Bora BİLAL, Hafize ÖKSÜZ, Fulsen BOZKUŞ

Ekstrakorporeal karbondioksit uzaklaştırma (ecco2r): olgu serisi ve literatür eşliğinde değerlendirme

Giriş: Özellikle respiratuvar asidozlu hastalarda, düşük tidal volümlü ventilasyonla yaşanan zorluklar olmasına rağmen, akut respiratuvar distres sendromunda (ARDS) bu yöntemin başarısı kanıtlamıştır. Konvensiyonel ventilasyonla birlikte kullanılan ekstrakorporeal karbondioksit uzaklaştırma (ECCO2R) yöntemi respira tuvar asidoz durumunda, koruyucu ventilasyon ayarlarında tidal volümü düşürerek katkı sağlar. Bu yöntem ARDS hastalarında daha az invaziv yaklaşımları olmasından dolayı, daha kolay bir tedavi yönetimi sağlamasıyla giderek artan ilgi konusu olmuştur. Aynı zamanda son yapılan çalışmalarda ECCO2R yönteminin, noninvaziv ventilasyona cevap vermeyen kronik obstrüktif akciğer hastalığı (KOAH) atağındaki hastalarda da kullanılabileceği gösterilmiştir. ECCO2R kullanımı ile endotrakeal entübasyondan etkili bir şekilde korunulmuştur. Materyal ve Metod: Üniversite hastanemiz üçüncü basamak yoğun bakım ünitesinde Mart 2014 ve Kasım 2015 tarihleri arasında ECCO2R metodu uyguladığımız hiperkapnik solunum yetersizliği olan hastalar değerlendirildi. Bulgular: Çalışma boyunca 5 hastaya 15.5 kateter kanülü ile ECCO2R uygulandı ve bütün hastalar başarılı bir şekilde bu tedavi yöntemini tamamladı. Sonuç: ECCO2R metodu KOAH hastalarında umut veren bir tedavi yöntemi ve ARDS hastalarında da koruyucu akciğer hedefleriyle başarılı bir şekilde kullanılmaktadır.

Extracorporeal carbondioxide removal (ecco2r): case series and review of literature

Introduction: Ventilation treatment has proven success in acute respiratory distress syndrome (ARDS), while it still remains achallenge to utilize it with lower tidal volumes especially in subjects with respiratory acidosis. The concept of supporting conventionalventilation with extracorporeal carbondioxide removal (ECCO2R) may contribute in adjusting respiratory acidosis consequent to tidalvolume reduction in protective ventilation setting. This method allows an easier management of ARDS due to its less invasiveapproach. As shown by recent studies, ECCO2R can be preferred in subjects with exacerbation of chronic obstructive pulmonarydisease (COPD) who are unresponsive to non-invasive ventilation (NIV). One of the most important aspects of this can be stated asthe reduced rate of endotracheal intubation.Materials and Methods: Subjects that were admitted to intensive care unit between March 2014 to November 2015 due tohypercapnic respiratory failure were treated using ECCO2R.Results: Over the study period, five patients received ECCO2R therapy. All subjects were managed with ECCO2R (Hemolung, A LungInc., Pittsburgh, USA) via a 15.5 FG percutaneously inserted cannula. We observed that ECCO2R is a promising method in themanagement of patients having COPD and can be used to protect lungs in patients with ARDS.

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