Ömer Faruk ŞAVLUK, Abdullah Arif YILMAZ, Yasemin YAVUZ, Fatma UKİL IŞILAK, Babürhan ÖZBEK, Ergin ARSLANOĞLU, Nihat ÇİNE, Hakan CEYRAN

Pediatrik Kalp Cerrahisi Sonrası Ekstübasyonu Takiben Yüksek Akışlı Nazal Kanül ve Geleneksel Oksijen Tedavisinin Karşılaştırılması: Bir Retrospektif Çalışma

Giriş: Doğuştan kalp hastalığı olan bebeklerde ve çocuklarda, kalp cerrahisine veya kalp hastalığına bağlı olarak solunum yetmezliği gelişebilir. Aslında, bu grup hastalarda ekstübasyon sonrası dönem karmaşık olabilir ve eğer geleneksel oksijen tedavisi yeterli olmazsa, sürekli pozitif hava yolu basıncı veya noninvaziv ventilasyon gerekli olabilir. Çalışmamızın amacı, pediatrik kalp cerrahisi sonrası ekstübasyon sonrasında yüksek akımlı nazal kanül veya konvansiyonel oksijen tedavisinin etkinlik ve sonuçlarını karşılaştırmaktır. Hastalar ve Yöntem: Ocak-Aralık ayları arasında 12 yataklı pediatrik kardiyak yoğun bakım ünitesinde tek merkezli retrospektif bir çalışma yapılmıştır. Bir grupta ekstübasyon sonrası yüksek akımlı nazal kanül alan 45 hasta (Grup I), diğer grupta ise ekstübasyon sonrası maske ile oksijen tedavisi alan 45 hasta (Grup II) vardı. Çalışmamızda yüksek akışlı nazal kanülün ve geleneksel oksijen tedavisinin PaCO2, PaO2 ve PaO2/FiO2 üzerindeki göreceli etkinliğini değerlendirmektir. Bulgular: Ekstübasyon sonrası 1, 6, 12, 24 ve 48. saatlerde PaO2 değerleri yüksek akışlı nazal kanül uygulanan grupta anlamlı olarak yüksekti (p< 0.05). Yüksek akışlı nazal kanül grubunda ekstübasyon sonrası 1, 6, 12, 24, 48. saatlerde PaCO2 değeri anlamlı olarak düşüktü (p= 0.01). Ekstübasyon sonrası tüm zamanlarda yüksek akışlı nazal kanül grubunda PaO2/PaCO2 değerleri geleneksel oksijen tedavisi alan gruba göre anlamlı olarak yüksekti (p= 0.01). Sonuç: Yüksek akışlı nazal kanül, kalp cerrahisi sonrası ekstübasyonu takiben çocuklarda PaCO2’yi düşürmede ve PaO2’yi iyileştirmede faydalıdır. Ek olarak, yüksek akışlı nazal kanül kullanımının basitliği ve tolere edilebilirliği de önemlidir. Daha pahalı olmasına rağmen, yüksek akışlı nazal kanül kullanımı pediatrik kalp cerrahisini takiben geleneksel oksijen tedavisine güvenli ve etkili bir alternatif olarak düşünülebilir.

Comparison of High-Flow Nasal Cannula and Conventional Oxygen Therapy Following Extubation After Pediatric Cardiac Surgery: A Retrospective Study

Introduction: Infants and children with congenital heart disease may develop respiratory failure in association with cardiac surgery or as a result of heart disease. In fact, the postextubation period in this group of patients can be complex and the use of continuous positive airway pressure or non-invasive ventilation may be necessary if conventional oxygen therapy is not sufficient. The aim of our study was to compare efficiency and outcomes of high-flow nasal cannula or conventional oxygen therapy post-extubation after pediatric cardiac surgery. Patients and Methods: A single centre retrospective study was conducted between January and December 2020 in our 12 beds pediatric cardiac intensive care unit. Patients were divided into two groups. In one group 45 patients (Group I), those who received high-flow nasal cannula after extubation, and in the other group 45 patients (Group II), those who received oxygen therapy with a mask after extubation. The aim of the study was to evaluate the relative efficacy of high flow nasal cannula and conventional oxygen therapy on PaCO2, PaO2 and PaO2/FiO2. Results: PaO2 values at 1, 6, 12, 24 and 48 hour post-extubation were significantly higher in high-flow nasal cannula group (p< 0.05). PaCO2 values were significantly lower in the high-flow nasal cannula group at 1, 6, 12, 24 and 48 hour post-extubation (p= 0.01). PaO2/FiO2 values in high-flow nasal cannula group at all-time points post-extubation were significantly higher than in conventional oxygen therapy group (p= 0.01). Conclusion: High-flow nasal cannula is useful in decreasing PaCO2 and improving PaO2 in children following extubation after cardiac surgery. In addition, the simplicity of and tolerability to high-flow nasal cannula is also important. Although more expensive, the use of high-flow nasal cannula can be considered as a safe and effective alternative to conventional oxygen therapy following pediatric cardiac surgery.

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi