Kardiyopulmoner Resüsitasyon Sırasında Ventilasyonun Manuel Balon-Valf Veya Mekanik Ventilatör İle Sağlanmasının Spontan Dolaşımın Geri Dönüşü Ve Laktat Düzeyi Üzerine Etkisi

Öz

Amaç: Kardiyopulmoner resüsitasyon sırasında balon-valf ile manuel olarak uygulanan ventilasyon ile mekanik ventilatör aracılığıyla uygulanan ventilasyonun spontan dolaşımın geri dönüşü ve laktat düzeyinin seyri üzerine etkisini araştırmaktır. Gereç ve Yöntemler: Çalışma; Sağlık Bilimleri Üniversitesi İstanbul Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi Acil Tıp Kliniği’nde 04.01.2019 ile 04.01.2021 tarihleri arasında etik kurul onayı alınmasını takiben yürütüldü. Prospektif, randomize olarak tasarlanan çalışma kliniğimize gelen kardiyak arrest hastalar üzerinde yapıldı. Kardiyak arrest olarak gelen hastalara Güncel American Heart Association İleri Kardiyak Yaşam Desteği algoritmasına uygun bir şekilde ileri kardiyak yaşam desteği başlandı ve yönetildi, hastaların ileri havayolu endotrakeal entübasyon ile sağlandı. Hastalar randomize edilerek iki gruba ayrıldı. Her gruba 15’er hasta dahil edildi. Resüsitasyon ekibi tarafından bir gruba balon-valf ile manuel; diğer gruba da mekanik ventilatör ile ‘KPR modu’nda ventilasyon yapıldı. Müdahale boyunca 0-5-10-15-20. dakikalardaki laktat düzeyleri, spontan dolaşımın geri dönüşü sağlanması, sağlandı ise süresi kaydedildi ve gruplar arasında karşılaştırıldı. Bulgular: Hastaların yaş ortalaması 47.8 ve 16sı erkek 14ü kadın cinsiyette idi. Minimum 20 dk kardio pulmoner resüsitasyon uygulandı. 4 hastada rosc sağlandı. Laktat düzeyleri mekanik ventilatör grubunda 0-20. dakika arasında azalırken balon-valf ile manuel ventilasyon grubunda artış eğiliminde izlendi. Ventilasyon yönteminin spontan dolaşımın geri dönüşü üzerine etkisi açısından gruplar arasında anlamlı bir fark bulunmadı (p>0.05). Sonuç: Mekanik ventilatör kullanımının, manuel bag-valve ventilasyon yerine spontan dolaşımın geri dönüşünü olumsuz etkilemediği gözlemlendi. Ayrıca, mekanik ventilasyon grubunda, bag-valve manuel ventilasyon grubuna kıyasla laktat seviyelerinin düşme eğiliminde olduğu not edilmiştir.

Anahtar Kelimeler

• İleri havayolu
• ventilasyon
• KPR sırasında mekanik ventilasyon
• balon-valf ventilasyon

The Effects of Ventilation During Cardiopulmonary Resuscitation Using Manual Bag-Valve or Mechanical Ventilator on the Return of Spontaneous Circulation and Lactate Levels

Öz

Aim: The aim is to investigate the effect of manual ventilation using a bag-valve versus mechanical ventilation on the return of spontaneous circulation and the progression of lactate levels during cardiopulmonary resuscitation. Materials and Methods: The study was conducted at the Emergency Medicine Department of Fatih Sultan Mehmet Training and Research Hospital, between January 4, 2019, and January 4, 2021, following ethical approval. It was designed as a prospective, randomized study. Advanced cardiac life support was administered to patients who presented with cardiac arrest. The patients were randomized into two groups, with 15 patients included in each group. The resuscitation team provided manual ventilation with a bag-valve for one group and mechanical ventilation in ‘CPR mode’ for the other group. Lactate levels at 0, 5, 10, 15, and 20 minutes during the intervention, as well as the duration of return of spontaneous circulation, if achieved, were recorded and compared between the groups. Results: The mean age of the patients was 47.8, with 16 male and 14 female patients. CPR was applied for a minimum of 20 minutes. Return of spontaneous circulation (ROSC) was achieved in 4 patients. Lactate levels showed a decrease in the mechanical ventilator group, while an increasing trend was observed in the bag-valve manual ventilation group. There was no significant difference between the groups regarding the effect of the ventilation method on the return of spontaneous circulation (p > 0.05). Conclusion: It was observed that the use of a mechanical ventilator instead of manual bag-valve ventilation did not negatively affect the return of spontaneous circulation. Furthermore, a tendency for lactate levels to decrease was noted in the mechanical ventilation group compared to the bag-valve manual ventilation group.

Anahtar Kelimeler

• Advanced Airway
• Ventilation
• Mechanical ventilation during CPR
• bag-valve ventilation

Kaynakça

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