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30 yıldır acil servis hekimi ve dünya çapında önde gelen bir solunum desteği uzmanı olan doktor Richard Levitan, corona virüsün yol açtığı zatürrenin, sıradan zatürreden farklı olarak uzun süre belirti göstermeden ilerlediğini ve bu yüzden farkedildiğinde genellikle çok geç kalınmış olduğu uyarısında bulundu ve bir de çözüm önerdi.
New York'taki Bellevue Hastanesi'nde 10 gündür gönüllü olarak Covid-19 hastalarının tedavisine katılan doktor Levitan, gözlemlerini ve uyarılarını New York Times gazetesinde yazdı:
"30 yıldır acil servis hekimi olarak çalışıyorum. 1994 yılında hastalara solunum cihazı takma işlemini öğretmek için bir görüntüleme sistemi geliştirdim. Bu amaçla araştırmalar yürüttüm ve son yirmi yıldır dünyanın dört bir yanındaki doktorlara solunum cihazı kullanımı eğitimi veren kurslar düzenlemekteyim." diyerek sözlerine başlayan Levitan, şöyle devam etti:
"Mart ayının sonunda New York City'de hastaneler Covid-19 hastası akınıyla başedemez noktaya geldiğinde, gönüllü olarak Bellevue Hastanesi'nde 10 gün görev yaptım. Bu günler boyunca şunu farkettim: Covid-19 hastalarında zatürreyi yeterince erken farkedemiyorduk ve bu yüzden hastaları hayatta tutma şansımız da azalıyordu.
"Evimin bulunduğu New Hampshire'den hastanede görev almak üzere New York'a giderken telefonla Bronx'da acil servis doktoru olan ve o sırada deli gibi çalışan arkadaşım Nick Caputo'yu aradım.
Neyle karşılaşacağımı, nasıl korunmak gerektiğini ve hastalık sırasında yaşanan solunum sorunlarıyla ilgili görüşünü almak istiyordum. "Berbat" dedi. "Daha önce gördüğüm hiç bir şeye benzemiyor."
Haklıydı. Corona virüsün yol açtığı zatürre şehrin hastanelerinde inanılmaz etki yaratmıştı. Normal olarak acil servislerde durumu hafiften ağıra bir çok hastayı bir arada görmek mümkünür: Kalp kirizi, felç ve ağır yaralanmalardan küçük kesikler, zehirlenmeler, kırıklar hatta başağrısına kadar şikayetlerle gelenler olur.
Richard Levitan, Bellevue Hastanesi'nde geçirdiği günlerde acil servis hastalarının neredeyse tamamının Covid-19 zatürresi olan hastalar olduğunu anlattı ve göreve başladıktan sonraki ilk saatinde iki hastaya solunum cihazı bağlaması gerektiğini ifade etti.
"Solunum şikayeti olmayan hastaların bile Covid zatürresi vardı. Omzundan bıçaklanan bir hastanın akciğer çökmesinden kuşkulanıp röntgenini çektiğimizde Covid zatürresi olduğunu gördük.
"Düşüp kendini yaralayan bazı hastaların tomografisini aldığımızda Covid zatürresi bulduk. Belirsiz bir sebepten ölen yaşlılarda, birçok şeker hastasında Covid zatürresi bulduk."
Richard Levitan, doktarları şaşırtan durumu ise şöyle özetledi: "Röntgenleri zatürre göstermesine ve oksijen seviyeleri düşük çıkmasına rağmen bu hastaların solunumla ilgili hiç bir şikayeti olmamıştı. Bu nasıl olabiliyordu?
"Covid zatürresinin, başlangıç aşamasında "sessiz hipoksi" diye adlandırdığımız bir tür oksijen yetmezliğine sebep olduğunu anlamaya başladık. Sessiz dememizin nedeni, farkedilmesinin çok güç olması, sinsi karakteriydi."
NORMAL ZATÜRREDEN ÇOK FARKLI Richard Levitan, normal zatürre ile Coviz zatürresinin farklarını şöyle anlatıyor: "Zatürre insanın akciğerlerindeki hava keseciklerini sıvı ve iltihapla dolduran bir enfeksiyondur.
"Normal olarak bu hastalığa yakalanan bir hasta göğsünde rahatsızlık, ağrı, nefes alma ve solunum güçlükleri yaşar. Fakat Covid zatürresi başladığında hastalar oksijen düzeyleri düşse de nefessiz kalmıyorlar.
"Sonra nefes almakta zorlanmaya başladıklarında ise oksijen düzeyleri aşırı düşmüş oluyor ve röntgenlerinden zatürre orta ve ağır düzeye kadar ilerlemiş olduğu anlaşılıyor.
"Normal bir insanın deniz seviyesinde oksijen düzeyi genellikle yüzde 94 ile yüzde 100 arasında olur. Covid zatürre hastalarında bunun yüzde 50'ye kadar düştüğünü gördüm.
"Çoğu hasta bir hafta gibi bir süredir ateş, öksürük, mide bulantısı ve yorgunluk hissettiğini ama nefes darlığının hastaneye geldikleri gün başladığını söylüyor, bu beni çok şaşırtıyordu. Zatürrelerinin günler önce başladığı belliydi ama farketmiyorlardı. Sıkıntı hissedip hastaneye koştukları gün ise kritik aşamaya gelmiş oluyorlardı.
"Acil servislerde kritik durumdaki hastaları birkaç sebeple solunum cihazına bağlarsınız. Ama benim 30 yıllık tecrübeme göre solunum cihazına bağlanması gereken hastaların çoğu ağır oksijen yetmezliği ile şoktadır, şuur yitimi yaramaktadır ya da nefes almak için çok büyük çaba harcamakta ve acı çekmektedirler."
NEDEN FARK EDİLMİYOR? "Covid-19 zatürresi vakalarındayken bu çok farklı oluyor. Gördüğüm korona virüs zatürresi hastalarının çok büyük bir kısmında oksijen düzeyi öyle düşüktü ki normalde hayatta olmamaları gerekse de cep telefonuyla konuşabiliyorlardı.
"Nefes alıp vermeleri hızlanmasına karşın oksijen düzeylerinin düşüklüğü ve akciğer röntgenleri göz önüne alındığında sıkıntıları, yaşamaları gerekenden çok daha azdı. Bunun neden böyle olduğunu yeni yeni anlamaya başlıyoruz. Korona virüs akciğerlerde sürfaktan dediğimiz yüzey maddesini üreten hücrelere saldırıyor."
Bu maddenin hücrelerin nefesten nefese açılıp kapanmasını sağlayan hayati bir işleve sahip olduğunu söyleyen Richard Levitan, Covid zatürresi başladığında bu saldırının hava keseciklerinin çökmesine ve oksijen düzeylerinin düşmesine yol açtığını anlattı.
Levitan sözlerini şöyle sürdürdü: "Ama akciğer sıvı dolumuyla tıkanmıyor ve işlevini sürdürüyor görünüyor. Bu da hastanın hala karbondioksit verebilmesini ve karbondioksit birikmediği için nefes darlığı hissetmemesini sağlıyor. Hastalar kanlarındaki oksijen yetersizliğini daha derin ve hızlı nefes alarak telafi ediyor ve bunun farkına varmıyor.
"İşte bu sessiz hipoksi ve hastanın vücudunun buna karşı geliştirdiği çözüm, enfeksiyonun farkettirmeden ilerlemesine, daha fazla hava keseciğinin çökmesine ve zatürrenin iyice derinleşmesine yol açıyor.
"Hasta giderek daha hızlı ve derin nefes almak suretiyle fiilen kendi ciğerlerine zarar veriyor. Covid zatürresi hastalarının yüzde yirmi kadarı buradan daha ölümcül olan akciğer hasarı aşamasına geçiyor.
Akciğerlerde biriken sivi yoğunlaşıyor, karbondiyoksit düzeyi yükseliyor ve hasta akut solunum yetmezliğine giriyor. Hastalar nefes alma güçlüğünü ferkettikleri ve hastaneye geldikleri zaman oksijen düzeyleri tehlikeli düzeylere inmiş oluyor ve çoğunun solunum cihazına bağlanması gerekiyor."
HASTANEYE YATAN HASTALARDA ZATÜRRE İLERLEMİŞ OLUYOR "Sessiz hipoksinin bu gelişimi Covid-19 hastalarının uzun süre nefes darlığı hissetmemelerine rağmen aniden yaşamlarını yitirdiği vakaları bize açıklıyor. (Bu arada Covid-19 hastalarının büyük çoğunluğunun hastalığı daha hafif geçirdiğini ve bir veya iki hafta içinde özel bir tedavi görmeye gerek duymadan iyileştiklerini hatırlatalım.)"
Bu salgın ın sağlık sistemini zorlamasının önemli bir sebebinin acil bölümlere gelen akciğer hasarlı hastaların durumunun kaygı verici düzeyde ağır olması olduğunu söyleyen doktor, "Covid-19 ölümlerinin büyük çoğunluğu akciğerlere etkisi nedeniyle meydana geliyor ve bu kadar çok sayıda hastanın zatürreleri iyice ilerledikten sonra hastaneye gelmesi bir çoğunun solunum cihazına bağlanmasına ve cihaz sıkıntısına yol açıyor." diyor ve ekliyor:
"Ayrıca solunum cihazına bağlananların çoğu da yaşamını yitiriyor. Dolayısıyla solunum cihazı kullanımından kaçınmak hem hasta hem sağlık sistemi açısından büyük kazanımlar."
"Solunum cihazına ihtiyaç duyan hasta sayısı inanılmaz düzeyde. Cihaza bağlı hastalara, kımıldamamaları ve boruları yerinden oynatmamaları için çok sayıda farklı uyuşturucu ilaç veriliyor.
"Damardan ve mideye bağlı borularla ilaç veriliyor, ciğerlerine boruyla oksijen pompalanıyor, idrar yollarına borular bağlanıyor. Her bir hastanın bakımı için her gün bir grup insan çalışıyor, akciğer işlevini geliştirmek amacıyla onları günde iki kez yüz üstü ve sırt üstü yatacak şekilde çevirmeleri gerekiyor."