Çocuk yoğun bakım ünitesinde kardiyopulmoner resusitasyon yapılan hastaların değerlendirilmesi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kardiyopulmoner resusitasyonda başarıyı sağlamak, yaş, altta yatan hastalık,
kardiyopulmoner arrest ile KPR başlama zamanı, resüsitasyon ekiplerinin hazır ve uygun olma
durumları gibi birçok faktöre bağlıdır. Birçok merkez çocuklarda kardiyopulmoner arrestin
nedenlerini, risk faktörlerini ve sonuçlarını araştıran çalışmalar yapmıştır. Bu çalışmada
Necmettin Erbakan Üniversitesi Tıp Fakültesi Çocuk Yoğun Bakım Ünitesi’nde KPR
uygulanan hastaların özelliklerinin değerlendirilmesi amaçlanmıştır.
Bu geriye yönelik çalışma 20 Eylül 2016–20 Eylül 2022 tarihleri arasında Necmettin
Erbakan Üniversitesi Tıp Fakültesi Çocuk Yoğun Bakım Ünitesi’nde kardiyopulmoner
resüsitasyon uygulanan 0-18 yaş tüm olgular çalışmaya dahil edilerek yapılmıştır. Hastane
bilgisayar sistemi ve hasta dosyalarından elde edilen yaş, cinsiyet, başvuru zamanı, başvuru
nedeni, altta yatan hastalık, resüsitasyon süresi, resüsitasyon zamanı, başlangıçtaki kalp ritmi,
uygulanan adrenalin, noradrenalin, dopamin, dobutamin, kalsiyum, sodyum bikarbonat, serum
fizyolojik gibi ilaçlar, kan ürünleri alıp almaması, kan gazında pH, laktat ve bikarbonat
değerleri kaydedilmiştir ve kardiyopulmoner resüsitasyon sonucunu etkileyen faktörler
araştırılmıştır.
KPR uygulanan 200 hasta çalışmaya dahil edildi. Hastaların %41’i kız, %59’u erkekti
ve yaş ortancası 83 aydı. Kardiyak arrest %98’inde (n=196) mevcuttu. Taburculukta sağkalım
oranı %5,5’di. Altta yatan hastalıklar sırasıyla %42,3’ünde (n=66) nörolojik hastalık,
%32,1’inde (n=50) akciğer hastalıkları, %24,4’ünde (n=38) hematolojik-onkolojik
hastalıklardı. ÇYBÜ’ye yatış nedenleri sırasıyla %66,0’ı akciğer hastalıkları, %11,0
kardiyolojik hastalıklar, %11,0 nörolojik hastalıklar, %5,5 nefrolojik hastalıklardı. Solunum
arrestine göre kardiyopulmoner arrestlerde prognoz daha kötü idi. Ölen hastalarda solunum
arresti gelişme oranı yaşayan hastalara göre istatistiksel olarak anlamlı ve daha düşüktü
(p=0,041). Gece veya gündüz KPR yapılması ile son durumları arasında anlamlı fark bulunmadı
(p>0,05). Ölen hastaların ortanca pH değeri anlamlı derecede düşüktü (p=0,017) ve PCO2,
değerleri yaşayan hastalara göre anlamlı yüksek tespit edildi (p=0,027). Ancak ölen ve yaşayan
hastaların PaO2, HCO3, Laktat değerleri benzer olarak saptandı. Ölen hastaların ortanca
resusitasyon süresi yaşayan hastalara göre anlamlı ve daha yüksekti (p<0,001). Hastaların son
VI
durumları ile cinsiyetleri ve altta yatan hastalık varlığı arasında anlamlı farklılık tespit edilmedi
(sırasıyla p=0,504; p=0,332)
Bu çalışmada ÇYBÜ’de KPR uygulanan olgularda sağkalım ile taburculuk oranı %5,5
bulunmuştur. Resüsitasyon süresi, kan gazında asidoz varlığı, arrestin çeşidi, sağkalım ile
ilişkili faktörlerdendir.
Achieving success in CPR depends on many factors including age, underlying disease, daytime of and initiation of cardiopulmonary arrest and CPR, preparedness and availability of resuscitation teams. There are studies investigating the causes which concluded in many centers, risk factors and consequences of cardiopulmonary arrest in children. In this study, it was aimed to evaluate the characteristics of patients who underwent CPR in the pediatric intensive care unit. This retrospective study was conducted in Necmettin Erbakan University Pediatric Intensive Care Unit (PICU) between 20 September 2016-20 September 2022. All patients aged 0-18 years who underwent cardiopulmonary resuscitation in the PICU were included in the study. Age, gender, time of admission, endication for admission, underlying disease, duration of resuscitation, time of resuscitation, initial heart rhythm, administered drugs including adrenaline, noradrenaline, dopamine, dobutamine, calcium, sodium bicarbonate, number of saline doses obtained from the hospital database system and patient files , blood products, pH, lactate and bicarbonate values in blood gas amination were recorded and factors affecting the outcome of CPR were investigated. 200 patients who underwent CPR were included in the study. 41% were girls, 59% were boys, and the median age was 83 months. Cardiac arrest was present in 98% (n=196). The survival rate at discharge was 5.5%. The underlying diseases were neurological diseases in 42.3% (n=66), pulmonary diseases in 32.1% (n=50), and hematologic-oncological diseases in 24.4% (n=38) respectively. The reasons for admission to the PICU were pulmonary diseases (66.0%), cardiological diseases 11.0%, neurological diseases 11.0%, and nephrological diseases 5.5%, respectively. Compared to respiratory arrest, the prognosis was worse in cardiopulmonary arrests. There was no significant difference between day or night CPR and their final status. The median pH value of the patients with itus was 7.24, and the PCO2 values were found to be significantly higher than those of the living patients. However, PaO2, HCO3, Lactate values of patient with itus and surviving patients were found to be similar. The median resuscitation time of patients with itus was significant and higher than the patients who survived. No significant difference was found between the final status of the patients, their gender, and the presence of underlying disease (p=0.504; p=0.332, respectively). VIII In this study, the rate of survival and discharge was found to be 5.5% in patients who underwent CPR in the PICU. Duration of resuscitation, presence of acidosis in blood gas, type of arrest are factors associated with survival.
Achieving success in CPR depends on many factors including age, underlying disease, daytime of and initiation of cardiopulmonary arrest and CPR, preparedness and availability of resuscitation teams. There are studies investigating the causes which concluded in many centers, risk factors and consequences of cardiopulmonary arrest in children. In this study, it was aimed to evaluate the characteristics of patients who underwent CPR in the pediatric intensive care unit. This retrospective study was conducted in Necmettin Erbakan University Pediatric Intensive Care Unit (PICU) between 20 September 2016-20 September 2022. All patients aged 0-18 years who underwent cardiopulmonary resuscitation in the PICU were included in the study. Age, gender, time of admission, endication for admission, underlying disease, duration of resuscitation, time of resuscitation, initial heart rhythm, administered drugs including adrenaline, noradrenaline, dopamine, dobutamine, calcium, sodium bicarbonate, number of saline doses obtained from the hospital database system and patient files , blood products, pH, lactate and bicarbonate values in blood gas amination were recorded and factors affecting the outcome of CPR were investigated. 200 patients who underwent CPR were included in the study. 41% were girls, 59% were boys, and the median age was 83 months. Cardiac arrest was present in 98% (n=196). The survival rate at discharge was 5.5%. The underlying diseases were neurological diseases in 42.3% (n=66), pulmonary diseases in 32.1% (n=50), and hematologic-oncological diseases in 24.4% (n=38) respectively. The reasons for admission to the PICU were pulmonary diseases (66.0%), cardiological diseases 11.0%, neurological diseases 11.0%, and nephrological diseases 5.5%, respectively. Compared to respiratory arrest, the prognosis was worse in cardiopulmonary arrests. There was no significant difference between day or night CPR and their final status. The median pH value of the patients with itus was 7.24, and the PCO2 values were found to be significantly higher than those of the living patients. However, PaO2, HCO3, Lactate values of patient with itus and surviving patients were found to be similar. The median resuscitation time of patients with itus was significant and higher than the patients who survived. No significant difference was found between the final status of the patients, their gender, and the presence of underlying disease (p=0.504; p=0.332, respectively). VIII In this study, the rate of survival and discharge was found to be 5.5% in patients who underwent CPR in the PICU. Duration of resuscitation, presence of acidosis in blood gas, type of arrest are factors associated with survival.
Açıklama
Anahtar Kelimeler
KPR, Çocuklar, Sağkalım, Çocuk yoğun bakım, CPR, Children, Survival, Pediatric intensive care unit
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Süer, S. (2023). Çocuk yoğun bakım ünitesinde kardiyopulmoner resusitasyon yapılan hastaların değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
