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Yoğun Bakımda Ödem ve Dehidratasyon

Ödem ve dehidratasyon yanıklar, travma, sepsis, beyin hasarı, kalp yetersizliği, renal yetersizlikler ve diyabet gibi pek çok hastalığa veya uygulanan tedavilere bağlı olarak ortaya çıkan, erken fark edilip tedavi edilmediğinde ciddi sorunlara yol açabilen özellikle yoğun bakım hastalarında ciddi morbidite ve mortaliteye neden olan ve yoğun bakımda kalış süresini uzatan önemli semptomlar arasında yer almaktadır. Bu nedenle yoğun bakımda çalışan hemşirelerin ödem ve dehidratasyona yol açan nedenleri bilmesi, belirti ve bulguları erken fark edebilmesi etkin bir tedavi ve bakımın sürdürülmesinde önemlidir. Bu derlemede ödem ve dehidratasyon nedenleri, fizyopatolojisi, tedavi ve bakımına kısaca yer verilmesi amaçlandı.

Anahtar Kelimeler:

Ödem, periferal ödem, pulmoner ödem, dehidratasyon

Edema and Dehydration in Intensive Care

Edema and dehydration may result from various conditions including burns, sepsis, brain damage, renal failure and their treatment. They may lead to serious problems if early detection and treatment is not provided, resulting in serious morbidity and mortality among intensive care patients in particular. They are also among significant symptoms that increase the length of stay in intensive care. Therefore, it is important for nurses who work in intensive care to know the reasons of edema and dehydration and to detect their symptoms and findings at early phases in order to maintain effective treatment and care. In this review, it was aimed to examine the reasons of edema and dehydration, their physiopathology, treatment, and care.

Keywords:

Edema, peripheral edema, pulmonary edema, dehydration,

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Lee JW. Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press 2010;8(2):72-81.
Sakr Y, Rother S, Ferreira AM, Ewald C, Dünisch P, Riedemmann N, et al. Fluctuations in serum sodium level are associated with an increased risk of death in surgical ICU pa- tients. Crit Care Med 2013;41(1):133-42.
Oude Lansink-Hartgring A, Hessels L, Weigel J, de Smet AM, Gommers D, Panday PV, et al. Long-term changes in dysnatremia inci- dence in the ICU: a shift from hyponatremia to hypernatremia. Ann Intensive Care 2016; 6(1):22.
Pokaharel M, Block CA. Dysnatremia in the ICU. Curr Opin Crit Care 2011;17(6):581-93.
Mahmoud MI, Khalil OA, Afifi WM, Osman FM. Epidemiology and Clinical Outcome of ICU- Acquired Dysnatremia in critically ill Medical patients, a Single Center Study Life Science Journal 2013;10(2):415-20.
Chan CM, Shorr AF. Venous thromboembolic disease in the intensive care unit. Semin Respir Crit Care Med 2010;31(1):39-46.
Danziger J, Chen K, Cavender S, Lee J, Feng M, Mark RG, et al. Admission Peripheral Edema, Central Venous Pressure, and Sur- vival in Critically Ill Patients. Ann Am Thorac Soc 2016;13(5):705-11.
Follath F, Yilmaz MB, Delgado JF, Parissis JT, Porcher R, Gayat E, et al. Clinical presenta- tion, management and outcomes in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). Intensive Care Med 2011;37(4):619-26.
Fan T, Wang G, Mao B, Xiong Z, Zhang Y, Liu X, et al. Prophylactic administration of par- enteral steroids for preventing airway compli- cations after extubation in adults: meta-analysis of randomised placebo con- trolled trials. BMJ 2008;337:a1841.
Sutherasan Y, Theerawit P, Hongphanut T, Ki- atboonsri C, Kiatboonsri S. Predicting laryn- geal edema in intubated patients by portable intensive care unit ultrasound. J Crit Care 2013;28(5):675-80.
Thomas DR, Cote TR, Lawhorne L, Levenson SA, Rubenstein LZ, Smith DA, et al.; Dehy- dration Council. Understanding clinical dehy- dration and its treatment. J Am Med Dir Assoc 2008;9(5):292-301.
El-Sharkawy AM, Watson P, Neal KR, Ljungqvist O, Maughan RJ, Sahota O, et al. Hydration and outcome in older patients ad- mitted to hospital (The HOOP prospective co- hort study). Age Ageing 2015;44(6):943-7.
Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harison iç hastalıklarıprensipleri. İstanbul: Nobel Tıp Ki- tapevleri; 2004. p.202-3, 217-22.
Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: diagnosis and management. Am Fam Physician 2013;88(2):102-10.
Çelik S. Sıvı-elektrolit Dengesizlikleri. İçinde Çelik S, ed. Yoğun Bakım Hastalarında Temel Sorunlar ve Hemşirelik Bakımı. İstanbul: Nobel Tıp Kitapevleri; 2014, p.9-12.
Lerma EV, Berns JS, Nıssenson AR. Current: Nefroloji ve hipertansiyonun esasları. Ankara: Güneş Tıp Kitapevleri; 2014. p.7-8.
Vaitkevicius PV, Baliga RR. Ödem. Keleş İ, çev. editörü. Pratik kardiyoloji. İstanbul: İstan- bul Medikal Yayıncılık; 2007. p.46-54.
Lobo DN, Lewington AJP Allison SP. Basic Concepts of Fluid and Electrolyte Therapy. Die Deutsche Bibliothek, Germany 2013: 9-57. http://www.bbraun.com/documents/Knowl- edge/Basic_Concepts_of_Fluid_and_Elec- trolyte_Therapy.pdf
Özgünen T (Çev). Vander insan fizyolojisi vücut fonksiyon mekanizmaları. Widmaier EP, Raff H, Strang KT. Vander’s human physiol- ogy: the mechanisms of body function, Ankara, Güneş Tıp Kitapevleri; 2014. p.402.
Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harison iç hastalıkları el kitabı. İstanbul: Nobel Tıp Ki- tapevleri; 2011. p.66-7, 240-4.
Vital FM, Ladeira MT, Atallah AN. Non-inva- sive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev 2013;(5):CD005351.
Parissis JT, Nikolaou M, Mebazaa A, Ikono- midis I, Delgado J, Vilas-Boas F, et al. Acute pulmonary oedema: clinical characteristics, prognostic factors, and in-hospital manage- ment. Eur J Heart Fail 2010;12(11):1193-202.
Goodacre S, Gray A, Newby D, Dixon S, Mas- son M, Sampson F, et al.; 3CPO Investigators. Health utility and survival after hospital ad- mission with acute cardiogenic pulmonary oedema. Emerg Med J 2011;28(6):477-82.
Skinner J, McKinney A. Acute cardiogenic pul- monary oedema: reflecting on the manage- ment of an intensive care unit patient. Nurs Crit Care 2011;16(4):193-200.
Ducros L, Logeart D, Vicaut E, Henry P, Plai- sance P, Collet JP, et al.; CPAP collaborative study group. CPAP for acute cardiogenic pul- monary oedema from out-of-hospital to car- diac intensive care unit: a randomised multicentre study. Intensive Care Med 2011;37(9):1501-9.
Kakouros NS, Kakouros SN. Non-Cardiogenic Pulmonary Edema. Hellenic J Cardiol 2003; 44:385-91.
Rabinstein AA. Treatment of cerebral edema. The Neurologist 2006;12(2):59-73.
Jha SK. Cerebral Edema and its Manage- ment. Med J Armed Forces India 2003;59(4):326-31.
Pluijms WA, van Mook WN, Wittekamp BH, Bergmans DC. Postextubation laryngeal edema and stridor resulting in respiratory fail- ure in critically ill adult patients: updated re- view. Crit Care 2015;19:295.
Roberts RJ, Welch SM, Devlin JW. Corticos- teroids for Prevention of Postextubation La- ryngeal Edema in Adults. Ann Pharmacother 2008;42:686-91.
Koyuncu A, Yava A, Kurkluoglu M, Guler A, Demirkilic U. Mekanik ventilsyondan ayırma ve hemşirelik. Türk Göğüs Kalp Damar Cer- rahisi Dergisi 2011;19(4):671-81.
Oczkowski SJ, Mazzetti I. Colloids to improve diuresis in critically ill patients: a systematic review. J Intensive Care 2014; 2:37.
Enar R. Temel Kardiyoloji Kalbin Fizik Muayenesi: Tekniği ve Klinik İpuçları Nobel Tıp Kitabevleri, Bölüm 1, İnspeksiyon, Ödem, 2012;51-55,83-91.
Parkosewich JA. Assessment of Cardiovas- cular Function. In: Smeltzer SC, Bare BG, ed. Brunner & Suddarth’s Textbook of Medical- Surgical Nursing. 10thed. Philadelphia. Lip- pincott 2004. p.646-81.
Badır A. Kalp ve dolaşım sisteminim değer- lendirilmesi. Karadakovan A, Eti Aslan F, eds. Dahili ve Cerrahi Hastalıklarda Bakım. Akademisyen Tıp Kitabevi. Ankara, 3. Baskı; 2014. p.395-8.
Gökdoğan F. Hemşireler İçin Sıvı Elektrolit Dengesi Hemşirelik Tanı ve Uygulamaları. Ankara: Alter Yayıncılık; 2007. p.52-3.
Kaymakçı Ş. Sıvı Elektrolit Dengesi ve Bozuk- lukları. Karadakovan A, Eti Aslan F, eds. Dahili ve Cerrahi Hastalıklarda Bakım. Akademisyen Tıp Kitabevi. Ankara, 3. Baskı; 2014. p.149- 54.
Ackley BJ, Ladwing GB. Nursing Diagosis Handbook, An Evidence- Based Guide to Planning Care. Mosby; 2014. p.370-4.
Allison SP, Lobo DN. Fluid and electrolytes in elderly. Curr Opin Clin Nutr Metab Care 2004; 7(1):27-33.
Erdemir F (Çev). Hemşirelik Tanıları El Kitabı. Handbook of Nursing Diagnosis. 13thed. Car- pentino-Moyet LJ, ed. Nobel Tıp Kitapevleri; 2012. p.422-4.
Workman ML. Assessment and Care of Pa- tients with Fluid and Electrolyte Imbalances. Ed. Ignatavicius, DD., Workman, ML. Medical- Surgical Nursing Patient-Centered Collabora- tive Care. 6thed. Elsevier Saunders, 2010. p.170-98.
Bhave G, Neilson EG. Volume depletion ver- sus dehydration: how understanding the dif- ference can guide therapy. Am J Kidney Dis 2011;58(2):302-9.
Adan A. Cognitive performance and dehydra- tion. J Am Coll Nutr 2012;31(2):71-8.
Bartel B, Gau E. Fluid Electrolyte Manage- ment. In: Johnson T, ed. Critical Care Phar- macotherapeutics. Burlington: Jones &Barlett Learning MA; 2013.
Shepherd A. Measuring and managing fluid balance. Nursing Times 2011;107(289):12-6.
Davenport M, Syed SHS. Fluids, Elec- trolytes, and Dehydration. In: SinhaCK , Davenport M, eds. Handbook of Pediatric Surgery. London: Springer-Verlag limited; 2010. p.9-19.
Sert H. Ödem ve dehidratasyon. Eti Aslan F, Olgun N, ed. Yoğun Bakım Seçilmiş Semp- tom ve Bulguların Yönetimi. Ankara; 2016. p.471.
Campbell N. Recognising and preventing de- hydration among patients. Nurs Times 2014;110(46):20-1.
Campbell N. Dehydration: why is it still a prob- lem? Nurs Times 2011;107:12-5.
Doenges ME, Moorhouse MF, Murr AC. Nurs- ing Care Plans Guidelines for Individualizing Client Care Across the Life Span. 8thed. Philadelphia; 2010.
Dalal S, Bruera E. Dehydration in cancer pa- tients: to treat or not to treat. J Support Oncol 2004;2(6):467-79.
Kruer RM, Ensor CR. Colloids in the intensive care unit. Am J Health Syst Pharm 2012; 69(19):1635-42.
Suhayda R, Walton JC. Preventing and man- aging dehydration. Medsurg Nurs 2002; 11(6):267-78.
Zümrütdal A. Sıvı elektrolit tedavisinde temel prensipler. Anadolu Kardiyol Derg 2013;13: 171-7.