Erkut ÖZTÜRK, İbrahim Cansaran TANIDIR, Yakup ERGÜL, Alper GÜZELTAŞ

Konjenital Kalp Cerrahisi Operasyonu Sonrası Uzamış Mekanik Ventilasyona Sebep Olan Hipotiroidizm

Amaç: Bu çalışmada pediatrik kardiyak operasyon sonrası uzamış mekanik ventilasyon desteği gereksinimi olan olgularda hipotiroidizmin insidansı ve olası etkileri değerlendirilmiştir.Yöntem: Çalışmaya 1 Eylül 2014 - 1 Eylül 2015 tarihleri arasında pediatrik kardiyak cerrahi yoğun bakım ünitesinde yatan, potoperatif dönemde uzamış mekanik ventilatör gereksinimi (> 7 gün) gelişen ve neden olarak hipotiroidi saptanmış olgular alındı. Olguların demografik verileri, kardiyak tanıları ve ek patolojileri belirlendi. Bulgular: Bu dönemde 430 pediatrik kalp cerrahisi operasyonu yapılmış ve 6 olguda (%1,4) hipotiriodizm saptanmıştır. Dört olgu kız (%66) idi. Olguların ortalama yaş 4,8 ±4,1 (aralık 1-12) ay, ortalama ağırlık 5,6±2,4(3-9) kg idi. Olguların 3’ü komplet atrioventriküler septal defekt, 1’i ventriküler septal defekt, 1’i büyük arterlerin transpozisyonu ve 1’i hipoplastik sol kalp sendromu tanılıydı. Üç olguda ayrıca genetik olarak Down Sendromu mevcuttu. Tüm olgularda TSH > 50 µIU/ml iken dört olguda TSH > 100 µIU/ml ve tüm olgularda fT4 < 0,3 ng/dl idi. Oral L-thyroxine 10 µg/kg/gün tedavisi sonrası ortalama 8 gün (4-12 gün) sonra TSH ve fT4 normal düzeye gelmişti. Olguların 5’i (%83) L-thyroxine tedavisi sonrası ortalama 4 gün sonra ekstübe edilip taburcu edildi. Hipoplastik sol kalp sendromlu olgu tedaviye rağmen ekstübe edilemedi ve sepsis nedeniyle kaybedildi. Sonuç: Kardiyak cerrahi sonrası pediatrik olgulardaki uzamış entübasyon durumunda tedavi edilebilen bir durum olan hipotiroidizm varlığı araştırılmalıdır.

Anahtar Kelimeler:

uzamış mekanik ventilatör süresi, Hipotiroidizm, konjenital kalp cerrahisi

Prolonged Mechanical Ventilation Associated with Hypothyroidism after Paediatric Cardiac Surgery

Aim: In this study we retrospectively evaluated the incidence and the possible effects of hypothyroidism in patients with Prolonged Mechanical Ventilation (PMV) after paediatric cardiac surgery.Method: We evaluated the patients who underwent cardiac surgery between September 2014 and September 2015, and needed PMV (>7 days) due to hypothyroidism. The demographic data, cardiac diagnosis and intensive care data of the patients were evaluated. Findings: During this period, 430 paediatric open heart surgeries were performed and in 6 patients (1.4%) hypothyroidism was identified. Four of the patients were female (66%). Mean age and weight at the time of operation were 4.8±4.1 months (range 1-12) and 5.6±2.4 kg (range 3-9), respectively. Diagnoses were complete atrioventricular septal defect (n=3), ventricular septal defect (n=1), transposition of great arteries (n=1), and hypoplastic left heart syndrome (n=1). Three patients had Down syndrome. TSH levels were higher than 50 µIU/ml in all patients and >100 µIU/ml in four patients. Free T4 levels are less than 0.3 ng/dl in all patients. After a 10 mg/kg/day oral L- thyroxine therapy, thyroid hormone levels normalized within a median of 8 days (4-12 days). Five of the patients (83%) have been extubated 4 days after L- thyroxine initiation. Despite oral L-thyroxine therapy, the patient with hypoplastic left heart syndrome could not be extubated and died due to sepsis. Conclusion: Hypothyroidism should be investigated in patients with PMV after paediatric cardiac surgery.

Keywords:

Hypothyroidism, prolonged mechanical ventilation, after paediatric cardiac surgery,

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