Abstract
Amaç: Beyin kan akımını ve
dokulara oksijen sunumunu etkileyen çeşitli durumlarda (boğulma, arrest,
asfiksi gibi) gelişebilen hipoksik iskemik beyin hasarı önemli bir morbidite ve
mortalite nedenidir. Bu çalışmanın amacı son iki yılda çocuk yoğun bakım
ünitesi'nde akut hipoksi nedeniyle yatan hastaların etyoloji, klinik
özellikler, tedavi ve yakın dönem nörolojik takip sonuçlarının
değerlendirilmesidir.
Gereç ve Yöntemler: Çalışmaya
Mayıs2017- Nisan 2019 tarihleri arasında ÇYBÜ'ye yatırılan 1 ay-18 yaş arası
daha öncesinden sağlıklı , mental ve motor gelişim basamakları normal olan akut
hipoksi nedeniyle yatırılan 25 hasta
alındı.ÇYBÜ'de arrest sonrası değerlendirme için Pediatrik Serebral Performans Kategori
Skorlama Sistemi (PCPC) kullanıldı.
Bulgular:Hastaların geliş Glaskow koma skalası (GKS) median:6 (min:3
max:15) iken; yoğun bakımdan çıkış GKS: 10 (min:6 max:15) olarak tespit
edildi(p<0,05).. Hastaların arrest olduktan hemen sonra kan gazında asidozda
oldukları, Hco3'ün belirgin düşük olduğu,pH: (min:6.91 - max:
7.49); Laktat'ın yüksek (min:8 - max: 145); AST'nin
min:21 - max:712 ve CK'nın yüksek (min:47
- max:3351) olduğunu ve ÇYBÜ'ye yatırılıp hızlıca
uygun tedavi başlandıktan 24 saat sonra hastaların asidozdan çıktığı pH:
(min:7.23 - max:7.61); AST (min:15 - max:83) ;ALT (min:6 - max:45)ve CK (min:16 -
max:258) ve Laktat'ın (min:8 - max:93) gerilediğini gördük ve bu
sonuçlar istatiksel olarak anlamlı
saptandı.( p<0,05)
Sonuç: Akut Hipoksinin patofizyolojisinin iyi anlaşılması,
erken dönemde tedavi stratejilerinin geliştirilerek beynin hasardan korunması
gereklidir.Olguların nörolojik izlemi ve yardımcı görüntüleme tetkikleri ile
hasarın ciddiyeti ve prognoz üzerine etkileri araştırılıp en uygun tedavi
yapılmalıdır. Akut hipoksiden geçen çocuklarda nörolojik sekel riskini en aza
indirmek için hastalar resusitasyon sonrası en erken dönmede ÇYBÜ'ye
yatırılmalı ve multidisipliner tedavi edilmelidir.
Keywords
Supporting Institution
Bu çalışmayı destekleyen herhangi bir kurum/kuruluş yoktur.
References
- 1. Kitai Y et al. Long-term outcome of childhood hypoxic-ischemic encephalopathy. No To Hattatsu 2015; 47: 43-48.
- 2. Mandel, R et al. Prediction of outcome after hypoxic-ischemic encephalopathy: a prospective clinical and electrophysiologic study. J Pediatr 2002; 141: 45-50.
- 3. Wong CP et al. Incidence, aetiology, and outcome of non-traumatic coma: a population based study. Arch Dis Child 2001; 84: 193-99.
- 4. Abend NS, Licht DJ. Predicting outcome in children with hypoxic ischemic encephalopathy. Pediatr Crit Care Med 2008; 9: 32-39.
- 5. Polat İK et al. Hipoksik İskemik Beyin Hasarı. Turkiye Klinikleri J Pediatr Sci 2018; 14: 30-36.
- 6. Kochanek PM et al. Cerebral resuscitation after traumatic brain injury and cardiopulmonary arrest in infants and children in the new millennium. Pediatr Clin North Am 2001; 48: 661-81.
- 7. Moler FW et al. Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Crit Care Med 2011; 39: 141-49.
- 8. Carter BG, Taylor A, Butt W. Severe brain injury in children: long-term outcome and its prediction using somatosensory evoked potentials (SEPs). Intensive Care Med 1999; 25: 722-28.
- 9. Ronco R et al. Outcome and cost at a children's hospital following resuscitation for out-of-hospital cardiopulmonary arrest. Arch Pediatr Adolesc Med 1995; 149: 210-14.
- 10. Alsina M et al. The Severity of Hypoxic-Ischemic Encephalopathy Correlates With Multiple Organ Dysfunction in the Hypothermia Era. Pediatr Crit Care Med 2017; 18: 234-40.
Recent neurological outcomes of patients admitted to pediatric intensive care unit for acute hypoxia
Abstract
Aim:
Hypoxic ischemic brain injury is an important cause of morbidity and mortality
in all age groups. It may develop in various conditions (such as drowning,
arrest, asphyxia ) affecting brain blood flow and oxygen supply to tissues. The
aim of this study was to evaluate the etiology, clinical features, treatment
and recent neurological follow-up outcomes of the patients hospitalized for
acute hypoxia in the pediatric intensive care unit (PICU) in the last two
years.
Material and Methods:
The study included 25 patients whose age was 1 month-18 years and hospitalized
in the PICU with complaint of acute hypoxia in between May 2017 and April 2019.
The patients were previously having normal mental and motor development levels.
Pediatric Cerebral Performance Category Scoring System (PCPC) was used for
evaluation.
Results:
The median Glaskow coma scale (GCS) was 6 (min: 3 max: 15) at admission
compared with the median GCS: 10 (min: 6
max: 15) at the time of discharge from PICU (p<0,05). The tests immediately after the
cardiac arrest revealed that the patients were in acidosis in blood gas test pH: (min:6.91 - max: 7.49);, Hco3 was lower, Laktat was high (min:8 - max: 145); AST (min:21 - max:712) ve
CK was high (min:47 - max:3351) compared with the results measured 24 hours after the appropriate treatment was
started the patients were released from acidosis pH:
(min:7.23 - max:7.61); AST (min:15 - max:83) ;ALT (min:6 - max:45)ve CK (min:16 -
max:258) ve Laktat'ın (min:8 - max:93) were
measured as in between normal limits and the differences were found to be
statistically significant (p <0.05).
Conclusion:
It is necessary to understand the pathophysiology of acute hypoxia and to
protect the brain from damage by developing treatment strategies in the early
period. The most appropriate treatment should be started while making close
neurological follow up and trying to understand the severity of damage and
effects on prognosis of these patients. To minimize the
risk of neurological sequelae in pediatric patients undergoing acute hypoxia,
in earlier period of admission these patients should be hospitalized in the PICU
and managed by multidisciplinary team.
References
- 1. Kitai Y et al. Long-term outcome of childhood hypoxic-ischemic encephalopathy. No To Hattatsu 2015; 47: 43-48.
- 2. Mandel, R et al. Prediction of outcome after hypoxic-ischemic encephalopathy: a prospective clinical and electrophysiologic study. J Pediatr 2002; 141: 45-50.
- 3. Wong CP et al. Incidence, aetiology, and outcome of non-traumatic coma: a population based study. Arch Dis Child 2001; 84: 193-99.
- 4. Abend NS, Licht DJ. Predicting outcome in children with hypoxic ischemic encephalopathy. Pediatr Crit Care Med 2008; 9: 32-39.
- 5. Polat İK et al. Hipoksik İskemik Beyin Hasarı. Turkiye Klinikleri J Pediatr Sci 2018; 14: 30-36.
- 6. Kochanek PM et al. Cerebral resuscitation after traumatic brain injury and cardiopulmonary arrest in infants and children in the new millennium. Pediatr Clin North Am 2001; 48: 661-81.
- 7. Moler FW et al. Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Crit Care Med 2011; 39: 141-49.
- 8. Carter BG, Taylor A, Butt W. Severe brain injury in children: long-term outcome and its prediction using somatosensory evoked potentials (SEPs). Intensive Care Med 1999; 25: 722-28.
- 9. Ronco R et al. Outcome and cost at a children's hospital following resuscitation for out-of-hospital cardiopulmonary arrest. Arch Pediatr Adolesc Med 1995; 149: 210-14.
- 10. Alsina M et al. The Severity of Hypoxic-Ischemic Encephalopathy Correlates With Multiple Organ Dysfunction in the Hypothermia Era. Pediatr Crit Care Med 2017; 18: 234-40.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Orıgınal Artıcle |
| Authors | |
| Publication Date | September 30, 2019 |
| Published in Issue | Year 2019 Volume: 10 Issue: 3 |
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e-ISSN: 2149-8296
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