Öz
Amaç: Yoğun bakım ortamı ve uygulanan yöntemler sempatoadarenal aktivitenin belirgin stimülasyonuna yol
açabilir. Sempatik aktivasyon sırasında plazmada artan katekolamin düzeyleri
ile QT intervali arasında direkt bağlantı olduğu yönünde yayınlar mevcuttur. Bu
sebeple bu çalışmanın amacı; rutinde uygulanan endotrakeal aspirasyonun aritmi belirteçleri olan QT intervali ve QT
dispersiyonu üzerine etkilerini ortaya koymaktır.
Yöntem: Solunum
yetmezliği nedeniyle yoğun bakım ünitesine alınmış, mekanik ventilatöre bağlı
ve yaşları 30-70 arası olan bireylerden toplam 90 hasta çalışmaya dahil edildi.
Qt intervalini uzatan ilaç kullanan, hemodinamisi stabil olmayan hastalar ile
edinsel ya da konjenital uzun QT sendromu olan hastalar çalışma kapsamına
alınmadı. Tüm hastalara endotrakeal aspirasyondan (ET) 1 dakika öne %100 O2
ile preoksijenizasyon uygulandı. Tüm hastaların yaşları, tanıları, sistolik kan
basınçları (SAB), diyastolik kan basınçları (DAB), ortalama kan basınçları
(OAB), kalp atış hızları (KH), periferik oksijen saturasyonları (SpO2),
QT, QTc değerleri, Glasgow Koma Skoru puanları endotrakeal aspirasyondan 5
dakika önce, aspirasyon sırasında, aspirasyondan 5 ve 10 dakika sonra
kaydedildi.
Bulgular: ET aspirasyon
sırasında ortalama QTc değeri 445.1± 23.0 ms, ortalama Qt değeri 379.2± 19.3 ms
idi. Çalışmaya alınan hastaların % 14'ünde bazal QTc değerlerinin 420 ms'nin
üzerinde olduğu tespit edildi. Bazal değerlere göre hemen hemen tüm hastalarda;
ET aspirasyon sırasında ve aspirasyondan 5 ile 10 dakika sonra QT ve QTc
aralıkları uzamıştır.
Sonuç: QT
intervali uzaması her zaman düzeltilmiş QT aralığı hesaplanarak kontrol
edilmeli ve yoğun bakım ünitesi hekimlerinin
koroner kalp hastalığı ve konjenital uzun QT sendromu olan hastalarda ölümcül
ventriküler aritmiler açısından daha dikkatli olmaları gerekmektedir.
Anahtar Kelimeler
Kaynakça
- 1. Kaplan JA, Thys DM. Electrocardiography. In: Miller RD Anesthesia Vol.1 3th ed. Churchill Livingstone 1990: 1101-1127.
- 2. Davies JM. Complication of general anaesthesia. In: Nimmo WS, Smith G. Anesthesia Vol. 1 Blackwell Scientific Publications 1989: 502-521.
- 3. Booker PD, Whyte SD, Ladusans EJ. Long QT syndrome and anaesthesia. Br J Anaesth 2003; 90: 349–66.
- 4. Al-Refai A, Gunka V, Douglas J. Spinal anesthesia for Cesarean section in a parturient with long QT syndrome. Can J Anaesth. 2004; 51: 993-6.
- 5. Arildsen H, May O, Christian EH, et al. Increased QT dispersion in patients with insulin dependent diabetes mellitus. International Journal of Cardiology 1999; 71: 235-42.
- 6. Andreoli T, Bennett CJ, Carpenter CJ, Plum F, Smith LH. Cecil Essentials of Medicine,Elektrokardiografi,1993: 21-23.
- 7. Guglielminotti, J, Alzieu, M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation. Clinical Investigations in Critical Care. 2000; 118: 1095-1099.
- 8. Giakoumidakis K, Kostaki Z, Patelarou E, Baltopoulos G, Brokalaki H. Oxygen Saturation and Secretion Weight After Endotracheal Suctioning. British Journal of Nursing, 2011; 20(21): 1344-135.
- 9. American association for respiratory care: AARC clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care, 2010; 55(6): 758-764.
- 10. Pedersen,MC, Rosandalh-Neilsen M, Hjerment J, Egerod I. Endotracheal suctioning of the adult intubated patient; What is the evidence? Intensive and Critical Care Nursing, 2009; 25(1): 21- 30.
- 11. Majeed S, Majee A, Shambhavi M. Effectiveness of planned teaching programme on knowledge and practice ofendotracheal suctioning among staff nurses in selected hospitals of mangalore. Asian J. Nursing Edu. and Research, 2013; 3(4): 243-247.
- 12. Beuret, P, Roux C, Constan A, Mercat A, Brochard L. Discrepancy between guidelines and practice of tracheal suctioning in mechanically ventilated patients; A french multicenter observational study. İntevsive care med, 2013; 39: 1335-1336.
- 13. Moss AJ, Long QT. Syndrome. JAMA. 2003; 289: 2041.
- 14. Drici MD, Cle´ment N. Is gender a risk factor for adverse drug reactions? The example of drug-induced long QT syndrome. Drug Saf. 2001; 24: 575.
- 15. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation. 2010; 121: 1047.
- 16. Kopp BJ, Erstad BL, Allen ME, et al. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Crit Care Med. 2006; 34: 415–25.
- 17. Krishnan V, Murray P. Pharmacologic issues in the critically ill. Clin Chest Med. 2003; 24: 671–88.
- 18. Avcı O, Gürsoy S, Kaygusuz K, Özdemir Kol İ, Düger C, İsbir C The effects of sedative agents used in intensive care unit on QT interval. Cumhuriyet Medical Journal 2017; 39: 417-429.
- 19. Kane-Gill SL, Weber RJ. Principles and practices of medication safety in the ICU. Crit Care Clin. 2006; 22: 273–90.
- 20. Goldstein DS. The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke. 1979; 10: 253.
- 21. Cooke RA, Chambers JB, Singh R, et al. QT interval in anorexia nervosa. Br Heart J. 1994; 72: 69.
- 22. Pickham D, Helfenbein E, Shinn JA, Chan G, Funk M, Weinacker A, et al. High prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality: Results of the QT in Practice (QTIP) Study. Crit Care Med 2012; 40: 394-9.
- 23. Tisdale JE, Wroblewski HA, Overholser BR, Kingery JR, Trujillo TN, Kovacs RJ. Prevalence of QT interval prolongation in patients admitted to cardiac care units and frequency of subsequent administration of QT interval-prolonging drugs: A prospective, observational study in a large urban academic medical center in the US. Drug Saf 2012; 35: 459-70.
- 24. Kozik TM, Wung SF. Acquired long QT syndrome: Frequency, onset, and risk factors in intensive care patients. Crit Care Nurse 2012; 32: 32-41.
- 25. Owczuk R, Wujtewicz MA, Sawicka A, Piankowski A, Polak-Krzeminska A. The effect of intravenous lidocaine on QT changes during tracheal intubation. Anaesthesia, 2008;63:924-931.
- 26. Andreoli T, Bennett CJ, Carpenter CJ, Plum F, Smith LH. Cecil Essentials of Medicine, Elektrokardiografi,1993: 21-23.
Öz
Objective: The intensive care unit (ICU) environment and applied methods may lead
to a significant stimulation of sympathoadrenal activity. There
are studies about the direct connection between increased plasma catecholamine
levels during sympathetic activation and QT interval. Therefore, the aim of
this study is to determine the effects of endotracheal aspiration on QT
interval and QT dispersion.
Method: 90 patients
connected to a mechanical ventilator from the ages of 30-70 in ICU were taken
into study. Patients taking any drug that prolongs QT, patients with unstable
hemodynamia and congenital QT prolongation were excluded. Preoxygenation was
done to all patients with 100% O2 administration for 1 minute before
the endotracheal aspiration (ET). Age, diagnosis, weight, systolic blood
pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP),
heart rate (HR), peripheral oxygen saturation (SpO2), QT, QTc,
Glasgow Coma Score (GCS) values were recorded before, during, 5 minutes after
and 10 minutes after the ET aspiration.
Results: During ET
aspiration, the mean QTc value was 445.1±23.0 milliseconds (ms), the mean QT
value was 379.2±19.3 ms. In 14% of
the patients included in the study, basal QTc values above 420 ms were found to
be prolonged. According to basal values, QT and QTc intervals were prolonged in
almost all patients during, 5 minutes after and 10 minutes after the ET
aspiration.
Conclusions: QT interval prolongation should always be
checked by calculating corrected QT interval, and ICU physicians need to be
more careful in patients with coronary heart disease and congenital prolonged QT
interval in terms of fatal ventricular arrhythmias.
Anahtar Kelimeler
Kaynakça
- 1. Kaplan JA, Thys DM. Electrocardiography. In: Miller RD Anesthesia Vol.1 3th ed. Churchill Livingstone 1990: 1101-1127.
- 2. Davies JM. Complication of general anaesthesia. In: Nimmo WS, Smith G. Anesthesia Vol. 1 Blackwell Scientific Publications 1989: 502-521.
- 3. Booker PD, Whyte SD, Ladusans EJ. Long QT syndrome and anaesthesia. Br J Anaesth 2003; 90: 349–66.
- 4. Al-Refai A, Gunka V, Douglas J. Spinal anesthesia for Cesarean section in a parturient with long QT syndrome. Can J Anaesth. 2004; 51: 993-6.
- 5. Arildsen H, May O, Christian EH, et al. Increased QT dispersion in patients with insulin dependent diabetes mellitus. International Journal of Cardiology 1999; 71: 235-42.
- 6. Andreoli T, Bennett CJ, Carpenter CJ, Plum F, Smith LH. Cecil Essentials of Medicine,Elektrokardiografi,1993: 21-23.
- 7. Guglielminotti, J, Alzieu, M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation. Clinical Investigations in Critical Care. 2000; 118: 1095-1099.
- 8. Giakoumidakis K, Kostaki Z, Patelarou E, Baltopoulos G, Brokalaki H. Oxygen Saturation and Secretion Weight After Endotracheal Suctioning. British Journal of Nursing, 2011; 20(21): 1344-135.
- 9. American association for respiratory care: AARC clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care, 2010; 55(6): 758-764.
- 10. Pedersen,MC, Rosandalh-Neilsen M, Hjerment J, Egerod I. Endotracheal suctioning of the adult intubated patient; What is the evidence? Intensive and Critical Care Nursing, 2009; 25(1): 21- 30.
- 11. Majeed S, Majee A, Shambhavi M. Effectiveness of planned teaching programme on knowledge and practice ofendotracheal suctioning among staff nurses in selected hospitals of mangalore. Asian J. Nursing Edu. and Research, 2013; 3(4): 243-247.
- 12. Beuret, P, Roux C, Constan A, Mercat A, Brochard L. Discrepancy between guidelines and practice of tracheal suctioning in mechanically ventilated patients; A french multicenter observational study. İntevsive care med, 2013; 39: 1335-1336.
- 13. Moss AJ, Long QT. Syndrome. JAMA. 2003; 289: 2041.
- 14. Drici MD, Cle´ment N. Is gender a risk factor for adverse drug reactions? The example of drug-induced long QT syndrome. Drug Saf. 2001; 24: 575.
- 15. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation. 2010; 121: 1047.
- 16. Kopp BJ, Erstad BL, Allen ME, et al. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Crit Care Med. 2006; 34: 415–25.
- 17. Krishnan V, Murray P. Pharmacologic issues in the critically ill. Clin Chest Med. 2003; 24: 671–88.
- 18. Avcı O, Gürsoy S, Kaygusuz K, Özdemir Kol İ, Düger C, İsbir C The effects of sedative agents used in intensive care unit on QT interval. Cumhuriyet Medical Journal 2017; 39: 417-429.
- 19. Kane-Gill SL, Weber RJ. Principles and practices of medication safety in the ICU. Crit Care Clin. 2006; 22: 273–90.
- 20. Goldstein DS. The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke. 1979; 10: 253.
- 21. Cooke RA, Chambers JB, Singh R, et al. QT interval in anorexia nervosa. Br Heart J. 1994; 72: 69.
- 22. Pickham D, Helfenbein E, Shinn JA, Chan G, Funk M, Weinacker A, et al. High prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality: Results of the QT in Practice (QTIP) Study. Crit Care Med 2012; 40: 394-9.
- 23. Tisdale JE, Wroblewski HA, Overholser BR, Kingery JR, Trujillo TN, Kovacs RJ. Prevalence of QT interval prolongation in patients admitted to cardiac care units and frequency of subsequent administration of QT interval-prolonging drugs: A prospective, observational study in a large urban academic medical center in the US. Drug Saf 2012; 35: 459-70.
- 24. Kozik TM, Wung SF. Acquired long QT syndrome: Frequency, onset, and risk factors in intensive care patients. Crit Care Nurse 2012; 32: 32-41.
- 25. Owczuk R, Wujtewicz MA, Sawicka A, Piankowski A, Polak-Krzeminska A. The effect of intravenous lidocaine on QT changes during tracheal intubation. Anaesthesia, 2008;63:924-931.
- 26. Andreoli T, Bennett CJ, Carpenter CJ, Plum F, Smith LH. Cecil Essentials of Medicine, Elektrokardiografi,1993: 21-23.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Mart 2019 |
| Kabul Tarihi | 25 Mart 2019 |
| Yayımlandığı Sayı | Yıl 2019Cilt: 41 Sayı: 1 |