Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Spontan Solunumdaki Yoğun Bakım Hastalarında Midazolamın Volüm Değişiklikleri Üzerine Etkilerinin Ekokardiyografi ile İncelenmesi
Echocardiographic Examination of the Effects of Midazolam on Volume Change in Patients Who are Hospitalized in Intensive Care, Who Have Spontaneous Breathing
Canan TİRYAKİa, Abdulkadir YEKTAŞa
aAnesteziyoloji ve Reanimasyon Kliniği, Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Diyarbakır, TÜRKİYE
Turkiye Klinikleri J Anest Reanim. 2019;17(3):77-88
doi: 10.5336/anesthe.2019-70770
Article Language: TR
Full Text
ÖZET
 Amaç: Yoğun bakım ünitemizde yatan entübe, asiste basınç destekli modlarda solunum yapan hastalarda, midazolamın damar içi volüme etkilerinin ekokardiyografi ile değerlendirmeyi amaçladık. Gereç ve Yöntemler: Yoğun bakım ünitesinde yatan, hipoksi nedeni ile entübe edilen 18 yaş üstü, spontan solunumu bulunup asiste invaziv mekanik ventilasyon uygulanan, Ramsey sedasyon skalası intravenöz midazolam sonrası 5. dk'da 5-6 olan ve sıvı açığı olup olmadığı bilinmeyen toplam 30 hasta çalışmaya alındı. Hastaların yaş, vücut ısısı, boyu, kilosu, beden kitle indeksleri, yoğun bakım kalış süreleri, komorbidite durumları, vazopresör ve inotrop kullanma durumları kaydedildi. Hastalara pasif bacak kaldırma testi (PBKT) uygulandı, daha sonra 0,1 mg/kg midazolam damar içi verilerek 5 dk beklendi ve aynı şartlarda 2. kez PBKT uygulandı. Hem midazolam öncesi hem sonrası yapılan pasif bacak kaldırma testleri öncesi ve sonrası tüm ölçümler karşılaştırıldı. Bulgular: Midazolam uygulanmasından önceki PBKT'nin sistolik arter basıncı (SAB) üzerindeki etkisini değerlendirdiğimizde; PBKT'den önceki SAB 126,53±20,58 mmHg, PBKT'den sonraki ise 134,67±18,58 mmHg idi. PBKT'den sonraki ortalama SAB'daki artış istatistiksel olarak anlamlıydı (p<0,01). Midazolam uygulanmasından sonraki PBKT'nin SAB üzerindeki etkisini değerlendirdiğimizde; PBKT'den önceki SAB 118,80±24,74 mmHg, PBKT'den sonraki ise 120,73±23,77 mmHg idi. PBKT'den sonra ortalama SAB artış göstermesine rağmen, bu artış istatistiksel olarak anlamlı değildi (p>0,05). Araştırmadaki bireylerde midazolamın ortalama CO artış %'si üzerindeki etkisini değerlendirdiğimizde; midazolam öncesi ortalama CO artış %'si %16,37, midazolam uygulandıktan sonra ise %9,12 olup; midazolam, CO artış %'sini istatistiksel olarak anlamlı derecede düşürdü (p<0,05). Sonuç: Midazolam vena kava kollapsibilite indeksi ve Delta V peaki etkilemiyor, ancak CO artış %'sini istatistiksel olarak anlamlı azaltıyordu. Yoğun bakım hastalarında midazolam sedasyonunun hemodinamik kompansasyonu rölatif hipovolemiyi artırarak ve kardiyak fonksiyonları deprese ederek bozduğunu ve bu nedenle PBKT'nin midazolam sedasyonu sonrasında bir anlam ifade etmediğini düşünmekteyiz.

Anahtar Kelimeler: Midazolam; pasif bacak kaldırma testi; ekokardiyografi
ABSTRACT
 In this study, we aimed to evaluate the effects of midazolam on intravenous volume in echocardiography in intubated, assisted pressure breathing patients in our intensive care unit. Material and Methods: A total of 30 patients hospitalized in the intensive care unit, over 18 years of age who were intubated due to hypoxia, who had the Ramsey sedation scale was 5-6 after intravenous midazolam who had spontaneous breathing and underwent assisted invasive mechanical ventilation were included in the study. Age, body temperature, height, weight, body mass index, duration of intensive care unit stay, comorbidity, vasopressor and inotropic use were recorded. Passive leg rising test was applied to the patients, then midazolam was administered intravenously at 0.1 mg/kg for 5 minutes and passive leg rising test was performed for the second time under the same conditions. All measurements before and after midazolam were compared. Results:When we evaluated the effect of passive leg raising test (PLRT) on systolic arterial pressure (SAP) before midazolam administration; SAP before PLRT was 126.53±20.58 mmHg and after PLRT was 134.67±18.58 mmHg. The increase in mean SAP after PLRT was statistically significant (p<0.01). When we evaluate the effect of PLRT on SAP after midazolam administration; SAP before PLRT was 118.80±24.74 mmHg and after PLRT was 120.73±23.77 mmHg. Although the mean SAB increased after PLRT, this increase was not statistically significant (p>0.05). When we evaluated the effect of midazolam on CO% increase in individuals in the study; the mean CO increase before midazolam was 16.37%, after midazolam it was 9.12%, and midazolam and CO increased significantly (p<0.05). Conclusion: All of these findings suggested that midazolam did not affect IVC-CI and Delta V peak, but increase CO% reduced a significant. The increase in SAP, CO and VTI in PLRT were administered after midazolam was a lower than before midazolam. We think that in intensive care unit patients with midazolam sedation disrupts hemodynamic compensation to increase relative hypovolemia and depressive cardiac functions, and therefore PLRT does not effect after midazolam sedation.

Keywords: Midazolam; pasif bacak kaldırma testi; ekokardiyografi
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