MEKANİK VENTİLASYONDA PRONE POZİSYONUNUN YÖNETİMİ

Öz

Mekanik ventilasyonda prone pozisyonu verilmesi akciğer hasarını azaltan ventilasyon stratejilerinden biridir. Tedavinin etkinliğini artıran ucuz, basit ve güvenli bir yöntemdir. Özellikle erken başlandığında ve uzun süreli uygulandığında yararlı etkileri olan bir uygulamadır. Önceki yıllarda yapılan randomize kontrollü çalışmalar ile metaanaliz çalışma sonuçlarında yararlı etkileri kanıtlanmasına karşın prone pozisyonunun kullanımı istendik düzeyde değildir. Prone pozisyonunda mekanik ventilasyon tedavisinin üçüncü basamak yoğun bakım ünitelerinde tedavi ve bakımlarının sürdürülmesi gerekmektedir. Yoğun bakım hemşireleri, pozisyon verilmesi, sürekli hasta izlemi, beslenmenin sağlanması ve sürdürülmesi, hasta transferi ve bakım gereksinimlerinin karşılanması, hasta ve ailesinin rahatlığının sağlanması için anahtar konumunda görev alırlar.

Anahtar Kelimeler

• Prone pozisyonu,Mekanik ventilasyon,Yoğun bakım hemşiresi

Kaynakça

1. 1. Oliveira VM, Weschenfelder ME, Deponti G, Condessa R, Loss SH, Bairros PM, et al. Good practices for prone positioning at the bedside: construction of a care protocol. Rev Assoc Med Bras 2016; 62(3): 287-93.
2. 2. Mora-Arteaga JA, Bernal-Ramírez OJ, Rodríguez SJ. The effects of prone position ventilation in patients with acute respiratory distress syndrome. A systematic review and metaanalysis. Med Intensiva 2015; 39(6): 359-72.
3. 3. Wong Sze LR. Evidence based guideline of prone positioning for adult patients with acute respiratory distress syndrome in ıntensive care unit. [Unpublished Master Thesis], Hong Kong:The University of Hong Kong, 2014.
4. 4. Kopterides P, Siempos II, Armaganidis A. Prone positioning in hypoxemic respiratory failure: meta-analysis of randomized controlled trials. J Crit Care 2009; 24(1): 89-100.
5. 5. Guérin C, Baboi L, Richard JC. Mechanisms of the effects of prone positioning in acute respiratory distress syndrome. Intensive Care Med 2014; 40(11): 1634-42.
6. 6. Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2017;195(9): 1253-1263.
7. 7. Hu SL, He HL, Pan C, Liu AR, Liu SQ, Liu L, et al. The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. Crit Care 2014;18(3):R109.
8. 8. Wright AD, Flynn M. Using the prone position for ventilated patients with respiratory failure: a review. Nurs Crit Care 2011; 16(1): 19-27.

9. 9. Della Volpe JD, Lovett J, Martin-Gill C, Guyette FX. Transport of Mechanically Ventilated Patients in the Prone Position. Prehosp Emerg Care 2016; 20(5): 643-7.
10. 10. Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD, Garcia Gigorro R, Terceros Almanza LJ, Sanchez Izquierdo JA, et al. Enteral nutrition in patients receiving mechanical ventilation in a prone position. JPEN J Parenter Enteral Nutr 2016; 40(2): 250-5.
11. 11. Sud S, Sud M, Friedrich JO, Adhikari NK. Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. CMAJ 2008; 178(9): 1153-61.
12. 12. Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA, 2009; 302(18): 1977-84.
13. 13. Fernandez R, Trenchs X, Klamburg J, Castedo J, Serrano JM, Besso G, et al. Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial. Intensive Care Med 2008; 34(8), 1487-91.
14. 14. Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO., et al. Prone position for acute respiratory distress syndrome. a systematic review and meta-analysis. Ann Am Thorac Soc 2017; 4: 280-8.
15. 15. Thomas PJ, Paratz JD, Stanton WR, Deans R, Lipman J. Positioning practices for ventilated intensive care patients: current practice, indications and contraindications. Aust Crit Care 2006; 19(4):122-6, 128, 130-2.
16. 16. Piraino T, Fan E. Acute life-threatening hypoxemia during mechanical ventilation. Curr Opin Crit Care 2017; 23(6): 541-548.
17. 17. Putensen C. Prone position in mechanically ventilated patients – the hard or the soft way?. Crit Care 2005; 9(3): 253–254.
18. 18. Venet C, Guyomarc'h S, Pingat J, Michard C, Laporte S, Bertrand M, et al. Prognostic factors in acute respiratory distress syndrome: a retrospective multivariate analysis including prone positioning in management strategy. Intensive Care Med 2003; 29(9):1435-41.
19. 19. Lee JM, Bae W, Lee YJ, Cho YJ. The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med 2014; 42(5): 1252-62.
20. 20. Koulouras V, Papathanakos G, Papathanasiou A, Nakos G. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World J Crit Care Med 2016; 5(2):121-36.
21. 21. Reignier J, Thenoz-Jost N, Fiancette M, Legendre E, Lebert C, Bontemps F, et al. Early enteral nutrition in mecha-nically ventilated patients in the prone position. Crit Care Med 2004; 32(1): 94-9.
22. 22. Tiruvoipati R, Bangash M, Manktelow B, Peek GJ. Efficacy of prone ventilation in adult patients with acute respiratory failure: a meta-analysis. J Crit Care 2008; 23(1): 101-10.
23. 23. Wilson JG, Matthay MA. Mechanical ventilation in acute hypoxemic respiratory failure: a review of new strategies for the practicing hospitalist. J Hosp Med 2014; 9(7): 469-75.
24. 24. Rowe C. Development of clinical guidelines for prone positioning in critically ill adults. Nurs Crit Care 2004; 9(2): 50-7.
25. 25. North of England Critical Care Network. Prone ventilation of the critically ill patient. Erişim adresi: https://www.noeccn.org.uk/resources/Documents/Benchmarks%20Guidelines/Guidelines%20%20old/NoECCN%20Guideline%20Proning%20the%20Critically%20Ill.pdf.