Simru TUĞRUL, Figen ESEN, Nahit ÇAKAR, Kutay AKPİR, Lütfü TELCİ, Özkan AKINCI, Ergin Perihan ÖZCAN

Hematolojik kanser hastalarında yoğun bakım deneyimlerimiz

Hematolojik kanser hastalarında tedavi sırasında gelişen ve yoğun bakım takibi gerektiren komplikasyonlara sık olarak rastlanmaktadır. Bu retrospektif araştırmada reanimasyon ünitesinde izlenmiş olan hematolojik kanser hastalarınının yoğun bakıma alınma nedenleri, altta yatan hastalığın ağırlık derecesi, tedavi özellikleri, mortalite oranı ve prognozu etkileyen faktörler incelenmiştir. 1991-2001 yılları arasında ünitemizde tedavi görmüş toplam 42 hastanın % 69'unun yoğun bakıma alınma sebebinin pnömoniye bağlı akut solunum yetersizliği olduğu tespit edilmiştir. Hastaların tümüne mekanik ventilasyon uygulanmış, mekanik ventilasyon süresi 11.04±9.4 gün, yoğun bakım kalış süresi ise 12.4±10.6 gün bulunmuştur, incelediğimiz popülasyonun mortalite oranı % 74'dür. Ölüm nedenleri incelendiğinde 15 hastanın (%48) septik şok ve çoğul organ yetersizliği tablosunda kaybedildiği görülmüştür. Çalışmamızda hastaların yaşı, giriş APACHE II, SOFA skorları, lökosit ve tromıbosit değerleri ve mekanik ventilasyon süresinin mortalite ile ilişkisi gösterilememiştir, incelediğimiz hasta grubunda septik şok gelişmesi mortalileyi artıran tek faktör olarak bulunmuştur.

Our experience with critically ill hematologic malignancies

Patients with hematologic malignancies can often develop complications which should be treated in intensive care units. In our study, we aimed to evaluate the severity of underlying disease and acute illness, the diagnosis of intensive care unit admission, treatment characteristics, mortality rate and prognostic indicators in patients with hematologic malignancies. We examined 42 patients with hematologic malignancies who admitted to the I.V. Istanbul Medical Faculty Anaesthesiology Department Intensive Care Unit between 1991-2001. The main admission diagnosis of the patients was acute respiratory failure mostly due to pneumonia (69 %). Mechanical ventilation Was performed to all of the patients. The duration of mechanical ventilation was found 11.04±9.4 days and intensive care unit stay was found 12.4+10.6 days. Overall mortality rate was found 74 % and most of the patients (48 %) were died due to septic shock and multiple organ failure. In this study, age, APACHE II and SOFA scores, leukocyte and thrombocyte counts, and duration of mechanical ventilation did not demonstrate any rela-tion with mortality rate. In our study population, the factor that influence the mortality was found to be the development of septic shock.

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