Aysel ALTAN, Aygen TÜRKMEN, Achmet ALİ, Tarık SARI, Namigar TURGUT

Kronik obstrüktif akciğer hastalığının akut alevlenmesinde uygulanan noninvaziv mekanik ventilasyonda helmet ile yüz maskesinin karşılaştırılması

Kronik obstrüktif akciğer hastalığı (KOAH) alevlenmesi akut solunum yetmezliklerinin sık nedenlerinden biridir. Prospektif randomize çalışmamızda KOAH alevlenmesi nedeniyle akut solunum sıkıntısı gelişen ve noninvaziv mekanik ventilasyon (NIMV) uygulaması için yoğun bakım ünitemize alınan hastalarda; yüz maskesi ile helmeti karşılaştırmayı hedefledik. KOAH alevlenmesi nedeniyle yoğun bakım ünitesine alınan 30 hasta çalışmaya dahil edildi. Hastalar NIMV’de kullanılacak maske türüne göre yüz maskesi grubu (Grup Y; n= 15) ve helmet grubu (Grup H; n= 15) olarak iki gruba ayrıldı. Başlangıç dönemi sonrasında saptanan uygun mekanik ventilasyon ayarları kaydedildi ve bu ayarlar ile hastalara iki saat boyunca aralıksız NIMV uygulandı. Tüm hastaların belirli aralıklarla solunum frekansları (f), kan gazı değerleri (PaO2, PaCO2, pH), PaO2/FiO2 değerleri ve hemodinamik verileri kaydedildi. Ayrıca hastaların uyumu hasta uyumu skalası (HUS) ile değerlendirildi. Çalışma sonunda hastaların yoğun bakım ünitesinde kalış süresi ve komplikasyonlar tespit edildi. Hastaların demografik özellikleri, saptanan uygun mekanik ventilatör ayarları ve hemodinamik veriler gruplar arasında benzer bulundu (p> 0.05). NIMV esnasında ölçülen f değerleri tüm ölçüm zamanlarında gruplar arasında benzer bulundu (p> 0.05). Her iki grupta da NIMV uygulaması sonrası solunum frekansında anlamlı ölçüde azalma olduğu saptandı (p< 0.001). Tüm ölçüm zamanlarında gruplar arasında PaO2, PH ve PaO2/FiO2 değerleri açısından fark saptanmadı (p> 0.05). Başlangıç Pa- CO2 değeri gruplar arasında benzer saptandı fakat diğer ölçüm zamanlarında Grup H’de ölçülen PaCO2 değeri istatistiksel olarak anlamlı ölçüde daha yüksek bulundu (p< 0.05). NIMV esnasında birinci saat ve ikinci saat de ölçülen HUS skoru Grup H’de anlamlı ölçüde daha yüksek bulundu (p< 0.05). Yüz maskesine alternatif olarak geliştirilen helmet maske çok daha yüksek hasta uyumu sağlamaktadır ve buna bağlı olarak NIMV başarı oranı artmaktadır. Fakat helmet maske ile Pa- CO2 değerindeki düşmenin daha yavaş olduğu unutulmamalıdır.

Comparison of non-invasive mechanical ventilation with helmet or face mask in patients with acute exacerbation of chronic obstructive pulmonary disease

Exacerbation of chronic obstructive pulmonary disease (COPD) is one of the frequent causes of acute respiratory failure. In our study, we aimed to compare helmet with face mask in noninvasive mechanical ventilation (NIMV) on patients who had acute respiratory failure because of exacerbation of COPD in intensive care unit (ICU). Thirty patients, taken into ICU for exacerbation of COPD, were included in the study. Patients were divided into two groups as face mask group (Group Y) and helmet group (Group H). Appropriate mechanical ventilation settings were recorded after the starting period and NIMV was applied to patients continuously for two hours with these settings. Respiratory frequency (f), blood gas (PaO2, PaCO2, PH) and PaO2/FiO2 values and hemodynamic data of all patients were recorded periodically. Compliance of patients were evaluated with patient tolerance scale (PTS). Duration of stay of the patients in ICU and complications were also noted. Demographic characteristics of patients, mechanical ventilator settings and hemodynamic data of the patients in the two groups were found to be similar (p> 0.05). Frequency values measured during NIMV are also similar at all measurement times (p> 0.05). It was determined that there was a remarkable decrease in respiratory frequency, in both groups after the application of NIMV (p< 0.001). There was no difference with respect to PaO2, PH and PaO2/FiO2 values at all measurement times, between groups (p> 0.05). PaCO2 values in the beginning were similar in both groups but PaCO2 measured at other measurement times for group H were statistically higher compared to the other group (p< 0.05). PTC score measured at during NIMV in group H were remarkably higher (p< 0.05). Helmet developed as an alternative to face mask has a better patient tolerance and accordingly in increases success rate in NIMV. But it must be keeping mind that the decrease in PaCO2 value is slow with helmet.

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