Wos İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4807
Browse
6 results
Search Results
Item 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-1419-2021The 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.Item 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-1419-2021Rib 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.Item Neurologic Complications in Heart Transplant Recipients Readmitted to the Intensive Care Unit(2021) Sahinturk, Helin; Yurtsever, Beyza Meltem; Ersoy, Ozgur; Kibaroglu, Seda; Zeyneoglu, Pinar; 34926017Introduction Neurologic complications after transplantation surgery are major causes of morbidity, and the incidence of neurologic complications among heart transplant recipients varies from 7% to 81%. In our study, we aimed to determine the incidence, etiologies, and risk factors of neurologic complications among patients readmitted to the intensive care unit (ICU) after heart transplantation. Method In this retrospective cohort study, the medical records of all patients who underwent cardiac transplantation from February 2003 to July 2019 were reviewed, and those admitted to the ICU due to neurologic complications during the early and late postoperative period were evaluated. The patients were divided into two groups based on the development of neurologic complications to compare demographic and other characteristics. Results A total of 130 heart transplant recipients were analyzed. We excluded 33 patients from the study because they either had neurologic complications or died postoperatively without discharge from the intensive care unit. The mean age of the cohort was 35.4 +/- 18.5 years, and 74 (76.3%) were male. Out of those 97 heart transplant recipients, 22 (22.7%) developed neurologic complications. Five patients (22.7% ) were admitted to the ICU in the first month, six patients (27.3%) were admitted to the ICU between one and six months, and 11 patients (50%) were admitted to the ICU six months after transplantation due to neurologic complications. The most common diagnosis was posterior reversible encephalopathy syndrome (PRES) (n = 6, 27.3%). The other diagnoses were calcineurin inhibitor toxicity (n = 5, 22.7%), intracranial hemorrhage (n = 3, 13.6%), seizures (n = 2, 9.2%), stroke (n = 2, 9.2%), femoral neuropathy (n = 1, 4.5%), myopathy (n = 1, 4.5%), phrenic nerve damage (n = 1, 4.5%), and cerebral abscess (n = 1, 4.5%). The rate of neurologic complications was higher in males when compared with females (p = 0.03). Both groups were similar in terms of the etiologies of cardiac failure, coexisting disease, and anticoagulant and immunosuppressive usage. The requirement for mechanical ventilation, renal replacement therapy, and the incidence of acute kidney injury were similar in both groups (p > 0.05). The incidence of sepsis was significantly higher in patients with neurologic complications (n = 8, 36.4%, versus n = 5, 6.7%; p < 0.001). The mean length of hospital stay was significantly higher in patients with neurologic complications (21.4 +/- 15.8 versus 11.1 +/- 13.3 days, p = 0.01). The risk of developing neurologic complications is 3.036 times higher in males, and this is statistically significant (odds ratio (OR), 3.036; 95% confidence interval (CI), 1.078-8.444; p = 0.036). Conclusion Our results suggest that neurologic complications develop in 22.7% of heart transplant recipients admitted to the ICU, and half of them are seen after six months postoperatively. PRES was the most frequent (27.3%) neurologic complication. The risk of neurologic complications is three times higher for males. The mean length of hospital stay and incidence of sepsis were significantly higher in heart transplant recipients who developed neurologic complications.Item 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-1419-2021Acute 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 outcomesItem SAPS III or APACHE IV: Which score to choose for acute trauma patients in intensive care unit?(2019) Toker, Melike Korkmaz; Gulleroglu, Aykan; Karabay, Ayse Gul; Bıcer, Ilhan Guncey; Demiraran, Yavuz; 31135940BACKGROUND: The aim of the present study was to evaluate the effectiveness of the Simplified Acute Physiology Score (SAPS) III and the Acute Physiology and Chronic Health Evaluation (APACHE) IV in the prediction of in-hospital mortality in surviving multi-trauma patients. METHODS: This study was conducted in the 13-bed intensive care unit (ICU) of a tertiary hospital. A retrospective review of multi-trauma patients whose care was managed in the ICU was performed. Data collection included details of age, gender, ICU admission, and outcome. APACHE IV and SAPS III scores, as well as the predicted mortality rate (PMR), were calculated using web-based calculators. RESULTS: Of the 90 patients 20% (n= 18) were female and 80% (n= 72) were male. The overall mortality rate was 25.6%. The mean APACHE IV, Acute Physiology Score (APS) and SAPS III score was 69.27 +/- 34.51, 66.42 +/- 33.72, and 26.36 +/- 27.14, respectively. The mean PMR according to the APACHE IV and the SAPS III was 26.36 +/- 27.14 and 17.07 +/- 24.88, respectively. The area under the curve result of receiver operating characteristic curve analysis was 0.87 for the APACHE IV and 0.93 for the SAPS III. CONCLUSION: The performance of the SAPS III was more sensitive and discriminative than the APACHE IV scoring system for multi-trauma ICU patients.Item Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use in acute respiratory failure(2016) Ugurlu, Aylin Ozsancak; Kivanc, Tulay; Dogrul, Ilgaz; 26963304Introduction: Noninvasive mechanical ventilation (NIV) has been increasingly used worldwide for acute respiratory failure (ARF), especially in patients with chronic lung disorders. We aimed to define the approach of pulmonologists in Turkey to NIV use for ARF management. Materials and Methods: A 38-question survey, developed and tested by authors, was distributed by e-mail to a total of 2.205 pulmonologists in Turkey. Results: Response rate was 27% (n=596). Seventy-one percent of responders were practicing NIV in clinic. NIV use was found to be associated with responder's academic title, age, duration of medical license, type of physician's hospital and its region, patient load, NIV experience during residency, and duration of NIV and intensive care unit (ICU) experience (p<0.001). Based on sub-group analysis of responders using NIV, median number of NIV patients followed-up per week was 4 [interquartile range (IQR): 2-6]. Most of the NIV users reported employment of wards (90%) and/or ICUs (86%) to follow-up patients, while 8.4% of the responders were applying NIV only in ICU's. Chronic obstructive lung disease (COPD) (99.5%), obesity hypoventilation syndrome (93.7%) and restrictive lung disease (89.4%) were the most common indications. Majority of NIV users (87%) were applying NIV to > 60% of patients with COPD, and success rate in COPD was reported as over 60% by 93% of users. Oronasal mask (median and IQR 90, 80-100%, respectively) and home care NIV ventilators (median and IQR 50, 10-85%, respectively) were the most commonly utilized equipment. Conclusion: NIV use in ARF varies based on hospital type, region and, especially, experience of the physician. Although consistent with guidelines and general practice, NIV use can still be improved and increased.