Akın KAYA, Aydın ÇİLEDAĞ

Akut kardiyojenik pulmoner ödem tedavisinde noninvazif mekanik ventilasyon

Akut kardiyojenik pulmoner ödem (AKPÖ), endotrakeal entübasyon ve invazif mekanik ventilasyon gereksinimin gelişebildiği, solunum yetmezliğinin sık bir nedenidir. Noninvazif mekanik ventilasyon (NİMV) AKPÖ'lü hastalarda entübasyon oranlarını ve böylece endotrakeal entübasyon ile ilişkili komplikasyonları azaltabilir. Akut kardiyojenik pulmoner ödem tedavisinde NİMV'nin etkinliğini değerlendiren gittikçe artan sayıda çalışma bulunmaktadır ve NİMV'nin fizyolojik parametreleri hızla düzelttiği, endotrakeal entübasyon ve mortaliteyi azalttığı gösterilmiştir. Noninvazif mekanik ventilasyonun AKPÖ tedavisinde uygulanan başlıca iki modu bulunmaktadır: sürekli pozitif havayolu basıncı (CPAP) ve noninvazif basınç destekli ventilasyon veya bilevel pozitif havayolu basıncı (BİPAP). Hem CPAP hem de BİPAP'ın iyi tolere edildiği ve ciddi yan etkiye neden olmadıkları gösterilmiştir.

Noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema

Acute cardiogenic pulmonary edema (ACPE) is a common cause of respiratory failure that necessitates endotracheal intubation and invasive mechanical ventilation. In patients with ACPE noninvasive mechanical ventilation (NIMV) may reduce intubation rate and hence, the complications related with endotracheal intubation. There has been a steady stream of trials investigating the effectiveness of NIMV in the treatment of ACPE, and NIMV has been shown to improve physiological parameters quickly and decrease endotracheal intubation and mortality. There are essentially two modes of NIMV that are used in the treatment of ACPE: continuous positive airway pressure (CPAP) and noninvasive pressure support ventilation or bilevel positive airway pressure (BIPAP). Both CPAP and BIPAP have been demonstrated to be well tolerated and are not associated with any serious events.

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