Mekanik Ventilasyonda Bakım, Analjezi ve Sedasyon
Özet
Kalp cerrahisi geçiren hastalarda solunum komplikasyonu gelişme riski fazladır. Solunum komplikasyonlarını önlemek için ameliyat sonrası erken dönemde (ilk 12-24 saat) hastalara mekanik ventilasyon (MV) işlemi uygulanmaktadır. Bu işlem hastalara solunum desteği sağlamaktadır. MV işleminde sedatif ilaçlar da uygulanabilmektedir Ayrıca mekanik ventilasyonda izlenen hastalar insizyon varlığı ve invaziv girişimler nedeniyle ağrı hissetmektedirler. Hemşireler MV ve sedasyon uygulanan hastaların bakımı ve izleminde ve ağrı yönetiminde anahtar role sahip kişilerdir.
Patients who have undergone cardiac surgery are at high risk of developing respiratory complications. In order to prevent respiratory complications, mechanical ventilation (MV) is applied to patients in the early postoperative period (first 12-24 hours). This procedure provides respiratory support to patients. Sedative drugs can also be applied during the MV procedure. In addition, patients monitored under mechanical ventilation feel pain due to the presence of incisions and invasive procedures. Nurses are key individuals in the care and monitoring of patients undergoing MV and sedation and in pain management.
Referanslar
Ak HY, Yıldız M. Mekanik Ventilasyona Pratik Yaklaşım. Koşuyolu Heart Journal. 2018; 21(1), 65-69. doi: 10.5578/khj.53920
Pruit B. The basics of mechanical ventilation in adults. Nursing. 2023; 53(3): 27-35. doi: 10.1097/01.NURSE.0000918996.32229.6b
Walter JM, Corbridge TC, Singer BD. Invasive mechanical ventilation. Southern Medical Journal, 2018;111(12): 746-753. doi: 10.14423/SMJ.0000000000000905.
Hyzy RC, Taha AR, Muller NL. Diagnosis, management, and prevention of pulmonary barotrauma during invasive mechanical ventilation in adults. 2024.Waltham, USA. Available from: https://www.uptodate.com/contents/diagnosis-management-and-prevention-of-pulmonary-barotrauma-during-invasive-mechanical-ventilation-in-adults?topicRef=1628&source=see_link (Accessed 15th Jan 2024)
Pileggi C, Mascaro V, Bianco A, et al. Ventilator Bundle and Its Effects on Mortality Among ICU Patients: A Meta-Analysis. Critical Care Medicine. 2018; 46(7):1167-1174. doi: 10.1097/CCM.0000000000003136.
Köse A, Yurtseven N, Düzyol İY. Açık Kalp Cerrahisi Sonrası Ventilatörle İlişkili ID Pnömoni: Risk Faktörleri. Journal of the Society of Thoracic Carido-Vascular Anaesthesia & Intensive Care. 2019;25(3):181-189. doi: 10.5222/GKDAD.2019.00719
Wu G, Fu Y, Feng W, et al. Prevalence and risk factors for ventilator-associated pneumonia after cardiac surgery: a systematic review and meta-analysis. Journal of Thoracic Disease. 2024;16(9):5946-5957.doi:10.21037/jtd-24-324
Semet C. The ongoing challenge of ventilator-associated pneumonia: Epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit. Infection Prevention in Practice. 2023; 5(4): 100320.doi: 10.1016/j.infpip.2023.100320
Belay CM., Zewale TA, Amlak BT, et al. Incidence and predictors of ventilator-associated pneumonia among adult intubated patients in Bahir Dar Specialized Hospitals, 2021: a retrospective follow-up study. International Journal of General Medicine. 2022; 15: 8173–8182. doi: 10.2147/IJGM.S380301
Modi AR, Kovacs CS. Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention. Cleveland Clinic Journal of Medicine. 2020;1;87(10):633-639. doi: 10.3949/ccjm.87a.19117.
Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Medicine. 2020;46(5):888-906. doi: 10.1007/s00134-020-05980-0.
Mastrogianni M, Katsoulas T, Galanis P, et al. The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review. Antibiotics (Basel). 2023; 12(2):227. doi: 10.3390/antibiotics12020227.
Uysal FE, Ekren PK, Kuntman A, Bacakoğlu F. Mekanik Ventilasyon İlişkili Barotravma. Yoğun Bakım Derg. 2017; 8(2): 39-43 doi: 10.5152/dcbybd.2017.1496
Hyzy RC, Taha AR, Muller NL. Diagnosis, management, and prevention of pulmonary barotrauma during invasive mechanical ventilation in adults. Waltham, USA. Available from: https://www.uptodate.com/contents/diagnosis-management-and-prevention-of-pulmonary-barotrauma-during-invasive-mechanical-ventilation-in-adults?topicRef=1628&source=see_link(Accessed 15th Jan 2024)
Russotto V, Myatra SN, Laffey JG, et al. Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries. Jama.2021; 325(12), 1164-1172. doi: 10.1001/jama.2021.1727.
Vemuri SV, Rolfsen ML, Sykes AV, et al. Association Between Acute Kidney Injury During Invasive Mechanical Ventilation and ICU Outcomes and Respiratory System Mechanics. Critical Care Explor. 2022; 4(7):e0720. doi: 10.1097/CCE.0000000000000720.
Vemuri SV, Rolfsen ML, Sykes AV, et al. Association between acute kidney injury during invasive mechanical ventilation and ICU outcomes and respiratory system mechanics. Critical care explorations. 2022; 4(7): e0720. doi: 10.1097/CCE.0000000000000720
Ostermann M, Zarbock A, Goldstein S, et al. Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement. JAMA Network Open. 2020; 3(10):e2019209. doi: 10.1001/jamanetworkopen.2020.19209.
Sarıkaya A, Şimşek AB. Beyin cerrahisi hastalarında kafa içi basınç artışı ve hemşirelik bakımı. Turkiye Klinikleri J Surg Nurs-Special Topics 2015;1(2): 8-20
Gürsoy A, Çilingir D. Cerrahi Hastaları İçin Sessiz Tehlike: Derin Ven Trombozu Risk Azaltıcı Hemşirelik Bakımı. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi.2028; (3), 213-219.
Yang R, Zheng Q, Zuo D, et al. Safety assessment criteria for early active mobilization in mechanically ventilated ICU subjects. Respiratory Care.2021; 66(2),:307-315.
Hodgson CL, Bailey M, Young PJ, et al. Early Active Mobilization during Mechanical Ventilation in the ICU. Reply. N Engl J Med. 2023;388(6):573-574. doi: 10.1056/NEJMc2216086. PMID: 36780686
Wang L, Hua Y, Wang L, et al. The effects of early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Front Med (Lausanne). 2023;28;10:1202754. doi: 10.3389/fmed.2023.1202754.
Çelik S. Mekanik Ventilasyon ve Temel Bakım İlkeleri. Erişkin yoğun bakım hastalarında temel sorunlar ve hemşirelik bakımı. İstanbul: Nobel tıp kitapevleri,;2014
Karayurt Ö, Çelik B. Ameliyata bağlı basınç yarası ve hemşirelik bakımı. Türkiye Klinikleri Cerrahi Hastalıkları Hemşireliği-Özel Konular. 2017; 3(3): 176-182
Güner CK, Kutlutürkan S. Mekanik Ventilasyon Ayırma Yöntemleri ve Hemşirenin Rolü. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi.2020; 11(3): 380-383.
Koyuncu A, Yava A, Kürklüoğlu M,et al. Mekanik ventilasyondan ayırma ve hemşirelik. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2011;19(4): 671-681.
Faisal H, Farhat S, Grewal NK, et al. ICU Delirium in Cardiac Patients. Methodist DeBakey Cardiovascular Journal.2023; 19(4): 74-84. doi: 10.14797/mdcvj.1246. eCollection 2023.
Araujo MCR, Silva DA, Wilson AMMM. Nursing interventions in palliative care in the intensive care unit: A systematic review. Enfermería Intensiva.2023; 34(3):156-172. doi: 10.1016/j.enfie.2023.08.008.
Seo Y, Lee HJ, Ha EJ, et al. 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit. Acute and Critical Care.2022; 37(1): 1-25. doi: 10.4266/acc.2022.00094.
Yağcı Ü, Saygın M. Ağri fizyopatolojisi. SDÜ Tıp Fakültesi Dergisi. 2019; 26(2): 209-220.
Park S, Na SH, Oh J, et al. Pain and anxiety and their relationship with medication doses in the intensive care unit. Journal of Critical Care. 2018; 47: 65-69. doi: 10.1016/j.jcrc.2018.05.014.
Yılmaz KF, Karaca ÇE. Ağrının davranışsal etkileri-ağrıyı algılama ve tepkileri etkileyen faktörler. Türkiye Klinikleri. 2019;19-26.
Jungquist CR, Quinlan-Colwell A, Vallerand A, et al. American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions. Pain Manag Nurs. 2020;21(1):7-25. doi: 10.1016/j.pmn.2019.06.007.
Lele A, Souter M. Sedation practices in the Neurocritical Care Unit. J Neuroanaesthesiol Crit Care 2016; 3: 81-87.
Tel Aydın H, Öztürk Birge A. Ağrı, ajitasyon/sedasyon ve deliryum yönetimi. Durmaz Akyol A (Ed). Yoğun Bakım Hemşireliği İçinde. İstanbul Tıp Kitabevi; 2017.
Kavurmacı M, Tan M. Sedatize Hastanın Bakımı. Ebelik ve Sağlık Bilimleri Dergisi. 2019;2(1): 20-27
