Hiperkapnik Solunum Yetmezliği Olan Hastalarda Karbondioksit Klirensinin Klinik Prognoza Etkisi

Abstract

Aim: Hypercapnic respiratory failure is defined as a carbon dioxide (CO2) level >45 mmHg. High PaCO2 levels are related with increased mortality in acute exacerbation of COPD. In our study, we aimed to determine CO2 clearance value for predicting patients' prognosis. Material and Methods: 68 patients were included in the study. The patients were divided into two as, good and poor prognosis groups according to the outcome. The patients’ demographic information, comorbidities, vital parameters, blood gas results on admission (first measurement) and in the first sixth hour (second measurement), treatment, and outcomes were recorded in data forms. The relation between CO2 change and outcome was evaluated. Results: There was no statistically significant difference in CO2 clearance and delta pCO2 levels between the good and poor prognosis groups (11.7±12 vs. 6.2 ± 23, p=0.205 and -11.77±12.92 mmHg vs. -7.66±24.76 mmHg, p=0.281 respectively). NaHCO3 levels in the second measurement were higher than the first measurement in both good (23.89 ±5.28, 25.78±4.39, p<0.0001) and poor prognosis (23,26±6.05, 23.53 ± 5.05, p<0.0001) groups. And also, pCO2 levels in the second measurement was lower than the first measurement in the good (60.68 ± 11.89, 48.92 ± 14.02, p=0.007) and poor (68.04 ± 20.15, 61.76 ± 22.87, p=0.007) prognosis groups. There was also a significant decrease in lactate levels in the poor prognosis group between the first and the second measurements (p<0.001). Conclusion: Our study revealed that the CO2 clearance calculated in the first six hours in hypercarbic patients who came to the emergency department with shortness of breath was not useful in predicting the short-term prognosis of the patients. However, delta lactate and delta NaHCO3 levels significantly changed in the poor prognosis group.