Changes in Blood Gases in Hypothermia and Respiratory Treatment Goals: Alpha-STAT and pH-STAT Approaches

Yıl 2020, Cilt: 3 Sayı: 4, 135 - 139, 31.12.2020

Tuba Cimilli , Fatma Sarı Ebru Ünal Akoğlu

Öz

In Emergency Medicine practice, hypothermia cases are generally seen with environmental accidents related to cold injuries. The body temperatures of the cases differ and the ultimate goal in treatment is to reach normal body temperature. Therapeutic Hypothermia, or "Targeted Temperature Management", is a neuroprotective treatment method that is thought to increase neurological functions and survival rate after cardiac arrest. Although the target values and duration of therapy after cardiac arrest have not been clarified, it is known that better neurological outcome is observed compared to those who received standard therapy in the first hours. Therefore, it will be inevitable to apply "Targeted Temperature Management" more widely in emergency services in the coming days. Interpretation of changes in blood gases observed in patients with hypothermia and respiratory therapy strategies that should be applied to carry out cellular physiological processes in a normal course are important problems that have been discussed for many years and there is still no consensus. In this review, physiological processes occurring in the human body in hypothermia and their reflections on blood gases are evaluated and at the same time, 'Alpha-Stat' and pH-Stat' respiratory treatment strategies, which have completely opposite goals are discussed.

Anahtar Kelimeler

hypothermia, blood gases, alpha stat, ph stat, targeted temprature management

Hipotermide Kan Gazlarında Gözlenen Değişiklikler Ve Solunumsal Tedavi Hedefleri: Alfa-STAT Ve pH-STAT Yaklaşımları

Öz

Acil Tıp pratiğinde hipotermi vakaları genellikle soğuk ile ilişkili çevresel kazalar ile birlikte görülür. Vakaların vücut ısıları farklılık gösterir ve tedavide nihai hedef normal vücut sıcaklığına ulaşmaktır. Terapötik hipotermi veya daha çok kabul gören ismi ile ‘Hedeflenmiş Sıcaklık Yönetimi’ ise kardiyak arrest sonrası nörolojik fonksiyonlarda ve hayatta kalma oranında artış sağlayabildiği düşünülen nöroprotektif bir tedavi yöntemidir. Kardiyak arrest sonrası her ne kadar hedef değerler ve uygulama süresi netlik kazanmamış olsa da ilk saatlerde uygulanmaya başlayan hastalarda standart tedavi uygulananlara göre daha iyi nörolojik sonlanımın gözlendiği bilinmektedir. Dolayısıyla önümüzdeki günlerde acil servislerde ‘Hedeflenmiş Sıcaklık Yönetimi’nin daha yaygın uygulanması kaçınılmaz olacaktır. Hipotermi uygulanan hastalarda kan gazlarında gözlenen değişikliklerin yorumlanması ve hücresel fizyolojik süreçleri normal seyrinde yürütmek için uygulanması gereken solunumsal tedavi stratejileri ise uzun yıllardır tartışılmaya devam eden ve üzerinde bir konsensüse varılamamış önemli sorunlardır. Bu derlemede, hipotermide insan vücudunda ortaya çıkan fizyolojik süreçler ve bunun kan gazlarına olan yansımaları değerlendirilmiş ve aynı zamanda bu hasta grubunda uygulanan ve birbirine tamamen zıt hedefleri olan ‘Alfa-Stat’ ve pH-Stat’ solunumsal tedavi yöntemleri tartışılmıştır.

Anahtar Kelimeler

hipotermi, kan gazı, alfa stat, ph stat, hedeflenilmiş sıcaklık yönetimi

Kaynakça

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