Aslı GÖREK DİLEKTAŞLI, Ezgi ÖZYILMAZ, Huriye BERK TAKIR, Erdal İN, Begüm ERGAN, Zuhal KARAKURT, Recai ERGUN, Tülay KIVANÇ, Eylem ACARTÜRK, Özkan DEVRAN, Sevinç SARINÇ ULAŞLI, Elif YILMAZEL UÇAR, Şehnaz OLGUN, Ege GÜLEÇ BALBAY, Aylin ÖZSANCAK UĞURLU, Özlem ERTAN EDİPOĞLU, Ilgaz DOĞRUL, Pervin KORKMAZ

Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use in acute respiratory failure

Giriş: Noninvaziv mekanik ventilasyon (NIV) akut solunum yetmezliğinin (ASY) tedavisinde, özellikle de kronik akciğer hastalığı olan hastalarda, dünya çapında giderek artan oranlarda kullanılmaktadır. Bu çalışmada Türkiye'deki göğüs hastalıkları doktorlarının ASY tedavisinde NIV kullanımına yönelik yaklaşımını belirlemeyi amaçladık.Materyal ve Metod: Yazarlarca geliştirilen ve test edilen 38 soruluk anket, e-posta yoluyla Türkiye genelinde toplam 2205 göğüs hastalıkları doktoruna iletildi.Bulgular: Katılım oranı %27 (n= 596) idi. Katılanların %71'i klinikte NIV uygulaması yapıyordu. NIV kullanımı ile katılımcıların ünvanı, yaşı, doktorluk süresi, çalıştıkları hastane ve bulunduğu bölge, hasta yükü, asistanlık eğitimi esnasındaki NIV deneyimi ve miktarı, NIV ve yoğun bakım ünitesi (YBÜ) deneyim süreleri ilişkili bulundu (Tablo 1, p= 0.000). ASY'de NIV kullanan 420 katılımcının alt grup analizinde, haftalık takip edilen ortanca hasta sayısı 4 (25 ve 75 persentil: 2.6) idi. Kullananların çoğunluğu servis (%90) ve/veya YBÜ (%86)'de hastalarını takip ederken; %8.4 hasta takibi için sadece YBÜ'yü kullanıyordu. En sık üç endikasyonu kronik obstrüktif akciğer hastalığı (%99.5), obezite hipoventilasyon sendromu (%93.7) ve restriktif akciğer hastalığına (%89.4) bağlı gelişen ASY idi. Kullanıcıların çoğunluğu (%87) NIV'ı KOAH'lı hastaların %60'ından fazlasında kullanmaktaydı ve kullananların %93'ü KOAH'lılarda NIV başarı oranını %60'ın üzerinde olarak bildirmekteydi. Oronazal maske (ortanca, 25 ve 75 persentil: %90, 80,100) ile ev tipi NIV ventilatörler (%50, 10, 85) en sık kullanılan ekipmanlardı.Sonuç: ASY'de NIV kullanımında bölgesel ve hastane kaynaklı, özellikle doktorun deneyimi ile ilişkili değişkenlik mevcuttur. Kılavuzlara ve genel pratiğe uygun olmakla birlikte, mevcut klinik NIV uygulamaları halen arttırılabilinir ve geliştirilebilinir.

Türkiye'de akut solunum yetmezliğinde noninvaziv mekanik ventilasyon kullanımına göğüs hastalıkları doktorlarının yaklaşımı

Introduction: Noninvasive mechanical ventilation (NIV) has been increasingly used worldwide for acute respiratory failure (ARF), especially in patients with chronic lung disorders. We aimed to define the approach of pulmonologists in Turkey to NIV use for ARF management. Materials and Methods: A 38-question survey, developed and tested by authors, was distributed by e-mail to a total of 2.205 pulmonologists in Turkey.Results: Response rate was 27% (n= 596). Seventy-one percent of responders were practicing NIV in clinic. NIV use was found to be associated with responder's academic title, age, duration of medical license, type of physician's hospital and its region, patient load, NIV experience during residency, and duration of NIV and intensive care unit (ICU) experience (p< 0.001). Based on sub-group analysis of responders using NIV, median number of NIV patients followed-up per week was 4 [interquartile range (IQR): 2-6]. Most of the NIV users reported employment of wards (90%) and/or ICUs (86%) to follow-up patients, while 8.4% of the responders were applying NIV only in ICU's. Chronic obstructive lung disease (COPD) (99.5%), obesity hypoventilation syndrome (93.7%) and restrictive lung disease (89.4%) were the most common indications. Majority of NIV users (87%) were applying NIV to > 60% of patients with COPD, and success rate in COPD was reported as over 60% by 93% of users. Oronasal mask (median and IQR 90, 80-100%, respectively) and home care NIV ventilators (median and IQR 50, 10-85%, respectively) were the most commonly utilized equipment.Conclusion: NIV use in ARF varies based on hospital type, region and, especially, experience of the physician. Although consistent with guidelines and general practice, NIV use can still be improved and increased.

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