Akut solunum yetmezliğinde optik sinir kılıf çapının prognostik önemi

Yıl 2022, Cilt: 47 Sayı: 3, 1187 - 1196, 30.09.2022

Mehmet Göktuğ Efgan Zeynep Karakaya Adnan Yamanoğlu Ahmet Kayalı

https://doi.org/10.17826/cumj.1128786

Öz

Amaç: Bu çalışmanın birincil amacı, hipoksemik solunum yetmezliği ve hiperkarbik solunum yetmezliği ayrımında ultrasonografi kullanılarak ölçülen ONSD'nin rolünü belirlemekti. Çalışmanın ikincil amacı, hiperkarbik hastaların klinik sonuçlarını tahmin etmede ONSD'nin değerini belirlemektir.
Gereç ve Yöntem: Bu çalışmaya dispne ile başvuran travmatik olmayan yetişkin hastalar dahil edildi. Çalışmaya başvuran tüm hastalardan başvuru sırasında ve tedavinin ikinci saatinde arter kan gazı ve eş zamanlı ONSD ölçümleri alındı. Hastalar hipoksik ve hiperkarbik solunum yetmezliği olmak üzere iki gruba ayrıldı. Hasta sayısı kadar sağlıklı gönüllüler çalışmaya dahil edildi.
Bulgular: Tip 1 solunum yetmezliği olan 24 hastada ortalama ONSD değerleri 3,8±0,2 mm, tip 2 solunum yetmezliği olan 25 hastada 5,2 ± 0,5 mm ve sağlıklı kontrollerde 3,9±0,3 mm idi. Hiperkarbik hastaların ONSD'si, hipoksik hastaların ve sağlıklı gönüllülerinkinden istatistiksel olarak anlamlı derecede daha yüksekti. Hiperkarbik hastaların ONSD'leri tedavi başlangıcında 5,2±0,5 mm ve tedavi sonrasında 4,4±0,6 mm idi ve aralarında istatistiksel olarak anlamlı fark vardı. Ancak ONSD farkı, hastaneye yatış ve mortaliteyi öngörmede istatistiksel olarak anlamlı değildi.
Sonuç: Sonografik olarak ölçülen ONSD, tip 1 ve tip 2 solunum yetmezliğinin ayırıcı tanısında etkili bir parametre olabilir. Tip 2 solunum yetmezliği olan hastalarda tedavi ile ONSD değerleri önemli ölçüde değişmiştir.

Anahtar Kelimeler

Hiperkarbi, okuler usg, optik sinir kilif çapi, acil tıp.

Prognostic significance of the optic nerve sheath diameter in acute respiratory failure

Öz

Purpose: The primary aim of this study was to determine the role of the optic nerve sheath diameter (ONSD) measured using ultrasonography in the differentiation of hypoxemic respiratory failure and hypercarbic respiratory failure. The secondary aim was to determine the value of ONSD in predicting the clinical outcome in hypercarbic patients.
Materials and Methods: Non-traumatic adult patients presenting with dyspnea were included in this study. Arterial blood gas and concurrent ONSD measurements were obtained from all patients included in the study during presentation and at the second hour of treatment. The patients were divided into two groups - hypoxic and hypercarbic respiratory failure. An equivalent number of healthy volunteers were enrolled as the control group.
Result: Mean ONSD values were 3.8±0.2 mm in the 24 patients with type 1 respiratory failure, 5.2 ± 0.5 mm in the 25 patients with type 2 respiratory failure, and 3.9±0.3 mm in the healthy controls. The ONSD of the hypercarbic patients was statistically significantly greater than that of the hypoxic patients and healthy volunteers. The ONSD of the hypercarbic patients was 5.2±0.5mm at baseline and 4.4±0.6 mm after treatment, the difference being statistically significant. However, the difference in ONSD was not statistically significant in predicting hospitalization and mortality.
Conclusion: Sonographically measured ONSD may be an effective parameter in the differential diagnosis of type 1 and 2 respiratory failure. ONSD values changed significantly with treatment in patients with type 2 respiratory failure.

Anahtar Kelimeler

Hypercarbia, ocular ultrasonography, optic nerve sheath diameter, emergency medicine

Kaynakça

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