Mediha Türktan, Ersel Gülec, Murat Türkeün Ilgınel, Dilek Özcengiz

Yoğun bakım hastalarında propofol ve deksmedetomidinin akciğer mekanikleri üzerine etkisi

Amaç: Propofol ve deksmedetomidin mekanik olarak ventile edilen yoğun bakım hastalarında en sık tercih edilen sedatif ajanlardır. Bu çalışmanın amacı; propofol ve deksmedetomidinin akciğer mekanikleri üzerine erken etkilerini karşılaştırmaktır.Gereç ve Yöntem: Sedasyon ihtiyacı olan, mekanik olarak ventile edilen, 18-65 yaş arası 70 hasta çalışmaya dahil edildi. İki gruba ayrılan hastalara sedasyon amacıyla deksmedetomidin grubuna (Grup D) deksmedetomidin infüzyonu, propofol grubuna (Grup P) propofol infüzyonu uygulandı. Uygulanan ventilasyon modları, kan gazı analizi, akciğer mekanik değerleri (havayolu direnci, pozitif soluk sonu basıncı, solunum sıklığı, tidal volüm, dakika volümü, tepe havayolu basıncı, kompliyans, soluk sonu CO2, SvO2 değerleri) ve ventilatör-hasta uyumu başlangıç, 5,15,30,45 ve 60 dakikalarda değerlendirilerek kaydedildi.Bulgular: Demografik veriler ve ventilasyon modları gruplar arasında benzerdi. Akciğer kompliyansı Grup D’de 60 dakika boyunca artmış olmasına rağmen istatistiksel olarak anlamlı değildi. Diğer akciğer mekanikleri değerleri gruplar arasında benzerdi. Arter kan gazı değerleri her iki grupta da normal aralıkta seyretti. Ventilatör-hasta uyumunun Grup P’de Grup D’ye göre daha iyi olduğu saptandı. Solunum depresyonu olan hasta sayısı Grup P’de Grup D’ye göre 45. ve 60. dakikalarda daha yüksekti. Sonuç: Propofol ile daha iyi ventilatör-hasta uyumu sağlanmasına rağmen, deksmedetomidin daha az solunum depresyonu yapar. Bu nedenle weaning dönemindeki yoğun bakım hastalarında deksmedetomidin tercih sebebi olabilir. Daha geniş örneklem büyüklüğü ile yapılacak çalışmalar propofol ve deksmedetomidinin akciğer mekanikleri üzerine etkilerini netleştirecektir.

Anahtar Kelimeler:

Yoğun bakım, tepe havayolu basıncı, havayolu direnci

Effect of propofol and dexmedetomidine on pulmonary mechanics in intensive care unit patients

Purpose: Propofol and dexmedetomidine are most preferred sedative agent for mechanically ventilated ICUs patients. The aim of this study is to compare the early effects of propofol and dexmedetomidine on pulmonary mechanics in these patients.Material and Methods: Between the ages of 18-65 years, requiring sedation, mechanically ventilated 70 patients were included in this study. Patients were divided into two groups and received dexmedetomidine infusion (dexmedetomidine group, Group D) and propofol infusion (propofol group, Group P) for sedation. Ventilation modes, blood gas analysis, pulmonary mechanics (airway resistance, positive end-expiratory pressure, frequency, tidal volume, minute volume, peak airway pressure, compliance, endtidal CO2, SvO2) and ventilator-patient conflict were evaluated and recorded at baseline, 5,15,30,45 and 60 minutes. Results: Demographic data and ventilation modes were similar between the groups. Pulmonary compliance gradually increased during 60 minutes in Group D but this difference was not statistically significant. Other pulmonary mechanics were similar between the groups. Arterial blood gase analysis remained within the normal range in both groups. Ventilator-patient conflict was significantly better in Group P than Group D. The number of patients with respiratory depression was higher in Group P than Group D at 45th and 60th minutes. Conclusions: Dexmedetomidine causes minimal respiratory depression altough propofol has better ventilator-patient conflict. Therefore dexmedetomidine may preferred during weaning period in ICUs patients. Further studies with larger simple size are warranted to reveal a significant difference in terms of pulmonary compliance between propofol and dexmedetomidine.

Keywords:

Intensive care, peak airway pressure, airway resistance,

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