Solunum yetmezlikli hastaların tedavisinde farklı solunum yöntemlerinin etkinliklerinin karşılaştırılması
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Dosyalar
Tarih
2020
Yazarlar
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Yayıncı
Trakya Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yoğun bakımlara alınan hastalarda sıklıkla solunum yetmezliği mevcut olup, bu hastalara solunum cihazı aracılığıyla solunum desteği verilmektedir. Solunum yetmezlikli hastaların tedavisinde farklı solunum yöntemlerinin etkinliklerinin araştırılması, noninvaziv solunum desteği araçlarından hasta için uygun yöntemi seçmek açısından önem taşımaktadır. Çalışmaya Trakya Üniversitesi Bilimsel Araştırmalar ve Etik Kurulu onayı alındıktan sonra Trakya Üniversitesi Tıp Fakültesi Hastanesi Cerrahi, Reanimasyon ve Postop Yoğun Bakım Ünitelerinde solunum yetmezliği nedeniyle yatışı yapılan 108 hasta dahil edildi. Tüm hastalarda yatışın ilk gününde; yaş, cinsiyet, vücut kitle indeksi, yatış tanısı, akut fizyoloji ve kronik sağlık değerlendirme ve ardışık organ yetmezliği değerlendirme skoru hesaplandı. Hastalara uygulanan solunum metodu kayıt altına alındı. Hastaların tedavi öncesi yoğun bakım ünitelerinde rutin olarak bakılan kalp tepe atımı, sistolik arter basıncı, diyastolik arter basıncı, ortalama arter basıncı, periferik oksijen saturasyonu ve arteryel kan gazı parametreleri kayıt edildi. Hastaların tedavi öncesi ve sonrasında inotrop ihtiyaçları olup olmadığı kaydedildi ve tedavinin 1. saatinde aynı veriler tekrar kayıt edildi. Tedavi süresince hastaların her iki yöntemdeki cihaz-konfor memnuniyetlerine uygun 5 seçenek sunuldu. Bu şeçeneklerden birini seçmeleri istendi. Hem yüksek akışlı nazal oksijen tedavi grubunda hem de sürekli pozitif havayolu basıncı tedavi grubunda tedavi sonrası kalp tepe atımı ve arteryel karbondiokasit basıncı değerlerinde düşüş bulunurken, arteryel oksijen basıncı ve periferik oksijen saturasyonu değerlerinde anlamlı artış bulundu. Grupların tedavi sonrası entübe olma oranlarında, entübasyona gidiş sürelerinde, mekanik ventilatörde kalış zamanlarında ve mortalitelerinde birbirlerine üstünlüğünün olmadığı bulundu. PaO2 /FiO2 oranındaki değişim sürekli pozitif havayolu basıncı tedavi grubunda anlamlı olarak daha yüksek bulundu. Hastaların cihaz-konfor memnuniyetlerinde yüksek akışlı nazal oksijen tedavi grubunda diğer gruba kıyasla tolere edilirliği daha yüksek bulundu. Gruplar içinde KOAH tanısı olan hastaların arteryel kan gazı parametreleri değişimleri gruplar arasında farklı olmadığı bulundu.
Respiratory failure is frequently present in patients taken to intensive care units, and these patients are given respiratory support through a respirator. Investigation of the effectiveness of different respiratory methods in the treatment of patients with respiratory failure is important in terms of choosing the appropriate method for the patient from noninvasive respiratory support tools. After the approval of Trakya University Scientific Research and Ethics Committee, 108 patients hospitalized in Trakya University Medical Faculty Hospital Surgery, Reanimation and Postop Intensive Care Units due to respiratory failure were included. On the first day of hospitalization in all patients; age, gender, body mass index, hospitalization, acute physiology and chronic health evaluation and successive organ failure evaluation score were calculated. Respiratory method applied to the patients was recorded. Heart peak, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, peripheral oxygen saturation and arterial blood gas parameters were recorded routinely in the intensive care units of the patients before treatment. Whether patients had inotropic needs before and after treatment was recorded and the same data were recorded again at the 1st hour of treatment. During the treatment, 5 options were presented to suit the device-comfort satisfaction of both methods. They were asked to choose one of these options. In both the high-flow nasal oxygen treatment group and the continuous positive airway pressure treatment group, there was a decrease in the heart rate and arterial carbon diocid pressure values after treatment, while the arterial oxygen pressure and peripheral oxygen saturation values were significantly increased. It was found that there was no superiority in the intubation rates, duration of intubation, stay in the mechanical ventilator, and mortality rates after the treatment. The change in PaO2 / FiO2 ratio was significantly higher in the continuous positive airway pressure treatment group. Patients' device-comfort satisfaction was found to be higher in the high-flow nasal oxygen treatment group compared to the other group. The arterial blood gas parameters changes of the patients with COPD diagnosis were not different between the groups.
Respiratory failure is frequently present in patients taken to intensive care units, and these patients are given respiratory support through a respirator. Investigation of the effectiveness of different respiratory methods in the treatment of patients with respiratory failure is important in terms of choosing the appropriate method for the patient from noninvasive respiratory support tools. After the approval of Trakya University Scientific Research and Ethics Committee, 108 patients hospitalized in Trakya University Medical Faculty Hospital Surgery, Reanimation and Postop Intensive Care Units due to respiratory failure were included. On the first day of hospitalization in all patients; age, gender, body mass index, hospitalization, acute physiology and chronic health evaluation and successive organ failure evaluation score were calculated. Respiratory method applied to the patients was recorded. Heart peak, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, peripheral oxygen saturation and arterial blood gas parameters were recorded routinely in the intensive care units of the patients before treatment. Whether patients had inotropic needs before and after treatment was recorded and the same data were recorded again at the 1st hour of treatment. During the treatment, 5 options were presented to suit the device-comfort satisfaction of both methods. They were asked to choose one of these options. In both the high-flow nasal oxygen treatment group and the continuous positive airway pressure treatment group, there was a decrease in the heart rate and arterial carbon diocid pressure values after treatment, while the arterial oxygen pressure and peripheral oxygen saturation values were significantly increased. It was found that there was no superiority in the intubation rates, duration of intubation, stay in the mechanical ventilator, and mortality rates after the treatment. The change in PaO2 / FiO2 ratio was significantly higher in the continuous positive airway pressure treatment group. Patients' device-comfort satisfaction was found to be higher in the high-flow nasal oxygen treatment group compared to the other group. The arterial blood gas parameters changes of the patients with COPD diagnosis were not different between the groups.
Açıklama
Anahtar Kelimeler
HFNO, Solunum Yetmezliği, CPAP Maske, Respiratory Failure, CPAP Mask
