NEINVAZIVNA MEHANIČKA VENTILACIJA KOD BOLESNIKA SA HRONIČNOM RESPIRATORNOM ACIDOZOM
KLJUČNE REČI: Neinvazivna mehanička ventilacija (NIV),Hronična opstruktivna bolest pluća (HOBP)
UVOD: Hronična respiratorna acidoza se javlja kod bolesnika sa HOBP gde postoji poremecen odnos ventilacije I perfuzije.Alveolana ventilacija I oksigenacija se poboljsava davanjem kiseonika preko venti maske ili kroz tubus.NIV zamenjuje tubus I sprecava njegove komplikacije.
MATERIJAL I METODE: Ispitano je 20 bolesnika u egzacerbaciji HOBP sa manifestnom globalnom respiratornom insuficijencijom prosecne starosti 72,7 godina od cega je bilo 16 muskih i 4 zenskih.Radjene su gasne analize arterijske krvi na prijemu,nakon dva sata I nakon dva dana uz kontinuirano pracenje saturacije hemoglobina puls oksimetrom,frekvencijom disanja (RR),pulsa I EKG-a.Svi pacijenti su odmah stavljeni na NIV u PSV rezimu(pritiskom podrzana ventilacija) u ukupnom trajanju od 6 sati na dan.Primili su I kiseonicnu I dezopstruktivnu terapiju.
REZULTATI: Na pocetku tretmana srednje vrednosti parcijalnog pritiska kiseonika (PaO2) su bile 5,43 kPa, PaCO2-8,76 kPa , pH-7,34 sa prosecnim RR 32/min.Nakon dva sata tretmana srednje vrednosti PaO2-7,21;PaCO2-8,03;pH-7,40;prosecna RR 28.Nakon dva dana srednje vrednosti PaO2-7,34;PaCO2-7,64;pH-7,39;RR-25.
Od ispitivanih pacijenata jedan je egzitirao a jedan skinut sa NIV-a zbog ekscitiranosti I asinhronizacije.
Koristeci NIV unazad godinu dana konstatujemo smanjenje smrtnosti na odelenju kod HOBP,2007 umrlo svega 4 (2003- 16,2004-21,2005-27,2006-16).
ZAKLJUCAK: NIV je indikovan u egzacerbaciji HOBP jer veoma brzo podize saturaciju hemoglobina,smanjuje visok PaCO2,podize pH,smanjuje disajni rad I na taj nacin daje bolesniku sansu da prezivi.
Pneumon,2007;Vol 44:29.
NON INVASIVE MECHANIC VENTILATION IN PATIENTS WITH CHRONIC RESPIRATORY ACIDOSIS
KEY WORDS: Non invasive mechanic ventilation (NIV) ,Chronic obstructive pulmonary disease (COPD)
INTRODUCTION: Chronic respiratory acidosis is present in patients with COPD that have dissarange relation between ventilation and perfusion.Alveolar ventilation and oxygenation are getting better after oxygen admission thrugh the venti mask or tube.NIV can substitute tube and prevents his complications.
MATERIALS AND METHODS: 20 patients with COPD and global respiratory failure was investigated average years 72,7:16 male and 4 femele.Blood gas analysis was made at the start ,two haours and two days after,with continous monitoring of hemoglobin saturation with puls oxymeters,respiratory rates (RR),heart rates (HR) and EKG.All of patients was on the NIV with PSV ( pressure supported ventilation) 6 hours on day,oxygenoterapy and bronchodilatatory medications.
RESULTS: At the start of investigation there was average values for following parameters:PO2-5,43 kPa,PCO2-8,76 kPa,pH-7,34 and RR-32/min.After two hours average values was:PO2-7,21 kPa,PCO2-8,03 kPa,pH-7,4 and RR- 28/min,and after two days average values was: PO2-7,34 kPa,PCO2-7,64 kPa,pH-7,39 and RR- 25/min.
One of patients was died and one was stoped with further investigation because of excitability.
One year after using NIV mortality rate from egzacerbation of COPD was reduce and 2007.it was 4 (2003. it was 16 ,2004. was 21,2005. was 27 and 2006.was 16 ).
CONCLUSION: NIV is indicated in COPD egzacerbation because of that: fastly incress hemoglobin saturation,decress PCO2,incress pH,decress respiratory muscles work and gave to patients chanse to live.
Pneumon,2007;Vol 44:29.