Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Results of a blue code implementation at a university hospital(2017) Ozmete, Ozlem; AAI-7779-2021Purpose: The blue code is an early warning system that enables the necessary interventions to be made individuals whose basic life functions are at risk or have stopped. The purpose of this study is to evaluate the blue code application in our hospital and to analyze the management of these patients. Material and Methods: Data of 154 patients with code blue call between April 2016 and September 2016 were retrospectively analysed. Patients age, gender, code blue call time, the most call given unit, team's arrival time to unit, cardiopulmonary resuscitation (CPR) time, the initial rhythm survival and discharge rates were investigated. Results: A total of 154 patients (97 male, 57 female) were evaluated in the study. The mean age of the patients was 62 years. 83 (53.9%) of the code blue calls occurred after hours and the most frequent calls given by internal intensive care unit. The mean time for the code blue team to arrive was 1.25 minutes and the mean duration of CPR was 27 minutes. The most frequent initial cardiac rhythm detected in patients was asystole (87%). Spontaneous circulation was provided in 24 patients and 130 died. Sixteen patient were discharged after further follow-up and treatment. When the blue code call was given from the patients who were discharged, the first cardiac rhythm detected ventricular fibrillation in 9 patient, sinus rhythm in 5 patient and asystole in 2 patient. Conclusion: When evaluated of the code-blue calls in our hospital, the most common rhythm in cardiopulmoner arrest cases were asystoly but survival and discharged rates were more likely in patient which initial rthym is ventricular fibrillation.Item The Effect of Extensively Drug-resistant Infections on Mortality in Surgical Intensive Care Patients(2018) Sahinturk, Helin; Ozdemirkan, Aycan; Kilic, Fatma; Ozalp, Onur; Arslan, Hande; Zeyneoglu, Pinar; Pirat, ArashObjective: The aim of the study was to assess the outcomes of intensive care unit acquired extensively drug-resistant (XDR) bacterial infections in a surgical patient cohort. Materials and Methods: The data of patients with XDR bacteria isolated at Baskent University Hospital, Anesthesia and Surgical Intensive Care Unit between January 2016 and December 2016 were reviewed retrospectively. Adult patients over 18 years of age who had undergone surgery within the first 24 hours and who developed intensive care unit infection 48 hours after admission to intensive care unit were included in the study. Results: All of the 341 patients who admitted to the surgical intensive care unit during the study period were underwent surgery within the first 24 hours. XDR bacterial infections were isolated in 30 out (9%) of these 341 patients. The mean APACHE II score was calculated as 18.5 +/- 5.3, and expected mean mortality rate of 35 +/- 17.1. The mean length of intensive care unit stay was 27.0 +/- 27.4 days, while the mean hospital stay was 49.0 +/- 34.3 days. The hospital mortality rate was found to be 57% (n=7). Conclusion: As a conclusion of our study, we found that XDR bacterial infections were common (9%) among intensive care surgical patients and their mortality rate was higher than their expected mortality rate according to their APACHE II scores calculated during intensive care unit admission (57% vs. 35%, respectively).Item Safra kesesi ameliyatı sonrası cerrahi müdahale gerektiren ciddi komplikasyonlar ve yaklaşımlar(Ulusal Cerrahi Dergisi ,25 (2) ,62-67, 2009) Törer, Nurkan; Nursal, Tarık Zafer; Çalışkan, Kenan; Ezer, Ali; Çolakoğlu, Tamer; Karakayalı, Hamdi; Haberal, MehmetKolosistektomi sonrası görülen ciddi komplikasyonlarla ilgili kliniğimizin deneyimlerini paylaşmak ve önemli gördüğümüz noktaları belirtmek. Gereç-Yöntem: Mayıs 1999 - Kasım 2007 tarihleri arasında kolesistektomi sonrası ciddi sorun gelişen ve hastanemizde ameliyat edilen hastaların dosyaları incelendi. Kolesistektominin tipi, başvuru süresi, başvuru anındaki bulguları, yaralanma tipi, başvurudan ameliyata kadar geçen süre, ameliyat sonrası sonuçları kaydedildi. Bulgular: Yirmi iki hastanın yaş ortancası 50 (27 - 73), kadın/erkek oranı 1,2 idi. Dokuz hastada laparoskopik kolesistektomi (LK), sekiz hastada açık kolesistektomi (AK), üç hastada laparoskopik başlanıp AK, iki hastada kolesistektomi sonrası benign biliyer darlık nedeniyle bilioenterostomi yapılmıştı. Amsterdam sınıflamasına göre hastaların yedisi Tip-B, onbiri Tip-C, üçü Tip-D yaralanma, biri damar yaralanmasıydı Tip-B yaralanma, LK veya laparoskopik başlanıp açığa geçilen olgularda gözlenirken, AK yapılanlarda hiç görülmedi. AK yapılanlardaki hakim yaralanma ise Tip-C idi (n=6/8) (p=0,029). Mortalite bir, ciddi komplikasyon yedi, uzun dönemde sorun iki hastada gözlendi. Komplikasyon gelişme oranları; Tip-D yaralanmalarda 3 hastadan ikisinde (p=0,167), erken dönemde başvuran (10 günden önce) hastalarda (5/9 - 2/13 p=0,046), erken müdahale yapılan (10 günden önce) hastalarda daha yüksekti (6/13 - 1/9 p=0,069). Uzun dönemde sorun yaşama oranı erken müdahale yapılan hastalarda (2/12 - 0/9 p=0,178) daha fazlaydı. Sonuç: AK ile safra yolu darlıkları, LK ile safra kaçaklarının daha sık meydana geldiği görüldü. We aim to share our experience on major complications of cholecystectomy. Methods: Records of patients operated for major cholecystectomy complications between May 1999 - November 2007 were analyzed. Type of cholecystectomy, clinical complaint, type of injury, period from first operation to referral and referral to corrective surgery, postoperative complications and long-term outcome were recorded. Results: Median age of 22 patients was 50 (27 - 73), female/male ratio was 1.2. Type of cholecystectomy was laparoscopic cholecystectomy (LC) (n=9), open cholecystectomy (OC) (n=8), bilioenterostomy (due to post-cholecystectomy benign biliary stricture) (n=2), conversion to open cholecystectomy (COC) (n=3). Detected type of injury was; Type-B (n=7), Type-C (n=11), Type-D (n=3) and unclassified (n=1) according to Amsterdam classification. All of the Type-B injuries were observed in four LC and three COC patients and none of the OC patients. However, in the OC group, most frequent type of injury was Type-C (n=6/8) (p=0.029). One patient died, 7 patients had complication, and two patients had recurrent biliary problems. Complication rate was more frequent for; Type-D injury (2/3 p=0.167), patients with early (<10 days) presentation (5/9 - 2/13) (p=0.046) and patients with early (<10 days) surgical intervention (6/13 - 1/9) (p=0.069). Experiencing recurrent problem rate was more frequent for the patients with early surgical intervention (2/12 - 0/9) (p=0.178). Conclusion: Most frequent complication of OC was biliary strictures and that of LC was bile leakage.Item Yoğun bakım ünitesinde akut böbrek yetmezliği gelişen hastalarda mortaliteyi etkileyen faktörler(Başkent Üniversitesi Tıp Fakültesi, 2005) Sayın, Cihat Burak; Sezer, SirenAkut böbrek yetmezliği, saatler-günler içinde böbrek fonksiyonlarının bozulmasıyla ve glomerular filtrasyon hızında azalmayla seyreden bir tablodur. ABY, özellikle yoğun bakım ünitelerinde yatmakta olan hastalarda, kritik tabloya %5-20 oranında eşlik etmekte ve sıklıkla "çoklu organ yetmezliği sendromunun" bir parçası olarak yer almakta, mortalite oranı ise % 35-65 arasında değişmektedir. Sağkalan hastalarda, kronik renal replasman tedavisi ihtiyacı yalnızca % 5 oranında görülmektedir. Bu nedenle, bu hastalarda temel amaç, uygun koruyucu tedavi stratejileriyle ve eğer gerekirse uygun ve etkili renal replasman tedavisi ile bu hastalarda gelişebilecek üremik komplikasyonların önlenmesidir. Çalışmaya, Başkent Üniversitesi Tıp Fakültesi Hastanesi'ne akut böbrek yetmezliği tablosuyla başvuran veya hastaneye yattıktan sonraki dönemde ABY gelişen, ve yoğun bakım ünitesinde yatan toplam 50 hasta dahil edildi. Hastaların ABY tanı kriteri olarak, bazal kreatinin düzeyinin, en az %50 oranında yada 0,5 mg/dL ve üzerinde üzerinde artış göstermesi öngörüldü. ABY tanısıyla yatırılan hastaların yatırıldığı günden itibaren, herhangi bir nedenle hastaneye yatıp hastanede ABY gelişen hastaların ise ABY tanısı aldığı günden itibaren prospektif takipleri yapıldı. ABY tanısıyla takibe alınan hastaların; hastaneye yattığı gün, ABY tanısı aldığı gün, ABY tanısı aldıktan sonraki 24, 48, 72. saatler ve (gerçekleşirse) taburcu olduğu günlerdeki; vital bulguları, BUN, kreatinin, albumin, prealbumin, total kolesterol, hemoglobin, hematokrit, beyaz küre, trombosit, C-reaktif protein, arteryal kan gazında pH ve HCO3, protrombin zamanı ve INR, fibrinojen, antitrombin III, d-dimer, fibrin yıkım ürünleri kaydedildi. Ayrıca, hastaların, beslenme tipi, taze donmuş plazma tedavisi ihtiyacı, ABY tipi, hemodiyaliz ihtiyacı, tipi, süresi ve sayısı, ABY öncesi ve sonrası kullandığı nefrotoksik ilaçlar, dozu ve süresi, kontrast maruziyeti, yoğun bakım ünitesine yatış sebebi, yatış süresi değerlendirildi. Yapılan çalışmada, 50 akut böbrek yetmezliği olan hasta değerlendirildi. İyileşmesi (recovery) gerçekleşen hastalar 29 kişiyken (% 58), diyalize bağımlı yaşam süren hastalar 5 (% 10), eksitus olan hastalar ise 16 kişi (% 32) bulundu. Yoğun bakım ünitesine yatış nedeni sepsis olanlar ve yoğun bakım ünitesinde yattığı dönemde sepsis gelişen hastalarda mortalite oranı, diğer hastalara göre istatistiksel olarak anlamlı bulundu (Sırasıyla P=0,02 ve P=0,000). Bu sonuçlar, sepsisin ABY olan hastalarda en önemli ölüm nedenlerinden biri olduğunu destekler nitelikteydi. Oligürik ve diyaliz ihtiyacı olan hastalarda, mortalitenin istatistiksel olarak çok daha yüksek oranda olduğunu saptadık. (Sırasıyla P=0,000 ve P=0,000). Bulgular, oligürik olmayan ve diyaliz ihtiyacı göstermeyen hastalarda ABY seyrinin daha selim olduğunu destekler nitelikteydi. ABY gelişimiyle diyalize başlama tarihi arasındaki süre ve toplam hastanede yatış süresinin mortaliteyle bir korelasyonu saptanmadı. ABY geliştiği günde ise hastaların kan beyaz küre sayısının yüksek olmasının (P=0,01) mortaliteyle istatistiksel ilişkili olduğu bulundu.Bu bulgular ışığında, akut böbrek yetmezliği gelişen hastalarda, mortalite prediktörleri belirlenmeye çalışıldı. Sepsis ve çoklu organ yetmezliğinin eşlik ettiği ABY hastalarındaki yüksek mortalite oranları göz önüne alınarak, bu hastalarda yeni gelişmekte olan tedavi stratejilerinin yararlı olabileceğini düşünmekteyiz. Acute renal failure (ARF) is a syndrome characterized by detoriation of renal function and decrease in glomerular filtration rate (GFR) in hours to days. AFR, specially seen in patients in intensive care unit (ICU) generally as a part of "multi-organ failure syndrome" with a percentage of 5-20%, and mortality rate of 35-60%. For survivors, renal replacement treatment is required for only 5%. For this reason, the main aim in these patients is to prevent uremic complications with suitable preventive therapy strategies and with suitable and effective renal replacement therapy if needed.For this study, a sample of 50 patients, who admitted to Baþkent University Hospital with diagnose of ARF, or who developed ARF in ICU after hospitalization were included. For ARF diagnose, a basal creatinin level higher than a least 50% or an increase higher than 0,5 mg/dL was considered. For patients diagnosed with ARF at the administration a follow-up was carried from the first day, and for patients who developed ARF during hospitalization, a follow-up was carried from the beginning of ARF. All the required data was collected prospectively. For all the 50 patients, vital signs, BUN, Creatinin, albumin, prealbumin, total cholesterol, hemoglobin, hematocrit, white blood cell, platelet, C-reactive protein, arterial PH and HCO3, prothrombin time, INR, antithrombin III, d-dimer, fibrin destroy product levels were recorded at admission, hospitalization day, ARF diagnose day, and 24th, 48th and 72nd hours after ARF diagnose. In addition, type of feeding, TDP need, ARF type, haemodialysis requirement, type, time and duration, drugs used before and after ARF diagnose, the reasons for staying in ICU and hospitalization duration for all these patients were recorded. Statistical analysis was made for all these 50 patients. 29 patients (58%) were grouped under the heading "recovery" for they lead a life without haemodialysis need, 5 patients (10%) were grouped as "patients who require haemodialysis for a life-time" and 16 paitents (32%) were grouped under the heading "exitus". The mortality rate of patients whose reason for admission to ICU was sepsis and patients who were diagnosed with sepsis during their ICU stay, was higher than other groups and these differences were statistically significant (p=0.003 and p=0.000, respectively). These results supported the importance of sepsis as a reason of mortality in ARF patients. The patients who were oliguric and who needed dialysis had a mortality rate higher than patients who were non-oliguric and who did not require dialysis and these results were also statistically significant (p=0.000 and p=0.000, respectively). These results showed that in patients who were non-oliguric and who did not require dialysis, ARF seems to have a benign course. A higher WBC count at the day of ARF development significantly increased the mortality rate (p=0.005). With the lightening of these results, mortality factors for the development of ARF were tried to be identified. As the high mortality rates of ARF patients with sepsis and multi-organ failure visualized, we think that the use of new treatment strategies for these patients would be helpful.