Postoperatif pnömonide destek tedavi

Tüm hastane kökenli pnömonilerin yarıya yakını postoperatif devrede görülmektedir. Postoperatif pnömonide destek tedavinin yeri tartışılmazdır. Özellikle torakotomi ve üst abdominal operasyonlardan sonra gelişen fonksiyonel kapasite azalmasına karşı solunum fizyoterapisi, spirometre ve postural drenaj teknikleri uygulanması önemlidir. Entübe hastalarda ise sekresyonların aspire edilmesi ve balon-valv-maske ile manuel akciğer vantilasyonu uygulanması tedaviye katkıda bulunur. Efektif öksürme ve spirometre uygulaması için yeterli analjezi mutlaka sağlanmalıdır. Mekanik ventilasyon gereksinimi olursa mümkün olduğunca noninvazif mekanik ventilasyon tercih edilmeli ve süre kısaltılmaya çalışılmalıdır. Bu amaçla sedatif ajan kullanımının kısıtlanması ve günlük kesilmeleri önerilmektedir. Zorunluluk olmadıkça hastanın hava yoluyla ile ilgili girişimlerde bulunmaktan kaçınılmalıdır. Enteral beslenme uygulaması sırasında gastrik aşırı distansiyon ve aspirasyon engellenmelidir. Bunların yanısıra genel yoğun bakım tedavi prensipleri uygulanarak hastaların hemodinamisi ve oksijenizasyonu optimal düzeyde tutulmalıdır. *25.ANKEM Antibiyotik ve Kemoterapi Kongresi, Yatay İnteraktif Kurs 1B sunularından (28 Nisan-02 Mayıs 2010, Kuzey Kıbrıs Türk Cumhuriyeti)

Supportive treatment in postoperative pneumonia

Almost half of hospital acquired pneumonia was seen at the postoperative period and supportive therapy is very important. Decrease in functional residual capacity, which is encountered especially after upper abdominal surgery or thoracotomy, should be treated with respiratory physiotherapy, spirometry and postural drainage techniques. In intubated patients, aspiration of secretions and manual inflation of lungs are important adjuncts in therapy. Adequate analgesia has utmost importance. If mechanical ventilatory support is needed, noninvasive methods should be preferred and period of mechanical ventilation should be minimized. For this purpose, sedative agents should be cautiously used and stopped daily. Unless necessary, airway manipulation should be minimized. Prevention of gastric distention and aspiration is recommended during enteral nutrition. Besides all these interventions, general principles about intensive care treatment including optimal hemodynamics and oxygenation should be provided.

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