AKUT AKCİĞER HASARI (ALI)/AKUT SOLUNUM SIKINTISI SENDROMU(ARDS) VE ARDS’Lİ COVID-19 HASTALARINDA BESLENME DESTEĞİ

Öz

Amerika- Avrupa Konsensus Konferans Komitesi tanımına göre “akut solunum sıkıntısı sendromu”(ARDS) göğüs radyolojisinde akut başlangıçlı yaygın bilateral pulmoner infiltratlar, arteriyel oksijen/fraksiyon parsiyel basıncı (PaO2/FiO2) “akut akciğer hasarı”(ALI) için ≤300 mmHg ve ARDS için ≤200 mmHg ve pulmoner arter oklüzyon basıncı <18 mmHg olması durumudur. Epidemiyolojik çalışmalara göre her yıl ALI/ARDS insidansı 100,000’de 30- 75 vaka arasında değişmektedir. Tedaviye cevap vermeyen respiratuar yetmezlik, çoklu organ yetmezliği ve bazı durumlarda ölümle sonuçlanabilmektedir. Son yıllarda yapılan çalışmalar ALI/ARDS’nin mortalite oranını 30-45% olarak göstermektedir. ALI/ARDS’nin patofizyolojisi pro-inlamatuar yanıt ile karakterizedir. ALI/ARDS’de karakterize olan pro- inflamatuar yanıt ve buna bağlı hiperkatabolizma önemli beslenme yetersizliklerine neden olabilir. Beslenme desteği; artan enerji ihtiyacının karşılanması, malnütrisyonun, yağsız vücut kütlesi kaybının, respiratuar kas gücü azalmasının önüne geçmek için ARDS’li hastalarda oldukça önemlidir. ARDS’li hastalarda beslenme desteği için enerji gereksinmesinin doğru hesaplanması hiperkapni, enfeksiyonlar, zayıf yara iyileşmesi, hiperglisemi, yoğun bakımda kalma süresinin artması gibi önemli klinik komplikasyonların oluşmasını engellemek ve hastalığın seyrini olumlu yöne çevirmek için oldukça önemlidir. Bu gereksinmelerin belirlenmesinde konsensus kılavuzları yol gösterici olmaktadır. ARDS’li hastalarda beslenme desteğinin olumlu etkilerinden maksimum yararlanmak için oral beslenmenin olmadığı veya yetersiz olduğu durumlarda erken enteral beslenmenin uygulanması, enteral beslenmenin mümkün olmadığı ya da yetersiz olduğu durumlarda tek başına parenteral beslenme veya enteral beslenme ile beraber parenteral beslenme yöntemlerinin tercih edilmesi gereklidir. ARDS’li hastalarda inflamasyonu önlemeye yönelik olarak; omega-3 yağ asitleri ve antioksidanlar ile zenginleştirilmiş ürünlerin kullanımının hastalığın klinik sonuçlarında olumlu etkiler yaratacağına dair bilgiler bulunmakla beraber, halen tartışma konusudur.

Anahtar Kelimeler

• ARDS
• ALI
• malnütrisyon
• beslenme desteği
• enteral beslenme
• COVID-19

NUTRITIONAL SUPPORT FOR ACUTE LUNG INJURY (ALI)/ACUTE RESPIRATORY SYNDROME (ARDS) AND COVID-19 PATIENTS WITH ARDS

Öz

According to the definition of American- European Consensus Conference Committee ARDS requires the acute onset of diffuse bilateral pulmonary infiltrates by chest radiograph; a partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ≤300 mmHg for ALI and ≤200 mmHg for ARDS; and a pulmonary artery wedge pressure <18 mm Hg. Epidemiology studies that have used this definition have reported that the incidence of ALI/ARDS is between 30 and 75 cases per 100,000 each year. The respiratory failure with resistant to treatment may result multiple organ failure and death. Recent studies indicate the mortality rate of ALI/ARDS, 30–45%. Pathophysiology of ALI/ARDS characterized by pro-inflammatory response. Pro-inflammatory response and hypercatabolism may be cause important nutrition deficiencies. Nutrition support is essential to avoid energy deficiency, malnutrition, loss of lean body mass, decrease of respiratory muscle strength. The correct calculation of energy requirement in patient with ARDS is very important for preventing important clinical complications like hypercapnia, infections, poor wound healing, hyperglycemia, increased stay in intensive care unit. Determination of this requirements, the consensus guidelines are used. In patients with ARDS; if the oral nutrition is impossible or inadequate, the early enteral feeding; and if the enteral nutrition is impossible or inadequate, the parenteral feeding or enteral combined parenteral feeding should be preferred in order to maximize the benefits of nutritional support. While there is some information about using the supplements enriched with omega- 3 fatty acids and antioxidants are beneficial to prevent the inflammation in patients with ARDS, this subject is still discussed.

Anahtar Kelimeler

• ARDS
• ALI
• malnutrution
• nutritional support
• enteral nutrition
• COVID-19

Kaynakça

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