Akut solunum yetmezliğinde optik sinir kılıf çapının prognostik önemi

Year 2022, Volume: 47 Issue: 3, 1187 - 1196, 30.09.2022

Mehmet Göktuğ Efgan , Zeynep Karakaya , Adnan Yamanoğlu , Ahmet Kayalı

https://doi.org/10.17826/cumj.1128786

Abstract

Amaç: Bu çalışmanın birincil amacı, hipoksemik solunum yetmezliği ve hiperkarbik solunum yetmezliği ayrımında ultrasonografi kullanılarak ölçülen ONSD'nin rolünü belirlemekti. Çalışmanın ikincil amacı, hiperkarbik hastaların klinik sonuçlarını tahmin etmede ONSD'nin değerini belirlemektir.
Gereç ve Yöntem: Bu çalışmaya dispne ile başvuran travmatik olmayan yetişkin hastalar dahil edildi. Çalışmaya başvuran tüm hastalardan başvuru sırasında ve tedavinin ikinci saatinde arter kan gazı ve eş zamanlı ONSD ölçümleri alındı. Hastalar hipoksik ve hiperkarbik solunum yetmezliği olmak üzere iki gruba ayrıldı. Hasta sayısı kadar sağlıklı gönüllüler çalışmaya dahil edildi.
Bulgular: Tip 1 solunum yetmezliği olan 24 hastada ortalama ONSD değerleri 3,8±0,2 mm, tip 2 solunum yetmezliği olan 25 hastada 5,2 ± 0,5 mm ve sağlıklı kontrollerde 3,9±0,3 mm idi. Hiperkarbik hastaların ONSD'si, hipoksik hastaların ve sağlıklı gönüllülerinkinden istatistiksel olarak anlamlı derecede daha yüksekti. Hiperkarbik hastaların ONSD'leri tedavi başlangıcında 5,2±0,5 mm ve tedavi sonrasında 4,4±0,6 mm idi ve aralarında istatistiksel olarak anlamlı fark vardı. Ancak ONSD farkı, hastaneye yatış ve mortaliteyi öngörmede istatistiksel olarak anlamlı değildi.
Sonuç: Sonografik olarak ölçülen ONSD, tip 1 ve tip 2 solunum yetmezliğinin ayırıcı tanısında etkili bir parametre olabilir. Tip 2 solunum yetmezliği olan hastalarda tedavi ile ONSD değerleri önemli ölçüde değişmiştir.

Keywords

Hiperkarbi, okuler usg, optik sinir kilif çapi, acil tıp.

Prognostic significance of the optic nerve sheath diameter in acute respiratory failure

Abstract

Purpose: The primary aim of this study was to determine the role of the optic nerve sheath diameter (ONSD) measured using ultrasonography in the differentiation of hypoxemic respiratory failure and hypercarbic respiratory failure. The secondary aim was to determine the value of ONSD in predicting the clinical outcome in hypercarbic patients.
Materials and Methods: Non-traumatic adult patients presenting with dyspnea were included in this study. Arterial blood gas and concurrent ONSD measurements were obtained from all patients included in the study during presentation and at the second hour of treatment. The patients were divided into two groups - hypoxic and hypercarbic respiratory failure. An equivalent number of healthy volunteers were enrolled as the control group.
Result: Mean ONSD values were 3.8±0.2 mm in the 24 patients with type 1 respiratory failure, 5.2 ± 0.5 mm in the 25 patients with type 2 respiratory failure, and 3.9±0.3 mm in the healthy controls. The ONSD of the hypercarbic patients was statistically significantly greater than that of the hypoxic patients and healthy volunteers. The ONSD of the hypercarbic patients was 5.2±0.5mm at baseline and 4.4±0.6 mm after treatment, the difference being statistically significant. However, the difference in ONSD was not statistically significant in predicting hospitalization and mortality.
Conclusion: Sonographically measured ONSD may be an effective parameter in the differential diagnosis of type 1 and 2 respiratory failure. ONSD values changed significantly with treatment in patients with type 2 respiratory failure.

Keywords

Hypercarbia, ocular ultrasonography, optic nerve sheath diameter, emergency medicine

References

• 1. Roussos C, Kutsoukou A. Respiratory failure. Eur Respir J 2003 ve 3-14, 22. 2. Naureckas ET, Wood LDH. Critical Care Emergency Medicine, s:370-377, Mc Graw Hill Education,2015.
• 3. Christiana C. Burt, Joseph E. Arrowsmith, Respiratory failure, Surgery (Oxford), 2009, Volume 27, Issue 11, Pages 475-479.
• 4. Özyılmaz E. Solunum Yetmezliği. Cukurova Medical Journal. 2014; 39(3):428 – 442.
• 5. David J. Feller-Kopman, MD . Richard M. Schwartzstein, MD. Up To Date. The evaluation, diagnosis, and treatment of the adult patient with acute hypercapnic respiratory failure. https://www.uptodate.com/contents/the-evaluation-diagnosis-and-treatment-of.
• 6. Nishiyama T, Matsukawa T, Yokoyama T, et al. Cerebrovascular carbon dioxide reactivity during general anesthesia: a comparison between sevoflurane and isoflurane. Anesth Analg. 1999;89:1437–1441.
• 7. Vigue B, Ract C, Zlotine N, et al. Relationship between intracranial pressure, mild hypothermia and temperature-corrected PaCO2 in patients with traumatic brain injury. Intensive Care Med. 2000;26:722–728.
• 8. Newman WD, Hollman AS, Dutton GN, Carachi R. Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 2002. s. 86(10):1109–13.
• 9. Zhang X, Medow JE, Iskandar BJ, et al. Invasıve andnonınvasive means of measuring intracranial pressure: a review. Physiol Meas. 2017;38(8):R143-182.
• 10. Wang LJ, Chen LM, Chen Y, et al. Ultrasonography assessments of optic nerve sheath diameter asa noninvasive and dynamic method of detecting changes in intracranial pressure. JAMA Ophthalmol. 2018;136(3):250-256.
• 11. Hansen HC, Helmke K. The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat. 1996;18(4):323-8.
• 12. Liu D, Kahn M. Measuremen and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol. 1993;116(5):548-560.
• 13. Roque PJ, Wu TS, Barth L, et al. Optic nerve ultrasound for the detection of elevated intracranial pressure in the hypertensive patient. Am J Emerg Med. 2012. s. 30(8):1357–63.
• 14. Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med. 2001;163(2):540-577.
• 15. Rochwerg B, Brochard L, Elliott MW, et.al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2):1602426.
• 16. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2020 Report. http://www.goldcopd.org (Accessed on January 29, 2020).
• 17. Soo Hoo GW, Santiago S, Williams AJ. Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure. Crit Care Med. 1994; 22(8):1253-1261.
• 18. Antón A, Güell R, Gómez J, et al. Predicting the result of noninvasive ventilation in severe acute exacerbations of patients with chronic airflow limitation. Chest 2000;117(3):828-833.
• 19. Czosnyka M. Association between arterial and intracranialpressures Br J Neurosurg. 2000, 14:127-8.
• 20. Seo H, Kim YK, Shin WJ, Hwang GS. Ultrasonographic optic nerve sheath diameter is correlated with arterial carbon dioxide concentration during reperfusion in liver transplant recipients. Transplant Proceedings. 2013. s. 45.
• 21. Doblar DD, Frenette L, Poplawski S, et al. Middle cerebral artery transcranial Doppler velocity monitoring during orthotopic liver transplantation: changes at reperfusionda report of six cases.
• 22. Doblar DD, Lim YC, Frenette L, et al. The effect of acute hypocapnia on middle cerebral artery transcranial Doppler velocity during orthotopic liver transplantation: changes at reperfusion.
• 23. Pott F, Larsen FS, Ejlersen E, et al. Cerebral perfusion during human liver transplantation. Clin Physiol. 1995 ve 15:119.
• 24. Joyce RR, McGee WT. Hypercapnic cerebral edema presenting in a woman with asthma: a case report. Journal of Medical Case Reports. 2011. s. 5:192.
• 25. Adnan Yamanoğlu, Nalan G. Çelebi Yamanoğlu, İsmet Parlak. The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients ve method?, best sonographic measurement.
• 26. Adnan Yamanoğlu, Nalan G. Çelebi Yamanoğlu, SEMİ ÖZTURK, et al. The value of the inferior vena cava ultrasound in the decision to hospitalise in patients with acute decompensated heart fail.
• 27. Baykal Y. Kronik obstrüktif akciğer hastalığı üzerinde epidemiyolojik bir araştırma.Tuberk Toraks ve 24:3–18. 1976.
• 28. Ray P, Birolleau S, Lefort Y,et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Critical care, 2006, 10.3: R82. Critical Care, s. 10:R82.
• 29. M Dinsmore, J S Han , J A Fisher , V W S Chan , L Venkatraghavan Effects of acute controlled changes in end-tidal carbon dioxide on the diameter of the optic nerve sheath: a transorbital ultrasonographic study in healthy volunteers.
• 30. Maissan IM, Dirven PJ, Haitsma IK, Hoeks SE, Gommers D,Stolker RJ. Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. Journal of Neurosurgery. 2015. s. 123.