Sertan ÖZYALÇIN, Adnan YALÇINKAYA, Adem İlkay DİKEN, Özlem ERÇEN DİKEN

Hızlı Yüzeyel Solunum İndeksinin kullanımı koroner arter baypas greftleme yapılan hastalarda ekstübasyon süresini kısaltır

Amaç: Bu çalışmada elektif izole koroner arter baypas greftleme yapılan hastalarda Hızlı Yüzeyel Solunum İndeks kullanımının ekstübasyon başarısı ve ekstübasyon süresi üzerindeki etkileri araştırıldı. Çalışma planı: Bu prospektif, randomize kontrollü çalışmaya Şubat 2016 - Kasım 2016 tarihleri arasında izole koroner arter baypas greftleme yapılan toplam 72 hasta (55 erkek, 19 kadın; ort. yaş 60.3±9.3 yıl; dağılım 45-76 yıl) alındı. Hastalar HYSİ grubu (n=36) ve kontrol grubu (n=36) olmak üzere iki gruba ayrıldı. Kontrol grubu kliniğimizde rutin olarak uygulanan konvansiyonel kriterlere göre ekstübe edilirken, HYSİ grubu, hemodinamik stabilizasyon sağlandıktan ve mekanik ventilasyondan ayrılma işleminden sonra indeks skorun 77 solunum L/dk. altına düştüğünde ekstübe edildi. Bulgular: Ortalama mekanik ventilasyondan ayrılma süresi HYSİ grubunda 5.8±1.0 saat ve kontrol grubunda 8.1±2.0 saat idi (p=0.03). Konvansiyonel ekstübasyon kriterlerine kıyasla, indeksin kullanıldığı ekstübasyon protokolü ile %26 daha erken ekstübasyon sağlandı. Ameliyat sonrası takip parametrelerinde veya klinik durumlarda anlamlı bir fark yoktu. Sonuç: Çalışma sonuçlarımız, Hızlı Yüzeyel Solunum İndeksi gibi pratik bir aracın, koroner arter baypas greftleme yapılan hastalarda ekstübasyon lehine karar vermede güvenle kullanılabileceğini göstermektedir. Bu indeksin kullanımı ile ekstübasyon süresinin kısalması; enfeksiyonların, mekanik ventilasyona bağlı akciğer hasarının ve muhtemel pulmoner komplikasyonların önlenmesi açısından ciddi yarar sağlayabilir.

The use of Rapid Shallow Breathing Index shortens time to extubation in patients undergoing coronary artery bypass grafting

Background: This study aims to investigate the effects of the use of the Rapid Shallow Breathing Index on extubation success and time to extubation in patients undergoing elective isolated coronary artery bypass grafting.Methods: This prospective, randomized-controlled study included a total of 72 patients (55 males, 19 females; mean age 60.3±9.3 years; range 45 to 76 years) who underwent isolated coronary artery bypass grafting between February 2016 and November 2016. The patients were divided into two groups as the RSBI group (n=36) and the control group (n=36). The control group was extubated by conventional criteria that were routinely applied in our clinic, while the RSBI group was extubated, when the index scores became below 77 breaths per min/L, following ensuring hemodynamic stability and weaning procedure from mechanical ventilation.Results: The mean time to wean from mechanical ventilation was 5.8±1.0 hours in the RSBI group and 8.1±2.0 hours in the control group (p=0.03). Extubation protocol performed through the use of the index was found to provide 26% earlier extubation compared to the conventional extubation criteria. There was no significant difference in the postoperative follow-up parameters or clinical conditions.Conclusion: Our study results show that a practical tool such as the Rapid Shallow Breathing Index can be reliably used for making a decision in favor of extubation in patients undergoing coronary artery bypass grafting. A shortened time to extubation by the use of this index may provide substantial benefits in terms of prevention of infections, mechanical ventilation-induced lung injuries, and potential pulmonary complications.

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