.: ORİJİNAL ARAŞTIRMA
Yoğun Bakım Ünitesinde Takip Edilen Kritik COVID-19 Hastalarında Yüksek Akımlı Nazal Kanül Uygulaması ve ROX İndeksi Kullanımı: Gözlemsel Kohort Çalışma
High-Flow Nasal Cannula Application and ROX Index Use in Critical COVID-19 Patients Followed in the Intensive Care Unit: Observational Cohort Study
Turkiye Klinikleri J Anest Reanim. 2023;21(3):104-11
doi: 10.5336/anesthe.2023-100316
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Bu çalışmada, koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] tanısıyla yoğun bakım ünitesinde (YBÜ) takip edilen ve yüksek akımlı nazal kanül [high-flow nasal cannula (HFNC)] uygulanan hastalarında ROX indeksi etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: COVID-19 tanısı konulmuş ve YBÜ'de en az 24 saat HFNC uygulanan hastalar değerlendirmeye alındı. Bu hastaların bazal, 2, 6, 12 ve 24. saatlerdeki ROX indeksleri hesaplanıp kaydedildi. Hastalar HFNC tedavisi başarılı olanlar ve başarısız olanlar şeklinde 2 gruba ayrılıp değerlendirildi. Bulgular: HFNC tedavisi başarılı olan gruptaki hastaların ilk prokalsitonin değerlerinin daha düşük olduğu, daha uzun süre HFNC tedavisi aldıkları ve YBÜ'de daha uzun süre kaldıkları saptandı. HFNC başarılı olan grupta 12 ve 24. saatlerde solunum sayısının anlamlı bir şekilde daha düşük olduğu saptandı. HFNC başarılı olan grupta, ROX indeksinin 12 ve 24. saatlerde daha yüksek olduğu görüldü. Gruplar solunumsal parametreler açısından karşılaştırıldığında; 2, 6, 12 ve 24. saatlerdeki SpO2 ve SpO2/FiO2 oranının HFNC başarılı olan grupta istatistiksel olarak anlamlı bir şekilde daha yüksek olduğu saptandı. Sonuç: HFNC uygulamasının başından itibaren tedavinin başarılı olduğu grupta ROX indeksinin giderek arttığı görüldü. COVID-19 tanısıyla YBÜ'de yatan hastalarda HFNC uygulamasının etkinliğini değerlendirmede, ROX indeksinin önemli bir indeks olabileceği sonucuna varılmıştır.
Anahtar Kelimeler: COVID-19; yoğun bakım ünitesi; ROX indeksi; entübasyon
Amaç: Bu çalışmada, koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] tanısıyla yoğun bakım ünitesinde (YBÜ) takip edilen ve yüksek akımlı nazal kanül [high-flow nasal cannula (HFNC)] uygulanan hastalarında ROX indeksi etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: COVID-19 tanısı konulmuş ve YBÜ'de en az 24 saat HFNC uygulanan hastalar değerlendirmeye alındı. Bu hastaların bazal, 2, 6, 12 ve 24. saatlerdeki ROX indeksleri hesaplanıp kaydedildi. Hastalar HFNC tedavisi başarılı olanlar ve başarısız olanlar şeklinde 2 gruba ayrılıp değerlendirildi. Bulgular: HFNC tedavisi başarılı olan gruptaki hastaların ilk prokalsitonin değerlerinin daha düşük olduğu, daha uzun süre HFNC tedavisi aldıkları ve YBÜ'de daha uzun süre kaldıkları saptandı. HFNC başarılı olan grupta 12 ve 24. saatlerde solunum sayısının anlamlı bir şekilde daha düşük olduğu saptandı. HFNC başarılı olan grupta, ROX indeksinin 12 ve 24. saatlerde daha yüksek olduğu görüldü. Gruplar solunumsal parametreler açısından karşılaştırıldığında; 2, 6, 12 ve 24. saatlerdeki SpO2 ve SpO2/FiO2 oranının HFNC başarılı olan grupta istatistiksel olarak anlamlı bir şekilde daha yüksek olduğu saptandı. Sonuç: HFNC uygulamasının başından itibaren tedavinin başarılı olduğu grupta ROX indeksinin giderek arttığı görüldü. COVID-19 tanısıyla YBÜ'de yatan hastalarda HFNC uygulamasının etkinliğini değerlendirmede, ROX indeksinin önemli bir indeks olabileceği sonucuna varılmıştır.
Anahtar Kelimeler: COVID-19; yoğun bakım ünitesi; ROX indeksi; entübasyon
ABSTRACT
Objective: This study aimed to evaluate the effectiveness of the ROX index in patients diagnosed with coronavirus disease-2019 (COVID-19) who were followed up in the intensive care unit (ICU) and underwent high-flow nasal cannula (HFNC). Material and Methods: Patients diagnosed with COVID-19 and who underwent HFNC for at least 24 hours in the ICU were evaluated. The ROX indexes of these patients at baseline, 2, 6, 12 and 24 hours were calculated and recorded. The patients were divided into two groups: those who were successful in HFNC treatment and those who were unsuccessful. Results: It was determined that the patients in the group whose HFNC treatment was successful had lower initial procalcitonin values, received HFNC treatment for a longer period of time, and stayed in the ICU for a longer time. It was determined that the respiratory rate was significantly lower at 12 and 24 hours in the group with successful HFNC. In the group with successful HFNC, the ROX index was observed to be higher at 12 and 24 hours. When the groups were compared in terms of respiratory parameters; SpO2 and SpO2/FiO2 ratio at 2, 6, 12 and 24 hours were found to be, statistically, significantly higher in the HFNC successful group. Conclusion: From the beginning of the HFNC application, it was observed that the ROX index gradually increased in the group where the treatment was successful. It was concluded that the ROX index may be an important index in evaluating the effectiveness of high-low nasal cannula application in patients hospitalized in the ICU with a diagnosis of COVID-19.
Keywords: COVID-19; intensive care units; ROX index; intubation
Objective: This study aimed to evaluate the effectiveness of the ROX index in patients diagnosed with coronavirus disease-2019 (COVID-19) who were followed up in the intensive care unit (ICU) and underwent high-flow nasal cannula (HFNC). Material and Methods: Patients diagnosed with COVID-19 and who underwent HFNC for at least 24 hours in the ICU were evaluated. The ROX indexes of these patients at baseline, 2, 6, 12 and 24 hours were calculated and recorded. The patients were divided into two groups: those who were successful in HFNC treatment and those who were unsuccessful. Results: It was determined that the patients in the group whose HFNC treatment was successful had lower initial procalcitonin values, received HFNC treatment for a longer period of time, and stayed in the ICU for a longer time. It was determined that the respiratory rate was significantly lower at 12 and 24 hours in the group with successful HFNC. In the group with successful HFNC, the ROX index was observed to be higher at 12 and 24 hours. When the groups were compared in terms of respiratory parameters; SpO2 and SpO2/FiO2 ratio at 2, 6, 12 and 24 hours were found to be, statistically, significantly higher in the HFNC successful group. Conclusion: From the beginning of the HFNC application, it was observed that the ROX index gradually increased in the group where the treatment was successful. It was concluded that the ROX index may be an important index in evaluating the effectiveness of high-low nasal cannula application in patients hospitalized in the ICU with a diagnosis of COVID-19.
Keywords: COVID-19; intensive care units; ROX index; intubation
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