{"id":2231,"date":"2018-11-21T00:00:00","date_gmt":"2018-11-20T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/mekanik-ventilasyon-destegi-alan-dolasimsal-sok-hastalarinda-sivi-yanitinin-tahmininde-inferior-vena-cava-capi-degisim-indeksinin-degeri-sistematik-derleme-ve-meta-analiz\/"},"modified":"2022-04-06T16:43:53","modified_gmt":"2022-04-06T13:43:53","slug":"mekanik-ventilasyon-destegi-alan-dolasimsal-sok-hastalarinda-sivi-yanitinin-tahmininde-inferior-vena-cava-capi-degisim-indeksinin-degeri-sistematik-derleme-ve-meta-analiz","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2018\/11\/21\/mekanik-ventilasyon-destegi-alan-dolasimsal-sok-hastalarinda-sivi-yanitinin-tahmininde-inferior-vena-cava-capi-degisim-indeksinin-degeri-sistematik-derleme-ve-meta-analiz\/","title":{"rendered":"Mekanik Ventilasyon Deste\u011fi Alan Dola\u015f\u0131msal \u015eok Hastalar\u0131nda S\u0131v\u0131 Yan\u0131t\u0131n\u0131n Tahmininde \u0130nferior Vena Cava \u00c7ap\u0131 De\u011fi\u015fim \u0130ndeksinin De\u011feri: Sistematik Derleme ve Meta-analiz"},"content":{"rendered":"\r\n<p class=\"is-layout-flow wp-block-quote-is-layout-flow\"><strong>\u00d6ns\u00f6z;<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Kritik hastayla u\u011fra\u015fan bizler i\u00e7in s\u0131v\u0131 res\u00fcsitasyonu karar\u0131 hep zor olmu\u015ftur. Hastaya fazla verirsem pulmoner \u00f6deme neden olur muyum korkusu hekimleri hastalara ihtiyac\u0131 olan s\u0131v\u0131y\u0131 vermekten al\u0131koyabilmektedir. Critical care dergisinde yay\u0131nlanan bu yeni makalede mekanik ventilat\u00f6rde solutulan hastalar i\u00e7in s\u0131v\u0131 res\u00fcsitasyonunda Vena Cava \u0130nferiordaki de\u011fi\u015fimler yol g\u00f6sterici midir sorusuna yan\u0131t aranmaktad\u0131r. \u0130yi okumalar<\/p>\r\n\r\n\r\n\r\n<p><em>Dr. Funda K. AKARCA<\/em><\/p>\r\n\r\n\r\n\r\n<p><strong>Meta Analiz;<\/strong><\/p>\r\n\r\n\r\n\r\n<p>S\u0131v\u0131 res\u00fcsitasyonu akut dola\u015f\u0131m bozuklu\u011fu olan hastalarda \u00e7ok hassas bir dengede uygulanmas\u0131 gereken bir s\u00fcre\u00e7tir. Uygun olmayan s\u0131v\u0131 inf\u00fczyonu y\u00fcklenme, akci\u011fer \u00f6demi ve artm\u0131\u015f hipoksiye neden olarak hastan\u0131n prognozunu do\u011frudan etkilemektedir.<\/p>\r\n\r\n\r\n\r\n<p>Hastalar\u0131n s\u0131v\u0131 durumu ve cevab\u0131n\u0131 de\u011ferlendirmede ultrasonografi ile santral ven\u00f6z bas\u0131n\u00e7, pulmoner wedge bas\u0131n\u00e7 gibi invaziv y\u00f6ntemler aras\u0131ndaki m\u00fccadele uzun y\u0131llard\u0131r devam etmektedir. \u00d6zellikle son y\u0131llarda ultrasonografinin acil ve kritik bak\u0131m hekimlerinin ayr\u0131lmaz bir par\u00e7as\u0131 haline gelmesiyle vena cava inferior (IVC) gibi b\u00fcy\u00fck venlerde olu\u015fan solunumsal varyasyonlar s\u0131v\u0131 durumu de\u011ferlendirmesinde \u00f6ne \u00e7\u0131kmaya ba\u015flam\u0131\u015ft\u0131r.<\/p>\r\n\r\n\r\n\r\n<p>Yazarlar \u00e7al\u0131\u015fmalar\u0131nda mekanik ventilat\u00f6re ba\u011fl\u0131 dola\u015f\u0131msal \u015fok tablosunda olan hastalarda IVC \u00e7ap\u0131ndaki varyasyonlar\u0131n (\u0394IVCD) s\u0131v\u0131 cevab\u0131n\u0131n tahmin edilmesindeki etkinli\u011fini ara\u015ft\u0131ran yay\u0131nlar\u0131 bir araya getirerek meta-analiz haline getirmeyi ama\u00e7lam\u0131\u015flar.<\/p>\r\n\r\n\r\n\r\n<p>Meta-analiz, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISM) k\u0131lavuzu dikkate al\u0131narak ger\u00e7ekle\u015ftirilmi\u015f. Konu ile ilgili Haziran 2017 tarihine kadar yay\u0131mlanm\u0131\u015f \u00e7al\u0131\u015fmalar PubMed, Embase ve Cochrane veritabanlar\u0131nda ara\u015ft\u0131r\u0131lm\u0131\u015f. Arama sonucu elde edilen \u00e7al\u0131\u015fmalar iki ba\u011f\u0131ms\u0131z yazar taraf\u0131ndan de\u011ferlendirilmi\u015f ve karar verilemeyen durumlarda grup toplant\u0131lar\u0131 ger\u00e7ekle\u015ftirilerek konsensus sa\u011flanm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n<p>Dahil etme kriterleri:<\/p>\r\n\r\n\r\n\r\n<ol class=\"wp-block-list\">\r\n<li>Mekanik ventilat\u00f6r deste\u011fi alan \u015fok hastalar\u0131n\u0131 konu alan \u00e7al\u0131\u015fmalar<\/li>\r\n<li>S\u0131v\u0131 yan\u0131t\u0131n\u0131 belirlemek i\u00e7in alt\u0131n standart referans kullanan \u00e7al\u0131\u015fmalar<\/li>\r\n<li>Herhangi bir dilde yay\u0131nlanm\u0131\u015f olan \u00e7al\u0131\u015fmalar<\/li>\r\n<li>Ger\u00e7ek pozitif, ger\u00e7ek negatif, yalanc\u0131 pozitif ve yalanc\u0131 negatif oranlar\u0131n belirlenebildi\u011fi \u00e7apraz k\u0131yaslama tablolar\u0131n\u0131n olu\u015fturuldu\u011fu \u00e7al\u0131\u015fmalar<\/li>\r\n<\/ol>\r\n\r\n\r\n\r\n<p>D\u0131\u015flama kriterleri:<\/p>\r\n\r\n\r\n\r\n<ol class=\"wp-block-list\">\r\n<li>Ayn\u0131 pop\u00fclasyonun kullan\u0131ld\u0131\u011f\u0131 ya da \u00f6rt\u00fc\u015fmelerin ya\u015fand\u0131\u011f\u0131 veriler olan \u00e7al\u0131\u015fmalar<\/li>\r\n<li>Hayvan modeli ile ger\u00e7ekle\u015ftirilen \u00e7al\u0131\u015fmalar<\/li>\r\n<\/ol>\r\n\r\n\r\n\r\n<p>Meta-analize dahil edilen \u00e7al\u0131\u015fmalar\u0131n kalitesinin de\u011ferlendirilmesinde Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) kriterleri g\u00f6z \u00f6n\u00fcnde bulundurulmu\u015f. Meta-analizlerde s\u0131k g\u00f6r\u00fclen yay\u0131n yanl\u0131l\u0131\u011f\u0131n\u0131n (bias) \u00f6n\u00fcne ge\u00e7ilmesi i\u00e7in kullan\u0131lan Deeks\u2019 funnel plot asimetri testinde p&lt;0.10 de\u011feri istatistiksel olarak anlaml\u0131 olarak belirlenmi\u015f. Ek olarak, \u00e7al\u0131\u015fmalar\u0131n kalitesi bias riski a\u00e7\u0131s\u0131ndan RevMan yaz\u0131l\u0131m\u0131 ile de\u011ferlendirilmi\u015f. Meta-analizin yazarlar\u0131 indeks test dikkate al\u0131nd\u0131\u011f\u0131nda y\u00fcksek d\u00fczeyde bias varl\u0131\u011f\u0131n\u0131n oldu\u011funu belirtmi\u015fler.<\/p>\r\n\r\n\r\n\r\n<p>Sonu\u00e7lara bak\u0131ld\u0131\u011f\u0131nda veri taban\u0131 taramas\u0131nda 145 \u00e7al\u0131\u015fma tespit edilmi\u015f. Yinelenmi\u015f kay\u0131tlara dayanan 36 \u00e7al\u0131\u015fma, derleme, meta-analiz \u00f6zelli\u011findeki 94 \u00e7al\u0131\u015fma, heterojen pop\u00fclasyona sahip 9 \u00e7al\u0131\u015fma d\u0131\u015flanm\u0131\u015f. Dahil edilme kriterlerini kar\u015f\u0131layan 6 \u00e7al\u0131\u015fma meta-analize al\u0131nm\u0131\u015f. Toplamda 603 hastan\u0131n dahil edildi\u011fi bu meta-analizde \u0394IVCD de\u011ferinin mekanik ventilat\u00f6re ba\u011fl\u0131 dola\u015f\u0131msal yetmezlikli hasta grubunda s\u0131v\u0131 yan\u0131t\u0131n\u0131n tahmin edilmesinde orta derecede etkili oldu\u011funu tespit etmi\u015fler [Karma AUROC 0,82 (%95 CI, 0,79-0,85)]. Pozitif IVC ultrason sonucunun s\u0131v\u0131 yan\u0131t\u0131n\u0131 tahmin etmede orta d\u00fczeyde oldu\u011fu ortaya konmu\u015f (Spesifite %80) ancak negatif IVC sonucunun d\u0131\u015flama i\u00e7in kullan\u0131lamayaca\u011f\u0131 da belirtilmi\u015f (Sensitivite %69).<\/p>\r\n\r\n\r\n\r\n<p>\u00c7al\u0131\u015fman\u0131n k\u0131s\u0131tlamalar\u0131na bak\u0131ld\u0131\u011f\u0131nda:<\/p>\r\n\r\n\r\n\r\n<ol class=\"wp-block-list\">\r\n<li>Sadece alt\u0131 \u00e7al\u0131\u015fman\u0131n dahil edilmesi sebebiyle meta-analizin nispeten k\u00fc\u00e7\u00fck bir \u00f6rneklemde ger\u00e7ekle\u015ftirilmi\u015f ve bu alt\u0131 \u00e7al\u0131\u015fmadan birinin hasta grubunun %60\u2019\u0131n\u0131 kaps\u0131yor olmas\u0131.<\/li>\r\n<li>\u0130ndeks test de\u011ferlendirmesi a\u00e7\u0131s\u0131ndan y\u00fcksek d\u00fczeyde bias olmas\u0131. Bunun sebebi olarak meta-analizde yer alan iki \u00e7al\u0131\u015fman\u0131n verilerinin de\u011ferlendirilmesinde k\u00f6rl\u00fck olup olmad\u0131\u011f\u0131n\u0131n belirlenememi\u015f olmas\u0131 olarak g\u00f6sterilmi\u015f. Yazarlar bu durumun \u0394IVCD de\u011ferinin prediktif g\u00fcc\u00fcn\u00fc azaltm\u0131\u015f olabilece\u011fini belirtmi\u015fler.<\/li>\r\n<li>Hasta verilerinin toplanmas\u0131ndaki yetersizlikler (kay\u0131tlara ula\u015famama vs.) nedeniyle \u00e7al\u0131\u015fmalar\u0131n ger\u00e7ekle\u015ftirildi\u011fi pop\u00fclasyonlardaki verilerin g\u00fcvenirlili\u011finin sorgulanmaya yol a\u00e7mas\u0131.<\/li>\r\n<li>\u00d6rneklem grubunun k\u00fc\u00e7\u00fck olmas\u0131n\u0131n istatistiksel a\u00e7\u0131dan anlaml\u0131 olmayabilecek tan\u0131sal fakt\u00f6rleri anlaml\u0131 hale getirmi\u015f olma olas\u0131l\u0131\u011f\u0131 olarak say\u0131labilir.<\/li>\r\n<\/ol>\r\n\r\n\r\n\r\n<p>Bu k\u0131s\u0131tlamalara ra\u011fmen yazarlar bu meta-analizin, mekanik ventilasyon deste\u011fi alan hastalarda s\u0131v\u0131 durumunun tespiti ve yan\u0131t\u0131n\u0131n tahminini de\u011ferlendiren ilk meta-analiz olmas\u0131 a\u00e7\u0131s\u0131ndan \u00f6nemli oldu\u011funu belirtmi\u015fler.<\/p>\r\n<p><a href=\"http:\/\/dx.doi.org\/10.1186\/s13054-018-2063-4.\" target=\"_blank\" rel=\"noreferrer noopener\">10.1186\/s13054-018-2063-4.<\/a><\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>\u00d6ns\u00f6z; Kritik hastayla u\u011fra\u015fan bizler i\u00e7in s\u0131v\u0131 res\u00fcsitasyonu karar\u0131 hep zor olmu\u015ftur. Hastaya fazla verirsem pulmoner \u00f6deme neden olur muyum korkusu hekimleri&hellip;<\/p>\n","protected":false},"author":1320,"featured_media":2243,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[19,12],"tags":[10030,10031,10032,108],"class_list":["post-2231","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-mekanik-ventilator","tag-sok","tag-vci","tag-vena-kava-inferior"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2231","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1320"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2231"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2231\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2243"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2231"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2231"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2231"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}