Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
COVID-19 İlişkili Akut Solunum Sıkıntısı Sendromu Tanılı Hastalarda Airway Pressure Release Ventilation Uygulamalarımız: Tanımlayıcı Araştırma
Our Airway Pressure Release Ventilation Experiences in Patients Diagnosed with COVID-19 Related Acute Respiratory Distress Syndrome: Descriptive Research
Mert NAKİPa , Yusuf Harun İRENa , Meltem BEKTAŞa , Mehmet ÇAKIRCAa , Ayşe ÖZCANb , Ümit Murat PARPUCUa , Çiğdem KIZILAY NAKİPa , Çetin KAYMAKa
aSağlık Bilimleri Üniversitesi Ankara Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Bölümü, Ankara, Türkiye
bSağlık Bilimleri Üniversitesi Gülhane Tıp Fakültesi, Ankara Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Bölümü, Ankara, Türkiye
Turkiye Klinikleri J Anest Reanim. 2023;21(3):112-9
doi: 10.5336/anesthe.2024-101343
Article Language: TR
Full Text
ÖZET
 Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pnömonisi klinik seyri oldukça değişkendir. Ciddi akut solunum sıkıntısı sendromuna [acute respiratory distress syndrome (ARDS)] neden olduktan sonra hastaların ventilasyonu güçleşmektedir. Bu vaka serisinde, üçüncü basamak yoğun bakım ünitesinde mekanik ventilasyonla takip edilen şiddetli COVID-19 pnömonisi olan, aralıklı airway pressure release ventilation (APRV) modunda takip edilen hastalarımızın sonuçları sunulmuştur. Gereç ve Yöntemler: İleri COVID-19 yoğun bakım ünitesinde, pron pozisyondan fayda görmeyen ve derin hipoksiye ek olarak PaCO2 yüksekliği olan hastalarda ventilasyon APRV moduyla sağlandı. On sekiz yaş üstünde, mekanik ventilatörde ve APRV modunda takip edilen 22 hastanın sonuçları değerlendirildi. Hastaların vital bulguları, ventilasyon süreleri ve toleransları sedasyon açısından günlük olarak değerlendirildi ve kaydedildi. Komplikasyonlar ve ventilatör parametreleri kaydedildi. Bulgular: Takip ettiğimiz APRV modundaki 22 hastanın 5'inde cilt altı amfizemi oluştu. Beş hastanın herhangi birinde amfizem ilerlemedi. Pnömotoraks veya pnömomediastinum görülmedi. Yandaş hastalıklar ve ARDS'nin ciddiyetine bağlı olarak hastaların 12'si eksitus ilan edildi, diğerlerinde ise weaninge başlandı. Sonuç: ARDS hastalarında akciğer kompliyanslarının düşük olması ventilasyonu zorlaştırmaktadır. Geleneksel olarak düşük tidal volüm ventilasyonu en kabul gören yöntemdir. Hipoksiye ek olarak PaCO2 yüksekliği bulunan hastalarda APRV alternatif bir yöntem olarak literatürde yer almaktadır. APRV modunda hastaların sedasyon ihtiyacı ventilatör uyumu açısından oldukça elzemdir. Alveollerin tam olarak kapanmaması, APRV'nin atelektotravmadan koruması açısından etkilidir. COVID-19 pnömonisinin ağır ARDS'ye dönüştüğü ve akciğer kompliyansının ciddi oranda azaldığı hastalarda APRV modu alternatif olarak düşünülebilir.

Anahtar Kelimeler: COVID-19 pnömonisi; APRV modu; akut solunum sıkıntısı sendromu
ABSTRACT
 Objective: The clinical course of coronavirus disease2019 (COVID-19) pneumonia is highly variable. After leading to severe acute respiratory distress syndrome (ARDS), patients experience increased difficulty in ventilation. In this case series, the outcomes of patients with severe COVID-19 pneumonia, who were followed with mechanical ventilation in the third-level intensive care unit using intermittent airway pressure release ventilation (APRV), are presented. Material and Methods: In the advanced COVID-19 intensive care unit, ventilation was provided using the APRV mode for patients who did not benefit from the prone position and had high PaCO2 levels in addition to profound hypoxia. The outcomes of 22 patients aged 18 and above, followed on mechanical ventilation in the APRV mode, were evaluated. The patients' vital signs, ventilation durations, and tolerances in terms of sedation were assessed and recorded daily. Complications and ventilator parameters were also documented. Results: In 5 out of the 22 patients under APRV mode surveillance, subcutaneous emphysema developed. None of the five patients experienced progression of emphysema. Pneumothorax or pneumomediastinum was not observed. Depending on comorbid conditions and the severity of ARDS, twelve patients were declared deceased, while weaning was initiated in the remaining cases. Conclusion: Low lung compliance in ARDS complicates ventilation. Traditionally, low tidal volume ventilation is widely accepted. In patients with high PaCO2 levels alongside hypoxia, APRV is considered an alternative in the literature. The sedation requirement in APRV is crucial for ventilator compliance. The partial closure of alveoli is effective in protecting against atelectrauma in APRV. In cases of severe reduction in lung compliance and progression of COVID-19 pneumonia to severe ARDS, APRV mode can be considered as an alternative.

Keywords: COVID-19 pneumonia; APRV mode; acute respiratory distress syndrome
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