YOĞUN BAKIMDA SİRKULATUVAR ŞOK VE MONİTÖRİZASYON YÖNTEMLERİ

Sirkülatuvar flok hayat› tehdit eden akut dolafl›m yetmezli¤i olarak tan›mlanmaktad›r. Uygun hemodinamik monitorizasyon flo- kun mevcut faz›na, kompleksli¤ine ve bafllang›ç tedaviye yan›t›na göre de¤iflmektedir. Yatak bafl› monitörizasyon teknikleri hemo- dinamik durumun ve tedaviye yan›t›n de¤erlendirilmesi aç›s›ndan klinisyene yard›mc›d›r. Klinik de¤erlendirmeden al›nan bilgiler ile beraber altta yatan sebeplerin aç›klanmas› ve flokun evresini belirlemede seçilecek bafllang›ç monitörizasyonu önemlidir. Bafl- lang›ç tedaviye yan›t veren fliddetli olmayan floku olan hastalarda ileri hemodinamik monitorizasyona gerek olmad›¤› görüflü yay- g›nd›r. Bafllang›ç tedaviye yan›t vermeyen/kompleks hastalar›n kardiyak disfonksiyonunun derecesini ve uygun tedavinin seçimini belirleme ileri hemodinamik de¤erlendirme olmadan zordur ve kardiyak output ölçüm endikasyonu mevcuttur. Son y›llarda hemo- dinamik monitorizasyon teknikleri belirgin flekilde invazivden minimal invaziv/noinvazive, intermittan'dan sürekli ve gerçek za- manl› hemodinamik de¤iflken ölçümüne do¤ru geliflmifltir. Gelecekte hemodinamik monitörizasyon flüphesiz non invaziv, cepte ta- fl›nabilen, teknolojik cihazlarla uyumlu olaca¤› yönündedir.

CIRCULATORY SHOCK AND MONITORIZATION TECHNIQUES IN INTENSIVE CARE UNIT

Circulatory shock is defined as a life threatening acute circulatory failure. Appropriate hemodynamic monitorisation varies according to the degree, complexity of the shock, response to the initial treatment. Bedside monitoring techniques help the clini- can evaluating hemodynamic status and response to treatment. Initial monitorization is important to determine underlying causes together with the information obtained from the clinical evaluation and phase of the shock. Advanced hemodynamic monitorizati- on is not necessary when the patients with shock respond the initial therapy is widely considered. It is difficult to determine the degree of the cardiac disfunction and appropriate choice of treatment without advanced hemodynamic evaluation when initial the- rapy is not appropriate or in complex cases and measuring cardiac output is indicated. In recent years hemodynamic monitoriza- tion techniques have evolved markedly from invasive to minimal/noninvasive, intermittant to continuous and real time hemodyna- mic variable measurement. In the future, hemodynamic monitoring will undoubtedly be non-invasive, can be carried in the pocket and compatible with the technological devices.

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