Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Ultrasonografi Eşliğinde Torasentez; Yoğun Bakım Ünitesi Hastalarında Yararı
Ultrasound-Guided Thoracentesis: Efficacy for Intensive Care Unit Patients
Nedim ÇEKMENa, Ş. Eser ŞANVERDİb, Zeynel YOLOĞLUb
aAnesteziyoloji ve Reanimasyon AD, bRadyoloji AD, Özel Güven Hastanesi, Ankara
Turkiye Klinikleri J Anest Reanim. 2010;8(1):34-8
Article Language: TR
Full Text
ÖZET
Amaç: Ultrasonografi (USG) altta yatan plevral patoloji ve fizyolojinin daha iyi anlaşılmasını sağlar, hekime tanısal ve tedavi kararlarını vermede yardımcı olur. Çalışmamızdaki amaç terapötik torasenteze ihtiyaç duyan yoğun bakım hastalarının plevral effüzyon drenajının USG ile birlikte yapıldığında komplikasyon engellenmesi boyutunda sağladığı kazancı tartışmaktır. Gereç ve Yöntemler: Hastanemizde Ağustos 2005 ile Mayıs 2009 tarihleri arasında yoğun bakım ünitesinde çeşitli endikasyonlarda mekanik ventilasyon uygulanan hastalara tedavi amaçlı torasenteze yardım etmede USG'nin uygunluğunu ve güvenliğini değerlendirmek amacıyla torasentez yapılan tüm hastalar (42) retrospektif olarak değerlendirildi. Veriler hastanemiz arşivinden dosyalarındaki kayıtlardan alındı. Bulgular: Hastaların 19'u kadın (%45), 23'ü erkek (%55) idi. Kırkiki hastaya toplam 59 kez torasentez yapıldı. Parapnömonik effüzyon kabul edilen olguların plevral sıvı kültürlerinin hiçbirinde üreme olmadı. Toplam 42 hastanın hepsine bir kez biyokimyasal inceleme yapıldı. Malignite hastası olan 8 hastanın dışındakilerin sıvı incelemesinde eksuda özelliğini karşılayan sonuç elde edilmedi. İşlem sırasında bir hastada şiddetli yan ağrısı olması nedeni ile uygulama sonlandırıldı. Diğer hastaların hiçbirinde komplikasyon gözlenmedi. Sonuç: Yoğun bakım ünitesi hastaları gibi komplike, kooperasyonu ve oryantasyonu kısıtlı hastalarda torasentezin USG eşliğinde yapılması işleme bağlı komplikasyonları önemli ölçüde azaltmaktadır.

Anahtar Kelimeler: Plevral effüzyon; ultrasonografi; yoğun bakım üniteleri
ABSTRACT
Objective: Ultrasonography makes the underlying pleural pathology and physiology more understandable and assist the physician in taking diagnostic and treatment measures. In our article we aimed to discuss the efficacy of ultrasound-guided thoracentesis as complication preventing method for intensive care unit patients. Material and Methods: The reliability and safety of ultrasonography in assisting theurapeutical thoracentesis in patients receiving mechanical ventilation due to various reasons in intensive care unit (ICU) of our hospital during August 2005 to May 2009 have been retrospectively studied. Results: Data collected from 42 ICU patients (19 female and 23 male, 45 and 55% respectively) who received ultrasonography guided theurapeutical thoracentesis is studied. A total of 59 thoracentesis has been performed to 42 patients. No microbial growth is observed in pleural fluid cultures of cases which were accepted as parapneumonical effusion. Biochemical studies were performed alt least once in all 42 cases. Excluding malignant cases, no result that meets exuda specifications were observed. One thoracentesis procedure has been stopped due to severe colic pain. Other cases did not have this complication. Conclusion: Usage of ultrasound during thoracentesis in patients with underlying diseases or limited cooperation and orientation like the ones in ICU greatly reduces procedural related complications.

Keywords: Pleural effusion; ultrasonography; intensive care units

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30.03.2014

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