Anestezi Yoğun Bakım Ünitesinde Ekstübe Edilen Kardiyak Hastaların Retrospektif Analizi

Abstract

Amaç: Bu çalışmada amacımız anestezi yoğun bakım ünitesi (YBÜ)’nde kardiyak kaynaklı mekanik ventilatör (MV) ile takip ettiğimiz ve ekstübe edilerek YBÜ ihtiyacı kalmayan hastaların kardiyoloji bölümüne nakledildikten sonraki süreçte uygulanan tedavilerin incelenmesidir. Gereç ve yöntem: Çalışmaya anestezi YBÜ’de MV’de takip edilen kalp yetmezliği (KY) sebepli yatışı olan ve ani kardiyak arrest (AKA) sonrası başarılı kardiyopulmoner resüsitasyon (PRS) hastaları çalışmaya dahil edildi. Hastaların cinsiyetleri, başvuru sırasındaki yakınmaları, altta yatan sistemik hastalık öyküsü, kaç gün entübe vaziyette takip edildiği, ekstübe edildikten kaç gün sonra kardiyoloji servisine devredildiği, yapılan ve/veya önerilen medikal tedaviler, girişimsel tedaviler değerlendirildi. Bulgular: Çalışmaya toplam 145 hasta dahil edildi ve yaş ortalaması 66.46 ± 13.8 idi. Hastaneye başvuru sebepleri sırasıyla %71 oranında dispne, %22,1 ile AKA sonrası PRS ve %13,8 ile kardiyak aritmiydi. Hastaların YBÜ ortalama yatış süreleri 8,7 gün, ekstübe edildikten sonra kardiyoloji bölümüne devredilme süresi ortalama 4,5 gündü. Hastaların %11’ine anjio-stent uygulandı. Hastaların %5,5’ine intrakardiyak defibrilatör (ICD) implante edildi. Hastaların %93,8’i taburcu olurken, %4,8’i eksitus oldu. Sonuç: Kardiyak kaynaklı takip edilen hastalar ekstübe edildikten sonra primer etiyolojinin araştırılması açısından kardiyoloji kliniğine danışılması ve özellikle ventriküler artimi ve KY hastalarının ICD ve ilaç tedavilerinin düzenlenmesi, ST eleve olmayan myokard infarktüsü hastalarının anjiolarının planlanması ve ilaç tedavilerinin düzenlenmesi açısından değerlendirilmesinin oldukça önemli olduğunu unutmamak gereklidir.

Keywords

• Yoğun bakım ünitesi
• Ani kardiyak ölüm
• Kalp yetmezliği
• Mekanik ventilasyon

A Retrospective Analysis of Cardiac Patients Extubated in the Anesthesia Intensive Care Unit

Abstract

Objectives: In this study, our aim is to examine the treatments administered during the period following the transfer of patients from the anesthesia intensive care unit (ICU), who are being monitored with cardiac-origin mechanical ventilation (MV) and no longer require ICU care after extubation, to the cardiology department. Material and Method: Patients with heart failure (HF) admitted to the anesthesia ICU and those who underwent successful cardiopulmonary resuscitation (CPR) after sudden cardiac arrest (SCA) and followed up with MV were included in the study. Patients' gender, complaints at admission, underlying systemic disease history, duration of intubation, duration until transfer to the cardiology service after extubation, medical treatments administered and/or recommended, and interventional treatments were evaluated. Results: A total of 145 patients were included in the study, with a mean age of 66.46±13.8. The reasons for hospital admission were dyspnea in 71% of cases, post-SCA CPR in 22.1%, and cardiac arrhythmia in 13.8%. The mean length of stay in the ICU was 8.7 days, and the mean time until transfer to cardiology department after extubation was 4.5 days. Angioplasty was performed in 11% of patients, and implantable cardioverter-defibrillator (ICD) was placed in 5.5%. While 93.8% of patients were discharged, 4.8% deceased. Conclusion: After extubation of patients followed up for cardiac reasons, it is important to consult the cardiology clinic for investigation of the primary etiology and, especially for patients with ventricular arrhythmias and HF, to evaluate the implantation of ICD and adjustment of drug treatments. It is crucial to evaluate planned angiography and adjustment of drug treatments for patients with non-ST elevated myocardial infarction.

Keywords

• Intensive care unit
• Sudden cardiac arrest
• Heart failure
• Mechanical ventilation

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