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Amaç: Akut solunum yetmezliğinde noninvaziv mekanik ventilasyon (NIMV) kullanımı önemli bir seçenek haline gelmiştir. Bu çalışmanın amacı hiperkarbik solunum yetmezliği (HSY)’nde NIMV başarısızlık sebepleri ve takip sonuçlarının değerlendirilmesidir. Gereç ve Yöntemler: Geriye dönük gözlemsel kohort çalışma üçüncü basamak göğüs hastalıkları hastanesinin yoğun bakım ünitesinde yapıldı. HSY ile NIMV başarısızlığı olan Ocak-Aralık 2016 arasındaki tüm hastalar çalışmaya alındı. Erken ve geç NIMV başarısızlığı olan gruplarda demografik özellikler, yoğun bakım verileri ve mortalite incelendi. Verilerin analizinde uygun istatistiksel test ve analizler kullanıldı. Bulgular: Çalışmaya alınan 218 hastanın büyük çoğunluğu (n=158, %72,5) kronik obstrüktif akciğer hastalığı idi. Olguların %56’sında erken dönem NIMV başarısızlığı görülmekteydi. En sık görülen başarısızlık nedenleri asidozun devam etmesi veya derinleşmesi ve parsiyel karbondioksit basıncında artış olmasıydı. Mortalite, yoğun bakımda %20, taburculuk sonrası 28 günde ise %9 olarak saptandı. NIMV başarısızlığını asidozun devam etmesinin 4,1 kat (%95 güven aralığı (GA) 1,711-9,882 p=0,002), hava yolunu koruyamamanın 10,4 kat (%95 GA 1,224-89,264 p=0,032), bilinç bulanıklığının ise 2,3 kat (%95 GA 1,023-5,295 p=0,044) artırdığı bulundu. Sonuç: Bu çalışmada olguların yarısında erken NIMV başarısızlığı görülmüş olup en sık başarısızlık sebeplerinin ise asidozun devam etmesi ve parsiyel karbondioksit basıncında artma olduğu bulundu. Yoğun bakım ve 28 günlük mortaliteler değerlendirildiğinde, NIMV başarısızlığı olan hastaların yoğun bakımdan taburcu olduktan sonra da yakın takip edilmesi gerektiği düşünülmektedir.
The use of non-invasive mechanical ventilation (NIMV) in acute respiratory failure has become an important option. The aim of this study is to evaluate the causes of NIMV failure and the follow-up results in hypercarbic respiratory failure (HSY). Tools and Methods: Backward observation cohort work was carried out in the third stage breast disease hospital’s intensive care unit. All patients between January and December 2016 with HSY and NIMV failure were taken to study. In groups with early and late NIMV failure, demographic characteristics, intensive care data and mortality were studied. In the analysis of the data, appropriate statistical tests and analyses were used. The majority of the 218 patients (n=158, 72.5%) were chronic obstructive lung disease. In 56% of cases, early-term NIMV failure was observed. The most common cause of failure was the continuation or deepening of acidosis and the increase in parcial carbon dioxide pressure. Mortality was estimated at 20% in intensive care, and 9% in 28 days after dismissal. The NIMV failure was 4.1 times increased by the continuation of acidose (95% confidence range (GA) 1.711-9.882; p=0,002), 10.4 times increased by the failure to maintain the air path (95% GA 1,224-89,264; p=0,032), and 2.3 times increased by conscious confusion (95% GA 1,023-5,295; p=0,044) The result: In half of the cases, early NIMV failure was observed and the causes of failure were the continuation of acidose and the increase in parcial carbon dioxide pressure. When evaluating intensive care and 28-day mortality, it is believed that patients with NIMV failure should be closely monitored after intensive treatment.
Aim: Use of noninvasive mechanical ventilation (NIMV) in acute respiratory failure has been an important option. The aim of this study is to evaluate causes of NIMV failure and follow-up results in hypercarbic respiratory failure (HRF). Material and Methods: Retrospective observational cohort study was performed in intensive care unit of tertiary chest disease hospital. All patients with NIMV failure due to HRF between January-December 2016 were included in the study. Demographic characteristics, intensive care data and mortality were evaluated in early and late NIMV failure groups. Appropriate statistical tests and analyzes were used for analysis of data. Results: The majority of 218 patients (n=158, 72.5%) included in the study was chronic obstructive pulmonary disease. Early NIMV failure was seen 56% of cases. The most common causes of failure were progression or worsening of acidosis and increase in partial carbon dioxide pressure. Mortality was detected as 20% in intensive care unit and 9% after discharge in 28-days. Factors increased NIMV failure was found as progression of acidosis by 4.1 fold (95% confidence interval (CI) 1.711-9.882, p=0.002), inability to protect airway by 10.4 fold (95% CI 1.224-89.264, p=0.032) and blurred consciousness by 2.3 fold (95% CI 1.023-5.295, p=0.044). Conclusion: Early NIMV failure was observed in half of cases and most common causes of failure were found as progression of acidosis and increase in partial carbon dioxide pressure. When intensive care and 28-day mortality are evaluated, it is thought that patients with NIMV failure should be followed-up closely after discharge from intensive care.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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