KAFA TRAVMALI HASTALARDA AKUT RESPİRATUVAR DİSTRES SENDROMU GELİŞİMİNE ETKİ EDEN FAKTÖRLER
Amaç: Travmatik beyin hasarı sonrası Akut Respiratuvar Distress Sendromu (ARDS) gelişimiyle ilişkili risk faktörleri halen tartışılmaktadır;klinik önemine rağmen hangi hastaların yüksek risk altında olduğu ve ARDS gelişiminin nasıl önlenebiliceği konusunda elde edilen bilgilerkısıtlıdır. Bu çalışmada kafa travmalı hastalarda Berlin tanımlamasına göre ARDS gelişimindeki risk faktörlerinin saptanması ve ARDS'ninmortalite üzerine olan etkisinin araştırılması amaçlanmıştır.Yöntem: Çalışma için etik kurul onayı alındıktan sonra yoğun bakım ünitesinde 1 Ocak 2013 - 1 Ocak 2016 tarihleri arasında takipedilen kafa travmalı hastalar retrospektif olarak incelenmiştir. Mekanik ventilatör stratejileri, hemodinamik parametreleri ve laboratuvarparametreleri kaydedilerek ARDS gelişen ve gelişmeyen hastalar arasındaki farklar araştırılmıştır.Bulgular: Çalışmada ilk kabulde düşük Glasgow Koma Skalası (GKS) skoru olan hastalarda ARDS gelişimi oranı daha yüksekbulundu (3.66±0.28 vs 5.48±0.38; p=0.014). Bunun yanı sıra kabulden 48 saat sonraki hematokrit düzeyi (36.25±6.01 31.08±4.98;p=0.005), vücut ısısı (37.20±0.75°C vs 36.74±0.59°C; p=0.04) ve kalp atım hızı ortalamaları (108.25±25.37 vs 95.22±16.70; p=0.048)ve baz açığı (-3.32±3.16 vs -0.96±2.73; p=0.017) ARDS gelişen hastalarda anlamlı düzeyde daha yüksek, bikarbonat düzeyi (21.50±2.35vs 23.32±2.19; p=0.019) ise daha düşük bulundu (p
FACTORS AFFECTING THE DEVELOPMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME IN HEAD TRAUMA
Objective: After traumatic brain damage, the risk of ARDS development is still being discussed and in spite of the clinical importance,the knowledge is limited about how to prevent ARDS development and which patients are under high risk of ARDS. In this study, weaimed to define the risk factors of ARDS development according to the Berlin definition on head trauma patients and determine ARDS’simpact on mortality.Method: After approval has been obtained from ethic committee, patients with head trauma and hospitalized in intensive care unitbetween dates 1st Jan 2013 – 1st Jan 2016, were examined retrospectively. Mechanic ventilator strategies, hemodynamic parameters andlaboratory parameters were recorded and the differences were researched between the patients who developed ARDS and the patientswho did not. Results: It was found that the patients with low GCS scores at the first admission, have higher risk of developing ARDS(3.66±0.28 vs5.48±0.38; p=0.014). Besides, in the first 48 hours, higher mean levels of hematocrit (36.25±6.01 vs 31.08±4.98; p=0.005), body temperature(37.20±0.75°C vs 36.74±0.59°C; p=0.040), heartbeat rate (108.25±25.37 vs 95.22±16.70; p=0.048), base excess (-3.32±3.16 vs 0.96±2.73; p=0.017) and lower mean levels of bicarbonate (21.50±2.35 vs 23.32±2.19; p=0.019) were found in patients with ARDS(p0,05). Mortality ratio was higher in the ARDS developed head trauma patients in the first 30 days (p
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