Akut hiperkapnik solunum yetersizliğinde noninvaziv mekanik ventilasyon kullanımının etkinliği ve serum bnp düzeyine olan etkisi

Amaç: Akut hiperkapnik solunum yetmezligi olan hastalarda, noninvaziv mekanik ventilasyonun solunum fonksiyonları, arter kan gazı, ve serum B-tipi natriüretik peptid düzeyleri üzerine olan etkinliginin arastırılması. Metod: Noninvaziv mekanik ventilasyon tedavisi endikasyonuna sahip, 36 akut hiperkapnik solunum yetmezligi olan hasta çalısmaya dahil edildi. Medikal tedavi ile birlikte, noninvaziv mekanik ventilasyon baslangıç basınçları, IPAP:8 santimetresu ve EPAP:4 santimetresu olmak üzere tüm hastalarda baslandi. Oksijen satürasyonu %88'in üzerinde olacak sekilde oksijen tedavisi verildi. Noninvaziv mekanik ventilasyon uygulaması süresince arter kan gazı degerlerine göre basınçlar modifiye edildi. Tüm hastalara noninvaziv mekanik ventilasyon tedavisi öncesi ve sonrasında solunum fonksiyon testleri, ekokardiyografi yapıldı ve serum örneklerinde NT-proBNP ölçümleri uygulandı. Verilerin istatistiksel degerlendirilmesinde, SPSS for Windows (10.0) istatistik paket programı ile paired sample test -Student's t-testi ve repeated Anova testi kullanıldı. Bulgular: Noninvaziv mekanik ventilasyon kullanım süresi 10.02±4.4 gün, günlük kullanım süresi ise 16.1±5.4 saat idi. Noninvaziv mekanik ventilasyon tedavisinin birinci saati sonunda arter kan gazı degerlerinden bikarbonat haricinde tüm parametrelerde, noninvaziv mekanik ventilasyon tedavisi sonunda ise arter kan gazı parametrelerinin tümüne istatistiksel olarak anlamlı düzelme saptandı (p0.05). Solunum fonksiyon testi parametrelerinde tedavi öncesi degerleri ile tedavi sonrası degerleri karsılastırıldıgında; FVC mutlak degeri, FVC beklenenin yüzdesi, FEV1 beklenenin yüzdesi, PEF mutlak degeri ile PEF beklenenin yüzdesin de istatistiksel olarak anlamlı düzelme saptandı (P0.05). Noninvaziv mekanik ventilasyon tedavisi sonrası yapılan transtorasik ekokardiyografi bulgularında; sag ventrikül ejeksiyon fraksiyonu, sistolik ve ortalama pulmoner arter basıncı degerlerinde tedavi öncesine göre istatistiksel olarak anlamlı düzelme saptandı (p0.05). NT-proBNP degerlerinde tedavi sonrasında istatistiksel olarak anlamlı azalma görüldü (p0.05). Noninvaziv mekanik ventilasyon tedavisi öncesi NT-pro BNP degeri ile arter kan gazı degerlerinden sadece pH arasında negatif yönde istatistiksel olarak anlamlı korelasyon saptandı. Sonuç: Noninvaziv mekanik ventilasyon tedavisi akut hiperkapnik solunum yetmezliginin, secilmis hastalarinda klinik düzelmenin yanı sıra solunum fonksiyonlarında, arter kan gazlarında, sag ventrikül ejeksiyon fraksiyonunda, pulmoner arter basınçlarında ve serum B-tipi natriüretik peptid düzeylerinde anlamlı olarak düzelme gösterebilir.Aim: To analyse the efficacy of noninvasive mechanical ventilation on pulmonary function tests, arterial blood gases, serum B type natriuretic peptide in patients with acute hypercapnic respiratory failure. Methods: 36 acute hypercapnic respiratory failure patients with noninvasive mechanical ventilation indications were included into the study. Besides medical therapy, noninvasive mechanical ventilation was started with initial pressures of IPAP 8 centimeter water and EPAP 4 centimeter water to all patients. Oxygen treatment was continued to sustain oxygen saturation above 88%. Pressures were modified according to arterial blood gas values during treatment. Pulmonary function tests, echocardiography and serum NT-proBNP measurements were repeated before and after noninvasive mechanical ventilation. For statistics, paired sample test and repeated Anova with SPSS package program (10.0) for Windows were applied. Results: Noninvasive mechanical ventilation usage was 10.02±4.4 days while daily usage was16.1±5.4 hours. All parameters of arterial blood gases except bicarbonate in the 1st hour of treatment and all parameters at the end of the noninvasive mechanical ventilation treatment were recovered significantly (p0.05). When we compare pre and post treatment values of pulmonary function tests, a significant improvement was detected in FVC, FVC predicted %, FEV1 predicted %, PEF, PEF predicted % (p0.05). Right ventricle ejection fraction, systolic and mean pulmonary artery pressures were improved significantly after treatment (p0.05). NT-pro BNP levels decreased significantly after treatment (p0.05). Among arterial blood gas parameters only pH showed a statistically significant negative correlation with NT pro-BNP levels before treatment. Conclusion: In selected patients of acute respiratory failure, noninvasive mechanical ventilation might improve pulmonary function tests, arterial blood gases, right ventricle ejection fraction, pulmonary artery pressure and serum B type natriuretic peptide

Case Report - A rapid decrease in pulmonary arterial pressure by noninvasive positive pressure ventilation in a patient with chronic obstructive pulmonary disease

The natural history of chronic obstructive pulmonary disease (COPD) is characterized by progressive decrements in expiratory airflow, increments in end-expired pulmonary volume, hypoxaemia, hypercapnia and the progression of pulmonary arterial hypertension (PAH). Noninvasive positive pressure ventilation (NPPV) treatment is increasingly used for the treatment of acute and chronic respiratory failure in patients with COPD. NPPV can increase PaO2 and decrease PaCO2 by correcting the gas exchange in such patients. The acute effect of NPPV on decreasing PAP is seen in patients with respiratory failure, probably due to the effect on cardiac output. Here, a case with COPD whose respiratory acidosis and PAH rapidly improved by NPPV was presented and therefore we suggested to perform an echocardiographic assessment to reveal an improvement of PAH as well as respiratory acidosis, hypercapnia and hypoxemia with that treatment

Differences between men and women in the clinical and laboratory findings of patients diagnosed with pulmonary embolism

Pulmonary embolism (PE) could not be diagnosed correctly in 2/3 of patients saving of that pathology, and unfortunately mortality in them could be as high as 30%. In the present study, we aimed to investigate the gender differences in clinical, electrocardiography (ECG) and laboratory findings of PE patients diagnosed with contrast-enhanced helical computerized tomography of thorax. 31 patients (18 females, 58% and 13 males, 42%) were Included into the study. Symptoms, risk factors, ECG and arterial blood gases were evaluated, and then Wells, Geneva and ECG scores were obtained in each subject. Alveolo-arterial (A-a) oxygen gradient was calculated as P(A-a)O2= 150-(PCO 2/0.8)-PO2. Mean pulmonary artery pressure (PAP) was measured by echocardiography. In female and male patients, Weils score (4.8 ± 1.9 and 3.2 ± 2.2, p= 0.017); ECG score (5.9 ± 3.6 and 3.1 ± 1.8, p= 0.036) and mean PAP (33.5 ± 12.3 mmHg and 23.2 ± 10.0 mmHg, p= 0.017) were significantly different. However, between female and male patients Geneva score (4.8 ± 1.7 and 5.0 ± 1.6), A-a gradient (35.2 ± 17.3 and 42.9 ± 12.3) and PaCO2 (33.5 ± 15.1 and 29.8 ± 5.4) did not differ significantly (p> 0.05). Immobilization and surgical interventions as risk factors for PE were established significantly higher In females than males (50%-30.8%, p= 0.02 and 50%-23.1%, p= 0.01). In female patients with PE, Wells and ECG scores, Immobilization, surgical interventions and mean PAP are significantly higher than male patients. So, In the clinical practice, these parameters may help to diagnose acute PE especially in females

Pulmoner emboli tanılı olguların klinik ve laboratuvar bulgularında erkek-kadın farkları

Pulmoner emboli (PE) geçiren ve yaşayan hastaların yaklaşık 2/3’ünde doğru tanı konulamamaktadır ve bu hastalarda mortalite oranı %30’lara ulaşmaktadır. Bu çalışmada, akciğerin kontrastlı spiral bilgisayarlı tomografisi ile PE tanısı konmuş hastalarımızda, klinik, elektrokardiyografi (EKG) ve laboratuvar bulguları açısından olası kadın-erkek farklarını incelemeyi amaçladık. On üç (%42)’ü erkek, 18 (%58)’i kadın toplam 31 hasta çalışmaya alındı. Her bir hasta için, semptomlar, risk faktörleri, EKG ve arteryel kan gazları değerlendirilerek Wells ve Geneva klinik skorları ile EKG skoru hesaplandı. Alveolo-arteryel (A-a) oksijen gradienti şu şekilde hesaplandı: P(A-a)O2= 150-(PCO2/0.8)-PO2. Ekokardiyografik yöntemle ortalama pulmoner arter basınçları (PAB) saptandı. Kadın ve erkeklerde sırasıyla Wells skoru 4.8 ± 1.9 ve 3.2 ± 2.2 (p= 0.017); EKG skoru 5.9 ± 3.6 ve 3.1 ± 1.8 (p= 0.036) ve ortalama PAB 33.5 ± 12.3 mmHg ve 23.2 ± 10.0 mmHg (p= 0.017) değerleriyle anlamlı olarak farklıydı. Ancak kadın ve erkekler arasında Geneva skoru (4.8 ± 1.7 ve 5.0 ± 1.6), A-a gradienti (35.2 ± 17.3 ve 42.9 ± 12.3) ve PaCO2 (33.5 ± 15.1 ve 29.8 ± 5.4) anlamlı bir fark oluşturmadı (p> 0.05). PE risk faktörlerinden immobilizasyon ve cerrahi girişim kadınlarda erkeklere göre daha sık bulundu (sırasıyla %50-%30.8, p= 0.02 ve %50- %23.1, p= 0.01). PE’li kadın hastalarda Wells ve EKG skorlarının daha yüksek, immobilizasyon ve cerrahi girişim risk faktörlerinin daha sık ve ekokardiyografik olarak ortalama PAB’ların daha fazla olduğunu belirtebiliriz. Bu nedenle kadın hastalarda akut PE tanısı koymada, belirtilen bu özellikler, klinik pratikte daha fazla yardımcı olabilir

Differences between men and women in the clinical and laboratory findings of patients diagnosed with pulmonary embolism

Pulmonary embolism (PE) could not be diagnosed correctly in 2/3 of patients saving of that pathology, and unfortunately mortality in them could be as high as 30%. In the present study, we aimed to investigate the gender differences in clinical, electrocardiography (ECG) and laboratory findings of PE patients diagnosed with contrast-enhanced helical computerized tomography of thorax. 31 patients (18 females, 58% and 13 males, 42%) were Included into the study. Symptoms, risk factors, ECG and arterial blood gases were evaluated, and then Wells, Geneva and ECG scores were obtained in each subject. Alveolo-arterial (A-a) oxygen gradient was calculated as P(A-a)O2= 150-(PCO 2/0.8)-PO2. Mean pulmonary artery pressure (PAP) was measured by echocardiography. In female and male patients, Weils score (4.8 ± 1.9 and 3.2 ± 2.2, p= 0.017); ECG score (5.9 ± 3.6 and 3.1 ± 1.8, p= 0.036) and mean PAP (33.5 ± 12.3 mmHg and 23.2 ± 10.0 mmHg, p= 0.017) were significantly different. However, between female and male patients Geneva score (4.8 ± 1.7 and 5.0 ± 1.6), A-a gradient (35.2 ± 17.3 and 42.9 ± 12.3) and PaCO2 (33.5 ± 15.1 and 29.8 ± 5.4) did not differ significantly (p> 0.05). Immobilization and surgical interventions as risk factors for PE were established significantly higher In females than males (50%-30.8%, p= 0.02 and 50%-23.1%, p= 0.01). In female patients with PE, Wells and ECG scores, Immobilization, surgical interventions and mean PAP are significantly higher than male patients. So, In the clinical practice, these parameters may help to diagnose acute PE especially in females

Nadir görülen 3 adet alveoler hemoraji vakası

Alveoler hemoraji (AH), dispne, hemoptizi, akciğer grafisinde yaygın bilateral alveoler infiltratlar ve anemi ile karakterize bir grup hastalığın neden olduğu bir durumdur. Dispne, hemoptizi, artmış alveolo-arteryel oksijen farkı, akciğerde diffüz alveoler dolum paterni gözlenmesi durumunda AH'den şüphelenilebilinir. Tedavide plasmaferez, steroidler ve siklofosfamid kullanılır. AH nadir görülen, fakat hayatı tehdit edici bir olaydır, altta yatan hastalığın ayırıcı tanısını yapıp uygun tedaviye erken başlamak hayat kurtarıcıdır. Bizde yazımızda farklı klinik tablolar ile başvuran 3 adet AH olgumuzu klinik tabloları, tedaviye yanıtları ve prognozları ile sunmayı planladık.(Akciğer Arşivi 2007;8:143-6

Relationship between functional status and fatigue after COVID-19 infection: a multicenter study from Türkiye

Background/aim: Symptoms of COVID-19 may persist for months. One of the persistent symptoms of COVID-19 is fatigue, which reduces functional status. The relationship between fatigue, functional status, and various other factors has received little attention, which this study aims to address.. Materials and methods: Patients with COVID-19 infection were included in this multicenter cross-sectional study. Age, sex, body mass index (BMI), marital status, smoking status, presence and duration of chronic disease, comorbidity index, regular exercise habits, time since COVID-19 diagnosis, hospitalization status, length of hospital stay, intubation status, home oxygen therapy after discharge, participation in a pulmonary rehabilitation program, presence of dyspnea, presence of cough, presence of sputum, and modified Medical Research Council, Post-COVID Functional Status (PCFS), Fatigue Severity Scale (FSS), and EQ-5D-5L Questionnaire scores were recorded. Results: We enrolled 1095 patients, including 603 (55%) men and 492 (45%) women with a mean age of 50 ± 14 years. The most common chronic lung disease was COPD (11%) and 266 (29%) patients had nonpulmonary disease. The median time elapsed since COVID-19 diagnosis was 5 months; the hospitalization rate was 47%. The median PCFS grade was 1 (0–4) and the median FSS score was 4.4 (1–7). The PCFS and FSS were positively correlated (r = 0.49, p 4.78 showed moderate to severe functional limitations. It is important to address modifiable patient risk factors and reduce the severity of COVID-19 infection