Author/Editor		Drnovšek-Kaljanac, Majda; Koren, Igor
Title		Vzroki življenje ogrožajočega poslabšanja astme pri bolnikih, zdravljenih v enoti intenzivne terapije Bolnišnice Topolšica
Translated title		The precipitating factors of severe life threatening asthma exacerbation - experience of intensive care unit in Hospital Topolšica
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 70, št. 1
Publication year		2001
Volume		str. 1-5
Language		slo
Abstract		Background. The asthma exacerbation is especially in women in some countries still an important cause of death. In a five years long retrospective design we tried to identify the precipitating factors of severe life threatening asthma exacerbation of patients, treated in intensive care unit (ICU) of the pulmonary department in hospital Topolšica. Methods. We reevaluated the data of 46 patients treated for life threatening asthma exacerbation (LTAE), admitted to ICU from January 1994 to December 1998. The authors focused primarily on arterial blood gas analysis at admission as an indicator for further mechanical ventilation (MV), the difference in arterial blood gas analysis between mechanical ventilated and non ventilated group of patients, the use of pre-admitted therapy and of precipitating factors for asthma deterioration. Results. There were 36 women (78%), 73.0 +- 5.5 years old, and 10 men (22%), 54.0 +- 13.5 years old. Women to men ratio was 3.6 : 1. The average APACHE II at admission was 14.9 +- 5.8 and the mean stay in ICU was 5.7 +- 6.7 days. The preadmission regiment was as follows: inhaled B2 agonists 87%, metlyxsanthines 80%, inhaled corticosteroids 59%, systemic corticosteroids 48%, other therapies 13%. 12 patients (26%) were on MV for 7.8+- 7.7 days. The mean pH of the arterial blood gas sample in MV group was 7.2 +- 0.31, compared to non MV group 7.4 +- 0.12 (p<0.05). The mean pCO2 of MV group was 10.3 +- 2.8 kPa, and of non-MV group 5.6 +- 1.7 kPa (p<0.001). Peak expiratory flow rate (PEFR) at discharge increased 2.15 +- 0.79 folds. 3 patients died (6.5%), all of cardiac complication. The precipitating factors that started LTAE were: respiratory tract infections 48%, arrythmias 22%, undertreated asthma 13% heart failure 11%, unidentified factors 11%, pulmonary embolisms 6.5%, pneumothorax 2% and epilepsy 2%. (Abstract truncated at 2000 characters).
Summary		Izhodišča. Poslabšanje astme je zlasti pri ženskah v nekaterih deželah še vedno pomemben vzrok smrti. V petletnem retrospektivnem pregledu smo želeli opredeliti vzroke, ki so privedli do življenje ogrožajočega poslabšanja astme pri bolnikih, zdravljenjih v enoti intenzivne terapije (EIT) pljučnega oddelka Bolnišnice Topolšica. Metode. Preučili smo 64 bolnikov, sprejetih v EIT zaradi življenje ogrožajočega poslabšanja astme od januarja 1994 do decembra 1998. Osredotočili smo se na plinsko analizo arterijske krvi (PAAK) ob sprejemu kot kazalniku potrebe za nadaljnjo mehanično ventilacijo, razliko v PAAK med mehanično ventiliranim in neventiliranimi bolniki, zdravljenje pred sprejemom v EIT ter na vzroke, ki so privedli do življenje ogrožajočega stanja. Rezultati. Žensk je bilo 36 (78%), starih 73,0 +- 5,5 leta, moških pa 10 (22%), starih 54 +- 13,5 leta. Razmerje ženske: moški je bilo 3,6:1. Povprečni APACHE II na dan sprejema je bil 14,9 +- 6,7 dneva. Terapija pred sprejemom v EIT je bila naslednja: inhalacijski agonisti B2 87%, metilksantini 80%, inhalacijski glukokortikoidi 59%, sistemskiglukokortikoidi 48%, druga zdravila 13%. 12 bolnikov (26%) je ob sprejemu potrebovalo mehanično ventilacijo, povprečno 7,8 +- 7,7 dneva. Povprečni pH arterijske krvi mehanično ventiliranih bolnikov pred priključitvijo na ventilator je bil 7,2 +- 0,3, neventiliranih pa 7,4+-0,2 (p<0,05). Povprečni pCO2 pri mehanično ventiliranih bolnikih je bil10,3 +- 2,8 kPa, pri neventiliranih pa 5,6 +- 1,7 kPa (p,0,001). Največji ekspiratorni pretok (PEF) se je ob odpustu povečal za 2,15 +- 0,79-krat. Trije bolniki so umrli (6,5%), vsi zaradi zapletov s strani srca. Vzroki, ki so privedli do življenje ogrožajočega stanja, so bili: okužbe spodnjih dihal (48%), motnje srčnega ritma (22%), nezadostno zdravljena astma (13%), srčno popuščanje (11%), neugotovljeni sprožilci (11%), plučni embolizmi (6,5%), pnevmotoraks (2%), epilepsija (2%).(Izvleček prekinjen pri 2000 znakih.)
Descriptors		ASTHMA INTENSIVE CARE UNITS BLOOD GAS ANALYSIS RESPIRATORY TRACT INFECTIONS ARRHYTHMIA HEART FAILURE, CONGESTIVE RISK ASSESSMENT RESPIRATION, ARTIFICIAL