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The Prognostic Value of the Early Brain Edema Score (SEBES) in traumatic and non-traumatic Subarachnoid Hemorrhage
Background: Subarachnoid hemorrhage (SAH) is a life-threatening cerebrovascular event with high morbidity and mortality. Early brain edema is a key determinant of prognosis and can be quantified using the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES). Although SEBES has demonstrated prognostic value in spontaneous SAH, its utility in traumatic SAH remains underexplored. This study aimed to evaluate the relationship between SEBES and clinical outcomes in both traumatic and non-traumatic SAH patients. Methods: In this retrospective cohort study, 50 SAH patients (30 traumatic, 20 non-traumatic) admitted to the intensive care unit (ICU) between January 2023 and May 2024 were analyzed. SEBES scores were calculated from brain CT scans obtained within 24 hours of SAH onset. Patients were classified by etiology and SEBES grade (≤2 vs. >2). Demographic data, clinical scores, laboratory parameters, and mortality at 1 and 3 months were compared. A subgroup analysis was performed to assess SEBES-associated outcomes within each SAH etiology. Results: SEBES scores were markedly higher in non-traumatic SAH patients. Higher SEBES (>2) was associated with lower admission and discharge neurological scores (GCS, FOUR), longer ICU and ventilator duration, and higher 1- and 3-month mortality (all p < 0.05). Subgroup analysis revealed that the negative prognostic impact of elevated SEBES was evident in both traumatic and non-traumatic SAH groups, particularly regarding mortality and ICU burden. Conclusion: SEBES is a valuable and simple radiological prognostic tool applicable to both traumatic and non-traumatic SAH. A SEBES score >2 may predict worse neurological outcomes, higher mortality, and increased ICU resource utilization. Its early application may aid in risk stratification and critical care planning.
Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
Clinical efficacy of a protocol-based hemoadsorption therapy in patients with septic shock
Introduction: Hemoadsorption (HA) removes circulating inflammatory mediators and is used as an adjunct in septic shock. We assessed whether a protocol-based HA330 strategy improved early organ dysfunctions and outcomes. Materials and Methods: We performed an observational study of adults with septic shock admitted to a 59-bed mixed ICU (January 2023–June 2024). We compared outcomes of patients who were treated with HA, to those who received standard of care alone. Results: During the study period, 52 of 127 septic shock patients received hemoadsorption therapy (HA group), while 75 received standard care (control group). On ICU admission age, sex, comorbidity, APACHE II, and SOFA scores were similar. By day 3, SOFA score decreased with HA (8 [5–11] to 7 [5–9]; p<0.05) but was unchanged in controls. Vasoactive inotropic score declined in both groups, more prominently with HA. Mechanical ventilation requirement and ICU length of stay were comparable. AKI decreased from 71.2% to 46.2% in the HA but increased from 44.0% to 50.7% in the control group. Hospital stay was longer with HA (29,5 [18-47,75] vs 19 [12-30], p=0.009), whereas 28-day mortality was lower (30.8% vs 49.8%, p<0.05). Conclusions: Protocol-based early HA at high vasopressor requirements was associated with improved organ dysfunctions and reduced 28-day mortality in septic shock patients.
Copyright © 2025 The Author(s) https://creativecommons.org/licenses/by/4.0
Posterior Reversible Encephalopathy Syndrome: Two Case Reports
Posterior reversible encephalopathy (PRES) syndrome is a clinical-radiological condition characterized by headache, changes in consciousness, epilepsy and visual disturbances, and usually occurs in the posterior parietal and occipital regions with vasogenic edema due to different etiologic factors. Risk factors include preeclampsia/eclampsia as well as hypertension, human immunodeficiency virus infection, organ transplantation, immunosuppressive and cytotoxic therapy, and analgesics. Treatment is usually aimed at correcting the cause of PRES. The aim of this case report was to present the characteristics of PRES, which was secondary to eclampsia in two cases, to discuss the differential diagnosis and to review the literature.
Copyright © 2019 The Author(s) https://creativecommons.org/licenses/by/4.0
Early Stage Muscarinic Findings and Syndromic Classification in Wild Mushroom Poisoning
Mushroom poisoning is a frequently encountered health problem around the globe. Depending on its type and toxin, it results in a wide spectrum of issues that range from asymptomatic findings to fatal organ failure. Since the toxin of the mushroom leading to poisoning is often unidentified, syndromic classification may benefit clinical management according to the findings of target organ system toxicity. A 64-year-old female patient with comorbidities such as diabetes mellitus, coronary artery disease, hypertension and hyperlipidemia was admitted to the intensive care unit. Approximately four hours after consuming wild mushrooms the patient’s diarrhea, muscle cramps, cold sweating, blurry vision, coughing and shortness of breath complaints have been begun. Her respiratory system examination revealed tachypnea, generalized bilateral rhonchus, bronchorrhea and wheezing. Patient was normotensive and had bradycardia (heart rate 35 beats/minute). She had anxiety and the Glasgow Coma score was 15. Her pupillary bilateral isochoric, miotic and light reflexes were diminished. In her arterial blood gas pH level 7.26, partial carbon dioxide pressure: 34 mmHg, potassium: 5.3 mmol/L, sodium: 130 mmol/L, lactate: 5.3 mmol/L, bicarbonate: 16 mEq/L and base excess: -10,3 mmol/L was found. Target organ system toxicity findings and timing of occurrence indicated early-onset cholinergic syndrome. Treatments that consisted of intravenous atropine, fluid, electrolytes and sodium bicarbonate alleviated the toxicity in a short period of time. Late mycologic examination results that followed the treatment revealed that the patient was poisoned by Inocybe lacera, a mushroom type that contains muscarine. With this case presentation, we summarized the syndromic classification that we use in the clinical management in the light of current information in the literature.
Copyright © 2018 The Author(s) https://creativecommons.org/licenses/by/4.0
Acute Renal Failure Due to Metformin Intoxication: Case Report
Metformin is an oral antidiabetic agent from the group of biguanide compounds. Metformin-related lactic acidosis is one of the adverse effects with high mortality in the cases of metforming poisoning. We aimed to present a case of attempted suicide that developed acute renal failure due to excessive dose of metformin intake, which was treated with methylprednisolone. This is the first case treated with pulse methylprednisolone in the literature without hemodialysis.
Icterohemorrhagic Leptospirosis: A Case Report
Leptospirosis is a zoonotic infection caused by spirochetes and is usually seen in rural areas. The clinical status may range from self-limiting mild leptospirosis to icterohemorrhagic leptospirosis characterized by jaundice, renal failure and hemorrhage progressing to acute respiratory distress syndrome and multiple organ dysfunction syndrome. In this study, we aimed to present a fatal leptospirosis case followed in the intensive care unit.
Hemodiafiltration Practice in a Patient with Severe Amitriptyline Intoxication
Tricyclic antidepressants are widely used drugs for treatment of depression despite serious mortality and morbidity in higher doses. They can cause severe cardiac arrhythmias, hypotension and central nervous system depression. Some patients may remain unresponsive in spite of conventional therapies such as gastric lavage and activated charcoal administration, benzodiazepines, volume replacement, lidocaine and sodium bicarbonate infusion. In this paper we report a 20-year-old female patient who had severe amitriptyline intoxication with a Glasgow Coma Scale score 4 and severe cardiac arrhythmias and was treated with hemodiafiltration. Conventional therapy was inadequate and hemodiafiltration was applied to the patient for 36 hours. At the end of the 36-hours the patient was conscious and became stabilized in terms of hemodynamics. In case of serious intoxication that does not respond to conventional therapy, approaches like hemodialysis, plasmapheresis, hemoperfusion and hemodiafiltration can be a rescue therapy and they should be considered.
Nursing Care for Patient Who Underwent Face Transplant During Intensive Care: A Case Report
There is restricted information on nursing care and follow-up for patients undergoing face transplantation. After face transplantation, the nursing interventions to follow-up and allayment the patient and the discussion of the responsibilities of the nurse in drug management will contribute significantly to the healing process of the patient. This case involves nursing care in the intensive care period after surgery of the patient with face transplantation. To 26-year-old male patient, a full face transplant including the ears and the scalp was performed. In the post-operative intensive care period; the patient was closely monitored for hemodynamic balance, pain management, with the aim of preserving for infection control and tissue viability. The patient was followed-up for 8 days in the intensive care unit and did not develop any life-threatening problems. The importance of nursing in the care of patients undergoing face transplants is undeniable. Especially in the intensive care process; feeling the presence of the nurse for pain and agitation control, drug management sudden changing hemodynamic status, maintaining patient and environmental safety for infection control is the responsibility of the nurse and are important initiatives that contribute to the patient’s recovery. However, the literature on proper nursing care for such an important responsibility is very restricted. This case report is thought to be enlightening for nurses in the care of patients undergoing face transplantation.
Which Thrombolytic Dose Should be Given to Which Patients with Massive Pulmonary Thromboembolism? Two Cases Report
Massive pulmonary thromboembolism (PTE) is a condition characterized by sudden onset of dyspnea, hypotension, right ventricular failure findings, presyncope or syncope and cardiac arrest which must be diagnosed and treated immediately. Massive PTE is an emergent and serious clinical condition with high morbidity and mortality rates. Besides close observation and monitorization during the treatment, due to severe hypoxemia often the need for mechanical ventilation, it is appropriate to follow-up in the intensive care units. According to the massive PTE algorithm in hemodynamically unstable patients, for diagnostic purposes the bedside echocardiography shows right ventricular dysfunction and if not contraindicated thrombolytic therapy must begin immediately. It is an appropriate approach to select the given thrombolytic therapy dose according to the characteristics of the patient and the disease. Two cases of massive PTE admitted to the emergency department due to dyspnea, angina and syncope were treated successfully with different doses of thrombolytic therapy and the cases were evaluated in the light of the literature information.
Acute Respiratory Distress Syndrome Associated Hemophagocytic Syndrome
Hemophagocytic histiocytosis is a syndrome of similar inflammatory response that can occur with different underlying pathologies that can be seen at any age. It is a rare disease characterized by fever, splenomegaly, jaundice, hemophagocytosis of bone marrow and other tissues (phagocytosis of erythrocytes, leukocytes platelets and their precursors by macrophages). There are two forms as primary and secondary, primary form (familial hemophagocytic syndrome) is autosomal recessive inheritance. It is seen in newborn children approximately 1/50.000 ratios. The secondary form is especially associated with Epstein-Barr virus infection, but it can be seen together with viral, bacterial, fungal and parasitic infections, collagen tissue diseases and malignant diseases. In this article, a 44-year-old female patient with no chronic disease history and has respiratory complaints was admitted to the chest diseases service with pre-diagnosis of pneumonia and the patient was admitted to the intensive care unit after the development of acute respiratory distress syndrome (ARDS). In this case, the development of hemophagocytic syndrome due to ARDS which is rarely seen syndrome is presented while ARDS therapy continues.
Spontanous Urinary Bladder Rupture and Urosepsis in Patient with Paraplegia
Spontaneous bladder rupture is a rarely seen clinical condition and usually occurs because of weakening of the bladder wall after urinary retention, urinary tract infections, increased intra-bladder pressure, and alcohol intoxication. Less frequently, perforation may encounter due to foley catheter erosion, inflammation (eosinophilic cystitis, interstitial cystitis), giant bladder stones, intra-arterial chemotherapy or atherosclerotic embolism. Cases due to neurogenic bladder are also involved in the literature. In this paper, we aimed to share our experience by presenting a paraplegic patient, who applied with clinical symptoms of sepsis, was followed-up at the intensive care unit, and was diagnosed with spontaneous urinary bladder perforation at laparotomy.
The Evaluation of the Effects of Erythrocyte Transfusion on Central Venous Oximetry in Major Surgery Patients
Objective: Blood transfussion is generally performed to improve oxygen delivery (DO2). Transfusion decision is mostly based on hemoglobin levels, regardless of actual DO2 requirement. As central venous oxygen saturation (ScvO2) may reflect the imbalance between DO2 and consumption (VO2), the aim of this study was to investigate the effect of red blood cell transfusion on ScvO2 levels in major surgery patients. Materials and Methods: The cases in which the clinician decided to perform blood transfusion among the major surgical cases between American Society of Anesthesiologists I and IV, which received central venous catheter insertion and admitted to intensive care unit after surgery, were included in the study. Arterial hemoglobin levels, oxygen saturations, lactate and base excess levels were measured before red blood cell transfusion (pre-T) and 1 hour after transfusion (post-T). Analysis of these variables was performed with using the Wilcoxon test or the Mann-Whitney U test, and p<0.05 was considered significant. Results: Data’s which belong to totally 128 red blood cell transfusion performed with 101 patients was included in the study. ScvO2 values significantly increased from 72.25±6.8% to 75.25±7.06% after transfusion (p<0.0001). While significant improvements were observed in arterial base excess values there was no change in lactate values. Conclusion: According to the results, it was observed that red blood cell transfusion performed in major surgery patients provided significant improvements in tissue oxygenation.
Intoxications in Intensive Care: Cost and Bed Occupancy According to Glasgow Coma Scale
Objective: Intensive care units (ICU) are the units in which critical patient care and follow-up are conducted. About 3.7-40% of ICU beds are used for intoxications. In ICU, intoxications may be mortal or can be discharged only by observation without any complication. The necessity of hospitalization of all these patients to the ICU is controversial in terms of bed occupancy and cost. In our study, it was aimed to determine the necessity and cost of hospitalization of ICU patients who were admitted to ICU with diagnosis of intoxication. Materials and Methods: This study was conducted by investigating the files of 205 intoxication patients who underwent more than 24 hours of follow-up and treatment at second and third level ICU. While patients were admitted to ICU, they were divided into two groups according to Glasgow Coma score (GCS) 15 (group=15) and below 15 (group <15). The patients’ age, gender, GCS, cause of poisoning, number of days stayed in the ICU and the need for mechanical ventilation (MV) were recorded, and the ICU costs of the groups were calculated. In addition, the cost that would be generated if the patients in group=15 were followed in the service environment rather than in the ICU was calculated. Results: Of the 205 patients examined, 145 had GCS of 15, while the GCS of 60 patients were below 15. The number of patients with GCS=15 and the intoxication case with suicide intent were higher in female gender. While the number of intoxications with cardiovascular system drugs and analgesic drugs was greater in group=15, the number of intoxications with carbon monoxide and drug substances was greater in group <15. The number of days stayed in ICU, MV requirement and ICU costs were higher in group <15. If the patients in group=15 had been followed up in the service environment, the cost would have been lower than the cost in ICU. Conclusion: GCS; it can be used to determine the necessity of hospitalization of intoxication cases into ICU due to its specificity and easy applicability. It is common belief that intoxications leading to life threatening and organ failure should be followed in second and third level ICUs. The fact that ICU beds in our country are not used according to the criteria is a big problem, which may increase the cost of use and also cause an increase in mortality. Adhering to the criteria for admitting patients to high cost units which require specialist and technological equipment such as ICUs will prevent unnecessary bed occupancy and ensure proper use of resources. According to our study, close follow-up of patients, who admitted to ICU with GCS=15, in an equipped service may reduce cost and bed occupancy.
The Success of ECMO in Flail Chest and ARDS Following Thoracic Gunshot Wound
Extracorporeal membrane oxygenation (ECMO) may be the last option in patients with severe acute respiratory distress syndrome (ARDS) in whom conventional methods have failed. The best results are obtained in patients with severe ARDS after trauma. Injured lungs can recover completely with ECMO therapy. A 44-year-old male patient was brought to the emergency department after sustaining severe thoracic gunshot injury. The patient was rushed into emergency surgery; however, pneumonectomy could not be performed due to morphological variation and widespread contusion in the lungs. The patient had flail chest with extensive damage of the ribs. Titanium plates could not be placed, as there was a major loss in the bone tissue. After cutting the fractured rib ends, the open chest wall was repaired with dual mesh and covered with serratus and latissimus dorsi muscles. However, the flail chest could not be corrected. During the follow-up in the intensive care unit, the patient developed ARDS and conventional therapies were unsuccessful. Thus, ECMO was used to allow lung healing. ECMO treatment was continued for seven days and was completed without any complications. The patient was transferred to the regular ward after 29 days. ECMO can be used as a life-saving treatment that allows lung healing in case conventional treatment methods have failed.
Thirty-day Mortality Outcomes of Trauma Patients in the Intensive Care Unit: A Three-year Retrospective Study
Objective: In this study, we aimed to investigate the characteristics of trauma patients hospitalized in intensive care units of a hospital, the first 30-day mortality rates and the causes affecting mortality in this period. Materials and Methods: In this study, the data of 150 trauma patients hospitalized in Nevşehir State Hospital between January 2013-2016 were examined retrospectively. Patients were divided into two groups, the survivors and the patients who died within the first 30 days (non-survivors). Initial findings of admission to the hospital, characteristics of trauma, interventions in intensive care units’s, and the latest conditions on the 30th day (still in bed, exitus or discharge cases) were recorded. Mortality rates and factors affecting mortality were studied. Results: In the first 30 days of hospitalization to intensive care units due to trauma, 115 (%76.7) of the 150 patients survived and 35 (23,3%) died. The mean Glasgow Koma Skala (GCS) scores were lower and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher in the non-survivors group than survivors (p<0.0001). Cardiopulmonary resuscitation (CPR) was successfully performed in 9 patients (6%) in the emergency department or in the first 30 days of intensive care hospitalization. The number of patients receiving CPR was higher in the non-survivors group than the survivors (p<0,0001). The most common cause of trauma was traffic accidents (n=52, 34.7%). Head was the most frequent trauma location (n=30.20%) and 27 (% 90) of them were due to the traffic accidents. Twelve (70.6%) of 17 (11.3%) multi-trauma patients died within the first 30-days and multi-trauma was an independent risk factor for mortality (p<0.0001). Low GCS score, high APACHE II score, multi-trauma and advanced age were identified as independent risk factors. Conclusion: During the first 30 days after admission to intensive care units of trauma patients, mortality rates are affected by factors such as age, multi-trauma, CPR and head trauma. Invasive procedures may increase mortality rates. GCS and APACHE II scores can be used as predictors of 30-day mortality of patients.
Ultrasonography in the Diagnosis of Pneumothorax Not Detected by Chest Radiography: Case Report
In patients with acute respiratory distress syndrome (ARDS), many factors, especially barotrauma may cause pneumothorax. Early detection of pneumothorax is critical in ARDS patients. When pneumothorax is suspected, chest radiography is usually preferred as the first line imaging modality. Recently, ultrasonography has been used by intensive care physicians in many fields, even in imaging of pneumothorax. We present a 75-year-old female patient with ARDS complicated by pneumothorax, in whom chest radiography was not diagnostic but ultrasound was used for diagnosis and follow-up.
Antibiotic Susceptibilities of Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii Strains Isolated from Patients in the Pediatric Intensive Care Unit
Objective: In this study, it was aimed to determine the antibiotic susceptibility of Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumanii bacteria isolated from blood and endotracheal aspirate samples, and to start the appropriate empirical antibiotic treatment. Materials and Methods: The antibiogram results of the patients’ whose blood and endotracheal aspirate samples sent from Erciyes University Faculty of Medicine Pediatric Intensive Care Unit to our hospital between January 1, 2013-August 30, 2017, and Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii bacteria reproduction detecting were evaluated retrospectively. Results: One hundred thirty-five samples sent from a total of 111 patients [65 male (63.6%), 56 female (36.4%)] with a median age of 17 months (7-112) were analyzed retrospectively. Of these samples reproduction of Pseudomonas aeruginosa were detected in 68 [blood: 31, endotrakealaspirat (ETA): 37], Acinetobacter baumannii in 42 (blood: 22, ETA: 20), Klebsiella pneumoniae in 25 samples (blood: 18, ETA: 7). Amikacin resistance rate was the lovest antibiotic (23.7%), while cefepime, ceftazidime, meropenem, ciprofloxacin and gentamicin resistance rates were 49.6%, 53.7%, 62.2%, 46.7% and 60%, respectively. Amikacin resistance was determined as 5.9%, 64.3% and 4% for Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae, respectively. Conclusion: Our study also suggests that, clinicians should be more careful when deciding to use this drug because of the severe carbapenem resistance for Acinetobacter, Pseudomonas and Klebsiella in Intensive Care Units. It also reveals that amikacin is a good option in empirical treatment.
Comparison of Different Gastric Residual Volumes in Intensive Care Patients Receiving Enteral Nutrition Support
Objective: This study aimed to determine and compare the effects of two different gastric residual volume (GRV) thresholds, 200 mL and 400 mL, on target calories and gastrointestinal intolerance in intensive care patients receiving enteral nutrition. Materials and Methods: Prospective data of 56 patients over 18 years of age who were expected to stay in the intensive care unit for more than three days were included in the study. Patients were randomized into two groups as GRV threshold 200 mL (group 1) and GRV 400 mL (group 2). Enteral Measurement of GRV was done every six hours. The feeding was initiated at a rate of 20 mL/h and was increased by 10 mL/h to reach the goal rate. Results: There was no significant difference between two groups regarding gender, age, APACHE II score, body mass index, length of stay in intensive care unit, admission reason, and co-morbidities. There was also no significant difference in the incidence of GRV, vomiting, diarrhea and intolerance. Time to target calories was 24 hours in group 1 and 26 hours in group 2, and no significant difference was found between the two groups. Conclusion: In this study, there was no significant difference between 200 mL and 400 mL GRV regarding time to target calories and incidence of gastrointestinal complications in critical intensive care unit patients.
The Effect of Education in Reducing Noise on Health Personnels’ Knowledge Level and Behavioral Change
Objective: Noise must be reduced and taken under control because negatively affects the health of health personnel and preterm newborns in particular. The American Academy of Pediatrics reported that noise levels must be kept below 45 dB. However, many studies demonstrated that the desired level could not be reached. This research was conducted with the aim of evaluating the level of noise in a neonatal intensive care unit (NICU), and the effect of given education on controlling the noise. Materials and Methods: This research was conducted with doctors (4), nurses (18), and personnel (4) who worked in the 3rd level NICU of a university hospital. This research had a pre-test, post-test quasi-experimental design in a single group. Ethics board and institutional approval were granted from the hospital. A noise information form that was prepared by researchers, educational program on noise control, noise observation form, and noise measuring equipment were used in the study. Noise was measured for 24 hours over 7 days in repeated measurements in the unit before education, after education, and 6 weeks after the education program. Results: The noise levels were significantly lower 6 weeks after the education program compared with before the program (p<0.01). The percentage of correct answers given to questions in the information form was significantly higher 6 weeks after the education program compared with before the program among health personnel (p<0.01). The kappa compliance level was found significant among observers in the evaluation of doctors, nurses, and personnel in accordance with the noise observation form (p<0.01). Conclusion: It could be suggested that the education method was effective in terms of reducing noise, reducing noise levels in the environment, improving the information level of health personnel, and positively affecting the behaviors of personnel. It can also be concluded that the noise observation form is reliable.
Tracheal ruptures are one of the life-threatening situations in critical care unit and can be formed after trauma, intubation, tracheotomy, bronchoscopy or spontaneously. Significant risk factors for tracheal rupture include urgent intubation, use of stilet, high cuff pressure, recurrent intubation attempts, double lumen endotracheal tubes, very thick endotracheal tubes, female gender, short height, older age, tracheomalacia, tracheal stenosis, congenital tracheal abnormalities and chronic steroid therapy. Among these risk factors, corticosteroids can cause rupture by inhibiting collagen synthesis and reducing connective tissue stability. In this case report, a case with spontaneous recurrent tracheal rupture was defined and the underlying mechanisms and therapeutic approach to this complication that could be seen in patients using chronic steroids were discussed.
Successful Treatment of Mushroom Poisoning with Silybin: A Case Report
Although up to 100 of them known to be toxic, there are more than 5,000 mushroom species in the world. Of these, the most poisonous species belong to Amanita and Gallerina species. Alpha-and beta-amanita toxins which are associated with serious liver, kidney and central nervous system damage is produced by Amanita phalloides which is responsible for 90% of fatal mushroom poisoning in Turkey. Two cases that we aimed to present are two male patients aged 55 and 42 who collected and consumed mushrooms in the forest. The patients were admitted to the county state hospital with complaints of nausea, vomiting, diarrhea and fatigue after 18 and 24 hours. Patients with increased liver function tests were referred to our hospital for further examination and treatment, and they were discharged after successful treatment in our intensive care unit.
Relationship Between Neutrophil Gelatinase-associated Lipocalin and Mortality in Acute Kidney Injury
Objective: Almost half of intensive care patients are affected by acute kidney injury (AKI). The purpose of this study is to determine parameters that can be used for predicting of early (within 28 days) and late (within 90 days) mortality in patients who are followed-up with AKI in intensive care units. Materials and Methods: In this study, a dataset that contains 50 patients with AKI in intensive care units was used. This dataset contains blood urea nitrogen, creatinine, plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL), lactate dehydrogenase, alkaline phosphatase and gamma-glutamyl transpeptidase values of patients who were admitted to intensive care for various reasons and who developed AKI on the days 1, 3 and 7. In addition to these values, laboratory results such as serum electrolytes on day 1, blood gas; vital signs such as mean arterial pressure, central venous pressure; and demographic data were also recorded. Data mining techniques were applied to determine correlation between all of these data and mortality. Results: The threshold level of urinary NGAL on day 7 was determined to be 69 ng/mL, and strong correlation was found between this threshold level and early mortality. Similarly, the threshold level of plasma NGAL on day 7 was determined to be 150 ng/mL, and this was highly correlated with early mortality. Besides, strong correlation was also found between the difference in the urinary NGAL levels on day 1 and 7, and early mortality. Conclusion: In this study, plasma and urinary NGAL levels were found to be closely related to early mortality in patients who were followed-up with AKI in intensive care units. On the other hand, any parameter associated with late mortality was not found.
Three Year Resistance Profile of Acinetobacter baumannii and Pseudomonas aeruginosa Strains Isolated from Intensive Care Units
Objective: The objective of the study was to investigate the three-year antibiotic susceptibility of Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from intensive care unit (ICU) specimens and to evaluate the changes in resistance rates. Materials and Methods: The resistance profiles of Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from ICU specimens between January 2015-2018 were analyzed retrospectively and the annual resistance rates were evaluated. Results: Acinetobacter baumannii was isolated in 609 and Pseudomonas aeruginosa was isolated in 420 of the ICU specimens over a three-year period. Strains were most frequently isolated from general ICU. The three-year mean resistance of Acinetobacter baumannii and Pseudomonas aeruginosa to colistin, amikacin, gentamycin, imipenem, meropenem, ciprofloxacin, ceftazidime, piperacillin / tazobactam was 0.5%, 79%, 86%, 96%, 96%, 97% 98%, 99% and 5%, 21%, 25%, 35%, 38%, 40%, 42%, 45%, 49% and 53%, respectively. The most effective antibiotics were for Acinetobacter baumannii and Pseudomonas aeruginosa were colistin (99.5% vs 95%) and amikacin (21% vs 79%), respectively. Conclusion: It was found that Acinetobacter baumannii strains isolated from ICUs were resistant to many antibiotics and that Pseudomonas aeruginosa isolates were more susceptible. These data are proof that new antibiotics are needed in the treatment of infections caused by Acinetobacter baumannii. It would be appropriate for each hospital to monitor changes in their resistance rates and to update the empirical treatment principles.
The Effect of Early Enteral Immunonutrition to Inflammatory Response for Intensive Care Patients
Objective: Early enteral immunonutrition affects cytokine-dependent stress response, providing an optimal inflammatory and immune response in the dynamic process of SIRS through sepsis. In our study, we examined the inflammatory response of standard and glutamine products in the early and late nutrition regimen. Materials and Methods: Forty patients aged between 30 and 60 who needed ventilation support were randomly divided into 4 groups, namely standard early enteral (SE), standard late enteral (SG), early enteral immunonutrition (IE) and late enteral immunonutrition (IG). In early enteral nutrition groups, nutrition started within the first 24 hours of treatment and after 72 hours in the late groups. Prealbumin, albumin, CRP, IL-6, IL-10, APACHE II and mortality were calculated. Results: There was no difference in terms of demographics. We found a decrease in the prealbumin level in the SE group (p<0.05). There was a decrease in CRP levels in the IE and IG groups compared to SG group. There was an increase in SE group at 5th and 7th days (p<0.05). In terms of IL-6 levels, we found a decrease in the IE, SE, IG groups compared to SG group. In the IE group, IL-6 level was decreased compared to IG and SE groups at the 7th day. IL-10 level in the IG group increased at 5th and 7th days. APACHE II scores at 5th day were higher in the IG group compared to SG group. There was no difference in terms of mortality. Conclusion: It was concluded that glutamine-rich early enteral immunonutrition efficiently suppressed the systemic inflammatory response without affecting mortality and biochemical parameters.
Retrospective Analysis of Trauma Patients Who were Treated and Followed in Anesthesia Intensive Care Unit
Objective: Intensive care units (ICU) are multidisciplinary structures dealing with potentially life-threatening diseases. Trauma patients are among some of the patients treated in ICU. In this study, we aimed to investigate the causes of mortality and morbidity in trauma patients treated in our ICU. Materials and Methods: The data of trauma patients hospitalized in anesthesia ICU between January 2014-2016 were evaluated retrospectively. Patients’ age, gender, concomitant disease, trauma etiology, clinical diagnoses, APACHE-2 revised trauma score (RTS) and injury severity scores, duration of stay in ICU, duration of mechanical ventilation, duration of hospital stay, mortality rates, discharge status from ICU and discharge Glasgow Coma Scale score, hemodialysis requirement during follow-up, enteral nutrition status within 48 hours after admission to ICU and lactate levels at admission to ICU were evaluated. Results: A total of 954 patients were treated in the ICU and 106 patients (11.1%) were followed up for trauma. Regarding 28-day and 90-day mortality, the mean lactate levels, duration of mechanical ventilation and APACHE-2 scores were significantly higher in non-survivors (p<0.05). When the 28-day and 90-day mortality rates were evaluated, the RTSs of the survivors were found to be significantly higher than non-survivors (p<0.01). While non-survivors were older than the survivors, this difference was only significant in 90-day mortality (p=0.03). Patients with early enteral nutrition within the first 48 hours, lactate levels ≤2 and an APACHE-2 score of 20 and below were found to have a statistically significantly lower 28-day and 90-day mortality rates. Conclusion: High lactate, APACHE-2 and low RTS levels increase the mortality rate in trauma patients during admission to ICU. In order to reduce the mortality, the duration of mechanical ventilation should be reduced as much as possible.
The Effects of Corticosteroid Use on Prognosis of Patients with Nosocomial Meningitis in Neurosurgical Intensive Care Unit: A Retrospective Descriptive Study
Objective: Invasive procedures such as craniotomies, external ventricular drainage catheters, and penetrating head traumas increase the risk of nosocomial meningitis in neurosurgical intensive care unit patients. While some studies suggest that corticosteroids increase this risk, others argue no such effect present. The aim of this retrospective descriptive study was to reveal the effect of corticosteroid use in patients with nosocomial meningitis in the neurosurgical intensive care unit for five years on mortality, nosocomial infection, the number of surgical interventions and the duration of stay in intensive care unit. Materials and Methods: In this study, 13 cases that developed nosocomial meningitis from 2228 patients in the neurosurgical intensive care unit during a 5-year period were retrospectively analyzed. The effects of corticosteroid use on mortality, nosocomial infections, number of surgical interventions and length of stay in intensive care unit were investigated in patients with nosocomial meningitis. Results: The use of corticosteroid in patients with nosocomial meningitis had no effect on mortality, nosocomial infection risk, number of surgical interventions and length of stay in intensive care unit (p>0.05). Conclusion: Corticosteroid use of neurosurgical intensive care unit patients with nosocomial meningitis does not affect mortality, nosocomial infection risk, number of surgical interventions and length of stay in intensive care unit.
Clinical Protocols for Preventing Ventilator-Associated Pneumonia: A Systematic Study
Objective: The purpose of this work was to review the current literature evaluating the efficacy of clinical protocols and preservation methods in preventing ventilator-associated pneumonia (VAP), and to examine the data obtained from the studies systematically. Materials and Methods: Articles reached by scanning national and international databases including “Google Scholar”, “Pubmed”, “Science Direct”, “Proquest”, “Cochrane”,” EBSCOhost”, “Clinical Key”, “Ovid”, “Web of Science”, “Google Akademik” between 2012-2017 were included in this review. In this review, articles with publication language Turkish or English, which evaluated the effects of (VAP) preventing protocols and applications on the results, whichwere published in last five years and of which full text was available were collected by using keywords; “VAP prevention”, “Prevention of VAP”, “Prevent VAP”, “VAP prevention”, “Prevent VAP”, and “Prevention of VAP”. A total of 48 studies which met the inclusion criteria constituted the sample of the study. Results: Randomized controlled; prospective, randomized controlled; semi-experimental; pilot, randomized controlled, prospective, cluster randomized controlled, open label; monocentric observational; double blind, randomized, placebo-controlled, double blind, prospective, randomized controlled; single-center,two-arm, randomized controlled, open label; prospective, double blind, randomized controlled;randomized controlled, experimental; pilot, randomized, placebo controlled-double blind, observational; prospective, observational; pretest-posttest; retrospective cohort/prospective cohort; prospective,randomized, placebo controlled,pilot; retrospective cohort; and retrospective type of studies presented in the articles were included in this review. In this systematic review, clinical protocols and preventive measures used in the prevention of VAP including oral administration of “chlorhexidine”, “hydrogen peroxide”, “OralBalance”, the use of “OroCare Aspire / Sensitive sticks” for oral care; preference for endotracheal tubes with subglottic drainage, application of abdominal massage, semi recumbent or trendelenburg position of the patient, probiotic preparations, hypertonic sodium chloride, hydrocortisone and antibiotics have been found to be effective. Conclusion: As a result of this systematic review, clinical protocols and preventive measures used in 18 studies to prevent VAP did not affect the results of VAP, whereas those used in 30 studies affected the results of VAP, positively.
Protective Effect of Hypothermia During Experimental Sepsis
Objective: In our study, we aimed to investigate the effect of hypothermia on survival, C-reactive protein (CRP), procalcitonin and leukocyte levels in rat models, induced with cecal ligation-perforation procedure. Materials and Methods: After formation of the sepsis, the rats were randomized as hypothermic sham, septic (32 °C-34 °C) and normothermic sham, septic (36 °C-38 °C). At the beginning of study (0 h) and at 6th hour blood was taken from all rats in all groups; CRP, procalcitonin, leukocyte levels were measured and the survival time of rats in all groups was recorded. Results: A statistically significant difference was found between the hypothermic and normothermic septic group in terms of survival time (hypothermic septic 24.3±20.2, normothermic septic group 15.9±13.5 h, p=0.039). There was no statistically significant difference for time dependent changes of CRP and procalcitonin all groups. Conclusion: It can be suggested that hypothermia in experimental sepsis might have positive effects on survival but the effect on the markers of infection is unclear and further studies are needed.
Retrospective Evaluation of Four-Year Acute Intoxication Cases Followed-up in Intensive Care Unit
Objective: Acute intoxication is a life-threatining clinical issue. Therefore, patients need follow-up in the intensive care unit (ICU). In this study, we aimed to evaluate the incidence, demographic characteristics, intoxication agents and mortality rate in patients diagnosed with acute intoxication in our ICU. Materials and Methods: The records of the patients who were diagnosed with acute intoxication between April 1, 2014 and March 31, 2018 were retrospectively analyzed and were included in this study. Result: Of the 300 patients included in the study, 68.7% n=206 were female, 31.3% n=94 were male and the mean age was 28.36±12.3 years. According to age groups, most patients in 21-30 years group with 37.3% n=112 rate and the least in ≥61 years group with 3.7% n=11 rate. It was detected that 94.3% n=283 of cases took drugs and/or chemical matter for suicide attempt, 5.7% n=17 of cases influenced by exposure or accidentally. Patients accepted to ICU owing to medicine intoxication (88%), chemical matter intoxication (%6.3), mushroom intoxication (4%), drug abuse (1.4%) and snakebite (0.3%). According to medicine groups; patients took most common antidepressants (n=55), subsequent to nonsteroid antiinflamatory drugs (n=38) , analgesics (n=37), influenza medicine (n=34) and intoxication occured most frequently in summer (29.7%). Tricyclic antidepressants were the most common intoxication-affecting agent in the antidepressant group, paracetamol in the analgesic group, carbamazepine in the antiepileptic group, ibuprofen+chlorpheniramine combination in the anti-depressant drugs, quetiapine in the antipsychotics, metformin in the oral antidiabetic group, pantoprozol in the proton pump inhibitor group. Duration of hospitalization in ICU of cases was 1.39±1.57 days and mortality rate was 0.67%. Conclusion: Acute intoxication cases may be severe and should therefore be followed in ICU. In this group of patients, drug and/or chemical causing intoxication should be detected as soon as possible, and physicians should be careful about possible side effects and treatment should be started immediately
Thrombolytic Use During Cardiopulmonary Arrest in Massive Pulmonary Embolism: Return to Life of Two Patients
The diagnosis of pulmonary embolism is still difficult, because it may occur with different symptoms and signs. These cases can be admitted to the emergency department with shock, syncope or cardiopulmonary arrest. More than 70 percent of cardiopulmonary arrest cases are caused by acute myocardial infarction or massive pulmonary embolism and it has a poor prognosis. We present two cases of massive pulmonary embolism requiring cardiopulmonary resuscitation and administered thrombolytic agents. Two patients received 10 mg bolus of recombinant tissue-type plasminogen activator (alteplase) followed by 90 mg intravenous infusion for two hours. Rapid clinical and hemodynamic improvement occurred after thrombolytic injection and the patients were discharged from the hospital. In case of suspicion of massive pulmonary embolism in cardiopulmonary arrest cases, thrombolytic agents should be administered during cardiopulmonary resuscitation. This procedure will treat the condition caused by arrest and also is shown to have beneficial effects on the early microcirculatory cerebral reperfusion and to prevent neurological sequelae.