Levent DÖŞEMECİ, Suat SANLI, NECMİYE HADİMİOĞLU, Murat YILMAZ, Atilla RAMAZANOĞLU

Mekanik ventilasyon süresinin mortaliteye etkisi

Mekanik ventilasyon (MV), akut solunumyetmezliğine neden olan birçok klinik durumda uygulaması zorunlu ve hayat kurtarıcıdır.Ancak uzun süreli MV uygulamasının da mortalite üzerine olumsuz etkileri olduğu, çeşitli çalışmalarda ileri sürülmüştür. Bu çalışmada Yoğun Bakım (YB) ünitemizde 1 yıl süresince tedavi gören 320 hastanın altta yatan patolojileri, MV süreleri ve MV süresine göre mortaliteleri retrospektif olarak incelendi. Hastaların % 82.5' ine MV uygulandığı, bunlardan % 42.0' sinde MV' un 1 gün ya da daha kısa, % 32.6' sında 1-7 gün, % 13.6' sında 7-15 gün ve % 11.7' sinde 15 günden uzun sürdüğü belirlendi.Ortalama MV süresi 5.3 gün ve YB kalış süresi 7.3 gün idi.Mortalite 1 günden az süreyle MV uygulananlarda % 6.3,1-7 gün arasındakilerde % 27.9, 7-15 gün arasındakilerde % 30.6 ve 15 günden uzun sürelerde %25.8 idi.MV süresi 1-7 gün, 7-15 gün ve 15 günden fazla olan gruplar arasında mortalite açısından anlamlı bir farklılık saptanmadı.(p>0.05). Literatürde yoğun bakımlarda mekanik ventilasyon uygulanma oranları, süreleri ve bu sürelere göre mortalite açısından çok değişik sonuçlar bildirilmiştir.Bu farklılıklar muhtemelen yoğun bakımlara değişik hasta gruplarının kabul edilmesi nedeniyle ortaya çıkmaktadır. Sonuç olarak;bulgularımız mekanik ventilasyonun yoğun bakım hastalarının tedavilerinde çok önemli bir yer tuttuğunu ve uzamış mekanik ventilasyon süresinin mortaliteyi artırmayabileceğini göstermektedir.

Anahtar Kelimeler:

Ölüm oranı, Solunum, yapay, Solunum yetmezliği, Geriyedönük çalışma, Trakeostomi, Zaman faktörleri

The effect of the duration of mechanical ventilation on mortality

Mechanical ventilation (MV) is mandatory in many clinical conditions that lead to acute respiratory failure and it is also life saving.However, negative effects of long term MV on mortality have been suggested in several studies.In our study, the underlying pathology, duration of MV and mortality rate related to the MV period of the 320 patients who bad been treated in intensive care unit (ICU) for 1 year were investigated. It is obtained that MV was used in 82.5 % of the patients and lasted for 1 day or less in 42.0 %, 1 to 7 days in 32.6 %, 7 to 15 days in 13.6 % and longer than 15 days in 11.7 % of these patients.The mean duration of MV and ICU stay were 5.3 and 7.3 days, respectively.The mortality rate was 6.3 % in less than 1day, 27.9 % in 1 to 7 days, 30.6 % in 7 to 15 days and 25.8 % in more than 15 days mechanically ventilated patients.There was not any significant difference in mortality rate between the groups in which MV period was 1 to 7 days, 7 to 15 days or more than 15 days(p 0.05). Many different results have been reported in literature on the use and duration of MV and the mortality rate related to MV period.The reason of these differences is probably the admission of various patient groups to ICU' s. In conclusion, our results showed that MV has a great value in treatment of the critically ill patients and prolonged MV may not increase mortality.

Keywords:

Mortality, Respiration, Artificial, Respiratory Insufficiency, Retrospective Studies, Tracheostomy, Time Factors,

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