Günseli Orhun

The Comparison of Automatic Tube Compensation (ATC) and T-piece During Weaning

OBJECTIVE Automatic Tube Compensation (ATC) is a newly developed mechanical ventilatory support method. The aim of this study was to compare the ATC and the T-piece as a weaning method. METHODS Patients who were treated in ICU with mechanical ventilation for longer than 24 hours were included in this prospective clinical study. Fifty patients were divided into two groups for weaning, ATC or T-piece group. Patients tolerating 30 minutes spontaneous breathing trial underwent immediate extubation. The following parameters were recorded just before the spontaneous breathing trial and every 5 minutes during the 30 minute period; PEEP, Pplt, Pmean, FiO2, heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, SaO2, ETCO2. The primary outcome of the study was successful extubation defined as the ability to maintain spontaneous breathing for 48 hours after extubation. RESULTS The mean duration of weaning were 4.96 days and 7.42 days in the ATC and T-piece groups, respectively (p value 0.022). There were no significant differences between the groups with respect to the hemodynamic parameters, mechanical ventilation and gas exchange parameters. CONCLUSION In terms of success for weaning, there was no superiority between the ATC and the T-Piece methods for spontaneous breathing and it was concluded that each of the methods can be used for weaning. The ATC group were compared in terms of successful weaning period but have shown no significant periods of time were found to be lower.

The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients

Background Gastrointestinal (GI) motility disorders in intensive care patients remain relatively unexplored. Nowadays, the frequency, risk factors and complications of GI dysfunction during enteral nutrition (EN) become more questionable. Aim To evaluate the frequency, risk factors and complications of GI dysfunction during EN in the first 2 weeks of the intensive care unit (ICU) stay and to identify precautions to prevent the development of GI dysfunction and avoid complications. Methods In this prospective observational study, we deliberately targeted at-risk patients. A total of 137 patients who received nasogastric tube feeding in an ICU of a tertiary hospital were enrolled. Results The incidence of GI dysfunction that was found to be 63% which was associated mainly between MDR bacteria positivity and negative fluid balance. Diarrhea was observed in 36 patients (26%) and on 147 patient-days (incidence rate, 5.5 per 100 patient-days). The median day of diarrhea onset was 6 days after the initiation of EN. Forty patients (29%) presented with constipation (85% during the first week). Fifty patients (36%) exhibited upper digestive intolerance on 212 patient-days (incidence rate, 7.9 per 100 patient-days), after a median EN duration of 6 days (range, 2–14 days). Logistic regression analysis revealed MDR bacteria growth in the culture (OR, 1.75; 95% CI, 1.15–2.67; P=0.008) and negative fluid balance (OR, 0.57; 95% CI, 0.34–0.94; P=0.03) as the risk factors for GI dysfunction. We also showed that GI dysfunction was associated with high SOFA score, hypoalbuminemia, catecholamine use, and prolonged length of stay (LOS). GI dysfunction, on the other hand, can cause some complications including inadequate nutrition, and newly developed decubitus ulcers. Conclusion GI dysfunction should be considered a clinical predictor of inadequate nutrition and prolonged LOS. In addition, the most dramatic risk for GI dysfunction was observed in patients with MDR bacteria growth in the culture and patients in negative fluid balance. Intensivists provide appropriate nutrition for patients, as well as prompt intervention and the development of treatment strategies in the event of GI dysfunction.

Evaluation of risk factors and development of acute kidney injury in aneurysmal subarachnoid hemorrhage, head injury, and severe sepsis/septic shock patients during ICU treatment

BACKGROUND There are few studies examining development of acute kidney injury (AKI) in the various types of patients in intensive care units (ICUs). Presently described is evaluation of risk factors and development of AKI in different groups of ICU patients. METHODS Present study was performed in 3 different ICUs. Development of AKI was measured using Acute Kidney Injury Network (AKIN) classification system. Total of 300 patients who were treated in trauma, neurosurgery, or general ICU departments (due to head injury, aneurysmal subarachnoid hemorrhage [aSAH], or severe sepsis/septic shock, respectively) were assessed for incidence, risk factors, and development of AKI. RESULTS AKI did not develop in aSAH patients when evaluated based on serum creatinine level; however, it was observed in 5% of aSAH patients according to volume adjusted creatinine (VACr) level. AKI developed in 76% of sepsis group, and in 20% of head injury group, based on AKIN classification, according to both serum and VACr levels. Incidence of AKI was significantly higher in sepsis group (p<0.001). Only use of vasopressor was significantly related to AKI development in sepsis and head injury groups. Mortality rate was 8%, 22%, and 42% in aSAH, head injury, and sepsis groups, respectively. AKI development and vasopressor use were significantly related to mortality in sepsis group. CONCLUSION Despite similar characteristics and risk factors, there were fewer instances of AKI in aSAH group. Hypertension or hydration therapy used to treat vasospasm and polyuria due to cerebral salt-wasting syndrome may prevent aSAH patients from developing AKI.

Evaluation of In-Hospital Cardiopulmonary Resuscitations at Istanbul

Evaluation of In-Hospital Cardiopulmonary Resuscitations at Istanbul This study aimed to investigate cardiopulmonary resuscitations (CPR) performed within the last year at Istanbul Medical Faculty and to determine success rates, to evaluate the factors affecting success rates and to compare outcomes to those previously performed.

Effects of Extracorporeal Liver Support Systems in Liver Failure

Yöntemler: Molekül abzorbe edici resirkülasyon sistemi (MARS) (10 hasta) ve plazmadan emilim yoluyla doğrudan adzorpsiyon (FPSA) (28 hasta) sistemlerinin uygulandığı 38 hastada, 114 işlem değerlendirilmiştir. Karaciğer nakli ve sağkalım sıklığı araştırılmış; SOFA ve hepatik ensefalopati skorları, total bilirübin, amonyak, albümin, kan idrar nitrojeni (BUN), kreatinin, laktat düzeyleri, INR ve lökosit ve trombosit sayıları ve ayrıca hemodinamik değişikliklerin sıklığı incelenip karşılaştırılmıştır. Kullanılmış olan antikoagülasyon yöntemi, destek sisteminin kaç kez uygulandığı ve hastanın yoğun bakım kalış süresi kaydedilmiştir.