Öz

Amaç: Akut respiratuvar distres sendromunun (ARDS) tedavi stratejileri oldukça karmaşık, mortalitesi yüksektir. Mekanik ventilasyonda soluk sonu pozitif basınç (PEEP) titrasyonunun önemi büyüktür. Ancak PEEP titrasyonuna optimal yaklaşım net olarak belirlenememiştir. Çalışmamızda basınç-volüm eğrisi üzerinden farklı PEEP seviyelerindeki volüm kazancı (gain), modifiye çoklu azot yıkama tekniği ile ölçülen soluk sonu akciğer hacmi (EELV) değişimi ve kompliyansın, solunum mekanikleri ile değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Etik Kurul onayı alındıktan sonra yoğun bakım ünitelerinde invaziv mekanik ventilasyon uygulanan 14 ARDS hastası çalışmaya alındı. Berlin Kriterlerine göre; 2 hafif, 7 orta, 5 ağır ARDS hastasıydı. Azalan PEEP titrasyon prosedürü (±5 cm H2O) ile fonksiyonel rezidüel kapasite (FRK) ve EELV, çoklu azot yıkama tekniği ile ölçüldü. İntratrakeal basınç sensörü ile oluşturulan dinamik basınç-volüm eğrileri üzerinden kazanç ve kompliyans ölçüldü. Her PEEP düzeyinde arteriyel kan gazı ile oksijenasyon değerlendirildi.

Bulgular: En yüksek kompliyans, kazanç, EELV değerine ve en düşük sürücü basınç değerine 10 cm H2O PEEP düzeyinde ulaşıldı. Oksijenasyon göstergesi olan PaO2’nin en yüksek değerleri 15 cm H2O PEEP düzeyinde ölçüldü. Kazancın; kompliyans, elastans, sürücü basıncı, statik strain ile anlamlı olarak değişmediği ve akciğer distansiyonuna duyarlı olmadığı görüldü.

Sonuç: PEEP titrasyonunda alveol distansiyonunun, EELV veya kazanç parametreleri ile belirlememediği görüldü. Klinik pratikte tek başına kullanılabilmesi için yeterli ve güçlü kanıtlar elde edilemedi. Bunun için daha fazla çalışmaya gerek vardır.

Anahtar Kelimeler: fonksiyonel rezidüel kapasite, kazanç, PEEP, EELV, pulmoner mekanikler

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Tanrıverdi SY, Kuvandık A, Tanrıverdi Ç, Sungurtekin H. ARDS hastalarının mekanik ventilasyonunda farklı PEEP düzeyleri ile soluk sonu akciğer hacmi ve pulmoner mekaniklerin değerlendirilmesi. Turk J Intensive Care. 2025;23(3):173-180. https://doi.org/10.63729/TJIC.2025.660