Hasta-ventilatör uyumu

GÜRSEL, Gül; AYDOĞDU, MÜGE

Hasta-ventilatör uyumu

Gül GÜRSEL, (Gazi Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye)

Müge AYDOĞDU (Gazi Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye)

Tüberküloz ve Toraks

35 3

Yıl: 2009 Cilt: 57 Sayı: 4 Sayfa Aralığı: 453 - 465 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Hasta-ventilatör uyumu

Öz:

Yoğun bakım ünitelerinde invaziv ve noninvaziv mekanik ventilasyon tedavisi uygulanan hastalar ventilatörün tetiklemesinden akım hızlarına, inspiryum-ekspiryum geçişlerine kadar birçok aşamada ventilatör fonksiyonları ile etkileşir. Bu etkileşim uyum içinde ve senkronize olduğu zaman hastanın solunum işi azalıp hasta-ventilatör uyumu iyi olurken, senkronize olmadığı zaman hasta ventilatörle savaşır, solunum işi artar ve solunum kas yorgunluğu gelişir. Hasta-ventilatör uyumsuzluğu ventilatörün sağladığı solunum ile hastanın solunum merkezinden çıkan nöral outputun birbirine uymamasından kaynaklanır. Klinik belirtileri; yardımcı solunum kaslarının kullanımı, takipne, taşikardi, ekspiryumun aktif olması, terleme, hastanın gözlenen solunum hareketlerinin ventilatör traseleri ile uyumlu olmaması ve diğer solunum sıkıntısı belirtileridir. Kronik obstrüktif akciğer hastalığı olanlar gibi dinamik hiperinflasyonu olan hastalarda hasta-ventilatör uyumsuzluğunun en sık nedenleri tetikleme ve ekspiryum asenkronisidir. Akut solunum sıkıntısı sendromlu hastalarda ise hasta-ventilatör uyumsuzluğu, tetikleme, akım veya ekspiryum asenkronisi nedeniyle gelişebilir. Noninvaziv mekanik ventilasyon sırasında hasta uyumu, kullanılan maskelerden, tercih edilen ventilatörlerden, ventilasyon modlarından, ventilatör ayarlarından, uygulanan nemlendirme ve sedasyondan etkilenebilir. Hasta-ventilatör uyumsuzluğunun nedenlerinin bilinmesi ve bunların düzeltilmesi ventilatörlere kolay adaptasyonu sağlayarak dispneyi, etkin olmayan solunum çabalarını ve solunum işini azaltabildiği; böylelikle tedavinin etkinliğini artırarak süresini kısaltabildiği için önemlidir.

Anahtar Kelime: Solunum, yapay Pozitif-basınçlı solunum Ventilatörler, mekanik

Konular: Solunum Sistemi Kulak, Burun, Boğaz

Patient-ventilator interaction

Öz:

Mechanically ventilated patients interact with ventilator functions at different levels such as triggering of the ventilator, pressurization and cycling from inspiration to expiration. Patient ventilator asynchrony in any one of these phase results in fighting with ventilator, increase in work of breathing and respiratory muscle fatigue. Patient ventilator dyssynchrony occurs when gas delivery from the ventilator does not match with the neural output of the respiratory center. The clinical findings of patient-ventilator asynchrony are; use of accessory respiratory muscle, tachypnea, tachycardia, active expiration, diaphoresis and observation of asynchrony between patient respiratory effort and the ventilator waveforms. Among the patients with dynamic hyperinflation such as chronic obstructive pulmonary disease the most frequent causes of patient-ventilator asynchrony are trigger and expiratory asynchronies. In acute respiratory distress syndrome patient-ventilator asynchrony may develop due to problems in triggering or asynchrony in flow and inspiration-expiration cycle. Patient-ventilator interaction during noninvasive mechanical ventilation may be affected by the type of masks used, ventilator types, ventilation modes and parameters, humidification and sedation. Among the different patient groups it is important to know causes and solutions of patient-ventilator asynchrony problems. By this way patient will adapt ventilator and then dyspnea, ineffective respiratory effort and work of breathing may decrease subsequently.

Anahtar Kelime: Positive-Pressure Respiration Ventilators, Mechanical Respiration, Artificial

Konular: Solunum Sistemi Kulak, Burun, Boğaz

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

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APA	GÜRSEL G, AYDOĞDU M (2009). Hasta-ventilatör uyumu. , 453 - 465.
Chicago	GÜRSEL Gül,AYDOĞDU MÜGE Hasta-ventilatör uyumu. (2009): 453 - 465.
MLA	GÜRSEL Gül,AYDOĞDU MÜGE Hasta-ventilatör uyumu. , 2009, ss.453 - 465.
AMA	GÜRSEL G,AYDOĞDU M Hasta-ventilatör uyumu. . 2009; 453 - 465.
Vancouver	GÜRSEL G,AYDOĞDU M Hasta-ventilatör uyumu. . 2009; 453 - 465.
IEEE	GÜRSEL G,AYDOĞDU M "Hasta-ventilatör uyumu." , ss.453 - 465, 2009.
ISNAD	GÜRSEL, Gül - AYDOĞDU, MÜGE. "Hasta-ventilatör uyumu". (2009), 453-465.

APA	GÜRSEL G, AYDOĞDU M (2009). Hasta-ventilatör uyumu. Tüberküloz ve Toraks, 57(4), 453 - 465.
Chicago	GÜRSEL Gül,AYDOĞDU MÜGE Hasta-ventilatör uyumu. Tüberküloz ve Toraks 57, no.4 (2009): 453 - 465.
MLA	GÜRSEL Gül,AYDOĞDU MÜGE Hasta-ventilatör uyumu. Tüberküloz ve Toraks, vol.57, no.4, 2009, ss.453 - 465.
AMA	GÜRSEL G,AYDOĞDU M Hasta-ventilatör uyumu. Tüberküloz ve Toraks. 2009; 57(4): 453 - 465.
Vancouver	GÜRSEL G,AYDOĞDU M Hasta-ventilatör uyumu. Tüberküloz ve Toraks. 2009; 57(4): 453 - 465.
IEEE	GÜRSEL G,AYDOĞDU M "Hasta-ventilatör uyumu." Tüberküloz ve Toraks, 57, ss.453 - 465, 2009.
ISNAD	GÜRSEL, Gül - AYDOĞDU, MÜGE. "Hasta-ventilatör uyumu". Tüberküloz ve Toraks 57/4 (2009), 453-465.