Hipotermide Kurtarma ve Resüsitasyon İlkeleri
Özet
Hipotermi, çekirdek vücut sıcaklığının 35°C’nin altına düşmesiyle tanımlanır ve tedavisi hastalığın şiddetine göre planlanır. İlk aşamada amaç; ısı kaybını durdurmak, yeniden ısıtmak ve gerekirse resüsitasyon uygulamaktır. Hastalar yatay pozisyonda taşınmalı, afterdrop gibi komplikasyonlardan korunmalıdır. Islak giysiler çıkarılmalı, ortam sıcak tutulmalı ve ani müdahalelerden kaçınılmalıdır. Nabız değerlendirmesi dikkatle yapılmalı, monitörde ritim olsa bile perfüzyon yoksa durum ayrıntılı değerlendirilmelidir. Çekirdek sıcaklık 30°C’nin altındaysa ileri yaşam desteği (İYD) ilaçları verilmemeli, defibrilasyon en fazla üç kez denenmelidir; 30°C’ye ulaşıldığında İYD ilaçları uygulanabilir ve müdahaleler tekrarlanabilir. Hastalar 32°C’ye kadar ısıtıldığı halde spontan dolaşım sağlanamazsa resüsitasyon sonlandırılır. Hafif hipotermide pasif ve aktif dış ısıtma yeterliyken, orta ve ağır olgularda aktif iç ısıtma veya ekstrakorporeal yaşam desteği (Extracorporeal Life Support, ECLS) gerekebilir. ECLS tercihi genellikle ekstrakorporeal membran oksijenizasyonu (Extracorporeal Membrane Oxygenation, ECMO)’dur ve kurtarılabilirliği değerlendirmek için hipotermi skoru (Hypothermia Outcome Prediction after ECLS, HOPE score) kullanılabilir. Isıtma sürecinde hipotansiyon, aritmi, elektrolit bozuklukları ve koagülopati gibi komplikasyonlar yaygındır. Hipoterminin yönetiminde erken tanı konması, sistematik bir şekilde değerlendirilmesi ve uygun tedavi protokollerinin uygulanması; komplikasyon gelişimini önlemek, sağkalımı artırmak ve uzun vadeli nörolojik sonuçları iyileştirmek açısından hayati öneme sahiptir.
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