Ameliyat sonrası ekstübe edilemeyen hastalar: Tek merkezde 50 vakanın incelenmesi

Amaç: Ameliyat sonrası ekstübe edilemeyen hastalar genel anestezi için ciddi bir durumdur. Uzun süreli mekanik ventilasyon artmış morbidite ve geç mortalite ile ilişkilidir. Ameliyat sonrası ekstübe edilememeyi etkileyen birçok faktör vardır. Çalışmamızda, bu faktörleri araştırdık.Yöntemler: Bu retrospektif kohort çalışma, Ocak 2016 - Ocak 2019 tarihleri arasında Medipol Üniversitesi Tıp Fakültesi Hastanesi’nde ameliyat sonrası ekstübe edilemeyen 50 hasta üzerinde yapıldı. Bulgular: Yaş ortalaması 61,2 (6,4) (50-77) yıldı. 29 (%58) hasta erkek, 21 (%42) hasta kadındı. Ortalama Vücut Kitle İndeksi 29,3 (3,6) (12-36) kilogram / metrekare (kg/m2), ortalama ameliyat süresi 240 (27,6) dakikaydı. Kronik obstrüktif akciğer hastalığı olan 39 (%78) hasta, konjestif kalp yetmezliği olan 13 (% 26) hasta vardı. Perioperatif oksijen satürasyonu 44 (%88) hastada ≤%95 ve 6 (%12) hastada >%95 idi.Sonuçlar: Ameliyat sonrası ekstübe edilemeyen hastalarda kronik obstrüktif akciğer hastalıkları, konjestif kalp yetmezliği ve düşük perioperatif oksijen satürasyonu sıklıkla görülmektedir. Bu hastaların yönetiminde daha dikkatli olunması gerektiğini düşünüyoruz.

Anahtar Kelimeler:

Ekstübasyon, Kronik obstrüktif akciğer hastalığı, Konjestif kalp yetmezliği, Perioperatif oksijen satürasyonu

Extubation failure in operating room: Review of management in 50 patients at a single center

Aim: Postoperative extubation failure is a serious complication of general anesthesia. Prolonged mechanical ventilation is associated with increased morbidity and late mortality. There are numerous factors affecting postoperative extubation failure. In our study, we aimed to evaluate these factors.Methods: This retrospective cohort study was conducted on 50 patients who could not be extubated postoperatively between January 2016 and January 2019 in Medipol University Medical Faculty Hospital. Results: The mean age was 61.2 (6.4) (50-77) years. 29 (58%) patients were male and 21 (42%) were female. The mean Body Mass Index was 29.3 (3.6) (12-36) kilogram/square meters (kg/m2). Mean duration of surgery was 240 (27.6) minutes. 39 (78%) patients had chronic obstructive pulmonary disease and 13 (26%) had congestive heart failure. Perioperative oxygen saturation was ≤95% in 44 (88%) patients and >95% in 6 (12%) patients. Conclusions: Chronic obstructive pulmonary diseases, congestive heart failure and low perioperative oxygen saturation are commonly seen in patients who could not be weaned from mechanical ventilation postoperatively. We advise watching out for patients with these risk factors.

Keywords:

Extubation, Chronic obstructive pulmonary disease, Congestive heart failure, Perioperative oxygen saturation,

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1. Acheampong D, Guerrier S, Lavarias V, Pechman D, Mills C, Inabnet W, et al. Unplanned postoperative reintubation following general and vascular surgical procedures: Outcomes and risk factors. Annals of Medicine and Surgery. 2018;33:40–3.
2. Johnson RG, Arozullah AM, Neumayer L, Henderson WG, Hosokawa P, Khuri SF. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007;204:1188-98.
3. Lee PJ, MacLennan A, Naughton NN, O'Reilly M. An analysis of reintubations from a quality assurance database of 152,000 cases. J Clin Anesth. 2003;15:575-581.
4. Chinachoti T, Chau-in W, Suraseranivongse S, Kitsampanwong W, Kongrit P. Postoperative reintubation after planned extubation in Thai Anesthesia Incidents Study (THAI Study). J Med Assoc Thai. 2005;88:84-93.
5. Ting PC, Chou AH, Yang MW, Ho AC, Chang CJ, Chang SC. Postoperative reintubation after planned extubation: A review of 137,866 general anesthetics from 2005 to 2007 in a Medical Center of Taiwan. Acta Anaesthesiologica Taiwanica. 2010;48:167-71.
6. Marquez-Lara A, Nandyala SV, Fineberg SJ, Singh K. Incidence, outcomes, and mortality of reintubation after anterior cervical fusion. Spine. 2014;39:134–9.
7. Tillquist MN, Gabriel RA, Dutton RP, Urman RD. Incidence and risk factors for early postoperative reintubations. J. Clin. Anesth. 2016;31:80–9.
8. Canet J, Mazo V. Postoperative pulmonary complications. Minerva Anestesiol. 2010;76:138–43.
9. Lawrence VA, Cornell JE, Smetana GW. American College of Physicians. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;8:596–608.
10. McAlister FA, Khan NA, Straus SE, Papaioakim M, Fisher BW, Majumdar SR, et al. Accuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery. Am J Respir Crit Care Med. 2003;5:741–4.
11. Tusman G, Böhm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anaesthesiol. 2012;1:1–10.
12. Kindgen-Milles D, Müller E, Buhl R, Böhner H, Ritter D, Sandmann W, et al. Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Chest. 2005;2:821–8.