Ahmet YÜKSEK, Aysegul PARLAK CIKRIKCI, Ökkeş Hakan MİNİKSAR, Cevdet YARDIMCI

Pediyatrik Hastalarda Güvenlik Önlemi Olarak Mekanik Güç Kullanılabilir mi?

Mekanik güç (MP), her nefes döngüsünde hastaların solunum sistemine aktarılan enerji miktarıdır. Solunum için gerekli olan dirençler aşıldıktan sonra kalan enerji akciğer parankimine zarar vererek sonlanabilir. Pediatrik hastalarda aşılmaması gereken MP sınırı henüz netlik kazanmamıştır. Bu gözlemsel tanımlayıcı çalışmanın amacı, sağlıklı pediatrik olgularda perioperatif MP ölçümlerini literatürde verilen değerlerle karşılaştırmaktır. Yöntem: Perioperatif MP, bilinen akciğer hastalığı olmayan pediatrik hastalarda basitleştirilmiş MP formülüne göre hesaplandı ve literatürle karşılaştırıldı. Bulgular: 34 hastanın yaş ortalaması 68.88±31.4 ay ve ortalama ağırlık 21.82±7.5 kg idi. Ortalama MP 3,93±1,1 J dak-1 ve indekslenmiş MP 0,19±0,08 J dak-1 kg-1 idi. Hem MP (p=0,008) hem de indekslenmiş MP (p3.76 değeri, 87 duyarlılık ve 50 özgüllük ile >10 tidal hacim için bir göstergeydi. >10 mL kg-1 tidal hacim için indekslenmiş MP’nin tahmin değeri 0.25 J kg-1 [AUC 0.856, %95 CI: 0.70-1.0, p=0.003] idi ve indekslenmiş MP, MP’den daha güçlü bir gösterge idi. Sonuç: Bu çalışma, yetişkinler veya ARDS akciğeri olan hastalar için hesaplanan MP eşik değerlerinin çocuk hastalar için hassas olmadığını ve bu hastalar için yeni bir eşik değerinin belirlenmesi gerektiğini ortaya koymuştur.

Can Mechanical Power be Used as a Safety Precaution in Pediatric Patients?

Mechanical power (MP) is the amount of energy transferred to the respiratory system of patients during each breath period. After overcoming the resistances required for respiration, the remaining energy may end up by damaging the lung parenchyma. The MP limit that should not be exceeded in pediatric patients is not yet clear. The aim of this observational descriptive study is to compare the perioperative MP measurements in healthy pediatric cases with the values given in the literature. Methods: Perioperative MP was calculated according to the simplified MP formula in pediatric patients without known lung disease and compared with the literature. Results: The mean age of 34 patients was 68.88±31.4 months and the mean weight was 21.82±7.5 kg. The mean MP was 3.93±1.1 J min-1, and the indexed MP was 0.19±0.08 J min-1 kg-1. Both MP (p=0.008) and indexed MP (p3.76 was an indicator for tidal volume >10 with 87 sensitivity and 50 specificity. Predictive value of indexed MP for tidal volume >10 mL kg-1 was 0.25 J kg-1 [AUC 0.856, 95%CI: 0.70-1.0, p=0.003], and indexed MP was a stronger indicator than MP. Conclusion: This study revealed that MP threshold values calculated for adults or patients with ARDS lung are not sensitive for pediatric patients, and a new threshold value should be determined for these patients.

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