Yoğun Bakım Hastalarında Anemi ve Hemşirelik Yönetimi

Öz

Anemi, yoğun bakım hastalarında sık görülen bir semptomdur. Yoğun bakım hastalarında görülen aneminin etyolojisinde genellikle birçok faktör etkilidir. Yoğun bakım ünitesi ile ilgili gelişen anemi tedavisinde kırmızı kan hücre transfüzyonu sık olarak uygulanmaktadır. Yoğun bakım ünitesi ile ilgili gelişen aneminin önlenmesi ve tedavisi için uygulanan diğer terapötik strateji, rekombinant insan eritropoetin uygulamasıdır. Bu makalede yoğun bakım hastalarındaki anemiyle ilgili güncel tanı ve tedavilerle anemide hemşirelik yönetimi irdelendi

Anahtar Kelimeler

• Yoğun bakım ünitesi, anemi, kırmızı hücre transfüzyonu, hemşirelik yönetimi

Anemia in Critically ill Patients and Nursing Management

Öz

Anemia is a common pathology in critically ill patients. Etiology of anemia observed in criti- cally ill patients, is often multifactorial. Treatment of intensive care unit associated anemia frequently involves the administration of allogeneic red blood cell transfusion. An alternative therapeutic and preventive strategy for associated anemia is using recombinant human erythropoietin. The purpose of this article was to review the literature regard- ing these important issues related to the current diagnosis, treatment, and nursing management of anemia in critically ill patient

Anahtar Kelimeler

• Intensive care unit, anemia, red blood transfusion, nursing management

Kaynakça

1. Shelton KB, Hematological and immune disor- ders. In: Sole ML, Lamborn LM, Hartshorn C, edi- tors. Introduction to critical care nursing. 3rd ed. Philadelphia: W. B. Saunders Company; 2001. p. 419-25.
2. National Anemia Actions Council, Inc. Anemia and critical illness. Available from: http://www.anemia. org/patients/educationsheets/critical_illness.pdf Anemia and critical illness; 2005.
3. Kızılkaya B, İyigün E, Hatipoğlu S. Yoğun bakım ünitelerinde bir sorun: Iatrojenik anemi. Sendrom 2005;17:102-6.
4. Dharmarajan TS, Wilson P, Edward P. Anemia, morbidity and mortality in older adults: Need for greater recognation. Geritarics 2005;60:22-9.
5. Granberg-Axell AI, Malmros CW, Bergbom IL, Lundberg D. Intensive care unit syndrome/delirium is associated anemia, drug therapy and duration of drug therapy. Acta Anaesth Scand 2002;46:726-31.
6. Wong P, Intragumtornchai T. Hospital-acquired ane- mia. J Med Assoc Thai 2006;89:63-7.
7. Shander A. Anemia: risks, tolerance, and pharma- cologic adjuvants for treatment. Available from: http://www.itaccs.com/traumacare/archive/05_ 03_Summer_2005/anemia.pdf
8. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J. Anemia is associated with worse symptoms, greater impairment in functional capac- ity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 2002;39:1780-6.

9. Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996;348:1055-60.
10. DeFoe GR, Ross CS, Olmstead EM, Surgenor SD, Fillinger MP, Groom RC, et al. Lowest hematocrit on bypass and adverse outcomes associated with coro- nary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg 2001;71:769-76.
11. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 2001;345:1230-6.
12. Markwell MM, Wilson P. Anemia in critically ill patients: real-life experience and treatment strate- gies. Available at: http://www.sr.cme-today.com/ cd/cd0082/AB0474.htm
13. Vincent JL, Yalavatti G. Transfusion practice in the ICU: When to transfuse?. Indian J Crit Care Med 2003;7:237-41.
14. Piagnerelli M, Boudjeltia KZ, Vanhaeverbeek M, Vincent JL. Red blood cell rheology in sepsis. Intensive Care Med 2003;29:1052-61.
15. Fink MP. Pathophysiology of intensive care unit- acquired anemia. Crit Care 2004;8 Suppl 2:S9-10.
16. Nguyen BV, Bota DP, Mélot C, Vincent JL. Time course of hemoglobin concentrations in nonbleed- ing intensive care unit patients. Crit Care Med 2003;31:406-10.
17. von Ahsen N, Müller C, Serke S, Frei U, Eckardt KU. Important role of nondiagnostic blood loss and blunted erythropoietic response in the anemia of medical intensive care patients. Crit Care Med 1999;27:2630-9.
18. Thavendiranathan P, Bagai A, Ebidia A, Detsky AS, Choudhry NK. Do blood tests cause anemia in hospitalized patients? The effect of diagnostic phle- botomy on hemoglobin and hematocrit levels. J Gen Intern Med 2005;20:520-4.
19. Stephenson JR, Axelrad AA, McLeod DL, Shreeve MM. Induction of colonies of hemoglobin-synthesiz- ing cells by erythropoietin in vitro. Proc Natl Acad Sci U S A 1971;68:1542-6.
20. Muñoz M, Romero A, Morales M, Campos A, García-Erce JA, Ramírez G. Iron metabolism, inflam- mation and anemia in critically ill patients. A cross- sectional study. Nutr Hosp 2005;20:115-20.
21. Rogiers P, Zhang H, Leeman M, Nagler J, Neels H, Mélot C, et al. Erythropoietin response is blunted in critically ill patients. Intensive Care Med 1997; 23:159-62.
22. Rodriguez RM, Corwin HL, Gettinger A, Corwin MJ, Gubler D, Pearl RG. Nutritional deficiencies and blunted erythropoietin response as causes of the anemia of critical illness. J Crit Care 2001;16:36-41.
23. Krafte-Jacobs B, Levetown ML, Bray GL, Ruttimann UE, Pollack MM. Erythropoietin response to critical illness. Crit Care Med 1994;22:821-6.
24. Hecht K. Adult ICU anemia management protocol approved Current Topics From Drug Information Center 2001;31:7;1-2.
25. May AK, Kauder RD. Use of blood products in the intensive care unit. Available from: http://www. uptodate.com
26. Napolitano LM. Scope of the problem: epidemiology of anemia and use of blood transfusions in critical care. Crit Care 2004;8 Suppl 2:S1-8.
27. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA 2002;288:1499-507.
28. Spahn DR, Marcucci C. Blood management in inten- sive care medicine: CRIT and ABC-what can we learn? Crit Care 2004;8:89-90.
29. Shorr AF, Jackson WL. Transfusion practice in the ICU: when will we apply the evidence? Chest 2005;127:702-5.