Factors affecting the success of weaning in patients with chronic obstructive pulmonary disease

Yıl 2011, Cilt: 38 Sayı: 3, 263 - 273, 01.09.2011

Turgut Teke Rukiye Metineren Emin Maden Kürşat Uzun

https://doi.org/10.5798/diclemedj.0921.2011.03.0029

Öz

Objectives: Weaning failure rate was higher in patients with chronic obstructive pulmonary disease (COPD) and many factors affect it. The aim of this study was to in­vestigate the factors affecting the success of weaning in COPD patients receiving invasive mechanical ventilation (IMV). Materials and methods: Totally 43 COPD patients who received IMV in intensive care unit were included. Clinical and laboratory results and Acute Physiology Assessment and Chronic Health Evaluation (APACHE II) scores were recorded and affecting factors on weaning success were investigated. Results: In 43 patients, 25 had successful weaning (58.1%). Patients with high APACHE II score prior to intu­bation was found as associated with weaning failure. High Glasgow coma scale (GCS) scores before entubation and weaning are associated with weaning success. Pre-weaning anxiety, positive endotracheal aspirate culture, pulmonary arterial pressure value, enteral feeding, pre-weaning tachycardia, pre-weaning cuff leaking and FiO2 values were found to be associated with weaning failure. Pre-weaning cortisol levels were associated with wean­ing success. In successful weaning group, measured NIF and VT in spontaneous mode were found as higher and f/VT ratio was lower compared with unsuccessful group. T-tube during the 15th and 30th minutes of the symptoms of fatigue (sweating assets) were associated with wean­ing failure. IMV duration and longer extubation duration of weaning, and more number of t-tube insertion attempts were found as associated with failure of weaning. Conclusions: Infection in patients with COPD, the pres­ence of anxiety, and hemodynamic and respiratory insta­bility significantly increases the weaning failure.

Anahtar Kelimeler

COPD, invasive mechanical ventilation, weaning failure, affecting factors

Kronik obstrüktif akciğer hastalığı bulunan hastalarda mekanik ventilatörden ayırma başarısını etkileyen faktörler

Öz

Amaç: Kronik obstrüktif akciğer hastalığı (KOAH) bulunan hastalarda ventilatörden ayırma başarısızlığı oranı yüksek olup, bunu etkileyen birçok faktör bulunmaktadır. Bu çalış­manın amacı invaziv mekanik ventilasyon (İMV) uygulanan KOAH hastalarında mekanik ventilatörden ayırma başarısını etkileyen faktörleri incelemektir. Gereç ve yöntem: Çalışmaya yoğun bakımımızda İMV uy­gulanan 43 KOAH hastası dahil edildi. Hastaların klinik ve laboratuar bulguları ve Akut Fizyoloji ve Kronik Sağlık Değer­lendirmesi (APACHE II) skorları kaydedildi ve mekanik venti­latörden ayırma başarısını etkileyen faktörler araştırıldı. Bulgular: Toplam 43 hastanın 25\'inde mekanik ventilatörden ayırma başarılı olarak gerçekleştirildi (%58.1). Hastaların entübasyon öncesi APACHE II skoru yüksekliği ile mekanik ventilatörden ayırma başarısızlığı arasında anlamlı ilişki bu­lundu. Entübasyon ve mekanik ventilatörden ayırma öncesi Glasgow koma skalasının yüksek olması ayırma başarısı ile ilişkili bulundu. Mekanik ventilatörden ayırma öncesi anksi­yete varlığı, endotrakeal aspiratta üreme, yüksek pulmoner arter basıncı değeri, enteral beslenme, taşikardi varlığı, kaf kaçağı miktarı ve FiO2 değeri ile ayırma başarısızlığı arasın­da anlamlı ilişki vardı. Hastalarda mekanik ventilatörden ayır­ma öncesi kortizol seviyesi ile mekanik ventilatörden ayırma başarısı ilişkili bulundu. Spontan modda ölçülen negatif inspi­ratuar kuvvet (NIF) ve tidal volüm (VT) mekanik ventilatörden ayırmanın başarılı olduğu grupta daha yüksek, f/VT oranı ise daha düşük bulundu. T-tüp sırasında 15. ve 30. dakikalarda yorgunluk belirtilerinin olması ile mekanik ventilatörden ayır­ma başarısızlığı ilişkili bulundu. Hastalara uygulanan İMV süresi ve ekstübe edilebilen hastalarda mekanik ventilatör­den ayırma süresinin uzun olması ve t-tüp deneme sayısının fazla olması ile mekanik ventilatörden ayırma başarısızlığı ilişkili saptandı. Sonuç: Sonuç olarak KOAH hastalarında enfeksiyon, anksi­yete varlığı, hemodinamik ve solunumsal instabilite durumu mekanik ventilatörden ayırma başarısızlığını anlamlı olarak artırmaktadır.

Anahtar Kelimeler

KOAH, invaziv mekanik ventilasyon, me­kanik ventilatörden ayırma başarısızlığı, etkileyen faktörler

Kaynakça

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