Hiperkapnik Solunum Yetmezliği Olan Hastalarda Karbondioksit Klirensinin Klinik Prognoza Etkisi

Year 2022, , 160 - 166, 30.12.2022

Emre Karslı , Nese Çolak , Damla Anbarlı Metin , Başak Bayram , Hülya Ellidokuz

https://doi.org/10.54996/anatolianjem.1057246

Abstract

Amaç: Hiperkapnik solunum yetmezliği, karbondioksit (CO2) seviyesinin >45 mmHg olması olarak tanımlanır. Yüksek PaCO2 seviyeleri, KOAH'ın akut alevlenmesinde artan mortalite ile ilişkilidir. Çalışmamızda hastaların prognozunu öngörmek için CO2 klirens değerini belirlemeyi amaçladık.

Gereç ve Yöntemler: 68 hasta çalışmaya dahil edildi. Hastalar sonuca göre iyi ve kötü prognoz grubu olarak iki gruba ayrıldı. Hastaların demografik bilgileri, komorbiditeleri, vital parametreleri, başvuru (ilk ölçüm) ve altıncı saat (ikinci ölçüm) kan gazı sonuçları, verilen tedavi ve sonuçları veri formuna kaydedildi. CO2 değişimi ve sonuç arasındaki ilişki değerlendirildi.

Bulgular: İyi ve kötü prognoz grupları arasında CO2 klirensi ve delta CO2 seviyelerinde istatistiksel olarak anlamlı bir fark yoktu (sırasıyla 11.7±12 vs 6.2 ± 23, p=0.205 ve -11.77±12.92 mmHg vs -7.66±24.76 mmHg, p=0.281). NaHCO3 seviyeleri ikinci ölçümde birinci ölçüme göre iyi (23.89 ±5.28, 25.78±4.39, p<0.0001) ve kötü (23,26±6.05, 23.53 ± 5.05, p<0.0001) prognoz gruplarında yüksek saptanmıştır. Bununla beraber pCO2 seviyeleri, ikinci ölçümlerde iyi (60.68 ± 11.89, 48.92 ± 14.02, p=0.007) ve kötü (68.04 ± 20.15, 61.76 ± 22.87, p=0.007) prognoz gruplarında ilk ölçümlere göre düşük çıkmıştır. Ayrıca kötü prognozlu grupta birinci ve ikinci ölçümler arasında laktat düzeylerinde anlamlı bir azalma oldu (p<0.001).

Sonuç: Çalışmamız sonucunda acil servise nefes darlığı şikayeti ile gelen hiperkarbik hastalarda ilk altı saatte hesaplanan CO2 klirensinin hastaların kısa dönem prognozunu öngörmede yararlı olmadığı görüldü. Ancak delta laktat ve delta NaHCO3 düzeyleri kötü prognozlu grupta anlamlı olarak değişmektedir.

Keywords

Karbondioksit klirensi, kiperkapni, solunum yetmezliği, acil tıp

The Effect of Carbondioxide Clearance on Clinical Prognosis in Patient With Hypercapnic Respiratory Failure

Abstract

Aim: Hypercapnic respiratory failure is defined as a carbon dioxide (CO2) level >45 mmHg. High PaCO2 levels are related with increased mortality in acute exacerbation of COPD. In our study, we aimed to determine CO2 clearance value for predicting patients' prognosis.

Material and Methods: 68 patients were included in the study. The patients were divided into two as, good and poor prognosis groups according to the outcome. The patients’ demographic information, comorbidities, vital parameters, blood gas results on admission (first measurement) and in the first sixth hour (second measurement), treatment, and outcomes were recorded in data forms. The relation between CO2 change and outcome was evaluated.

Results: There was no statistically significant difference in CO2 clearance and delta pCO2 levels between the good and poor prognosis groups (11.7±12 vs. 6.2 ± 23, p=0.205 and -11.77±12.92 mmHg vs. -7.66±24.76 mmHg, p=0.281 respectively). NaHCO3 levels in the second measurement were higher than the first measurement in both good (23.89 ±5.28, 25.78±4.39, p<0.0001) and poor prognosis (23,26±6.05, 23.53 ± 5.05, p<0.0001) groups. And also, pCO2 levels in the second measurement was lower than the first measurement in the good (60.68 ± 11.89, 48.92 ± 14.02, p=0.007) and poor (68.04 ± 20.15, 61.76 ± 22.87, p=0.007) prognosis groups. There was also a significant decrease in lactate levels in the poor prognosis group between the first and the second measurements (p<0.001).

Conclusion: Our study revealed that the CO2 clearance calculated in the first six hours in hypercarbic patients who came to the emergency department with shortness of breath was not useful in predicting the short-term prognosis of the patients. However, delta lactate and delta NaHCO3 levels significantly changed in the poor prognosis group.

Keywords

Carbondioxide clearance, hypercapnia, respiratory failure, emergency medicine

References

• Kaynar AM. Respiratory Failure. Web Site. Available at: http://emedicine.medscape.com/article/167981-overview (Accessed January 23, 2021).
• Konishi M, Akiyama E, Suzuki H, et al. Hypercapnia in patients with acute heart failure. ESC Heart Fail. 2015;2:12-9. doi: 10.1002/ehf2.12023.
• Vestbo J, Hurd SS, Agustí AG, Jones PW, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347-365. doi: 10.1164/rccm.201204-0596PP.
• Stapczynski JS. Respiratory Distress. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, Thomas SH editors. Tintinalli's Emergency Medicine : A Comprehensive Study Guide, 9th Ed. New York: McGraw-Hill Education Medical: 2020, p.425-432.
• Morgan GE, Jr, Mikhail MS, Murray MJ. Breathing Systems. In:Morgan GE, Jr., Mikhail MS, Murray MJ: Clinical Anesthesiology, 5th Ed.. New York: McGraw-Hill Education Medical: 2013,p.29-42.
• Conti G, Antonelli M, Navalesi P, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med. 2002;28:1701-7. doi: 10.1007/s00134-002-1478-0.
• Xuan J, Duong PT, Russo PA, Lacey MJ, Wong B. The economic burden of congestive heart failure in a managed care population. Am J Manag Care. 2000;6:693-700. PMID: 10977478.
• Glass CM. Blood Gases, Pulse Oximetry, and Capnography.In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, Thomas SH editors. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th Ed. New York: McGraw-Hill Education Medical; 2020:78-81.
• Fayyaz J. Hypoventilation Syndromes Workup. Web Site. Availabe at: http://emedicine.medscape.com/article/304381-workup (Accessed January 23, 2021).
• Contou D, Fragnoli C, Córdoba-Izquierdo A, Boissier F, Brun-Buisson C, Thille AW. Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation. Ann Intensive Care. 2015;5:55. doi: 10.1186/s13613-015-0055-y.
• Quintana JM, Esteban C, Unzurrunzaga A, et al, Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments. BMC Medicine. 2014;12:66.
• Gattinoni L, Pesenti A, Mascheroni D, et al. Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA. 1986; 256:881-6.
• Pesenti A, Patroniti N, Fumagalli R. Carbon dioxide dialysis will save the lung, Crit Care Med. 2010; 38:S549 –S554.
• Acide-Bas Regulation. In: Hall JE. Editor. Guyton and Hall Textbook of Medical Physiology. 12 th Ed. Philadelphia: Saunders Elsevier; 2011:379-410.
• Conti V, Terzano C, Mollica C, et al, Predictors of Outcome in COPD Patients with Hypercapnic Respiratory Failure Requiring NIV. Enliven: J Anesthesiol Crit Care Med. 2014;1: 004.
• Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013;88:1127-40. doi: 10.1016/j.mayocp.2013.06.012.
• Husain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg. 2003;185:485-91. doi: 10.1016/s0002-9610(03)00044-8.
• Dellinger PR, Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock; 2012:12.
• Tobacco Control Studies in Turkey. Available at: http://www.saglik.gov.tr/TR/belge/1-15787/turkiyede-tutun-kontrolu-calismalari-31052012.html [Last Accessed Date: 23 January 2021].
• Ucgun I, Metintas M, Moral H, Alatas F, Yildirim H, Erginel S. Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure. Respir Med. 2006;100:66-74. doi: 10.1016/j.rmed.2005.04.005.