İlker YILMAZ, Alper EKER, Necdet SÜT, Özlem TANSEL, Osman Nuri HATİPOĞLU, Çakır Ebru EDİS

Yoğun bakım dışı koşullarda takip edilen entübe hastalardaki ventilatör ilişkili pnömonilerin değerlendirilmesi

Aralık 2006 tarihine kadar hastanemizde sadece 7 yatak kapasiteli, genellikle postoperatif hastaların izlendiği yoğun bakım ünitesi (YBÜ) mevcuttu. Yatak kapasitesi yetersiz olduğundan dolayı invaziv mekanik ventilasyon ihtiyacı olan hastalar servislerin içinde ideal olmayan koşullarda takip edilmekteydi. Biz bu çalışmada YBÜ dışında, ideal olmayan koşullarda servislerde takip edilmek zorunda kalan ventilatör ilişkili pnömonilerde (VIP) izole edilen etkenleri, tedavi başarısını ve sağkalım oranlarını saptamayı amaçladık.Biz bu çalışmada; YBÜ dışında servislerde invaziv mekanik ventilasyon uygulanan hastalarda geli- şen VIP'li ardışık 43 erişkin hastayı prospektif olarak değerlendirdik. Tüm hastalar tedavi başar ısı açısından Göğüs Hastalıkları, İnfeksiyon Hastalıkları ve hastadan sorumlu klinisyenden oluşan bir ekip tarafından izlendi. Hastaların yaşam sürelerinin analizinde Kaplan Meier yöntemi uygulandı.Bu hastalarda en sık izole edilen etken Acinetobacter spp. (n= 17) olarak saptandı. Tedavi sonu klinik başarı (kür+iyileşme) oranı %20.9 iken bu oran takip sonunda (altı hafta) %16.3'e geriledi. Kaplan Meier sürvi analizine göre 3,14, 42 ve 365. gün sürvi oranları sırasıyla %72, 34, 16, 11 olarak bulundu.VIP ide al yoğun bakım koşullarında yönetilse dahi mortalitesi yaklaşık %50'dir. Gerçek yoğun bakım koşulları dışında ise mortalite %80'lere yükselmektedir. İnvaziv mekanik ventilasyon gereksinimi olan hastalar mutlaka ideal yoğun bakım koşullarında yönetilmelidir.

The assessment of ventilator associated pneumonia at intubated patients who has followed up non-intensive care conditions?

In our h ospital, there was only one intensive Care Units (ICU) with seven beds capacity, following up postoperative patients, until 2006. Due to the insufficient number of beds, some patients requiring mechanical ventilation followed-up in the general wards under the unsuitable conditions. The aim of this study is to determine the isolated pathogens, the success rate of the treatment and survival rates of patients with ventilator- associated pneumonia (VAP) who had monitorized in poorly conditions in the outside of ICU.Forty three adult patients with VAP who had followed-up outside of the ICU were assessed prospectively. All patients were monitored by a team of Pulmonary and Infectious Disease specialists, and the clinician in charge of the patient. Kaplan-Meier methods were used for survival analysis.In t hese patients, the most common isolated pathogen was Acinetobacter spp. (n=17). The clinical success (cure+convalescent) rate was 20.9% at the end of the treatment, whereas it was 16.3% at the end of the follow-up period (six week). According to the Kplan-Meier method, survival rates were 72%, 34%, 16% and 11% for 3, 14, 42 and 365 days, respectively.In spite of management under ideal ICU conditions, the mortality rate of VAP is approximately 50%, and this rate increases up to 80% outside of the ICU conditions. Patients requiring invasive mechanical ventilation should be managed under ideal ICU conditions.

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