İnci TURHAN, Dinçer YILDIZDAŞ, Ahmet YÖNTEM

Çocuk yoğun bakım ünitesindeki akut solunum sıkıntısı sendromu vakalarının değerlendirilmesi

Amaç: Bu çalışmanın amacı akciğer koruyucu mekanik ventilasyon stratejisi, erken enteral beslenme, negatif sıvı dengesi ve hasta kaynaklarının yeterliliğinin akut solunum sıkıntısı sendromu olan çocuklarda sağ kalım üzerine etkisini değerlendirmektir. Gereç ve Yöntem: Çalışmaya çocuk yoğun bakım ünitemizde akut solunum sıkıntısı sendromu gelişen 32 hasta dahil edildi. Bulgular: Oksijenizasyon durumlarına göre 14’ü hafif (% 43.8), 9’u orta (% 28.1) ve 9’u ağır (% 28.1) evre akut solunum sıkıntısı sendromu gelişmiş idi. Üç hastaya (% 9,4) yüksek frekanslı osilasyon ventilasyon, dört (% 12,5) hastaya ekstrakorporeal membran oksjenizasyon desteği sağlandı. En sık görülen komplikasyonlar ventilatör ilişkili pnömoni (% 21.9) ve pnömotoraks (% 12.5) idi. Mortalite oranı % 6.3 idi. Ekstrakorporeal membran oksjenizasyon uygulanan hastalarda sağ kalım oranı %75 idi. Pediatric Index of Mortality-2 skoru yüksek olan ve non-pulmoner kaynaklı akut solunum sıkıntısı sendromu hastaların takibi sırasında gelişebilecek akut solunum sıkıntısı sendromunun şiddetinin daha ağır olduğu görüldü. Sonuç: Akciğer koruyucu mekanik ventilasyon desteği, erken enteral beslenme, negatif sıvı dengesi ve yeterli hastane kaynakları sağkalımı arttırabilir. Ancak, çok merkezli randomize kontrollü çalışmalara ihtiyaç vardır.

Evaluation of acute respiratory distress syndrome cases in a pediatric intensive care unit

Purpose: The aim of this study was to evaluate the lung-protective mechanical ventilation strategy, early enteral nutrition, negative fluid balance, and adequacy of hospital resources in our pediatric intensive care unit. Materials and Methods: This study included 32 patients who developed acute respiratory distress syndrome (ARDS) during their monitoring in the pediatric intensive care unit. Results: According to their oxygenation status, 14 patients (43.8%) had mild ARDS, nine patients (28.1%) had moderate ARDS, and nine patients (28.1%) had severe ARDS. High-frequency oscillatory ventilation was applied to three patients (9.3%), and four patients (12.5%) received extracorporeal membrane oxygenation (ECMO) support. The most common complications were nosocomial infection (31.3%) and pneumothorax (12.5%). The mortality rate was 6.3%. The survival rate was 75.0% in patients with ECMO support. The patients with a higher Pediatric Index of Mortality (PIM-2) score confronted more severe ARDS, and non-pulmonary ARDS also progressed in advanced stages. Conclusion: In patients with high PIM-2 and PELOD scores, attention must be given to the development of severe ARDS. The lung-protective mechanical ventilation support, early enteral nutrition, negative fluid balance practices, and the adequacy of hospital resources led to a successful survival rate in our study. However, multicenter randomized controlled trials are needed on this subject.

Keywords:

Acute Respiratory Distress Syndrome, PICU Children, Stage, Survival,

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