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Solunum Yetmezliği Olmayan KOAH Atakda Kısa Süreli Noninvaziv Mekanik Ventilasyonun Etkisi

The Effect of Short Term Noninvasive Mechanical Ventilation in COPD Exacerbation Without Respiratory Failure

Journal Name:

  • Selçuk Tıp Dergisi

Publication Year:

  • 2011

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Positive end expirium pressure(PEEPi) develops due to dynamic hyperinflation caused by increased airway resistance during the COPD exacerbations. This PEEPi causes muscle weakness and ventilation deficiency. It is thought that noninvasive mechanical ventilation(NIMV) helps the muscle to relax and provide a better feeling in severe COPD patients. In this study we aimed to evaluate whether NIMV has additional benefit to medical therapy in patients with nonasidotic COPD exacerbations. Forty five patients presented with COPD exacerbation were divided into three groups randomly. First group received medical therapy, second group received 2 hours of BiPAP in addition to medical therapy in the first day and third group received BiPAP for two hours in addition to medical therapy every day. The dyspnea scores and StGoerge respiratory questionnaire was applied. All patients underwent MIP, MEP measurement and 6 minutes walking test before discharge. While there was significant decrease in dyspnea scores obtained during discharge compared to admission scores in all three groups, no significant difference was found between discharge and 1st month control scores. Also, while significant improvement was present in StGoerge Questionnaire of first and second groups during hospitalization, no difference was present in the third group. The treatment options caused no significant improvement in the arterial blood gas(ABG) parameters in all three groups. We found that NIMV had no additional effect on hospitalization period, ABG and functional status of the cases admitted with COPD exacerbation, so NIMV had no place in exacerbation treatment of these patients.
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Abstract (Original Language): 
KOAH atak esnasında artan hava yolu direncine bağlı dinamik hiperinflasyon ve dolayısıyla ekspiryum sonu pozitif basınç (PEEPi) gelişmektedir. Meydana gelen PEEPi ise kas yorgunluğuna ve yetersiz ventilasyona sebep olmaktadır. Şiddetli KOAH’lı hastalarda noninvaziv mekanik ventilasyonun (NIMV) solunum kaslarının dinlenmesine yardımcı olabileceği ve hastanın kendisini daha iyi hissetmesini sağlayabileceği düşünülmüştür. Biz çalışmamızda atakla gelen ancak solunum yetmezliği olmayan KOAH’lılarda NIMV’un standart medikal tedaviye ek olarak faydası olup olmadığını araştırmayı amaçladık. Çalışmaya KOAH atakla gelen 45 hasta dahil edildi. Hastalar randomize olarak üç gruba ayrıldı. Birinci gruba medikal tedavi, 2. gruba medikal tedaviye ek olarak ilk gün 2 saat BiPAP tedavisi ve 3. gruba da medikal tedaviye ek olarak hergün 2 saat BiPAP tedavisi verildi. Hastaların yatış, çıkış ve 1 ay sonraki kontrollerinde olmak üzere toplam 3 kez dispne skorları hesaplandı. Yatış ve 1 ay sonraki kontrollerinde St George solunum anketi uygulandı. Bütün hastalara taburcu olurken MIP, MEP ölçümü yapıldı ve 6 dakika yürüme testi uygulandı. Her üç grupta dispne skorlarında çıkışta anlamlı azalma varken 1 ay sonraki kontrolde ölçülen azalma çıkış skoruna göre anlamlılık göstermedi. Ayrıca yatış süresi boyunca birinci ve ikinci grupda St George solunum anketinde anlamlı düzelme varken 3. grupda anlamlı değişiklik tesbit edilmedi. Her üç gruptaki tedavi arteryel kan gazlarında (AKG) anlamlı değişikliğe neden olmadı. Atakla gelen KOAH’lı hastalarda NIMV’un hastanede yatış süresi, AKG ve fonksiyonel durum üzerine standart tedaviye ek olarak anlamlı etkisinin olmadığı ve böylece de atak tedavisinde yeri olmadığı kanaatine vardık.
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  • 2
53-58
  • Turkish

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