ÖZET
Akut respiratuvar distres sendromu (ARDS) akut gelişen, her iki akciğeri içine alan, kapiller endotelyal hasar, yaygın pulmoner infiltrasyon ve oksijen tedavisine dirençli hipoksemi ile karekterize, yaşamı tehdit eden bir durumdur. Yoğun bakım ünitelerinde insidans 7,1-12,5 arasında olup, ciddi olgularda mortalite %40’lara kadar çıkabilmektedir. ARDS’de farklı etyolojik faktörlere yanıt olarak akciğerlerde oluşan eksüdatif, proliferatif ve fibrotik aşamaları olan patolojik süreçler hipoksemi, hiperkapni ve akciğer kompliyansında azalma ile sonuçlanır. ARDS tedavisinde etkinliği kanıtlanmış herhangi bir ilaç bulunmamaktadır. ARDS yönetiminde en önemli parametre düşük tidal volüm, yüksek PEEP düzenlemeleri, prone pozisyonu ve recruitment manevrasını içeren koruyucu mekanik ventilasyondur. Ek olarak sıvı yönetimi, beslenme desteği, oksijen tüketiminin azaltılması, ventilatör ilişkili pnomoninin önlenmesi, ağrı yönetimi, derin ven trombozu profilaksisi, peptik ülser profilaksisi, kan şekerinin regülasyonu ve deri/doku bütünlüğünün sürdürülmesi gibi destekleyici girişimler uygulanır. Bu derleme makalede ARDS ve ilişkili faktörler kısaca tanımlanacak, takiben hekim ve hemşire perspektifinden tedavi, bakım ve hasta izlemi konuları ele alınacaktır.
References
1
Diamond M, Peniston Feliciano HL, Sanghavi D, Mahapatra S. Acute respiratory distress syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. URL: https://www.ncbi.nlm.nih.gov/books/NBK436002/. January 30, 2021.
2
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967;2:319‑23.
3
Cutts S, Talboys R, Paspula C, Ail D, Premphe EM, Fanous R. History of adult respiratory distress syndrome. Lancet Respir Med 2016;4:547-8.
4
Murray JF, Matthay MA, Luce JM, Flich MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988;138:720-3.
5
ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307:2526-33.
6
T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Bilimsel Danışma Kurulu Çalışması. COVID-19 (SARS-CoV-2 Enfeksiyonu): ağır pnömoni, ARDS, sepsis ve septik şok yönetimi. 2020, Ankara.
7
Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016;315:788‑800.
8
Bein T, Weber-Carstens S, Apfelbacher C. Long-term outcome after the acute respiratory distress syndrome: different from general critical illness? Curr Opin Crit Care 2018;24:35-40.
9
Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, et al. EOLIA Trial Group, REVA, and ECMONet. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018;378:1965-75.
10
Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, et al. Acute respiratory distress syndrome. Nat Rev Dis Primers 2019;5:18.
11
Yalçın A. Acute Respiratory Distress Syndrome. Güncel Göğüs Hastalıkları Serisi 2018;6:146-56.
12
Simou E, Leonardi-Bee J, Britton J. The Effect of alcohol consumption on the risk of ARDS: a systematic review and meta-analysis. Chest 2018;154:58-68.
13
Moazed F, Hendrickson C, Conroy A, Kornblith LZ, Benowitz NL, Delucchi K, et al. Cigarette smoking and ARDS after blunt trauma: the influence of changing smoking patterns and resuscitation practices. Chest 2020;158:1490-8.
14
Xu J, Yang J, Chen J, Luo Q, Zhang Q, Zhang H. Vitamin D alleviates lipopolysaccharide‑induced acute lung injury via regulation of the renin‑angiotensin system. Mol Med Rep 2017;16:7432-8.
15
Reilly JP, Christie JD, Meyer NJ. Fifty years of research in ARDS. genomic contributions and opportunities. Am J Respir Crit Care Med 2017;196:1113-21.
16
Lynn H, Sun X, Casanova N, Gonzales-Garay M, Christian B, Garcia JNC. Genomic and genetic approaches to deciphering acute respiratory distress syndrome risk and mortality. Antioxid Redox Signal 2019;31:1027-52.
17
Pelosi P, Rocco PRM, Gama de Abreu M. Close down the lungs and keep them resting to minimize ventilator-induced lung injury. Crit Care 2018;22:72.
18
Nanchal RS, Truwit JD. Recent advanced in understanding and treating acute respiratory distress syndrome. F1000Res 2018;7:1322.
19
Vasques F, Duscio E, Cipulli F, Romitti F, Quintel M, Gattinoni L. Determinants and prevention of ventilator-induced lung ınjury. Crit Care Clin 2018;34:343-56.
20
Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2017;195:1253-63.
21
Guérin C, Albert RK, Beitler J, Gattinoni L, Jaber S, Marini JJ, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med 2020; 46:2385-96.
22
Türk Yoğun Bakım Hemşireleri Derneği. Yoğun bakım ünitesinde görev alacak hemşireler için kaynak kitapçık. COVID-19 Pandemisi’ne Özel. [online]. Nisan 2020. URL:https://tybhd.org.tr/wpcontent/uploads/2020/04/TYBHD_COVID19_Kitapc%CC%A7%C4%B1k-11.04.2020.pdf. Ocak 30, 2021.
23
Vignon P, Evrard B, Asfar P, Busana M, Calfee CS, Coppola S, et al. Fluid administration and monitoring in ARDS: which management? Intensive Care Med 2020;46:2252-64.
24
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019; 38:48-79.
25
Evans EM, Doctor RJ, Gage BF, Hotchkiss RS, Fuller BM, Drewry AM. The association of fever and antipyretic medication with outcomes in mechanically ventilated patients: a cohort study. Shock 2019;52:152-9.
26
Sert H, Aygin D, Pınar Bölüktaş. Ventilator-Associated Pneumonia and Prevention in Elderly Patients in Intensive Care Units. Yoğun Bakım Hemşireliği Dergisi 2015;19:60-7.
27
Osti C, Wosti D, Pandey B, Zhao Q. Ventilator-associated pneumonia and role of nurses in ıts prevention. JNMA 2017;56:461-8.
28
Sıla F, Akyol A. Nurses’ Role In Pain Control In Intensive Care Units. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2018;3:31-8.
29
Moraes FDS, Marengo LL, Silva MT, Bergamaschi CC, Lopes LC, Moura MDG, et al. ABCDE and ABCDEF care bundles: a systematic review protocol of the implementation process in intensive care units. Medicine (Baltimore) 2019;98:e14792.
30
Şapulu Alakan Y, Ünal E. Pain Assessment in Intensive Care Nursing and Pain Management. HÜ Sağlık Bilimleri Fakültesi Dergisi 2017;4:12-29.
31
Ejaz A, Ahmed MM, Tasleem A, Rafay Khan Niazi M, Ahsraf MF, Ahmad I, et al. Thromboprophylaxis in intensive care unit patients: a literature review. Cureus 2018;10:e3341.
32
Toews I, George AT, Peter JV, Kirubakaran R, Fontes L, Ezekiel J, et al. Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units. The Cochrane Database Syst Rev 2018;6:CD008687.
33
American Diabetes Association. 15. Diabetes care in the hospital: standards of medical care in diabetes-2020. Diabetes Care 2020;43:S193-202.
34
Shah RD, Wunderink RG. Viral pneumonia and acute respiratory distress syndrome. Clin Chest Med 2017;38:113-25.
35
Reddy K, O’Kane C, McAuley D. Corticosteroids in acute respiratory distress syndrome: a step forward, but more evidence is needed. Lancet Respir Med 2020;8:220-2.
