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Halaçlı B, Hancı P, Ortaç Ersoy E, Öcal S, Tanrıöver MD, Topeli A. Influenza or other respiratory viruses: does it matter as the cause of acute respiratory failure in the critically-ill patients? Tuberk Toraks 2021; 68:388-398. [PMID: 33448736 DOI: 10.5578/tt.70350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Respiratory virus infections may cause serious respiratory failure requiring intensive care unit (ICU) admission. The objective of this study was to evaluate the clinical features and the outcome in patients with acute respiratory failure (ARF) due to viral infections comparing etiological agents. Materials and Methods ARF patients with positive viral serology were retrospectively recruited. Cohort was evaluated with regard to subgroups as influenza and other respiratory viruses (ORV), as well as survivors and nonsurvivors. Result Out of 938 admitted patients, 319 were followed as ARF and only 149 patients had viral respiratory panel results. In 49 patients with ARF, 52 positive viral results were detected and 47 patients with single positive viral isolates of either influenza or ORV were included. Among them, 62% had ORV with quite similar characteristics with influenza group apart from diabetes mellitus which was encountered more in influenza group (p= 0.02). Overall ICU mortality was 32% and there was no difference between the two groups (p= 0.42). Acute Physiology and Chronic Health Evaluation (APACHE) II score was independently associated with ICU mortality (OR: 1.25; 95% CI: 1.04-1.51; p= 0.02). Conclusions This study emphasizes to consider the possibility of other respiratory viruses for the cause of ARF with similar characteristics and mortality as influenza species.
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Topeli A, Cakir B. Evaluation of the blue code system established in the health campus of a university hospital. Turk J Emerg Med 2021; 21:14-19. [PMID: 33575510 PMCID: PMC7864126 DOI: 10.4103/2452-2473.301912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/14/2020] [Accepted: 07/29/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We report the hospital outcomes after implementing the blue code system in our hospital and health campus. We also aimed to determine factors related to mortality. METHODS This is a retrospective observational study of the patients who received cardiopulmonary resuscitation (CPR). All blue code calls for all age groups between March 15, 2013, and April 30, 2015 were analyzed. Logistic regression analysis was performed to find independent predictors of in-hospital mortality. RESULTS A total of 155 patients from the blue code calls were evaluated. Return of spontaneous circulation was achieved in 45.5% of patients, and 54.8% of the patients had died at the end of the CPR. The hospital discharge rate was 20%. Of all patients, 65% were adults with a survival rate of 7.9%, whereas pediatric patients had a 44.2% survival rate. Asystole and pulseless electrical activity were the predominant electrocardiography rhythms in 92.4% of patients. The comparison of survivors and nonsurvivors revealed that nonsurvivors were older, had more cancer as the comorbidity, had a more cardiac arrest, and sepsis as the underlying cause and had >20 min of CPR. The logistic regression analysis demonstrated the independent risk factors for mortality as arrest at a hospital ward, and sepsis as the underlying cause and being adult patient. CONCLUSION The performance of the blue code system should be evaluated periodically. Every effort should be made to prevent unexpected cardiac arrests and increase hospital discharge with good neurologic outcomes.
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Ortac Ersoy E, Er B, Ciftci F, Gulleroglu A, Suner K, Arpinar B, Aygencel G, Bacakoglu F, Akpinar S, Comert B, Sungurtekin H, Altıntas D, Rollas K, Turan S, Topeli A. Outcome of Patients Admitted to Intensive Care Units due to Influenza-Related Severe Acute Respiratory Illness in 2017-2018 Flu Season: A Multicenter Study from Turkey. Respiration 2020; 99:954-960. [PMID: 33271560 DOI: 10.1159/000511092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Influenza can cause severe acute respiratory illness (SARI), which occurs as local outbreaks or seasonal epidemics with high intensive care unit (ICU) admission and mortality rates. Mortality is mainly due to SARI. OBJECTIVE The aim of this study was to evaluate the outcome of patients admitted to ICU due to influenza-related SARI in 2017-2018 flu season in Turkey. METHODS A retrospective multicenter study was conducted in 13 ICUs with a total of 216 beds from 6 cities in Turkey. All adult patients (over 18 years) admitted to the ICUs in 2017-2018 flu season (between September 1, 2017, and April 30, 2018) because of SARI and with a positive nasopharyngeal swab for influenza were included in the study. RESULTS A total of 123 cases were included in the study. The mean age of patients was 64.5 ± 17.5 years, and 66 (53.7%) patients were older than 65 years. The ICU mortality was 33.9%, and hospital mortality was 35.6%. Invasive mechanical ventilation (IMV), acute kidney injury (AKI), hematologic malignancy, and >65 years of age were the factors affecting mortality in influenza. CONCLUSION SARI due to influenza carries a high mortality rate, and IMV, AKI, presence of hematologic malignancy, and older age are independent risk factors for mortality.
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Ozsurekci Y, Aykac K, Er AG, Halacli B, Arasli M, Oygar PD, Gürlevik S, Cura Yayla BC, Karakaya J, Alp A, Topeli A, Cengiz AB, Akova M, Ceyhan M. Predictive value of cytokine/chemokine responses for the disease severity and management in children and adult cases with COVID-19. J Med Virol 2020; 93:2828-2837. [PMID: 33225509 PMCID: PMC7753701 DOI: 10.1002/jmv.26683] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023]
Abstract
The disease course of children with coronavirus disease 2019 (COVID‐19) seems milder as compared with adults, however, actual reason of the pathogenesis still remains unclear. There is a growing interest on possible relationship between pathogenicity or disease severity and biomarkers including cytokines or chemokines. We wondered whether these biomarkers could be used for the prediction of the prognosis of COVID‐19 and improving our understanding on the variations between pediatric and adult cases with COVID‐19. The acute phase serum levels of 25 cytokines and chemokines in the serum samples from 60 COVID‐19 pediatric (n = 30) and adult cases (n = 30) including 20 severe or critically ill, 25 moderate and 15 mild patients and 30 healthy pediatric (n = 15) and adult (n = 15) volunteers were measured using commercially available fluorescent bead immunoassay and analyzed in combination with clinical data. Interferon gamma‐induced protein 10 (IP‐10) and macrophage inflammatory protein (MIP)−3β levels were significantly higher in patient cohort including pediatric and adult cases with COVID‐19 when compared with all healthy volunteers (p ≤ .001 in each) and whereas IP‐10 levels were significantly higher in both pediatric and adult cases with severe disease course, MIP‐3β were significantly lower in healthy controls. Additionally, IP‐10 is an independent predictor for disease severity, particularly in children and interleukin‐6 seems a relatively good predictor for disease severity in adults. IP‐10 and MIP‐3β seem good research candidates to understand severity of COVID‐19 in both pediatric and adult population and to investigate possible pathophysiological mechanism of COVID‐19.
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Durhan G, Ardalı Düzgün S, Başaran Demirkazık F, Irmak İ, İdilman İ, Akpınar MG, Akpınar E, Öcal S, Telli G, Topeli A, Arıyürek OM. Visual and software-based quantitative chest CT assessment of COVID-19: correlation with clinical findings. Diagn Interv Radiol 2020; 26:557-564. [PMID: 32876569 PMCID: PMC7664745 DOI: 10.5152/dir.2020.20407] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study was to evaluate visual and software-based quantitative assessment of parenchymal changes and normal lung parenchyma in patients with coronavirus disease 2019 (COVID-19) pneumonia. The secondary aim of the study was to compare the radiologic findings with clinical and laboratory data. METHODS Patients with COVID-19 who underwent chest computed tomography (CT) between March 11, 2020 and April 15, 2020 were retrospectively evaluated. Clinical and laboratory findings of patients with abnormal findings on chest CT and PCR-evidence of COVID-19 infection were recorded. Visual quantitative assessment score (VQAS) was performed according to the extent of lung opacities. Software-based quantitative assessment of the normal lung parenchyma percentage (SQNLP) was automatically quantified by a deep learning software. The presence of consolidation and crazy paving pattern (CPP) was also recorded. Statistical analyses were performed to evaluate the correlation between quantitative radiologic assessments, and clinical and laboratory findings, as well as to determine the predictive utility of radiologic findings for estimating severe pneumonia and admission to intensive care unit (ICU). RESULTS A total of 90 patients were enrolled. Both VQAS and SQNLP were significantly correlated with multiple clinical parameters. While VQAS >8.5 (sensitivity, 84.2%; specificity, 80.3%) and SQNLP <82.45% (sensitivity, 83.1%; specificity, 84.2%) were related to severe pneumonia, VQAS >9.5 (sensitivity, 93.3%; specificity, 86.5%) and SQNLP <81.1% (sensitivity, 86.5%; specificity, 86.7%) were predictive of ICU admission. Both consolidation and CPP were more commonly seen in patients with severe pneumonia than patients with nonsevere pneumonia (P = 0.197 for consolidation; P < 0.001 for CPP). Moreover, the presence of CPP showed high specificity (97.2%) for severe pneumonia. CONCLUSION Both SQNLP and VQAS were significantly related to the clinical findings, highlighting their clinical utility in predicting severe pneumonia, ICU admission, length of hospital stay, and management of the disease. On the other hand, presence of CPP has high specificity for severe COVID-19 pneumonia.
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Fadiloglu E, Unal C, Tanacan A, Ocal S, Kilicaslan B, Akinci SB, Topeli A, Beksac MS. Maternal Mortality: 10 Year Experience of a Tertiary Center in Turkey. Case Rep Med 2020; 2020:3595024. [PMID: 33061988 PMCID: PMC7545441 DOI: 10.1155/2020/3595024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
We retrospectively evaluated five maternal mortality cases that occurred in our institution within the last 10 years. Rate of maternal mortality was 24.5 per 100000 live births. Maternal mortality causes were cardiopulmonary failure secondary to veno-occlusive disease, septic shock secondary to osteosarcoma, pulmonary thromboembolism secondary to metastatic breast cancer, septic shock secondary to cholecystitis, and postpartum hemorrhage secondary to Niemann-Pick disease. Four out of five cases were evaluated as indirect maternal mortality cases. Three out of five cases ended up with a healthy newborn, while other cases ended up with abortus and postpartum exitus.
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Özdemir U, Ortaç Ersoy E, Yüksel RC, Kaya E, Aygencel G, Türkoğlu M, Topeli A, Güven M, Sungur M, Altintaş ND. Value of prognostic scores in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis patients in intensive care unit: a multicenter retrospective cohort study from Turkey. Turk J Med Sci 2020; 50:1223-1230. [PMID: 32304194 PMCID: PMC7491289 DOI: 10.3906/sag-1911-86] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/18/2020] [Indexed: 11/11/2022] Open
Abstract
Background/aim There is a need for a scoring system for predicting ICU prognosis of patients with ANCA-associated vasculitis (AAV), but there are limited data on it in the literature. Therefore, we aimed to determine the scores that can estimate the prognosis of patients with AAV during intensive care follow up. Materials and methods All adult patients admitted to the medical ICUs of 4 reference university hospitals in Turkey due to AAV activation and/or disease/treatment complications in the last 10 years were included in this study. Demographic data, treatments before ICU, the Birmingham Vasculitis Activity Score (BVAS) score at the time of vasculitis diagnosis, and BVAS, APACHE II, SOFA, and SAPS II scores at the ICU admission, treatments, procedures, and complications during ICU stay were recorded for all AAV patients. Results Thirty-four patients were included in the study. The median age of the patients was 60 (42–70) years, and 64.7% were male. Twenty-five patients were diagnosed with Granulomatosis with polyangiitis, and 9 were diagnosed with Microscopic polyangiitis. The most common ICU admission causes were hemorrhage (85.3%) and sepsis/septic shock (67.6%). Twenty patients (58.8%) died in the ICU follow up. There were significant differences in APACHE II (P = 0.004) and SAPS II (P = 0.044) scores between survivors and nonsurvivors, while there were no significant differences in BVAS (during diagnosis P = 0.089 and ICU admission P = 0.539) and SOFA (P = 0.097) scores. APACHE II score was found to be an independent risk factor for ICU mortality (OR = 1.231, CI 95% = 1.011–1.498, P = 0.038) according to logistic regression analysis. An APACHE II score of greater than 20.5 predicted ICU mortality with 80% sensitivity and 70% specificity (AUC = 0.8, P = 0.004, Likelihood ratio = 2.6) according to the ROC curve analysis. Conclusion APACHE II score can be used for the prediction of ICU mortality in AAV patients.
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Topeli A, Baspinar B, Ortac Ersoy E. In Search of the Ideal Risk Score in Sepsis. Am J Respir Crit Care Med 2020; 202:152-153. [PMID: 32250644 PMCID: PMC7328329 DOI: 10.1164/rccm.202002-0315le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pektezel MY, Ocal S, Ersoy EO, Topeli A. The Neuropsychiatric Iceberg Under Withdrawal Syndrome. Am J Crit Care 2020; 29:168. [PMID: 32355978 DOI: 10.4037/ajcc2020256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Halacli B, Kaya A, Topeli A. Critically-ill COVID-19 patient. Turk J Med Sci 2020; 50:585-591. [PMID: 32293831 PMCID: PMC7195980 DOI: 10.3906/sag-2004-122] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) stands out as the major pandemic that we have experienced in the last century. As it affects every social structure, it brought the importance of intensive care support once again to the agenda of healthcare system after causing severe acute respiratory syndrome. The precautions to be taken against this virus, where our knowledge is extremely small, intensive care units take an indispensable place in pandemic planning. In this review, we aimed to emphasize the crucial points regarding intensive care management of COVID-19 patients, which we have written not only for intensivists but also for all healthcare professionals.
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Fadiloglu E, Bulut Yuksel ND, Unal C, Ocal S, Akinci SB, Topeli A, Beksac MS. Characteristics of obstetric admissions to intensive care unit: APACHE II, SOFA and the Glasgow Coma Scale. J Perinat Med 2019; 47:947-957. [PMID: 31603858 DOI: 10.1515/jpm-2019-0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/07/2019] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the characteristics of obstetric admissions to an intensive care unit (ICU) and assess the utility of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and the Glasgow Coma Scale (GCS). Methods This study is consisted of 160 patients admitted to an ICU during the antenatal period or within 7 days at the postpartum period. Clinical characteristics and ICU scores were evaluated. Results The rate of admission to the ICU was 7.8/1000 deliveries. Four cases ended with maternal mortality (2.5%). The most common hospitalization indications were hypertensive disorders of pregnancy, cardiovascular disorders and obstetric hemorrhage, at 40 (25%), 34 (21.2%), and 31 (19.3%) cases, respectively. The receiver operating characteristics (ROC) curve analysis for prediction of maternal mortality revealed area under curve (AUC) values as 0.971 both for APACHE II and predicted mortality rate (PMR), and 24.5 and 47.1 were determined as the cut-offs with sensitivities of 100%. AUCs were also 0.901 and 0.929 for the initial and worst SOFA score, respectively. The cut-off value for the initial and worst SOFA score was 3.5, with a sensitivity of 100%, and was 10 with a specificity of 98.9%, respectively. Conclusion APACHE II and PMR overpredict maternal mortality, but those higher scores predict maternal mortality. Higher SOFA scores are related with maternal mortalities with high specificity.
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Ocal S, Ozen S, Nemutlu E, Kart D, Eylem CC, Demirkan K, Ortac Ersoy E, Topeli A. Aerosol Drug Deposition Level of Inhaled Salbutamol by Mesh Nebulizer on Endotracheal Tube and Heat and Moisture Exchangers with and without an In Vitro Model of Acinetobacter baumanii Biofilm. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Öcal S, Portakal O, Öcal A, Demir AU, Topeli A, Çöplü L. Corrigendum to "Factors associated with pulmonary hypertension and long-term survival in bronchiectasis subjects" [Respir. Med. (2016) 119 109-114]. Respir Med 2019; 160:105706. [PMID: 31200983 DOI: 10.1016/j.rmed.2019.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Esme M, Topeli A, Yavuz BB, Akova M. Infections in the Elderly Critically-Ill Patients. Front Med (Lausanne) 2019; 6:118. [PMID: 31275937 PMCID: PMC6593279 DOI: 10.3389/fmed.2019.00118] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022] Open
Abstract
Infections are leading causes of morbidity and mortality in the advanced aged. Various factors including immunosenescens, comorbid chronic diseases, and alterations in normal physiological organ functions may modify the frequency and severity of infections in elderly patients. Normal body reactions to ensuing infection, such as increased body temperature, may be blunted in those patients causing difficulties in differential diagnosis between infection and other diseases. In severe infections the respiratory and urinary tracts are the most frequently involved systems which may be accompanied by severe sepsis. Bacteremia and sepsis are also associated with indwelling vascular catheters in the elderly who are admitted to the intensive care unit (ICU). Older patients are more vulnerable to the Clostridioides difficile infection, as well. Although the general management of infections in severely ill elderly patients is not different than in younger patients, meticulous care in fluid management and careful individualized optimization in antibiotic therapy, along with the other principals of antimicrobial stewardship are warranted in order to prevent increased mortality caused by infection. Organized team management when treating critically ill elderly patients in the ICU is essential and will reduce the morbidity and mortality due to infection in such patients.
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Sendur SN, Topeli A. The effect of the first-year residents orientation period on intensive care and hospital mortality, in a medical intensive care unit, within a developing country. J Crit Care 2019; 51:105-110. [PMID: 30798097 DOI: 10.1016/j.jcrc.2019.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine whether the adaptation of junior residents, during their first week rotation period within the ICU, has any effect on ICU and hospital mortality rates, in a developing country. MATERIALS AND METHODS Patients who were admitted to the ICU were included, with 1207 out of 1547 of the admitted patients being eligible. The effect of age, gender, co-morbidities, the cause of the ICU admission, the presence of hospital-acquired infections, residents rotation week, admission time (weekday vs. weekend), number of patients admitted on the same day (one vs. two or more) and APACHE II score upon the ICU and hospital mortality rates were evaluated. RESULTS The first rotation week of junior residents is an independent risk factor determining hospital mortality (OR (95% CI) = 2.42 (1.23-4.76); p = .010). The effect of the first rotation week on intensive care mortality was not statistically significant (1.92 (0.97-3.84); p = .063). In addition, the presence of malignancy, sepsis-septic shock, hospital-acquired infection and high APACHE II score were found to be other independent determinants of increased hospital mortality. CONCLUSION The junior residents first rotation week is an independent risk factor on hospital mortality, in a tertiary medical intensive care unit, within a developing country.
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Ediboğlu Ö, Moçin ÖY, Özyılmaz E, Saltürk C, Önalan T, Seydaoğlu G, Çelikel T, Arıkan H, Ataman S, Kıraklı C, Özçelik Z, Kultufan S, Kara İ, Kara A, Dağlı E, Bülbül SD, Kahveci K, Dinçer M, Şenoğlu N, Özkarakaş H, Bahar İ, Cengiz M, Ramazanoğlu A, Çelik B, Gaygısız Ü, Kır G, Bindal A, Akan B, Turan IÖ, Yıldırım F, Başarık B, Ulukan ZA, Efe S, Sungur M, Temel Ş, İzdeş S, Hoşgün D, Karadeniz N, Tuncay E, Gökşenoğlu NÇ, Irmak İ, Datlı U, Zerman A, Akdağ D, Özdemir L, Elay G, Karaçayır Y, Topeli A, Hancı P, Kaya EK, Güven P, Sazak H, Aydemir S, Aygencel G, Aydemir Y, Doğanay Z, Kömürcü Ö, Hancı V, Karakoç E, Sözütek D, Coşkun G, Ateş G, Tiryaki C, Soytürk AN, Girgin NK, Çalışkan G, Bıyıklı O, Gökmen N, Koca U, Çiledağ A, Süner KÖ, Cinel İ, Arslantaş MK, Gül F, Ergün R, Yılmaz N, Altıntaş D, Talan L, Yalçınsoy M, Güllü MN, Özcan PE, Orhun G, Savran Y, Tokur ME, Akpınar S, Şen P, Gürsel G, Şerifoğlu İ, Gedik E, Balbay ÖA, Akbaş T, Cesur S, Yolacan H, Sağmen SB, Ekren PK, Bacakoğlu F, Ergan B, Günay E, Sarıaydın M, Sağlam DA, Karakurt S, Eryüksel E, Öztuna F, Mürtezaoğlu ESA, Cinemre H, Nalbant A, Yağmurkaya Ö, Mandal T, İkidağ B. Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers. Turk Thorac J 2018; 19:209-215. [PMID: 30322437 PMCID: PMC6196900 DOI: 10.5152/turkthoracj.2018.170104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/17/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.
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Ortac Ersoy E, Abdulkerim S, Oz A, Aslan G, Bozkurt Kavak P, Fakili D, Topeli A. Evaluation of Nursing Workload in Intesive Care Unit. ACTA ACUST UNITED AC 2017. [DOI: 10.5152/dcbybd.2017.1353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ergan B, Topeli A. Antibiotic Decision in Severe Chronic Obstructive Pulmonary Disease Exacerbations. Respiration 2017; 94:75. [PMID: 28434001 DOI: 10.1159/000472719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Rello J, Krenn CG, Locker G, Pilger E, Madl C, Balica L, Dugernier T, Laterre PF, Spapen H, Depuydt P, Vincent JL, Bogár L, Szabó Z, Völgyes B, Máñez R, Cakar N, Ramazanoglu A, Topeli A, Mastruzzo MA, Jasovich A, Remolif CG, Del Carmen Soria L, Andresen Hernandez MA, Ruiz Balart C, Krémer I, Molnár Z, von Sonnenburg F, Lyons A, Joannidis M, Burgmann H, Welte T, Klingler A, Hochreiter R, Westritschnig K. A randomized placebo-controlled phase II study of a Pseudomonas vaccine in ventilated ICU patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:22. [PMID: 28159015 PMCID: PMC5291979 DOI: 10.1186/s13054-017-1601-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022]
Abstract
Background Currently, no vaccine against Pseudomonas is available. IC43 is a new, recombinant, protein (OprF/I)-based vaccine against the opportunistic pathogen, Pseudomonas aeruginosa, a major cause of serious hospital-acquired infections. IC43 has proven immunogenicity and tolerability in healthy volunteers, patients with burns, and patients with chronic lung diseases. In order to assess the immunogenicity and safety of IC43 in patients who are most at risk of acquiring Pseudomonas infections, it was evaluated in mechanically ventilated ICU patients. Methods We conducted a randomized, placebo-controlled, partially blinded study in mechanically ventilated ICU patients. The immunogenicity of IC43 at day 14 was determined as the primary endpoint, and safety, efficacy against P. aeruginosa infections, and all-cause mortality were evaluated as secondary endpoints. Vaccinations (100 μg or 200 μg IC43 with adjuvant, or 100 μg IC43 without adjuvant, or placebo) were given twice in a 7-day interval and patients were followed up for 90 days. Results Higher OprF/I IgG antibody titers were seen at day 14 for all IC43 groups versus placebo (P < 0.0001). Seroconversion (≥4-fold increase in OprF/I IgG titer from days 0 to 14) was highest with 100 μg IC43 without adjuvant (80.6%). There were no significant differences in P. aeruginosa infection rates, with a low rate of invasive infections (pneumonia or bacteremia) in the IC43 groups (11.2-14.0%). Serious adverse events (SAEs) considered possibly related to therapy were reported by 2 patients (1.9%) in the group of 100 µg IC43 with adjuvant. Both SAEs resolved and no deaths were related to study treatment. Local tolerability symptoms were mild and rare (<5% of patients), a low rate of treatment-related treatment-emergent adverse events (3.1–10.6%) was observed in the IC43 groups. Conclusion This phase II study has shown that IC43 vaccination of ventilated ICU patients produced a significant immunogenic effect. P. aeruginosa infection rates did not differ significantly between groups. In the absence of any difference in immune response following administration of 100 μg IC43 without adjuvant compared with 200 μg IC43 with adjuvant, the 100 μg dose without adjuvant was considered for further testing of its possible benefit of improved outcomes. There were no safety or mortality concerns. Trial registration ClinicalTrials.gov, NCT00876252. Registered on 3 April 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1601-9) contains supplementary material, which is available to authorized users.
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Durusu Tanrıöver M, Halaçlı B, Sait B, Öcal S, Topeli A. Daily surveillance with early warning scores help predicthospital mortality in medical wards. Turk J Med Sci 2016; 46:1786-1791. [PMID: 28081329 DOI: 10.3906/sag-1411-101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/14/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM To analyze the potency of a modified early warning score (EWS) to help predict hospital mortality when used for surveillance in nonacute medical wards. MATERIALS AND METHODS Patients in internal medicine wards were prospectively recruited. First, highest, and last scores; and mean daily score recordings and values were recorded. Nurses calculated scores for each patient upon admission and every 4 h. The last score was the score before death, discharge, or transfer to another ward. The highest scores in total and for each single parameter were used for analysis. RESULTS Fifty-nine percent of 182 recruited patients had recordings eligible for data analysis. Patients admitted from the emergency room had higher mortality rates than patients admitted from outpatient clinics (15% vs. 1.5%; P = 0.01) as well as patients whose first (40% vs. 4.9%; P = 0.033) and highest scores (18.8% vs. 1.3%; P = 0.003) were equal to or more than 3. The first recorded EWS was not predictive for mortality while the maximum score during the admission period was. CONCLUSION This study underlines the fact that each physiological variable of EWS may not have the same weight in determining the outcome.
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Tufan A, Dede DS, Cavus S, Altintas ND, Iskit AB, Topeli A. Rhabdomyolysis in a Patient Treated with Colchicine and Atorvastatin. Ann Pharmacother 2016; 40:1466-9. [PMID: 16772404 DOI: 10.1345/aph.1h064] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To report a case of severe rhabdomyolysis that developed after administration of atorvastatin to a patient receiving regular colchicine treatment. Case Summary: A 45-year-old man with nephrotic syndrome and amyloidosis presented with dyspnea, altered mentation, and severe fatigue. He had been taking colchicine 1.5 mg/day for amyloidosis for 3 years without adverse effects. Atorvastatin 10 mg/day was prescribed for hypercholesterolemia one month prior to admission. After 2 weeks of atorvastatin treatment, he began to experience myalgia and reduced muscle strength. The creatinine and creatine kinase concentrations on admission were 8.1 mg/dL and 9035 U/L, respectively. The patient was diagnosed with rhabdomyolysis with the findings of myoglobinuric, oliguric acute renal failure, and more than 50–fold elevated creatine kinase concentration. His muscle strength improved after withdrawal of atorvastatin and colchicine. However, he died because of nosocomial pneumonia that developed during his hospital stay. The Naranjo probability scale indicated that atorvastatin and colchicine were probable causes of rhabdomyolysis. Discussion: Atorvastatin and colchicine have well-known myotoxic adverse effects. Despite atorvastatin's proven safety, its use with certain drugs, such as colchicine, makes it a potential myotoxic drug. This might be because concomitant administration of P-glycoprotein substrates, such as statins, and colchicine, which is a P-glycoprotein inhibitor, modifies pharmacokinetics by increasing bioavailability and organ uptake of the substrates, leading to more adverse reactions and toxicities. Conclusions: We recommend checking the creatine kinase level one week after prescribing 2 or more potentially myotoxic drugs concomitantly, after dose increase of a myotoxic drug, or after prescribing a new drug to a patient already using other myotoxic agents.
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Öcal S, Portakal O, Öcal A, Demir AU, Topeli A, Çöplü L. Factors associated with pulmonary hypertension and long-term survival in bronchiectasis subjects. Respir Med 2016; 119:109-114. [DOI: 10.1016/j.rmed.2016.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022]
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Sivakumar S, Taccone FS, Desai KA, Lazaridis C, Skarzynski M, Sekhon M, Henderson W, Griesdale D, Chapple L, Deane A, Williams L, Strickland R, Lange K, Heyland D, Chapman M, Rowland MJ, Garry P, Westbrook J, Corkill R, Antoniades CA, Pattinson KT, Fatania G, Strong AJ, Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG, Hofmeijer J, Sondag L, Tjepkema-Cloostermans MC, Beishuizen A, Bosch FH, van Putten MJAM, Carteron L, Patet C, Solari D, Oddo M, Ali MA, Dias C, Almeida R, Vaz-Ferreira A, Silva J, Monteiro E, Cerejo A, Rocha AP, Elsayed AA, Abougabal AM, Beshey BN, Alzahaby KM, Pozzebon S, Ortiz AB, Cristallini S, Lheureux O, Brasseur A, Vincent JL, Creteur J, Taccone FS, Hravnak M, Yousef K, Chang Y, Crago E, Friedlander RM, Abdelmonem SA, Tahon SA, Helmy TA, Meligy HS, Puig F, Dunn-Siegrist I, Pugin J, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Tomar DS, Shafi M, Harne R, Arora DP, Talwar N, Mazumdar S, Papakrivou EE, Makris D, Manoulakas E, Tsolaki B, Karadodas B, Zakynthinos E, Garcia IP, Martin AD, Encinares VS, Ibañez MP, Montero JG, Labrador G, Cangueiro TC, Poulose V, Koh J, Kam JW, Yeter H, Stepinska J, Pérez AG, Ordoñez PF, Giribet A, Cuervo MAA, Cuervo RA, Esteban MAR, Fraile LI, Mittelbrum CP, Albaiceta GM, Kara A, Koeze J, Keus F, Dieperink W, van der Horst ICC, van Meurs M, Zijlstra JG, Roberts S, Caballero CH, Isgro G, Hall D, Aktepe O, Beitland S, Trøseid AMS, Brusletto BS, Waldum-Grevbo BE, Berg JP, Sunde K, Huertas DG, Manzano F, Quintana MMJ, Osuna A, Topeli A, Santiago-Ruiz F, Rodríguez-Mejías C, Wangensteen R, Jamaati HR, Masjedi M, Zand F, Hashemian SMR, Sabetian G, Abbasi G, Khaloo V, Tsolakoglou I, Tabei SH, Kafilzadeh A, Bakhodaei HH, Diaz JA, Silva R, Garcia DJ, Luis E, Gomez MN, Soriano R, Gonzalez PL, Intas G, Ibrahim IA, Rafik MM, Al-Ansary AM, Algendi MA, Ali AA, Fuhrmann V, Roedl K, Horvatits T, Drolz A, Rutter K, Stergiannis P, Benten D, Kluwe J, Siedler S, Kluge S, Adedugbe I, Bird GT, Kennedy RM, Sharma S, Butler MB, Yugi G, Kolaros AA, Haroon BA, Witter T, Khaliq W, Singer M, Havaldar AA, Krishna B, Sriram S, Espinoza EDV, Pozo MO, Edul VSK, Chalari E, Furche M, Motta MF, Vazquez AR, Birri PNR, Ince C, Dubin A, Dogliotti A, Ramos A, Lovesio C, Delile E, Athanasiadou E, Nevière R, Thiébaut PA, Maupoint J, Mulder P, Coquerel D, Renet S, do Rego JC, Rieusset J, Richard V, Tamion F, Martika A, Khaliq W, Andreis DT, Singer M, Smit B, Smulders YM, de Waard MC, van Straaten HMO, Girbes ARJ, Eringa EC, Man AMESD, Fildisis G, Alegría L, Soto D, Luengo C, Gomez J, Jarufe N, Bruhn A, Castro R, Kattan E, Tapia P, Rebolledo R, Faivre V, Achurra P, Ospina-Tascón G, Bakker J, Hernández G, Bertini P, Guarracino F, Baldassarri R, Pinsky MR, Alegría L, Vera M, Mengelle C, Dreyse J, Carpio D, Henriquez C, Gajardo D, Bravo S, Castro R, Ospina-Tascón G, Bakker J, Hernández G, Kim S, Favier B, Lee M, Park SY, So S, Lee H, Kačar MB, Kačar SM, Uddin I, Belhaj AM, Aydın MA, Avsec D, Payen D, Kapuağası A, Kaymak Ç, Kovach L, Şencan İ, Meço B, Özçelik M, Ünal N, Lazaridis C, Jenni-Moser B, Jeitziner MM, Poppe A, Galassi MS, Sales FL, de Moraes KCL, Batista CL, Júnior JADS, Marcari TB, Lobato R, Castro CSAA, de Souza LM, Rodrigues FFP, Winkler MS, Correa NG, Pelegrini AM, Eid RAC, Timenetsky KT, Cazati D, Lobato M, Diniz PS, Rocha LL, Cavalheiro AM, Lucinio NM, Mudersbach E, Santos ER, Norrenberg M, Gleize A, Preiser JC, Simón IF, Carmona SA, Valhonrat IL, Domínguez JP, Abellán AN, Almudévar PM, Schreiber J, Dávila F, Rubio JJ, Ramos AJ, Reina ÁJR, López NP, Pérez MA, Apolo DXC, Villén LM, López FMP, García IP, Wruck ML, Izurieta JRN, Guerrero JJE, Calvert S, Quint M, Adeniji K, Young R, Shevill DD, Robertson E, Garside P, Walter E, Schwedhelm E, Isotti P, De Vecchi MM, Perduca AE, Negro A, Villa G, Manara DF, Cabrini L, Zangrillo A, Frencken JF, van Baal L, Kluge S, Peelen LM, Donker DW, Horn J, van der Poll T, van Klei WA, Bonten MJM, Cremer OL, Menard CE, Kumar A, Rimmer E, Zöllner C, Doucette S, Turgeon AF, Houston BL, Houston DS, Zarychanski R, Pinto BB, Carrara M, Ferrario M, Bendjelid K, Nunes J, Tavladaki T, Diaz P, Silva G, Escórcio S, Chaves S, Jardim M, Fernandes N, Câmara M, Duarte R, Pereira CA, Vieira J, Spanaki AM, Nóbrega JJ, Robles CMC, de Oca-Sandoval MAM, Sánchez-Rodríguez A, Joya-Galeana JG, Correa-Morales A, Camarena-Alejo G, Aguirre-Sánchez J, Franco-Granillo J, Soliman M, Dimitriou H, Al Azab A, El Hossainy R, Nagy H, Nirmalan M, Crippa IA, Cavicchi FZ, Vincent JL, Creteur J, Taccone FS, Chaari A, Kondili E, Hakim KA, Hassanein H, Etman M, El Bahr M, Bousselmi K, Khalil ES, Kauts V, Casey WF, Imahase H, Sakamoto Y, Choulaki C, Inoue S, Yamada KC, Koami H, Miike T, Nagashima F, Iwamura T, Boscolo A, Lucchetta V, Piasentini E, Bertini D, Meleti E, Manesso L, Spiezia L, Simioni P, Ori C, Souza RB, Martins AM, Liberatore AMA, Kang YR, Nakamae MN, Vieira JCF, Kafetzopoulos D, Koh IHJ, Hanslin K, Wilske F, Skorup P, Sjölin J, Lipcsey M, Long WJ, Zhen CE, Vakalos A, Avramidis V, Georgopoulos D, Wu SH, Shyu LJ, Li CH, Yu CH, Chen HC, Wang CH, Lin KH, Aray ZE, Gómez CF, Tejero AP, Briassoulis G, Monge DD, Losada VM, Tarancón CM, Cortés SD, Gutiérrez AM, Álvarez TP, Rouze A, Jaffal K, Six S, Stolz K, la Torre AGD, Cattoen V, Nseir S, Arnal JM, Saoli M, Novotni D, Garnero A, Becher T, Buchholz V, Schädler D, Frerichs I, de la Torre-Prados MV, Weiler N, Eronia N, Mauri T, Gatti S, Maffezzini E, Bronco A, Alban L, Sasso T, Marenghi C, Grasselli G, Tsvetanova-Spasova T, Pesenti A, Bellani G, Al-Fares A, Del Sorbo L, Anwar S, Facchin F, Azad S, Zamel R, Ferguson N, Cypel M, Nuevo-Ortega P, Keshavjee S, Fan E, Durlinger E, Spoelstra-de Man A, Smit B, de Grooth HJ, Girbes A, Straaten HOV, Smulders Y, Alfaro MA, Rueda-Molina C, Parrilla F, Meli A, Pellegrini M, Rodriguez N, Goyeneche JM, Morán I, Aguirre H, Mancebo J, Heines SJH, Strauch U, Fernández-Porcel A, Bergmans DCJJ, Blankman P, Shono A, Hasan D, Gommers D, Chung WY, Lee KS, Jung YJ, Park JH, Sheen SS, Camara-Sola E, Park KJ, Worral R, Denham S, Isherwood P, Rees SE, Larraza S, Dey N, Spadaro S, Brohus JB, Winding RW, Salido-Díaz L, Volta CA, Karbing DS, Ampatzidou F, Vlachou A, Kehagioglou G, Karaiskos T, Madesis A, Mauromanolis C, Michail N, Drossos G, García-Alcántara A, Saraj N, Rijkenberg S, Feijen HM, Endeman H, Donnelly AAJ, Morgan E, Garrard H, Buckley H, Russell L, Haase N, Tavladaki T, Perner A, Goh C, Mouyis K, Woodward CLN, Halliday J, Encina GB, Ros J, Lagunes L, Tabernero J, Bosch F, Spanaki AM, Rello J, Huertas DG, Manzano F, Morente-Constantin E, Rivera-Ginés B, Colmenero-Ruiz M, Abellán AN, Pérez LP, Lucendo AP, Almudévar PM, Dimitriou H, Domínguez JP, Villamizar PR, Sanz JG, Simon IF, Valbuena BL, Carmona SA, Pais M, Ramalingam S, Díaz C, Fox L, Kondili E, Santafe M, Barba P, García M, Leal S, Pérez M, Pérez MLP, Abellán AN, Lucendo AP, Almudevar PM, Domínguez JP, Choulaki C, Villamizar PR, Veganzones J, Simón IF, Valbuena BL, Martínez N, Carmona SA, Moors I, Mokart D, Pène F, Lambert J, Meleti DE, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne L, Rabbat A, Lebert C, Perez P, Chaize M, Kafetzopoulos D, Renault A, Meert AP, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V, Azoulay E, Benoit D, Georgopoulos D, Martins-Branco D, Sousa M, Marum S, Bouw MJ, Galstyan G, Makarova P, Parovichnikova E, Kuzmina L, Troitskaya V, Drize N, Briassoulis G, Gemdzhian E, Savchenko V, Chao HC, Kılıc E, Demiriz B, Uygur ML, Sürücü M, Cınar K, Yıldırım AE, Kiss K, Suberviola B, Köves B, Csernus V, Molnár Z, Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, Koulouras V, Riera J, Gaffney S, Black E, Docking R, Judge C, Drew T, Misran H, Munshi R, McGovern L, Coyle M, Dunne L, Rellan L, Deasy E, Lavin P, Fahy A, Darcy DM, Donnelly M, Ismail NH, Hall T, Wykes K, Jack J, Ngu WC, Sanchez M, Morgan P, Ruiz-Ramos J, Ramirez P, Gordon M, Villarreal E, Frasquet J, Poveda-Andrés JL, Castellanos A, Ijssennagger CE, ten Hoorn S, Robles JC, van Wijk A, van den Broek JM, Tuinman PR, Elmenshawy AM, Hammond BD, Gibbon G, Belcham T, Burton K, Taniguchi LU, Ramos FJS, Lopez E, Momma AK, Martins-Filho APR, Bartocci JJ, Lopes MFD, Sad MH, Rodrigues CM, Pires EMC, Vieira JM, Leite MA, Murbach LD, Vicente R, Osaku EF, Barreto J, Duarte ST, Taba S, Miglioranza D, Gund DP, Lordani CF, Costa CRLM, Ogasawara SM, Jorge AC, Miñambres E, Duarte PAD, Spadaro S, Capuzzo M, Corte FD, Terranova S, Scaramuzzo G, Fogagnolo A, Bertacchini S, Bellonzi A, Ragazzi R, Santibañez M, Volta CA, Cruz C, Nunes A, Pereira FS, Aragão I, Cardoso AF, Santos C, Malheiro MJ, Castro H, Cardoso T, Le Guen M, Paratz J, Kenardy J, Comans T, Coyer F, Thomas P, Boots R, Pereira N, Vilas-Boas A, Gomes E, Dias C, Moore J, Torres J, Carvalho D, Molinos E, Vales C, Araújo R, Cruz C, Nunes A, Pereira FS, Cardoso AF, Santos C, Mason N, Malheiro MJ, Castro H, Cardoso T, Karnatovskaia L, Philbrick K, Ognjen G, Clark M, Montero RM, Varas JL, Sánchez-Elvira LA, Windpassinger M, Delgado CP, Díaz PV, Ruiz BL, Guerrero AP, Galache JAC, Jiménez R, Rebollo S, Alejandro O, Fernández A, Moreno S, Plattner O, Herrera L, Ojados A, Galindo M, Murcia J, Contreras M, Sánchez-Argente S, Bonilla Y, Rodríguez MD, Allegue JM, Cakin Ö, Mascha E, Parlak H, Kirca H, Mutlu F, Aydınlı B, Cengiz M, Ramazanoglu A, Jung EJ, Oh SY, Lee H, Filho NMF, Sessler DI, Ricaldi EF, Gomes SS, Ramos BB, De Lucia CV, Ballalai CS, Oliveira JCA, Araponga GP, Veiga LN, Silva CS, Garrido ME, Research O, Domenech JC, Montalvo AP, Chornet TC, Martinez PC, Ribas MP, Costa RG, Ortega AC, Forbes C, Prescott H, Lal A, Melia U, Khan FA, Dela Pena EG, Dizon JS, Perez PPP, Wong CMJ, Garach MM, Romero OM, Puerta RR, Diaz FA, Bailon AMP, Fontanet J, Pinel AC, Maldonado LP, Kalaiselvan MS, kumar RLS, Renuka MK, Kumar ASA, De Rosa S, Ferrari F, Checcacci SC, Rigobello A, van den Berg JP, Joannidis M, Politi F, Pellizzari A, Bonato R, Fernandez-Carmona A, Macias-Guarasa I, Gutierrez-Rodriguez R, Martinez-Lopez P, Diaz-Castellanos MA, Fernandez-Carmona A, Struys MMRF, Arias-Diaz M, Aguilar-Alonso E, Macias-Guarasa I, Martinez-Lopez P, Diaz-Castellanos MA, Nikandish RN, Artemenko V, Budnyuk A, Bassi GL, Senussi T, Vereecke HEM, Idone F, Xiol EA, Travierso C, Chiurazzi C, Motos A, Amaro R, Hua Y, Fernández-Barat L, Ranzani OT, Bobi Q, Jensen EW, Rigol M, Torres A, Youn A, Hwang JG, Garach MM, Romero OM, Ossorio MEY, Diaz FA, Bailon AMP, Pinel AC, Rood PJT, Maldonado LP, Teixeira C, Figueira H, Oliveira R, Mota A, Aragão I, Kamp O, Cruciger O, Aach M, Kaczmarek C, van de Schoor F, Waydhas C, Schildhauer TA, Hamsen U, Camprubí-Rimblas M, Chimenti L, Guillamat-Prats R, Lebouvier T, Bringué J, Tijero J, Gómez MN, van Tertholen K, Blanch L, Artigas A, Tagliabue G, Ji M, Jagers JVS, Easton PA, Souza RB, Liberatore AMA, Martins AMCRPF, Vieira JCF, Pickkers P, Kang YR, Nakamae MN, Koh IHJ, Hong JY, Shin MH, Park MS, Pomprapa A, Pickerodt PA, Hofferberth MBT, Russ M, van den Boogaard M, Braun W, Walter M, Francis R, Lachmann B, Leonhardt S, Koh IHJ, Souza RB, Martins AMCRPF, Vieira JCF, Liberatore AMA, Beardow ZJ, Landaverde-López A, Canedo-Castillo NA, Esquivel-Chávez A, Arvizu-Tachiquín PC, Sánchez-Hurtado LA, Baltazar-Torres JA, Cardoso V, Krystopchuk A, Castro S, Melão L, Redhead H, Firmino S, Marreiros A, Granja C, Almaziad S, Kubbara A, Barnett W, Nakity R, Alamoudi W, Altook R, Tarazi T, Paramasivam K, Fida M, Safi F, Assaly R, Santini A, Milesi M, Maraffi T, Pugni P, Andreis DT, Cavenago M, Gattinoni L, Numan T, Protti A, Perchiazzi G, Borges JB, Bayat S, Porra L, Broche L, Pellegrini M, Scaramuzzo G, Hedenstierna G, Larsson A, van den Boogaard M, Pellegrini M, Hedenstierna G, Roneus A, Segelsjö M, Vestito MC, Larsson A, Perchiazzi G, Gremo E, Nyberg A, Castegren M, Kamper AM, Pikwer A, Yoshida T, Engelberts D, Otulakowski G, Katira B, Post M, Ferguson ND, Brochard L, Amato MBP, Kavanagh BP, Rood P, Koch N, Huber W, 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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Blanch L, Abillama FF, Amin P, Christian M, Joynt GM, Myburgh J, Nates JL, Pelosi P, Sprung C, Topeli A, Vincent JL, Yeager S, Zimmerman J. Triage decisions for ICU admission: Report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2016; 36:301-305. [PMID: 27387663 DOI: 10.1016/j.jcrc.2016.06.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
Demand for intensive care unit (ICU) resources often exceeds supply, and shortages of ICU beds and staff are likely to persist. Triage requires careful weighing of the benefits and risks involved in ICU admission while striving to guarantee fair distribution of available resources. We must ensure that the patients who occupy ICU beds are those most likely to benefit from the ICU's specialized technology and professionals. Although prognosticating is not an exact science, preference should be given to patients who are more likely to survive if admitted to the ICU but unlikely to survive or likely to have more significant morbidity if not admitted. To provide general guidance for intensivists in ICU triage decisions, a task force of the World Federation of Societies of Intensive and Critical Care Medicine addressed 4 basic questions regarding this process. The team made recommendations and concluded that triage should be led by intensivists considering input from nurses, emergency medicine professionals, hospitalists, surgeons, and allied professionals. Triage algorithms and protocols can be useful but can never supplant the role of skilled intensivists basing their decisions on input from multidisciplinary teams. Infrastructures need to be organized efficiently both within individual hospitals and at the regional level. When resources are critically limited, patients may be refused ICU admission if others may benefit more on the basis of the principle of distributive justice.
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