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Title:
Spremljanje tkivne oksimetrije med zunaj-bolnišničnim kardiopulmonalnim oživljanjem
Authors:
ID
Prosen, Gregor
(Author)
ID
Mekiš, Dušan
(Mentor)
More about this mentor...
Files:
DR_Prosen_Gregor_2018.pdf
(3,43 MB)
MD5: D110947911894C7F7F4750013C3B00AF
PID:
20.500.12556/dkum/966241ed-af69-49ad-b346-f824c0c9f52d
Language:
Slovenian
Work type:
Doctoral dissertation
Typology:
2.08 - Doctoral Dissertation
Organization:
MF - Faculty of Medicine
Abstract:
Izhodišča: NIRS (angl. Near-infrared spectroscopy) je v klinični praksi relativno nova metoda ki v realnem času prikazuje vrednosti tkivne oksimetrije. Uporaba te merilne tehnike na čelu bolnika se imenuje možganska oksimetrija (ScO2). Številne raziskave so pokazale vrednost spremljanja možganske oksimetrije med operacijami, pravtako so bile objavljene raziskave o spremljanju ScO2 med srčnim zastojem, a nobena raziskava do sedaj ni spremljala vrednosti ScO2 med celotnim potekom srčnega zastoja v zunaj-bolnišničnem srčnem zastoju; od prepoznave do post-reanimacijske oskrbe. Hipoteze: V naši raziskavi smo želeli ovrednosti dinamiko gibanja vrednosti ScO2 med kardio-pulmonalnim oživljanjem (KPO) v zunaj-bolnišničnem okolju. Predvidevali smo, da so vrednosti ScO2 ob prihodu ekip nujne medicinske pomoči nevarno nizke in da se z KPO zvišujejo. Dinamika tega zviševanja pa je poglavitna spremenljivka ki vpliva na kasnejše preživetje. Dodatno smo spremljali vrednosti serumskega laktata pri istih pacientih in dinamiko gibanja the vrednosti primerjali z preživetjem. Metode: V raziskavo smo vključili 53 bolnikov, ki so utrpeli zunaj-bolnišnični srčni zastoj. Vsi postopki oživljanja so bili opravljeni v skladu s takrat-veljavnimi smernicami za oživljanje, le pacientom, vključenim v raziskavo smo od prepoznave srčnega zastoja do zaključka oživljanja nenehno merili vrednosti možganske oksimetrije. Rezultati: Vrednosti ScO2 ob pričetku oživljanja so pri vseh bolnikih bile kritično nizke. Vrednosti so se tekom KPO zlagoma zviševale, statistično bolj pri pacientih ki so kasneje preživeli. Preživelim bolnikom so se vrednosti ScO2 pričele pomembno zviševati že pred dosegom spontane cirkulacije (ROSC) in so se po ROSC normalizirale in ostale stabilne. Vzorec hitrega, jasnega in statistično pomembnega porasta ScO2 ki se normalizirajo, so tipične za bolnike ki so preživeli do sprejema v bolnišnico, za razliko od pacientov ki so umrli na terenu. Podobno so vrednosti serumskega laktata med KPO pomembno padale pri bolnikih ki so preživeli. Zaključek: Vrednosti ScO2 pri bolnikih ki so v zunaj-bolnišničnem okolju oživljani, so do prihoda reševalnih ekip že kritično nizke in se tekom KPO zlagoma zvišujejo. Zvišanje je pri bolnikih ki kasneje preživijo. Za slednje je značilen vzorec hitrega, jasnega in statistično pomembnega dviga ScO2 tik pred dosegom ROSC ki se normalizirajo. Vrednosti serumskega laktata pri istih bolnikih tekom KPO pomembno padejo.
Place of publishing:
Maribor
Year of publishing:
2019
PID:
20.500.12556/DKUM-70843
COBISS.SI-ID:
298707712
NUK URN:
URN:SI:UM:DK:7JHL7BHS
Publication date in DKUM:
18.02.2019
Views:
1842
Downloads:
239
Metadata:
Categories:
MF
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PROSEN, Gregor, 2019,
Spremljanje tkivne oksimetrije med zunaj-bolnišničnim kardiopulmonalnim oživljanjem
[online]. Doctoral dissertation. Maribor. [Accessed 9 April 2025]. Retrieved from: https://dk.um.si/IzpisGradiva.php?lang=eng&id=70843
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Secondary language
Language:
English
Title:
Monitoring tissue oximetry during cardiopulmonary resuscitation
Abstract:
Background: NIRS (angl. Near-infrared spectroscopy) is relatively novel diagnostic modality that measures levels of tissue oximetry in real time. Use of its detectors over skull is called cerebral oximetry (ScO2). Several studies have proven value of ScO2 monitoring during anesthesia. There were also studies describing use of ScO2 in different phases of cardiopulmnary resuscitation (CPR). But none of the studies have until ours been conducted to describe dynamics of ScO2 values during out-of-hospital cardiac arrest, from beginning of CPR well into post-resuscitation period in field. Hypothesis: The aim of our study was to describe dynamics of ScO2 values during CPR in out-of-hospital setting. We hypothesised, that levels of ScO2 on arrival of Emergency medical services would be dangerously low, but would rise during CPR. Dynamics of this rise would be main determinant of later clinical outcome. In addition, we measured dynamics of serum lactate levels and compared it with outcomes. Methods: Our study included 53 patients that suffered out-of-hospital cardiac arrest during study period. All patients were resuscitated as per current CPR guidelines and patients enrolled in the study had NIRS optodes applied and levels of ScO2 measured continuously. Results: Levels of ScO2 in all patients were critically low at the beginning of CPR. Levels of ScO2 have risen during CPR, statistically higher in patients that later survived. These patients also exhibited rise of ScO2 minutes before achieving return of spontaneous circulation (ROSC) and have normalised after achieving ROSC. We have found, that pattern of clear, rapid, statistically significant and sustained rise of ScO2, is specific for patients that have achieved ROSC. This pattern is very different to occasional spikes in ScO2 levels that we observed in patients that died in field. Similarly, values of serum lactate have fallen significantly during CPR in patients that achieved ROSC. Conclusion: Levels of ScO2 during out-of-hospital cardiac arrest fall dangerously low by the time CPR is started. Levels of ScO2 rise during CPR, more so in group of surviving patients. In later group, we found specific pattern of clear, rapid, significant and sustained rise in ScO2 levels minutes before ROSC that normalize during post-arrest care. Levels of serume lactate fall during successful CPR.
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