Meltem MİDİLLİ, Sedat ÜRKMEZ, Feza BACAKOĞLU, Mehmet Sezai TAŞBAKAN, Adnan Tolga ÖZ, Özen BAŞOĞLU KAÇMAZ, Alev GÜRGÜN, Pervin EKREN KORKMAZ

The factors aff ecting noninvasive mechanical ventilation failure in COPD exacerbations

Amaç: Kronik obstrüktif akciğer hastalığı (KOAH) alevlenmesi nedeniyle oluşan solunum yetmezliğinde noninvaziv mekanik ventilasyon (NİMV) başarısızlığı oranı % 5-40 arasındadır. Bu çalışmanın amacı NİMV başarısızlığının nedenlerini değerlendirmektir. Yöntem ve gereç: Endotrakeal entübasyon gerekliliği NİMV başarısızlığı olarak kabul edilmiştir. Yoğun bakım ünitesi (YBÜ)nde KOAH alevlenmesi ve solunum yetmezliği nedeniyle tedavi edilen 54 olguda (45i erkek, ortalama yaş: 67,7 ± 11.0) NİMV başarısızlığı değerlendirilmiştir. Bulgular: 20 olguda (% 37,0) NİMV tedavisi başarısızlığı vardı. Noninvaziv mekanik ventilasyonun başarısız olduğu olgularda, hastane kökenli pnömoni ve hastane içi mortalite oranları daha yüksek (sırasıyla P = 0,003 ve P = 0,002), yanı sıra YBÜ kalış süreleri daha uzundu (P < 0.0001). NİMVnin başarısız olduğu grupta; başvuru anında, arteriyel pH, serum albumin ve Glasgow koma skalası değerleri daha düşüktü (sırasıyla P = 0,032, P = 0,024 ve P = 0,013). Noninvaziv mekanik ventilasyonun başarısız olduğu grupta; birinci saatte arteriyel pH daha düşük (P = 0,039) ve solunum sayısı daha yüksek (P = 0,010), üçüncü saatte ise; PaO2/FiO2 oranı daha düşük (P = 0,017), solunum sayısı ve kalp hızı daha yüksekti (sırasıyla P = 0,002, P = 0,020). Sonuç: Başlangıç ve izlemde yapılan klinik ve arteriyel kan gazı değerlendirmelerinin, KOAH alevlenmesinde NİMV başarısızlığı hakkında önemli ipuçları verebileceği mevcut verilerle kuvvetle desteklenmiştir.

KOAH alevlenmesinde noninvaziv mekanik ventilasyon başarısızlığını etkileyen faktörler

Aim: To evaluate causes of noninvasive mechanical ventilation (NIMV) failure. Th e rate of NIMV failure in respiratory failure due to chronic obstructive pulmonary disease (COPD) exacerbations was reported as 5%-40%. Materials and methods: Th e necessity of endotracheal intubation was accepted as NIMV failure. Th e causes of NIMV failure were assessed in 54 patients (45 males; mean age: 67.7 ± 11.0 years) treated with NIMV because of COPD exacerbations and respiratory failure in an intensive care unit (ICU). Results: Th ere was NIMV failure in 20 patients (37.0%). Th e rates of hospital-acquired pneumonia and in-hospital mortality were higher (P = 0.003 and P = 0.002, respectively) and the duration of ICU stay was longer (P < 0.0001) in patients with NIMV failure. On admission, arterial pH, serum albumin, and Glasgow Coma Scale levels were lower (P = 0.032, P = 0.024, and P = 0.013, respectively) in the NIMV failure group. Arterial pH was lower (P = 0.039) and respiratory rate was higher (P = 0.010) aft er 1 h, and the PaO2/FiO2 rate was lower (P = 0.017) and respiratory and heart rates were higher (P = 0.002 and P = 0.020, respectively) aft er 3 h in the NIMV failure group. Conclusion: Th e present data strongly suggest that baseline and follow-up clinical and arterial blood gas evaluations can give important clues about NIMV failure in COPD exacerbations.

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