TR-Dizin İndeksli Açık & Kapalı Erişimli Yayınlar
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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 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.