Arzu TOPELİ, Ebru ERSOY ORTAÇ, Banu ÇAKIR, Serpil ÖCAL, Sabahat TEZCAN, Atilla KARA, Başak BOLAYIR, Muhammet Cemal KIZILARSLANOĞLU

Mekanik ventilasyon uygulanan hastalarda ventilatörden ayırma başarısını belirlemede hipofosfateminin yeri

Giriş: Hipofosfatemi akut solunum yetmezliği ve doku hipoksisine neden olabilir. Bu çalışmada hipofosfateminin ventilatörden ayırma başarısını belirlemeye olan etkisi incelenmiştir. Hastalar ve Metod: Hastanemiz İç Hastalıkları Yoğun Bakım Ünitesinde 2005-2010 yılları arasında invaziv mekanik ventilasyon uygulanan 76 hasta üzerinde birinci denemede ventilatörden ayrılamayan veya ayrılsa dahi post-ekstübasyon mekanik ventilasyon uygulanan hastalar vaka grubunu (başarısız grup), birinci denemede ekstübe olan hastalar kontrol grubunu (başarılı grup) oluşturacak şekilde retrospektif bir kohort içerisinden yuvalandırılmış olgu-kontrol çalışma planlanmıştır. Bulgular: Tüm kohort içerisinde yoğun bakım ünitesine yatış gününde hipofosfatemi [Fosfor (P) düzeyi < 2.5 mg/dL] sıklığı %23.7 idi. Ventilatörden ayırma başarısızlığı %71.1 hastada gözlendi. Yatışta hipofosfatemi varlığında ventilatörden ayırma başarısızlığı için risk %88.9 iken, hipofosfatemi yokluğunda ventilatörden ayırma başarısızlığı için risk %65.5 idi. Buna göre risk oranı 1.36 (1.061.74) idi (p= 0.096). Başarılı grupta yatış P değeri ortalaması (± SS) 3.6 ± 1.0 mg/dL iken başarısız grupta bu değer 3.2 ± 1.0 mg/dL idi (p= 0.113). Lojistik regresyon analizinde ventilatörden ayırma başarısızlığı belirleyen dört bağımsız risk faktörü altta yatan kronik akciğer hastalığı, yatış günü yüksek organ yetmezlik skoru (SOFA), ventilatörden ayırma gününde yüksek kan üre nitrojen değeri ve yatış günündeki P değeri (her 1 mg/dL P yüksekliğinde ventilatörden ayrılma başarısızlığı OR değeri 0.43 (0.21-0.88) idi. Sonuç: Sonuç olarak, hipofosfatemi ile ventilatörden ayırma başarısızlığı arasında bir ilişki saptanmıştır. Bu ilişkinin yeterli güce sahip prospektif kohort çalışmalarla ve müdahale araştırmalarla desteklenmesi uygundur.

Effect of hypophosphatemia on weaning success from mechanical ventilation

Introduction: Hypophosphatemia may cause acute respiratory failure and tissue hypoxia. In this study we investigated the effect of hypophosphatemia on weaning success. Patients and Methods: A nested case-control study was conducted in a retrospective cohort of 76 patients who received invasive mechanical ventilation in 2005-2010 in the Medical Intensive Care Unit (MICU) of university hospital. Case patients (failure group) were those who could not be weaned in the first trial or who required post-extubation mechanical ventilation after first extubation. Control patients (success group) were successfully extubated in the first weaning attempt. Results: Frequency of hypophosphatemia (P level < 2.5 mg/dL) at admission was 23.7%. Weaning failure rate was 71.1%. Risk of weaning failure in the presence of hypophosphatemia was 88.9%, whereas risk in the absence of hypophosphatemia was 65.5%, resulting in risk ratio of 1.36 (1.061.74) (p= 0.096). Mean (± SD) P levels in the success and failure groups were 3.6 ± 1.0 and 3.2 ± 1.0 mg/dL, respectively (p= 0.113). Logistic regression analysis revealed four independent risk factors which were presence of underlying chronic pulmonary disease, high organ dysfunction score (SOFA) at admission, high blood urea nitrogen at the day of weaning trial and low P level at admission to predict weaning failure. Each 1 mg/dL increment in P level resulted in decreased probability of weaning failure with an OR of 0.43 (0.21-0.88). Conclusion: In conclusion, a relation between hypophosphatemia and weaning failure was determined which has to be confirmed with prospective cohort and interventional studies with adequate power.

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