{"id":5551,"date":"2020-04-30T10:00:31","date_gmt":"2020-04-30T07:00:31","guid":{"rendered":"http:\/\/blog.ulubat.org\/?p=5551"},"modified":"2020-04-30T11:57:51","modified_gmt":"2020-04-30T08:57:51","slug":"nefes-alamadiginizda-hicbir-sey-onemli-degil","status":"publish","type":"post","link":"https:\/\/blog.ulubat.org\/index.php\/genel\/nefes-alamadiginizda-hicbir-sey-onemli-degil\/","title":{"rendered":"Nefes Alamad\u0131\u011f\u0131n\u0131zda Hi\u00e7bir \u015eey \u00d6nemli De\u011fil"},"content":{"rendered":"\n

AKUT RESP\u0130RATUAR D\u0130STRESS SENDROMU<\/h3>\n\n\n\n
\"\"<\/figure><\/div>\n\n\n\n

Ani geli\u015fen solunum s\u0131k\u0131nt\u0131s\u0131yla ba\u015flayan, her iki akci\u011ferde non-kardiyojenik vas\u0131fta diff\u00fcz infiltrasyonla karakterize ve oksijen tedavisine yan\u0131t vermeyen bu klinik durum ilk olarak 1967′ de David Ashbaugh ve arkada\u015flar\u0131 taraf\u0131ndan tan\u0131mlanm\u0131\u015ft\u0131r. G\u00fcn\u00fcm\u00fczde yeni tip Corona vir\u00fcs\u00fc(COV\u0130D 19) enfeksiyonunun bir par\u00e7as\u0131 ve ayn\u0131 zamanda mortalite ve morbiditenin \u00f6nemli bir nedeni olan Akut Respiratuar Distress Sendromu’na k\u0131saca ARDS’ ye biraz daha yak\u0131ndan bakal\u0131m istedim… <\/p>\n\n\n\n

ARDS’ nin bug\u00fcne kadar \u00e7e\u015fitli isimlendirmeleri olmu\u015ftur. Travmatik \u0131slak akci\u011fer, \u015fok akci\u011feri, eri\u015fkin solunum s\u0131k\u0131nt\u0131s\u0131 sendromu bu isimlendirmelerden baz\u0131lar\u0131d\u0131r. Ancak bu klinik durumun pediatrik \u00e7a\u011fda da g\u00f6r\u00fclebilmesi \u00fczerine yeni tan\u0131m Akut Respiratuar Distress Sendroumu olarak g\u00fcn\u00fcm\u00fczde kullan\u0131lmaktad\u0131r. Ne var ki, bu kadar fazla isimlendirmeye ra\u011fmen hastal\u0131\u011f\u0131n seyri a\u00e7\u0131s\u0131ndan fazla ilerleme kaydedilememi\u015ftir. <\/p>\n\n\n\n

\u0130lk olarak 1994’te Amerikan- Avrupa Konsensus’una(AECC) g\u00f6re, daha sonra 2012 Berlin (ES\u0130CM ve ATS) kriterlerine g\u00f6re tan\u0131mlanm\u0131\u015f olup g\u00fcn\u00fcm\u00fczde Berlin kriterlerine uygun klinik tan\u0131mlama kullan\u0131lmaktad\u0131r.<\/p>\n\n\n\n

T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan uygun g\u00f6r\u00fclen bu kriterler \u015f\u00f6yledir:<\/p>\n\n\n\n

  • Son bir haftada ortaya \u00e7\u0131kan ve k\u00f6t\u00fcle\u015fen solunum s\u0131k\u0131nt\u0131s\u0131<\/li>
  • Radyolojik olarak plevral ef\u00fczyon, kollaps veya nod\u00fcler bilateral opasiteler<\/li>
  • Kalp yetmezli\u011fi veya vol\u00fcm fazlal\u0131\u011f\u0131 ile a\u00e7\u0131klanamayan solunum yetmezli\u011fi<\/li>
  • Parsiyel oksijen bas\u0131nc\u0131n\u0131n oksijen sat\u00fcrasyonuna oran\u0131n\u0131n % 200-300 den d\u00fc\u015f\u00fck olmas\u0131<\/li><\/ul>\n\n\n\n

    Bu kriterlere g\u00f6re tan\u0131 konan hastalarda son kriterde bahsedilen de\u011fere g\u00f6re hafif, orta, \u015fiddetli olmak \u00fczere yeniden ayr\u0131ma gidilmi\u015ftir. Eskiden akut akci\u011fer hasar\u0131 (Acute Lung Injury- ALI) olarak tan\u0131mlanan klinik, g\u00fcn\u00fcm\u00fczde hafif ARDS s\u0131n\u0131f\u0131na girmektedir. <\/p>\n\n\n\n

    Et\u0130yolojiye bakacak olursak ARDS, akci\u011fere ba\u011fl\u0131 veya di\u011fer sistemik nedenlerin bir komplikasyonu olarak geli\u015febilmektedir. En \u00e7ok su\u00e7lanan etken gram negatif bakteriyel enfeksiyona ba\u011fl\u0131 geli\u015fen sepsis olsa da g\u00fcn\u00fcm\u00fczde Covid- 19 gibi di\u011fer viral etkenlere ba\u011fl\u0131 pn\u00f6momiler, toksik gazlar, a\u015f\u0131r\u0131 doz ila\u00e7 kullan\u0131m\u0131, ciddi travma, \u00e7oklu transf\u00fczyon, suda bo\u011fulma veya gastrik i\u00e7eri\u011fin aspire edilmesiyle de ortaya \u00e7\u0131kabilmektedir. Hangi nedenle olursa olsun ARDS prognozunun benzer oldu\u011funu s\u00f6ylemek m\u00fcmk\u00fcnd\u00fcr. <\/p>\n\n\n\n

    PEK\u0130 NE OLUYOR DA AN\u0130 SOLUNUM YETMEZL\u0130\u011e\u0130 GEL\u0130\u015e\u0130YOR? <\/p>\n\n\n\n

    \u0130\u015e\u0130N H\u0130STOPATOLOJ\u0130S\u0130NE G\u00d6Z ATALIM..<\/p>\n\n\n\n

    Yukar\u0131da bahsetti\u011fim gibi, bu pulmoner ve ekstrapulmoner tetikleyiciler yani toksinler, viral veya bakteriyel ajanlar \u00e7ok narin olan alveolleri direkt etkileyerek veya dolayl\u0131 olarak kan yoluyla kapiller endotellerinde inflamasyona neden olmaktad\u0131r. Bu inflamasyon sonucunda tip 1 alveol ve endotel h\u00fccrelerinde y\u0131k\u0131ma neden olarak, sa\u011fl\u0131kl\u0131 bir bireyde gaz al\u0131\u015fveri\u015finin yap\u0131ld\u0131\u011f\u0131 alveolo-kapiller membranda b\u00fct\u00fcnl\u00fck bozulmaktad\u0131r. Klinik bu a\u015famayla birlikte tetiklenir. Kapiller ge\u00e7irgenli\u011fin artmas\u0131yla alveol i\u00e7ine ve h\u00fccreler aras\u0131 dokuya s\u0131v\u0131 birikimi olur b\u00f6ylece \u00f6dem tablosu oturur. Bu evreye patolojik olarak EKS\u00dcDAT\u0130F FAZ denir. Alveol i\u00e7i s\u0131v\u0131 nedeniyle havalanma ve gaz al\u0131\u015fveri\u015fi azal\u0131r, hastada hipoksemi ve hen\u00fcz etkilenmemi\u015f akci\u011fer alanlar\u0131na do\u011fru hava ak\u0131\u015f\u0131 yani intrapulmoner \u015fant geli\u015fir. Ayr\u0131ca bu fazla hastalar\u0131n radyolojik g\u00f6r\u00fcnt\u00fclerinde yayg\u0131n b\u00fcy\u00fck opasiteleri g\u00f6rmek m\u00fcmk\u00fcnd\u00fcr. <\/p>\n\n\n\n

    Eks\u00fcdatif evreyi, PROL\u0130FERAT\u0130F ve F\u0130BROT\u0130K FAZ takip eder. Histopatolojik olarak s\u0131n\u0131fland\u0131r\u0131lan bu evrelerde \u00f6nce tip 2 alveolar h\u00fccre proliferasyonu daha sonra fibrozis olur. Akci\u011fer hasar\u0131n\u0131n ba\u015flang\u0131c\u0131ndan itibaren 3-4 hafta i\u00e7inde \u00e7o\u011fu hastada akci\u011fer fonksiyonlar\u0131 d\u00fczelirken baz\u0131 hastalar fibrotik faza ge\u00e7i\u015f yapar. <\/p>\n\n\n\n

    \"\"
    NORMAL AKC\u0130\u011eER H\u0130STOLOJ\u0130S\u0130<\/figcaption><\/figure>\n\n\n\n
    \"\"
    ARDS – AKC\u0130\u011eER H\u0130STOLOJ\u0130S\u0130<\/figcaption><\/figure>\n\n\n\n

    Klini\u011fi inceleyecek olursak, akci\u011fer hasar\u0131 ba\u015flay\u0131p eks\u00fcdatif faz ilerledik\u00e7e yakla\u015f\u0131k 48-72 saat i\u00e7inde dispne (solunum s\u0131k\u0131nt\u0131s\u0131), hipoksi, hipoksemi ve kompanzasyon olarak hiperventilasyon mekanizmas\u0131 devreye girer. Ancak buna ra\u011fmen hiperkapni (kanda karbondioksit seviyesi y\u00fcksekli\u011fi) devam eder.<\/p>\n\n\n\n

    ARDS GEL\u0130\u015eEN HASTALAR \u0130\u00c7\u0130N NE \u00c7E\u015e\u0130T TEDAV\u0130LER KULLANILDI\u011eINDAN BAHSEDECEK OLURSAK…<\/p>\n\n\n\n

    Asl\u0131nda ARDS’nin kesin bir tedavisi yoktur… Tedavinin as\u0131l amac\u0131 destek tedavisidir. D\u00fc\u015f\u00fck tidal vol\u00fcml\u00fc mekanik ventilasyon, gerekirse pozitif ekspirasyon sonu bas\u0131n\u00e7 (PEEP) uygulamas\u0131, akci\u011fer koruyucu ventilasyona ra\u011fmen devam eden ( refrakter hipoksemisi olan) hastalara ECMO kullan\u0131labilmektedir. Ayr\u0131ca alveolar \u00f6demi kontrol alt\u0131na alabilmek i\u00e7in s\u0131v\u0131 k\u0131s\u0131tlamas\u0131na gidilmektedir. Ancak ARDS’yi e\u015flik eden di\u011fer patolojilerden ayr\u0131 ele almak do\u011fru de\u011fildir bu nedenle altta yatan nedenler de ayr\u0131ca dikkate al\u0131nmal\u0131d\u0131r. <\/p>\n\n\n\n

    \"\"<\/figure>\n\n\n\n

    Bir\u00e7ok hastan\u0131n \u00e7ok \u00e7e\u015fitli nedenlerle bu klini\u011fe sahip olmas\u0131 dolay\u0131s\u0131yla ve \u015fu anda \u00e7o\u011fu hastanede Covid-19 ile m\u00fccadele eden \u00e7o\u011fu ARDS hastas\u0131n\u0131n yo\u011fun bak\u0131m \u00fcnitelerinde tedavi g\u00f6rmesi \u00fczerine bunu yak\u0131ndan incelemek istedim. Bu ki\u015fi belki bir yak\u0131n\u0131n\u0131z, belki hastan\u0131z, belki de sizsiniz… Tabiri caizse suda bo\u011fulur gibi nefes alamad\u0131\u011f\u0131n\u0131z\u0131 bir d\u00fc\u015f\u00fcn\u00fcn… <\/p>\n\n\n\n

    Faydal\u0131 olaca\u011f\u0131na inanarak bu yaz\u0131y\u0131 sizinle payla\u015f\u0131yorum, okudu\u011funuz i\u00e7in te\u015fekk\u00fcrler… <\/p>\n\n\n\n

    KAYNAK\u00c7A: <\/p>\n\n\n\n

    • T\u00fcrkiye Solunum Ara\u015ft\u0131rmalar\u0131 Derne\u011fi Pulmoner Bildiri Kitab\u0131, Pulmoner Fibrozis, <\/li>
    • 2018 Sel\u00e7uk \u00dcniversitesi T\u0131p Fak\u00fcltesi Covid 19 Enfeksiyonu Y\u00f6netim Algoritmas\u0131, 2020 <\/li>
    • T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Halk Sa\u011fl\u0131\u011f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc Covid Rehberi Bilim Kurulu \u00c7al\u0131\u015fmas\u0131,2020<\/li>
    • Z.A., regulation ain’t so bad: T-REGS in acute injury.
      Science Translational Medicine<\/em> . vol 4,issue 154, pp154ec180, 2012.<\/li>
    • G.P.,Q.L.,P.S., COV\u0130D-19 ARDS:clinical features and diffrences to usual pre-covid ARDS. Medical Journal of Australia, 2020<\/li>
    • K.R., Akut hipoksemik solunum yetmezli\u011finde non invaziv mekanik ventilasyon, T\u00fcrkiye Solunum Ara\u015ft\u0131rmalar\u0131 Derne\u011fi<\/li>
    • K.G.,K.A., SARS: \u015fiddetli solunum yetmezli\u011fi sendromu, \u00c7ocuk Sa\u011fl\u0131\u011f\u0131 ve Hastal\u0131klar\u0131 Dergisi , 46,155-161,2003 <\/li>
    • \u00d6.Y., E. H., ARDS, T\u00fcrk G\u00f6\u011f\u00fcs Kalp Cerrahi Dergisi, vol:10, 126-130, 2002 <\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"

      AKUT RESP\u0130RATUAR D\u0130STRESS SENDROMU Ani geli\u015fen solunum s\u0131k\u0131nt\u0131s\u0131yla ba\u015flayan, her iki akci\u011ferde non-kardiyojenik vas\u0131fta diff\u00fcz infiltrasyonla karakterize ve oksijen tedavisine<\/p>\n","protected":false},"author":196,"featured_media":5554,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"acf":[],"views":1251,"_links":{"self":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/5551"}],"collection":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/comments?post=5551"}],"version-history":[{"count":7,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/5551\/revisions"}],"predecessor-version":[{"id":5568,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/5551\/revisions\/5568"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media\/5554"}],"wp:attachment":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media?parent=5551"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/categories?post=5551"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/tags?post=5551"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}