Turkiye Klinikleri Journal of Pediatrics

Cerrahi ve Medikal Tedavi Edilen Pediatrik Olgularda Modifiye Ventilasyon İndeksinin Prognozu Belirlemedeki Yeri
THE ROLE OF MODIFIED VENTILATORY INDEX IN DEFINING THE PROGNOSIS IN SURGICAL AND NON-SURGICAL PEDIATRIC PATIENTS
Zekeriya İLÇE*, Cengiz GÜNEY**, Nur ERAY*, Barboros ILIKKAN***, Sinan CELAYİR****
*, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Çocuk Cerrahisi AD**, Asis., İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Çocuk Cerrahisi AD***, Doç., İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları AD****, Doç., İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Çocuk Cerrahisi AD, İSTANBUL
Turkiye Klinikleri J Pediatr. 2003;12(1):13-8
Article Language: TR
Full Text
ÖZET
 Önbilgi/Amaç: Konjenital diyafragma hernili (KDH) olgularda prognozu belirlemede birçok yöntem ve indeks kullanılmaktadır. Modifiye Ventilasyon Indeksi (MVI) bu amaçla kullanılan indekslerden biridir. Bu indeksin, KDH dışı nedenlerle ventilatör tedavisi uygulanan olgularda etkinliği konusunda literatür çok azdır. Bu çalışmada MVInin mekanik ventilasyon uygulanan olgularda prognozu belirlemeki rolünün araştırılması amaçlandı. Gereç ve Yöntem: Çalışmada KDH li olgular Grup-I, KDH dışı nedenlerle ameliyat edilen olgular Grup-II, medikal tedavi edilen olgular ise Grup-III olarak sınıflandırıldı. Olgular yaş, cins, kilo, APGAR ve MVI sonuçları açısından geriye dönük olarak değerlendirildi. Erken ve geç MVI değerleri hesaplandı ve karşılaştırılıldı. İndeksin hesaplamasında PIP, dakikada solunum sayısı, PCO2 değerleri gözönünde bulunduruldu (MVI = PIP * PCO2 * dakika solunum sayısı/1000). Bulgular: Toplam 74 olgunun (E:K = 50:24) 43ü (%58) taburcu edilirken 31i (%42) kaybedildi. Ortalama doğum ağırlıkları 2610 gr (1060-3790) idi. Toplam 74 olgunun 30u (%40,5) Grup I, 18i (%24,3) Grup-II, 26sı (%35,2) ise Grup-III olgular idi. Grup-Ideki olguların 5. dakika APGAR değerleri taburcu olanların ortalama 7 (4-9), kaybedilenlerin ortalama 3 (1-7) idi. Taburcu edilen olguların ortalama MVI değeri 38,8 (16-77), kaybedilenlerin ortalama MVI değeri ise 114,3 (48-210) olarak saptandı. Bu grupta kaybedilen ve yaşayan olgular arasındaki erken ve geç MVI değerleri arasındaki fark istatistiksel olarak anlamlıydı. Grup-IIde yaşayan olguların ortalama MVI değeri 33,1 (12-85), kaybedilenlerin ortalama MVI değeri ise 33,2 (18-59) olarak saptandı. Grup-IIIde olguların 5. dakika APGAR değerleri taburcu olanların ortalama 6 (3-8), kaybedilenlerin ortalama 3,7 (2-5) idi. Bu grupta yaşayan olguların ortalama MVI değeri 66,7 (19-187), kaybedilenlerin ortalama MVI değeri ise 72,1 (24-133) olarak saptandı. Grup-II ve IIIdeki yaşayan ve kaybedilen olguların MVI değerleri ise istatistiksel olarak anlamlı değildi. Sonuç: Bu çalışmada MVInin mekanik ventilasyon gerektiren KDHli olgularda özellikle prognozun belirlenmesinde uygun bir yöntem olduğunu ancak KDHli olgular dışında prognozu belirlemede etkin olmadığı saptandı.

Anahtar Kelimeler: Yenidoğan, Mekanik ventilasyonu, Prognoz, Modifiye ventilasyon indeksi
ABSTRACT
 Background/Aim: Many index including Modified Ventilatory Index (MVI) are used to define the prognosis in congenital diaphragmatic hernia (CDH). However there is not much data in the literature about the use of this index on defining the prognosis in the diseases other than from CDH. In this study we investigated the role of MVI in defining the prognosis in surgical and non-surgical pediatric patients. Material and Methods: The patients in the study are classified into three groups. Group-I: Patients with CDH, Group-II: Patients without CDH ? surgical treated and Group-III: Patients without CDH - medicaly treated. 74 patients were analysed retrospectively according to their age, sex, weight, APGAR scores and MVI results. Early and late MVI results were recorded. MVI was calculated as the factors of PIP, ventilation frequency, and PCO2 (MVI= PIP * PCO2 * ventilation frequency / 1000). Results: Male: female ratio was 50:24. Fourty three of the patients were discharged from hospital and 31 of the patients died. Mean birthweight was 2610 gr (1060-3790). Thirty of the patients were in Group-I, 18 of the patients were in Group-II, and 26 of the patients were in Group-III. The mean APGAR scores were in survivors 7 (4-9) and in non-survivors 3 (1-7) in Group-I. The MVI was 38.8 in survivors and 114.3 in non-survivors in this group. The difference between the MVI of the survivors and non-survivors was found statistically significant. The mean MVI was calculated as 33.1 and non-survivors had a mean MVI of 33.2 in Group-II. In Group-III the APGAR scores were 6 (3-8) in survivors and 3,7(2-5) in non-survivors. The mean MVI was calculated as 66.7 in survivors and the non-survivors had a mean MVI of 72.1 in this group. There was no statistically significant difference between the MVI scores of survivors and non-survivors in Group-II and III. Conclusion: In this study we conclude that MVI is a good criteria to define the prognosis in CDH. However it has no value in defining the prognosis in non-surgical cases.

Keywords: Newborn, Mechanical ventilation, Prognosis, Modified ventilatory index,

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