�NTERST�YEL AKC��ER HASTALI�INDA YO�UN BAKIM �N�TES�NDE MEKAN�K VENT�LASYON

��FTC�, Fatma; DA�TAN, Ahmet Onur; EROL, Serhat; ��LEDA�, Ayd�n; KAYA, Ak�n

Cilt : 37 Say� : 3 Y�l : 2023

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�NTERST�YEL AKC��ER HASTALI�INDA YO�UN BAKIM �N�TES�NDE MEKAN�K VENT�LASYON [G��s Hastanesi Dergisi]

G��s Hastanesi Dergisi. 2018; 32(3): 141-151

�NTERST�YEL AKC��ER HASTALI�INDA YO�UN BAKIM �N�TES�NDE MEKAN�K VENT�LASYON

Fatma ��FTC�¹, Ahmet Onur DA�TAN¹, Serhat EROL¹, Ayd�n ��LEDA�¹, Ak�n KAYA¹
Ankara �niversitesi T�p Fak�ltesi, G��s Hastal�klar�, Ankara, T�rkiye

Ama�: �nterstisyel akci�er hastal�� (�AH) olan ve akut solunum yetersizli�i nedeniyle yo�un bak�m �nitesinde (YB�) tedavi edilen hastalar�n prognozu hakk�nda veriler k�s�tl�d�r. YBܒ nde mekanik ventilat�r ile solunum destek tedavisi alan �AH olgular�n�n �zellikleri ve mortaliteyi etkileyen risk fakt�rleri de�erlendirildi. Y�ntem ve Gere�: Tek merkezli, prospektif ara�t�rmaya Ocak 2013- A�ustos 2017 tarihleri aras�nda 65 hasta (29 K, 36 E) dahil edildi. Olgular�n YBܒ ne al�nd�klar�ndaki klinik bulgular�, takiplerinde ventilasyon destek tedavilerinin (NIV, IMV) mortalite �zerindeki etkileri incelendi. Bulgular: Tan�lar� 34 hastada IPF, 13 kollajen doku hastal��, 10 akut interstisyel pn�moni, 3 Wegener granulomatozu, 2 sarkoidoz, 1 kronik hipersensitivite pn�monisi, 1 ilaca ba�l� akci�er hastal��, 1 hastada pl�roparankimal fibroelastozis bulundu. 43 (%66,1) hasta YBܒ nde ex oldu. YB� takibi sonunda ya�ayan ve ya�amayan hasta gruplar� kar��la�t�r�ld��nda PaO2/FiO2 oran� ve GKS ya�ayan grupta anlaml� y�ksek bulundu. Tek de�i�kenli Cox regresyon analizinde GKS (HR 1,225; 95% CI: [0,783-1,550]; p=0,052), APACHE II (HR 2,845; 95% CI: [1,431-3,751]; p=0,006), PaO2/FiO2 (HR 1,753; 95% CI: [1,169-1,932]; p=0,012), sPAP (HR 1,601; 95% CI: [0,263-1,710]; p=0,031), ve IMV ihtiyac�n�n (HR 8,441; 95% CI: [3,225-12,632]; p<0,001) YBܒ nde mortalite riskini artt�rd�� g�r�ld�. �ok de�i�kenli analiz sonu�lar�na g�re PaO2/FiO2 (HR 1,224; 95% CI: [0,832-1,705]; p=0,015), APACHE II (HR 1,956; 95% CI: [1,031-4,216]; p=0,010), ve IMV ihtiyac� (HR 7,473; 95% CI: [3,028-9,243]; p<0,001) mortalitenin ba��ms�z risk fakt�rleriydi. Sonu�: �AH ba�l� akut solunum yetersizli�i nedeniyle YBܒ ne al�nan hastalarda mortalite y�ksektir ve PaO2/FiO2, APACHE II ve IMV ihtiyac� mortalitenin en �nemli risk fakt�rleridir.

Anahtar Kelimeler: �nterstisyel akci�er hastal��, akut solunum yetersizli�i, non-invaziv ventilasyon, invaziv mekanik ventilasyon

MECHANICAL VENTILATION OF PATIENTS WITH INTERSTITIAL LUNG DISEASE IN ICU

Fatma ��FTC�¹, Ahmet Onur DA�TAN¹, Serhat EROL¹, Ayd�n ��LEDA�¹, Ak�n KAYA¹
Ankara �niversitesi T�p Fak�ltesi, G��s Hastal�klar�, Ankara, T�rkiye

Aim: A limited number of studies have investigated the prognosis of patients with interstitial lung disease (ILD) who are treated for acute respiratory failure in the intensive care unit. This study aimed to evaluate the outcome of patients with ILD in ICU. Material and Methods: A total of 65 patients with ILD (29 females, 36 males) were enrolled in this single-center study between January 2013 and August 2017. Survivor and non-survivor groups were compared according to characteristics and treatment needs (NIV and IMV) during their follow up in the ICU. Baseline characteristics and effects of ventilatory supports (NIV,IMV) on mortality were evaluated. Results: The type of ILD was IPF in 34 patients, collagen tissue disease in 13, interstitial pneumonia in 10, Wegener granulomatosis in 3, sarcoidosis in 2, chronic hypersensitivity pneumonitis in 1, druginduced ILD in 1 and pleuroparenchymal fibroelastosis in 1. Forty-three (66.1%) patients died during their treatment in the ICU setting and were grouped as non-survivors. PaO2/FiO2 rate and GCS .were lower and APACHE II score was higher in the non-survivor group than the survivor group. A univariate cox regression analysis revealed that GCS (HR 1.225; 95% CI: [0.783-1.550]; p=0.042), APACHE II (HR 2.845; 95% CI: [1.431-3.751]; p=0.006), PaO2/FiO2 (HR 1.753; 95% CI: [1.169- 1.932]; p=0.012), sPAP (HR 1.601; 95% CI: [0.263- 1.710]; p=0.031), and IMV need (HR 8.441; 95% CI: [3.225-12.632]; p<0.001) were significantly correlated to mortality in the ICU. A multivariate analysis showed that PaO2/FiO2 (HR 1.224; 95% CI: [0.832-1.705]; p=0.015),, APACHE II (HR 1.956; 95% CI: [1.031-4.216]; p=0.010), and IMV need (HR 7.473; 95% CI: [3.028-9.243]; p<0.001) were the significant independent predictors of mortality. Conclusion: PaO2/FiO2, APACHE II, and IMV need are the most important risk factors for mortality among patients with ILD and ARF who are admitted to ICU.

Keywords: Interstitial lung disease, acute respiratory failure, non-invasive ventilation, invasive mechanical ventilation

Makale Dili: T�rk�e

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