Kronik Kritik Hastalıkta Sirkadiyen Ritim
Özet
Kronik kritik hastalık (KKH), akut süreçleri atlatan ancak mekanik ventilasyon ve organ desteklerine uzun süre bağımlı kalan hastaların karmaşık iyileşme dönemini tanımlar; bu süreçte yoğun bakım ortamındaki ışık, gürültü, sık hasta bakımı, ilaçlar ve sirkadiyen ritim dışı beslenme gibi faktörler hastaların sirkadiyen ritimlerini ciddi şekilde bozarak deliryum, immün yetmezlik ve metabolik düzensizliklere yol açar. Bu ritim bozukluklarını önlemek adına sabah ışığı uygulamaları, melatonin desteği, kişiye özel kortikosteroid zamanlaması, normal düzeni taklit eden aralıklı enteral beslenme ve gece ortamının sessizleştirilmesi gibi sirkadiyen optimizasyon stratejilerinin yoğun bakım süreçlerine dahil edilmesi hasta sonuçlarını iyileştirmektedir.
Chronic critical illness (CCI) defines the complex recovery period of patients who survive acute stages but remain long-term dependent on mechanical ventilation and organ support; during this process, factors in the intensive care environment such as light, noise, frequent patient care, medications, and non-circadian nutrition severely disrupt patients' circadian rhythms, leading to delirium, immunodeficiency, and metabolic dysregulation. In order to prevent these rhythm disruptions, incorporating circadian optimization strategies into intensive care processes—such as morning light exposure, melatonin supplementation, personalized corticosteroid timing, intermittent enteral nutrition mimicking normal patterns, and silencing the nocturnal environment—improves patient outcomes.
Referanslar
Angus DC, Kelley MA, Schmitz RJ. Current and projected workforce requirements for care. Jama. 2000;284(21): 2762-2770.
Sprung CL, Danis M, Iapichino G, et al. Triage of intensive care patients: identifying agreement and controversy. Intensive care medicine. 2013;39(11): 1916-1924.
Ellis H. Florence Nightingale: creator of modern nursing and public health pioneer. Journal of perioperative practice. 2008;18(9): 404-406.
Cowan RM, Trzeciak S. Clinical review: emergency department overcrowding and the potential impact on the critically ill. Critical care. 2004;9(3): 1-5.
Polastri M, Comellini V, Pisani L. Defining the prevalence of chronic critical illness. Pulmonology. 2020;26(3): 119-120.
Herridge MS, Tansey CM, Matté A, et al. Functional disability 5 years after acute respiratory distress syndrome. New England Journal of Medicine. 2011;364(14): 1293-1304.
Carson SS. Definitions and epidemiology of the chronically critically ill. Respiratory Care. 2012;57(6): 848-858.
Gao CA, Knauert MP. Circadian biology and its importance to intensive care unit care and outcomes. In Seminars in Respiratory and Critical Care Medicine. 2019;40(5): 629-637.
Drouot X, Cabello B, d’Ortho MP, et al. Sleep in the intensive care unit. Sleep medicine reviews. 2008;12(5): 391-403.
Toublanc B, Rose D, Glérant JC, et al. Assist-control ventilation vs. low levels of pressure support ventilation on sleep quality in intubated ICU patients. Intensive care medicine. 2007;33(7): 1148-1154.
Olofsson K, Alling C, Lundberg D, et al. Abolished circadian rhythm of melatonin secretion in sedated and artificially ventilated intensive care patients. Acta anaesthesiologica scandinavica. 2004;48(6): 679-684.
Danielson SJ, Rappaport CA, Loher MK, et al. Looking for light in the din: An examination of the circadian-disrupting properties of a medical intensive care unit. Intensive and Critical Care Nursing. 2018;46: 57-63.
Haus E, Sackett-Lundeen L, Smolensky MH. Circadian Rhythms in Disease Activity, Signs and Symptoms, and Rationale for Chronotherapy with Corticosteroids and Other Medications. Bulletin of the NYU Hospital for Joint Diseases. 2012;70.
Oster H, Challet E, Ott V, et al. The functional and clinical significance of the 24-hour rhythm of circulating glucocorticoids. Endocrine reviews. 2017;38(1): 3-45.
Moran-Ramos S, Baez-Ruiz A, Buijs RM, et al. When to eat? The influence of circadian rhythms on metabolic health: are animal studies providing the evidence?. Nutrition research reviews. 2016;29(2): 180-193.
Chaix A, Manoogian EN, Melkani GC, et al. Time-restricted eating to prevent and manage chronic metabolic diseases. Annual review of nutrition. 2019;39: 291-315.
Celik S, Öztekin D, Akyolcu N, et al. Sleep disturbance: the patient care activities applied at the night shift in the intensive care unit. Journal of clinical nursing. 2005;14(1): 102-106.
Tamburri LM, DiBrienza R, Zozula R, et al. Nocturnal care interactions with patients in critical care units. American Journal of Critical Care. 2004;13(2): 102-113.
Gehlbach BK, Patel SB, Van Cauter E, et al. The effects of timed light exposure in critically Ill patients: a randomized controlled pilot clinical trial. American journal of respiratory and critical care medicine. 2018;198(2): 275-278.
Penders TM, Gestring RE, Vilensky DA. Excited delirium following use of synthetic cathinones (bath salts). General hospital psychiatry. 2012;34(6): 647-650.
Taguchi, T. Bright light treatment for prevention of perioperative delirium in elderly patients. Journal of Nursing Education and Practice. 2013;3(10): 10.
Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. Sleep. 2007;30(11): 1460-1483.
de Jonghe A, van Munster BC, Goslings JC, et al. Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial. Cmaj. 2014;186(14): E547-E556.
Perkisas SM, Vandewoude MF. Ramelteon for prevention of delirium in hospitalized older patients. JAMA. 2015;313(17): 1745-1746.
Hoang H, Wang S, Islam S, et al. Evaluation of hydrocortisone continuous infusion versus intermittent boluses in resolution of septic shock. Pharmacy and Therapeutics. 2017;42(4): 252.
Tilouche N, Jaoued O, Ali HBS, et al. Comparison between continuous and intermittent administration of hydrocortisone during septic shock: a randomized controlled clinical trial. Shock. 2019;52(5): 481-486.
Ichimaru S. Methods of enteral nutrition administration in critically ill patients: continuous, cyclic, intermittent, and bolus feeding. Nutrition in Clinical Practice. 2018;33(6): 790-795.
Jobanputra AM, Scharf MT, Androulakis IP, et al. Circadian disruption in critical illness. Frontiers in neurology. 2020;11: 820.
