Mustafa DENİZ, Zerrin ÖZÇELİK, Pınar OZGUN

Yoğun bakım ünitesinde takip edilen KOAH'lı hastalarda mortalite ve hasta sonuçlarını etkileyen faktörler

Amaç: KOAH alevlenme ile karakterize olup pnömoni ve sepsis gibi durumlarda yoğun bakım ünitesine yatışa neden olabilmektedir. Non-invaziv mekanik ventilasyon yoğun bakım ünitelerinde ilk tedavi seçeneği olmakla birlikte mortaliteyi ve hastanede kalış süresini azaltmaktadır. Çalışmamızda yoğun bakım ünitesine kabul edilen KOAH'lı hastalarda mortaliteyi etkileyen faktörleri belirlemeyi amaçladık. Materyal ve Metod: Çalışmamızda Bolu İzzet Baysal Devlet Hastanesi yoğun bakım ünitesine KOAH tanısı ile yatırılan hastaların verileri retrospektif olarak değerlendirildi. Yoğun bakımda kalış süresi, APACHE II skoru, komorbiditeler, noninvaziv mekanik ventilasyon ihtiyacı, CRP albumin oranı ve lökosit lenfosit oranı kaydedildi. Bulgular: Çalışmamıza 177'si (%42,5) kadın olmak üzere toplam 416 hasta dahil edilmiştir. Hastaların 107'si (%25,7) (Grup 1) KOAH alevlenmesi, 183'ü (%44) (Grup 2) pnömoni ve 126'sı (%30,3) (Grup 3) sepsis nedeniyle YBÜ'ye kabul edilmiştir. Hipertansiyon 112 hastada (%26,9) en sık görülen komorbidite olmuştur. Mortalite, pnömoni ve sepsis hastalarında KOAH alevlenmesi olan hastalara göre daha yüksekti. Tüm hastalar prognoza göre karşılaştırıldığında, ölen hastalarda yaş, YBÜ'de kalış süresi, NLR, CAR ve APACHE II skorları daha yüksekti. Non-invaziv mekanik ventilasyon süresi KOAH atağı olan hastalarda daha yüksekken, mortalite invaziv mekanik ventilasyon desteği alan hastalarda daha yüksekti. Sonuç: KOAH'lı hastalarda pnömoni ve sepsis mortaliteyi artırırken, NIMV bu hastalarda olumlu bir prognoza sahiptir ve cesaret verici sonuçlar vermektedir.

Anahtar Kelimeler:

kronik obstrüktif akciğer hastalığı alevlenmesi, noninaziv mekanik ventilasyon, yoğun bakım ünitesi, CRP albümin oranı, Nötrofil lenfosit oranı

Factors affecting mortality and patient outcome in patients with COPD followed in the intensive care unit

Objective: COPD is characterized by exacerbation and may lead to intensive care unit admission in cases such as pneumonia and sepsis. While non-invasive mechanical ventilation is the first treatment option in intensive care units, it reduces mortality and hospitalization. In our study, we aimed to determine the factors affecting mortality in patients with COPD admitted to intensive care unit. Materials and Methods: In our study, the data of patients admitted to the intensive care unit of Bolu Izzet Baysal State Hospital with COPD were evaluated retrospectively. Duration of intensive care unit stay, APACHE II score, comorbidities, need for noninvasive mechanical ventilation, CRP albumin ratio and leukocyte lymphocyte ratio were recorded. Results: A total of 416 patients, including 177 (42.5%) women, were included in our study. Of the patients, 107 (25.7%) (Group 1) were admitted to ICU for COPD exacerbation, 183 (44%) (Group 2) for pneumonia and 126 (30.3%) (Group 3) for sepsis. Hypertension was the most common comorbidity in 112 patients (26.9%). Mortality was higher in patients with pneumonia and sepsis than in patients with COPD exacerbation. When all patients were compared according to prognosis, age, length of ICU stay, NLR, CAR and APACHE II scores were higher in patients who died. The duration of non-invasive mechanical ventilation was higher in patients with an episode of COPD, while mortality was higher in patients receiving invasive mechanical ventilation support. CONCLUSION While pneumonia and sepsis increase mortality in patients with COPD, NIMV has a favorable prognosis in these patients with encouraging results.

Keywords:

chronic obstructive pulmonary disease exacerbation, non inasive mechanical ventilation, intensive care unit, CRP to albümin ratio, Neutrophil to lymphocyte ratio,

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez