Hiperkapnik Solunum Yetmezliği Gelişen Kronik Obstrüktif Akciğer Hastalığı Hastalarında Noninvaziv AVAPS (Average Volume Assured Pressure Support) Modu

Year 2018, , 55 - 60, 28.03.2018

Ege Güleç Balbay , Fuat Aytekin Öner Balbay , Ali Nihat Annakkaya , Peri Arbak

https://doi.org/10.18521/ktd.371095

Abstract

Amaç: Bu çalışmada, AVAPS (Average Volume Assured Pressure Support) modu ile Noninvazif Mekanik Ventilasyon (NMV) uygulanan hastalarda hasta uyumu ve klinik başarı
oranlarının araştırılması amaçlanmıştır. Bu çalışma Düzce Üniversitesi Bilimsel Araştırma
Projesidir (Proje No: 2015.04.03.312).

Yöntem:
Hiperkapnik Solunum Yetmezliği
Gelişen 22 Kronik Obstrüktif Akciğer Hastalığı (KOAH) hastalarına AVAPS modu uygulandı.
Başlangıç parametreleri olarak; AVAPS Modunda
IPAP Max 20 cm
H₂O, IPAP Min 12 cm
H₂O,  Hedef Tidal volüm= İdeal
kilo x 6 ml/kg, EPAP 5 cm
H₂O ayarları ile başlanıp hastanın tolere ettiği ölçüde arttırılacak
ve SaO₂ ≥ %90 olacak şekilde verildi. Hastaya verilen basınç
desteğinin 6 ml/kg TV’ü oluşturacak şekilde olmasına dikkat edildi. Hastaların NIV
bağlandıktan sonra 1, 2, 8 ve 24.  saatlerde
arter kan gazı kontrolleri, nabız, solunum sayısı, Borg dispne skalası
ölçümleri yapıldı.

Bulgular:
Çalışmaya dahil edilen yaş ortalaması 70±10 olan 22 hastanın %72,7 (n:16)’si
erkekti. Geliş APACHE Skor ortalaması 16,50±4,24’tü. Geliş nabız ve solunum
sayısı ortamaları sırasıyla 96±13 ve
24±4 idi. Borg dispne skalası
ortancası 6 (min:2, max:8) idi. Hastaların %59 (n:13)’unda 24
saat içerisinde PH değerleri normal aralığına ulaştı. Hastaların NMV öncesi PH, PCO₂, PaO₂/FiO₂
ve Borg dispne skalası değerler ile NMV uygulamasının 1, 2, 8, 24 saat PH, PCO₂,
PaO₂/FiO₂ ve Borg dispne skalası değerleri
karşılaştırıldığında istatistiksel anlamlı olarak PH (p<0,001) ve Pa0₂/FiO₂
(p=0,002) değerlerinde artma, PCO₂ veBorg dispne skalası
değerlerinde sırasıyla (p<0,001, p<0,001) azalma olduğu görüldü. İzlenen
parametrelerinde tümünde 1. Saatte anlamlı değişiklik görüldü. 24 saat izlenen hastaların sadece 1’i entübe
edilerek yoğun bakım ünitesine devri gerçekleştirildi. Hiçbir hastada
uyumsuzluk izlenmedi. Servis takipleri sonucunda hastaların %95 (n:21)’i evine
taburcu edilebildi.

Sonuç: AVAPS modu ile NMV
uygulanmasında hasta uyumu ve klinik başarı oranlarının yüksek olduğu görüldü.

 

Keywords

KOAH, Solunum yetmezliği

Noninvasive AVAPS (Average Volume Assured Pressure Support) Mode in COPD Patients with Respiratory Failure

Abstract

Objective: In this study, we
aimed to investigate patient compliance and clinical success rates in patients
undergoing NIV with AVAPS (Average Volume Assured Pressure Support) mode. This
study is Düzce University Scientific Research Project (Project No: 2015.04.03.312).

Method: As initial
parameters; IPAP Max 20 cm H2O, IPAP Min 12 cm H2O, Target Tidal volume = Ideal
weight 6 ml / kg EPAP in AVAPS mode, starting with 5 cm H2O settings and
increasing to the extent that the patient is tossed and SaO2 ≥ 90% . Care was taken
to ensure that the pressure support supplied to the patient was 6 ml / kg TV.
Arterial blood gas controls, pulse rate, respiratory rate and Borg dyspnea were
measured at 1, 2, 8 and 24 hours after NMV adherence of the patients.

Results: 72.7% (n: 16) of 22
patients included in the study had a mean age of 70 ± 10. The arrival APACHE
Score averaged 16,50 ± 4,24. The number of arriving pulses and respiration were
96 ± 13 and 24 ± 4, respectively. Borg dyspnea scale mean was 6 (min: 2, max:
8). 59% (n: 13) of the patients had undetectable pH values ​​within 24 hours.
When PH, PCO2, PaO2 / FiO2 and Borg dyspnea scores of patients before NIV and NIV
application values ​​of 1,2,8,24 hours PH, PCO2, PaO2 / FiO2 and Borg dyspnea
scores of patients were compared statistically, PH (p <0,001) and Pa02 /
FiO2 (p = 0.002), PCO2 and Borg dyspnea scores were decreased (p <0.001, p
<0.001), respectively. Significant changes were observed in all of the
monitored parameters at 1 hour. Only one of the patients who were followed for
24 hours was entitled to the intensive care unit. No incompatibility was
observed in any patient. As a result of service interventions, 95% (n: 21) of
the patients could be discharged home.

Conclusion: It was observed that
patient compliance and clinical success rates were higher in NIV application
with AVAPS mode.

Keywords

KOAH, Solunum yetmezliği

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