Wos İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4807
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Item Multivariable haemodynamic approach to predict the fluid challenge response A multicentre cohort study(2021) Messina, Antonio; Romano, Salvatore M.; Ozdemirkan, Aycan; Persona, Paolo; Tarquini, Riccardo; Cammarota, Gianmaria; Romagnoli, Stefano; Della Corte, Francesco; Bennett, Victoria; Monge Garcia, Manuel I.; 32833857; AAH-7003-2019BACKGROUND Beat-to-beat stroke volume (SV) results from the interplay between left ventricular function and arterial load. Fluid challenge induces time-dependent responses in cardiac performance and peripheral vascular and capillary characteristics. OBJECTIVE To assess whether analysis of the determinants of the haemodynamic response during fluid challenge can predict the final response at 10 and 30 min. DESIGN Observational multicentric cohort study. SETTING Three university ICUs. PATIENTS 85 ICU patients with acute circulatory failure diagnosed within the first 48 h of admission. INTERVENTION(S) The fluid challenge consisted of 500 ml of Ringer's solution infused over 10 min. A SV index increase at least 10% indicated fluid responsiveness. MAIN OUTCOME MEASURES The SV, pulse pressure variation (PPV), arterial elastance, the systolic-dicrotic pressure difference (SAP-P-dic) and cardiac cycle efficiency (CCE) were measured at baseline, 1, 2, 3, 4, 5, 10, 15 and 30 min after the start of the fluid challenge. All haemodynamic data were submitted to a univariable logistic regression model and a multivariable analysis was then performed using the significant variables given by univariable analysis. RESULTS The multivariable model including baseline PPV, and the changes of arterial elastance at 1 min and of the CCE and SAP-P-dic at 5 min when compared with their baseline values, correctly classified 80.5% of responders and 90.7% of nonresponders at 10 min. For the response 30 min after starting the fluid challenge, the model, including the changes of PPV, CCE, SAP-P-dic at 5 min and of arterial elastance at 10 min compared with their baseline values, correctly identified 93.3% of responders and 91.4% of nonresponders. CONCLUSION In a selection of mixed ICU patients, a statistical model based on a multivariable analysis of the changes of PPV, CCE, arterial elastance and SAP-P-dic, with respect to baseline values, reliably predicts both the early and the late response to a standardised fluid challenge.Item A Comparison of Echocardiography and the Pressure Recording Analytical Method (PRAM) for Predicting Fluid Responsiveness after Passive Leg Raising(2021) Ozdemirkan, Aycan; Aitakhanoya, Manat; Gedik, Ender; Zeyneloglu, Pinar; Pirat, Arash; 0000-0002-7175-207X; ABI-2971-2020Objective: This study aims to assess the agreement between the cardiac index (CI) measured by pressure recording analytical method (PRAM) and transthoracic echocardiography (TTE) before and after the passive leg raise (PLR) maneuver. Methods: This is a prospective observational study in critically ill patients who were monitored with MostcareUp/PRAM (Vygon, Vytech, Padova, Italy). Cardiac index (CI) values and percent changes in CI values in response to PLR were recorded by TTE and PRAM. Results: Data of a total of 25 patients were collected. The median CI values that were calculated by TTE before and after PLR were 2.5 (1.2-4.7) L/min/m(2) and 2.9 (1.4-5.6) L/min/m(2), respectively. The median CI values that were calculated by PRAM before and after PLR were 2.5 (1.5-4.8) L/min/m(2) and 2.6 (1.7-5.7) L/min/m(2), respectively. There was significant correlations between the measured CI values both by TTE and PRAM before and after PLR (r=0.635, p=0.001 and r=0.610, p=0.001, respectively). The median percent changes in CI with TTE and PRAM were -0.13 (-0.7-0.4) and -0.11 (-0.5-0.5), respectively. Sixteen patients were determined as FR by TTE (64%) and 13 patients were determined as FR by PRAM (52%). The Kappa test showed moderate agreement between TTE and PRAM for predicting fluid responsiveness (k=0.595; p=0.002). The mean biases between the CI values measured by TTE and PRAM before and after PLR were 0.04 +/- 0.77 L/min/m(2) and 0.22 +/- 0.88 L/min/m(2), respectively. Conclusion: This study showed a significant correlation for CI values measured by both methods. For predicting fluid responsiveness there was agreement between the two methods after PLR.Item Effect of Graft Weight to Recipient Body Weight Ratio on Hemodynamic and Metabolic Parameters in Pediatric Liver Transplant: A Retrospective Analysis(2017) Haberal, Mehmet; Ersoy, Zeynep; Kaplan, Serife; Ozdemirkan, Aycan; Torgay, Adnan; Arslan, Gulnaz; Pirat, Arash; 0000-0003-0767-1088; 0000-0002-6829-3300; 0000-0002-3462-7632; 28260433; AAF-3066-2021; AAJ-5221-2021; AAJ-8097-2021; AAH-7003-2019Objectives: To analyze how graft-weight-to-body-weight ratio in pediatric liver transplant affects intraoperative and early postoperative hemodynamic and metabolic parameters. Materials and Methods: We reviewed data from 130 children who underwent liver transplant between 2005 and 2015. Recipients were divided into 2 groups: those with a graft weight to body weight ratio > 4% (large for size) and those with a ratio <= 4% (normal for size). Data included demographics, preoperative laboratory findings, intraoperative metabolic and hemodynamic parameters, and intensive care follow-up parameters. Results: Patients in the large-graft-for-size group (>4%) received more colloid solution (57.7 +/- 20.1 mL/kg vs 45.1 +/- 21.9 mL/kg; P = .08) and higher doses of furosemide (0.7 +/- 0.6 mg/kg vs 0.4 +/- 0.7 mg/kg; P = .018). They had lower mean pH (7.1 +/- 0.1 vs 7.2 +/- 0.1; P = .004) and PO2 (115.4 +/- 44.6 mm Hg vs 147.6 +/- 49.3 mm Hg; P = .004) values, higher blood glucose values (352.8 +/- 96.9 mg/dL vs 262.8 +/- 88.2 mg/dL; P < .001), and lower mean body temperature (34.8 +/- 0.7 degrees C vs 35.2 +/- 0.6 degrees C; P = .016) during the neohepatic phase. They received more blood transfusions during both the anhepatic (30.3 +/- 24.3 mL/kg vs 18.8 +/- 21.8 mL/kg; P = .013) and neohepatic (17.7 +/- 20.4 mL/kg vs 10.3 +/- 15.5 mL/kg; P = .031) phases and more fresh frozen plasma (13.6 +/- 17.6 mL/kg vs 6.2 +/- 10.2 mL/kg; P = .012) during the neohepatic phase. They also were more likely to be hypotensive (P < .05) and to receive norepinephrine infusion more often (44% vs 22%; P < .05) intra-operatively. More patients in this group were mechanically ventilated in the intensive care unit (56% vs 31%; P = .035). There were no significant differences between the groups in postoperative acute renal dysfunction, graft rejection or loss, infections, length of intensive care stay, and mortality (P > .05). Conclusions: High graft weight-to-body-weight ratio is associated with adverse metabolic and hemodynamic changes during the intraoperative and early postoperative periods. These results emphasize the importance of using an appropriately sized graft in liver transplant.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).