Farklı O2 (Oksijen) konsantrasyonlarının basınç kontrollü ters orantılı ventilasyon modunda (PC-İRV) intrapulmoner şanta etkisi

Abstract

SUMMARY Ten patients were included in this study who did not have any diffuse paranchimal pulmonary pathologies but supported by mechanic ventilation for respiratory insuffiency. Patients were entubated for mechanic ventilation after intravenous administration of penthotal (7 mg/kg) and lysthenon (1-2 mg/kg). Patients were supported by a ventilator in CMV mode. After the insersion of a canule in the radial artery; sistolic, diastolic and mean arterial pressures were obserwed and blood gases were analysed. A Swan-Ganz cathether was introduced via the internal jugular vena. In order to perform a reversed ranged ventilation mode the pressure of the ventilator was adjusted as follows: İ/E as 2/1, TV as 10-12 ml/kg and f as 10 ventilation number/min. Fi02 was raised from 0.2 up to 1.0 by a latency period of 30 minutes ventilation in every Fi02 raise and blood samples were taken from pulmonary and radial arteries. Blood gas values were observed. Arterial 02 pressure (Pa02), arterial 02 saturation (Sa02), pulmonary artery pressure (Pv02), pulmonary artery saturation (Sv02) arterial C02 pressure (PaC02), mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), mean pulmonary arterial pressure (MPAP), pulmonary arterial occlussion pressure (PAOP) were all recorded. Cardiac output was measured by termodilution method (Oxymetric 3 Abbott). Cardiac output (CD), Cardiac index (CI), arterial 02 (CaOj), pulmonary arter 02 (Cv02), pulmonary vascular resistance (PVR), systemic vascular resistance(SVR) were automatically recorded. Intrapulmonary shunt calculation was made according to the above values. The intrapulmonary shunt percentage in Fi02 : 0.21 group was accepted as the control group. The difference that was observed between Fi02 increase and the values of MAP, CVP, HR, MPAP, PAOP, CDI, CI, SVR, PVR, PaC02 was not statistically 37significant (p>0.05). Besides Fi02 increase, the values of Pa02, Sa02, Pv02, Sv02, Pa02, Ca02, and Cv02 were also increased (p< 0.001). Percentage of shunt was changed with the increase in Fi02. When Fi02 was increased up to 0.40 the percentage of the shunt decreased and stayed constant when FiOz was equal to 0.50. When Fi02 raised over 0.60 the percentage of shunt was also increased. As a result, it was assessed that Fi02 concentrations were not affecting the cardiovascular parameters. But intrapulmonary shunt values were decreased when Fi02 pressures were up to 0.40 and increased when Fi02 was 0.60. For this reason pulmonary functions should be evaluated when Fi02 was 0.60. Besides, Fi02 should be decreased in order to gain a satisfactory 02 pressure value for the patients. 38

SUMMARY Ten patients were included in this study who did not have any diffuse paranchimal pulmonary pathologies but supported by mechanic ventilation for respiratory insuffiency. Patients were entubated for mechanic ventilation after intravenous administration of penthotal (7 mg/kg) and lysthenon (1-2 mg/kg). Patients were supported by a ventilator in CMV mode. After the insersion of a canule in the radial artery; sistolic, diastolic and mean arterial pressures were obserwed and blood gases were analysed. A Swan-Ganz cathether was introduced via the internal jugular vena. In order to perform a reversed ranged ventilation mode the pressure of the ventilator was adjusted as follows: İ/E as 2/1, TV as 10-12 ml/kg and f as 10 ventilation number/min. Fi02 was raised from 0.2 up to 1.0 by a latency period of 30 minutes ventilation in every Fi02 raise and blood samples were taken from pulmonary and radial arteries. Blood gas values were observed. Arterial 02 pressure (Pa02), arterial 02 saturation (Sa02), pulmonary artery pressure (Pv02), pulmonary artery saturation (Sv02) arterial C02 pressure (PaC02), mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), mean pulmonary arterial pressure (MPAP), pulmonary arterial occlussion pressure (PAOP) were all recorded. Cardiac output was measured by termodilution method (Oxymetric 3 Abbott). Cardiac output (CD), Cardiac index (CI), arterial 02 (CaOj), pulmonary arter 02 (Cv02), pulmonary vascular resistance (PVR), systemic vascular resistance(SVR) were automatically recorded. Intrapulmonary shunt calculation was made according to the above values. The intrapulmonary shunt percentage in Fi02 : 0.21 group was accepted as the control group. The difference that was observed between Fi02 increase and the values of MAP, CVP, HR, MPAP, PAOP, CDI, CI, SVR, PVR, PaC02 was not statistically 37significant (p>0.05). Besides Fi02 increase, the values of Pa02, Sa02, Pv02, Sv02, Pa02, Ca02, and Cv02 were also increased (p< 0.001). Percentage of shunt was changed with the increase in Fi02. When Fi02 was increased up to 0.40 the percentage of the shunt decreased and stayed constant when FiOz was equal to 0.50. When Fi02 raised over 0.60 the percentage of shunt was also increased. As a result, it was assessed that Fi02 concentrations were not affecting the cardiovascular parameters. But intrapulmonary shunt values were decreased when Fi02 pressures were up to 0.40 and increased when Fi02 was 0.60. For this reason pulmonary functions should be evaluated when Fi02 was 0.60. Besides, Fi02 should be decreased in order to gain a satisfactory 02 pressure value for the patients. 38