Yoğun Bakım Ünitesinde Sağ Kalp Yetmezlikli Hastaya Yaklaşım
Özet
Nefes darlığı ve bilinç bulanıklığı ile acil servise getirilen 68 yaşındaki erkek hasta acil servisde entübe edildikten sonra yoğun bakım ünitesine kabul edildi. KOAH, sağ ventrikül yetmezliği, hipervolemi ve pnömoni olarak değerlendirilen hastanın yatak başı ekokardiyografik incelemesinde vena cava inferior çapı 24 mm, sağ ventrikül çapı 49 mm, tahmini pulmoner arter basıncı 70 mmHg ve 3° triküspid yetmezliği tespit edildi. Dexmedetomidin ile sedasyon sağlandı, invaziv mekanik ventilasyon uygulandı ve antibiyoterapi başlandı. Diüretik tedavi ile negatif denge sağlandıktan sonra yatak başı ekokardiyografi tekrarlandı. Vena cava inferior çapı 19 mm, sağ ventrikül çapı 45 mm ve tahmini pulmoner arter basıncı 59 mmHg olarak belirlendi. Eş zamanlı olarak periferik ödem, akut faz reaktanları ve kan gazı tablosunda düzelme olan hasta 48 saat entübasyonundan 48 saat kadar sonra ekstübe edildi. Noninvaziv mekanik ventilasyon ile tedavisine devam edilen hastanın göğüs hastalıkları servisine deviri sağlandı.
A 68-year-old man was admitted to the intensive care unit after being intubated in the emergency department with shortness of breath and confusion. He was evaluated as COPD, right ventricular failure, hypervolemia and pneumonia. Bedside echocardiographic examination revealed vena cava inferior diameter 24 mm, right ventricular diameter 49 mm, estimated pulmonary artery pressure 70 mmHg and 3° tricuspid regurgitation. Sedation was achieved with dexmedetomidine, invasive mechanical ventilation was applied and antibiotherapy was started. After negative balance was achieved with diuretic treatment, echocardiography was repeated. Vena cava inferior diameter was 19 mm, right ventricular diameter was 45 mm and estimated pulmonary artery pressure was 59 mmHg. The patient with simultaneous improvement in peripheral edema, acute phase reactants and blood gas picture was extubated 48 hours after 48 hours of intubation. Treatment was continued with noninvasive mechanical ventilation and the patient was transferred to the chest diseases service.
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