Acil servise başvuran sepsisli hastalarda intravenöz sıvı tedavisinin pleth variability indeks ve laktat ölçümleriyle değerlendirilmesi.
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Tarih
2023
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmaya acil servise başvuran ve ilk değerlendirmesi neticesinde sepsis ön tanısı alan hastalar dahil edildi. Hastaların başvuru esnasında ve takibindeki 1. saatte elde edilen laktat değerleri, ölçülen pleth variability indeks (PVI) değerleri ve PVI ile laktatın birlikte kullanımı ile elde edilen PVI-laktat indeksleri kaydedildi. Bu değerlerdeki değişimlerle hastalarailk bir saat içerisinde verilen sıvı tedavisinin etkinliğinin belirlenebilirliğinin ortaya konulması amaçlandı.
Gereç ve Yöntem
Bu çalışmaya Nisan 2022- Aralık 2022 tarihleri arasında acil servise başvurup sepsis ön tanısı alan hastalar prospektif olarak dahil edildi. Hastaların demografik özellikleri, laktat değerleri, ölçülen pleth variability indeks değerleri, verilen sıvı tedavisi miktarı, acil servis sonlanımları, hastane sonlanımları ve mortaliteleri değerlendirildi.
Bulgular
Çalışmamıza sepsis ön tanısı alan 126 hasta dahil edildi. Hastaların %65,7’si (n=67) erkek ve yaş ortalaması 70,38 ± 14,11 yıl olarak kaydedildi. Komorbit hastalıklardan en sık görülenler %43,1 (n=44) ile malignite, % 26,5 (n=27) ile diyabetes mellitus, %25,5 (n=26) ile hipertansiyon olarak saptandı. Verilen sıvı tedavi miktarı <11,75 litre olan hastalarda eksitus oranı sıvı tedavisi ≥11,75 litre olan hastalara kıyasla daha yüksek belirlendi (p=0,013) Başvurudaki PVI değeri için 21,50 daha yüksek değerlerin mortaliteyi %77,42 sensitivite ve %72,73 spesifite ile ön görebileceği belirlendi. Başvurudaki laktat değeri için 2,00 ve daha yüksek değerlerin mortaliteyi %78,18 sensitivite ve %74,55 spesifite ile ön görebileceği belirlendi. Başvurudaki PVI-laktat indeksi için 0,41 ve daha yüksek değerlerin mortaliteyi %78,18 sensitivite ve %68,63 spesifite ile ön görebileceği belirlendi. 1. saatte
iii
bakılan PVI-laktat indeksi için 0,44 ve daha yüksek değerlerin mortaliteyi %66,67 sensitivite ve %68,18 spesifite ile ön görebileceği belirlendi.
Sonuç
Sepsis tanısı alan hastalarda laktat ve pleth variability indeks ve pleth variability indeks-laktat indekslerinin yüksekliği mortalite ile ilişkilidir. Sıvı tedavisi sonrası bakılan pleth variability indeks, laktat ve pleth variability indeks-laktat indekslerinde değişim olmasına rağmen sıvı tedavisinin miktarıyla korelasyonu bulunmamaktadır.
Patients who applied to the emergency department and were diagnosed with sepsis as a result of the initial evaluation were included in this study. The lactate values obtained at the time of admission and at the first hour of follow-up, the measured pleth variability index (PVI) values, and the PVI-lactate indices obtained by using PVI and lactate together were recorded. With the changes in these values, it was aimed to determine the effectiveness of the fluid therapy given to the patients within the first hour. Materials and Methods Patients who were admitted to the emergency department and diagnosed with sepsis between April 2022 and December 2022 were prospectively included in this study. Demographic characteristics of the patients, lactate values, measured pleth variability index values, amount of fluid therapy given, emergency department outcomes, hospital outcomes and mortality were evaluated. Results 126 patients with a prediagnosis of sepsis were included in our study. 65.7% (n=67) of the patients were male and the mean age was 70.38 ± 14.11 years. The most common comorbid diseases were malignancy with 43.1% (n=44), diabetes mellitus with 26.5% (n=27), and hypertension with 25.5% (n=26). The death rate was found to be higher in patients with a fluid therapy amount of <11.75 liters compared to patients with fluid therapy ≥11.75 liters (p=0.013). For PVI value at admission, values higher than 21.50 resulted in a sensitivity of 77.42% and a sensitivity of 72%. It was determined that it could predict with a specificity of .73. It was determined that values of 2.00 and higher for lactate value at admission could predict mortality with 78.18% sensitivity and 74.55% specificity. It was determined that values of 0.41 and higher for the PVI-lactate index at admission could predict mortality with a sensitivity of 78.18% and a specificity of 68.63%. It was determined that values of 0.44 and higher for the PVI-lactate index measured at 1 hour could predict mortality with a sensitivity of 66.67% and a specificity of 68.18%. v Conclusion High lactate and pleth variability index and pleth variability index-lactate indices are associated with mortality in patients diagnosed with sepsis. Although there were changes in the pleth variability index, lactate and pleth variability index-lactate indices after fluid therapy, there was no correlation with the amount of fluid therapy.
Patients who applied to the emergency department and were diagnosed with sepsis as a result of the initial evaluation were included in this study. The lactate values obtained at the time of admission and at the first hour of follow-up, the measured pleth variability index (PVI) values, and the PVI-lactate indices obtained by using PVI and lactate together were recorded. With the changes in these values, it was aimed to determine the effectiveness of the fluid therapy given to the patients within the first hour. Materials and Methods Patients who were admitted to the emergency department and diagnosed with sepsis between April 2022 and December 2022 were prospectively included in this study. Demographic characteristics of the patients, lactate values, measured pleth variability index values, amount of fluid therapy given, emergency department outcomes, hospital outcomes and mortality were evaluated. Results 126 patients with a prediagnosis of sepsis were included in our study. 65.7% (n=67) of the patients were male and the mean age was 70.38 ± 14.11 years. The most common comorbid diseases were malignancy with 43.1% (n=44), diabetes mellitus with 26.5% (n=27), and hypertension with 25.5% (n=26). The death rate was found to be higher in patients with a fluid therapy amount of <11.75 liters compared to patients with fluid therapy ≥11.75 liters (p=0.013). For PVI value at admission, values higher than 21.50 resulted in a sensitivity of 77.42% and a sensitivity of 72%. It was determined that it could predict with a specificity of .73. It was determined that values of 2.00 and higher for lactate value at admission could predict mortality with 78.18% sensitivity and 74.55% specificity. It was determined that values of 0.41 and higher for the PVI-lactate index at admission could predict mortality with a sensitivity of 78.18% and a specificity of 68.63%. It was determined that values of 0.44 and higher for the PVI-lactate index measured at 1 hour could predict mortality with a sensitivity of 66.67% and a specificity of 68.18%. v Conclusion High lactate and pleth variability index and pleth variability index-lactate indices are associated with mortality in patients diagnosed with sepsis. Although there were changes in the pleth variability index, lactate and pleth variability index-lactate indices after fluid therapy, there was no correlation with the amount of fluid therapy.
Açıklama
Anahtar Kelimeler
Sepsis, PVI, Laktat, Mortalite, Acil servis, Sepsis, PVI, Lactate, Mortality, Emergency room
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çuhadar, R. (2023). Acil servise başvuran sepsisli hastalarda intravenöz sıvı tedavisinin pleth variability indeks ve laktat ölçümleriyle değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
