Yoğun bakım hastalarında diyafram ve rektus abdominis kas kalınlıklarının mortalitenin, morbiditenin ve mekanik ventilatörden ayırma başarısının belirlenmesindeki rolü

Öz

Amaç: Bu çalışmada, yoğun bakım ünitesine kabul edilen hastalarda diyafram ve rektus abdominis (RA) kas kalınlıklarının mortalite, morbidite ve mekanik ventilatörden ayırma (weaning) başarısı ile ilişkisi değerlendirilmiştir. Gereç ve yöntem: Çalışmaya 87 erişkin yoğun bakım hastası dahil edildi. Hastaların diyafram ve RA kas kalınlıkları, yatışın 1., 3., 7. ve çıkış günlerinde ultrasonografi ile ölçüldü. Klinik veriler, mekanik ventilatör ihtiyacı, weaning durumu, enfeksiyon gelişimi, sedasyon, inotrop ve steroid kullanımı ile birlikte kaydedildi. Bulgular: Çalışmaya dahil edilen hastaların %82,7’sinde invaziv mekanik ventilasyon (İMV) uygulandı. Weaning başarısı yalnızca %15,2 oranında sağlandı. Çıkış gününde İMV uygulanan hastalarda diyafram ve RA kalınlıkları, uygulanmayanlara göre anlamlı derecede daha düşüktü (sırasıyla p=0,029, p=0,004). RA kalınlığı ile weaning başarısı arasında anlamlı ilişki saptandı (p=0,03). Diyafram kalınlığı ile BKİ arasında pozitif yönde zayıf korelasyon mevcuttu. NUTRIC skoru ile RA kalınlığı arasında zayıf negatif korelasyon bulundu. Kas kalınlıkları ile yaş, APACHE-II ve SOFA skorları arasında korelasyon izlenmedi. Sonuç: Diyafram ve RA kas kalınlıklarının takibi, yoğun bakım hastalarında ventilatörden ayırma süreci ve mortalite riski açısından yol gösterici olabilir. Özellikle RA kalınlığı, weaning başarısının öngörülmesinde potansiyel bir biyobelirteç olarak değerlendirilebilir.

Anahtar Kelimeler

• Diyafram
• rektus abdominis
• kas ultrasonografisi

The role of diaphragm and rectus abdominis muscle thickness in predicting mortality, morbidity, and weaning success from mechanical ventilation in ICU patients

Öz

Purpose: This study aimed to evaluate the relationship between diaphragm and rectus abdominis (RA) muscle thickness and mortality, morbidity, and weaning success from mechanical ventilation in intensive care unit (ICU) patients. Materials and methods: A total of 87 adult ICU patients were included. Diaphragm and RA muscle thicknesses were measured via ultrasound on the 1st, 3rd, 7th, and discharge days of ICU stay. Clinical data, including mechanical ventilation status, weaning outcome, infections, and the use of sedation, inotropes, and steroids, were recorded. Results: Invasive mechanical ventilation (IMV) was applied in 82.7% of patients. Weaning was successful in only 15.2% of IMV patients. On the discharge day, diaphragm and RA thicknesses were significantly lower in the IMV group than in the non-IMV group (p=0.029, p=0.004, respectively). RA thickness was significantly higher on day 1 in the successfully weaned group (p=0.03). Diaphragm thickness showed a weak positive correlation with BMI. A weak negative correlation was found between RA thickness and NUTRIC score. No correlation was observed between muscle thicknesses and age, APACHE-II or SOFA scores. Conclusion: Monitoring diaphragm and RA muscle thickness may guide the assessment of weaning and mortality risk in ICU patients. Particularly, RA thickness may serve as a potential biomarker for predicting weaning success.

Anahtar Kelimeler

• Diaphragm
• rectus abdominis
• muscle ultrasound

Kaynakça

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