Çocuk Yoğun Bakım Ünitesinde Tedavi Edilen Şiddetli Astım Ataklı Hastaların Değerlendirilmesi: 8 Yıllık Tek Merkez Deneyimi

Year 2021, Volume: 11 Issue: 4, 570 - 576, 31.07.2021

Serhat Emeksiz Emel Uyar Zeynep Sengul Emeksiz Serhan Özcan Oktay Perk Emine Dibek Mısırlıoğlu Ersoy Civelek

Abstract

Amaç: Bu çalışmada, Şiddetli astım atağı (ŞAA) nedeniyle üçüncü basamak çocuk yoğun bakım ünitesinde (ÇYBB) izlenen çocuk hastaların demografik ve klinik özelliklerini değerlendirmeyi ve bu hastalar için optimal yoğun bakım yönetimini tartışmayı amaçladık.
Gereç ve Yöntem: 2013-2020 yılları arasında ÇYBB'de ŞAA tanısıyla izlenen 12 ay ile 18 yaşları arasında toplam 103 hastayı geriye dönük olarak inceledik.
Bulgular: Solunum desteği açısından değerlendirildiğinde; hastaların 34’ünün (%33) nazal kanül yada geri soluması oksijen maskesi, 13’ünün (%12,6) yüksek akışlı nazal kanül oksijenizasyonu (YANKO), 46’ünün (%44,7) non-invaziv mekanik ventilasyon (NIMV), 10’unun (%9,7) da invaziv mekanik ventilasyonda (IMV) takip edildiği görüldü. Yıllara göre kullanılan solunum destek tedavileri değerlendirildiğinde, son yıllarda IMV kullanım oranımız, ilk yıllara göre istatistiksel olarak azalmıştı (%5.6 vs %20; sırasıyla; p<0.001). Bir (%1) hastada pnömotoraks gelişti. İzlenen 103 hastadan ölen hasta olmadı.
Sonuç: Bronkodilatörler, sistemik kortikosteroidler ve gerekirse intravenöz magnezyum sülfat ile birlikte YANKO veya NIMV'in erken başlatılmasının ŞAA tedavisi için güvenli ve uygulanabilir bir tedavi seçeneği olduğunu düşünmekteyiz. ÇYBÜ’de ŞAA’da, çocuk yoğun bakım uzmanı, hastayı sistematik olarak değerlendirmeli, solunum desteği ve ek tedavi ihtiyacına hızlı bir şekilde karar vermelidir.

Keywords

Şiddetli astım atağı, çocuk yoğun bakım, non-invaziv mekanik ventilasyon

Evaluation of Patients with Severe Asthma Exacerbation treated in a Pediatric Intensive Care Unit: 8 Years of Single-Center Experience

Abstract

Aim: In this study, we aimed to evaluate the demographic and clinical characteristics of pediatric patients followed in tertiary pediatric intensive care unit (PICU) due to severe asthma exacerbation (SAE) and to discuss the optimal intensive care management for these patients.
Material and Method: We retrospectively analyzed a total of 103 patients between the ages of 12 months and 18 years who were followed up in the PICU with a diagnosis of SAE between 2013 and 2020.
Results: On the evaluation of data in terms of respiratory support, it was observed that 34 (33%) of the patients were treated during follow-up with, nasal oxygen cannula or standard non-rebreather oxygen face mask (NC/NRB), 13 (12.6%) with high-flow nasal cannula oxygenation (HFNC), 46 (44.7%) with non-invasive mechanical ventilation (NIMV), and 10 (9.7%) with invasive mechanical ventilation (IMV). When the respiratory supports applied by years were evaluated, the rate of invasive mechanical ventilation usage decreased significantly in recent years compared to the first years (5.6% and 20%; respectively; p < 0.001). Pneumothorax developed in one (1%) patient. No patient died among 103 patients who were followed up.
Conclusion: We think that early initiation of HFNC or NIMV in combination with bronchodilators, systemic corticosteroids, and if necessary, intravenous magnesium sulfate is a safe and viable treatment option for SAE treatment. In SAE cases in the PICU, the pediatric intensive care specialist should systematically evaluate the patient and quickly decide whether there is a need for respiratory support and additional treatment.

Keywords

Severe asthma exacerbation, pediatric intensive care, non-invasive mechanical ventilation

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