Mehmet Göktuğ EFGAN, Zeynep KARAKAYA, Adnan YAMANOĞLU, Ahmet KAYALI

Akut solunum yetmezliğinde optik sinir kılıf çapının prognostik önemi

Amaç: Bu çalışmanın birincil amacı, hipoksemik solunum yetmezliği ve hiperkarbik solunum yetmezliği ayrımında ultrasonografi kullanılarak ölçülen ONSD'nin rolünü belirlemekti. Çalışmanın ikincil amacı, hiperkarbik hastaların klinik sonuçlarını tahmin etmede ONSD'nin değerini belirlemektir. Gereç ve Yöntem: Bu çalışmaya dispne ile başvuran travmatik olmayan yetişkin hastalar dahil edildi. Çalışmaya başvuran tüm hastalardan başvuru sırasında ve tedavinin ikinci saatinde arter kan gazı ve eş zamanlı ONSD ölçümleri alındı. Hastalar hipoksik ve hiperkarbik solunum yetmezliği olmak üzere iki gruba ayrıldı. Hasta sayısı kadar sağlıklı gönüllüler çalışmaya dahil edildi. Bulgular: Tip 1 solunum yetmezliği olan 24 hastada ortalama ONSD değerleri 3,8±0,2 mm, tip 2 solunum yetmezliği olan 25 hastada 5,2 ± 0,5 mm ve sağlıklı kontrollerde 3,9±0,3 mm idi. Hiperkarbik hastaların ONSD'si, hipoksik hastaların ve sağlıklı gönüllülerinkinden istatistiksel olarak anlamlı derecede daha yüksekti. Hiperkarbik hastaların ONSD'leri tedavi başlangıcında 5,2±0,5 mm ve tedavi sonrasında 4,4±0,6 mm idi ve aralarında istatistiksel olarak anlamlı fark vardı. Ancak ONSD farkı, hastaneye yatış ve mortaliteyi öngörmede istatistiksel olarak anlamlı değildi. Sonuç: Sonografik olarak ölçülen ONSD, tip 1 ve tip 2 solunum yetmezliğinin ayırıcı tanısında etkili bir parametre olabilir. Tip 2 solunum yetmezliği olan hastalarda tedavi ile ONSD değerleri önemli ölçüde değişmiştir.

Anahtar Kelimeler:

Hiperkarbi, okuler usg, optik sinir kilif çapi, acil tıp.

Prognostic significance of the optic nerve sheath diameter in acute respiratory failure

Purpose: The primary aim of this study was to determine the role of the optic nerve sheath diameter (ONSD) measured using ultrasonography in the differentiation of hypoxemic respiratory failure and hypercarbic respiratory failure. The secondary aim was to determine the value of ONSD in predicting the clinical outcome in hypercarbic patients. Materials and Methods: Non-traumatic adult patients presenting with dyspnea were included in this study. Arterial blood gas and concurrent ONSD measurements were obtained from all patients included in the study during presentation and at the second hour of treatment. The patients were divided into two groups - hypoxic and hypercarbic respiratory failure. An equivalent number of healthy volunteers were enrolled as the control group. Result: Mean ONSD values were 3.8±0.2 mm in the 24 patients with type 1 respiratory failure, 5.2 ± 0.5 mm in the 25 patients with type 2 respiratory failure, and 3.9±0.3 mm in the healthy controls. The ONSD of the hypercarbic patients was statistically significantly greater than that of the hypoxic patients and healthy volunteers. The ONSD of the hypercarbic patients was 5.2±0.5mm at baseline and 4.4±0.6 mm after treatment, the difference being statistically significant. However, the difference in ONSD was not statistically significant in predicting hospitalization and mortality. Conclusion: Sonographically measured ONSD may be an effective parameter in the differential diagnosis of type 1 and 2 respiratory failure. ONSD values changed significantly with treatment in patients with type 2 respiratory failure.

Keywords:

Hypercarbia, ocular ultrasonography, optic nerve sheath diameter, emergency medicine,

PDF

___

1. Roussos C, Kutsoukou A. Respiratory failure. Eur Respir J. 2003;3:14,22.
2. Naureckas ET, Wood LDH. Critical Care Emergency Medicine. New York, Mc Graw Hill, 2015.
3. Christiana C. Burt, Joseph E. Arrowsmith, Respiratory failure. Surgery (Oxford), 2009;27:475-79.
4. Özyılmaz E. Solunum yetmezliği. Cukurova Medical Journal. 2014;39:428–42.
5. David J. Feller-Kopman, MD . Richard M. Schwartzstein, MD. Up To Date. The evaluation, diagnosis, and treatment of the adult patient with acute hypercapnic respiratory failure. https://www.uptodate.com/contents/the- evaluation-diagnosis-and-treatment-of.
6. Nishiyama T, Matsukawa T, Yokoyama T, Hanaoka K. Cerebrovascular carbon dioxide reactivity during general anesthesia: a comparison between sevoflurane and isoflurane. Anesth Analg. 1999;89:1437-41.
7. Newman WD, Hollman AS, Dutton GN, Carachi R. Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol. 2002;86:1109–13.
8. Zhang X, Medow JE, Iskandar BJ, Wang F, Shokoueinejad M, Koueik J et al. Invasive and noninvasive means of measuring intracranial pressure: a review. Physiol Meas. 2017;38:143-82.
9. Wang LJ, Chen LM, Chen Y, Bao LY, Zheng NN, Wang YZ et al. Ultrasonography assessments of optic nerve sheath diameter as a noninvasive and dynamic method of detecting changes in intracranial pressure. JAMA Ophthalmol. 2018;136:250-56.
10. Hansen HC, Helmke K. The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat. 1996;18:323- 8.
11. Liu D, Kahn M. Measuremen and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol. 1993;116:548-60.
12. Roque PJ, Wu TS, Barth L, Drachman D, Khor KN, Lovecchio F et al. Optic nerve ultrasound for the detection of elevated intracranial pressure in the hypertensive patient. Am J Emerg Med. 2012;30:1357-63.
13. Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med. 2001;163:540-77.
14. Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50:1602426.
15. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2020 Report. http://www.goldcopd.org 2020.
16. Soo Hoo GW, Santiago S, Williams AJ. Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure. Crit Care Med. 1994;22:1253-61.
17. Antón A, Güell R, Gómez J, Serrano J, Castellano A, Carrasco JL et al. Predicting the result of noninvasive ventilation in severe acute exacerbations of patients with chronic airflow limitation. Chest. 2000;117:828- 33.
18. Komut E, Kozacı N, Sönmez BM, Yılmaz F, Komut S, Yıldırım ZN et al. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in ED. Am J Emerg Med. 2016;34:963-7.
19. Czosnyka M. Association between arterial and intracranialpressures Br J Neurosurg. 2000;14:127-8.
20. Seo H, Kim YK, Shin WJ, Hwang GS. Ultrasonographic optic nerve sheath diameter is correlated with arterial carbon dioxide concentration during reperfusion in liver transplant recipients. Transplant Proc. 2013;45:2272-6.
21. Doblar DD, Frenette L, Poplawski S, Gelman S, Boyd G, Ranjan D et al. Middle cerebral artery transcranial Doppler velocity monitoring during orthotopic liver transplantation: changes at reperfusion--a report of six cases. J Clin Anesth. 1993;5:479-85.
22. Doblar DD, Lim YC, Frenette L, Poplawski S, Ranjan D, Ronderos J. The effect of acute hypocapnia on middle cerebral artery transcranial Doppler velocity during orthotopic liver transplantation: changes at reperfusion. Anesth Analg. 1995;80:1194-8.
23. Pott F, Larsen FS, Ejlersen E, Linkis P, Jørgensen LG, Secher NH. Cerebral perfusion during human liver transplantation. Clin Physiol. 1995;15:119-30.
24. Joyce RR, McGee WT. Hypercapnic cerebral edema presenting in a woman with asthma: a case report. J Med Case Rep. 2011;5:192.
25. Yamanoğlu A, Çelebi Yamanoğlu NG, Parlak İ, Pınar P, Tosun A, Erkuran B et al. The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients; best sonographic measurement method? Am J Emerg Med. 2015;33:396-401.
26. Yamanoglu A, Celebi Yamanoglu NG, Ozturk S, Cakmak S, Akay S, Akyol PY et al. The value of the inferior vena cava ultrasound in the decision to hospitalise in patients with acute decompensated heart failure; the best sonographic measurement method? Acta Cardiol. 2021;76:245-57.
27. Baykal Y. Kronik obstrüktif akciğer hastalığı üzerinde epidemiyolojik bir araştırma. Tuberk Toraks. 1976;24:3–18.
28. Ray P, Birolleau S, Lefort Y, Becquemin MH, Beigelman C, Isnard R et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care. 2006;10:82.
29. Dinsmore M, Han JS, Fisher JA, Chan VW, Venkatraghavan L. Effects of acute controlled changes in end-tidal carbon dioxide on the diameter of the optic nerve sheath: a transorbital ultrasonographic study in healthy volunteers. Anaesthesia. 2017;72:618-23.
30. Maissan IM, Dirven PJ, Haitsma IK, Hoeks SE, Gommers D, Stolker RJ. Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. J Neurosurg. 2015;123:743-7.