Kritik hastanın radyodiagnostik tetkikler için transportu: Tedaviye etkileri, komplikasyonlar ve maliyet
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Date
2020
Authors
Oğur, Suat Yılmaz
Journal Title
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Çalışmamızın amacı yoğun bakımdan (YB) radyodiagnostik tetkikler için transport edilen hastalarda gelişen transport ile ilişkili komplikasyonları, yapılan tetkiklerin tedaviye etkilerini ve maliyetlerini değerlendirmektir. Bursa Uludağ Üniversitesi Tıbbi Araştırmalar Etik Kurulu'nun 24/10/2017 tarih ve 2017-15/22 no’lu kararından sonra, 01 Kasım 2017 ve 31 Mart 2019 arasında Anesteziyoloji ve Reanimasyon Anabilim Dalı YB’de tedavi edilen 100 hastanın, 111 hastane içi transportu prospektif olarak değerlendirildi. Transportların 13(%11)'ünde dolaşımsal, 19(%17)'unda solunumsal, 8(%7)'inde cihazlarla ilgili komplikasyon gelişti. Dolaşımsal komplikasyon olanlarda, 50 yaş üstü hasta oranı, APACHE II skoru >19 hasta oranı, vazoaktif/inotropik ilaç kullanımı ve cihaz komplikasyon oranı anlamlı olarak yüksekti (sırasıyla p=0,22, p=0,001, p=0,006, p=0.00). Solunumsal komplikasyon gelişenlerde sedasyon uygulanma ve cihaz ile ilişkili komplikasyon oranları anlamlı olarak yüksekti (sırasıyla p=0,026, p=0,028). Cihaz komplikasyonu olanlarda ise APACHE II skoru >19 hasta oranı cihaz komplikasyonu olmayanlardan anlamlı olarak yüksek saptandı. (p=0,022). Ortalama 32.6±16.4 dakikada transport edilen olguların vücut sıcaklığı anlamlı olarak düşmüştü (ortalama 37.4'ten 36.9'a). Transport olgularının 65(%58,6)'inde yeni bir görüntüleme bulgusu saptandı. Bu tetkiklerin 34(%52)'ü tedavide değişiklik ile sonuçlandı. Radyodiyagnostik tetkiklerin maliyeti 6871 Türk Lirası (TL) idi. Görüntülemede bulgu saptananların maliyeti, toplam maliyetin %64.5'ini, transport sonrası tedavide değişiklik oluşan tetkiklerin maliyeti ise %40.3'ünü oluşturmuştur. iii Sonuç olarak; kritik hastalarda taşikardi, desatürasyon gibi solunumsal ve dolaşımsal komplikasyonların gelişebildiği, transport sırasında oksijen kaynağının kesintiye uğrayabildiği saptandı. Bu hastalarda istenen tetkiklerin tedaviye katkıları göz önünde bulundurulup, yarar/zarar ilişkisi dikkate alınarak transport kararı alınmasının uygun olacağı düşünüldü.
The aim of our study was to evaluate transport-related complications in patients transported from intensive care unit (ICU) for radiodiagnostic examinations, and the effects and costs of examinations. After the decision of Bursa Uludağ University Medical Research Ethics Committee dated 24/10/2017 and numbered 2017-15/22, 111 intra-hospital transports performed between November 2017 and March 2019 of 100 patients treated in Department of Anesthesiology and Reanimation ICU were prospectively evaluated. Among transported patients, 13(11%) developed circulatory, 19(17%) respiratory and 8(7%) device related complications. In the patients with circulatory complications, the rates of; patients older than 50 years, APACHE II score >19 and vasoactive/inotropic drug use and device complications were significantly higher (p=0.22, p=0.001, p=0.006, p=0.00, respectively). The rate of sedation use and device complications were significantly higher in patients with respiratory complications (p=0.026, p=0.028, respectively). The rate of patients with APACHE II score >19 was significantly higher in patients with device complications (p = 0.022). Body temperature of cases transported in an average of 32.6±16.4 minutes decreased significantly (mean from 37.4 to 36.9). A new imaging finding was detected in 65(58.6%) of the transport cases. 34(52%) of these tests resulted in change in treatment. v The cost of radiodiagnostic examinations was 6871 Turkish Liras (TL). 64.5% of the total cost was arisen from findings detected in imaging, whereas 40.3% was arisen from examinations with changes in post-transport therapy. In conclusion, It was determined that during transport, respiratory and circulatory complications such as tachycardia and desaturation may develop in critical patients, and oxygen supply might be interrupted. Thus a more appropriate approach would be taking transport decisions, by taking benefit/loss ratio and the contribution of requested investigations, to treatment of these patients into account.
The aim of our study was to evaluate transport-related complications in patients transported from intensive care unit (ICU) for radiodiagnostic examinations, and the effects and costs of examinations. After the decision of Bursa Uludağ University Medical Research Ethics Committee dated 24/10/2017 and numbered 2017-15/22, 111 intra-hospital transports performed between November 2017 and March 2019 of 100 patients treated in Department of Anesthesiology and Reanimation ICU were prospectively evaluated. Among transported patients, 13(11%) developed circulatory, 19(17%) respiratory and 8(7%) device related complications. In the patients with circulatory complications, the rates of; patients older than 50 years, APACHE II score >19 and vasoactive/inotropic drug use and device complications were significantly higher (p=0.22, p=0.001, p=0.006, p=0.00, respectively). The rate of sedation use and device complications were significantly higher in patients with respiratory complications (p=0.026, p=0.028, respectively). The rate of patients with APACHE II score >19 was significantly higher in patients with device complications (p = 0.022). Body temperature of cases transported in an average of 32.6±16.4 minutes decreased significantly (mean from 37.4 to 36.9). A new imaging finding was detected in 65(58.6%) of the transport cases. 34(52%) of these tests resulted in change in treatment. v The cost of radiodiagnostic examinations was 6871 Turkish Liras (TL). 64.5% of the total cost was arisen from findings detected in imaging, whereas 40.3% was arisen from examinations with changes in post-transport therapy. In conclusion, It was determined that during transport, respiratory and circulatory complications such as tachycardia and desaturation may develop in critical patients, and oxygen supply might be interrupted. Thus a more appropriate approach would be taking transport decisions, by taking benefit/loss ratio and the contribution of requested investigations, to treatment of these patients into account.
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Keywords
Kritik hasta, Transport, Radyodiagnostik, Komplikasyon, Maliyet, Critical patient, Transport, Radiodiagnostic, Complication, Cost
Citation
Oğur, S. Y. (2020). Kritik hastanın radyodiagnostik tetkikler için transportu: Tedaviye etkileri, komplikasyonlar ve maliyet. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.