NONİNVAZİV MEKANİK VENTİLASYON DESTEĞİ OLAN VE OLMAYAN AKUT SOLUNUM YETMEZLİĞİNDE FONKSİYONEL BAĞIMSIZLIK VE KAS KUVVETİ

Yıl 2020, Cilt: 31 Sayı: 3, 247 - 254, 17.12.2020

Şahveren Çakartaş Deniz İnal İnce , Sema Savcı , Arzu Topeli İskit , Naciye Vardar Yağlı , Melda Sağlam , Meral Boşnak Güçlü , Hülya Arıkan , Ebru Çalik Kütükcü

https://doi.org/10.21653/tjpr.638459

Cited By: 1

Öz

Amaç: Akut solunum yetmezliği (ASY) sürecinde kas zayıflığı gelişimi sıktır. Bu çalışmanda yoğun bakımda ASY nedeni ile tek başına standart medikal tedavi (SMT) ve SMT’ye ek olarak noninvaziv mekanik ventilasyon (NIV) uygulanan olgularda kas kuvveti ve fonksiyonel bağımsızlığı karşılaştırılmak amaçlandı. Yöntem: Çalışmaya ASY ile izlenen 32 olgu (19 NIV ve 13 SMT) dahil edildi. Olguların özellikleri kaydedildi. Periferal kas kuvveti için Medical Research Council Skalası (MRC) kullanıldı ve el kavrama kuvveti ölçüldü. Fonksiyonel bağımsızlık düzeyi Barthel İndeksi (Bİ) ile değerlendirildi. Sonuçlar: NIV grubunda proksimal kas kuvveti (omuz abduktorleri) distal ekstremite kas kuvvetinden (el bileği ekstansorleri) anlamlı olarak daha düşüktü (p=0,030). Her iki grupta, proksimal alt ekstremite kas kuvveti (kalça fleksiyonu), distal ekstremite kas kuvveti (ayak bileği)’nden anlamlı olarak daha azdı (p=0,002). NIV grubunun Bİ toplam puanı SMT grubundan anlamlı olarak daha düşüktü (p=0,016). Bİ puanı, MRC toplam puanı (r=0,633) ve el kavrama kuvveti (r=0,629) ile ilişkiliydi (p<0,05). Tartışma: ASY nedeni ile NIV uygulanan hastalarda fonksiyonel bağımsızlık ve distal kas kuvveti ile karşılaştırıldığında proksimal kas kuvveti olumsuz yönde etkilenmektedir. Yoğun bakımda rehabilitasyon uygulamalarında zayıflık veya fonksiyonel kısıtlılığın hastaların uygun fonksiyon görmesini engelleyebileceği göz önünde bulundurulmalıdır.

Anahtar Kelimeler

Yoğun Bakım, Kas Kuvveti, Noninvaziv Ventilasyon, Solunum Yetmezliği

FUNCTIONAL INDEPENDENCE AND MUSCLE STRENGTH IN ACUTE RESPIRATORY FAILURE WITH AND WITHOUT NON-INVASIVE MECHANICAL VENTILATORY SUPPORT

Öz

Purpose: Development of muscle weakness is common in the course of acute respiratory failure (ARF). This study aimed to compare muscle strength and physical function in subjects with ARF undergoing noninvasive mechanical ventilation (NIV) added to standard medical treatment (SMT) and SMT only in the intensive care unit. Methods: Thirty-two subjects with ARF (19 NIV and 13 SMT) were included. Subject characteristics were recorded. Peripheral muscle strength was measured using the Medical Research Council Scale (MRC) and handgrip strength. Functional independence was evaluated using the Barthel Index (BI). Results: In the NIV group, proximal muscle strength (shoulder abduction) was significantly lower than distal limb strength (wrist extension) (p=0.030). In both groups, proximal lower limb strength (hip flexion) was also significantly lower than distal limb strength (ankle dorsiflexion) (p=0.002). The BI total score was significantly lower in the NIV group than that of the SMT group (p=0.016). The BI score was significantly related to the MRC sum score (r=0.633) and handgrip strength (r=0.629, p<0.05). Conclusion: Functional independence and proximal muscle strength compared to distal adversely affected in patients undergoing NIV for ARF. Weakness or functional limitations may prevent patients from functioning adequately in rehabilitation practices in intensive care.

Anahtar Kelimeler

Intensive care, muscle strength, noninvasive ventilation

Kaynakça

• Referans 1. Ali NA, O'Brien JM, Hoffmann SP, Phillips G, Garland A, Finley JC, et al Acquired weakness, handgrip strength, and mortality in critically ill subjects. Am J Respir Crit Care Med. 2008;178(3):261-8.
• Referans 2. Hashem MD, Parker AM, Needham DM. Early mobilization and rehabilitation of patients who are critically ill. Chest. 2016;150(3):722-31.
• Referans 3. Hodgson CL, Tipping CJ. Physiotherapy management of intensive care unit-acquired weakness. J Physiother 2017;63(1):4-10.
• Referans 4. Vanpee G, Hermans G, Segers J, Gosselink R. Assessment of limb muscle strength in critically ill subjects: a systematic review. Crit Care Med. 2014;42(3):701-11
• Referans 5. Boldrini R, Fasano L, Nava S. Noninvasive mechanical ventilation. Curr Opin Crit Care. 2012;18(1):48-53.
• Referans 6. Nava S. Behind a mask: tricks, pitfalls, and prejudices for noninvasive ventilation. Respir Care. 2013;58(8):1367-76.
• Referans 7. McNeill GBS, Glossop AJ. Clinical applications of non-invasive ventilation in critical care. Contin Educ Anaesth Crit Care Pain. 2012;12(1):33-7.
• Referans 8. Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014;42(5):1178-86.
• Referans 9. Dyer F, Flude L, Bazari F, Jolley C, Englebretsen C, Lai D. Non-invasive ventilation (NIV) as an aid to rehabilitation in acute respiratory disease. BMC Pulm Med. 2011;11:58.
• Referans 10. Inal-Ince D, Savci S, Topeli A, Arıkan H. Active cycle of breathing techniques in non-invasive ventilation for acute hypercapnic respiratory failure. Aust J Physiother. 2004;50(2):67-73.
• Referans 11. Zanni JM, Korupolu R, Fan E, Pradhan P, Janjua K, Palmer JB, et al. Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project. J Crit Care 2010;25(2):254-62.
• Referans 12. De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288(22):2859-67.
• Referans 13. Cottereau G, Dres M, Avenel A, Fichet J, Jacobs FM, Prat D, et al. Handgrip strength predicts difficult weaning but not extubation failure in mechanically ventilated subjects. Respir Care. 2015;60(8):1097-104.
• Referans 14. Silveira LTYD, Silva JMD, Soler JMP, Sun CYL, Tanaka C, Fu C. Assessing functional status after intensive care unit stay: the Barthel Index and the Katz Index. Int J Qual Health Care. 2018;308(4):265-270.
• Referans 15. Vanpee G, Segers J, Van Mechelen H, Wouters P, Van den Berghe G, Hermans G, et al. The interobserver agreement of handheld dynamometry for muscle strength assessment in critically ill subjects. Crit Care Med. 2011;39(8):1929-34.
• Referans 16. Pati S, Goodfellow JA, Iyadurai S, Hilton-Jones D. Approach to critical illness polyneuropathy and myopathy. Postgrad Med. 2008;84(993):354-60.
• Referans 17. Elliot D, Denehy L, Berney S, Alison JA. Assessing physical function and activity for survivors of a critical illness: a review of instruments. Aust Crit Care. 2011;24(3):155-66.
• Referans 18. Fan E, Ciesla N, Truong AD, Bhoopathi V, Zeger SL, Needham DM. Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated subjects. Intensive Care Med. 2010;36(6):1038-43.
• Referans 19. Baldwin CE, Paratz JD, Bersten AD. Muscle strength assessment in critically ill subjects with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation. J Crit Care. 2013;28(1):77-86.
• Referans 20. Puthucheary Z, Montgomery H, Moxham J, Harridge S, Hart N. Structure to function: muscle failure in critically ill subjects. J Physiol. 2010;588(pt23):4641-48.