Yoğun bakım hastalarında mekanik ventilatörden ayırmaya akut böbrek hasarının etkisinin değerlendirilmesi
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Tarih
2017
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info:eu-repo/semantics/embargoedAccess
Özet
Giriş ve Amaç: Akut böbrek hasarı (ABH) yoğun bakımdaki hasta populasyonunda %5-%30 oranında görülmekte ve yoğun bakımda ABH gelişen olgularda mortalite %40-90'a ulaşmaktadır. Yoğun bakımda ABH gelişimi mortaliteyi ciddi biçimde arttıran, yoğun bakımda kalış süresini uzatan, diyaliz ve diğer pahalı tedavi yöntemlerini gerekli kılarak maliyeti artıran önemli bir problemdir. Akciğer ve renal fonksiyon bozulması birlikteliği ile ilgili son zamanlarda birçok çalışma yapılmaktadır. Fakat mekanik ventilatöre bağlı hastalarda akut böbrek hastalığının mekanik ventilatörden ayırma üzerine etkisi üzerine yapılmış çok az çalışma bulunmaktadır. Biz yapacağımız bu çalışmayla dahiliye yoğun bakımda entübe şekilde takip edilen hastalarda akut böbrek hasarının mekanik ventilatörden ayırma üzerine olan etkisini ortaya koymaya çalışacağız. Materyal-metod: Bu çalışmaya 2010-2016 yılları arasında Dicle Üniversitesi Tıp Fakültesi dahiliye yoğun bakımda takibi yapılan hastalardan seçim yapılmıştır. Hastaların akut böbrek hasarı tanısı KDIGO kriterlerine bakılarak konulmuştur. Kronik böbrek yetmezliği ve kronik böbrek hastalığı, kronik akciğer hastalığı ve kalp yetmezliği tanısı olan hastalar çalışmaya dahil edilmedi. En az kırk sekiz saat takibi yapılan ve solunum yetmezliği nedeniyle entübe olan hastalar tasnif edildi. Bu kriterleri karşılayan 100 akut böbrek hasarı olan ve 100 akut böbrek hasarı olmayan hasta incelendi. Hastaların yaş, cinsiyet, kreatinin, albümin, SOFA skoru, APACHE II skoru, hemoglobin değeri, oksijen saturasyonu, parsiyel oksijen basıncı, parsiyel karbondioksit basıncı, PH değeri ve sepsis kriterlerini taşıyıp taşımadığına bakıldı. Bulgular: Hastalarımızın cinsiyet dağılımı % 58,5 erkek % 41,5 kadın (erkek; 117 ve kadın;83) olarak saptandı. Tüm hastalar içerisinde weaning yapılabilme oranı % 23 olarak bulundu. ABH olan hastalarda weaning yapılabilenlerin oranı ABH olmayan hastalardaki weaning yapılabilenlerin oranına göre daha düşük saptandı (%13 vs %43 - p < 0.001). Weaning yapılabilen hastalarda kreatinin düzeyi weaning yapılamayan hastalara göre daha düşük bulundu (Kreatinin; 1,35 + 1,39 vs 2,10 + 1.42, mg/dl; p = 0.001). Ek olarak weaning yapılabilen hastalarda APACHE II (21,7 + 4,6 vs. 26,6 + 5,7) ve SOFA (7,45 + 2,3 vs. 9,5 + 3,2) ölçümleri yapılamayan hastalara göre daha düşük bulundu (p < 0.001). Multipl lojistik regresyon analizine göre akut böbrek hasarına sahip olmamanın weaning yapılabilme oranını arttırdığı gösterildi.(Tahmini rölatif risk:4,95 - Güvenlik aralığı :2,41-10,16 - p<0,001). Sonuç: Sonuç olarak, çalışmamızda mekanik ventilasyon ile takip edilen yoğun bakım hastalarında böbrek fonksiyon bozukluğu ile solunum sistemi arasında yakın bir ilişki olduğu görülmektedir. ABH yoğun bakımda mekanik ventilatöre bağlı takip edilen hastalarda weaning üzerine olumsuz etkisi görülmektedir. Bu hasta populasyonunda ABH' ın erken tanınması, prognozun belirlenmesinde ve diğer klinik yaklaşımların tayin edilmesinde faydalı olabilir. Anahtar Kelimeler: Akut böbrek hastalığı, mekanik ventilatör, weaning, solunum yetmezliği
Introduction: Acute kidney injury (AKI), which is seen in 5 to 30 % of intensive care unit patients, remains as a big problem that leading to higher mortality rate (40 - 90 %.), longer stay in ICU, and increased need for high cost treatment modalities such dialysis. Recent studies were done to highlight the association between lung injury and kidney injury. However, very few of them evaluated the effect of acute kidney injury on weaning from mechanical ventilation. In this study, we aim to evaluate the effect of acute kidney injury on weaning in intensive care unit patients. Material and methods: Patients followed in the intensive care unit of deparment of internal medicine between period of 2010 and 2016 in Dicle University Faculty of Medicine were selected in this study. Acute kidney injury diagnosis were done according to KDIGO guideline criterias. Patients with chronic kidney disease, chronic lung disease and heart failure were excluded from the study. Respiratory failure being intubated at least for 48 hours was inclusion criteria. 100 patients with acute kidney injury and 100 patients without acute kidney injury meeting these criterias were compared. Patients age, gender, creatinine, albümin, SOFA score, APACHE II score, hemoglobin level, oxygene saturation, partial oxygene and carbondioxide pressure, pH and presence of sepsis or not were evaluated. Results: In all patients, gender distribution with % 58,5 of male % 41,5 of female, weaning was done in 23 %, which in AKI group was 13% (13/100), and in non-AKI group was %43 (43/100) (p < 0.001). In the patients weaned from mechanical ventilation, creatinine levels were lower (creatinine; 1,35+ 1,39 vs 2,10 + 1.42, mg/dl; p = 0.001), as well as APACHE II and SOFA score (p < 0.001). In multiple logistic regression analysis, weaning rate was found to be higher in the absence of acute kidney injury ( predicted relative risk:4,95 – Confidence interval :2,41-10,16 - p<0,001). Conclusion: Our study showed a strong association between acute kidney injury and respiratory system in intensive care unit patients following intubated. Acute kidney injury was found to have a negative effect on weaning from mecnanical ventilation. Thus, in this population, early recognition of acute kidney injury may play an important role in determining the prognosis and other clinical approaches. Keywords: Acute kidney injury, mechanic ventilation, weaning, respiratory failure
Introduction: Acute kidney injury (AKI), which is seen in 5 to 30 % of intensive care unit patients, remains as a big problem that leading to higher mortality rate (40 - 90 %.), longer stay in ICU, and increased need for high cost treatment modalities such dialysis. Recent studies were done to highlight the association between lung injury and kidney injury. However, very few of them evaluated the effect of acute kidney injury on weaning from mechanical ventilation. In this study, we aim to evaluate the effect of acute kidney injury on weaning in intensive care unit patients. Material and methods: Patients followed in the intensive care unit of deparment of internal medicine between period of 2010 and 2016 in Dicle University Faculty of Medicine were selected in this study. Acute kidney injury diagnosis were done according to KDIGO guideline criterias. Patients with chronic kidney disease, chronic lung disease and heart failure were excluded from the study. Respiratory failure being intubated at least for 48 hours was inclusion criteria. 100 patients with acute kidney injury and 100 patients without acute kidney injury meeting these criterias were compared. Patients age, gender, creatinine, albümin, SOFA score, APACHE II score, hemoglobin level, oxygene saturation, partial oxygene and carbondioxide pressure, pH and presence of sepsis or not were evaluated. Results: In all patients, gender distribution with % 58,5 of male % 41,5 of female, weaning was done in 23 %, which in AKI group was 13% (13/100), and in non-AKI group was %43 (43/100) (p < 0.001). In the patients weaned from mechanical ventilation, creatinine levels were lower (creatinine; 1,35+ 1,39 vs 2,10 + 1.42, mg/dl; p = 0.001), as well as APACHE II and SOFA score (p < 0.001). In multiple logistic regression analysis, weaning rate was found to be higher in the absence of acute kidney injury ( predicted relative risk:4,95 – Confidence interval :2,41-10,16 - p<0,001). Conclusion: Our study showed a strong association between acute kidney injury and respiratory system in intensive care unit patients following intubated. Acute kidney injury was found to have a negative effect on weaning from mecnanical ventilation. Thus, in this population, early recognition of acute kidney injury may play an important role in determining the prognosis and other clinical approaches. Keywords: Acute kidney injury, mechanic ventilation, weaning, respiratory failure
Açıklama
Anahtar Kelimeler
Akut böbrek hastalığı, Mekanik ventilatör, Weaning, Solunum yetmezliği, Acute kidney injury, Mechanic ventilation, Respiratory failure
