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Er AG, Ding DY, Er B, Uzun M, Cakmak M, Sadee C, Durhan G, Ozmen MN, Tanriover MD, Topeli A, Aydin Son Y, Tibshirani R, Unal S, Gevaert O. Multimodal data fusion using sparse canonical correlation analysis and cooperative learning: a COVID-19 cohort study. NPJ Digit Med 2024; 7:117. [PMID: 38714751 DOI: 10.1038/s41746-024-01128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/25/2024] [Indexed: 05/10/2024] Open
Abstract
Through technological innovations, patient cohorts can be examined from multiple views with high-dimensional, multiscale biomedical data to classify clinical phenotypes and predict outcomes. Here, we aim to present our approach for analyzing multimodal data using unsupervised and supervised sparse linear methods in a COVID-19 patient cohort. This prospective cohort study of 149 adult patients was conducted in a tertiary care academic center. First, we used sparse canonical correlation analysis (CCA) to identify and quantify relationships across different data modalities, including viral genome sequencing, imaging, clinical data, and laboratory results. Then, we used cooperative learning to predict the clinical outcome of COVID-19 patients: Intensive care unit admission. We show that serum biomarkers representing severe disease and acute phase response correlate with original and wavelet radiomics features in the LLL frequency channel (cor(Xu1, Zv1) = 0.596, p value < 0.001). Among radiomics features, histogram-based first-order features reporting the skewness, kurtosis, and uniformity have the lowest negative, whereas entropy-related features have the highest positive coefficients. Moreover, unsupervised analysis of clinical data and laboratory results gives insights into distinct clinical phenotypes. Leveraging the availability of global viral genome databases, we demonstrate that the Word2Vec natural language processing model can be used for viral genome encoding. It not only separates major SARS-CoV-2 variants but also allows the preservation of phylogenetic relationships among them. Our quadruple model using Word2Vec encoding achieves better prediction results in the supervised task. The model yields area under the curve (AUC) and accuracy values of 0.87 and 0.77, respectively. Our study illustrates that sparse CCA analysis and cooperative learning are powerful techniques for handling high-dimensional, multimodal data to investigate multivariate associations in unsupervised and supervised tasks.
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Affiliation(s)
- Ahmet Gorkem Er
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University, Stanford, CA, 94305, USA.
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University, 06800, Ankara, Turkey.
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey.
| | - Daisy Yi Ding
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94305, USA
| | - Berrin Er
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - Mertcan Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - Mehmet Cakmak
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - Christoph Sadee
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Gamze Durhan
- Department of Radiology, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - Yesim Aydin Son
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University, 06800, Ankara, Turkey
| | - Robert Tibshirani
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94305, USA
- Department of Statistics, Stanford University, Stanford, CA, 94305, USA
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - Olivier Gevaert
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University, Stanford, CA, 94305, USA.
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94305, USA.
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Kaya EK, Taştekin MB, Arikan Akdağli S, Gülmez D, Topeli A, Uzun Ö. [Lomentospora prolificans Fungemia in a Patient With T-Cell Large Granular Leukemia: A Rare Pathogen in Türkiye]. MIKROBIYOL BUL 2024; 58:209-219. [PMID: 38676587 DOI: 10.5578/mb.202498145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Scedosporium/Lomentospora is an opportunistic fungal pathogen found worldwide. While Scedosporium apiospermum and Scedosporium boydii are commonly observed globally, Lomentospora prolificans, which mainly affects immunosuppressed individuals, is rarely encountered and is more prevalent in arid climates, particularly in Australia and Spain. L.prolificans is a fungus commonly found in environmental sources such as contaminated water and soil. This species is known as an opportunistic pathogen that can cause deep-seated fungal infections, especially in immunosuppressed individuals. In this case report, a fatal case of L.prolificans fungemia in a patient with T-cell large granular leukemia during profound neutropenia was presented. The patient admitted to the hospital with prolonged fever, neutropenia, and shortness of breath. Antibiotherapy was administered to the patient for febrile neutropenia, but the fever persisted and his clinical status rapidly deteriorated. L.prolificans was isolated from the blood culture, and considering its antifungal resistance, combination therapy of voriconazole and terbinafine was initiated. However, the patient died of septic shock and multiple organ failure. In conclusion, although L.prolificans infections are rare, they can be life-threatening, especially in immunosuppressed individuals. Diagnosis and treatment of such infections may be difficult, therefore rapid diagnostic methods and appropriate treatment protocols should be developed. Consideration of infections caused by rare fungal pathogens in patients with risk factors may be critical for patient care. The literature review revealed that the first case of L.prolificans fungemia from Türkiye was reported in 2023. This case presentation represents the second reported case. However, in our case, L.prolificans fungemia occurred in 2018, it can be considered that L.prolificans may have been an invasive fungal pathogen of significant concern in Türkiye much earlier than previously documented.
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Affiliation(s)
- Esat Kıvanç Kaya
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care, Ankara, Türkiye
| | | | - Sevtap Arikan Akdağli
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Türkiye
| | - Dolunay Gülmez
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Türkiye
| | - Arzu Topeli
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care, Ankara, Türkiye
| | - Ömrüm Uzun
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
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Kahveci FS, Demirkan K, Doganay M, Gomceli I, Gundogan K, Topeli A, Tumer G, Uyar M, Abbasoglu O. Parenteral nutrition consensus report from KEPAN. Nutrition 2024; 123:112424. [PMID: 38593671 DOI: 10.1016/j.nut.2024.112424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Medical nutrition therapy is one of the core components of patient management, although its implication is still limited in Daily practice globally. Clinicians are in need of guidance that will ease the application of medical nutrition therapy. The pre- and post-graduate curriculum for medical nutrition therapy is limited in most regions, worldwide. A report that is short, clear, and having clear-cut recommendations that will guide the primary healthcare professionals in indications, choice, practical application, follow-up, and stopping parenteral nutrition (PN) would facilitate the application and success of medical nutrition therapy. KEPAN is the Clinical Enteral and Parenteral Nutrition Society of Turkey and is an active member of the European Society for Clinical Nutrition and Metabolism (ESPEN). METHOD In this study, we present the KEPAN PN consensus report on optimal PN use in medical nutrition therapy as outlined by the works of academicians experienced in the clinical application of PN (nine working group academicians and 10 expert group academicians). RESULTS This report provides 22 clear-cut recommendations in a question-answer format. CONCLUSIONS We believe that this report could have a significant impact on the optimum use of PN in the context of medical nutrition therapy when clinicians manage everyday patients.
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Affiliation(s)
- Ferda Sohret Kahveci
- Department of Anesthesiology, Division of Critical Care, Uludağ University Faculty of Medicine, Bursa, Turkey.
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Mutlu Doganay
- Department of General Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ismail Gomceli
- Department of Gastroenterological Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Guzin Tumer
- Department of Nutrition and Dietetics, Ondokuz Mayıs University, Samsun, Turkey
| | - Mehmet Uyar
- Department of Anesthesiology and Intensive Care, School of Medicine, Ege University, Izmir, Turkey
| | - Osman Abbasoglu
- Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Abstract
OBJECTIVES To evaluate the presence of chronic critical illness (CCI) in COVID-19 patients and compare clinical characteristics and prognosis of patients with and without CCI admitted to intensive care unit (ICU). METHODS It was a retrospective, observational study at a university hospital ICU. Patients were accepted as CCI if they had prolonged ICU stay (≥14 days) and got ≥1 score for cardiovascular sequential organ failure assessment (SOFA) score and ≥2 score in other parameters on day 14 of ICU admission which was described as persistent organ dysfunction. RESULTS 131 of 397 (33%) patients met CCI criteria. CCI patients were older (p = 0.003) and frailer (p < 0.001). Their Acute Physiology and Chronic Health Evaluation (APACHE) II and SOFA scores were higher, PaO2/FiO2 ratio was lower (p < 0.001). Requirement of invasive mechanical ventilation (IMV), steroid use, and septic shock on admission were higher in the CCI group (p < 0.001). CCI patients had higher ICU and hospital mortality than other patients (54.2% vs. 19.9% and 55.7% vs. 22.6%, p < 0.001, respectively). Regression analysis revealed that IMV (OR: 8.40, [5.10-13.83], p < 0.001) and PaO2/FiO2 < 150 on admission (OR: 2.25, [1.36-3.71], p = 0.002) were independent predictors for CCI. DISCUSSION One-third of the COVID-19 patients admitted to the ICU were considered as CCI with significantly higher ICU and hospital mortality.
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Affiliation(s)
- Burcin Halacli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Yildirim
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Esat Kivanc Kaya
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Ege Ulusoydan
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Ortac Ersoy
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University, Ankara, Turkey
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Bayraktar I, Halacli B, Demirkan K, Topeli A. Polymyxin B-related neurotoxicity: a brief case report. Eur J Hosp Pharm 2023; 31:66-67. [PMID: 37286311 PMCID: PMC10800244 DOI: 10.1136/ejhpharm-2023-003786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
Polymyxin B and colistin are considered the last therapeutic option to treat infections caused by highly drug-resistant bacteria. However, their administration may lead to various adverse effects such as nephrotoxicity, neurotoxicity, and allergic reactions. The current case report presents the clinical manifestation of polymyxin B-associated neurotoxicity in a female patient with no chronic illness history. The patient was rescued from under rubble during an earthquake. She was diagnosed with an intra-abdominal infection caused by Acinetobacter baumannii (A. baumannii) After the initiation of the polymyxin B infusion, the patient developed numbness and tingling sensations in her hands, face, and head. On discontinuing polymyxin B and starting colistimethate, the patient's symptoms improved. Therefore, healthcare professionals should be aware of the potential risk factors associated with neurotoxicity in patients receiving polymyxin B. On identifying such symptoms treatment should be discontinued promptly to prevent further neurological damage.
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Affiliation(s)
- Izgi Bayraktar
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Burcin Halacli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ortac Ersoy E, Erdemir B, Halacli B, Guven G, Yildirim M, Geldigitti IT, Yazdali Koylu N, Topeli A. Effect of Awake Prone Positioning on ROX Index in Critically-ill Patients With Respiratory Failure due to COVID-19. J Intensive Care Med 2023; 38:1158-1164. [PMID: 37611188 DOI: 10.1177/08850666231186956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
COVID-19 pneumonia causes acute respiratory distress syndrome (ARDS). Prone positioning (PP) is beneficial to pulmonary physiology and improves oxygenation in patients with ARDS. We aimed to investigate the effect of the PP on oxygenation, respiratory rate (RR) and ROX index in non-intubated patients with COVID-19 associated respiratory failure and to determine whether ROX index predicts intubation. Awake critically-ill patients with confirmed diagnosis of COVID-19 who underwent PP were enrolled in the retrospective, single-center study. Oxygenation parameters were recorded 1 h before PP, during PP and 1 h after return to supine position (after PP). Intubation was defined as the endpoint. Seventy-one patients with a median age of 64 [55-73] years were enrolled in the study. PaO2/FiO2 and SpO2/FiO2 improved during PP, this improvement did not persist after PP. RR improved during and after PP in both intubated and non-intubated patients (for all P < .001). ROX index improved only in non-intubated patients (P < .001) but not in intubated patients (P = .07). Area under the curve (AUC) of ROX index for intubation before PP, during PP and after PP were 0.74 [0.61-0.88] (P = .002), 0.76 [0.62-0.91] (P = .001), and 0.76 [0.64-0.89] (P = .001), respectively. ROX index >6.83 before PP had a negative predictive value (NPV) of 0.85; ROX index >8.28 during PP had a NPV of 0.88 and ROX index >7.48 after PP had a NPV of 0.85. In logistic regression adjusted for APACHE II score, ROX index ≤6.83 before PP had an odds ratio (OR) 4.47 [1.39-14.38], ROX index ≤8.28 during PP had an OR 7.96 [2.29-27.64] and ROX index ≤7.48 had an OR 3.98 [1.25-12.61] for prediction of intubation. In conclusion, awake PP improves oxygenation and decreases RR. ROX index improved only in non- intubated patients and a higher ROX index predicts lower risk of progressing to mechanical ventilation with intubation.
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Affiliation(s)
- Ebru Ortac Ersoy
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Begüm Erdemir
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcin Halacli
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Goksel Guven
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Yildirim
- Diskapi Training and Research Hospital, Intensive Care Unit, University of Health Sciences, Ankara, Turkey
| | - Ismail Tuna Geldigitti
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nur Yazdali Koylu
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Er AG, Ding DY, Er B, Uzun M, Cakmak M, Sadée C, Durhan G, Ozmen MN, Tanriover MD, Topeli A, Son YA, Tibshirani R, Unal S, Gevaert O. Multimodal Biomedical Data Fusion Using Sparse Canonical Correlation Analysis and Cooperative Learning: A Cohort Study on COVID-19. Res Sq 2023:rs.3.rs-3569833. [PMID: 38045288 PMCID: PMC10690316 DOI: 10.21203/rs.3.rs-3569833/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Through technological innovations, patient cohorts can be examined from multiple views with high-dimensional, multiscale biomedical data to classify clinical phenotypes and predict outcomes. Here, we aim to present our approach for analyzing multimodal data using unsupervised and supervised sparse linear methods in a COVID-19 patient cohort. This prospective cohort study of 149 adult patients was conducted in a tertiary care academic center. First, we used sparse canonical correlation analysis (CCA) to identify and quantify relationships across different data modalities, including viral genome sequencing, imaging, clinical data, and laboratory results. Then, we used cooperative learning to predict the clinical outcome of COVID-19 patients. We show that serum biomarkers representing severe disease and acute phase response correlate with original and wavelet radiomics features in the LLL frequency channel (𝑐𝑜𝑟𝑟(𝑋 u 𝟏 , Z v 𝟏 ) = 0.596, p-value < 0.001). Among radiomics features, histogram-based first-order features reporting the skewness, kurtosis, and uniformity have the lowest negative, whereas entropy-related features have the highest positive coefficients. Moreover, unsupervised analysis of clinical data and laboratory results gives insights into distinct clinical phenotypes. Leveraging the availability of global viral genome databases, we demonstrate that the Word2Vec natural language processing model can be used for viral genome encoding. It not only separates major SARS-CoV-2 variants but also allows the preservation of phylogenetic relationships among them. Our quadruple model using Word2Vec encoding achieves better prediction results in the supervised task. The model yields area under the curve (AUC) and accuracy values of 0.87 and 0.77, respectively. Our study illustrates that sparse CCA analysis and cooperative learning are powerful techniques for handling high-dimensional, multimodal data to investigate multivariate associations in unsupervised and supervised tasks.
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Gundogan K, Sahin GG, Ergul SS, Ozer NT, Temel S, Akbas T, Ercan T, Yildiz H, Dizdar OS, Simsek Z, Aydın K, Ulu R, Zerman A, Dal HC, Aydin E, Ozyilmaz E, Ateş N, Gonderen K, Yalcin N, Topeli A, Tok G, Edipoglu O, Ergan B, Aydemir FD, Akbudak IH, Ergun R, Yuksel RC, Sungur M, Griffith DP, Ziegler TR. Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study. J Crit Care 2023; 77:154326. [PMID: 37186999 DOI: 10.1016/j.jcrc.2023.154326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND/OBJECTIVES Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations. SUBJECTS/METHODS This observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. RESULTS A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all). CONCLUSIONS Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.
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Affiliation(s)
- Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye.
| | - Gulsah G Sahin
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Serap S Ergul
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Nurhayat T Ozer
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Sahin Temel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Turkay Akbas
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Talha Ercan
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Hamit Yildiz
- Department of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkiye
| | - Oguzhan S Dizdar
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Zuhal Simsek
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Kaniye Aydın
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Ramazan Ulu
- Department of Nephrology, Firat Medical Faculty, Elazig, Turkiye
| | - Avsar Zerman
- Department of Intensive Care Unit, Kirsehir Ahi Evran University, Kirsehir, Turkiye
| | - Hayriye C Dal
- Department of Intensive Care Unit, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkiye
| | - Emre Aydin
- Department of Nephrology, School of Medicine, Dicle University, Diyarbakır, Turkiye
| | - Ezgi Ozyilmaz
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Nazire Ateş
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Kamil Gonderen
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Nazif Yalcin
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Gulay Tok
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Ozlem Edipoglu
- Department of Intensive Care Unit, Health Sciences University, İzmir Dr.Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkiye
| | - Begum Ergan
- Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkiye
| | - Ferhan D Aydemir
- Division of Intensive Care Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkiye
| | - Ismail H Akbudak
- Division of Intensive Care Medicine, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkiye
| | - Recai Ergun
- Department of Chest Diseases, Selçuk University Faculty of Medicine, Konya, Turkiye
| | - Recep C Yuksel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Murat Sungur
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Daniel P Griffith
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Halacli B, Tok G, Yildirim M, Geldigitti IT, Ortac Ersoy E, Topeli A. Comparison of Cumulative Corticosteroid Doses in Critically-ill COVID-19 Patients. mjima 2023. [DOI: 10.4274/mjima.galenos.2023.2022.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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10
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Yildirim M, Halacli B, Yuce D, Gunegul Y, Ersoy EO, Topeli A. Assessment of Admission COVID-19 Associated Hyperinflammation Syndrome Score in Critically-Ill COVID-19 Patients. J Intensive Care Med 2023; 38:70-77. [PMID: 36213939 PMCID: PMC9549159 DOI: 10.1177/08850666221131265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE We aimed to evaluate the relation between admission COVID-19 associated hyperinflammatory syndrome (cHIS) score and intensive care unit (ICU) outcomes. MATERIALS AND METHODS Patients with laboratory confirmed COVID-19 admitted to our ICU between 20th March 2020-15th June 2021 were included. Patients who received immunomodulatory treatment except corticosteroids were excluded. Main outcomes were ICU mortality and invasive mechanical ventilation (IMV) requirement after ICU admission. RESULTS Three hundred and seventy patients with a median (IQR) age of 66 (56-77) were analyzed. Median admission cHIS score was 3 (2-4). A cHIS score ≥3 was found to be associated with ICU mortality (sensitivity = 0.63, specificity = 0.50; p < 0.01) and IMV requirement after ICU admission (sensitivity = 0.61, specificity = 0.51; p < 0.01). Patients with an admission cHIS score ≥3 (n = 199) had worse median admission APACHEII, SOFA scores and PaO2/FiO2 ratio than others (n = 171) (p < 0.01). IMV requirement after ICU admission (38.5% vs 26.1%;p = 0.03), ICU (36.2% vs 25.1%;p = 0.02), hospital (39.1% vs 26.9%;p = 0.01) and 28th day (28.1% vs 19.1%;p = 0.04) mortality were higher in patients with admission cHIS score ≥3 than others (p < 0.01). Age <65 years, malignancy and higher admission SOFA score were independent variables associated with admission cHIS score ≥3. CONCLUSION Critically-ill COVID-19 patients with admission cHIS score ≥3 have worse disease severity and outcomes than other patients.
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Affiliation(s)
- Mehmet Yildirim
- Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care, Hacettepe University, Ankara, Turkey,Mehmet Yildirim, Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care, Hacettepe University, Ankara, Turkey.
| | - Burcin Halacli
- Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care, Hacettepe University, Ankara, Turkey
| | - Deniz Yuce
- Faculty of Medicine, Department of Preventive Oncology, Hacettepe University, Ankara, Turkey
| | - Yunus Gunegul
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Ortac Ersoy
- Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care, Hacettepe University, Ankara, Turkey
| | - Arzu Topeli
- Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care, Hacettepe University, Ankara, Turkey
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11
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Guven G, Dijkstra A, Kuijper TM, Trommel N, van Baar ME, Topeli A, Ince C, van der Vlies CH. Comparison of laser speckle contrast imaging with laser Doppler perfusion imaging for tissue perfusion measurement. Microcirculation 2023; 30:e12795. [PMID: 36524297 PMCID: PMC10078364 DOI: 10.1111/micc.12795] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/29/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Laser-based tissue perfusion monitoring techniques have been increasingly used in animal and human research to assess blood flow. However, these techniques use arbitrary units, and knowledge about their comparability is scarce. This study aimed to model the relationship between laser speckle contrast imaging (LSCI) and laser Doppler perfusion imaging (LDPI), for measuring tissue perfusion over a wide range of blood flux values. METHODS Fifteen healthy volunteers (53% female, median age 29 [IQR 22-40] years) were enrolled in this study. We performed iontophoresis with sodium nitroprusside on the forearm to induce regional vasodilation to increase skin blood flux. Besides, a stepwise vascular occlusion was applied on the contralateral upper arm to reduce blood flux. Both techniques were compared using a linear mixed model analysis. RESULTS Baseline blood flux values measured by LSCI were 33 ± 6.5 arbitrary unit (AU) (Coefficient of variation [CV] = 20%) and by LDPI 60 ± 11.5 AU (CV = 19%). At the end of the iontophoresis protocol, the regional blood flux increased to 724 ± 412% and 259 ± 87% of baseline measured by LDPI and LSCI, respectively. On the other hand, during the stepwise vascular occlusion test, the blood flux reduced to 212 ± 40% and 412 ± 177% of its baseline at LDPI and LSCI, respectively. A strong correlation was found between the LSCI and LDPI instruments at increased blood flux with respect to baseline skin blood flux; however, the correlation was weak at reduced blood flux with respect to baseline. DISCUSSION LSCI and LDPI instruments are highly linear for blood flux higher than baseline skin blood flux; however, the correlation decreased for blood flux lower than baseline. This study's findings could be a basis for using LSCI in specific patient populations, such as burn care.
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Affiliation(s)
- Goksel Guven
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands.,Departments of Trauma and Burn Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Annemieke Dijkstra
- Departments of Trauma and Burn Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Nicole Trommel
- Departments of Trauma and Burn Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Can Ince
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Cornelis Hendrik van der Vlies
- Departments of Trauma and Burn Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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12
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Hancı P, Öcal S, Kıvanç Kaya E, Topeli A. The Use of High-Flow Nasal Oxygen Therapy in the Management of Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Feasibility Study. Turk Thorac J 2022; 23:336-342. [PMID: 35943069 PMCID: PMC9524492 DOI: 10.5152/turkthoracj.2022.21268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: This study investigated the efficacy of high-flow nasal oxygen therapy in patients with severe acute exacerbation of chronic obstructive pulmonary disease admitted to the intensive care unit. MATERIAL AND METHODS: Totally, 23 patients were enrolled in the study. High-flow nasal oxygen therapy was administered with a predefined protocol. Vital signs, Visual Analog Scale for dyspnea, and arterial blood gas parameters were recorded at the beginning under low-flow oxygen support therapy and the 1st, 6th, 12th, and 24th hours of high-flow nasal oxygen therapy. High-flow nasal oxygen therapy duration, intensive care unit length of stay, and intensive care unit, in-hospital, and 60-day mortality were recorded as outcomes and compared according to the presence of pneumonia upon admission. Results: In 12 patients (52.2%), pneumonia was present. High-flow nasal oxygen therapy was applied for a median of 57 hours [49.2-104.5]. Overall decreases were detected in heart rate (P = .001), respiratory rate (P < .001), and Visual Analog Scale for dyspnea (P = .001) during the first 24 hours of the therapy. Although there was an increase in PaCO2 (P = .001), pH increased (P < .001) over time too. No change in partial arterial oxygen pressure (P = .63) and partial arterial oxygen pressure/fraction of inspired oxygen ratio (P = .22) was noted. Nineteen patients (77%) were successfully weaned from high-flow nasal oxygen therapy. While the high-flow nasal oxygen therapy failure rate was 23%, the in-hospital and 60-day mortality rates were 8.6%. Outcomes were not different between patients with and without pneumonia. Conclusion: High-flow nasal oxygen therapy was efficient in relieving respiratory distress and well-tolerated with no adverse outcome in severe acute exacerbation of chronic obstructive pulmonary disease patients admitted to the intensive care unit.
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Affiliation(s)
- Pervin Hancı
- Department of Pulmonary Medicine, and Intensive Care, Trakya University, Faculty of Medicine, Edirne,Turkey
- Corresponding author: Pervin Hancı, e-mail:
| | - Serpil Öcal
- Department of Internal Medicine, and Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Esat Kıvanç Kaya
- Department of Internal Medicine and Intensive Care, Turkish Ministry of Health Haseki Education and Research Hospital, İstanbul, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, and Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey
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13
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Metan G, Demir Çuha M, Hazirolan G, Telli Dizman G, Tanriverdi ES, Otlu B, Tas Z, Zarakolu P, Arik Z, Topeli A, Akinci SB, Ünal S, Uzun Ö. The impact of COVID-19 pandemic on nosocomial multidrug-resistant bacterial bloodstream infections and antibiotic consumption in a tertiary care hospital. GMS Hyg Infect Control 2022; 17:Doc15. [PMID: 36157382 PMCID: PMC9487780 DOI: 10.3205/dgkh000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
We investigated the change in the epidemiology of nosocomial bloodstream infections (BSIs) caused by multidrug-resistant bacteria during Coronavirus Disease (COVID-19) and antibiotic consumption rates at a pandemic hospital and at the Oncology Hospital which operated as COVID-19-free on the same university campus. Significant increases in the infection density rate (IDRs) of BSIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and ampicillin-resistant Enterococcus faecium (ARE) were detected at the pandemic hospital, whereas carbapenem-resistant Klebsiella pneumoniae BSIs were increased at the non-pandemic Oncology Hospital. Pulsed field gel electrophoresis showed a polyclonal outbreak of CRAB in COVID-19 intensive care units. Antibiotic consumption rates were increased for almost all antibiotics, and was most significant for meropenem at both of the hospitals. Increased IDRs of CRAB and ARE BSIs as well as an increased consumption rate of broad-spectrum antibiotics emphasize the importance of a multimodal infection prevention strategy combined with an active antibiotic stewardship program.
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Affiliation(s)
- Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey,*To whom correspondence should be addressed: Gökhan Metan, Hacettepe Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları Binası Kat: 1, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Ankara, Turkey, E-mail: ,
| | - Mervenur Demir Çuha
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülsen Hazirolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey
| | - Elif Seren Tanriverdi
- Department of Medical Microbiology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Baris Otlu
- Department of Medical Microbiology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Zahit Tas
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pinar Zarakolu
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zafer Arik
- Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Section of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seda Banu Akinci
- Section of Intensive Care Medicine Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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14
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Er B, Er AG, Gülmez D, Şahin TK, Halaçlı B, Durhan G, Ersoy EO, Alp A, Metan G, Saribas Z, Arikan‐Akdagli S, Hazırolan G, Akıncı SB, Arıyürek M, Topeli A, Uzun Ö. A screening study for
COVID
‐19‐associated pulmonary aspergillosis in critically ill patients during the third wave of the pandemic. Mycoses 2022; 65:724-732. [PMID: 35531631 PMCID: PMC9348343 DOI: 10.1111/myc.13466] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 12/15/2022]
Abstract
Background COVID‐19‐associated pulmonary aspergillosis (CAPA) has been reported as an important cause of mortality in critically ill patients with an incidence rate ranging from 5% to 35% during the first and second pandemic waves. Objectives We aimed to evaluate the incidence, risk factors for CAPA by a screening protocol and outcome in the critically ill patients during the third wave of the pandemic. Patients/Methods This prospective cohort study was conducted in two intensive care units (ICU) designated for patients with COVID‐19 in a tertiary care university hospital between 18 November 2020 and 24 April 2021. SARS‐CoV‐2 PCR‐positive adult patients admitted to the ICU with respiratory failure were included in the study. Serum and respiratory samples were collected periodically from ICU admission up to CAPA diagnosis, patient discharge or death. ECMM/ISHAM consensus criteria were used to diagnose and classify CAPA cases. Results A total of 302 patients were admitted to the two ICUs during the study period, and 213 were included in the study. CAPA was diagnosed in 43 (20.1%) patients (12.2% probable, 7.9% possible). In regression analysis, male sex, higher SOFA scores at ICU admission, invasive mechanical ventilation and longer ICU stay were significantly associated with CAPA development. Overall ICU mortality rate was higher significantly in CAPA group compared to those with no CAPA (67.4% vs 29.4%, p < .001). Conclusions One fifth of critically ill patients in COVID‐19 ICUs developed CAPA, and this was associated with a high mortality.
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Affiliation(s)
- Berrin Er
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
- Ankara City Hospital, Intensive Care Unit Ankara
| | - Ahmet Görkem Er
- Department of Infectious Diseases and Clinical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Dolunay Gülmez
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Taha Koray Şahin
- Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Burçin Halaçlı
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Gamze Durhan
- Department of Radiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Ebru Ortaç Ersoy
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Zeynep Saribas
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Sevtap Arikan‐Akdagli
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Seda Banu Akıncı
- Division of Intensive Care, Department of Anaestesiology and Reanimation Hacettepe University Faculty of Medicine Ankara Turkey
| | - Macit Arıyürek
- Department of Radiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Arzu Topeli
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
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15
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Yildirim M, Halacli B, Pektezel MY, Er B, Geldigitti IT, Tok G, Ersoy EO, Topeli A. Comparison of critically ill COVID-19 and influenza patients with acute respiratory failure. Acute Crit Care 2022; 37:168-176. [PMID: 35280038 PMCID: PMC9184989 DOI: 10.4266/acc.2021.00920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/27/2021] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is one of the biggest pandemic causing acute respiratory failure (ARF) in the last century. Seasonal influenza carries high mortality, as well. The aim of this study was to compare features and outcomes of critically-ill COVID-19 and influenza patients with ARF. Methods Patients with COVID-19 and influenza admitted to intensive care unit with ARF were retrospectively analyzed. Results Fifty-four COVID-19 and 55 influenza patients with ARF were studied. Patients with COVID-19 had 32% of hospital mortality, while those with influenza had 47% (P=0.09). Patients with influenza had higher Eastern Cooperative Oncology Group, Clinical Frailty Scale, Acute Physiology and Chronic Health Evaluation II and admission Sequential Organ Failure Assessment (SOFA) scores than COVID-19 patients (P<0.01). Secondary bacterial infection, admission acute kidney injury, procalcitonin level above 0.2 ng/ml were the independent factors distinguishing influenza from COVID-19 while prone positioning differentiated COVID-19 from influenza. Invasive mechanical ventilation (odds ratio [OR], 42.16; 95% confidence interval [CI], 9.45–187.97), admission SOFA score more than 4 (OR, 5.92; 95% CI, 1.85–18.92), malignancy (OR, 4.95; 95% CI, 1.13–21.60), and age more than 65 years (OR, 3.31; 95% CI, 0.99–11.03) were found to be independent risk factors for hospital mortality. Conclusions There were few differences in clinical features of critically-ill COVID-19 and influenza patients. Influenza cases had worse performance status and disease severity. There was no significant difference in hospital mortality rates between COVID-19 and influenza patients.
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Affiliation(s)
- Mehmet Yildirim
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcin Halacli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Yasir Pektezel
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berrin Er
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ismail Tuna Geldigitti
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gulay Tok
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Ortac Ersoy
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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16
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Bruno RR, Wernly B, Wolff G, Fjølner J, Artigas A, Bollen Pinto B, Schefold JC, Kindgen-Milles D, Baldia PH, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Topeli A, Elhadi M, Joannidis M, Oeyen S, Kondili E, Marsh B, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Flaatten H, Jung C. Association of chronic heart failure with mortality in old intensive care patients suffering from Covid-19. ESC Heart Fail 2022; 9:1756-1765. [PMID: 35274490 PMCID: PMC9065875 DOI: 10.1002/ehf2.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/20/2022] Open
Abstract
Aims Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID‐19). This prospective international multicentre study investigates the role of pre‐existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID‐19. Methods and results Patients with pre‐existing CHF were subclassified as having ischaemic or non‐ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre‐existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5–2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5–1.5; P = 0.137]. More patients suffered from pre‐existing ischaemic than from non‐ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non‐ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9–1.0; P = 0.128). Conclusions In critically ill older COVID‐19 patients, pre‐existing CHF was not independently associated with 30 day mortality. Trial registration number: NCT04321265.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bernhard Wernly
- Center for Public Health and Healthcare Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital Bern, University of Bern, Bern, Switzerland
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Heinrich Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care Unit, Department of Anaesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Arzu Topeli
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, Department of Intensive Care Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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17
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Yamanyar GK, Halacli B, Yildirim M, Topeli A. Neurological complications during the course of severe COVID-19: Is it just the tip of the iceberg? Acute Crit Care 2022; 37:124-126. [PMID: 35279980 PMCID: PMC8918712 DOI: 10.4266/acc.2021.01445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
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18
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Rollas K, Hanci P, Topeli A. Effects of end-expiratory lung volume versus PaO 2 guided PEEP determination on respiratory mechanics and oxygenation in moderate to severe ARDS. Exp Lung Res 2021; 48:12-22. [PMID: 34957895 DOI: 10.1080/01902148.2021.2021326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is no ideal method for determination of positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) patients. We compared the effects of end-expiratory lung volume (EELV)-guided versus PaO2-guided PEEP determination on respiratory mechanics and oxygenation during the first 48 hours in moderate to severe ARDS. Twenty-two patients with moderate to severe ARDS admitted to an academic medical ICU were assigned to PaO2-guided (n = 11) or to EELV-guided PEEP determination (n = 11) group. First, an incremental PEEP trial was performed by increasing PEEP by 3 cmH2O steps from 8 to 20 cmH2O and in each step EELV and lung mechanics were measured in both groups. Then, oxygenation and respiratory mechanics were measured under the determined PEEP at 4, 12, 24, and 48th hours. After the incremental PEEP trial, over the 48 hours of the study period, in the EELV-guided group PaO2 and PaO2/FiO2 increased (p = 0.04 and p = 0.02; respectively), whereas they did not change in PaO2-guided group (p = 0.09 and p = 0.27; respectively). In all patients, the median value of EELV change (ΔEELV) during incremental PEEP trial was 25%. In patients with ΔEELV > 25% (n = 11) PaO2, PaO2/FiO2 and Cs increased over time in 48 hours (p = 0.03, p < 0.01, and p = 0.04; respectively), whereas they did not change in those with ΔEELV ≤ 25% (n = 11) (p = 0.73, p = 0.51, and p = 0.73; respectively). Compared to PaO2-guided PEEP determination, EELV-guided PEEP determination resulted in greater improvement in oxygenation over time. Patients who had > 25% improvement in EELV during a PEEP trial had greater improvement in oxygenation and compliance over 48 hours. Supplemental data for this article is available online at.
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Affiliation(s)
- Kazim Rollas
- Division of Intensive Care Medicine, Department of Anaesthesiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Pervin Hanci
- Division of Intensive Care Medicine, Department of Pulmonology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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19
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Halaçlı B, Topeli A. Implementation of post-intensive care outpatient clinic (I-POINT) for critically ill COVID-19 survivors. Turk J Med Sci 2021; 51:3350-3358. [PMID: 34333907 PMCID: PMC8771014 DOI: 10.3906/sag-2106-306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/31/2021] [Indexed: 11/05/2022] Open
Abstract
Although we have enough and cumulative information about acute effects of COVID-19, our knowledge is extremely limited about long-term consequences of COVID-19, in terms of its impacts and burdens on patients, families, and the health system. Considering the underlying pathophysiological mechanisms affecting all of the organ systems in critically ill COVID-19 patients who are admitted to intensive care units, the development of post-intensive care syndrome is inevitable. This situation brings along the development of long-COVID. These patients should be followed regarding cognitive, physical, and psychiatric aspects and necessary specialist referrals should be carried out. In this article, we are presenting the experience and recommendations of our center, as a guide for the establishment process of post-intensive care outpatient clinics for the critically ill patients who required intensive care admission due to COVID-19 and could be discharged.
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Affiliation(s)
- Burçin Halaçlı
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Member of COVID-19 Scientific Advisory Board of Turkish Ministry of Health
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20
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Gursoy G, Uzun O, Metan G, Yildirim M, Bahap M, Demirkan SK, Topeli A, Akinci SB, Topcuoglu MA, Berker M, Hazirolan G, Akova M, Unal S. Does Antimicrobial Stewardship Program Improve the Quality of Care in ICU Patients Consulted to Infectious Diseases? Experience in a Tertiary Care Hospital. Int J Infect Dis 2021; 115:201-207. [PMID: 34883234 DOI: 10.1016/j.ijid.2021.12.315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND One of the most important public health problems is the ever growing problem of antibiotic resistance. On one hand, the rate of introduction of new molecules into clinical practice has considerably slowed down, on the other hand, rapid emergence of resistance shortens the effective "life-span" of these molecules. OBJECTIVE In this study, the quality of care before and after active intervention and feedback was evaluated in patients diagnosed with sepsis/septic shock or ventilator-associated pneumonia (VAP) in Hacettepe University Adult and Oncology Hospitals ICUs. RESULTS There was a significant increase in total scores. Significant improvements were achieved in the management of these patients in terms of requesting necessary diagnostic tests, and prolonged infusion of beta-lactam agents. CONCLUSION Implementation of an ASP in centers where antimicrobial management of ICU patients is largely controlled by infectious diseases specialists is still a feasible strategy that leads to better patient care.
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Affiliation(s)
- Gamze Gursoy
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe, A. Adnan Saygun Street, 06230 Altındag/Ankara.
| | - Omrum Uzun
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe, A. Adnan Saygun Street, 06230 Altındag/Ankara
| | - Gokhan Metan
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe, A. Adnan Saygun Street, 06230 Altındag/Ankara
| | - Mehmet Yildirim
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Section of Intensive Care Medicine
| | - Melda Bahap
- Hacettepe University Faculty of Pharmacy, Department of Clinical Pharmacy
| | | | - Arzu Topeli
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Section of Intensive Care Medicine
| | - Seda Banu Akinci
- Hacettepe University Faculty of Medicine, Department of Anesthesiology and Reanimation, Section of Intensive Care Medicine
| | - Mehmet Akif Topcuoglu
- Hacettepe University Faculty of Medicine, Department of Neurology, Section of Intensive Care Medicine
| | - Mustafa Berker
- Hacettepe University Faculty of Medicine, Department of Neurosurgery, Section of Intensive Care Medicine
| | | | - Murat Akova
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe, A. Adnan Saygun Street, 06230 Altındag/Ankara
| | - Serhat Unal
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe, A. Adnan Saygun Street, 06230 Altındag/Ankara
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21
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Gündoğan K, Akbudak İH, Hancı P, Halaçlı B, Temel Ş, Güllü Z, İnci K, Bilir Y, Bozkurt FT, Yıldırım F, Şimşek M, Yüksel RC, Eren E, Altıntaş ND, Talan L, Elay G, Güven G, Kara İ, Aydın E, Yılmaz S, Mengi T, Sarı S, Akbaş T, Acar Cinleti B, Ateş Ayhan N, Aral Özbek D, Şahin TK, Açıkgöz A, Esbah AÜ, Fırat A, Aydemir F, Gürkök MÇ, Zerman A, Gümüş A, Türkoğlu M, Aydoğdu M, Ulu R, Çelik JB, Balcı C, Kıraklı C, Karakoç E, Özyılmaz E, Ortaç Ersoy E, Öcal S, Akın Şen İ, Tor İH, Cömert B, Ergan B, Saraçoğlu KT, Ergil J, Yüksel ÜG, Tutar N, Sungur M, Topeli A. Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units. Balkan Med J 2021; 38:296-303. [PMID: 34558415 PMCID: PMC8880837 DOI: 10.5152/balkanmedj.2021.21188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.
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Affiliation(s)
- Kürşat Gündoğan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - İsmail Hakkı Akbudak
- Division of Intensive Care Medicine, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkey
| | - Pervin Hancı
- Division of Intensive Care Medicine, Department of Chest Diseases, Ministry of Health, Intensive Care Unit, Erzurum Training and Research Hospital, Erzurum, Turkey and Trakya University School of Medicine, Edirne, Turkey
| | - Burçin Halaçlı
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Şahin Temel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Zuhal Güllü
- Intensive Care Unit, Ministry of Health, Ankara Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Kamil İnci
- Intensive Care Unit, Ministry of Health, Ankara Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Yeliz Bilir
- Intensive Unit, Ministry of Health, İstanbul Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Firdevs Tuğba Bozkurt
- Intensive Care Unit, Ministry of Health, Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Fatma Yıldırım
- Intensive Care Unit, Ministry of Health, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Meltem Şimşek
- Intensive Care Unit, Ministry of Health, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Recep Civan Yüksel
- Intensive Care Unit, Ministry of Health, Kayseri City Hospital, Kayseri, Turkey
| | - Esma Eren
- Intensive Care Unit, Ministry of Health, Kayseri City Hospital, Kayseri, Turkey
| | - Neriman Defne Altıntaş
- Division of Intensive Care Medicine, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Leyla Talan
- Division of Intensive Care Medicine, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Gülseren Elay
- Division of Intensive Care Medicine, Department of Internal Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Göksel Güven
- Division of Intensive Care Medicine, Department of Internal Medicine, Ministry of Health, Intensive Care Unit, Tokat State Hospital, Tokat and Hacettepe University School of Medicine, Ankara, Turkey
| | - İskender Kara
- Department of Anesthesiology, Intensive Care Unit, Selçuk University School of Medicine, Konya, Turkey
| | - Emre Aydın
- Division of Intensive Care Medicine, Department of Internal Medicine, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Seda Yılmaz
- Anesthesiology Intensive Care Unit, Kütahya Health Science University, Kütahya, Turkey
| | - Tuğçe Mengi
- Intensive Care Unit, Ministry of Health, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Sema Sarı
- Intensive Care Unit, Ministry of Health, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Türkay Akbaş
- Division of Intensive Care Medicine, Department of Internal Medicine, Düzce University School of Medicine, Düzce, Turkey
| | - Burcu Acar Cinleti
- Intensive Care Unit, Ministry of Health, İzmir Suat Seren Training and Research Hospital, İzmir, Turkey
| | - Nazire Ateş Ayhan
- Division of Intensive Care Medicine, Department of Internal Medicine, Çukurova University School of Medicine, Adana, Turkey
| | - Deniz Aral Özbek
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Taha Koray Şahin
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aslı Açıkgöz
- Department of Anesthesiology, Intensive Care Unit, Selçuk University School of Medicine, Konya, Turkey
| | - Ali Ümit Esbah
- Division of Intensive Care Medicine, Department of Internal Medicine, Düzce University School of Medicine, Düzce, Turkey
| | - Ahmet Fırat
- Division of Intensive Care Medicine, Department of Internal Medicine, Çukurova University School of Medicine, Adana, Turkey
| | - Ferhan Aydemir
- Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mehmet Çağatay Gürkök
- Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Avşar Zerman
- Intensive Care Unit, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Ayça Gümüş
- Intensive Care Unit, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Melda Türkoğlu
- Division of Intensive Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Müge Aydoğdu
- Division of Intensive Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Ramazan Ulu
- Division of Intensive Care Medicine, Department of Internal Medicine, Fırat University School of Medicine, Elazığ, Turkey
| | - Jale Bengi Çelik
- Department of Anesthesiology, Intensive Care Unit, Selçuk University School of Medicine, Konya, Turkey
| | - Canan Balcı
- Anesthesiology Intensive Care Unit, Kütahya Health Science University, Kütahya, Turkey
| | - Cenk Kıraklı
- Intensive Care Unit, Ministry of Health, İzmir Suat Seren Training and Research Hospital, İzmir, Turkey
| | - Emre Karakoç
- Division of Intensive Care Medicine, Department of Internal Medicine, Çukurova University School of Medicine, Adana, Turkey
| | - Ezgi Özyılmaz
- Division of Intensive Care Medicine, Department of Chest Diseases, Çukurova University School of Medicine, Adana, Turkey
| | - Ebru Ortaç Ersoy
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serpil Öcal
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - İrem Akın Şen
- Division of Intensive Care Medicine, Department of Chest Diseases, Ministry of Health, Intensive Care Unit, Erzurum Training and Research Hospital, Erzurum, Turkey and Trakya University School of Medicine, Edirne, Turkey
| | - İbrahim Hakkı Tor
- Division of Intensive Care Medicine, Department of Chest Diseases, Ministry of Health, Intensive Care Unit, Erzurum Training and Research Hospital, Erzurum, Turkey and Trakya University School of Medicine, Edirne, Turkey
| | - Bilgin Cömert
- Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Begüm Ergan
- Division of Intensive Care Medicine, Department of Chest Diseases, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Kemal Tolga Saraçoğlu
- Intensive Unit, Ministry of Health, İstanbul Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Jülide Ergil
- Intensive Care Unit, Ministry of Health, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Ümmü Gülsüm Yüksel
- Division of Intensive Care Medicine, Department of Internal Medicine, Ministry of Health, Intensive Care Unit, Tokat State Hospital, Tokat and Hacettepe University School of Medicine, Ankara, Turkey
| | - Nuri Tutar
- Division of Intensive Care Medicine, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey
| | - Murat Sungur
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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22
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Yildirim M, Halacli B, Kaya EK, Turkoglu M, Topeli A. Diversity of intensive care specialists and fellows-in-training in Turkey. Can J Anaesth 2021; 68:1833-1835. [PMID: 34478053 DOI: 10.1007/s12630-021-02096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Mehmet Yildirim
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Burcin Halacli
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Esat Kivanc Kaya
- Division of Intensive Care, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Melda Turkoglu
- Division of Intensive Care, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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23
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Öcal S, Özen S, Nemutlu E, Kart D, Eylem CC, Topeli A. Salbutamol Delivered by Jet Nebulizer: Closed System Design and Impact of a Model Biofilm. Respir Care 2021; 66:1440-1445. [PMID: 33824174 PMCID: PMC9993873 DOI: 10.4187/respcare.08142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aerosol therapy is commonly used by intensivists during invasive mechanical ventilation. More information is needed to optimize outcomes. The first aim of this study was to assess the deposition of salbutamol on components of a closed mechanical ventilation system, both in the presence and absence of biofilm generated by Acinetobacter baumannii. The second aim was to evaluate the deposition of salbutamol, using a single dose and a double dose, delivered via a jet nebulizer placed between the flexible tube and the heat and moisture exchanger. METHODS A mechanical ventilator was connected to a standard system, and a jet nebulizer was placed between the heat and moisture exchanger and the flexible tube. Clinical isolates of A. baumanii were used to generate a biofilm layer on the endotracheal tube. Two amounts of salbutamol were delivered via the jet nebulizer. An analytical liquid chromatography tandem mass spectrometry method was developed to evaluate salbutamol deposition. RESULTS The presence of a biofilm on the endotracheal tube had no impact on salbutamol deposition (P = .83). There was no difference in surface deposition of salbutamol on component parts of the closed system in a comparison of a single dose and a double dose delivered via a jet nebulizer. CONCLUSIONS Our findings indicate that an A. baumannii biofilm had no impact on the extent of salbutamol deposition. Salbutamol deposition was comparatively low and could be delivered without removal of the heat and moisture exchanger.
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Affiliation(s)
- Serpil Öcal
- Faculty of Medicine, Department of Medical Intensive Care Unit, Hacettepe University, Ankara, Turkey.
| | - Serkan Özen
- Faculty of Medicine, Department of Medical Intensive Care Unit, Hacettepe University, Ankara, Turkey
| | - Emirhan Nemutlu
- Faculty of Pharmacy, Department of Analytical Chemistry, Hacettepe University, Ankara, Turkey
| | - Didem Kart
- Faculty of Pharmacy, Department of Pharmaceutical Microbiology, Hacettepe University, Ankara, Turkey
| | - Cemil Can Eylem
- Faculty of Pharmacy, Department of Analytical Chemistry, Hacettepe University, Ankara, Turkey
| | - Arzu Topeli
- Faculty of Medicine, Department of Medical Intensive Care Unit, Hacettepe University, Ankara, Turkey
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24
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Abstract
Severe acute respiratory syndrome coronavirus 2 has rapidly spread worldwide and resulted in the coronavirus disease 2019 (COVID-19) pandemic. The disease raised an unprecedented demand for intensive care support due to severe pulmonary dysfunction and multiorgan failure. Although the pulmonary system is the potential target of the COVID-19, recent reports have demonstrated that COVID-19 profoundly influences the cardiovascular system and the kidneys. Research studies on cadavers have shown that direct heart and kidney injury can be frequently seen in patients deceased due to COVID-19 infection. On the other hand, functional or structural dysfunction of the heart may deteriorate the renal function and vice versa. This concept is already known as the cardiorenal syndrome and may play a role in COVID-19. Proactive monitoring of micro- and macrohemodynamics could allow prompt correction of circulatory dysfunction and can be of pivotal importance in the prevention of acute kidney injury. Moreover, type and amount of fluid therapy and vasoactive drug support could help manage these patients either with or without mechanical ventilator support. This brief review outlines the current evidence regarding the COVID-19-related renal and cardiorenal complications and discusses potential hemodynamic management strategies.
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Affiliation(s)
- Goksel Guven
- Department of Intensive Care Adults, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands, .,Department of Intensive Care Adults, Tokat State Hospital, Tokat, Turkey, .,Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey,
| | - Can Ince
- Department of Intensive Care Adults, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kadir Caliskan
- Department of Cardiology, Unit Heart Failure, Heart Transplantation & Mechanical Circulatory Support, Thorax Center, Rotterdam, The Netherlands
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25
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Er B, Er AG, Metan G, Halaçlı B, Ortaç Ersoy E, Hazırolan G, Alp A, Sarıbaş Z, Arıkan Akdağlı S, Topeli A, Uzun Ö. Is COVID-19 a risk factor for invasive pulmonary aspergillosis in critically ill patients? Tuberk Toraks 2021; 69:118-120. [PMID: 33853317 DOI: 10.5578/tt.20219918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Berrin Er
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Görkem Er
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burçin Halaçlı
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Ortaç Ersoy
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Sarıbaş
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevtap Arıkan Akdağlı
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Burçin Halaçlı
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pervin Hancı
- Intensive Care Unit, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ebru Ortaç Ersoy
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serpil Öcal
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mine Durusu Tanrıöver
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Banu Cakir
- Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Ebru Ortac Ersoy
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey,
| | - Berrin Er
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Ciftci
- Department of Chest Diseases, Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Kezban Suner
- Intensive Care Unit, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Burcu Arpinar
- Intensive Care Unit, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gulbin Aygencel
- Medical Intensive Care Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Feza Bacakoglu
- Division of Chest Diseases, Intensive Care Unit, Ege University Faculty of Medicine, İzmir, Turkey
| | - Serdar Akpinar
- Medical Intensive Care Unit, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Bilgin Comert
- Medical Intensive Care Unit, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Hulya Sungurtekin
- Intensive Care Unit, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Defne Altıntas
- Medical Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kazim Rollas
- Intensive Care Unit, Tepecik Education Hospital, University of Health Sciences, Izmir, Turkey
| | - Sema Turan
- Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kubra Aykac
- Department of Pediatric Infectious Diseases, University of Health Science Ankara Training and Research Hospital, Ankara, Turkey
| | - Ahmet Gorkem Er
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcin Halacli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Arasli
- Department of Immunology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Pembe Derin Oygar
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sibel Gürlevik
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Ceylan Cura Yayla
- Department of Pediatric Infectious Diseases, University of Health Science Ankara Training and Research Hospital, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alparslan Alp
- Department of Microbiology and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Bülent Cengiz
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ceyhan
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Gamze Durhan
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Selin Ardalı Düzgün
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Figen Başaran Demirkazık
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - İlim Irmak
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - İlkay İdilman
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Meltem Gülsün Akpınar
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Erhan Akpınar
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Serpil Öcal
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Gülçin Telli
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Arzu Topeli
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Orhan Macit Arıyürek
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Serpil Ocal
- Division of Critical Care, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Banu Kilicaslan
- Division of Critical Care, Department of Anaesthesiology and Reanimation, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Seda Banu Akinci
- Division of Critical Care, Department of Anaesthesiology and Reanimation, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Arzu Topeli
- Division of Critical Care, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - M Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Uğur Özdemir
- Division of Intensive Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Ebru Ortaç Ersoy
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Recep Civan Yüksel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Erhan Kaya
- Division of Intensive Care Medicine, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Gülbin Aygencel
- Division of Intensive Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Melda Türkoğlu
- Division of Intensive Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Muhammet Güven
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Murat Sungur
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Neriman Defne Altintaş
- Division of Intensive Care Medicine, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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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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Affiliation(s)
- Burcin Halacli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Akin Kaya
- Pulmonary and Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Sıhhiye, Ankara, Turkey, Tel.: +90 5464750175
| | - Nihal Deniz Bulut Yuksel
- Division of Critical Care, Department of Anaesthesiology and Reanimation, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Sıhhiye, Ankara, Turkey
| | - Serpil Ocal
- Division of Critical Care, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Seda Banu Akinci
- Division of Critical Care, Department of Anaesthesiology and Reanimation, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Arzu Topeli
- Division of Critical Care, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - M Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Sıhhiye, Ankara, Turkey
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Serpil Öcal
- Department of Medical Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Oytun Portakal
- Department of Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Ahmet Uğur Demir
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Arzu Topeli
- Department of Medical Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Lütfi Çöplü
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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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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Affiliation(s)
- Mert Esme
- Section of Geriatric Medicine, Department of Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Section of Intensive Care, Department of Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Burcu Balam Yavuz
- Section of Geriatric Medicine, Department of Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Suleyman Nahit Sendur
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Arzu Topeli
- Division of Intensive Care Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Özlem Ediboğlu
- Department of Intensive Care Unit, Health Sciences University, İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Özlem Yazıcıoğlu Moçin
- Department of Intensive Care Unit, Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ezgi Özyılmaz
- Department of Intensive Care Unit, Çukurova University School of Medicine Balcalı Hospital, Adana, Turkey
| | - Cüneyt Saltürk
- Department of Intensive Care Unit, Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Tuğba Önalan
- Department of Intensive Care Unit, İzmir Çiğli District Hospital, İzmir, Turkey
| | - Gülşah Seydaoğlu
- Clinic of Biostatistics, Çukurova University School of Medicine, Adana, Turkey
| | - Turgay Çelikel
- Department of Intensive Care Unit, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Hüseyin Arıkan
- Department of Intensive Care Unit, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Sena Ataman
- Department of Intensive Care Unit, Health Sciences University, İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Cenk Kıraklı
- Department of Intensive Care Unit, Health Sciences University, İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Zerrin Özçelik
- Department of Intensive Care Unit, Balıkesir State Hospital, Balıkesir, Turkey
| | - Sema Kultufan
- Department of Intensive Care Unit, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - İskender Kara
- Clinic of Intensive Care Unit, Konya Numune Hospital, Konya, Turkey
| | - Atilla Kara
- Clinic of Intensive Care Unit, Sivas Numune Hospital, Sivas, Turkey
| | - Emine Dağlı
- Clinic of Intensive Care Unit, Tarsus State Hospital, Mersin, Turkey
| | - Selma Duru Bülbül
- Clinic of Intensive Care Unit, Tarsus State Hospital, Mersin, Turkey
| | - Kadriye Kahveci
- Clinic of Intensive Care Unit, Ankara Ulus State Hospital, Ankara, Turkey
| | - Metin Dinçer
- Clinic of Intensive Care Unit, Ankara Ulus State Hospital, Ankara, Turkey
| | - Nimet Şenoğlu
- Clinic of Intensive Care Unit, Health Sciences University, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hüseyin Özkarakaş
- Clinic of Intensive Care Unit, Health Sciences University, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - İlhan Bahar
- Clinic of Intensive Care Unit, Van Training and Research Hospital, Van, Turkey
| | - Melike Cengiz
- Clinic of Intensive Care Unit, Akdeniz University Hospital, Antalya, Turkey
| | - Atilla Ramazanoğlu
- Clinic of Intensive Care Unit, Akdeniz University Hospital, Antalya, Turkey
| | - Burcu Çelik
- Clinic of Intensive Care Unit, Akdeniz University Hospital, Antalya, Turkey
| | - Ümmügülsün Gaygısız
- Clinic of Intensive Care Unit, Erzurum District Training and Research Hospital, Erzurum, Turkey
| | - Gülay Kır
- Department of Intensive Care Unit, University of Health Sciences Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Bindal
- Clinic of Intensive Care Unit, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Belgin Akan
- Clinic of Intensive Care Unit, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Işıl Özkoçak Turan
- Clinic of Intensive Care Unit, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Fatma Yıldırım
- Clinic of Intensive Care Unit, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Burcu Başarık
- Clinic of Intensive Care Unit, Denizli State Hospital, Denizli, Turkey
| | - Zeliha Arslan Ulukan
- Clinic of Intensive Care Unit, Medicana International İstanbul Hospital, İstanbul, Turkey
| | - Serdar Efe
- Department of Intensive Care Unit, Trakya University Health Research and Application Hospital, Edirne, Turkey
| | - Murat Sungur
- Department of Intensive Care Unit, Erciyes University School of Medicine, Kayseri, Turkey
| | - Şahin Temel
- Department of Intensive Care Unit, Erciyes University School of Medicine, Kayseri, Turkey
| | - Seval İzdeş
- Clinic of Intensive Care Unit, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Derya Hoşgün
- Clinic of Intensive Care Unit, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Nurhan Karadeniz
- Clinic of Intensive Care Unit, Manisa State Hospital, Manisa, Turkey
| | - Eylem Tuncay
- Department of Intensive Care Unit, Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Nezihe Çiftarslan Gökşenoğlu
- Department of Intensive Care Unit, Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - İlim Irmak
- Department of Intensive Care Unit, Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Utku Datlı
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
| | - Avşar Zerman
- Clinic of Intensive Care Unit, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Devrim Akdağ
- Department of Intensive Care Unit, Çukurova University School of Medicine Balcalı Hospital, Adana, Turkey
| | - Levent Özdemir
- Clinic of Intensive Care Unit, Dörtyol State Hospital, Hatay, Turkey
| | - Gülseren Elay
- Clinic of Intensive Care Unit, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Yücel Karaçayır
- Clinic of Intensive Care Unit, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Arzu Topeli
- Department of Intensive Care Unit, Hacettepe University School of Medicine Hospital, Ankara, Turkey
| | - Pervin Hancı
- Department of Intensive Care Unit, Hacettepe University School of Medicine Hospital, Ankara, Turkey
| | - Esat Kıvanç Kaya
- Department of Intensive Care Unit, Hacettepe University School of Medicine Hospital, Ankara, Turkey
| | - Pınar Güven
- Clinic of Intensive Care Unit, Bolu İzzet Baysal State Hospital, Bolu, Turkey
| | - Hilal Sazak
- Clinic of Intensive Care Unit, Ankara Atatürk Chest Diseases and Surgery Training and Research Hospital, Ankara, Turkey
| | - Semih Aydemir
- Clinic of Intensive Care Unit, Ankara Atatürk Chest Diseases and Surgery Training and Research Hospital, Ankara, Turkey
| | - Gülbin Aygencel
- Department of Intensive Care Unit, Gazi University School of Medicine Hospital, Ankara, Turkey
| | - Yusuf Aydemir
- Clinic of Intensive Care Unit, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Zahide Doğanay
- Clinic of Intensive Care Unit, Samsun Training and Research Hospital, Samsun, Turkey
| | - Özgür Kömürcü
- Clinic of Intensive Care Unit, Samsun Training and Research Hospital, Samsun, Turkey
| | - Volkan Hancı
- Department of Post-op Anesthesia Care Unit, Dokuz Eylül University School of Medicine Hospital, İzmir, Turkey
| | - Emre Karakoç
- Department of Intensive Care Unit, Çukurova University School of Medicine Balcalı Hospital, Adana, Turkey
| | - Didem Sözütek
- Department of Intensive Care Unit, Çukurova University School of Medicine Balcalı Hospital, Adana, Turkey
| | - Güven Coşkun
- Clinic of Intensive Care Unit, Afyonkarahisar State Hospital, Afyon, Turkey
| | - Güngör Ateş
- Clinic of Intensive Care Unit, Memorial Diyarbakır Hospital, Diyarbakır, Turkey
| | - Civan Tiryaki
- Clinic of Intensive Care Unit, Memorial Diyarbakır Hospital, Diyarbakır, Turkey
| | - Ayşe Nur Soytürk
- Department of Intensive Care Unit, Uludağ University School of Medicine Hospital, Bursa, Turkey
| | - Nermin Kelebek Girgin
- Department of Intensive Care Unit, Uludağ University School of Medicine Hospital, Bursa, Turkey
| | - Gülbahar Çalışkan
- Department of Intensive Care Unit, Uludağ University School of Medicine Hospital, Bursa, Turkey
| | - Oben Bıyıklı
- Clinic of Intensive Care Unit, İzmir Central Hospital, İzmir, Turkey
| | - Necati Gökmen
- Department of Intensive Care Unit, Dokuz Eylül University School of Medicine Hospital, İzmir, Turkey
| | - Uğur Koca
- Department of Intensive Care Unit, Dokuz Eylül University School of Medicine Hospital, İzmir, Turkey
| | - Aydın Çiledağ
- Department of Intensive Care Unit, Ankara University School of Medicine Hospital, Ankara, Turkey
| | - Kezban Özmen Süner
- Clinic of Intensive Care Unit, Konya Training and Research Hospital, Konya, Turkey
| | - İsmail Cinel
- Clinic of Intensive Care Unit, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Kemal Arslantaş
- Clinic of Intensive Care Unit, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Fethi Gül
- Clinic of Intensive Care Unit, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Recai Ergün
- Clinic of Intensive Care Unit, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Nafiye Yılmaz
- Clinic of Intensive Care Unit, Atatürk University Health Research and Application Hospital, Erzurum, Turkey
| | - Defne Altıntaş
- Department of Intensive Care Unit, Ankara University School of Medicine Hospital, Ankara, Turkey
| | - Leyla Talan
- Department of Intensive Care Unit, Ankara University School of Medicine Hospital, Ankara, Turkey
| | - Murat Yalçınsoy
- Department of Intensive Care Unit, İnönü University School of Medicine Hospital, Malatya, Turkey
| | - Mehmet Nezir Güllü
- Clinic of Intensive Care Unit, Health Sciences University, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Perihan Ergin Özcan
- Department of Intensive Care Unit, İstanbul University Istanbul School of Medicine Hospital, İstanbul, Turkey
| | - Günseli Orhun
- Department of Intensive Care Unit, İstanbul University Istanbul School of Medicine Hospital, İstanbul, Turkey
| | - Yusuf Savran
- Department of Intensive Care Unit, Dokuz Eylül University School of Medicine Hospital, İzmir, Turkey
| | - Murat Emre Tokur
- Department of Intensive Care Unit, Dokuz Eylül University School of Medicine Hospital, İzmir, Turkey
| | - Serdar Akpınar
- Clinic of Intensive Care Unit, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Pelin Şen
- Department of Intensive Care Unit, İstanbul Başkent University Hospital, İstanbul, Turkey
| | - Gül Gürsel
- Department of Intensive Care Unit, Gazi University School of Medicine Hospital, Ankara, Turkey
| | - İrem Şerifoğlu
- Department of Intensive Care Unit, Ankara Başkent University Hospital, Ankara, Turkey
| | - Ender Gedik
- Department of Intensive Care Unit, Ankara Başkent University Hospital, Ankara, Turkey
| | - Öner Abidin Balbay
- Clinic of Intensive Care Unit, Düzce University Health Research and Application Hospital, Düzce, Turkey
| | - Türkay Akbaş
- Clinic of Intensive Care Unit, Düzce University Health Research and Application Hospital, Düzce, Turkey
| | - Sinem Cesur
- Clinic of Intensive Care Unit, Düzce University Health Research and Application Hospital, Düzce, Turkey
| | - Hülya Yolacan
- Clinic of Intensive Care Unit, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Seda Beyhan Sağmen
- Clinic of Intensive Care Unit, Health Sciences University, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Pervin Korkmaz Ekren
- Department of Intensive Care Unit, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Feza Bacakoğlu
- Department of Intensive Care Unit, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Begüm Ergan
- Department of Intensive Care Unit, Dokuz Eylül University School of Medicine Hospital, İzmir, Turkey
| | - Ersin Günay
- Clinic of Intensive Care Unit, Afyon Kocatepe University Ahmed Necdet Sezer Research and Application Hospital, Afyon, Turkey
| | - Muzaffer Sarıaydın
- Clinic of Intensive Care Unit, Afyon Kocatepe University Ahmed Necdet Sezer Research and Application Hospital, Afyon, Turkey
| | - Dursun Ali Sağlam
- Clinic of Intensive Care Unit, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Sait Karakurt
- Clinic of Intensive Care Unit, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Emel Eryüksel
- Clinic of Intensive Care Unit, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Funda Öztuna
- Department of Intensive Care Unit, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | | | - Hakan Cinemre
- Clinic of Intensive Care Unit, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Ahmet Nalbant
- Clinic of Intensive Care Unit, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Öznur Yağmurkaya
- Clinic of Intensive Care Unit, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Tuğba Mandal
- Department of Intensive Care Unit, Adıyaman University School of Medicine Hospital, Adıyaman, Turkey
| | - Belgin İkidağ
- Clinic of Intensive Care Unit, American Hospital, Gaziantep, Turkey
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Affiliation(s)
- Begum Ergan
- Medical Intensive Care Unit, Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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44
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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. Crit Care 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Jordi Rello
- Hospital Universitari Joan XXIII, C. Dr. Mallafrè Guasch 4, 43007, Tarragona, Spain. .,CIBERES, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119, 08035, Barcelona, Spain. .,Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Claus-Georg Krenn
- Medical University of Vienna, Intensive Care 13C1, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Gottfried Locker
- Department of Internal Medicine I, Medical University of Vienna, Intensive Care 13I2, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Ernst Pilger
- Intensive Care, Department of Internal Medicine, University Hospital Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Christian Madl
- Department of Internal Medicine III, Intensive Care 13H1, Medical University of Vienna, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Laura Balica
- Emergency Clinical Hospital Bucharest, Toxicology - ICU, 8 Floreasca Street, 01446, Bucharest, Romania
| | - Thierry Dugernier
- Clinique St. Pierre, Intensive Care Department, Avenue Reine Fabiola 9, 1340, Ottignies, Belgium
| | - Pierre-Francois Laterre
- Department of CCM, St. Luc University Hospital UCL, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Herbert Spapen
- University Hospital Vrije Universiteit Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | | | - Jean-Louis Vincent
- Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Lajos Bogár
- University of Pécs Anesthesiology and Intensive Care Department, Ifjúság ut 13, 7624, Pécs, Hungary
| | | | - Barbara Völgyes
- Bajcsy Zsilinszky Hospital and Polyclinic, Intensive Care Unit, Maglodi út 89-91, 1106, Budapest, Hungary
| | - Rafael Máñez
- Department for Critical Care Medicine, Bellvitge University Hospital, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nahit Cakar
- Department of Anesthesiology and Reanimation, Istanbul University Capa Medical Faculty, 34390, Istanbul, Turkey
| | - Atilla Ramazanoglu
- Department of Anesthesiology, Dumlupinar Bulvari Kampus Antalya, Akdeniz University, Faculty of Medicine Hospital, 07070, Antalya, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Intensive Care Unit, Hacettepe University Hospital, 06100, Ankara, Turkey
| | - Maria A Mastruzzo
- Hospital Dr. Carlos Bocalandro, Ruta 8 No. 9100, B1657BHD Loma Hermosa, Partido 3 de Febrero, Buenos Aires, Argentina
| | - Abel Jasovich
- Sanatorio Güemes, Av. Roque Sanchez Pena 811 5°C, C1035AAP, Buenos Aires, Argentina
| | - Christian G Remolif
- Hospital "Heroes de Malvinas", Av. Ricardo Balbín 1910, B1721FJN Merlo, Buenos Aires, Argentina
| | | | - Max A Andresen Hernandez
- Hospital Clinico, Facultad de Medicina Pontificia, Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Carolina Ruiz Balart
- Hospital Dr. Sótero del Rio, Unidad de Cuidado Intensivo, Departamento de Medicina Intensiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, Santiago, Chile
| | - Ildikó Krémer
- Flor Ferenc County Hospital, Semmelweis tér 1, 2143, Kistarcsa, Hungary
| | - Zsolt Molnár
- Department of Anaesthesia and Intensive Care, University of Szeged, Semmelweis u. 6, 6720, Szeged, Hungary
| | - Frank von Sonnenburg
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Georgenstr. 5, 80799, Munich, Germany
| | - Arthur Lyons
- Clinical Research Department, Division of Virus Diseases, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Michael Joannidis
- Department of Internal Medicine, Division of Intensive Care and Emergency Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Heinz Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases, Medical University of Vienna, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Stadlweg 23, 6020, Innsbruck, Austria
| | - Romana Hochreiter
- Valneva Austria GmbH, Campus Vienna Biocenter 3, 1030, Vienna, Austria
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Mine Durusu Tanrıöver
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burçin Halaçlı
- Medical Intensive Care Unit, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bilgin Sait
- Department of Internal Medicine, Private Memorial Hospital, İstanbul, Turkey
| | - Serpil Öcal
- Medical Intensive Care Unit, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Arzu Topeli
- Medical Intensive Care Unit, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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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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Affiliation(s)
- Abdurrahman Tufan
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
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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] [What about the content of this article? (0)] [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, Hoellthaler J, Mair S, Phillip V, Schmid RM, Beitz A, Baladrón V, Calvo FJR, Padilla D, Peelen LM, Villarejo P, Villazala R, Yuste AS, Bejarano N, Steenstra RJ, Banierink H, Hof J, van der Horst IC, Nijsten MW, Hoekstra M, Zeman PM, Roedl K, Sterz F, Horvatits T, Horvatits K, Drolz A, Herkner H, Fuhrmann V, Kott M, Zitta K, Brandt B, Slooter AJ, Schildhauer C, Elke G, Hummitzsch L, Frerichs I, Weiler N, Albrecht M, González LR, Alonso DC, Ortiz AB, Sánchez RDP, van Ewijk CE, Lucas JH, Roedl K, Sterz F, Drolz A, Horvatits K, Horvatits T, Herkner H, Fuhrmann V, Horvatits T, Drolz A, Jacobs GE, Roedl K, Rutter K, Ferlitsch A, Fauler G, Trauner M, Fuhrmann V, Horvatits T, Pischke S, Fischer L, Thaiss F, Girbes ARJ, Koch M, Bangert K, Fuhrmann V, Kluge S, Lohse AW, Nashan B, Sterneck M, Faenza S, Siniscalchi A, Pierucci E, Myatra SN, Mancini E, Ricci D, Gemelli C, Cuoghi A, Magnani S, Atti M, Sotos F, Cánovas J, López A, Burruezo A, Harish MM, Torres D, Herrera-Gutierrez ME, 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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] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Lluís Blanch
- Universitat Autònoma de Barcelona, CIBERes, Parc Taulí Hospital, Sabadell, Spain.
| | | | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | | | - Gavin M Joynt
- The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | | | - Joseph L Nates
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy
| | - Charles Sprung
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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