Figen DEVECİ, Müge AKPINAR, Kunter PERİM, Emel ÇELİKTEN, Naime TAŞDÖĞEN, Melih BÜYÜKŞİRİN

KOAH'a bağlı akut solunum yetmezliğinde noninvaziv mekanik ventilasyonun etkinliği

Bu çalışma kronik obstrüktif akciğer hastalığı (KOAH)'nda akut atak nedeniyle gelişen hipoksik-hiperkapnik solunum yetmezliğinde standart medikal tedavi (SMT)'ye ek olarak uygulanan noninvaziv pozitif basınçlı ventilasyon (NPPV)'un etkinliğini araştırmak amacıyla planlandı. Bu amaçla yoğun bakım servisinde KOAH'a bağlı akut solunum yetmezliği tanısıyla yatan 40 olgunun 20'sine sadece SMT, 20'sine SMT ve ek olarak "Bilevel Airway Pressure (BİPAP)" uygulandı. Olguların belirli saatlerdeki kan gazı parametreleri, nabız, ortalama arteryel basınç, zirve akım hızı (PEF) değerleri, hastanede yatış süreleri ve endotrakeal entübasyon ihtiyacı (ETİ) değerlendirildi. SMT grubundaki olguların 18'i erkek (%90), 2'si kadın (%10), yaş ortalaması 64.05 ± 6.76 (46-80), BİPAP grubunda olguların 17'si erkek (%85), 3'ü kadın (%15) yaş ortalamaları ise 61.05 ± 11.31 (40-74) idi. BİPAP grubunda tüm parametrelerde (solunum sayısı, PaCO2, PaO2, pH) 1. saatten itibaren, SMT grubunda ise PaO2'de 1. solunum sayısında 6. pH'da 24. saatten sonra düzelme olduğu PaCO2 değerinde ise hiçbir saatte düzelme olmadığı saptandı. Her iki grup karşılaştırıldığında PaCO2'de 1. solunum sayısında ve pH'da 1. ve 6. saatlerde BİPAP grubundaki düzelmenin SMT grubuna göre anlamlı derecede fazla olduğu izlendi. Nabız ve ortalama arteryel basınç değerleri açısından iki grup arasında fark saptanmadı. PEF'deki ortalama artışın BİPAP grubunda, kontrol grubuna göre anlamlı olarak yüksek olduğu saptandı. Kontrol grubunda 8, BİPAP grubunda ise 4 olguya ETİ uygulandı. Ayrıca BİPAP grubundaki olguların hastanede yatış sürelerinin daha kısa olduğu saptandı. Sonuç olarak, BİPAP'ın KOAH'da akut atak nedeniyle gelişen akut solunum yetmezliğinde, oksijenizasyonu arttırarak ve solunum kaslarını dinlendirerek entübasyon ihtiyacını azalttığı ve hastanede kalış süresini kısalttığı saptanmıştır.

Effect of noninvasive mechanic ventilation in patients with acute respiratory failure due to COPD

This study was planned to investigate the efficacy of noninvasive positive pressure ventilation (NPPV) which was applied additionally to standard medical treatment (SMT) in Chronic Obstructive Pulmonary Disease (COPD) patients who developed hypoxic-hypercapnic respiratory failure because of an acute attack. In this study only SMT was applied to 20 of 40 patients hospitalized in intensive care unit for acute respiratory failure related to COPD. SMT and bilevel airway pressure (BIPAP) was applied to the rest 20. All patients were evaluated for blood gas parameters, pulses, mean arteriel pressures, PEF, duration of hospitalizasyon, and endotracheal intubation (ETI), hour by hour periodically. 18 male (90%) and 2 female (10%) patients with the mean age 64.05 ± 6.76 (46-80) were included in the SMT group. In the BIPAP group 17 male (85%) and 3 female (15%) patients with the mean age 61.05 ± 11.31 (40-74) were included. In BIPAP patients all parameters (number of respiration, PaCO2, PaO2, pH) ameliorated by the first hour, while in the SMT group, improvement in PaO2 was seen in the first hour, in number of respiration in the sixth hour and in pH in the twenty fourth hour. In this group no improvement was seen in PaCO2. We evaluated that the improvement in the BİPAP group was significantly better than the SMT group when PaCO2, number of respiration, and pH parameters were compared for the first and sixth hours. There were no significant different between the two groups, in pulses, and the mean arteriel pressures. It was determined that the mean increase in PEF in the BIPAP group was significantly higher than the control group. ETI was applied to 8 patients in the control group, and 4 patients in the BIPAP group. Additionally we found that the duration of hospital stay was shorter in the BIPAP group. Finally we concluded that BIPAP reduced the necessity for entubation and the duration of hospitalizasyon in COPD patients with acute respiratory failure because of an acute attack, by increasing oxigenisation and relaxing the respiratory muscles.

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