COVID-19 Hastalarında Akut Solunum Sıkıntısı Sendromu Yönetimi

Abstract

Covid 19, koronovirüsün, şiddetli akut solunum sıkıntısı sendromuna neden olduğu bulaşıcı bir hastalıktır. İlk vaka 2019'da Çin'in Wuhan kentinde tespit edildi. Hastalık o zamandan beri dünya çapında yayılarak bir pandemiye yol açtı. Çoğu insan hafif ila orta şiddette semptomlara sahip olsa da, hastaların % 5'i kritik semptomlara (ARDS, şok, çoklu organ yetmezliği) sahiptir. Kalp hastalığı, hipertansiyon, diyabet ve kronik obstrüktif akciğer hastalığı gibi mevcut sağlık koşullarına sahip kişiler ve bağışıklık sistemi zayıflamış kişiler, daha ciddi komplikasyonlar için daha yüksek risk altındadır. Akut solunum sıkıntısı sendromu (ARDS), akciğerlerde hızlı başlayan yaygın inflamasyon ile karakterize bir solunum yetmezliği türüdür. Koronavirüsün neden olduğu hastalık olan COVID-19, pnömoni gibi akciğer komplikasyonlarına ve şiddetli vakalarda akut solunum sıkıntısı sendromuna (ARDS) neden olabilir. Bu duruma COVID-19 ile ilişkili akut solunum sıkıntısı sendromu (CARDS) denir. CARDS' a özgü mekanizmalar ve komorbiditeler mevcuttur ve bazı yönleri ile atipik bir ARDS olduğu düşünülebilir. Önemli olarak, CARDS için spesifik kanıta dayalı tıbbi müdahaleler şu anda mevcut değildir ve tedavi çabaları çoğunlukla destekleyici YBÜ bakımı ile sınırlıdır. CARDS yönetimi, önemli klinik ikilemler ortaya çıkarmaktadır. Şu anda hastalığa özgü tedavi yaklaşımının bulunmadığı spesifik CARDS durumunda, önleyici tedbirlerin özel bir önemi olduğu görülmektedir. Bu derlemede, altta yatan pulmoner patofizyolojiyi ve CARDS'ın klinik yönetimini tartışacağız.

Keywords

• ARDS
• Covid 19
• Covid 19 ilişkili akut solunum sıkıntısı sendromu

Acute Respiratory Distress Syndrome Management in COVID-19 Patients

Abstract

COVID-19 is a contagious disease caused by severe acute respiratory distress syndrome coronovirus. The first case was identified in Wuhan, China, in 2019. The disease has since spread worldwide, leading to an ongoing pandemic. Most people develop mild to moderate symptoms, only 5% of patients suffer critical symptoms (ARDS, shock, multiorgan dysfunction). People with existing health conditions like heart disease, hypertension, diabetes, and chronic obstructive pulmonary disorder, and people with a compromised immune system are at higher risk for more severe complications. Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. COVID-19, the disease caused by the coronavirus, can cause lung complications such as pneumonia and, in the most severe cases, acute respiratory distress syndrome (ARDS). This state is called COVID-19-associated acute respiratory distress syndrome (CARDS). CARDS-specific mechanisms and comorbidities can be noted and some aspects of CARDS can be considered ARDS atypical. Importantly, specific evidence-based medical interventions for CARDS are currently unavailable, limiting treatment efforts to mostly supportive ICU care. The management of CARDS poses significant clinical dilemmas. In the specific setting of CARDS, with currently no disease-specific treatment approach available, preventive measures appear to be of a particular importance. In this review, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS.

Keywords

• ARDS
• Covid 19
• COVID-19-associated acute respiratory distress syndrome,

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