AI Summary & Key Takeaways
AI InsightWhile themortality rate was 26.3% in first 24 h, the overall mortality rate was 100%.Conclusion: The incidence of barotrauma was lower among our ICU patients whoreceived MV, but the prognosis of these patients was poor.
📌 3 Key Takeaways
Abstract
Objective: The incidence of barotrauma in patients who received mechanical ventilation(MV) has decreased due to protective MV strategies. This study aimed toassess the incidence, treatment, and prognosis of barotrauma in patients who receivedMV in our tertiary intensive care unit (ICU) and to discuss with the literature.Material and Methods: Patients hospitalized between January 2008 and December2014 were assessed. Those who had barotrauma were retrospectively analyzed.Results: Invasive MV was performed in 861 of 1341 patients. Barotrauma was seenin 19 (2.2%) patients. These patients' (mean age, 63.2±18.2 years; 14 males) medianAPACHE II score was 18, and their median duration of MV was 168 h. Acute RespiratoryDistress Syndrome(ARDS) was diagnosed in 57.9% of the patients at admission, andvolume-controlled ventilation was mostly used (47.4%). Barotrauma occurred on day8 (median; range, day 4-21). Pneumonia was diagnosed in 84.2% of the patients. Pressuresupport ventilation was mostly used (47.4%) at the time of barotrauma. All patientshad pneumomediastinum. Pneumothorax was diagnosed in 16 (84.2%) patients(bilaterally in 3 patients). Subcutaneous emphysema was seen in 11 patients (57.9%).Pneumothorax was treated by tube thoracostomy in 15 patients (83.3%). While themortality rate was 26.3% in first 24 h, the overall mortality rate was 100%.Conclusion: The incidence of barotrauma was lower among our ICU patients whoreceived MV, but the prognosis of these patients was poor.
Özet
Amaç: Barotravma sıklığı, koruyucu mekanik ventilasyon (MV) stratejilerinin kullanılmasıyla azalmaktadır. Bu çalışmada; kliniğimiz 3. seviye yoğun bakım ünitesi (YBÜ)'nde invaziv MV uygulanan olgularda, barotravmanın gelişme sıklığı, tedavi ve prognozunun literatür eşliğinde tartışılması amaçlanmıştır.Gereç ve Yöntemler: Çalışmaya Ocak 2008-Aralık 2014 tarihleri arasında yatan olgular dahil edilmiştir. Barotravma gelişen olgular retrospektif olarak gözden geçirilmiştir. Bulgular: Yedi yıl süresince YBÜ'de yatan 1341 olgudan 861'ine invaziv MV tedavisi uygulanmış, toplam 19 olguda (%2,2) barotravma saptanmıştır. Olguların; %73,7'si erkek olup, yaş ortalaması 63,2±18,2, ortanca APACHE II skoru 18, ortanca invaziv MV süresi 168 saat bulunmuştur. Başvuruda; olguların %57,9'unda Akut Solunum Zorluğu Sendromu (ARDS) saptanmış olup, en sık (%47,4) volüm kontrol modu kullanılmıştır. Barotravma ortanca 8. günde gelişmiş, barotravma gününde; olguların %84,2'sinde pnömoni saptanmış, en sık (%47,4) basınç destekli mod uygulanmıştır. Olguların tümünde mediasten amfizemi, 16 (%84,2)'sında pnömotoraks (3'ünde bilateral), 11 (%57,9)'inde ciltaltı amfizemi mevcuttu. Pnömotoraks gelişen olguların, 15 (%83,3)'ine tüp torakostomi ve kapalı sualtı drenajı uygulanmıştır. İlk 24 saat içindeki mortalite oranı %26,3 iken, total mortalite %100 olarak saptanmıştır.Sonuç: İnvaziv MV uygulanan olgularımızda barotravma görülme sıklığı düşük olmakla beraber, prognozun kötü olduğu saptanmıştır.