Ozgur Senturk

Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: risk factors for mortality.

PURPOSE The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality. MATERIALS AND METHODS An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses. RESULTS Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P = .003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P = .042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P = .001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P = .045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P = .007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P = .032) were independent factors related to mortality. CONCLUSION Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission.

Ultrasound guided Erector Spinae Plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty

First described by Forero in 2016 for the treatment of thoracic neuropathic pain, Erector Spinae Plane (ESP) block is a regional anesthesia technique in which local anesthetic is injected between the erector spinae muscle and transverse process under ultrasound guidance, blocking the dorsal and ventral rami of the thoracic and abdominal spinal nerves [1,2]. Studies have shown that the spread of local anesthetic in the paravertebral space in the cephalic and caudal direction can lead to analgesia from C7-T2 to L2-3 [2]. It has also been reported that paravertebral block performed at L2 segment has similar postoperative analgesic effects when compared to psoas compartment block in patients undergoing total hip arthroplasty [3].Wehypothesized that ultrasound guided ESP performed at L4 transverse process level would lead to adequate postoperative analgesia in total hip arthroplasty surgeries, as the local anesthetic would spread similar to ESP performed in thoracal levels. To our knowledge, ESP performed in lumbar region has not been reported. We report a successful ultrasound guided ESP block performed at L4 transverse process level for postoperative analgesia in an 86 year old female patient with controlled hypertension, undergoing left sided total hip arthroplasty under general anesthesia. The patient received routine intravenous perioperative analgesia (paracetamol 1 g, tenoxicam 20 mg and morphine 3 mg). At completion of surgery ultrasound guided ESP was performed under general anesthesia using a linear transducer under sterile conditions. The transverse process was visualised by sliding the transducer 3.5–4 cm laterally from the midline at the T4 vertebral level in the parasagittal plane. Thirtymillilitre of local anesthetic (15 ml bupivacaine 0.5%, 5 ml lidocaine 2% and 10 ml serum physiologique)was injected between the erector spinaemuscle and the transverse process. The patient was extubated. Standard multimodal analgesia regimen was ordered (scheduled acetaminophen, tenoxicam at bedtime in addition to tramadol as required). The patients numeric rating score (NRS) was 1/10 in the postoperative recovery room immediately after extubation. Sensorial block was

Mortality indicators in community-acquired pneumonia requiring intensive care in Turkey

BACKGROUND Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey. METHODS This study evaluated SCAP cases hospitalized in the ICUs of 19 different hospitals between October 2008 and January 2011. The cases of 413 patients admitted to the ICUs were retrospectively analyzed. RESULTS Overall 413 patients were included in the study and 129 (31.2%) died. It was found that bilateral pulmonary involvement (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.7) and CAP PIRO score (OR 2, 95% CI 1.3-2.9) were independent risk factors for a higher in-ICU mortality, while arterial hypertension (OR 0.3, 95% CI 0.1-0.9) and the application of non-invasive ventilation (OR 0.2, 95% CI 0.1-0.5) decreased mortality. No culture of any kind was obtained for 90 (22%) patients during the entire course of the hospitalization. Blood, bronchoalveolar lavage, and non-bronchoscopic lavage cultures yielded enteric Gram-negatives (n=12), followed by Staphylococcus aureus (n=10), pneumococci (n=6), and Pseudomonas aeruginosa (n=6). For 22% of the patients, none of the culture methods were applied. CONCLUSIONS SCAP requiring ICU admission is associated with considerable mortality for ICU patients. Increased awareness appears essential for the microbiological diagnosis of this disease.

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study

BackgroundWe evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings.MethodsA multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated.ResultsA total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT.ConclusionCXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series.

Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study

STUDY OBJECTIVE In this study we investigated and compared the predictive values of different airway assessments tests including thyromental height measurement test, which has been recently suggested, in difficult laryngoscopy (Cormack and Lehane [C-L] scores 3 and 4). In addition, we compared the effectiveness of methods and C-L scores, by IDS, in terms of predicting difficult intubation. DESIGN Prospective, blinded study. SETTING Maltepe University. PATIENTS Four hundred fifty-one patients selected randomly who underwent general anesthesia. INTERVENTIONS In this study we compared predictive value of thyromental height measurement test (TMH), which has been recently suggested, modified Mallampati test (MMT), upper lip bite test (ULBT), and thyromental distance measurement test (TMD) in difficult laryngoscopy. Final C-L scores were compared with intubation difficulty scale (IDS) in terms of predicting difficult intubation. MEASUREMENTS Patients American Society of Anesthesiology score, age and weight were recorded. TMH, TMD, MMT, ULBT, IDS and C-L scores were measured and determined. MAIN RESULTS The optimal cut-off point for TMH for predicting difficult laryngoscopy was 43.5 mm and for TMD was 82.06 mm. Use of TMH <43.5 with MMT has the highest sensitivity for predicting difficult intubation (78.38) with 75.36% specificity and 97.50% negative predictive value. TMH showed sensitivity of 91.89% and specificity 52.17% at 50 mm cut-off value. In the comparison of the area under the receiver operating characteristic curve values, none of the tests came forth individually or in combination with MMT test. CONCLUSIONS The present study demonstrates the practicality of TMH as a digitalized test however the clinical benefits of TMH in daily medical practice are drawn into question. The additional variable of race may have had some bearing on this and further studies, larger in patient sample size, may need to use different methodology concerning age-, sex-, and race-dependent variables in evaluating these tests.

Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial

STUDY OBJECTIVE Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC. DESIGN Single-blinded, prospective, randomized, efficiency study. SETTING Tertiary university hospital, postoperative recovery room & ward. PATIENTS 36 patients (ASA I-II) were recruited in two equal groups (block and control group). Following exclusion, 30 patients were included in final analysis. INTERVENTIONS Standard multimodal analgesia was performed in Group C (control) while ESPB block was also performed in Group B (block). MEASUREMENTS Pain intensity between groups were compared using Numeric Rating Scores (NRS). Also, tramadol consumption and additional rescue analgesic requirement were measured. MAIN RESULTS NRS was lower in Group B during the first 3 h. There was no difference in NRS scores at other hours. Tramadol consumption was lower in Group B during the first 12 h. Less rescue analgesia was required in Group. CONCLUSION Bilateral ultrasound guided ESPB leads to effective analgesia and a decrease in analgesia requirement in first 12 h in patients undergoing LC.

Hypoxia during general anesthesia? Unknown foreign body aspiration

An 18-month-old male patient, classified as American Society of Anesthesiologists I, with bilateral inguinal hernia was scheduled for operation. Preanesthetic evaluation revealed history of completed medical treatment of acute bronchitis 10 days ago, and his respiratory examination was recorded as normal. He was successfully operated under general anesthesia with a laryngeal mask. After removal of the laryngeal mask, he displayed signs of hypoxia. Respiratory sounds were undetectable in the left thorax. He was intubated due to failure of adequate ventilation. Positive pressure ventilation and bronchodilators were administered to provide sufficient ventilation. In his chest X-ray, total atelectasis was determined in the left lung. Pleural effusion was ruled out with thoracic ultrasonography. Diagnostic rigid bronchoscopy was performed, and in left bronchial tree, hazelnut fragments were removed. The patients hemodynamic and respiratory parameters recovered quickly after foreign body removal, and the patient was transferred to intensive care unit. His parents were questioned for persistent respiratory symptoms and they gave information about repeating respiratory tract infections in the last 3 months. We predict that displaced foreign body in lobar bronchus due to mechanical ventilation can cause this condition.

Scientific ArticleYouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesiaYouTube como fonte de informação de raquianestesia, anestesia peridural e anestesia combinada raquiperidural

Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information.

YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia

Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information.

YouTube as a source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia

Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information.