Noninvaziv mekanik ventilasyonun mortaliteye etkisi ve başarıyı etkileyen faktörler

Amaç: Çalışmamızda esas olarak Noninvaziv mekanik ventilasyon (NİMV)’un mortalite oranları üzerine olan etkisini, ikincil olarak ise NİMV’un başarısında etkili olan faktörleri değerlendirmeyi amaçladık. Yöntem: Retrospektif olarak planlanan çalışmaya Ocak 2005–Nisan 2010 tarihleri arasında yoğun Bakım ünitesinde NIMV uygulanan 204 hasta alındı. Bulgular: Çalışmaya alınan 204 hastanın 47’si (% 23) hipoksemik, 157’si (% 77) hiperkapnik solunum yetmezliği (SY) idi. NİMV uygulanan tüm hastalarda mortalite % 23.4, hipoksemik SY’de % 43.3, hiperkapnik SY’de % 15.2 idi. Hipoksemik SY’de alt başlık olarak değerlendirilen ve 2009-2010 yılında tüm dünyada pandemik olarak seyreden H1N1 influenza A nedeniyle SY gelişen NİMV uygulanan hastalarda mortalite % 62 idi. NİMV başarı oranları tüm hastalarda % 74.6, hipoksemik SY’de % 57.7, hiperkapnik SY’de % 81.0, H1N1 influenza A grubunda ise % 38.1 idi. NIMV uygulanan tüm hastalarda APACHE II skoru 18.9±4.7, hipoksemik SY’de 18.5±5.2 hiperkapnik SY’de 18.8±4.4, H1N1 grubunda ise 16.8±3.6 idi. Sonuç: Özellikle hiperkapnik SY olanlarda NİMV mortaliteyi ve entübasyon oranlarını büyük oranda azaltmaktadır. Hipoksemik SY olan hastalarda NİMV’un başarısını hipokseminin derecesinden daha çok altta yatan etyoloji belirlemektedir. APACHE skoru, Arteriyel kan gazı (AKG)’ndaki ilk 1 saatteki düzelme, yoğun bakım ünitesine kabulde ilk 24 saatteki NİMV’un kullanım süresinin fazla olması, NİMV başarısını ve mortaliteyi etkileyen faktörlerdir. Başlangıçta maske türü olarak oranazal maske seçilmesi başarıda etkilidir. Ancak oronazal maskeyi tolere edemeyen ve AKG değerleri kötüleşenlerde tam yüz maskesi önerilebilir.

The effect of noninvasive mechanic ventilation in mortality and affecting factors in success

Objective: The aim of our study is primarily to evaluate the effect of noninvasive mechanic ventilation NIV to the rates of mortality and secondarily to show predictor factors of being successful during the application of NIV. Methods: We conducted a retrospective study on NIV for acute respiratory failure in the medical intensive care unit from January 2005 to April 2010. Results: We evaluated outcomes of 204 patients.47 (23%) patients had hypoxic and 157 (77%) patients had hypercapnic respiratory failure. Mortality rate was 23. 4% in all patients, it was 43.3% in hypoxic and 15.2% in hypercapnic patients. We analyzed the global H1N1 influenza pandemic caused respiratory failure as a subgroup of under hypoxic respiratory failure. The mortality rate of patients with H1N1 influenza was 62 %. The success rates of NIV in all patients, hypoxic, hypercapnic, and H1N1 subgroup were 75%, 57.7%, 81%, 38.1%, respectively. The patients’ APACHE score was 18.9±4.7, for all patients, (hypoxic, hypercapnic and H1N1 subgroup; 18.5±5,2, 18.8±4.4 and 16.8±3.6, respectively. Conclusion: Especially NIV decreases the rate of mortality and intubation with hypercapnic respiratory failure. NIV success is associated with underlying diseases, rather than to the degree of hypoxia with hypoxic respiratory failure. APACHE II score, improved 1 hour after the initial trial of NIV in arterial blood gas and respiratory rate, the period of NIV application for hour in the 24 hours at the time of admission to the intensive care were highly factors of NIV successful and mortality. To use oronasal mask at the beginning effects NIV success. But if the patients are intolerance to the mask or values of arterial blood gas suffer, the full-face mask is could be suggested.

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