Kronik obstrüktif akciğer hastalığı bulunan hastalarda mekanik ventilatörden ayırma başarısını etkileyen faktörler
Küçük Resim Yok
Tarih
2011
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kronik obstrüktif akciğer hastalığı (KOAH) bulunan hastalarda ventilatörden ayırma başarısızlığı oranı yüksek olup, bunu etkileyen birçok faktör bulunmaktadır. Bu çalışmanın amacı invaziv mekanik ventilasyon (İMV) uygulanan KOAH hastalarında mekanik ventilatörden ayırma başarısını etkileyen faktörleri incelemektir. Gereç ve yöntem: Çalışmaya yoğun bakımımızda İMV uygulanan 43 KOAH hastası dahil edildi. Hastaların klinik ve laboratuar bulguları ve Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE II) skorları kaydedildi ve mekanik ventilatörden ayırma başarısını etkileyen faktörler araştırıldı. Bulgular: Toplam 43 hastanın 25’inde mekanik ventilatörden ayırma başarılı olarak gerçekleştirildi (%58.1). Hastaların entübasyon öncesi APACHE II skoru yüksekliği ile mekanik ventilatörden ayırma başarısızlığı arasında anlamlı ilişki bulundu. Entübasyon ve mekanik ventilatörden ayırma öncesi Glasgow koma skalasının yüksek olması ayırma başarısı ile ilişkili bulundu. Mekanik ventilatörden ayırma öncesi anksiyete varlığı, endotrakeal aspiratta üreme, yüksek pulmoner arter basıncı değeri, enteral beslenme, taşikardi varlığı, kaf kaçağı miktarı ve FiO2 değeri ile ayırma başarısızlığı arasında anlamlı ilişki vardı. Hastalarda mekanik ventilatörden ayırma öncesi kortizol seviyesi ile mekanik ventilatörden ayırma başarısı ilişkili bulundu. Spontan modda ölçülen negatif inspiratuar kuvvet (NIF) ve tidal volüm (VT) mekanik ventilatörden ayırmanın başarılı olduğu grupta daha yüksek, f/VT oranı ise daha düşük bulundu. T-tüp sırasında 15. ve 30. dakikalarda yorgunluk belirtilerinin olması ile mekanik ventilatörden ayırma başarısızlığı ilişkili bulundu. Hastalara uygulanan İMV süresi ve ekstübe edilebilen hastalarda mekanik ventilatörden ayırma süresinin uzun olması ve t-tüp deneme sayısının fazla olması ile mekanik ventilatörden ayırma başarısızlığı ilişkili saptandı. Sonuç: Sonuç olarak KOAH hastalarında enfeksiyon, anksiyete varlığı, hemodinamik ve solunumsal instabilite durumu mekanik ventilatörden ayırma başarısızlığını anlamlı olarak artırmaktadır.
Weaning failure rate was higher in patients with chronic obstructive pulmonary disease (COPD) and many factors affect it. The aim of this study was to investigate the factors affecting the success of weaning in COPD patients receiving invasive mechanical ventilation (IMV). Materials and methods: Totally 43 COPD patients who received IMV in intensive care unit were included. Clinical and laboratory results and Acute Physiology Assessment and Chronic Health Evaluation (APACHE II) scores were recorded and affecting factors on weaning success were investigated. Results: In 43 patients, 25 had successful weaning (58.1%). Patients with high APACHE II score prior to intubation was found as associated with weaning failure. High Glasgow coma scale (GCS) scores before entubation and weaning are associated with weaning success. Preweaning anxiety, positive endotracheal aspirate culture, pulmonary arterial pressure value, enteral feeding, preweaning tachycardia, pre-weaning cuff leaking and FiO2 values were found to be associated with weaning failure. Pre-weaning cortisol levels were associated with weaning success. In successful weaning group, measured NIF and VT in spontaneous mode were found as higher and f/VT ratio was lower compared with unsuccessful group. T-tube during the 15th and 30th minutes of the symptoms of fatigue (sweating assets) were associated with weaning failure. IMV duration and longer extubation duration of weaning, and more number of t-tube insertion attempts were found as associated with failure of weaning. Conclusions: Infection in patients with COPD, the presence of anxiety, and hemodynamic and respiratory instability significantly increases the weaning failure.
Weaning failure rate was higher in patients with chronic obstructive pulmonary disease (COPD) and many factors affect it. The aim of this study was to investigate the factors affecting the success of weaning in COPD patients receiving invasive mechanical ventilation (IMV). Materials and methods: Totally 43 COPD patients who received IMV in intensive care unit were included. Clinical and laboratory results and Acute Physiology Assessment and Chronic Health Evaluation (APACHE II) scores were recorded and affecting factors on weaning success were investigated. Results: In 43 patients, 25 had successful weaning (58.1%). Patients with high APACHE II score prior to intubation was found as associated with weaning failure. High Glasgow coma scale (GCS) scores before entubation and weaning are associated with weaning success. Preweaning anxiety, positive endotracheal aspirate culture, pulmonary arterial pressure value, enteral feeding, preweaning tachycardia, pre-weaning cuff leaking and FiO2 values were found to be associated with weaning failure. Pre-weaning cortisol levels were associated with weaning success. In successful weaning group, measured NIF and VT in spontaneous mode were found as higher and f/VT ratio was lower compared with unsuccessful group. T-tube during the 15th and 30th minutes of the symptoms of fatigue (sweating assets) were associated with weaning failure. IMV duration and longer extubation duration of weaning, and more number of t-tube insertion attempts were found as associated with failure of weaning. Conclusions: Infection in patients with COPD, the presence of anxiety, and hemodynamic and respiratory instability significantly increases the weaning failure.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Dicle Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
38
Sayı
3
