Hiperkapnik Solunum Yetmezliği Gelişen Kronik Obstrüktif Akciğer Hastalığı Hastalarında Noninvaziv AVAPS (Average Volume Assured Pressure Support) Modu

Yıl 2018, Cilt: 10 Sayı: 1, 55 - 60, 28.03.2018

Ege Güleç Balbay Fuat Aytekin Öner Balbay Ali Nihat Annakkaya Peri Arbak

https://doi.org/10.18521/ktd.371095

Öz

Amaç: Bu çalışmada, AVAPS (Average Volume Assured Pressure Support) modu ile Noninvazif Mekanik Ventilasyon (NMV) uygulanan hastalarda hasta uyumu ve klinik başarı
oranlarının araştırılması amaçlanmıştır. Bu çalışma Düzce Üniversitesi Bilimsel Araştırma
Projesidir (Proje No: 2015.04.03.312).

Yöntem:
Hiperkapnik Solunum Yetmezliği
Gelişen 22 Kronik Obstrüktif Akciğer Hastalığı (KOAH) hastalarına AVAPS modu uygulandı.
Başlangıç parametreleri olarak; AVAPS Modunda
IPAP Max 20 cm
H₂O, IPAP Min 12 cm
H₂O,  Hedef Tidal volüm= İdeal
kilo x 6 ml/kg, EPAP 5 cm
H₂O ayarları ile başlanıp hastanın tolere ettiği ölçüde arttırılacak
ve SaO₂ ≥ %90 olacak şekilde verildi. Hastaya verilen basınç
desteğinin 6 ml/kg TV’ü oluşturacak şekilde olmasına dikkat edildi. Hastaların NIV
bağlandıktan sonra 1, 2, 8 ve 24.  saatlerde
arter kan gazı kontrolleri, nabız, solunum sayısı, Borg dispne skalası
ölçümleri yapıldı.

Bulgular:
Çalışmaya dahil edilen yaş ortalaması 70±10 olan 22 hastanın %72,7 (n:16)’si
erkekti. Geliş APACHE Skor ortalaması 16,50±4,24’tü. Geliş nabız ve solunum
sayısı ortamaları sırasıyla 96±13 ve
24±4 idi. Borg dispne skalası
ortancası 6 (min:2, max:8) idi. Hastaların %59 (n:13)’unda 24
saat içerisinde PH değerleri normal aralığına ulaştı. Hastaların NMV öncesi PH, PCO₂, PaO₂/FiO₂
ve Borg dispne skalası değerler ile NMV uygulamasının 1, 2, 8, 24 saat PH, PCO₂,
PaO₂/FiO₂ ve Borg dispne skalası değerleri
karşılaştırıldığında istatistiksel anlamlı olarak PH (p<0,001) ve Pa0₂/FiO₂
(p=0,002) değerlerinde artma, PCO₂ veBorg dispne skalası
değerlerinde sırasıyla (p<0,001, p<0,001) azalma olduğu görüldü. İzlenen
parametrelerinde tümünde 1. Saatte anlamlı değişiklik görüldü. 24 saat izlenen hastaların sadece 1’i entübe
edilerek yoğun bakım ünitesine devri gerçekleştirildi. Hiçbir hastada
uyumsuzluk izlenmedi. Servis takipleri sonucunda hastaların %95 (n:21)’i evine
taburcu edilebildi.

Sonuç: AVAPS modu ile NMV
uygulanmasında hasta uyumu ve klinik başarı oranlarının yüksek olduğu görüldü.

 

Anahtar Kelimeler

KOAH, Solunum yetmezliği

Noninvasive AVAPS (Average Volume Assured Pressure Support) Mode in COPD Patients with Respiratory Failure

Öz

Objective: In this study, we
aimed to investigate patient compliance and clinical success rates in patients
undergoing NIV with AVAPS (Average Volume Assured Pressure Support) mode. This
study is Düzce University Scientific Research Project (Project No: 2015.04.03.312).

Method: As initial
parameters; IPAP Max 20 cm H2O, IPAP Min 12 cm H2O, Target Tidal volume = Ideal
weight 6 ml / kg EPAP in AVAPS mode, starting with 5 cm H2O settings and
increasing to the extent that the patient is tossed and SaO2 ≥ 90% . Care was taken
to ensure that the pressure support supplied to the patient was 6 ml / kg TV.
Arterial blood gas controls, pulse rate, respiratory rate and Borg dyspnea were
measured at 1, 2, 8 and 24 hours after NMV adherence of the patients.

Results: 72.7% (n: 16) of 22
patients included in the study had a mean age of 70 ± 10. The arrival APACHE
Score averaged 16,50 ± 4,24. The number of arriving pulses and respiration were
96 ± 13 and 24 ± 4, respectively. Borg dyspnea scale mean was 6 (min: 2, max:
8). 59% (n: 13) of the patients had undetectable pH values ​​within 24 hours.
When PH, PCO2, PaO2 / FiO2 and Borg dyspnea scores of patients before NIV and NIV
application values ​​of 1,2,8,24 hours PH, PCO2, PaO2 / FiO2 and Borg dyspnea
scores of patients were compared statistically, PH (p <0,001) and Pa02 /
FiO2 (p = 0.002), PCO2 and Borg dyspnea scores were decreased (p <0.001, p
<0.001), respectively. Significant changes were observed in all of the
monitored parameters at 1 hour. Only one of the patients who were followed for
24 hours was entitled to the intensive care unit. No incompatibility was
observed in any patient. As a result of service interventions, 95% (n: 21) of
the patients could be discharged home.

Conclusion: It was observed that
patient compliance and clinical success rates were higher in NIV application
with AVAPS mode.

Anahtar Kelimeler

KOAH, Solunum yetmezliği

Kaynakça

• 1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: updated 2014. 2. Lightowler JV, Wedzicha JA, Elliott MW, et al. Non-invasive po¬sitive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 2003;326:185. 3. Sifakas NM, Vermeire P, Pride NB, et al. Optimal assessment and management of chronic obstructive pumonary disease(COPD). Eur Respir J 1995;8:1398-1420. 4. Meduri GH, Turner RE, Abou-Shala N, et al. Noninvasive positive pressure ventilation via face mask. First-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest. 1996;109:179–193. 5. Keenan SP, Sinuff T, Cook DJ, et al. Which patients with acute exacerbation of chronic obstructive pulmonare disease benefit from noninvasive positive – pressure ventilation? A systematic review of the literature. Ann Intern Med. 2003;138:861–870. 6. Lightowler JV, Wedzicha JA, Elliott MW, et al. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ. 2003;362:1-5. 7. Winck JC, Azevedo LF, Costa-Pereira A, et al. Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema—a systematic review and meta-analysis. Crit Care. 2006;10:69. 8. Bott J, Carroll MP, Conway JH, et al. Randomised controlled trial of nasal ventilation in acute ven¬tilatory failure due to chronic obstructive airways disease. Lancet 1993;341:1555-7. 9. Carlucci A, Delmastro M, Rubini F, et al. Changes in the practice of non-invasive ventilation in treating COPD patients over 8 years. Intensive Care Med. 2003;29:419-425. 10. Storre JH, Seuthe B, Fiechter R, et al. Average Volume-Assured Pressure. Support in Obesity Hypo¬ventilation: A Randomized Crossover Trial. Chest 2006;130:815-21. 11. Antonescu-Turcu A, Parthasarathy S. CPAP and bi-level PAP therapy: new and established roles. Respir Care 2010;55:1216-28. 12. Storre JH, Seuthe B, Fiechter R. Average volume-assured pressure support in obesity hypoventilation: a randomized crossover trial. Chest. 2006;130:815-821. 13. Murphy PB, Davidson C, Hind MD. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised control ed. Thorax. 2012;67:727-734. 14. Ambrogio C, Lowman X, Kuo M, et al. Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency. Intensive Care Med. 2009;35:306–313. 15. Celli BR, MacNee W. ATS/ERS Task Force. Standards for the diagnosis and care of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004;23:932-46. 16. Plant PK, Owent JL, Elliot MW. Early use of noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease on general respiratory wards: A multicenter randomized controlled trial. Lancet 2000;355:1931-5. 17. Concensus conference report. Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD and nocturnal hypoventilation. Chest 1999;116:521-34. 18. Brouchard L, Mancebo C, Wysocki M, et al. Noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. N Eng J Med 1995;333:817-22. 19. Çelikel TH, Sungur M, Ceyhan B, et al. Comparation of noninvasive positive pressure ventilation with standart medical therapy in hypercapnic acute respiratory failure. Chest 1998;114:1636-42. 20. Plant PK, Owen JL, Elliott MW. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Thorax 2001;56:708-12. 21. Sinuff T, Keenan SP. Clinical practice guideline for the use of nonin¬vasive positive pressure ventilation in COPD patients with acute respiratory failureJ Crit Care. 2004;19:82-91. 22. Conti G, Antonelli M, Navalesi P, et al. Noninvasive vs conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medicaltreatment in the ward: a randomized trial. Intensive Care Med 2002;28:1701-7. 75. 23. Plant PK, Elliot MW. Chronic obstructive pulmonary disease 9:Management of ventilatory failure in COPD. Thorax 2003;58:537-42. 24. Wood KA, Lewis L, Von Harz B, Kollef MH. The use of noninvasive positive pressure ventilation in the emergency department: results of a randomized clinical trial. Chest 1998;113:1339-46. 25. Scala R, Archinucci I, Naldi M. Non-invasive nasal ventilation in a case of hypercapnic coma. Minerva Anestesiol. 1997;63:245-8. 26. El-Abdin, l Shaaban, S Farghaly, et al. Average volume-assured pressure support ventilation mode in the management of acute hypercapnic respiratory failure. Egypt J Bronchol 2017; 11 (3): 231-7. 27. Pluym M, Kabir AW, Gohar A. The use of volume assured pressure support noninvasive ventilation in acute and chronic respiratory failure: a practical guide and literature review. Hosp Pract. 2015;43(5):299-307. 28. Oscroft NS, Ali M, Gulati A, et al. A randomised crossover trial comparing volume assured and pressure preset noninvasive ventilation in stable hypercapnic COPD. COPD 2010;7:398-403. 29. Rollas K, Berktaş MB, Berkoğlu M. Kronik Obstrüktif Akciğer Hastalığına Bağlı Akut Solunum Yetmezliğinde, Noninvazif Mekanik Ventilasyon Volüm Garantili Basınç Desteği Modunun, Manuel Basınç Desteği ile Karşılaştırılması. Solunum 2012; 14(3):148-57. 30. Briones Claudett KH, Briones Claudett M, Chung Sang Wong M, et al. Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy. BMC Pulm Med. 2013 Mar 12;13:12.