COVID-19 Pnömonisi ile Yoğun Bakıma Yatan Hastalarda Yüksek Akışlı Nazal Oksijen Tedavisinin Etkinliğinin Retrospektif Olarak Değerlendirilmesi

Year 2023, Volume: 6 Issue: 1, 152 - 162, 01.01.2023

Miray Kübra Turgut Aksu Emel Yıldız Canan Balcı

https://doi.org/10.19127/bshealthscience.1175991

Abstract

COVID-19 pnömonisi nedeniyle yoğun bakım ünitesine (YBÜ) yatırılan hastalar yüksek oranda oksijene ihtiyaç duyarlar. Gelişen kanıtlar ışığında hastalarda, invaziv mekanik ventilasyon (IMV) yerine non-invaziv oksijenasyon stratejileri çok büyük öneme sahip olmuştur. Yüksek akışlı nazal oksijen (High Flow Nasal Oxygen (HFNO)) tedavisi bu yöntemlerden birisidir. HFNO tedavisinin mortaliteyi azalttığına dair literatürde çalışmalar mevcuttur. Çalışmamızda COVID-19 pnömonisine bağlı akut solunum yetmezliğinde HFNO tedavisinin etkinliğini ve sonuçlarını değerlendirmeyi amaçladık. Çalışmaya COVID-19 pnömonisi nedeniyle YBÜ’ne kabul edilen, periferik oksijen saturasyonu (SpO2) <%92 olan ve HFNO başlanan 23 hasta dahil edildi. Hastaların yaş, cinsiyet, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE) ІІ skorları, ek hastalık varlığı, HFNO verilme süresi ve bu süreçteki hemodinamik parametreleri, laboratuvar sonuçları, PaO2/FiO2 oranı, solunum hızı oksijenasyonu (Respiratory Rate Oxygenation (ROX)) indeksi, YBÜ’de kalış süresi, mortalitesi, non-invaziv mekanik ventilasyon (NIMV) ve IMV’ye geçme süresi kaydedildi. HFNO tedavisi sürecinde; servise çıkan ve YBÜ’de exitus olan hastalar, demografik veriler ve solunum parametreleri açısından değerlendirildi. Hastaların %69,6’sında ek hastalık olup en çok hipertansiyon bulunmaktaydı. Hastaların mortalitesi % 69,6 bulundu. Exitus olanlarda olmayanlara göre yaş ve APACHE-II skoruları daha yüksekti (P=0,012; P=0,005). Hastaların HFNO süresi 48,22±26,20 saatti. Hastaların entübasyon zamanı ortalaması 4,94±2,48 gündü. NIMV’ye geçenlerin ROX indeks ortalamaları, IMV’ye geçenlere göre yüksek bulundu (P=0,01). ROX indeksi ve PaO2/FiO2 oranı HFNO tedavisinden sonra ilk olarak artmış ancak devam eden tedavi süresince HFNO’dan ayrılma anına kadar oranlarda düşme saptanmıştır. HFNO süresince nötrofil yüzdesi ve PaO2 ortalamalarında yükselme bulunmuşken (P=0,001), lenfosit yüzdesinde düşme saptandı (P=0,001). Sonuç olarak biz bu çalışmada ek hastalık, cinsiyet, yaş, solunum sayısı, hipoksemi şiddeti, düşük ROX indeks değerinin HFNO başarısını etkileyebileceğini düşünmekteyiz.

Keywords

HFNO, COVID-19, Pnömoni, ROX indeksi

Retrospective Evaluation of the Efficacy of High-Flow Nasal Oxygen Therapy in Intensive Care Patients with COVID-19 Pneumonia

Abstract

Patients hospitalized in the intensive care unit (ICU) due to COVID-19 pneumonia require high levels of oxygen. In the light of the developing evidence, non-invasive oxygenation strategies instead of invasive mechanical ventilation (IMV) have become of paramount importance in patients. High flow nasal oxygen (High Flow Nasal Oxygen (HFNO)) therapy is one of these methods. There are studies in the literature showing that HFNO treatment reduces mortality. In our study, we aimed to evaluate the efficacy and results of HFNO treatment in acute respiratory failure due to COVID-19 pneumonia. The study included 23 patients who were admitted to the ICU due to COVID-19 pneumonia, had peripheral oxygen saturation (SpO2) <92%, and were started on HFNO. Patients' age, gender, Acute Physiology and Chronic Health Assessment (APACHE) ІІ scores, presence of additional disease, HFNO administration time and hemodynamic parameters in this process, laboratory results, PaO2/FiO2 ratio, respiratory rate oxygenation (ROX) index, length of stay in the ICU, mortality, non-invasive mechanical ventilation (NIMV), and time to switch to IMV were recorded. In the process of HFNO treatment; Patients who went to the ward and died in the ICU were evaluated in terms of demographic data and respiratory parameters. In 69.6% of the patients, comorbidity was the most common hypertension. The mortality of the patients was 69.6%. Age and APACHE-II scores were higher in those who did not have exitus (P=0.012; P=0.005). The HFNO duration of the patients was 48.22±26.20 hours. The mean intubation time of the patients was 4.94±2.48 days. ROX index averages of those who switched to NIMV were higher than those who switched to IMV (P=0.01). ROX index and PaO2/FiO2 ratio initially increased after HFNO treatment, but decreased until the moment of weaning from HFNO during continued treatment. While neutrophil percentage and PaO2 averages increased during HFNO (P=0.001), a decrease was found in lymphocyte percentage (P=0.001). In conclusion, we think that additional disease, gender, age, respiratory rate, hypoxemia severity, and low ROX index value may affect the success of HFNO in this study.

Keywords

COVID-19, Pneumonıa, HFNO, ROX index

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