The Relation of Standard Analgesia and Sedation Protocol in Intensive Care with Serum Procalcitonin Level

Öz

Objective: In this study, it was aimed to determine the relationship between sedo-analgesia of intensive care patients and serum procalcitonin levels. Materials and Methods: The research was carried out retrospectively by analyzing the information from intensive care records. Before applying the sedo-analgesia protocol, the pain treatments of the patients were performed as required, according to the subjective evaluation of the patients at irregular intervals by the physicians and nurses (Group 1). With the protocol, pain and sedation needs, which were evaluated at regular intervals with reliable scales, were started to be treated with pre-determined drugs and doses (Group 2). Procalcitonin levels of the patients were measured once in the morning for 5 days. Results: Although paracetamol was used more in group 2, there was no significant difference between the two groups. Tramadol was used statistically significantly more in group 2. Fentanyl dose did not differ significantly between the two groups. On the other hand, midazolam was used statistically significantly less in group 2. Procalcitonin levels tended to decrease gradually in both groups. When the difference between the 1st day and the 5th day was compared, no statistically significant difference was found between the two groups (p = 0.56). Serum procalsitonin median values monitored for five days were found to be similar in both groups. Conclusion: We did not find any difference in procalcitonin levels in patients who underwent protocolized sedo-analgesia. In order to understand whether procalcitonin can be a suitable marker for pain follow-up as in infection, we think that new studies are needed in better standardized patient groups and larger case series.

Anahtar Kelimeler

• Inflammation
• Intensive care
• Procalcitonin
• Sedoanalgesia.

Yoğun Bakımda Standart Analjezi ve Sedasyon Uygulamasının Serum Prokalsitonin Düzeyi ile İlişkisi

Öz

Giriş ve Amaç: Bu çalışmada, yoğun bakım hastalarının tedavi sürecinde ağrı düzeylerinin kontrolünde uygulanan standart sedo-analjezinin, bir enflamasyon belirteci olan serum prokalsitonini ile ilişkisinin saptanması amaçlanmıştır. Gereç ve Yöntemler: Araştırma, retrospektif olarak yoğun bakım kayıtlarından toplanan bilginin analizi ile gerçekleştirildi. Sedo-analjezi protokolü uygulanmadan önce hastaların ağrı tedavileri, hekim ve hemşirelerin düzensiz aralıklarla hastaları sübjektif değerlendirmeleri sonucuna göre, gereği halinde yapılmakta idi (1. Grup). Protokol ile güvenilir ölçeklerle, düzenli aralıklarla değerlendirilen ağrı ve sedasyon gereksinimleri, önceden kararlaştırılan ilaçlar ve dozlarla tedavi edilmeye başlandı (2. Grup). Hastaların prokalsitonin düzeyleri 5 gün süreyle sabah 1 kez ölçüldü. Bulgular: Parasetamol 2. grupta daha fazla kullanılmakla birlikte her iki grup arasında anlamlı fark saptanmadı. Tramadol 2. grupta istatistiksel olarak anlamlı oranda fazla kullanıldı. Fentanil dozu iki grup arasında anlamlı farklılık göstermedi. Sedasyon amaçlı kullanılan midazolam ise 2. grupta istatistiksel olarak anlamlı oranda daha az kullanıldı. Her iki grupta da prokalsitonin değerlerinin giderek azalma gösterme eğiliminde olduğu saptandı. 1. gün ile 5. gün arasındaki fark karşılaştırıldığında iki grup arasında istatistiksel olarak anlamlı farklılık saptanmadı (p= 0,56). Beş gün boyunca izlenen serum prokalsitonin median değerlerinin her iki grupta da benzer olduğu bulundu. Sonuç: Protokolize sedo-analjezi uygulaması yaptığımız olgularda prokalsitonin düzeylerinde bir farklılık saptamadık. Prokalsitoninin enfeksiyonda olduğu gibi ağrı takibinde de uygun bir belirteç olup olamayacağını anlamak için daha iyi standardize edilmiş hasta gruplarında ve daha geniş olgu serilerinde yeni araştırmalara gereksinim olduğu görüşündeyiz.

Anahtar Kelimeler

• Yoğun Bakım
• sedoanaljezi
• enflamasyon
• prokalsitonin

Kaynakça

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