Browsing by Author "Yesiler, Fatma Irem"

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Comparison Of Confirmed And Probable COVID-19 Patients In The Intensive Care Unit During The Normalization Period
(2022) Yesiler, Fatma Irem; Capras, Mesher; Kandemir, Emre; Sahinturk, Helin; Gedik, Ender; Zeyneloglu, Pinar; https://orcid.org/0000-0002-0612-8481; https://orcid.org/0000-0003-0159-4771; 34812130; AAJ-4212-2021; AAJ-1419-2021
The decrease in social distance together with the normalization period as of June 1, 2020, in our country caused an increase in the number of coronavirus disease 2019 (COVID-19) patients. Our aim was to compare the demographic features, clinical courses, and outcomes of confirmed and probable COVID-19 patients admitted to our intensive care unit (ICU) during the normalization period. Critically ill 128 COVID-19 patients between June 1, 2020, and December 2, 2020, were analyzed retrospectively. The mean age was 69.7 +/- 15.5 y (61.7% male). Sixty-one patients (47.7%) were confirmed. Dyspnea (75.0%) was the most common symptom and hypertension (71.1%) was the most common comorbidity. The mean Acute Physiology and Chronic Health Evaluation System (APACHE II) score; Glasgow Coma Score; Sequential Organ Failure Assessment scores on ICU admission were 17.4 +/- 8.2,12.3 +/- 3.9, and 5.9 +/- 3.4, respectively. One hundred and one patients (78.1%) received low-flow oxygen, 48 had high-flow oxygen therapy (37.5%), and 59 (46.1%) had invasive mechanical ventilation. Fifty-three patients (41.496) had vasopressor therapy and 30 (23.4%) patients had renal replacement therapy due to acute kidney injury (AKI). Confirmed patients were more tachypneic (p= 0.005) and more hypoxemic than probable patients (p < 0.001). Acute respiratory distress syndrome and AKI were more common in confirmed patients than probable (both p < 0.001). Confirmed patients had higher values of hemoglobin, C- reactive protein, fibrinogen, and D-dimer than probables (respectively, p = 0.028. 0.006, 0.000. and 0.019). The overall mortality was higher in confirmed patients (p = 0.209, 52.6% vs. 47.4%). Complications are more common among confirmed COVID-19 patients admitted to ICU. The mortality rate of confirmed COVID-19 patients admitted to the ICU was found to be higher than probable patients. Mortality of confirmed cases was higher than prediction of APACHE-II scoring system.
Donor management in intensive care unit: Practices at our center
(2019) Yesiler, Fatma Irem; Sahinturk, Helin; Zeyneoglu, Pinar; Haberal, Mehmet
Ethics and Clinical Communications
(2023) Yesiler, Fatma Irem; Gedik, Ender
The diagnosis of brain death has medical, legal and ethical aspects. While the main determinant is the medical approach of the physician in terms of ethics, legal situations are also effective in the process. Non-harm, beneficence, respect for autonomy and justice are the principles that are widely accepted and form the basis of medical ethics. Understanding these principles is a must in order to talk about the ethics of brain death and organ transplantation. In the process of diagnosis and management of brain death, the physician should convey the process to the relatives of the patients in a clear and understandable language and in accordance with the educational-cultural levels of the relatives of the patients. The fact that the concept of brain death is misunderstood in the society or lack of knowledge creates social ethical problems. Special training should be given to health professionals for brain death awareness and early diagnosis, and their ability to resolve ethical problems should be strengthened. Human resources are of great importance in the diagnosis of brain death and in the process of organ transplantation from a cadaver. Communication skills are the mainstay of interaction within the clinic. Organ transplant coordinators should run the process smoothly by creating a bridge between the physician responsible for the case and the intensive care physicians. Such an approach will reduce ethical issues and ensure a successful diagnosis and donation process.
Evaluation of Sepsis and Extensively Drug Resistant Infections in Deceased Critically Ill Patients
(2022) Yesiler, Fatma Irem; Yazar, Cagla; Ordu, Irem Ulutas; Sahinturk, Helin; Yalcin, Tugba Yanik; Zeyneloglu, Pinar; 0000-0003-0159-4771; 0000-0002-0612-8481; AAJ-1419-2021; AAJ-4212-2021
Objective: Sepsis due to the drug resistant infections is associated with the higher mortality rates in an intensive care unit (ICU). The aim of this study was to determine the demographic characteristics of the deceased critically ill patients, prevalence of the sepsis, and extensively drug resistant infectious-related (XDR) deaths within a year in the ICU. Materials and Methods: The data of patients who died in the ICU between January 1, 2019 and 2020 was retrospectively analyzed. Results: Out of 525 patients admitted to the ICU, 269 of them died. One hundred fifty-one of those deceased patients (56.1%) were in medical and 118 (43.9%) in the surgical ICU. Their mean age was 70.5 +/- 15 years and 126 (46.8%) of them were female. The mean Acute Physiology and Chronic Health Evaluation-II, Glasgow coma score, Sequential Organ Failure Assessment scores at ICU admission were 23.4 +/- 20.9, 9.8 +/- 4.4, and 8.2 +/- 3.6, respectively. A few reasons for the ICU admission were: respiratory failure (34.9%), neurologic dysfunction (19%), sepsis (17.8%), and cardiovascular failure (16%). Infection occurred in the 231 (85.9%) patients. Of the 109 (40.5%) deceased patients with the diagnosis of sepsis, 48 (40%) of them were admitted in the ICU with sepsis. The most common site of infection was the respiratory system (34.6%). Septic shock was seen in 170 patients (63.2%) and renal replacement therapy was needed in 61 (22.7%) of them. XDR developed in 34.6% of the deceased patients and was more frequent among those with an antibiotic usage before the ICU admission (p=0.02). The mean length of stay at hospital before the ICU admission and length of the ICU stay were 22 +/- 25.8 and 10.1 +/- 12.7 days, respectively. The number of the deceased medical patients were significantly higher than the surgical patients (p=0.018). Conclusion: The deceased critically ill medical patients were higher than the surgical patients. A total of 40% of the deceased critically ill patients were diagnosed with a sepsis, and one third of them had XDR infection. XDR infections were more frequent among the patients with an antibiotic usage before the ICU admission.
Incidence of and Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery Among Elderly Patients
(2022) Yesiler, Fatma Irem; Akmatov, Nursultan; Nurumbetova, Oktom; Beyazpinar, Deniz Sarp; Sahinturk, Helin; Gedik, Ender; Zeyneloglu, Pinar; 0000-0003-0159-4771; 36540477; AAJ-1419-2021
Objective: Open heart surgery (OHS) is frequently performed on elderly patients. We aimed to investigate the risk factors associated with prolonged intensive care unit (ICU) stay in elderly patients undergoing open heart surgery. Materials and Methods: Medical records of all patients > 75 years who underwent OHS (coronary artery bypass grafting (CABG) and/or heart valve surgery) between June 1, 2013, and December 31, 2020, were retrospectively analyzed. Those staying in the ICU longer than five days were determined as prolonged ICU stay. Patients were divided into two groups, according to ICU stay <5 days and >5 days. Results: Out of the 198 patients included in the study, 130 (65.7%) were male. Seventy patients (35.4%) had prolonged ICU stay. The mean age was higher in patients within the prolonged ICU stay group when compared to the other group (79.9 +/- 3.5 years vs.78.1 +/- 2.7 years, p<0.001). The patients who used statins and angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) in the preoperative period had a shorter ICU stay compared to those who did not (45% vs 31.4%, p=0.04; 57% vs 42.9%, p=0.03). The history of previous thoracic surgery (2.3% vs 10% p=0.03), emergency surgery (12.5% vs 24.5% p=0.04), and preoperative pacemaker usage (0.8% vs 7%, 1 p=0.01) were higher in the group of patients with prolonged ICU stay compared to the other group. Preoperative ejection fraction (EF)% (47.7 +/- 11.3 vs 51.1 +/- 8.8, p<0.001) and hemoglobin level (11.8 +/- 1.9 mg/dL vs 12.9 +/- 1.6, p<0.001) were lower in the group with prolonged ICU stay compared to the other group. Incidence of cardiac arrest (3.9% vs 15.7% p=0.006), presence of arrhythmia (16.4% vs 41.6%,p<0.001), frequency of pacemaker and intra-aortic balloon pump (IABP) usage (0 vs 10% p=0.002; 1.6% vs 8.6% p=0.02), and need for renal replacement therapy (3.1% vs 12.9%,p=0.02) were higher in the group with prolonged ICU stay compared to the other group. According to the logistic regression analysis; higher age (OR: 1.225, 95%CI 1.104-1.360, p<0.001), preoperative pacemaker usage (OR: 0.100, 95%CI 0.01-0.969, p<0.04), preoperative statin non-use (OR: 2.056, 95%CI 1.040-4.066, p<0.03) and preoperative low EF (OR: 0.947, 95%CI 0.915-0.981, p=0.002) were determined as independent risk factors for prolonged ICU stay. Conclusion: The incidence of prolonged ICU stay after OHS among patients >75 years was 35.4% in our cohort. Higher age, preoperative pacemaker usage, preoperative statin non-use, and low preoperative EF were associated with prolonged ICU stay.
A Novel Therapeutic Approach for Renal Transplant Recipient with Septic Shock and Acute Kidney Injury: A Case Report
(2021) Yesiler, Fatma Irem; Yurtsever, Beyza Meltem; Gedik, Ender; Zeyneloglu, Pinar; Haberal, Mehmet; 0000-0002-0612-8481; 0000-0002-4737-7660; 0000-0002-7175-207X; 0000-0002-3462-7632; AAJ-4212-2021; ABI-2971-2020; AAJ-8097-2021
Extracorporeal blood purification (EBP) therapies, using oXiris (R) haemofilter, are popular and used globally in intensive care units for management of patients with septic acute kidney injury (AKI). Herein, we present a case of an immunocompromised renal transplant recipient with sepsis and AKI who was treated with continuous renal replacement therapy (CRRT) using oXiris (R) haemofilter. A 45-year-old female who underwent cadaveric renal transplantation in 2015 was admitted due to septic shock secondary to Escherichia coli urinary tract infection (bacteraemia) and acute respiratory distress syndrome (ARDS). Her acute physiology and chronic health assessment score was 23, sepsis-related organ failure score was 11 and Glasgow coma scale was 15. She was intubated because of moderate ARDS and administered vasopressors due to hemodynamic instability. For immunosuppressive therapy, methylprednisolone (40 mg q12h) was administered. Antimicrobial therapies, including intravenous meropenem, linezolid, trimethoprim-sulfamethoxazole, voriconazole and oseltamivir, were administered. She exhibited metabolic acidosis and septic AKI and was classified as Kidney Disease Improving Global Outcomes stage 3. Therefore, CRRT with oXiris (R) haemofilter was administered at the 11th hour after admission. A full recovery of transplant renal function and diuresis was observed 7 days after admission. She was transferred to ward after 9 days and discharged after 2 weeks, without the requirement of RRT. EBP is proposed as an adjuvant therapy for sepsis and AKI. Solid organ transplant recipients with septic AKI may benefit from early usage of oXiris (R) haemofilter with CRRT as a novel approach for improving survival and clinical outcomes.
Pain Management of a Critically Ill Oldest-old Trauma Patient with Multiple Rib Fractures in Intensive Care Unit
(2022) Yazar, Cagla; Yesiler, Fatma Irem; Sahinturk, Helin; Araz, Coskun; Zeyneloglu, Pinar; 0000-0002-3887-0314; 0000-0002-0612-8481; 0000-0003-0159-4771; AAJ-4212-2021; AAJ-1419-2021
Rib fracture due to blunt chest trauma is a painful condition with high morbidity and mortality and it is two times prevalent among the elderly compared to young people. If adequate an analgesic treatment is not administered, respiratory complications, need for mechanical ventilation, and length of stay in intensive care unit may increase. Erector spinal plane (ESP) block is a regional unaesthetic method that can provide effective analgesia in the unilateral thoracic region. In this study, we present ESP block, which is used successfully in pain management of a critically ill old patient with multiple rib fractures.
Posttransplant Pneumonia Among Solid Organ Transplant Recipients Followed in Intensive Care Unit
(2022) Yesiler, Fatma Irem; Yazar, Cagla; Sahinturk, Helin; Zeyneloglu, Pinar; Haberal, Mehmet; 0000-0002-3887-0314; 0000-0003-0159-4771; 0000-0002-3462-7632; 34269656; AAJ-1419-2021; AAJ-8097-2021
Objectives: Pneumonia is a significant cause of morbidity and mortality in solid-organ transplant recipients. We studied the demographic characteristics, respiratory management, and outcomes of solid-organ transplant recipients with pneumonia in an intensive care unit. Materials and Methods: There have been 2857 kidney, 687 liver, and 142 heart transplants performed between October 16, 1985, and February 28, 2021, at our center. We retrospectively analyzed records for 51 of 193 recipients with pneumonia during the posttransplant period between January 1, 2016, and December 31, 2018. Results: Fifty-one of 193 recipients were followed in the intensive care unit. Mean age was 45.4 +/- 16.6 years among 42 male (82.4%) and 9 female (17.6%) recipients. Twenty-six patients (51%) underwent kidney transplant, 14 (27.5%) liver transplant, 7 (13.7%) heart transplant, and 4 (7.8%) combined kidney and liver transplant. Most pneumonia episodes occurred 6 months after transplant (70.6%) with acute hypoxemic respiratory failure. Mean Acute Physiology and Chronic Health Evaluation System II score was 18.9 +/- 7.7, and the Sequential Organ Failure Assessment score was 8.5 +/- 3.9 at intensive care unit admission. Whereas 66.7% of pneumonia cases were nosocomial acquired, 33.3% were community acquired. The intensive care unit and 28-day mortality rates were 39.2% and 64.7%, respectively. Conclusions: Solid-organ transplant recipients with pneumonia have been associated with poor prognosis. Our cohort followed in the intensive care unit comprised mostly patients with nosocomial pneumonia with acute hypoxemic respiratory failure, hospitalized 6 months after transplant with high Acute Physiology and Chronic Health Evaluation System II scores predictive of mortality. In this high-risk patient group, careful follow-up, early discovery of warning signs, and rapid treatment initiation could improve the outcomes in the intensive care unit.
A Pregnant Woman with Jaundice in the Intensive Care Unit
(A Pregnant Woman with Jaundice in the Intensive Care Unit, 2020) Yesiler, Fatma Irem; Sahinturk, Helin; Gunakan, Emre; Gedik, Ender; Zeyneloglu, Pinar; 0000-0003-0159-4771; 0000-0001-8854-8190; AAJ-1419-2021
Acute fatty liver of pregnancy (AFLP) is a life-threatening disorder characterized by maternal liver failure, and it occurs in the third trimester of pregnancy or postpartum period. The resultant effects include coagulopathy, electrolyte abnormalities, and the multiple organ dysfunction syndrome (MODS), which may require liver transplantation. Therefore, pregnant women having MODS should be managed in an intensive care unit (ICU) with multidisciplinary inputs to facilitate the appropriate supportive care. We present a successful case report of a pregnant women admitted to the ICU with jaundice and MODS without the need for liver transplantation and organ support therapies. A 20-year-old patient in her first pregnancy at 31 weeks gestation who presented with nausea, vomiting, and jaundice was admitted to our hospital. She was referred from a rural medical center (a center 608 kilometers away) to the ICU due to the possible diagnosis of acute liver failure requiring liver transplantation. Acute physiology and chronic health assessment score was 12, sepsis related organ failure score was 8, and Glasgow coma scale was 15 on ICU admission. AFLP was considered in the patient and an emergency delivery was performed by caesarean section. She recovered with intensive care support after pregnancy delivery without the need for liver transplantation. The patient was discharged from the ICU and hospital after 6 and 10 days, respectively. AFLP should be suspected in the differential diagnosis of a pregnant woman with jaundice and hyperbilirubinemia who is admitted to the ICU in the third trimester of pregnancy or postpartum period. Intensivist should not delay in the diagnosis of AFLP due to its morbid complications and high mortality. Early diagnosis, prompt pregnancy delivery, and intensive care support in the peripartum and postpartum periods may improve maternal and fetal outcomes