Acil Serviste Noninvaziv Mekanik Ventilasyon (NIMV) Başarısını Etkileyen Faktörler

Abstract

Keskin E. Factors Affecting Non-invasive Mechanical Ventilation Success in Emergency Department. Hacettepe University Faculty of Medicine, Department of Emergency Medicine Thesis of Emergency Medicine, Ankara 2019 Non-invasive mechanical ventilation (NIMV) is an airway management and oxygen therapy modality used frequently in emergency departments and intensive care units for critical patients with respiratory distress. The aim of this study was to determine factors affecting NIMV success. This retrospective descriptive study included 208 patients over 18 years of age who admit to Hacettepe University Medical Faculty Adult Emergency Department and received NIMV therapy between 01.01.2018 - 01.01.2019. Patients who died under NIMV therapy or switched to invasive mechanical ventilation were considered unsuccessful. There were 143 patients in the successful group and 65 in the unsuccessful group. A total of 48 (23%) of patients; 12 patients during NIMV therapy and 36 of 53 patients who switched to invasive mechanical ventilation were died. Success rate of NIMV therapy was 68.8%. NIMV was successful in 78.1% of patients with asthma / COPD . Fifty percent of patients with a history of SVO, 38% of patients without home O2 treatment, and 66.7% of patients with malignant cancer were in the unsuccessful group of NIMV therapy. When the vital signs were examined, SBP (129 mmHg vs 139 mmHg, p = 0.044), DBP (70 mmHg vs 77 mmHg, p = 0.003), OAB (70 mmHg vs 97 mmHg, p = 0.004) measurements were lower and mean heart rate (110 beats / min vs 101 beats / min, p = 0.013) were found to be high in the group in which NIMV therapy failed. In the group where NIMV therapy failed; BUN (35 vs 25mg/dl), p = 0.001), creatinine (1.13 vs 0.95 mg/dl, p = 0.015) and lactate (1,94 vs 3,29 mMol/L, p=0,000) were significantly higher and pO2 measurements (45 vs 54mmHg (unit summer), p = 0.001) were significantly lower. Logistic regression analysis revealed that the presence of malignant cancer, MEUS being 4 and above, GCS below 15, creatinine value of 1.5mg / dl and above and lactate value of 6 and above increased the risk of failure. As a result, it was concluded that it is necessary to be prepared for transition to IMV theraphy considering the failure of NIMV therapy in the early period in patients with malignant cancer, hemodynamically instable and organ perfusion disorder.