Beliz Bilgili

Vitamin D level is associated with mortality predictors in ventilator-associated pneumonia caused by Acinetobacter baumannii

INTRODUCTION Vitamin D plays a role in host defense and is known to be associated with mortality in patients in the intensive care unit (ICU). We aimed to evaluate the relationships between vitamin D levels and predictors of mortality in patients with ventilator-associated pneumonia (VAP) caused by extensively drug-resistant Acinetobacter baumanii (XDR A. baumanii). METHODOLOGY A retrospective single-center study was conducted in an 18-bed adult ICU of a teaching hospital, including all patients with VAP due to XDR A. baumanii. Levels of 25(OH)D, procalcitonin (PCT), C-reactive protein (CRP), n-terminal pro-BNP (NT-proBNP), as well as clinical scores (Sequential Organ Failure Assessment [SOFA], Acute Physiology And Chronic Health Evaluation [APACHE II], Clinical Pulmonary Infection Score [CPIS) were recorded. RESULTS Forty-for patients were studied over six months. All patients had vitamin D deficiency. The 28-day mortality in patients with 25(OH)D levels ≤ 10 ng/mL was higher than in patients with 25(OH)D > 10ng/mL (p = 0.001). The fourth- and seventh-day SOFA scores (p= 0.04 and p= 0.001) and first- and fourth-day procalcitonin levels (p = 0.03 and p = 0.004) were higher in patients with 25(OH)D levels ≤ 10 ng/mL. The clinical scores (SOFA, CPIS, and CEPPIS) and biomarkers (NT-proBNP, PCT) were negatively correlated with 25(OH)D levels in all study groups. CONCLUSIONS Severe vitamin D deficiency was associated with adverse outcome in VAP due to XDR A. baumanii. Vitamin D levels may be a prognostic predictor of VAP. It is also important to evaluate the effect of rapid vitamin D replacement on mortality.

Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study

Purpose The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p < 0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.

Low Tidal Volume-Positive End-expiratory Pressure versus High Tidal Volume-Zero Positive End-expiratory Pressure and Postoperative Pulmonary Functions in Robot-assisted Laparoscopic Radical Prostatectomy

Objective: The aim was to compare the effects of low tidal volume (V_T) and moderate positive end-expiratory pressure (PEEP) with high V_T and zero end-expiratory pressure (ZEEP) on postoperative pulmonary functions and oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy. Subjects and Methods: Forty-four patients were randomized into low V_T-PEEP and high V_T-ZEEP groups. The patients were ventilated with a V_T of 6 mL/kg and 8 cm H₂O PEEP in the low V_T-PEEP group and a V_T of 10 mL/kg and 0 cm H₂O PEEP in the high V_T-ZEEP group. Preoperative and postoperative spirometric measurements were done and chest X-rays were evaluated using the radiological atelectasis score (RAS). p < 0.05 was considered statistically significant. Results: The intraoperative and postoperative arterial partial pressure of oxygen and arterial oxygen saturation values were significantly higher in the low V_T-PEEP group than in the high V_T-ZEEP group. At all times, the arterial-to-alveolar oxygenation gradients were significantly lower in the low V_T-PEEP group than in the high V_T-ZEEP group. Preoperative RAS were similar in both groups, but the postoperative RAS was significantly lower in the low V_T-PEEP group (p < 0.001). Forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow rate recorded postoperatively were significantly lower in the high V_T-ZEEP group (p < 0.001). Conclusions: Postoperative pulmonary functions were less impaired in patients ventilated with a V_T of 6 mL/kg and 8 cm H₂O PEEP than in patients ventilated with a V_T of 10 mL/kg and ZEEP.

The Assessment of Intravascular Volume with Inferior Vena Cava and Internal Jugular Vein Distensibility Indexes in Children Undergoing Urologic Surgery

ABSTRACT Purpose: The purpose of this work is to assess the predictive value, for fluid responsiveness (FR), of the inferior vena cava distensibility index (IVC-DI) and internal jugular vein distensibility index (IJV-DI) in pediatric surgical patients. Material and Methods: Prior to being placed under general anesthesia, 24 surgical patients were enrolled. Baseline parameters were recorded with the patient in the semirecumbent position (Stage 1). Next, the passive leg raising (PLR) maneuver was carried out and a second measurement was recorded (Stage 2). Patients with an increase in the cardiac index (CI) of >10%, induced by PLR, were considered to be responders (R), otherwise they were classified as nonresponders (NR). At both stages, CI and DI of the IVC and IJV were measured. Results: Responders had higher IVC-DI and IVJ-DI than NR in stage 1 (both p <.001). In stage 2, IVC-DI and IJV-DI were not different in R and NR groups (p =.164, p =.201). Utilizing cut-off values of > 22.7% for IVC-DI and > 25% for IJV-DI, these parameters had positive correlation coefficients, both in R and NR of, respectively, 0.626 and 0.929. Conclusions: The IVC-DI predicts FR in anesthetized pediatric patients and correlates well with the IJV-DI; both may be used as prediction markers of FR in children.

The Type of Anesthesia Technique Does Not Have an Impact on 30-Day Mortality in Geriatric Patients Undergoing Lower Extremity Amputation

This study aimed to determine the appropriate anesthetic technique for patients who underwent amputation due to peripheral vascular disease. The anesthetic technique to be applied during lower extremity amputations in geriatric patients with limited functional capacity may be important in terms of clinical outcomes and mortality rates. Patients aged older than 65 years who had undergone major lower extremity amputation were retrospectively evaluated. The patients were divided into 2 groups: regional anesthesia (RA) and general anesthesia (GA). Demographic characteristics, comorbidities, medications used, anesthesia technique, the durations of anesthesia and surgery, need for blood transfusion, 30-day mortality, postoperative cardiac and pulmonary complication rates were recorded from the medical records of the patients. Among the 441 patients, 244 had received RA, while 197 had received GA. The average length of stay in the hospital was longer in the GA group (P = 0.001). The use of antiplatelet drugs (P ...

The value of internal jugular vein collapsibility index in sepsis

BACKGROUND Rapid, accurate, and reproducible assessment of intravascular volume status is crucial in order to predict the efficacy of volume expansion in septic patients. The aim of this study was to verify the feasibility and usefulness of the internal jugular vein collapsibility index (IJV-CI) as an adjunct to the inferior vena cava collapsibility index (IVC-CI) to predict fluid responsiveness in spontaneously-breathing patients with sepsis. METHODS Three stages of sonographic scanning were performed. Hemodynamic data were collected using the Ultrasonic Cardiac Output Monitor 1A system (Uscom, Ltd., Sydney, NSW, Australia) coupled with paired assessments of IVC-CI and IJV-CI at baseline, after passive leg raise (PLR), and again in semi-recumbent position. Fluid responsiveness was assessed according to changes in the cardiac index (CI) induced by PLR. Patients were retrospectively divided into 2 groups: fluid responder if an increase in CI (ΔCI) ≥15% was obtained after PLR maneuver, and non-responder if ΔCI was <15%. RESULTS Total of 132 paired scans of IJV and IVC were completed in 44 patients who presented with sepsis and who were not receiving mechanical ventilation (mean age: 54.6±16.1 years). Of these, 23 (52.2%) were considered to be responders. Responders had higher IJV-CI and IVC-CI before PLR maneuver than non-responders (p<0.001). IJV-CI of more than 36% before PLR maneuver had 78% sensitivity and 85% specificity to predict responder. Furthermore, less time was needed to measure venous diameters for IJV-CI (30 seconds) compared with IVC-CI (77.5 seconds; p<0.001). CONCLUSION IJV-CI is a precise, easily acquired, non-invasive parameter of fluid responsiveness in patients with sepsis who are not mechanically ventilated, and it appears to be a reasonable adjunct to IVC-CI.

A Comparison of Pregabalin and Ketamine in Acute Pain Management after Laparoscopic Cholecystectomy

Objective: Pregabalin and ketamine are popular analgesic adjuvants for improving perioperative pain management. We designated this double-blind, placebo controlled study to test and compare the preventive effects of pregabalin and ketamine on postoperative pain management after elective laparoscopic cholecystectomy. Methods: Seventy five patients (18 to 65 years of age) undergoing laparoscopic cholecystectomy were randomly assigned to one of the following 3 groups: control group (group C) received oral placebo capsule 1 h before surgery and bolus plus intravenous (iv) infusion of saline during surgery; ketamine group (group K) received oral placebo capsule 1 h before surgery and 0.3 mg kg-1 iv bolus plus 0.05 mg kg-1 h-1 iv infusion of ketamine during the surgery; pregabalin group (group P) received oral pregabalin 150 mg 1 h before surgery and bolus plus iv infusion of saline during surgery. The anesthetic technique was standardized, total tramadol consumption, visual analog scale (VAS), incidence of postoperative nausea and vomiting (PONV), sedation score and complications related to the drugs used in the study were assessed in the postoperative 24 h period. Results: Postoperative total tramadol consumption were significantly lower in the pregabalin and ketamine group compared to the group C (p=0.001). Tramadol requirement was similar between pregabalin and ketamine groups. At 30 min postoperatively, VAS values were lower in the pregabalin and ketamine groups compared with group C (p=0.001). There was no difference between the three groups in the need for supplemental analgesia, incidence of PONV and sedation score >2. Discussion: Pregabalin and ketamine improved postoperative pain control and decreased analgesic consumption after laparoscopic cholecystectomy with a good safety profile without any changes in sedation level or PONV.

Damar Dişi Akciğer Suyu ve Sepsis

Extravascular Lung Water and SepsisThe incidence of sepsis has been increasing because of the advancing age of the general population, a greater number of invasive procedures, and more immunosuppressive therapies. Nowadays, the mortality of sepsis is still high, and is still the major cause of morbidity and mortality for patients admitted to an intensive care unit. In sepsis, exaggerated responses might induce organ dysfunction including lung injury and shock, whether the focus is located in the lung or not. Extravascular lung water (EVLW) consists nearly of fluid in the pulmonary interstitial and alveolar spaces. EVLW can be measured at the bedside using the transpulmonary thermodilution technique and has a diagnostic value for the identification of patients. It is an indicator of prognosis and severity of sepsis-induced lung injury. Measurement of EVLW is useful in characterising the severity of respiratory disease, it is also beneficial in the management of patients with sepsis. Increased EVLW is associated with decreased life expectancy in patients with sepsis. Reduction of EVLW at an early stage and a negative fluid balance are associated with a more favorable outcomes.