Non Invaziv ve Invaziv Mekanik Ventilasyon

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Dinçer YILDIZDAŞ
Çukurova Üniversitesi Tıp Fakültesi, Çocuk Yoğun Bakım BD, Adana
Article Language: TR
Ventilasyonun gelişimi tarihsel olarak Hipokrat'ın havayı bilimsel olarak değerlendirmesi ve suda boğulma vakalarında nefes borusu vasıtasıyla hastaya hava gönderilmesi gerekliliğini bildirmesiyle başlar. Yayınlanmış ilk raporlarda yapay solunum sağlam bir kişinin hastaya ağızdan ağıza solunum yaptırması olarak bildirilmiştir. On sekizinci yüzyılda boğulma durumlarında ağızdan ağıza yapılan suni solunum birinci basamak tedavi hâline gelmişti. Makineler tarafından otomatik olarak yapılan suni solunumun ilkel şekli ise ancak 150 yıl sonra ortaya çıkabilmişti. Çelik ciğer olarak da bilinen negatif basınçla çalışan klasik tank ventilatörü 1930'lu yıllarda Amerika'daki polio salgınında kullanılmıştı. Ancak bu cihazların çok yer kaplaması, hasta bakımının iyi olmaması, dolaşımı etkilemesi gibi yan etkileri mevcuttu.

Mekanik ventilasyon (MV); çocuk yoğun bakım ünitelerinde kullanım sıklığı gittikçe artan hayat kurtarıcı bir tekniktir. MV kullanımının yaygınlaşması ve araştırmaların artması ile birlikte pozitif basınçlı ventilasyonun eskiden sanıldığının aksine zararsız bir yöntem olmadığı artık bilinmektedir. Mekanik ventilasyon hem invaziv hem de non invaziv olarak uygulanmaktadır. Son yıllarda non invaziv uygulamaların sıklığı giderek artmıştır. Özellikle de Yüksek Akışlı Nazal Kanül Oksijen kullanımı çok yaygınlaşmıştır. Mekanik ventilatör ile solunum desteği hayat kurtarıcı bir tedavi olmakla birlikte, tedavi sırasında karşılaşılan komplikasyonlar nedeni ile morbidite ve mortalite risklerini beraberinde getirdiği gösterilmiştir. Bu nedenle yeni, daha güvenilir ventilasyon tekniklerinin ve mekanik ventilatörlerin geliştirilmesine yönelik arayışlar devam etmektedir. Birçok yeni ventilasyon yöntem ve yaklaşımları klinikte kullanıma girmesine rağmen, tedavi etkinlikleri ve birbirine üstünlükleri konusunda yeterli araştırmalar bulunmamaktadır. Dünyanın her yerinde üstünlüğü kabul edilmiş tek bir MV yöntemi yoktur. Farklı ülkelerde farklı merkezler, kendi ünitelerinin olanaklarına, uygulayıcılarının bilgi, beceri, deneyimlerine ve hastalarının özelliklerine göre farklı yöntemlerden bir ya da birkaçını seçebilmekte veya zaman içerisinde bir yöntemden diğerine geçebilmektedir. Çocuk Yoğun Bakım Üniteleri'nde hastalara standart bakım sağlamak ve nedene yönelik MV stratejilerini belirlemek, o ülkede verilen yoğun bakım hizmetlerinin geliştirilmesi açısından büyük önem taşımaktadır. Bu nedenle güncel klinik uygulamalar ve bu uygulamaların zaman içerisindeki değişimi yakından takip edilmelidir. Kritik durumdaki çocukların nasıl ventile edilmesi gerektiğine dair bilgiler, doğru ve geniş klinik çalışmaların planlanmasıyla elde edilecektir. Bu kitapta yakın zamanda kaybettiğimiz Prof. Dr. Tolga Fikri Köroğlu hocamızın da bir konusu olması beni çok mutlu etmiştir.

Tüm yazarların büyük bir istekle katkı sunduğu bu kitabın çocuklarla uğraşan tüm hekimlere yardımcı olması dileğiyle...

Prof. Dr. Dinçer YILDIZDAŞ
Editör
Historically, development of ventilation begins with Hippocrate's scientific evaluation of air and his statement of the necessity to ventilate the patient through the trachea in cases of drowning in water. In the first reports published, artificial respiration is reported as a healthy person respirating a patient from mouth to mouth. In the eighteenth century, artifical respiration from mouth to mouth had become a first line therapy in cases of drowning in water. Primitive form of artificial respiration carried out automatically by machines could emerge as late as 150 years later. Conventional tank ventilator- also known as the iron lung- that functioned with negative pressure was used during the polio epidemic in America in the 1930s. However, these devices had such side effects as taking up a lot of room, being unskilled in patient care and affecting circulation.

Mechanical ventilation (MV) is a life saving technique, use frequency of which is on the increase in pediatric intensive care units. Upon proliferation of the use of MV and enhancement of researches, it is now known, contrary to what was believed in the past, that positive-pressure ventilation is not a harmless method. Mechanical ventilation is applied both in an invasive and non-invasive manner. Frequency of non-invasive applications have gradually increased. The use of high-flow nasal cannula oxygen has proliferated in particular. Despite being a life saving treatment, respiration support with a mechanical ventilator has been demonstrated to accompany the risks of morbidity and mortality due to complications encountered during the treatment. Therefore, the pursuit of development of more reliable ventilation techniques and mechanical ventilators continues. Although many new ventilation methods and approaches have become available in clinics, adequate research as to the efficiency of the treatment provided by them and the superiority thereof over each other is not available. There is not a single MV method, the superiority of which has been accepted worldwide. Various centers in various countries can select one or several of the various methods according to the resources of their own units; knowledge, skills and experience of the practitioners; and the characteristics of the patients or switch from one method to the other in time. Providing patients with standard care and determining cause-specific MV strategies in pediatric intensive care units are of capital importance in terms of improvement of intensive care services provided in that country. Therefore, we should be a close follower of current clinical applications and the variation thereof in time. Information about how to ventilate children in a critical condition will be obtained by planning accurate and extensive clinical trials. The fact that our dear lecturer Prof. Dr. Tolga Fikri Köroğlu, who departed in the not too distant past, has a text in this book has made me very happy.

I hope that this book, to which all authors contributed eagerly, will be helpful for all doctors working with children'..

Prof. Dr. Dinçer YILDIZDAŞ
Editor

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