Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Respiratory Complications After Solid-Organ Transplantation(2015) Zeyneloglu, Pinar; 0000-0003-2312-9942; 25871362; C-3736-2018The risk for respiratory complications after solid-organ transplantation continues to be high, even though progress has been achieved with surgical techniques, immunosuppressive agents, and perioperative treatment of transplant recipients. This review is an overview of infectious and noninfectious respiratory complications in liver, kidney, heart, and lung transplant patients. Postoperative respiratory complications are more frequent after liver, heart, and lung transplant recipients, but the incidence is lower in kidney transplant recipients. Lung infiltrates due to multidrug-resistant bacterial infections are increasing and may cause respiratory failure associated with high morbidity and mortality. Treatment strategies including early, broad-spectrum empiric antibiotic therapy, lung protective mechanical ventilation, and appropriate timing of tracheotomy for patients who need prolonged mechanical ventilation. Early recognition and aggressive treatment of these respiratory complications may improve outcomes.Item Percutaneous Dilational Tracheotomy in Solid-Organ Transplant Recipients(2015) Ozdemirkan, Aycan; Ersoy, Zeynep; Zeyneloglu, Pinar; Gedik, Ender; Pirat, Arash; Haberal, Mehmet; 0000-0003-0767-1088; 0000-0002-3462-7632; 0000-0003-2312-9942; 0000-0002-7175-207X; 26640911; AAF-3066-2021; AAH-7003-2019; AAJ-8097-2021; C-3736-2018; ABI-2971-2020Objectives: Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients. Materials and Methods: Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen. Results: The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [inter quartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P=.052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P=.001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to 8 patients [25.8%]; P=.004]). Conclusions: Percutaneous dilational tracheotomy with bronchoscopic guidance is an efficacious and safe technique for maintaining airways in solid-organ transplant recipients who require prolonged mechanical ventilation, resulting in possible improvements in ventilatory mechanics and patient comfort.Item Late Intensive Care Unit Admission in Liver Transplant Recipients: 10-Year Experience(2015) Atar, Funda; Gedik, Ender; Kaplan, Serife; Zeyneloglu, Pinar; Pirat, Arash; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-7175-207X; 0000-0003-2312-9942; 0000-0001-6762-895X; 26640903; AAJ-8097-2021; ABI-2971-2020; C-3736-2018; GLV-1652-2022Objectives: We evaluated late intensive care unit admission in liver transplant recipients to identify incidences and causes of acute respiratory failure in the postoperative period and to compare these results with results in patients who did not have acute respiratory failure. Materials and Methods: We retrospectively screened the data of 173 consecutive adult liver transplant recipients from January 2005 through March 2015 to identify patients with late admission (> 30 d posttransplant) to an intensive care unit. Patients were divided into 2 groups: patients with and without acute respiratory failure. Acute respiratory failure was defined as severe dyspnea, respiratory distress, decreased oxygen saturation, hypoxemia or hypercapnia on room air, or need for noninvasive or invasive mechanical ventilation. Demographic, laboratory, clinical, and respiratory data were collected. Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores; lengths of intensive care unit and hospital stays; and hospital mortality were assessed. Results: Among 173 patients, 37 (21.4%) were admitted to an intensive care unit, including 22 (59.5%) with acute respiratory failure. The leading cause of acute respiratory failure was pneumonia (n = 19, 86.4%). Patients with acute respiratory failure had significantly lower levels of albumin before intensive care unit admission (P =.003). In patients with acute respiratory failure, severe sepsis and septic shock were more frequently observed and tracheotomy was more frequently performed (P=.041). Conclusions: Acute respiratory failure developed in 59.5% of liver transplant recipients with late intensive care unit admission. The leading cause was pneumonia, with this group of patients having higher requirements for invasive mechanical ventilation and tracheotomy, longer stays in an intensive care unit, and higher mortality.