Yoğun Bakımda KOAH
Özet
Kronik Obstrüktif Akciğer Hastalığı (KOAH), bronşit, bronşiyolit veya amfizem gibi hava yollarının veya alveollerin anormalliklerinden kaynaklanan, kronik solunum semptomları (nefes darlığı, öksürük, balgam üretimi ve / veya alevlenmeler) ile karakterize heterojen bir akciğer hastalığıdır. Dünyada KOAH prevelansı erkekler için %11,8 (SE 7,9) ve kadınlar için %8,5 (SE 5,8) saptanmıştır. KOAH tanısı semptomları olan hastada postbronkodilatör fev1/FVC oranı < %70 saptanması üzerine konur. Uygun inhaler tedavi semptomları azaltır ve alevlenme riski azaltır. Kronik obstrüktif akciğer hastalığı olan hastalar yoğun bakıma genellikle KOAH alevlenmesi ve solunum yetmezliği sebebiyle kabul edilmektedir. KOAH alevlenmeleri önemli bir morbidite ve mortalite nedenidir. KOAH alevlenmeleri için en önemli risk faktörleri KOAH şiddeti ve önceki alevlenme öyküsüdür. Enfeksiyonlar(viral-bakteriyel), ileri yaş, ısı değişiklikleri, düşük fev1 en sık saptanan nedenlerdendir. KOAH tanılı hastaların yıl içinde %15’inde alevlenme nedeniyle hastane yatışı gerçekleşmektedir. Başvurusunda veya takibinde yoğun bakım yatışı gereken hastalar solunum yetmezliği olağan, dekompanze hiperkapnik hastalar olup solunum yetmezliğinin ciddiyetine göre %6.3’ünde noninvaziv mekanik ventilasyon(NIMV) ihtiyacı, %4.6’sında invaziv mekanik vantilatör ihtiyacı oluşmaktadır. Kullanımı COVİD-19 pandemisi ile yaygınlaşan yüksek akımlı oksijen tedavisi(HFOT) NIMV tolere edemeyen, yakın takip edilebilecek hastalarda yararlı olabilir.
Referanslar
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diag nosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2023 Report. www.goldcopd.org www.goldcopd.org (Accessed on December 13, 2022).
Kocabas A, Hancioglu A, Turkyilmaz S, et al. Prevalence of COPD in Adana, Turkey (BOLD-Turkey Study). Proc Am Thorac Soc 2006;3(Abstract Issue):A543.
Gunen H, Yılmaz M, Aktaş O, et al. Categorization of COPD pa- tients in Turkey via GOLD 2013 strategy document: ALPHABET study. Int J COPD 2015;10:2485-99.
BOLD. Burden of Obstructive Lung Disease Initiative Webpage, published by Imperial College London, available here: http://www.boldstudy.org/ [accessed Oct 2022]
Al Ghobain M, Alhamad EH, Alorainy HS, Al Kassimi F, Lababidi H, Al-Hajjaj MS. The prevalence of chronic obstructive pulmonary disease in Riyadh, Saudi Arabia: a BOLD study. Int J Tuberc Lung Dis 2015; 19(10): 1252-7.
Denguezli M, Daldoul H, Harrabi I, et al. COPD in Nonsmokers: Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study. PLoS One 2016; 11(3): e0151981.
Tashkin DP, Altose MD, Bleecker ER, et al. The lung health study: airway responsiveness to inhaled methacholine in smokers with mild to moderate airflow limitation. The Lung Health Study Research Group. Am Rev Respir Dis 1992;145(2 Pt 1): 301-10.
Eisner MD, Anthonisen N, Coultas D, et al. An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010; 182(5): 693-718.
Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2095-128.
Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2163-96.
Stern DA, Morgan WJ, Wright AL, Guerra S, Martinez FD. Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet 2007; 370(9589): 758-64.
Hogg JC, Chu F, Utokaparch S, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 2004;350:2645-53.7
Rodriguez-Roisin R, Drakulovic M, Rodriguez DA, Roca J, Barbera JA, Wagner PD. Ventilation-perfusion imbalance and chronic obstructive pulmonary disease staging severity. J Appl Physiol 2009;106:1902-8.
Wells JM, Washko GR, Han MK, et al. Pulmonary arterial en- largement and acute exacerbations of COPD. N Engl J Med 2012;367:913-21.
Barbera JA, Roca J, Ferrer A, et al. Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. Eur Respir J 1997;10:1285-91
Kessler R, Partridge MR, Miravitlles M, et al. Symptom variability in patients with severe COPD: a pan-European crosssectional study. Eur Respir J 2011; 37(2): 264-7.
Torres A, Blasi F, Dartois N, Akova M. Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease. Thorax 2015; 70(10): 984-9.
Martinez FJ, Han MK, Flaherty K, Curtis J. Role of infection and antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease. Expert Rev Anti Infect Ther 2006; 4(1): 101-24.
Cheng DO, Hurst JR. COVID-19 and ‘basal’ exacerbation frequency in COPD. Thorax. 2020.
Lindenauer PK, Dharmarajan K, Qin L, et al. Risk Trajecto- ries of Readmission and Death in the First Year after Hospi- talization for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018; 197: 1009-17.
Rothnie KJ, Mullerova H, Smeeth L, et al. Natural History of Chronic Obstructive Pulmonary Disease Exacerbations in a General Practice-based Population with Chronic Obs- tructive Pulmonary Disease. Am J Respir Crit Care Med 2018; 198: 464-71.
Oshagbemi OA, Keene SJ, Driessen JHM, et al. Trends in moderate and severe exacerbations among COPD patients in the UK from 2005 to 2013. Respir Med 2018; 144: 1-6.
Aaron SD, Vandemheen KL, Hebert P, et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med 2003; 348:2618.
Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013; 309:2223.
Sivapalan P, Ingebrigtsen TS, Rasmussen DB, et al. COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months. BMJ Open Respir Res 2019; 6(1): e000407.
Miravitlles M, Kruesmann F, Haverstock D, Perroncel R, Choudhri SH, Arvis P. Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis. Eur Respir J 2012; 39(6): 1354-60.
Prins HJ, Duijkers R, van der Valk P, et al. CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions. Eur Respir J 2019; 53(5).
Butler CC, Gillespie D, White P, et al. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. N Engl J Med 2019; 381(2): 111-20.
Gallego M, Pomares X, Espasa M, et al. Pseudomonas aeruginosa isolates in severe chronic obstructive pulmonary disease: characterization and risk factors. BMC Pulm Med 2014; 14:103.
Fu C, Liu X, Zhu Q, et al. Efficiency of High-Flow Nasal Cannula on Pulmonary Rehabilitation in COPD Patients: A Meta- Analysis. Biomed Res Int 2020; 2020: 7097243.
Hernández G, Vaquero C, González P, et al. Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial. JAMA 2016; 315:1354.
Hernández G, Vaquero C, Colinas L, et al. Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial. JAMA 2016; 316:1565.
Stefan MS, Shieh MS, Pekow PS, et al. Trends in mechanical ventilation among patients hospitalized with acute exacerbations of COPD in the United States, 2001 to 2011. Chest 2015; 147:959.
Lindenauer PK, Stefan MS, Shieh MS, et al. Hospital patterns of mechanical ventilation for patients with exacerbations of COPD. Ann Am Thorac Soc 2015; 12:402.
Nava S, Navalesi P, Conti G. Time of non-invasive ventilation. Intensive Care Med 2006; 32:361.
BTS / RCP London / Intensive Care Society (2008) The use of noninvasive ventilation in the management of patients with chronic obstructive pulmonary disease admitted to hospital with acute type II respiratory failure: In Concise Guidance to Good Practice series, London, UK.
Patrycja Popowicz, MD, MSa , Kenji Leonard, MD. Noninvasive Ventilation and Oxygenation Strategies. Surg Clin N Am 102 (2022) 149–157.
Alexandre Demoule, Laurent Brochard, Martin Dres, Leo Heunks, Amal Jubran, Franco Laghi, Armand MekontsoDessap, Stefano Nava, Lamia OuanesBesbes, Oscar Peñuelas, Lise Piquilloud, Theodoros Vassilakopoulos and Jordi Mancebo. How to ventilate obstructive and asthmatic patients. Intensive Care Med (2020) 46:2436–2449.
Mancebo J (2013) Assist-control ventilation. In: Tobin MJ (ed) Principles and practice of mechanical ventilation, 3rd edn. The McGraw-Hill Com panies, New York, pp 159–174.
Hernández G, Vaquero C, Colinas L et al (2016) Efect of postextuba tion high-fow nasal cannula vs noninvasive ventilation on reintuba tion and postextubation respiratory failure in high-risk patients: a randomized clinical trial. JAMA 316:1565–1574.
Hanna Sandelowsky, Ulla Møller Weinreich, Bernt B. Aarli, Josefn Sundh, Kristian Høines, Georgios Stratelis, Anders Løkke, Christer Janson, Christian Jensen and Kjell Larsson. COPD – do the right thing. Sandelowsky et al. BMC Family Practice (2021) 22:244.
Referanslar
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diag nosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2023 Report. www.goldcopd.org www.goldcopd.org (Accessed on December 13, 2022).
Kocabas A, Hancioglu A, Turkyilmaz S, et al. Prevalence of COPD in Adana, Turkey (BOLD-Turkey Study). Proc Am Thorac Soc 2006;3(Abstract Issue):A543.
Gunen H, Yılmaz M, Aktaş O, et al. Categorization of COPD pa- tients in Turkey via GOLD 2013 strategy document: ALPHABET study. Int J COPD 2015;10:2485-99.
BOLD. Burden of Obstructive Lung Disease Initiative Webpage, published by Imperial College London, available here: http://www.boldstudy.org/ [accessed Oct 2022]
Al Ghobain M, Alhamad EH, Alorainy HS, Al Kassimi F, Lababidi H, Al-Hajjaj MS. The prevalence of chronic obstructive pulmonary disease in Riyadh, Saudi Arabia: a BOLD study. Int J Tuberc Lung Dis 2015; 19(10): 1252-7.
Denguezli M, Daldoul H, Harrabi I, et al. COPD in Nonsmokers: Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study. PLoS One 2016; 11(3): e0151981.
Tashkin DP, Altose MD, Bleecker ER, et al. The lung health study: airway responsiveness to inhaled methacholine in smokers with mild to moderate airflow limitation. The Lung Health Study Research Group. Am Rev Respir Dis 1992;145(2 Pt 1): 301-10.
Eisner MD, Anthonisen N, Coultas D, et al. An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010; 182(5): 693-718.
Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2095-128.
Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2163-96.
Stern DA, Morgan WJ, Wright AL, Guerra S, Martinez FD. Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet 2007; 370(9589): 758-64.
Hogg JC, Chu F, Utokaparch S, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 2004;350:2645-53.7
Rodriguez-Roisin R, Drakulovic M, Rodriguez DA, Roca J, Barbera JA, Wagner PD. Ventilation-perfusion imbalance and chronic obstructive pulmonary disease staging severity. J Appl Physiol 2009;106:1902-8.
Wells JM, Washko GR, Han MK, et al. Pulmonary arterial en- largement and acute exacerbations of COPD. N Engl J Med 2012;367:913-21.
Barbera JA, Roca J, Ferrer A, et al. Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. Eur Respir J 1997;10:1285-91
Kessler R, Partridge MR, Miravitlles M, et al. Symptom variability in patients with severe COPD: a pan-European crosssectional study. Eur Respir J 2011; 37(2): 264-7.
Torres A, Blasi F, Dartois N, Akova M. Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease. Thorax 2015; 70(10): 984-9.
Martinez FJ, Han MK, Flaherty K, Curtis J. Role of infection and antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease. Expert Rev Anti Infect Ther 2006; 4(1): 101-24.
Cheng DO, Hurst JR. COVID-19 and ‘basal’ exacerbation frequency in COPD. Thorax. 2020.
Lindenauer PK, Dharmarajan K, Qin L, et al. Risk Trajecto- ries of Readmission and Death in the First Year after Hospi- talization for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018; 197: 1009-17.
Rothnie KJ, Mullerova H, Smeeth L, et al. Natural History of Chronic Obstructive Pulmonary Disease Exacerbations in a General Practice-based Population with Chronic Obs- tructive Pulmonary Disease. Am J Respir Crit Care Med 2018; 198: 464-71.
Oshagbemi OA, Keene SJ, Driessen JHM, et al. Trends in moderate and severe exacerbations among COPD patients in the UK from 2005 to 2013. Respir Med 2018; 144: 1-6.
Aaron SD, Vandemheen KL, Hebert P, et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med 2003; 348:2618.
Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013; 309:2223.
Sivapalan P, Ingebrigtsen TS, Rasmussen DB, et al. COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months. BMJ Open Respir Res 2019; 6(1): e000407.
Miravitlles M, Kruesmann F, Haverstock D, Perroncel R, Choudhri SH, Arvis P. Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis. Eur Respir J 2012; 39(6): 1354-60.
Prins HJ, Duijkers R, van der Valk P, et al. CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions. Eur Respir J 2019; 53(5).
Butler CC, Gillespie D, White P, et al. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. N Engl J Med 2019; 381(2): 111-20.
Gallego M, Pomares X, Espasa M, et al. Pseudomonas aeruginosa isolates in severe chronic obstructive pulmonary disease: characterization and risk factors. BMC Pulm Med 2014; 14:103.
Fu C, Liu X, Zhu Q, et al. Efficiency of High-Flow Nasal Cannula on Pulmonary Rehabilitation in COPD Patients: A Meta- Analysis. Biomed Res Int 2020; 2020: 7097243.
Hernández G, Vaquero C, González P, et al. Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial. JAMA 2016; 315:1354.
Hernández G, Vaquero C, Colinas L, et al. Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial. JAMA 2016; 316:1565.
Stefan MS, Shieh MS, Pekow PS, et al. Trends in mechanical ventilation among patients hospitalized with acute exacerbations of COPD in the United States, 2001 to 2011. Chest 2015; 147:959.
Lindenauer PK, Stefan MS, Shieh MS, et al. Hospital patterns of mechanical ventilation for patients with exacerbations of COPD. Ann Am Thorac Soc 2015; 12:402.
Nava S, Navalesi P, Conti G. Time of non-invasive ventilation. Intensive Care Med 2006; 32:361.
BTS / RCP London / Intensive Care Society (2008) The use of noninvasive ventilation in the management of patients with chronic obstructive pulmonary disease admitted to hospital with acute type II respiratory failure: In Concise Guidance to Good Practice series, London, UK.
Patrycja Popowicz, MD, MSa , Kenji Leonard, MD. Noninvasive Ventilation and Oxygenation Strategies. Surg Clin N Am 102 (2022) 149–157.
Alexandre Demoule, Laurent Brochard, Martin Dres, Leo Heunks, Amal Jubran, Franco Laghi, Armand MekontsoDessap, Stefano Nava, Lamia OuanesBesbes, Oscar Peñuelas, Lise Piquilloud, Theodoros Vassilakopoulos and Jordi Mancebo. How to ventilate obstructive and asthmatic patients. Intensive Care Med (2020) 46:2436–2449.
Mancebo J (2013) Assist-control ventilation. In: Tobin MJ (ed) Principles and practice of mechanical ventilation, 3rd edn. The McGraw-Hill Com panies, New York, pp 159–174.
Hernández G, Vaquero C, Colinas L et al (2016) Efect of postextuba tion high-fow nasal cannula vs noninvasive ventilation on reintuba tion and postextubation respiratory failure in high-risk patients: a randomized clinical trial. JAMA 316:1565–1574.
Hanna Sandelowsky, Ulla Møller Weinreich, Bernt B. Aarli, Josefn Sundh, Kristian Høines, Georgios Stratelis, Anders Løkke, Christer Janson, Christian Jensen and Kjell Larsson. COPD – do the right thing. Sandelowsky et al. BMC Family Practice (2021) 22:244.
