Ipek CANDEMIR, Pinar ERGUN, Dicle KAYMAZ, Fatma AKTAS

Weaning İçin Pulmoner Rehabilitasyon Programı İçeren Yeni Bir Model

Amaç: Akut / kronik solunum yetmezliği olan hastaları yöneten kronik solunum yetmezliği servisimiz, multidispliner ekibi ile yapılandırılmış entegre pulmoner rehabilitasyon (PR), evde bakım birimi olan hastane ünitesidir. Buçalışmanın amacı, yatarak tedavi gören uzamış mekanik ventilasyonu (MV) olan hastalarda weaning deneyimlerimizi ve multidispliner yapılandırılmış yatan hasta kliniği modelinin weaning için alternatif bir yöntem olupolmadığını sunmaktı.Yöntem: Multidisipliner yatarak PR programı ve weaning için evde invaziv mekanik ventilasyonu (IMV) olan 23hasta incelendi. Dispne skorları, vücut kompozisyonları, solunum kas kuvvetleri, psikolojik durumları, PR öncesive weaning işleminden ekokardiyografik ölçümleri, IMV süresi (trakeostominin açılmasından bu yana), weaningöncesi ve 24 saat sonra AKG düzeyleri kaydedildi. Bulgular: Bir hastada pnömoni, 13’ünde KOAH, 5’inde bronşektazi, 2’sinde kifoskolyoz, 2’sinde konjestif kalpyetmezliği tanısı mevcuttu. IMV süresinin ortanca değeri 126 gündü. Weaning, 21 hastanın 15’inde denenedi. 6hasta weaning için uygun bulunmadı. 15 hastanın 12’si, %80 weaning başarısı ile dekanüle edildi. Dört hasta uzunsüreli oksijen tedavisi (USOT), nokturnal non-IMV, 7’si USOT, 1 cihazı olmadan taburcu edildi. Weaning başarısızlığı olan hastalarda daha yüksek aksiyet depresyon skorları, sistolik pulmoner arter basıncı değerleri, daha düşükmaksimum inspiratuar, ekspiratuar basınçlar, daha kısa IMV süreleri mevcuttu. Sonuç: Bu çalışma, uzun süreli MV’de uzmanlaşmış merkezlerin bulunmaması durumunda multidispliner ekibinden oluşan ve PR’nin hasta yönetimine entegre edilmesinde kronik solunum yetmezliği yatan hasta kliniklerininweaning merkezleri olarak hizmet edebileceğini göstermiştir.

A New Model Consisting Pulmonary Rehabilitation Program ForWeaning

Objective: Our chronic respiratory failure service where we manage the patients with acute /chronic respiratory failure, is a hospital unit with multidisciplinary team with structured integrated pulmonary rehabilitation (PR) and home care unit. The aim of the study was to present our weaning experiences of inpatient hospital service in patients with prolonged mechanical ventilation (MV) and whether multidisciplinary structured inpatient service model could be an alternative method for weaning.Method: Twenty-three patients with home invasive mechanical ventilation (IMV) who underwent multidiscipli-nary inpatient PR program and weaning trials were analyzed. Dyspnea scores, body composition, respiratory muscle strength, physicological status, echocardiagraphic measurements before PR and weaning process, dura-tion of IMV (since the opening of the tracheostomy), ABG levels before and 24 hours after weaning were recor-ded.Results: One patient was with pneumonia, 13 with COPD, 5 with bronchiectasis, 2 with kyphoscoliosis, and 2 with congestive heart failure. The median value of duration of IMV was 126 days. The weaning trial was perfor-med on 15 of 21 patients. Six patients were not found to be appropriate for weaning. 12 of 15 patients were decannulated with 80% weaning success. Four patients were discharged with long term oxygen therapy (LTOT), nocturnal non-IMV, 7 with LTOT, and 1 without device. The patients with weaning failure had higher anxiety depression scores, systolic pulmonary arterial pressures, lower maximum inspiratory, expiratory pressures, and shorter duration of IMV.Conclusion: This study showed that chronic respiratory failure inpatients services consisting of multidisciplinary team and integrating PR into patients’ managements could serve as weaning centers in case of absence of spe-cialized centers in prolonged MV.

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ISSN: 1300-4115
Yayın Aralığı: 3
Başlangıç: 1986
Yayıncı: Ali Cangül

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