Genel anestezi sırasında preoksijenizasyonda CPAP uygulaması ile indüksiyonda PEEP uygulamasının non-hipoksik apne süresine ve hemodinamik parametrelere etkisi

Yıl 2018, Cilt: 2 Sayı: 3, 310 - 314, 01.09.2018

Havva Esra Uyar Türkyılmaz , Asutay Göktuğ , Selçuk Tur Hülya Başar

https://doi.org/10.28982/josam.436032

Öz

Amaç: Bu çalışmada preoksijenizasyonda CPAP ve maske ile ventilasyon sırasında PEEP uygulamanın non-hipoksik apne süresine ve hemodinamik parametrelere etkisi incelenmiştir. Yöntemler: Prospektif randomize çalışmada 100 hasta 4 gruba ayrılmıştır. Grup I ve III’te preoksijenizasyon CPAP maskesiyle uygulanmış ama hastalara basınç uygulanmamış ve indüksiyon sırasında Grup I’de hacim kontrollü ventilasyon (CMV) , Grup III’te ise CMV+6 cmH2O PEEP uygulanmıştır. Grup II ve IV’te ise preoksijenizasyonda CPAP maskesi ile 6 cmH2O basınç uygulanmış; indüksiyon sırasında Grup II’de CMV ile ventilasyon sağlanmış, Grup IV’te ise CMV+6 cmH2O PEEP uyfulanmıştır. Trakeal entübasyondan sonra, tüp havaya açılmış ve hasta spO2 değeri %90’a düşene kadar apneik bırakılmıştır. 

Bulgular: Saturasyonun %90’a düşme süresi Grup IV’te diğer gruplardan anlamlı olarak uzun bulundu. Süreler Grup I’de 412,50±97,37 sn, Grup II’de 443,52±88,84 sn, Grup III’de 415,20±117,45 sn ve Grup IV’de 522,92±83,44 sn şeklinde idi. Tek başına preoksijenizasyonda CPAP veya maske ile ventilasyon sırasında PEEP kullanmanın non-hipoksik apne süresine etkisi olmadığı görüldü.

Sonuç: Özellikle entübasyon güçlüğü düşünülen vakalarda preoksijenizasyon sırasında CPAP ve maske ile ventilasyon sırasında PEEP kullanmak güvenli, basit ve rahat tolere edilen bir yöntemdir ve non-hipoksik apne süresini uzatmaktadır.

Anahtar Kelimeler

CPAP, Non-hipoksik apne, PEEP, Preoksijenizasyon

The effect of CPAP during preoxygenation and PEEP during induction upon the duration of non-hypoxic apnea and hemodynamic parameters

Öz

Aim: This study evaluated the effects of applying CPAP during preoxygenation and PEEP during mask ventilation upon the duration of non-hypoxic apnea and hemodynamic parameters. 

Methods: This prospective randomized study included 100 patients allocated to 4 groups. In Groups I and III, preoxygenation was applied with CPAP mask without any pressure and during induction ventilation was performed with volume-controlled ventilation (CMV) in Group I and CMV + 6 cm H2O PEEP in Group III. In Groups II and IV, preoxygenation was applied with CPAP mask with 6 cmH2O pressure and during induction; ventilation was performed with CMV in Group II and CMV + 6 cm H2O PEEP in Group IV. After tracheal intubation, the tube was left open to air and the patient remained apneic until SpO2 reached 90%. 

Results: The time for SpO2 to reach 90% is significantly longer in Group IV compared to the other groups. The durations were 412.50±97.37 sec in Group I, 443.52±88.84 sec in Group II, 415.20±117.45 sec in Group III and 522.92±83.44 sec in Group IV. Using only CPAP during preoxygenation and only PEEP during mask ventilation had no significant effect on duration of non-hypoxic apnea. 

Conclusion: Especially for patients with difficult intubation, application of CPAP during preoxygenation followed with PEEP during mask ventilation safe, simple and it prolongs non-hypoxic apnea period.

Anahtar Kelimeler

CPAP, PEEP, Non-hypoxic apnea, Preoxygenation

Kaynakça

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