Ali DUR, Sedat KOÇAK, Başar CANDER, Ertan SÖNMEZ, Cemil CİVELEK

Yoğun bakım biriminde izlenen çoklu travma hastalarında mortaliteye etki eden faktörler

Amaç: Bu çalışmanın amacı, bir üniversite hastanesinin acil yoğun bakım biriminde takip edilen çoklu travma hastalarının değerlendirilmesidir. Yöntemler: Çalışmaya Ocak 2006- Ocak 2009 tarihleri arasında fakültemizin acil yoğun bakım biriminde takip edilen çoklu travma hastaları alındı. Travma sonrası ilk altı saat içinde hayatını kaybedenler, kronik böbrek yetmezliği, kronik karaciğer hastalığı, konjestif kalp yetersizliği ve metastatik kanser hastaları çalışma dışı bırakıldı. Travmanın nedeni, yoğun bakım ve mekanik ventilatörlerde kalış süreleri, aldığı destek tedaviler, travma skorları ve mortalite oranları belirlendi. Elde edilen bulgular istatistiksel olarak değerlendirildi. Bulgular: Çalışmaya alınan hastaların yaş ortalaması 31±21.82 (aralık 1-80) yıl idi. Hastaların 112\'si (%81.2) erkek 26\'sı (%18.8) kadın idi. Çoklu travmanın en sık nedenleri araç içi trafik kazaları (%40.6) ve araç dışı trafik kazaları (%37) idi. Ortalama yoğun bakımda ve mekanik ventilatörde kalış süreleri sırasıyla 5.3 gün (1-30 gün) ve 2.2 gün (0- 30 gün) idi. Hastalardan 56\'sı (%43.5) mekanik ventilatör desteği alırken, 34 (%26.4) hastanın beslenme desteği aldığı ve 22 (%14.5) hastanın inotrop desteği aldığı belirlenmiştir. Bu hastaların mortalite oranları sırasıyla %50, %44.1 and %77.7 idi. Mekanik ventilasyondaki, inotrop ve beslenme desteği alan çoklu travma hastalarındaki mortalite oranları tüm hastalardaki mortalite oranlarından yüksek bulunmuştur. Sonuç: Çoklu travma yaralanmalarının en sık nedeni motorlu araç kazaları olup, özellikle genç erkekleri etkilemektedir. Hastaların mekanik ventilasyon, inotrop ve beslenme desteği ile ilgili komplikasyonlar travma yoğun bakım merkezlerindeki ölüm ve sakatlıklar üzerinde etkili olmaktadır.

Anahtar Kelimeler:

Acil servis, çoklu travma, yoğun bakım ünitesi

Factors affecting mortality in patients with multitrauma which were treated in intensive care unit

Objective: The aim of this study was to evaluate multiple trauma patients hospitalized in intensive care unit (ICU) of an emergency department at a university hospital. Methods: The study was performed between January 2006 and January 2009 with 138 patients in the emergency intensive care unit. Those patients who die within 6 hours after trauma and the patients with chronic renal failure, chronic liver failure, chronic heart failure and metastatic cancers were excluded to this study. Trauma etiology, duration of intensive care and mechanical ventilation, support therapies, trauma scores and mortality rates were determined. Data were evaluated by statistical methods. Results: The mean age of the patients was 31±21.8 (range 1-80) years. Of these patients, 112 (81.2%) were male and 26 (18.8%) were female. The most common etiologies of multitrauma were car occupant\'s accidents (40.6%) and pedestrian\'s accidents (37%). Mean length of stay at mechanical ventilation and length of stay in ICU were 2.2 days (0-30 days) and 5.3 days (1-30 days), respectively. Totally 56 (43.5%) patients were ventilated mechanically, 34 (26.4%) patients received nutritional support and 22 (14.5%) were given inotropic agents. Mortality rate of these papatients were 50%, 44.1% and 77.7% respectively. The multitrauma patients, who mechanically ventilated, supported by inotropic and nutritional therapy had higher mortality rate than other patients. Conclusion: The most common cause of multitrauma injuries were motor vehicle accidents, especially for young males. Trauma scores at admission, complications related to mechanical ventilation, inotropic and nutritional support therapies affected to morbidity and mortality in ICU trauma centers.

Keywords:

Emergency departments, multitrauma, intensive care unit,

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