Neşe DURSUNOĞLU, Dursun DURSUNOĞLU, Aylin MORAY, Şükrü GÜR

Acute improvement of pulmonary artery pressure by non-invasive positive pressure ventilation in the patients with hypercapnic respiratory failure

Kronik obstrüktif akciğer hastalığı (KOAH) olan hastalarda, sağ kalp yetersizliğine ilerleyişi önlemek için, pulmoner arter basıncını (PAB) düşürmek çok önemlidir. Bu çalışmada, hiperkapnik solunum yetersizliği olan hastalarda noninvaziv pozitif basınçlı ventilasyon (NPPV) tedavisi ile PABde akut iyileşme saptandığı gösterilmiştir. Yirmi altı KOAH hastası (18 erkek, 8 kadın) fizik muayene, Doppler ekokardiyografi ve arteryel kan gazları analizi ile ilk kabulde ve taburculukta değerlendirilmiştir. PAB, Doppler ekokardiyografi ile ölçülmüştür. Kontrendikasyon yokluğunda ve şu durumlarda NPPV uygulanmıştır: 1- Orta-ciddi dispne ile birlikte solunumsal sıkıntı, 2- Arteryel pH < 7.35 ve PaCO2 > 45 mmHg, 3- Solunum sayısı ≥ 25/dakika. Hastaların ortalama yaşı 62.6 ± 10.8 yıl ve ortalama NPPV kullanımı 12.6 ± 5.5 gün idi. Hastalarda ortalama ve sistolik PAB (43.8 ± 16.9 mmHg ve 66.7 ± 23.3 mmHg), NPPV tedavisi ile anlamlı olarak düştü (sırasıyla 26.6 ± 8.4 mmHg, p< 0.0001 ve 41.8 ± 14.6 mmHg, p< 0.0001). Aynı zamanda arteryel kan gazı parametrelerinin her biri NPPV tedavisi ile anlamlı düzelmeler gösterdi. Akut solunum yetersizliğine bağlı olarak NPPV tedavisi alan KOAH hastalarında ekokardiyografik bir değerlendirme; bu tedavinin solunumsal asidoz, hiperkapni ve hipoksemiyi düzeltici etkilerine ilaveten, bu hastaların takibinde destekleyici bir ölçüm olarak PABdeki bir iyileşmenin gösterilmesi bakımından kolay ve faydalı bir yöntem olabilir.

Hiperkapnik solunum yetersizliği olan hastalarda noninvaziv pozitif basınçlı ventilasyon tedavisi ile pulmoner arter basıncında akut iyileşmenin gösterilmesi

It is very important to decrease pulmonary artery pressure (PAP) in patients with chronic obstructive pulmonary disease (COPD) in order to prevent progression to right heart failure. We showed an acute improvement of PAP by non-invasive positive pressure ventilation (NPPV) treatment in patients with hypercapnic respiratory failure. In 26 patients with COPD (18 males and 8 females), physical examination, Doppler echocardiographic evaluation and arterial blood gases analysis were performed on admission and at discharge. PAP was measured by Doppler echocardiography. NPPV was used when 2 of the following were present without contraindications: 1. Respiratory distress with moderate to severe dyspnea, 2. Arterial pH less than 7.35 with PaCO2 above 45 mmHg, 3. Respiratory rate of 25/minute or greater. Mean age of the patients was 62.6 ± 10.8 year, and mean usage of the NPPV was 12.6 ± 5.5 day. Mean and systolic PAPs of the patients (43.8 ± 16.9 mmHg and 66.7 ± 23.3 mmHg) were significantly decreased with NPPV treatment (26.6 ± 8.4 mmHg, p< 0.0001 and 41.8 ± 14.6 mmHg, p< 0.0001). Also, each parameter of the arterial blood gases was improved significantly with NPPV usage. An echocardiographic assessment in the COPD patients having NPPV treatment due to acute respiratory failure, might be a useful and easy method to show an improvement of PAP as a supportive measure in the management of those patients, in addition to beneficial effects of that treatment on respiratory acidosis, hypercapnia and hypoxemia

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