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Zuhal Karakurt , Tülay Yarkın, Döndüye Özgül

Respiratory Intensive Care Unit Polyclinic: Evaluation and Follow-up of the Patients with Chronic Respiratory Failure. Zuhal Karakurt , Tülay Yarkın, Döndüye Özgül Nalan Adıgüzel, Gökay Güngör, Hilal Altınöz, Raziye Sancar Süreyyapaşa Chest Diseases and Thoracic Surgery Teaching Hospital,

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Zuhal Karakurt , Tülay Yarkın, Döndüye Özgül

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  1. Respiratory Intensive Care Unit Polyclinic: Evaluation and Follow-up of the Patients with Chronic Respiratory Failure Zuhal Karakurt, Tülay Yarkın, Döndüye Özgül Nalan Adıgüzel, Gökay Güngör, Hilal Altınöz, Raziye Sancar Süreyyapaşa Chest Diseases and Thoracic Surgery Teaching Hospital, İstanbul, Türkiye

  2. Introduction Why Intensive Care Unit Polyclinic? • Home-vent patients control • Requirment of monitorization • It takes time

  3. Aim To evaluate the difficulties of patients with home-vent during follow-up period and a special polyclinic which was organised for these kind of patients.

  4. ICU Polyclinic ICU polyclinic • Establishment day: 25th Agust 2005 • Work hours: 13.30 - 16.00 • Working style: appointment • Staff: 1 ICU physcian, 1 ICU nurse • Equipments: Monitor, aspirator, oxygen consantrator, medical other equipments

  5. ICU Polyclinic • Patients discharged from ICU: • Patients with home-vent: • Patients consultated for home-vent:

  6. Optimum medical treatment (bronchodilators±steroid, O2) with symptomatic patients PaCO2>55 mm Hg or PaCO2= 50-54 mm Hg and nocturnal desaturation (SaO2< 88% with 2L/min O2 -5 minutes- or 10% of whole monitorization) PCO2=50-54 mm Hg and >2 hospitalization due to acute hypercapnic respiratory failure in a year Diseases Chronic bronchitis Emphsema Bronchiectasis (TB) Cysistic Fibrosis Chronic Obstructive Lung DiseasesHome-vent Indications Hill N. Concensus report. Chest 1999:116:521-34

  7. Major Diseases Chest wall diseases Kyphoscolyosis ALS, myopathy Neuromuscular diseases (DMD) Polio sequela Sypmtomatic patients: fatique, morning headache , dyspnea Objective findings: 1) PaCO2>45 mm Hg in daytime 2) Observation of nocturnal desaturation (SaO2 < 88% in 5 min) 3) Neuromuscular Diseases: FVC <%50 or MIP > - 60cmH2O Restrictive Lung Diseases: Home-vent Indications Patrick Leger. Consensus Conference Report, Chest 1999;116:521-534

  8. Nocturnal Hypoventilation Syndroms:Home-vent Indications Diseases • Sleep Apnea • Obesite Hypoventilation • Endocrine abnormalities • Diagnose of diseases • Unresponsive sleep apnea with CPAP observed by PSG • Nocturnal hypoventilation • Santral sleep apnea Criner G. Concensus report. Chest 1999:116:521-34

  9. Methods Patients: Patients in the ICU polyclinic, 1) discharged from ICU 2) consultating for home-vent, 3) patients with home-vent,

  10. Results 1288 admissions, • Patients controlled after ICU discharged : 187 • Patients evaluated for home-vent: 93 • Patients with home-vent: 215

  11. Results 93 patients were consultated for HMV oxygen consantrator prescribed for 24 (%26) pts HMV prescribed for 33 (% 35) pts follow-up pts 36 (%39) pts 1 patient was given HMV 14 months later

  12. Home-vent Follow-up patients 2 DMD and MM 9 ALS 9 OHS 18 kyphoscoliosis 74 COPD

  13. Number of home-vent prescriptions according to the years COPD Kyphoscoliosis ALS after ICU polyclinic

  14. Results • Evaluation and prescription of home-vent, and follow-up these patients in a special polyclinic may prevent inadequate or over indication of long term home-vent. • These kind of polyclinics can be most useful for the patients with severe COPD or ALS leading to respiratory failure.

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