PubMed İndeksli Açık & Kapalı Erişimli Yayınlar
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Item ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure(2022) Oczkowski, Simon; Ergan, Begum; Bos, Lieuwe; Chatwin, Michelle; Ferrer, Miguel; Gregoretti, Cesare; Heunks, Leo; Frat, Jean-Pierre; Longhini, Federico; Nava, Stefano; Navalesi, Paolo; Ugurlu, Aylin Ozsancak; Pisani, Lara; Renda, Teresa; Thille, Arnaud W.; Winck, Joao Carlos; Windisch, Wolfram; Tonia, Thomy; Boyd, Jeanette; Sotgiu, Giovanni; Scala, Raffaele; 34649974Background High-flow nasal cannula (HFNC) has become a frequently used noninvasive form of respiratory support in acute settings; however, evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF). Materials and methodology The European Respiratory Society task force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The task force used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and noninvasive ventilation (NIV) for the management of adults in acute settings with ARF. Results The task force developed eight conditional recommendations, suggesting the use of 1) HFNC over COT in hypoxaemic ARF; 2) HFNC over NIV in hypoxaemic ARF; 3) HFNC over COT during breaks from NIV; 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications; 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications; 6) HFNC over COT in nonsurgical patients at low risk of extubation failure; 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV; and 8) trialling NIV prior to use of HFNC in patients with COPD and hypercapnic ARF. Conclusions HFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of noninvasive respiratory support to provide to patients in different acute settings.Item Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies(2014) Ozyilmaz, Ezgi; Ugurlu, Aylin Ozsancak; Nava, StefanoBackground: Identifying the predictors of noninvasive ventilation (NIV) failure has attracted significant interest because of the strong link between failure and poor outcomes. However, very little attention has been paid to the timing of the failure. This narrative review focuses on the causes of NIV failure and risk factors and potential remedies for NIV failure, based on the timing factor. Results: The possible causes of immediate failure (within minutes to <1 h) are a weak cough reflex, excessive secretions, hypercapnic encephalopathy, intolerance, agitation, and patient-ventilator asynchrony. The major potential interventions include chest physiotherapeutic techniques, early fiberoptic bronchoscopy, changing ventilator settings, and judicious sedation. The risk factors for early failure (within 1 to 48 h) may differ for hypercapnic and hypoxemic respiratory failure. However, most cases of early failure are due to poor arterial blood gas (ABGs) and an inability to promptly correct them, increased severity of illness, and the persistence of a high respiratory rate. Despite a satisfactory initial response, late failure (48 h after NIV) can occur and may be related to sleep disturbance. Conclusions: Every clinician dealing with NIV should be aware of these risk factors and the predicted parameters of NIV failure that may change during the application of NIV. Close monitoring is required to detect early and late signs of deterioration, thereby preventing unavoidable delays in intubation.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.Item Combined catheter thrombus fragmentation and percutaneous thrombectomy in a patient with massive pulmonary emboli and acute cerebral infarct(2015) Ugurlu, Aylin Ozsancak; Cinar, Ozlem; Caymaz, Ismail; Cevik, Halime; Gumus, Burcak; 25550253Item Use and Outcomes of Noninvasive Ventilation for Acute Respiratory Failure in Different Age Groups(2016) Ugurlu, Aylin Ozsancak; Sidhom, Samy S.; Khodabandeh, Ali; leong, Michael; Mohr, Chester; Lin, Denis Y.; Buchwald, Irwin; Bahhady, Imad; Wengryn, John; Maheshwari, Vinay; Hill, Nicholas S.; 26374908BACKGROUND: The prevalence of chronic disease and do-not-intubate status increases with age. Thus, we aimed to determine characteristics and outcomes associated with noninvasive ventilation (NIV) use for acute respiratory failure (ARF) in different age groups. METHODS: A database comprising prospective data collected on site on all adult patients with ARF requiring ventilatory support from 8 acute care hospitals in Massachusetts was used. RESULTS: From a total of 1,225 ventilator starts, overall NIV utilization, success, and in-hospital mortality rates were 22, 54, and 18% in younger (18-44 y); 34, 65, and 13% in middle-aged (45-64 y); 49, 68, and 17% in elderly (65-79 y); and 47, 76, and 24% in aged (>= 80 y) groups, respectively (P < .001, P = .08, and P = .11, respectively). NIV use for cardiogenic pulmonary edema and subjects with a do-not-intubate order increased significantly with advancing age (25, 57, 57, and 74% and 7, 12, 18, and 31%, respectively, in the 4 age groups [P < .001 and P = .046, respectively]). For subjects receiving NIV with a do-not-intubate order, success and in-hospital mortality rates were similar in different age groups (P = .27 and P = .98, respectively). CONCLUSIONS: NIV use and a do-not-intubate status are more frequent in subjects with ARF >= 65 y than in those < 65 y, especially for subjects with cardiogenic pulmonary edema. However, NIV success and mortality rates were similar between age groups.Item Effects of biomass smoke on pulmonary functions: a case control study(2016) Balcan, Baran; Akan, Selcuk; Ugurlu, Aylin Ozsancak; Handemir, Bahar Ozcelik; Ceyhan, Berrin Bagci; Ozkaya, Sevket; 27486318Background: Biomass smoke is the leading cause of COPD in developing countries such as Turkey. In rural areas of Turkey, females are more exposed to biomass smoke because of traditional lifestyles. Aim: The aim of this study was to determine the adverse effects of biomass smoke on pulmonary functions and define the relationship between duration in years and an index (cumulative exposure index) with altered pulmonary function test results. Participants and methods: A total of 115 females who lived in the village of Kagizman (a borough of Kars located in the eastern part of Turkey) and were exposed to biomass smoke were included in the study. The control group was generated with 73 individuals living in the same area who were never exposed to biomass smoke. Results: Twenty-seven (23.8%) females in the study group and four (5.5%) in the control group had small airway disease (P=0.038). Twenty-two (19.1%) females in the study group and ten (13.7%) in the control group had obstruction (P=0.223). Twenty (17.3%) females in the study group who were exposed to biomass smoke had restriction compared with ten (13%) in the control group (P=0.189). The duration needed for the existence of small airway disease was 16 years, for obstructive airway disease was 17 years, and for restrictive airway disease was 17 years. The intensity of biomass smoke was defined in terms of cumulative exposure index; it was calculated by multiplying hours per day, weeks per month, and total years of smoke exposure and dividing the result by three. Conclusion: Exposure to biomass smoke is a serious public health problem, especially in rural areas of developing countries, because of its negative effects on pulmonary functions. As the duration and the intensity of exposure increase, the probability of having altered pulmonary function test results is higher.Item Results of Polysomnographies and Treatment Strategies in Elderly Patients with Symptoms of Obstructive Sleep Apnea Syndrome(2017) Ugurlu, Aylin Ozsancak; Balcan, Baran; 0000-0003-3598-3986; 29404173; A-4721-2018; AAA-2925-2020OBJECTIVES: In this study, we evaluated data regarding the management of geriatric patients with symptoms of obstructive sleep apnea syndrome (age, >65 years) who were admitted to our sleep clinic. MATERIAL AND METHODS: Symptoms and sleep data of the patients were retrospectively evaluated, and the patients were reevaluated after treatment. RESULTS: A total of 85 patients with a median age of 69 years were included. Snoring and fatigue were the most common symptoms. Cardiovascular diseases were the most frequently listed comorbidity. The median Epworth sleepiness scale was 10, and based on Berlin sleep questionnaire findings, 63.5% of the participants were in the high-risk group. Eighty-seven percent were diagnosed with obstructive sleep apnea (2/3 of them were positional), and moderate-to-severe obstructive sleep apnea was observed more in women than in men. Only one patient was diagnosed with central sleep apnea. There were positive and linear correlations between increased age and the apnea-hypopnea index, arousal index, Epworth sleepiness scale, and being in a high-risk group according to the Berlin sleep scale; however, there was no correlation between increased age and the number of hypopnea and apnea events. There were also positive and linear correlations between the apnea-hypopnea index and the Epworth sleepiness scale, being in a high-risk group according to the Berlin sleep questionnaire, an increased number of known medical conditions, and increased body mass index. We were able to contact 72 of the 85 patients via phone calls. Patients who adjusted to treatment had positive feedbacks. CONCLUSION: Sleep disorders are observed more in the elderly, and an increasing age is an independent factor for sleep disorders. Besides the usual signs and symptoms of sleep disorders, it should be considered in elderly who have cognitive dysfunction and dementia.