4r
fr.rurfluzunriorfla{s'lnnrefioon8tsulu6onaordrnt d.uiuffr
fl
o.rfiunmufi ornre voonfi rqulurdo nn
n dT
artfi
tonrndevlfi ornrcvuuenffoudu 1 finr
fiafln{fine
nmrudr.rrrr-ufesu,irsalern-iln1?rrJdeuuilasnirnmru6rJn-cflo{oanirquluuaoor
tn'anun.t
t
flodetvrrt
6T
uarq
orsq ytilfi
rJ
aTnre
nrt fiu ni r nrar ruad ru frcsotoo
nB
rqutu
unonrtdonunrttunrcvilnfi uriurntfinnrcvQnqmduhi"ilsrnnrua4torfrmrrunvnu"i'r rfin
$
trinrmen:l5upTetfidlviT fflur!rfialfiornrcvfiflnfiu ( Hazinski 1992 : 1
qa n6
rqu
r6nss lfi nnrc yyraaroonfi lqu'[uuna nr t6o or trrttffqurre.rn'jT nreq uninm niau
{r.rdrurn
urn^.ndf,oda'lrfilfinrnrclilrdsurst frf,uoilil,)vdrdrytfiurn lprelanrvlutdn
yrranuanlfia ffinnnootriquriruuot unv#ndn (
Mackenzie , et at 1989 :
)
178
nrcrrufinrarioa{ercrdrdrptd.iT
Hon 1971 cited
Cordero and
in
rdo.rsrnrdnl6nqvfiflflr?n?eunnrir.lernr6nlmu?afftrarU
nrn ru4zunfi rdn 16nsvrfi ornrevnao.roanB
t
) tilnr']vn"l?flrrl
rsutd.ire
sn'jr'[u't"trrU 6tnu'jr
.rT
guue.l
uarriotrlrfi
or
uQ{udcu'[rar!nvulufinm
e4v9)eotdl
t{nn?vVl:l1l0.:nSn??3J}ltl1U1nUAAn1?SUFlO.ine[nnU1?nUtnnnAnU?O fl1?nnnOnn0U
riruuorrionirncrrudrufioso.roond^reu'[uunonrr6onttn.i
rdu flrnofn ( Peters ,
1gg2
l16
drnrefin:srruasorfiqn??Nnslulndsvdtzunnavmuriannluvvrl{nlernrntot{:Jce6n
niruru 10 Fru
nnoorriouriruuorfi:l'lerficEro''lnrflo.rtvuurrltlloqnnn
d
o
4
tt,
I
e
tffud
v
a
v
d
fisneeil
nlen:cs.Yndrgrprrudn nra{orqruuqfinrtnem
n1?
rildfluyi'r nrarnrry:lonEnrc{rJriv nr#rrirurin nratsrvtdonnrcsm{fio{vrnna{
n1?
ilerrurnfrvnnraRntn
rirflnrni{d:lon nre{r.r
I
.i
|
v
nrenldEJuffrdoru
e
FroFrlFr?lNorJneso{oonfl[su
:ro.rri'ets
61
rnr
nu'jrqnfien??NdlN1?nr{truanavnu
4
4
t6l
v
.
v
[uunon[nonLn{ ?erJn{ nnrud'uluaruo.r dmernretmu
nntidulnfirr lnefiqn:arufirirtrirfiornrqvildoroon8rsulfiurn tfiuri
fiqna:ru
'dirhrarin finnearqa16rJlrv fiqnreildrenTni.rdrlon fiqnaeil6{flnramofoon rdu
rfiflcfiu nmfintnsa.r ntilda ( Speidel 1978 : 864 - 865 t fifinurarnnavmuso.rfi.nttud
a
o
6f
I
o o
vn
I
c
vtlt:JuU?vs'] tury:leflnaannaun1lruFt
!
coc,
9t
4
v
6
4
-
o
{{n tlrrJnnnlgnn{nuno 4nnsnttiln1N1?nil1
trlnirnreruduso{aonfireuluunonr16aor![n{nora{ 6.rur.rfisnrarufinnntrurnsurio'lfirfitl
n1,ryy{do{oonfirqulfindu
ffiud
fiqnarsJrq''rvrdon fiqnearur:-ldauffr:lfiuou nrarire
nrnfsfirloor urn..ndriofinrefinmdnunrflnrefinmfir,irtu{:Jcafifiorqrioe
syrflunranuentfior nrannaoorrioudruuor mranilrufnoTcfiae
tdu
r{ru'[rargj
sosnotdtmvnrruv
( Longs , et al 1980 :203 - ZOz ) maf,pra{ uav rrrdTn'i'( Murdoch & Darlow 1984 : 957 -
g6t ) unrudafn unv
nilv
( Danford , et al 1983 :20 - 23 t
flluaf
unv
s{s?ert
( Finer
& Stewart 1980 : 319 - 323 ) nonrril,lareri uny nruv ( Gottfried , et al 1984 :292 - 294) fr
qvdn:rt unvlffarnnrefi n:g.rtudn:gruyFrfi1fl nn{nu'rr
i
A
enfl n
, 3
[ualu
ct
I o i
1\et1:J1nqv t:Jul4u.t tu6.l ttc
adAlt,6.lvevegttt"-Yr'.!9a
e
f,, oea
nnoilnno
O
lun13E $n
94
O
{uefl luuo
r d
tu tn n n1??llneunq
[nnil1?n
o
v
[e1:J1u
Fl
4
noSJnqv
Nnqnmililqyno{yt1 [14ltnvquno.lne{u1EJUoEJFl?.I tmntn?{nqvno [u[nn9Jan?tvtuvt'].t
48
*
6.'rn.uo.*oioffrJce tri"irqyrflurirnctrdr.rd'QsataonBtqu'[uuaonrt6onLm{ nclrudu
'[uaruo.r dnmnmrfiuqa{ri,]ts nrnrruffuTafin dt:.ntfiqner:.rriotrirfiornrar:Jdeurt:ln.l
r
a '- <r
--4--^^^-^^^^^r^-.-9---^.-..^^-F.^!.-^^^t----.--.tu?aumnnnonrriounruununvilullr{n
Torerrqilryfiuyrlenu?ntfin
sJlnqun{fluounflEr
d'cfioe firurnrfiornroyildo{oonfirsurflurcn1il1u 1 raiaffrprgrrudnfinrar:ldsurtiln.i
qvvirtrirfiorn,.Jruldsureu6ofinT erioo{fl'Jvde{rA'zu 1
4sdur?ono,n.rn,ir:lnfiuny:JoeF i.r
rdu nruo.r rflufru
ritaiu
a
fflrrvirnmfi
nm
n,mfi
nur ttl?eu rfi fl utueyu"jT .ldn.lorq
u^ru^dr.
nrefinmsor btnrttn
Lrav
nrurfi ei.rtri nq:ltfr urid'orir
nilv
ufl
( Potacek , et al 1992
oir.lrfu nu"jr
riuviiohi ldu
urunqr narqfi rirt
:
457
-
qaz
I
nioefi
eT{1ri
til"frlrnrafinuafi.lzun
sarnra{orvirrianirnrcrud'uso.roanfirqu'[uunontdaoruor.ltu{:Jcerrdnud'trird'orri'QtsLmvfi
nteyrlooruylu lorsvirnrefinm{:Jcetrdnrad'.lrird'orri'c1q'irueu
rdou fis
to
fl
a.qr"du 94 rdau )
{
nreud.iv,{6nnyMr{d,t{nvi,rix 1
25 nu orqevu'jrt
1
{ornirrrctr6ilfr'rso{oonBtquluunoortdoorun.l
riu tfiud viruouu.$1fl
viruounvunr.lrfiu:-lonrr{cufi6
rl
liruounyunr.lrfiu:lanrfiur'lu Lrnyu"rne1ilfrrur{ufevu'jT .lorqfirirtriuri'urirprerru6rud'cto.l
a,l
5t
a
r
el y
q
aJ r
d
A
v
e
I
v
o1qilne1il6tJ?\uott:llltJntlununlnelNFtuflo.S
e
.ae
aanEirquluunonthanun.ioal.rtJuelalnrunl{nfifi
d
g--r4-.!..
d
r
A
i
rf,
| u I
oan{tqufitildElurtiln.iltj Tru'r1
^, , 4^
6o
lr =-0.24, ^P<.0s)
t2t
d
O
|
.
Y^Il--
{:Joatdnfi
| dl
ldel4
4
fiorqmnnrfirirnrcrruduro{oonfrreu luunoor16oorror.rfag uuiruanq:.lfieTttrilf]ufiuilfor
Jtvrrvv
t
tuo.ts']n?u1 nnqil nloa1{ Ftoufl ''l{uafl
urioei'Ntefrnrru u.nrr4u^dtffnaircruruff'r{tffu
q
dr d
c I
zi da
e
v
e
ct
a
rirtrltdo'jr flq{e
ld
alflnulqyruuonuq{flufr.rfrfrnrrruffi.rr{urioianretfrornretildsuuilnsrirnerru6:ld'cso.l
q
oonfi rquluuno
pr
rdopr unrr'[ufr:Jca 16nfi oqjtunrcvn-n qor
s'lnn1sndrr.l,f,"u^rures{uilesaru nerilf,urf,udesra'ir.r ettn-untatildsuuiln.r
r.lv
n1n?1 ila il
t
nera{aanirqulurana nt6ia n uor.r
fn
t,t
t
16
a
q :J e r n
t rir o r n r adr
.u ttve
,
ro 1 fl 1 n n 1 er n fi r
'
ru
rdo ua vfl r e vdu :l
o 3
av a
o i
ru
ru
r'[{lu
o qst v
{:jcafioqilunrc;6nqnfrotldfunredrerrudotBrs'[{rnr?o.rdcenare"tsil frrfrofir"tfindrru
,d.^.u ( sketetat muscte ) rfiornmnnretd'e {rjctfiornrentunttridura?aio.rtr1 nafrm
*
irruyffirri6o{dqflurstq rirtri{:JnuuT e'[qn']:Jr#o{dQEJure'[qtfid flatf,unmvuuen
{ouddrd'rgda nrns:Jonunn
( pneumothorax t rirlfinreunnnJdeuffrsrflul:ltfidntl
uruunreintnsoruyryrri urn^.nduntunrerirtrXnffruldanarsd'c fiqvtflunrannrnrfl{
oonfitsu ( oxygen
consumption
d{u
(Arterial oxygenation f
t lotnfirurdo
(Stark, Bascom,
rir'[rlnTevoonBtqutuuaaortdaorupr.l
Frantz 1979
:a+Z ttdfinladn:rnfi'lruntos
e,'lnnrEJnfirurdotufr:Jnel6nmmnuenrfirrfia{'[unrcrinqnunvffo.ltdrndaldceure'[q
ldu filruaf uny vrorufiei(
unls?.rgl
Finer & Tomney 1981
:
641 -646 ttfirirnrefin:s"l
{:Jcu,irucu 10 r-ltr nnonrriouriruuorlnflfiorqnaaritJavrurru 26 34 drJotf
ururleyrurru aa deh{ riT rafnuennrnoor:Jav:nru 9oo - 2ooo nia.r hlerrrnuqlardu:.r
-
I
luer.nsd ( pancuronium
Bromide t
Toretri4n 12 t'otuo
nu'ir
nrnoortfi
{rJcertunr!runrcur;runrfi
dq
?vslylcnlvtrr]ornrcyylda{oonfirsu ( Po2 < 50 ton ) illun"jlnojr.rvrorno.lotjrtfiriuz{rd'rg
nNdfifi(p<.001 )unyrilnelr.rd'utouSrtulfiodurtruo.i(intracranial
pressure)tunrjr.t
ncuqruovfirirurnn.irn{rumoranrmeir.rfiriadrA'ryflfid4fi(P<.001
)rrritilfin"Jril$nn
r,
dA
|
4
,,---9--y
I
v
d
I
d o C
Evivt ,____-__fif.lflututSo.lRif n0f rudugo{filtn1.i "l yl?tFrf1y14 [ns1nn']?tslvtnan nlnelNt9iNtluflo{
oonfirsulunuuretsr{ldoYit{t^u,^dasdceuretq uriffi{afrnq:ltfi"jr nredrirn'crrud'u
q Av
? o J z' s' - r^^-^e^^-C-r- nsvflcflnnn01&lv'ln1?vlolssv
'
flo{u1 t1JtElAq3J6ilA{nnn{ Rley?\to.tOOn{[quiluogncl
o A
v
et
o 61 2t
e v I'
-i3
6t?. i
I
^
lflIFI30{scEl1r1g
rringiunutdnL[?nrnnytulilunncuogunyslruuno.t
q VIV
[q
[n
.,t,--4-.-r,
tnutolEJ']nun1?
flnmso.ltnru unynily ( crone , etat 1980 :237 | d'i,loudffifuarrrarenfirilrdosvfiri.
nerrud'uro.roonfirquluuaonrdanrrrnfi{u unv nrafintnso.r ul.runamd ttnv nilv
I
(
Manthous
fl r n n'l a n ff.r
, et al 1995 :
r.r
rdo s vdc
.J
<i
- 214 t vlu"jr{:Jeuntcrinqnfiffo.ll{lnr?atdnflilrtlts
etrln r at{o o n? rq ue o{ n ffT ru rdo n n, nt rur n n'i
nrefin:gngotg{nrari unv
6
210
f
nilv
r
( Stark , Bascom , Frantz : 1979 :439
I
rd
@
v
a
20
3".r
uonqlnunN
Yo
- 443 ) fi{iln?o.rer
6l
|
d
Ytl
Turrursri rio nraunnr:ldeuff'rqunvdnfln.leufinnrcv:loorrwrnlufr:jcurfrn
ruvruqTerfiaru
yrranfi'Hrn?a.rdcsurets runnrefinmnu.ir {:Jce tz mfl'[u 27 T1u nvfi n.oo, ddu
rur n n.ir 1 00 Torr nr gild{sr ntder o detru.r tJ.r ru n fi eT.rtri n qrJtdrfl ud uri{o
rn
r;
run ruffi $o{Er1 nnlsndrru rdo rrn vEJrn6iail:lrvnln $avt{nnrafi
n:rd
o OZJ
&
r
d
,
V
?, 2, 2,
* - !
t:
lFlnnl?3J1Uneq'r{FrU yt't tlrr{ae''l :lqqflt30.ig1FlR1flnn1Ntuaunvfl1nnoil:.J?v61vrnu']
Vi?t |
t
I
d
q
e
A
tl
dd
(
v
a
|
a
v
a
dr
dr
ral
|
qytiluon:JqsEll4u.tytSJFr?'uJ63Jytu6non1tInnn1e[:JnEJiltr:Jn{n1nc13JoilF|eflo.loonfl
tsu
'[uuno
pr
6o or uor.rtu{:jce rdndoqjlunrcvlnqn
50
t
nrailastftunmsaanitqu ( Determination of oxygenation )
6
tunlf
di
oio,
t n
q
I
rq
-
n t6 rn ?a.i{ efl ulEr ts un vaq tunl? vc
a ttn ryiles
nq
n
ldotqrnnratfio'
oanfireudrfifl.iflotud''r.in1flso{{:-hsrflud.idfinrcr:.re{rd'rgrfluoeir.rdt
Rlcy?\?o.toonfileuilo.rrdrrdr
( tissue hypoxia
)
n''l?r{.iai1u
o'tssvtfindulfrnaon'realuarun?o{n1?
rfinnreynea.rsasaanfi,^uruodudodqvrirhl{nrarfinrnrcrrufinreunvrirtrfi{:Jcerrdfldin
tudnrrfi4.l ( Szaflarski & Chan 1989 : M4
|
nrelflrdrtnnalnl?unvo'rn1?LtdFr.ffito.rR']cv
nda.roonBrqufiarflunrarflrey6'.rfiuuenurififra'i1firrun1floeir{
a
rdu
n.rd6tlouuulro
arnrerder,r(cyanosistfitritfrlflur.n.rddufiotfita.rnr?vrlra{oon?tquunvurnsvtdfr
fio,irrfluarn.ruulror?r4orfireno.rn1,rvildo{aonQtsu urn..ndr.n1?Lmvo1n1?udFl.r
so{a{s,rydfinrequfirs?u4nrfi'ra ( end - organ dysfunction) frtric{rilrenuonlfifunrru4fi
lu,o
a
[a?\1ytq''l yq.igo{n1?6.t rJ1iloo n{ tsuu
rdordorfio,n
milrderurflufic
116or{oonml.rornrerir.r
t
[3J
uo
[y'lEl.w\o
3
d
nsl nilo1 n1?nqvu6
6v d i
tlrulrJo
Fr{ [u
natndmtnlEJrIEr''lErlrJflFrt{sRl"Jvnda{oonfilsulnetnlt
d.rur.rornrefiqvt:lnrdrgfiuarnrtllavo1n1?unntgotnratfin
o.ordr* 1 ,dro..n,fluarnrefikiranryrs'lys{ n1tilrvtfiunrQvoanBteuso{dl.inrafirda
&
4 hrxt
o
o,
4
v
v
|
^'
no rn ruflruyuuonqlnqytfrnmdT u"Jruu?onnnln?1NorlFr,rro{oonfitsu'[uunoort6onun.r
nirnrers.rd'u$asoanfitsuluunoorrdorr*nrrunyevd'udlrulnnfiuudc rrei{orstfrdrrirt 1
Jd < rar,.
I e , 3
I a
a
- , u rjj
(Azaflarski & Chan 1989 : 444 1 6i1fr'.1n61'11.1
Fr.iFloluut?\ou?vtNuRlevoonfltsuv[gonotfr
6o
- diumnrtrr?fl ( serum Lactate
- dn m e urvu.i rr Gru 1 rua o nA rs ud rdo rd ot{fi'ul?m
)
*
r{
rua a nfi rs ufi
d{t#
&d
tuotElo ( Oxygen Extraction Ratio - OER
-
rirdneT
r{euso{[donfitiltfiiuoon8rqu
I o
fi
)
&eo-
4
( shunt Fraction
d
lne.r?' I v
'
rlunrefr n:enfl {8{at6"Hdr,6'mn deuso.:
6a
Lnild1un1?:leyffi unr.JyoonA rqusot ffrjcu
vd
tl.i
:Jfl
4l
)
A,'lri'tdiuoo
,re'-
orfr
e
nd rsurfl
u
-&a
fl A YLOtl tl Fl.lUF|O
drdnerr{nuqatdonfitiltfiiuoonfi rail ( shunt Fractions t 6o nirdnyrr{'lu
s
ot
rd o
nr
d r dtra n
ai
r u rfi u
u6 o
or
rl a s
nr
eTu:l
on
urfi,rtillffiu
n
r
e urn
n ul d
Er
ufrl
q o o nQ rs
u
rfio.rqrntilfinlaivursornT nr,16ofinl??v:r'rErolnldrJlnfiorriT .rriu'[uqrnruu?rrrufirfiu
rdoorriru (underventilated alveoli )nrnartu4'[nfinre.r (Ahrens 1993 :200, Butler 1992
:
51
r
t0t ) r?flnn.otd"i. tfiornred'ornretu:lon ( Intraputmonary
f,o
v
shunting ) d'snrJvdfiarflu
6
c{1[ur]ilalnrU lun1?finRlevr\ro.roonA[suvr1.rnrdfin d{torfl:lnfil6c'[udrsnrsdltJ"l?n
svrfinnlesdornrsturlordlduoit*l^e*fiu
5 o/o go{il?sJlrurdoorfitr,lnaiT
rdatorfimrrudnr.Jydt'nrstu:loor ( Intraputmonary shunting
uiloo'fi.rur.ro'
t 1fiil{u rictqunvnfrrudufi
lflunraurerlssyfio{dr.rT ulfiududrtruuun''r?nnn.iqa{nreunnr:ldflufirttdo.iq1nn1?
a
nn{$a{n1?fvu1el01n1
da
O
t
Fl
r
tuTtl{nnun
nleynF]R']EJ
6l
r
h
' '
tuiloFtsvlilna
frordruso.r16op,fitrltffiuoonfirsufirir4.rurnn.jr
t s'2"
al9,a
5l
|
4
turnnolnlttol'] sunelHoFrl
d.rdevdud{rl.ranvflnrardrumutu
n1?u1flts ( work of breathing ) uavndruldarictssvfinr:l{oanfitqu ( myocardial
consumption
( work of
oxygen
t rdudu dtaiurvd'ud4trurnn.jT soz" trutunraev:r'ltro1n1flerd'uqtnru
)
atveotar ventitation
svtrirfie.ino {:Jcerirrfluffottfffunrrd'terudatnet{
mda.rd.Jtlil.rfl'[q (West 1985 , 6'N'[u Ahrens 1993 : 201
)
nra:levffi udrnrcvffornretu:lon ( Intrapulmonary shunt t tu{:Jcenrufl u
I
o
r
o
I
ia{
a
uty [Elt1lN1n tunlr:J?vtNuo1n1?vr
:layrfi
d
F]1rulrt?o
va
qddc
a{
rnen{fl o{ ryuefl
og.t
NUn1fl eOilU18J','l tfl
u d.rrad'nlunT a:lry ffi usur orsor nraffnnre'[urlo do oo nA teuJ'rlatuqr
n fi
:l o or rfl u d'e u o n r?u ff ufi { ri r o o n B rs u'[uu
no
nr 16
o n un { n 1 il :l n fi ufr c 16o n d r
dtu
n
ai
tunlt
n
T
ruto.r
url o n
qvff:lffnri'uq.rnrutffficunrorruaruqnrieyu.ir.rdordcunirncrrud'uso.roan?lsu'[uqtnuunrtu
I
navuAtdorr( equilibration of alveolar
/ blood oxygen tension )
fistuvrT.lnqufinirnrarrud'u
sa{oan?rsuluunaondaauortunv'[uq{nNne?svrvirrTu usifisvfiur{n.,rEdd.trl'[rirvir
rrv
cg
c{<{
c <{h
r
tn o n n'] yt tu n rJ 1 uq.t n il vt u Tt fl
v4dcata
nun o q{ n il il n1?yt1.l1urJ nu
n
Dl
a 16
d
h thrv
aR 1 Tt ils v tu
tFt ?:.1
oonE tsuri''rtrifinrezus{:Jii'uryu.ir.r rdondr uny6onrunrdurflunaEdrt#finranornrsosri'r
ncrru d'uoonfi rsutuuna
rr
ldo
or
uor.r
nredrucruurnirnmvdnrnrfl'luilan (
.g
q
Intrapulmonary Shunt
o
q.f{
t
q.ft
riSonirdmer
c
Ah ,Uvu
,
h?t
v
nauqo{tnannHJtFr?uoonatsu ( Shunt Fraction ) g{lNranvi'tlnrunrflerq.i?fi'vlFnueilLtnl
tfr
rlrtndrds{ fiu nor :r rfl uq?r ru r nfi 4 n s1 n q n?
52
?
Intrapulmonary
where
=
CcO,
CvO, -
&O,
uoi
=
Shunt
CcO, CcO,
CvO,
Capillary oxygen content
Arterial oxygen content
Venous oxygen content
nradrueruqlnq n?dfi fit ffriau{r.r.irr{n lfio.rnT n ff:.lca,ir
aeur{rtrltuduudaoruor{nlettuilon ( Pulmonary Artery
t
CaOz
catheters
nirrir.r 1 dffauirrurt{drurru d'.rriu6.rfinret{i6nradu
q
qd
o
1
- PA
uffo.rk{arEl
catheters ) rfio{'or
rn'ofinvrira.n'W:levru1ruri1
I
v
i
r 4 hgz r I v t
nirffordeuevu"ir.rnelsJAu
r frnaircfr.r't6rrri
9o{oonAtsuluunonr6onLln.uiil'[uq{nsJ ( Arterial / alveolar ratio ) drfforr{cuevu"jr.l
ne"rrJd'uso.ioanfirsutuunonr6onLn.ifi':Jrilrrcrrur{ru{uro{oan?rsudtff5u t Pao, I Fio,
r
I
e
I
i
n1cydnn1fl"lu:loordtnri''l'] 4En''r?Fr1ueildu
ratio
)
nirruarir.revu.jrtncrrud'ugo.ioonAtsututl.insJunv'luuaontdanun.i
arterial gradient
(
t nirfrgfltun''l?u1sts ( Respiratory
oxygen content index
) frtumntlunlfl{d
Estimate
index
Measure Formular
D
/ FiO, ratio
PaO,
Normal Value
I
Greater than 300
Greater than 6070
0 -20 mmHg
<
1
PaO,
O^z
content
CcO^
--2
(CcO,
where FiO2 =
=
PAo2 =
PaO, =
CaO,
snfl {d
a
dr.rr I
us{
fraction
of
-
- CaO^
<
5o/o
CaOr)+3.S
inspired oxygen
arterial oxygen content
alveolar oxygen tension
arterial oxygen tension
n{fi {661un1 ?d''lue il rirnrc ydnnretuilo
Ahrens 1993 :202
F}
(
Alveolar -
) nird'tfitot,i''tueuoanatsu
3
FiO,
Arterial / alveolar ratio
PaO2 I PAO2
Alveolar - arterial gradient PAO, - PaO,
Respiratory index
PAO. - PaO,
PaO,
i'
rfl
un
vdtj n fi
I
AaiJ d' io
i6fr rilufr
6e'
f, e
ru'H
i
n vor c n un v rfl
< uc"r
ofr 016 lug
3oa
ruviifi
oe I e
6o nT rHdld'n
fl rhuiro.r
ueddvlttra-l
(Pao, lFioz )
Fl.JlrJdUOOn{rSUIUUAAAT6iAA$n{nUnCleJ[trJ,lUlrO{OOn{reil
$nvFilrJn
oir.revu.ir.rnrcl:Jduflo{aanfirnu'[uq{nNuavtuunant6onun{ ( Alveolar - arterial gradient
j
fir
)
lotreua ( Ahrens 1993 : 202 ) nair'r'ir i6fit{nra{nrniratnrirtavu"ir{nr,rreJdu?o.r
oonBrquturl{nNrnvtuunanrdanLrnrufluiifitrXncrruuiluoulfirioerfi4ortunrailavrurru
ertu:Jan urilflufiriru:lnn'[q'itirtru6rrfluQf;fifinrurirt:Jt{rrnfi4or tunm
n{rnre vffornT
4
|
|
2'
v
ri
<r
:Javqrudortfiorar{orrq:JrfiecfluTan [o o1i
f
ARDS
d roc{ ( Acute
Respiratory Distress syndrome -
) flo.tuililEinrrrduorr.r?nlmyqTt:l ( The American -
conference on ARDS t
European Consensus
d.r{n'{udrfia.rtruard :Jrrrvranuffgaru?n1 tu{ufi 1o v{q:en'rnsJ
n.A. 1ss2 unvdrfioturfrqnlarir :levmnnr:lu lu{ud 20 qn1nil n.A. lssz fitfifinre
nnn{fiqv'[fin''rad1ueil ntilad,)ueu,r"ir.rnnrrud'uira{aanAtsuluunaor6aorun{flun"Jrrr
lFioz)
rffru{uqoroonfirnufi{:J'rs1fii:r1uq*rtiu(pao,
rflurnrus{"[unra:-j.ruonnlev
oonfirsuro.r{rlca rdo'Hlunrernh{:hedfinmurBrr6usor:-lanoeir{rdeundu ( Acute
t oannrn{:lce ro arf d ron d.rrflu{rlefldfiflflrBnnrntu:-lonqur?.r
Lung Injury
lore
riruun'jr{:Jcefifinraurort6usatrlaoraeir.udflund'u ( Acute Lung Injury ) qyfiri1d1frFl
r{euevu.itnrcrruduqo.raanErquluunoorrdoorun{fi'uFrcltJt{Nfiusro.roanBroufifrrJnetfi
Sutu:rruvriu ( Pao,
t Fiozl
evfiFirrvirfiurlsoriofln"ir 2oo lil.t,:Jeon ( Bernard , et al 1994 : 820
d
v
lY \
rfracrYu{:jrer
I
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nc
r
ru
6
ro orf
aJ
d
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orf d
rvirriuriBorioen"ir 300 lur.:lean dcu{:jru ro
dt
9/ t
a{alq
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)
ran
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e
4
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fi re uluu
n a n rd o n
un{ fiu
nr
c
r :r rff ru{us ot
oo
fr:-l c
atfifutu
sruvfu ( pao, lFio2 ) lflufrcrlevlfiunrnvoonfirnura.r{:Jeflm1ru,Jndq:Jornnrailavqru
dnruqorulrvrti{rdsetrrgd'rndle rdu tunT afin:flflot uoud unvrrruv
(
(
Knaus
, et al
1994
)
rSo.rnra:lavrfiunre'lridrnirfirrprerue{tafu{:Jre ro
Evaluation of Definitions for Adult Respiratory Distress Syndrome
tnru.rflunmtlernnc''l:Jqurra.rto.r{:jcerdvirnmfin:cl
( Morris . et
al
1994
orf d ran
t fit6"Hrird'snrir'tLflu
don
16 o or
rd o ra r ff T q
orf d ros{ ( Randomized Clinlcal Trial of Pressure -
controlled Inverse Ratio Ventilation and Extracorporeal
t
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unytunrefin:flflo.l ruoSs{ Lraynfuy
tfi x r n n "i r u l s tq a o n un y n T a'lfr r ndos
nnfuouloroontqniaonlu{rlre to
Distress Syndrome
n,A,
) tunrafintn6atnral{rn6adeflurfl'[ntfinrn":u4runretrffutner#.r
rc n rtu n r eu r er'[q r{T
i
tufl
CO,
Removal for Adult Respiratory
firdurdecfi'u 6tfio,jrnreurrirnrrsdnnre'[uiloor ( intrapulmonary
54
I
shunting ) uionmutdTffnrc{euea.lrfioo,dt*tfifuoonfirsu ( shunt Fraction
t
rdo:-i.ruanfi.r
nreyoon?rqutudr.lnrrla.l{:JcerTnenT at{drdnardcuevu.ir.rnrcrudusatoonfitqutu
( Pao, t Fiozt rflunirfi
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.aJ-d<
t:tuvlElo
u ?1l
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ft
ulor
erldriaaaanift r naf
nreynaotoonfirqulurdopr uN1sfi{ o.ordfimnBrsulurdanhirfisr
*
T{o ( Brunner and Suddarth 1982
: log t Torgfisl?tu''ls1nn.tdfioi.^o.Ltd'uta.laanfitsu
'tl,
'[ur6onrutor.lnoroirn.ir
n'ir
g4o/o
I
os finhrr.rna:laon
Rieget and Forshee 198b
u?onirncrru6rufrcso.loonElqulu6anuor.:dr
: soz ) urituff:-teadlffrnrdo{dcauret1sil6ofiflerG
nnrndtdrarafunirrirt 1 tunm:Jayrfiunrcyoan?rsutudon n'rat{rnruqidd'orfiuqvtr.i
n rJlynrJ nrcal:l?erurfir.rurTuniT rJnfirorurinrqnrnrn lnQn mvnontdflf ( Lewis and
Qolier 1983 : b97-b98 )
tur6oor
rfi
nair'r"ir lufr:jcafifinnrn:lonrilnfievfio'jrufinnrcvndo.loon8tsu
ofi rirnrmrud'uaonfi rsutu6oor
unraeiavu.ir.r bo - 60
fi nh
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niT
ncrrudr.rd'cto.raanfirquluunaor16ooruorrdrn.ir 9oo/o rri{:Jcudrflulonr:.Janrqortirtf.fo
3
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et,
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oanfirsu'[urdaorrrrrdrn.iT bo -
I
oo finhmma:laon
d'.rriu{rJee:Jrrrrd6o^cedruuBr
.irqsfiayd'uso.rnersJd'uoonErsu'[urdonuor.ru?orirn ctrdr.rd'csoroonQtsu'lutdonun.r
nan.lqrndr:lnfisoruoinvunnn dofduod urfdaunvrrruv (
Marcus
, et at ,
1992
:
1230 ) tA'Hrnruqid'nrhunrcyyrda.roonBrsulorfltffdrnorru6rfrcqotoonfitquluunaortdonr
tttl
uoxfidrn'ir
9oo/o
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^^
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n fi
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aanfirsutuunonrr6onltrr{ ( sao, ) ( petty 197G: eoe ) drnra{nrs{rsJrendrtfiunreriido
55
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1. n1?m?0satnmvrfrrff'a'Lum'orrun{lnene.l
A
a.r3ocr.c
,
nreqe rn?1vlr?ou rs L6on Lm{:hvillru
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(
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o
n1?
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Blood Gas Analysis
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t
Transcutaneous
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t filff{rrrirncrruduaanfir^utiu
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( calibrated)riou'H4nni.runveyt{drnrcrrud'uoonfiusudil?lng..n,^du.llfrrad'.1
56
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fioruaiu6ranrlvrerr
to -
zo urfit:lufrc
tdo{srnfforaohificrlrftlfiudu6rnnrlyreoFoudu
dau t Mok , et at 198G : 960 - 962 )
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uan tfi n rir pr']r
N
d'uo
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( Pao2 )
a
nfi rqulurdo
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s yfi Fi'r
rdorire,crrud'uoonBrqulu6anruor.l
at,
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t
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( paoz ) qrn'jr
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n?1sJd'uoan8tqututdoorunrr
( Pao2 t dqnffortfr
oonf rqutu16ooruorrdficrarft
(
tcpo2
( Pao2 t tffuri nolrJrrlllto.rfiruri.r
ad
liiatEo ( oxygen consumption
1991 :489
)
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flrgrardu
1 dtl.ttfoirpnrrud'u
unnrir.rqrnnirnrcrrud'uaonQleulurdanrunr.r
nratranrdflurdaorfifi'rilf{ nr:lffoonfirquflo.r
t qruraqfitatuiludtnnlvranrfluffu ( Hansen and Corbet
)
g.nm{orrirnrcru6ild'eso{oonBtsu'[utdoorttor.ryrr{fi,]uli.i ( Transcutaneous
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rdrrdr uny uipr6opruorr
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)
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(
oxygenation
and
57
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ventilation )
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( sleep stage change
)
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58
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1991
:60 - 63
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Fiberoptic Transmission
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nr,
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1983 rsarnofruluunyfie ( Yetderman and New 1983 : 34g-g52 f lfluffir?ulorelfrrGeurir
t
nrerildild'cita{oonfirsuturdooruor.lyn.rficuf.rsrntrido.ldnrlunnrof - 100 ( Nellcor - 100 )
r:l6eurfieurYunirsrnTn-oonfifirrtof (co - oximeter )llu'irfinerruffr.n{uffrud (gooo
conelation ) rdanirnertdrud'cso.roonfirsu'[urdooruor.loqjaru'jr.l zo
nily
( Kagte, et
at
1987 : 376 - 380 t
100o/o
dilrd'cso.$oanfilsutu6oorurrtoqiavu"jrt
) nu'ir
fincT rudrur{u:ifirfionirnrnrru
oo-tooy. tfrfinrefin::nu1ne1rJfri.n{uf,riuranrtl
a
Ja
cffvl Mm?lq
tFltO.lN0
frrirnrafin:*T
nr!rud'eodr.:
Sa02range
lo/ol N*
r:-Eiflurfiflu
Yelderman and New
tnntfia $nv
finmtrrfll{nirnntr6rud'csta.iaonfitqutu6onun.l
m.lfiQufi.tqrnlnrdo.ltamdr - szoo ( ohmeda 3700
nmfin:rnd'rtunrmtd
-
1983
N11;
Nellcor
r
CGOx
{fi4rnrn6orq razs fl
70-100
79
0.98
CGOx
{fi4:rnrndorH2240fl
7U100
277
0.98
CGOx
HUeilNVtfl16AR','rvilr
35
0.93
117
0.96
index finger
|l
Mackenzie
1986
Nellcor
N'I1;
middlefinger
Brodsky. et al.
1985
Nellcor
Chapman, et al.
1986
Boix ll ;
lGgle, et al.
1987
Ohmeda3700;Corning
index
finger
CO-Ox
a
d
79-100
t {r.r
{fir1nnTndorq2z44fl
{fi4rnrnfiorq2244fl
7S100
48
0.99
60-98 24
0.98
60-98
CGOX
Ohmeda ; ear, Corning
Nellcor ; finger ,Corning
G
a
rloor
index finger
?
vo
{fi4nnrvrdoT
q2z44fl
{fi4rnrvrdor q 2244
fl
n1fl{d 4 nraQ{edunn{ne1ilil1rdefiotun'reinrso.rfinaaanBfirnof
-l
yll.l'l
; Bowes , 1989 : 543
60-98
48
0.99
60
I
tuynrnfiorq:.nnn.jr
r
rdou{ul:-l fi{frnmnrer:.nirlqdofiotunT al{r{n
noonBfipraf luurannrjr.rdranretarfltdufiu rdu rMuTnrdunvnfuv ( Fanconi , et al
: 362 - soo )
lthrurtu unynrruy ( Solimano, et al 1986 : 844 - 848 ) eon ic{tqad
( Ross Russell and Helms 1990
:
725-727 )
1985
unvBdr.r
dn:*rnu.irrirnrnru6rud'csotoonfi,.ua.n,#.0
rdnnoanBfilmoffinrerrud'tr{'ufriuriunirnQril6ud'csotoonf rquLtnvrirncrilfruoonBtqu
lu6o
or
qsdql
qqs
il
I
uor.rsl
n
n1?n?eq u6o orlne ne.i
il il fl n or a n r affn un s ua or s rh n'l'l il A il
n"ndoonitnod
n-.r g a
sa o n
i
t
q
ul
u t6 a
or
u
or
sl n e
(Bowes, et al, 1989:541 Llov Sonnesso, 1991:63)
r .n r
ern d a
utu
c
ff
r yn en ln d outrac o {fl
e
vd
c
ufi fi or d'e iprt{r{n
naa
nfi fi
r
no
f
orsdnrirfinnnrortffrfloou.nn.r,^doutu':rirhifiemrvrnrfirflnretffuso.rdnqedtrfludctfi
@AAavQ,luo
r{nnoon6frrmof,L{{nrirne1ildiln'eflo{oonArqu(sao2)d'triu6.rnrce6pru?rcrufifrailqh
5r,
ue't Ad a uc,
d
,l
tuoqu{ s{ev [FtFrlvl[flon0
2.
tol
nTetranrdeuoir ( tow perfusion
t rlnfinT rtr,lnfisudonu?rerudefiofi
cr a -la
€
v
I v v v n
riouaqjudr fir{:JeerrflulenrfrNrrQrilForilnfisosunonr6oord,tu:lnre ( peripheral
|
disease )uSounoortdooruord'c ( vasoconstriction )
vascular
svdr'[fifinaoonfifilrrof tilneru{.lunv
nreduso.rdnse unytrialrJl?n$dn.rrirn',nsJdNd'csoraenQrqulurdorrllor.rlrlvrerutff
I
3.
unanr6ondr
n1?rffuso.rl,raon6oordr ( Venous pulsation
t
rlnfiqvtilfinreffiuso.r
uoifir,rn.un.,ro;drirtrhfiornrfiT snl?tffu$atdnqatfiprdulurdoorriT tdu
nrcvrietq{r{flc.re1el ( right sided heart faiture
)
nrefiord'c{nrrniurfiut:l svd1lfifinnoon
u
fifirnof
)
( pulsating venous blood uavdctnra#uta.l
d I
Xo uu
4
u
i , Auv a u I
UnOn[n0nUO.l ( pulsation arterial blood ) {.lFllyltnSvtJn[:J n1?Uan[4fl{:Jruil']ilvl1[Fl
{nrrf.rdo.qnTatffuso.runoart6oorrir
4{
c
| v
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Cv
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i
v
d
d
lntrn1?rvrgruFr'loFrfln1?rffuto.rriclqqrnfineloonfifirnof tYuun?a.r{rr ( monitor ) rnr?atou
'
,
d - I vo
t
t{u rn?a{cnnnuuc
ts { ECG monitor ) firnr.rriu6tnvtrfinirfirdofiolfi
I
4.
j.{
i
ve
monatsJoFreruL[6.r
M{{q1nn1fluan ( outside light
(
Photodetector
)
nirnr"Jrildild'c"Jo{aonarsuqvtilrir
) to.lfr'c{'nr qneuncuqlnud.tR'tguon tdu
ttc{.tLlnrrl
"61
t
r6{t}l
torrndunyorrnf ( Eisete and Downs,
f, .f
,
|
1987 :864-865
r
|
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.J
4
C
| .v tY
frnilffi ?\:l,"j''l
-tl--t--r-frranoorlt'loqituf,atfre.idr
alrffnrf,.liluc{{r{.i1{qlnunondqoar?dr{udrJln
turXo.l
I
rnrdo.rr{nc{oonSfirnofunprrrirfi.r 98o/o ta'odrfot*Ufind'o{rrr{rriud'o{rJce nronnGTu
Llnynily (
Costarino,
et al. 1987 :
830-831
] erg{ru"ir
v{un1?udFl{drncrrudrud'cso{
aonfirquqrnr{nnaanfifimafForyrnrnt:lda {orrirnrQrildrud'csaroonErquturdanun.ltfi
o
<J
Jrn
ti'sht
)
n ev
r :Eu?o
or
d
i
)
d
100y0 tunrurfifrrJcefiarnrerfiflc ( cyanosis
tfiassrnfiLtn.ltv'ls''lnnredrd'or ( surgical
do.lairud'cfurr6{sa.id'c{a n1?Lffihrtilh1un{nreuon:J1rilneu rirtfiIoret{
v,r
a1n
fi n u 1t
t:
1 d tlr
s. nrcydnr
ffirnof
n
r
n vio
r{r.rt{6 n'fura
flt
ra6o o r
st{ttrfl nt{fi1fr
) nernecqavd'ufiXr.rlnafiufirsmsJa
( Anemia
dot{r{anoon
s nfi.t / orn. nirnrnrru
rne"ryuff.ireyd'udTr.rlnnfiuqo.ruransvnnn{til6atfis.l
drud',:so.roonErsuturdaoruro..n,^datfinnoon?fiunof olssvur{n.rrir:lnfifi1fr tnmvd
l:r1n nfi u
rfi
rvi
fi oqj fi nrc1 N 6'uJ1 ?n rfi :rfi
leu
lunT e{u riuoo nB
uoi
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tri lfi fl{fl otfi rneT vfi fiI:i1nnfi udqv{urTuoonfi rsufioEl tfi ulil
6,
.
:lnreund'o
3
( peripheral vasoconstriction
z.
6r
^
ne']tJt:.1ils?.t
)
qruraqfiar.rnlsd.r ( hypothermia
d.rorqfizunrirtrfirananrdondcu
)
I
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o
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v
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t
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-
2537
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fievfrudtr.rlnn
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fi
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nir PaO, I FiO2 > 300 - 500 ton I
do
fr:J eerd
fi
o/o
z
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pao,lFio2 > 200 - 300 ton I o/o
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fi n1?yrFr6oune1il
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National Survey of Neonatd Endotracheal Suctioning Practices."
Neonat Nehrv'1990 ; 9 :
Tremper , K,K. & Barksr , S,J.
'
7'
14,
Pulse Oximetry.'Anesthesiology l9S9 ; 70 :
98'
108.
Walsh , J.M, , et al. ' Unsupected homodynamic albrations during endotrecheal suctioning.'
Chest 19€Nl; 95 : 162 - 165.
Zander , J. & Hazinski , M.F.'Pulmonary Disorder.'ln : Hazinski , M,F. , ed. Nursing Care of
the Crltically lll Child, 2nd edition, St,Louis
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