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

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

References

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