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Prognostic value of Charlson comorbidity index, ASA status, and APACHE-II score in predicting in-hospital mortality in critically ill geriatric hip fracture patients
Objective: This study aimed to investigate the prognostic value of the Charlson comorbidity index (CCI), American Society of Anesthesiologists (ASA) status, and Acute Physiology and Chronic Disease Evaluation II (APACHE-II) score in critically ill geriatric hip fracture patients followed in the surgical intensive care unit (SICU). Materials and Methods: Critical geriatric hip fracture patients who underwent surgery and were followed in the SICU between January 2022 and December 2023 were evaluated retrospectively. The performance of CCI, ASA status, and APACHE-II scores in predicting in-hospital mortality was investigated. Results: The study included 137 patients, and 66.4% (n=91) were female. ASA IV status, APACHE-II, CCI score, and the number of patients with coronary vascular disease/heart failure were significantly higher in the mortality group (p=0.003, p<0.001, p<0.001, and 0.010, respectively). Mean Glasgow Coma Scale and serum albumin levels at SICU admission were significantly lower in the mortality group (p=0.008 and p=0.006, respectively). ASA status, APACHE-II, and CCI scores were independent predictors of mortality (p=0.002, p=0.022, and p=0.034, respectively). In ROC curve analysis, the area under the curve (AUC) for APACHE-II was 0.803 (95% CI, 0.697-0.908), AUC for CCI was 0.742 (95% CI, 0.598-0.886), and AUC for ASA status was 0.614 (0.458-0.769). Conclusions: CCI, ASA status, and APACHE-II scores independently predict in-hospital mortality in patients with critical hip fractures. It has prognostic value in predicting mortality and is listed from highest to lowest as APACHE-II, CCI, and ASA status.
Copyright © 2025 The Author(s) https://creativecommons.org/licenses/by/4.0
Intentional drug overdose in the intensive care unit: A three-year retrospective cohort on polypharmacy and length of stay
Aims: Intentional drug overdose is a leading cause of poisoning-related intensive care admissions and a major concern in clinical toxicology and public health. Identifying toxicological patterns, demographic features, and associated outcomes is essential to guide prevention and optimize early management. Methods: We conducted a retrospective analysis of toxicological profiles, psychiatric history, and clinical outcomes among patients admitted to the intensive care unit after intentional drug overdose. Data collected included demographics, psychiatric comorbidities, ingested drug classes, length of stay in the intensive care unit, need for mechanical ventilation, and mortality. Patients were categorized as single- or multiple-drug ingestion, and groups were compared using appropriate statistical tests. Results: Among 229 patients (57.2% female; 59.1% aged 18–33 years), antidepressants (20.9%) and analgesics (17.3%) were the most frequent agents. Multiple-drug ingestion occurred in 65.9% and was associated with a longer intensive care unit stay (2.31 ± 2.61 vs. 1.60 ± 0.83 days; P = 0.0088). Mechanical ventilation was required in 3.1%, and mortality was 0.3%. Conclusion: Intentional overdose predominantly affects young adults and often involves multiple-drug ingestion (acute polypharmacy). Although critical outcomes were rare, polypharmacy correlated with prolonged intensive care unit stay, supporting prevention efforts and targeted psychiatric follow-up.
Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
Arterial pH at hospital admission and its relationship with early mortality in post-cardiac arrest patients
Objective: To evaluate the prognostic value of arterial pH at ICU admission for short-term survival after cardiac arrest. Materials and Methods: This single-center observational study included 60 adults (≥18 years) admitted to the ICU between May 2024 and June 2025 after successful resuscitation with return of spontaneous circulation (ROSC). Clinical, demographic, and laboratory data were collected. Survivors and non-survivors at day 7 were compared using logistic regression and ROC analyses to determine independent predictors of mortality. Results: The mean age was 61 ± 17 years, and 43% of patients were women. Seven-day mortality was 51.7%. Non-survivors were older and had higher APACHE II scores, lactate and procalcitonin levels, longer CPR-to-ROSC intervals, lower arterial pH values, and shorter ICU stays (all p < 0.05). In multivariable logistic regression analysis, age, higher APACHE II score, elevated procalcitonin levels, and lower arterial pH were independently associated with 7-day mortality. Lower arterial pH remained significantly associated with mortality (OR: 1.53; 95% CI: 0.93–2.86; p = 0.044). ROC analysis yielded an AUC of 0.668, with an optimal pH cut-off value of 7.13 (sensitivity 61.3%, specificity 75.9%). Conclusion: Lower arterial pH at ICU admission independently predicts 7-day mortality after cardiac arrest, emphasizing the importance of early recognition and correction of acidosis in post-resuscitation care
Therapeutic plasma exchange in the treatment of complicated Plasmodium falciparum malaria and invasive aspergillus fumigatus coinfection: A case report
Objective: A rare case of coinfection of Plasmodium falciparum and Aspergillus Fumigatus from travel to Tanzania is presented in this report. Methods: A-43-year-old, Turkish male patient who travelled to Tanzania for business without any malaria prophylaxis was admitted to hospital with high fever (39.5 degrees C), weakness, nausea and vomiting and dyspnea when returned to Turkey. The patient had been treated in intensive care unite for sepsis and multi organ dysfunction as a result of the delayed malaria diagnosis. In addition to the presence of thrombocytopenia, anemia, metabolic acidosis, acute respiratory distress syndrome, hepatosplenomegaly and acute renal failure, aspergillus fumigatus emerged as a secondary opportunistic infection. Consent was obtained from the patient’s family to publish and all patient specific information has been identified, as a case report and negligible risk to the patient; formal ethics approval was not required because it posed negligible risk to the patient. Results: He was treated with therapeutic plasma exchange seven times, prone position for 36 hours, continued renal replacement therapy for 72 hours, three cycles of artesunate, artemether lumefantrine for three days, with clindamycin and doxycycline. Additionally, meropenem for empirical antibiotherapy, and voriconazole and amphotericin b for Aspergillus were used. Conclusion: This case report showed that malaria should be suspected in patients with febrile illness and that travel history to a malaria-endemic region and when fever recurs during the treatment process, secondary opportunistic infections should be considered in addition to malaria. Pulmonary aspergillosis can be seen in people with supressed immune systems and should also be considered in patients with plasmodium falciparum. Since it has been shown that complications may continue even after the parasite load is eliminated, the addition of extracorporeal treatments to antimalarial therapy may be effective in reducing mortality.
Methanol poisoning: Case series and treatment approaches in intensive care unit
Objective: This case series aims to present the clinical characteristics, diagnostic processes, treatment strategies, and outcomes of patients with methanol intoxication treated in the intensive care unit (ICU). Methods: Eight male patients, aged between 31 and 75 years, who were treated in the ICU for methanol intoxication within three weeks, were included. Their medical histories, clinical findings, laboratory results, treatments, and prognoses were described. Results: The patients presented with a variety of symptoms such as visual loss, nausea, vomiting, abdominal pain, altered mental status, and respiratory distress. All patients had a history of consuming homemade alcohol, although in some cases the exact source and amount of alcohol were unknown. Arterial blood gas analyses revealed metabolic acidosis with elevated lactate levels. Negative blood ethanol levels, along with increased anion and osmolar gaps, supported the diagnosis of methanol intoxication. Patients received intravenous ethanol infusion, hemodialysis, and appropriate ICU supportive treatments. Three patients died (37.5%), while five survived. Conclusion: This case series emphasizes the importance of prompt intervention in emergencies such as methanol intoxication. Early diagnosis and administering antidotes like ethanol and hemodialysis improve survival rates. Preventing the production of counterfeit alcohol and raising public awareness of its dangers should be key priorities.
The expanding role of palliative care in critical illness: A narrative review
Objective: To synthesize current evidence on the integration of palliative care into the care of critically ill patients, with a focus on models of delivery, symptom management, communication frameworks, ethical dimensions, and emerging trends in the field. Materials and Methods: This narrative review was conducted through a structured literature search of PubMed, MEDLINE, and Cochrane databases using terms including ‘palliative care,’ ‘intensive care unit,’ ‘critical illness,’ ‘goals of care,’ and ‘symptom management,’ restricted to English-language articles published between 2000 and 2024. Articles were selected based on relevance to the review’s core domains and methodological quality, prioritizing randomized controlled trials, systematic reviews, and consensus guidelines where available. Results: Early and structured integration of palliative care in the ICU is associated with improved symptom control, reduced rates of post-intensive care syndrome in patients and families, decreased non-beneficial interventions, shorter ICU stays at end of life, and lower healthcare costs without increasing mortality. Structured communication interventions and validated trigger-based referral criteria demonstrate consistent benefit. Evidence is strongest in medical ICU and oncology populations; emerging data support application across neurocritical care, cardiac, and surgical ICUs. Conclusion: As ICU populations continue to age and life-sustaining treatments grow more complex, integrating palliative care principles alongside intensive therapies is essential to providing high-quality, goal-concordant, and compassionate critical care globally.
The impact of incidental endoscopic findings on PEG-related complications in critically ill patients
Objective: This study investigated whether endoscopic abnormalities detected during percutaneous endoscopic gastrostomy placement are associated with complications in critically ill patients and whether these incidental findings predict adverse outcomes. Materials and Methods: This retrospective cohort study included adult patients who underwent percutaneous endoscopic gastrostomy between January 2014 and January 2024 in the intensive care unit of a tertiary academic hospital. Demographic data, clinical features, endoscopic findings, biopsy results, and complications were recorded. Patients were grouped according to the presence or absence of complications, and statistical comparisons were performed. Results: Eighty-seven critically ill patients were included. The median age was 69 years; 63.2% were male. Incidental endoscopic findings were observed in 39.1%, including esophagitis, gastritis, ulcers, and other mucosal abnormalities. Biopsies were obtained in 14.9% of patients and revealed chronic inflammation, intestinal metaplasia, or Helicobacter pylori. Complications occurred in 19.5%, with wound infection, bleeding, and leakage being most common. No statistically significant association was found between any endoscopic or histopathological findings and complication development. Conclusion: Endoscopic and histopathological abnormalities were common but not predictive of complications. Percutaneous endoscopic gastrostomy can be safely performed without delay in the presence of mild to moderate mucosal changes. Systemic factors should guide risk assessment in critically ill patients.
The procalcitonin kinetics paradox in hemoadsorption therapy for septic shock: Infection source, immunomodulation, and biomarker reliability
Reconsidering the interplay between PEEP, optic nerve sheath diameter, and neurological assessment in critically ill patients
A case of invasive pulmonary aspergillosis seen in a earthquake victim impacted by the disaster in Türkiye
Objective: Invasive pulmonary aspergillosis (IPA) is a life-threatening fungal infection that predominantly affects immunocompromised individuals. Environmental exposure to large amounts of construction dust following natural disasters may also increase the risk of invasive fungal infections. We aimed to present a fatal case of IPA that developed in an earthquake survivor rescued from prolonged entrapment under collapsed buildings. Methods: A female earthquake victim with no known chronic disease or history of immunosuppressive therapy was admitted to the intensive care unit (ICU) after prolonged entrapment under rubble, cardiac arrest, and severe crush-related complications. Clinical findings, microbiological results, imaging studies, treatment course, and outcome were retrospectively reviewed. Results: The patient developed septic shock, acute kidney injury requiring renal replacement therapy, and persistent respiratory failure. Despite broad-spectrum antimicrobial therapy, fever and hypoxemia persisted. Thoracic computed tomography revealed multiple pulmonary nodular lesions and consolidations suggestive of invasive fungal infection. Aspergillus fumigatus was isolated from endotracheal aspirate cultures on the 17th day of ICU admission. Voriconazole therapy was initiated; however, the patient died on the 35th day of ICU hospitalization. Conclusion: IPA should be considered in critically ill survivors of natural disasters, even in the absence of classical host-related risk factors. Early recognition of invasive fungal infections in patients exposed to substantial environmental dust and debris may facilitate timely antifungal treatment and potentially improve outcomes.
Associated factors of transfer to intensive care unit among hospitalized patients with COVID-19 disease-related pulmonary thromboembolism
Introduction: The most common thromboembolic condition in coronavirus disease 2019 (COVID-19) is acute pulmonary embolism (APE). Factors associated with transfer to the intensive care unit among cases diagnosed with COVID-19 are separately known for COVID-19 and APE. However, it is important to identify factors associated with transfer to intensive care in patients with COVID-19-related APE. This study aimed to determine these factors in the coexistence of these conditions. Methods: Adult patients diagnosed with APE by pulmonary computed tomography angiography were included in this cross-sectional study. The patients’ demographic and laboratory data, Wells scores, pulmonary embolism severity index (PESI) scores, and imaging findings were recorded. Pairwise comparisons were made between the patients with and without intensive care unit admissions. Results: Of the 123 patients included in the study, 38 (30.8%) were transferred to the intensive care unit. In pairwise comparisons, age, number of comorbidities, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), CRP-to-albumin ratio, d-dimer values, Wells scores, and PESI scores were higher among patients who transferred to intensive care. A higher Wells score (odds ratio (OR) = 1.70, 95% confidence interval (CI) =1.13 – 2.56, p=0.011), PESI score (OR = 1.03, 95% CI = 1.00 – 1.07, p=0.048), and CRP (OR = 1.01, 95% CI = 1.00 – 1.02, p=0.049) were associated with admission to the intensive care unit among patients with COVID-19-related APE. Discussion and Conclusion: High Wells and PESI scores and CRP levels in adult patients hospitalized with a diagnosis of COVID-19-related APE were determined to increase the probability of transfer to the intensive care unit. Therefore, it is recommended to monitor these patients more closely for intensive care needs.
Research on attitudes of senior anesthesia assistants and intensive care physicians towards compliance with the “pain, agitation/sedation, immobility, and sleep disruption” guidelines and symptom management in the intensive care units in Türkiye
Introduction: It was aimed to investigate the attitudes of senior anesthesia assistants and intensive care physicians in Türkiye towards compliance with the “Pain, Agitation/Sedation, Immobility and Sleep Disruption” (PADIS) Guidelines and symptom management in the intensive care unit (ICU). Methods: The survey, consisting of 40 questions was sent to the participants electronically. The answers to the questions were evaluated according to the recommendations in the PADIS 2018 guidelines. Results: While anesthesiology and reanimation specialists gave less compatible answers (58.9%) with the guideline in “identifying risk factors affecting pain”; responses were more consistent with the guideline (100%, 69.5%, and 85.3%, respectively) in “use of medication in addition to opioids”, “use of medication to prevent delirium”, and “pharmacological interventions to improve sleep” Discussion and Conclusion: This study demonstrates that intensive care physicians, including anesthesiology and reanimation assistants in Türkiye, generally exhibit a compatible attitude with the PADIS 2018 guideline in the management of “pain, agitation/sedation, delirium, immobility and sleep disruption” symptoms in critically ill adults in the ICU. Additionally, as the medicine career progresses, more guideline-compliant responses in the management of some symptoms have demonstrated the importance of clinical experience in critically ill adults management.
Content analysis of Youtube videos related to brain death
Introduction: This study aimed to evaluate the quality of information content in YouTube videos related to brain death. Methods: A search was conducted on the YouTube video platform using the keywords “brain death” and “brain death and organ donation” on November 20, 2024. A total of 42 videos were included in the evaluation. Data regarding the number of views, likes, comments, video duration, the number of days since the video was uploaded, and the source of the video were recorded. To classify the quality of the video content, DISCERN (Quality Criteria for Consumer Health), GQS (Global Quality Scale) for evaluating educational content, JAMA (Journal of the American Medical Association) for assessing the accuracy of the video source, and USEFULNESS for determining the utility of the videos were used. Results: Among the analyzed videos, 25 (59.52%) were uploaded by physicians. Sixteen videos (38.10%) were rated as having very low educational quality, 13 (30.95%) provided partially sufficient information about the video source, 16 (38.10%) were of low information quality, and 13 (30.95%) were found to be of low usefulness. The quality scores of videos uploaded by physicians were significantly higher compared to other groups. Discussion and Conclusion: The quality and educational value of YouTube videos related to brain death are low. Therefore, it is crucial that videos accessed through YouTube and other social media platforms are supervised by experts in the field to ensure accurate and useful information.
Reliability and validity of the Turkish version of the Chelsea critical care physical assessment tool (CPAx-TR)
Objective: Assessing physical function in Intensive Care Unit(ICU) patients is essential for clinical decision-making. The Chelsea Critical Care Physical Assessment Tool(CPAx) is a validated instrument developed to evaluate functional status. This study aimed to cross culturally adapt the CPAx into Turkish and examine its validity and reliability. Materials and Methods: The tool was translated into Turkish using forward–backward translation and administered to 60 ICU patients. For the reliability analysis, internal consistency was evaluated using Cronbach’s alpha coefficient. The construct validity of the CPAx was tested by factor analysis. The criterion validity was performed using the correlation between the CPAx and the Physical Function ICU Test (PFIT). Results: The internal consistency of the tool was found to be high and Cronbach’s alpha value was calculated as 0.960. All item-total score correlations were above 0.30. Exploratory Factor Analysis revealed that all items were grouped into a single factor. In Confirmatory Factor Analysis, the model showed good fit (CMIN/df=1.207;CFI=0.993;NFI=0.959;GFI=0.907; RMSEA=0.059). Furthermore, the correlation analysis with P-FIT revealed a strong positive relationship (r=0.892; p<0.001). Conclusion: It has been determined that the CPAx-TR shows acceptable levels of validity and reliability in evaluating functionality in ICU patients.
Retrospective evaluation of the effect of intensive care specialist on productivity in a 2nd level hospital
Introduction: While intensive care practices in 3rd level hospitals are carried out by a full-time intensive care team, 2nd level hospitals, there is mostly open type intensive care. In this study, the evaluation of the positive results observed in health care by employing an intensive care (ICU) specialist in a 2nd level ICU was investigated. Materials and Methods: Patients hospitalized in the 2nd level intensive care unit of Gümüşhane State Hospital were retrospectively examined. Non-covid patients from the period between October 2020-2021 (period without an ICU specialist) and October 2021-2022 (period with an ICU specialist) were compared. Patients were compared in terms of age, gender, post-operative status, comorbidities, APACHE 2 score, malignancy, hospitalization day, transfer to the service, out-of-province referral, and intensive care mortality. Results: 127 of 142 patients in the October 2020-2021 period and 212 of 402 patients in the October 2021-2022 period were included in the study. It was determined that the number of post-operative patients was higher and the length of stay was lower in the period when there was an ICU specialist. The average hospitalization day and ICU mortality of the patients were significantly less in the period when there was an ICU specialist (p<0.001). The number of patient transfers to the service was significantly higher in the period when there was an ICU specialist. The rate of out-of-province referrals was significantly lower in the period when there was an ICU specialist (p<0.001). Conclusion: We came to the conclusion that intensive care specialists can work in 2nd level hospitals and that on-site health services are possible in addition to more active and effective intensive care practices. In our country, it is important for intensive care specialist physicians to actively take part in the processes in both 2nd and 3rd level hospitals and to develop intensive care units there.
Family needs, psychological distress and social support in the intensive care unit: a cross-sectional study
Objectives: The aim of the study was to determine the relationships between sociodemographic factors related to the needs of individuals and family needs, psychological distress and social support. Methods: A Personal Information Form, Critical Care Family Needs Inventory (CCFNI), Kessler Psychological Distress Scale (K10-PDS), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to collect data. Results: The domains in which the participants were determined to have the greatest degree of need were information (38.45±5.23) and support (32.04±7.05). Participants with low education level and who visited their patients more frequently than once a week had significantly higher scores on the information, assurance, proximity, and comfort subscales. The participants had high K10-PDS (25.77±9.99) and MSPSS (68.62±15.54) scores. There was a significant positive relationship between the CCFNI and MSPSS scores of the participants (r=0.400). Conclusions: The family members of intensive care patients were determined to have a high degree of need and high levels of psychological distress. It is extremely important for health professionals to support the family and include them in the care process. Increasing the quality of care for the patient and providing psychological relief to the family will increase the quality of care.
Evaluation of outcomes of obstetric patients with COVID-19 disease followed up in the intensive care unit
Objective: We aimed to evaluate the characteristics, prognosis, laboratory parameters, and mortality of severely ill obstetric patients due to severe COVID-19 disease and determine the factors affecting mortality. Methods: Medical records of obstetric patients with COVID-19 infection were reviewed. Patients were admitted to the intensive care unit (ICU) and the outcomes of the newborns were evaluated furtherly. Results: A total of 325 women were included. The ICU requirement was 8.6% (28/325). Among 28 women admitted to ICU maternal mortality rate was 53.6% (15/28), and preterm delivery rate was 88% (24/28). The 27 newborns were evaluated furtherly. Six stillbirths occurred. 40.7% (11/27) of the newborns had 1st minute APGAR scores lower than 7, while 33.3% (9/27) of them had 5th minute APGAR scores lower than 7. Body mass index, CRP, D-dimer, LDH, and CRP/Alb ratio were found to be significantly higher in the mortality cohort than surviving women requiring ICU. The CRP/Alb ratio was the most significant predictor of COVID-19-related maternal death in ICU. Conclusion: The study revealed that COVID-19-related maternal mortality is considerably high in severely ill patients. The CRP/Alb ratio is a significant predictor of mortality. The cesarean section and preterm delivery rates were significantly high in severely ill mothers with COVID-19. Additionally, the severity of the mothers’ illness negatively influenced neonatal outcomes.
An unexpected consequences of severe rhabdomyolysis induced by Plasmodium Vivax: Acute respiratory failure with preserved renal function
We described a case of a previously healthy young man with Plasmodium vivax induced severe rhabdomyolysis with a creatinine kinase (CK) level of 812,000 U/L leading to acute respiratory failure and subsequent weaning failure. Mix infections with Plasmodium falciparum were ruled out by polymerase chain reaction (PCR) and other causes including trauma, heat exhaustion, autoimmune diseases, inflammatory myopathy, drugs, and infections such as leptospirosis and COVID-19 were excluded. He presented with respiratory distress requiring intubation and ventilatory support. There was no heart or lung pathology, fever, metabolic acidosis, anaemia, or drop in consciousness level upon presentation. Extubation was attempted twice during the first week of admission, however, respiratory failure ensued after each attempt requiring reintubation in which one of the episodes was complicated by lung collapse. The respiratory distress upon presentation and failed extubation episodes were attributed to respiratory muscle weakness secondary to severe rhabdomyolysis. He was successfully extubated after almost two weeks of admission. Despite the extremely high CK level, renal function was unexpectedly preserved without the need for renal replacement therapy. To the best of our knowledge, this is the first reported case of severe rhabdomyolysis induced by P. vivax leading to respiratory failure but with preserved renal function. This case highlights that P. vivax infection can cause severe rhabdomyolysis and consequently acute respiratory failure due to muscle weakness. Awareness of such complications will guide clinicians’ decisions for timely initiation and weaning from mechanical ventilation, hence avoidance of associated complications.
The impact of window on delirium, sedation, and sleep quality of intensive care patients: a prospective study
Objective: The aim of this study was to assess the impact of window on delirium, sedation, and sleep quality of intensive care patients. Materials and Methods: This prospective study was conducted with 140 patients admitted to anesthesia intensive care units from April to September 2023. The data collection tools included the patient information form, the Visual Analog Scale for Pain, the Delirium Screening Scale, the RAMSAY Sedation Scale, and the Richards–Campbell Sleep Questionnaire. Multiple linear regression analysis was used. Results: In the 72nd hour evaluation of the patients, the most important predictors of nighttime delirium were determined to be agitation (β=0.40), non-compliance with treatment (β=0.26), and antipsychotic use (β=0.14) (p<.05). The predictors of daytime delirium were agitation (β=0.41) and non-compliance with treatment (β=0.26, p<.05). In the 7th day evaluation, the predictors of nighttime delirium were determined to be non-compliance with treatment (β=0.28), age (β=–0.26), gender (β=–0.22), and sedative use (β=0.18) (p<.05). Predictors of daytime delirium were age (β=–0.25) and gender (β=–0.19, p<.05). Conclusion: Having a window in the room is not a significant predictor of delirium and sedation, but it is important for sleep quality. Sleep quality and sedation are significant predictors of each other. Intensive care healthcare professionals should plan and implement psychosocial interventions to reduce the frequency of delirium, sleep problems, and sedation use in patients.
Drug-induced hepatotoxicity among critically ill patients in the intensive care unit
Background: Drug-induced liver injury (DILI) is a significant complication in intensive care unit (ICU) patients, driven by polypharmacy and critical illness. This study aimed to investigate the incidence, clinical characteristics, implicated agents, and outcomes of DILI in ICU patients. Methods: This retrospective, cross-sectional study included patients with abnormal liver function tests admitted to a tertiary ICU between October 2023 and October 2024. Patients with viral, alcoholic, autoimmune, tumor-related, or other non-drug-related liver diseases were excluded. Data on demographics, clinical scores, medications, and outcomes were analyzed. Causality was assessed using the RUCAM scale. Results: Among 475 ICU patients, 16 cases (9.89%) were identified as DILI. The mean age was 47.1±23.6 years; 43.8% were female. Antibiotics were the most frequently implicated agents (62.5%), followed by anticoagulants and antipsychotics. The predominant pattern of liver injury was hepatocellular (81.3%). DILI developed approximately 9.5±5.2 days after ICU admission. Mortality among DILI patients was 56.3%, emphasizing the critical nature of hepatotoxicity in this population. Conclusion: DILI in ICU patients is strongly associated with anti-infectives, particularly β-lactam antibiotics, and predominantly manifests as hepatocellular injury. High mortality underscores the need for vigilant liver monitoring, timely withdrawal of suspected drugs, and a multidisciplinary approach where clinical pharmacists can play a key supportive role. DILI may contribute to morbidity and mortality in critically ill patients, highlighting the importance of early recognition and proactive management.
Global trends in sepsis and artificial intelligence studies in intensive care units: Bibliometric analysis with Biblioshiny
Objective: The aims of the study was to identify and visualize studies conducted between 2006 and 2025 in the fields of sepsis and artificial intelligence in intensive care units, with the aim of revealing trends in this area. Materials and Methods: The data were obtained from the Web of Science Core Collection database on May 2, 2025. Performance analysis, visualization, mapping, and bibliometric analyses were performed using the R software program Biblioshiny interface. For bibliometric data, a search was conducted in the WoS database using the keywords “intensive care” OR “ICU” OR “intensive care unit” OR “ICUs” AND “artificial intelligence” OR “machine learning” OR “deep learning” AND ‘Sepsis’ OR “sepsis prediction” in all files. The analysis of the study was conducted using 1,072 publication data. Results: The study found that the average annual number of articles produced in intensive care units in the fields of sepsis and artificial intelligence obtained from the WoS database was 2.76, with an annual growth rate of 27.63. A total of 1,072 articles were produced in 371 journals between 2006 and 2025. A total of 1,531 keywords were used. The average number of citations per publication was 18.13. It was observed that authors used 2,255 keywords across all publications, 7,015 authors were involved in these publications, only 6 articles had a single author, the average number of co-authors per article was 8.95, and the international co-authorship rate was 21.64%. Conclusions: The results of the bibliometric analysis showed that studies in this field are extremely recent. Studies conducted between 2006 and 2025 on sepsis and artificial intelligence in intensive care units have been included in the literature.
A rare clinical manifestation of lactate elevation explained by the Warburg effect: report of two lymphoma cases and literature review
Type B lactic acidosis is a rare life-threatening condition associated with hematological malignancies. This condition is of great clinical importance because it requires rapid diagnosis and treatment. Its association with malignancies is based on the Warburg effect. The Warburg effect is a condition in which tumor cells prefer glycolysis over oxidative phosphorylation for energy production, which may lead to severe lactic acidosis. Here, we report two cases of patients who presented with severe lactic acidosis and hypoglycemia that could be explained by Warburg phenomenon, were followed up in the intensive care unit and subsequently diagnosed with lymphoma. We aim to contribute to the literature on Warburg phenomenon by detailing the rapid and successful management of these cases.
Unraveling paroxysmal sympathetic hyperactivity syndrome; what is behind the storm?
Paroxysmal sympathetic hyperactivity syndrome (PSH) is a rarely diagnosed syndrome associated with acute brain injury which involves traumatic brain injury, stroke, infectious diseases, and encephalopathy, and results in cyclic episodes of sympathetic and motor hyperactivity (hypertension, tachypnea, hyperthermia, diaphoresis, dystonic posturing). Even though there are some theories regarding the pathophysiology of PSH, the main mechanism still remains unclear. However, it is mostly agreed upon that PSH is caused by an unbalanced activation of the autonomic nervous system caused by the loss of inhibition of excitation in the sympathetic nervous system. Although PSH has been well known for many decades there were misunderstandings regarding the nomenclature and the definition of this syndrome. The term “Paroxysmal Sympathetic Hyperactivity and a diagnostic tool consisted of two different components and named PSH-Assessment Measure (PSH-AM),” was developed to help guiding clinical management in 2014. These components are the diagnostic likelihood tool and the clinical features scale. To diagnose this syndrome first other neurological issues should be ruled out. Once diagnosed in order to treat and avoid secondary brain damage and other adverse outcomes of this syndrome an approach of both pharmacological (such as opioids, B-blockers, alfa2 agonists, benzodiazepines, gabapentin and muscle relaxants) and nonpharmacological should be combined. Pharmacological approach focuses on symptom abortion, prevention and refractory treatment.
paroxysmal sympathetic hyperactivity syndrome
Retrospective analysis of the efficacy of molnupiravir and favipiravir in COVID-19 patients admitted to intensive care unit
Objective: During the pandemic, molnupiravir and favipiravir treatments have been applied at different stages of the treatment of COVID-19 patients. However, their effectiveness in COVID-19 patients admitted to the ICU is not clear. Methods: Patients who were admitted to the ICU between March 1, 2022, and December 31, 2023 and managed according to the guidelines of the Scientific Committee of the Turkish Ministry of Health were included. Results: Data of 152 patients who met the inclusion criteria for the study were evaluated. Patients were divided into two groups according to the treatment modality applied. When both groups were compared in terms of median hospital stay; It was found to be statistically significant (p=0.025) in Group F and 16 (11) days in Group M. When respiratory support was examined in the entire cohort; the percentage of invasive mechanical ventilation application was found to be significant as 40 (60.5) in Group F and 61 (80.3) in Group M (p=0.008). Similarly, the number of days of invasive mechanical ventilation was found to be significant as 9 (14) in Group F and 12 (8) in Group M (p=0.010). On the other hand, when evaluated in terms of hospital mortality percentage; it was found to be 42 (55.3) in Group F and 39 (51.3) in Group M and no statistically significant difference was found (p=0.626). Conclusion: In our study, no difference was found in terms of mortality rate between molnupiravir and favipiravir, two antiviral drugs used in COVID-19 treatment. However, further studies are needed to clarify this issue.
Renal resistive index and biomarkers of cell cycle arrest in the early diagnosis of sepsis-induced acute kidney injury in rats
Objective: This study evaluates the diagnostic performance of renal resistive index (RRI) and urinary cell cycle arrest biomarkers for early detection of sepsis-induced acute kidney injury (AKI) in a rat model using cecal ligation and puncture (CLP). Materials and Methods: Sixty female Wistar Albino rats were allocated into six groups (n=10): five CLP groups based on measurement timing (3, 6, 12, 24, and 48 hours post-procedure) and one sham group. Following CLP, RRI measurements were performed, and blood, urine, and tissue samples were collected before sacrifice. Urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) were quantified via enzyme-linked immunosorbent assay (ELISA). Serum creatinine and lactate levels were measured, and histopathological kidney examination was conducted. Results: RRI increased significantly at six hours (0.44±0.04), peaking at 24 hours (0.73±0.02) post-CLP. The [TIMP-2×IGFBP-7] combination elevated significantly at three hours (P<0.05) versus sham, reaching maximum levels at 48 hours. Strong positive correlations existed between histopathological injury severity and IGFBP-7 (p=0.764), TIMP-2 (p=0.779), [TIMP-2×IGFBP-7] (p=0.785), and RRI (p=0.837) (all P<0.0001). For predicting grade ≥3 tubular injury (>25% damage), cell cycle arrest biomarkers outperformed serum creatinine and lactate. RRI >0.45 demonstrated optimal diagnostic accuracy (sensitivity 89%, specificity 87%). Conclusions: In this CLP-induced polymicrobial sepsis model, both RRI and urinary cell cycle arrest biomarkers predicted early AKI within similar timeframes, with RRI >0.45 showing superior predictive value.
The impact of the inspiratory-to-expiratory ratio on mechanical power in ARDS patients
Objective: Mechanical power (MP) is a promising parameter that may guide lung-protective ventilation strategies. The MP equation encompasses all variables involved in the pathogenesis of ventilator-induced lung injury (VILI), as well as the inspiratory-to-expiratory (I:E) ratio. Shortening the inspiratory time—by altering the I:E ratio—increases gas flow and may lead to lung injury. The optimal I:E ratio for preventing VILI remains uncertain. The present study aimed to investigate the effects of different I:E ratios on inspiratory gas flow and MP in patients with acute respiratory distress syndrome (ARDS). Materials and Methods: This study was conducted on 19 adult patients diagnosed with moderate ARDS who were admitted to the intensive care unit and received mechanical ventilation. Patients were ventilated at a PEEP level of 10 cmH2O, a tidal volume of 6 mL/kg, and three sequentially applied I:E ratios (1:2, 1:1, and 1.5:1), each maintained for 10 minutes. MP and respiratory parameters across the three I:E groups were compared using repeated-measures ANOVA. Results: Compared with the I:E ratio of 1:2, ventilation with an I:E ratio of 1:1 resulted in slower inspiratory gas flow, lower inspiratory resistance and peak inspiratory pressure, higher dynamic compliance, and lower MP values. Plateau pressure and driving pressure did not differ significantly. When comparing I:E 1:1 with I:E 1.5:1, a persistent slowing of inspiratory gas flow was observed, but no significant difference in MP was detected. Conclusion: In patients with ARDS, transitioning the I:E ratio from the conventional 1:2 to 1:1 or 1.5:1 resulted in progressively slower inspiratory gas flow and lower resistive and total mechanical power, suggesting that reducing inspiratory flow may enhance lung-protective ventilation.
Refractory lactic acidosis and hypoglycemia: a very rare presentation in critically ill leukemic patient possibly associated with adult-onset glycogen storage disease type Ib
Lactic acidosis is a serious and frequently encountered condition in oncological critical care. Although it is commonly associated with generalized or localized tissue hypoperfusion, metabolic and drug-related causes should also be considered. Early recognition and appropriate management are essential for improving outcomes in critically ill patients. We report a case of refractory lactic acidosis associated with unexplained hypoglycemia, hypertriglyceridemia, and hyperuricemia. Common causes of type A lactic acidosis, including hypoperfusion, anemia, hypoxia, and seizures, were excluded. Other potential causes of type B and D lactic acidosis, such as liver disease and medication effects, were also ruled out. The patient had no known history of metabolic disease during childhood; however, the clinical presentation and laboratory findings were highly suggestive of glycogen storage disease type Ib (GSD-Ib). GSD-Ib is a rare autosomal recessive metabolic disorder caused by mutations in the glucose-6-phosphate translocase (G6PT) gene located on chromosome 11q23. The resulting defect impairs both glycogenolysis and gluconeogenesis, leading to metabolic abnormalities including hypoglycemia, hyperlactatemia, hyperuricemia, and hypertriglyceridemia. GSD-Ib Patients commonly develop neutropenia, which predisposes them to recurrent infections and often requires treatment with granulocyte colony-stimulating factor (G-CSF). Long-term G-CSF therapy has been associated with an increased risk of myeloid malignancies, particularly acute myeloid leukemia (AML). Glycogen storage diseases are genetic disorders that are typically diagnosed in childhood, making diagnosis in adulthood extremely rare. In this case, a late genetic mutation was suspected to have resulted in adult-onset GSD-Ib and malignancy. This rare presentation suggests a possible link between GSD-Ib and AML. Therefore, surveillance for glycogen storage disease in patients with AML, and vice versa, may be warranted. This association should be considered in critically ill AML patients presenting with refractory lactic acidosis after exclusion of other etiologies.
A case of thoracic aortic thrombosis in a patient with COVID-19 pneumonia
Patients infected with the 2019 novel coronavirus (COVID-19) predominantly present with respiratory symptoms. In severe cases, COVID-19 creates a prothrombotic state that significantly increases the risk of thromboembolic events. These complications are primarily in the form of venous thromboembolism, with a cumulative incidence of up to 49% among hospitalized patients. In contrast, arterial thromboembolic events such as ischemic stroke and myocardial infarction have been rarely reported in the literature. In this case report, we present a case of aortic thrombosis complicated by peripheral embolism and/or thrombosis as an example of arterial thromboembolism.
Retrospective Analysis of Percutaneous Tracheostomi Cases in Intensive Care Unit
Objective: We aimed to retrospectively evaluate the percutaneous dilatational tracheostomies that we performed in our intensive care unit in the last two years. Materials and Methods: Patients who had undergone percutaneous tracheostomy in the intensive care unit of the anesthesiology and reanimation clinic of our hospital between May 2015 and May 2017 were assessed retrospectively. Patients over 18 years old were included in the study. Surgical tracheostomies were not included in the study. Results: One hundred thirty-two patients were examined. 56.1% of the patients were male with the mean age 66.61±17.84. The most common reason for hospitalization diagnosis was neurological diseases. Duration of intubation was 16.51±8.32 days and the total length of stay in the intensive care unit was 61.43±49.37 days. Percutaneous tracheostomy related complications developed in 17 (12.9%) patients. The most common complications during the procedure were hypoxemia and acute bleeding followed by subcutaneous emphysema and minor bleeding. Conclusion: Percutaneous dilatational tracheostomy is a method that can lead to serious complications during the procedure.
Copyright © 2018 The Author(s) https://creativecommons.org/licenses/by/4.0
Examination of a Newborn with Necrotizing Enterocolitis According to Neuman Systems Model
Necrotizing Enterocolitis (NEC) is one of the most common problems with gastrointestinal system in newborns. The aim of the study was to evaluate the nursing care that should be applied in newborns diagnosed with NEC with Neuman Systems Model approach and NANDA nursing diagnoses. In the first stage of the nursing process, patient data were collected. The stressors perceived by the patient, and the stressors perceived by the nurse and the patient were determined, and the data were summarized. Following data collection, five different nursing diagnoses were determined according to the NANDA diagnosis, and the expected patient outcomes, interventions and nursing diagnosis results were determined for each nursing diagnosis. In this case report, there is a nursing care plan to solve the current and possible problems of a newborn with NEC, which is frequently seen in premature infants. The use of Neuman Systems Model in nursing provides a planned nursing care.
Copyright © 2019 The Author(s) https://creativecommons.org/licenses/by/4.0