Akın KAYA, Elif ŞEN, İpek ÇAYLI, Zeynep Pınar ÖNEN, Banu GÜLBAY, Aydın ÇİLEDAĞ

Associated factors with non-invasive mechanical ventilation failure in acute hypercapnic respiratory failure

Bu çalışmada amaç; akut hiperkapnik solunum yetmezliğinde noninvaziv mekanik ventilasyon (NİMV) başarısızlığı ile iliş- kili faktörleri saptamaktır. Akut hiperkapnik solunum yetmezliği nedeniyle NİMV uygulanan 95 hasta değerlendirildi. NİMV, hastanın entübasyon ihtiyacı gelişmeden hastaneden taburcu olması halinde başarılı, invaziv mekanik ventilasyon ihtiyacı gelişmesi veya hastanın ölmesi halinde ise başarısız olarak kabul edildi. Tedavi öncesi ortalama pH değeri başarı- lı grupta 7.30, başarısız grupta 7.28 (p> 0.05), PaCO2 başarılı grupta 71.45 mmHg, başarısız grupta ise 72.17 mmHg (p> 0.05) idi. Tedavinin birinci saatinde pH, başarılı grupta 7.33, başarısız grupta 7.26 (p= 0.01), PaCO2 başarılı grupta 65.50 mmHg, başarısız grupta 73.47 mmHg (p= 0.02) olarak saptandı. Tedavinin birinci saatinde başarılı grupta pHde anlamlı yükselme, PaCO2de anlamlı düşme izlenirken, başarısız grupta anlamlı fark saptanmadı. Başarısız grupta, tedavi öncesiAcute Physiology Assessment and Chronic Health Evaluation (APACHE) II skoru, serum C-reaktif protein düzeyi ve eş- lik eden komplikasyon sıklığı anlamlı olarak daha yüksek, Glasgow Koma Skoru ise anlamlı olarak daha düşük saptandı. Sonuç olarak, tedavi öncesi yüksek APACHE II skoru ve C-reaktif protein düzeyi, düşük Glasgow Koma Skoru, eşlik eden ek komplikasyon varlığı ve tedavinin birinci saatinde pH ve PaCO2de düzelme olmaması NİMV başarısızlığı ile ilişkili faktörlerdir.

Akut hiperkapnik solunum yetmezliğinde noninvaziv mekanik ventilasyon başarısızlığı ile ilişkili faktörler

Our aim was to determine associated factors with non-invasive mechanical ventilation (NIMV) failure in acute hypercapnic respiratory failure ninety live patients treated with NIMV for acute hypercapnic respiratory failure were evaluated. While success of NIMV was defined as absence of need of intubation with the patient s discharge from hospital, failure of NIMV was defined as death or need of intubation. The pretreatment pH level was 7.30 in success and 7.28 in failure group (p> 0.05), PaCO2 was 71.45 mmHg in success and 72.17 mmHg in failure group (p> 0.05). After 1h of NIMV, pH was 7.33 in success and 7.26 in failure group (p= 0.01), PaCO2 was 65.50 mmHg in success and 73.47 mmHg in failure group (p= 0.02). After 1h of treatment, in success group there was significant increase of pH and decrease of PaCO2 in contrast to baseline levels, while there was no significant change in failure group. The pretreatment Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, serum C-reactive protein level and frequency of associated complication on admission were significantly higher and Glasgow Coma Score was lower in failure group. In conclusion, high APACHE II and C-reactive protein level, low Glasgow Coma Score, associated complication on admission and inadequate response in pH and PaCO2 after first hour of NIMV are associated factors with NIMV failure.

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