Kadir Bulut

Introduction and aimTwo consecutive earthquakes that razed the southeast part of Turkiye on February 06, 2023, were one of the strongest earthquakes ever recorded in the last century. Unfortunately, over 13 million people were affected in 11 provinces, and around 50,000 patients passed away, based on the official reports of the Turkish Government (1). Data from previous earthquakes demonstrated that 80% of patients who suffered from earthquakes stuck under the rubble suddenly died, and 10% survived with minor injuries. The remaining 10% of patients had severe injuries and needed hospitalization, including intensive care unit (ICU) admission (2). Presenting the issues encountered in earthquakes and sharing experiences and the results of the medical interventions can enable more accurate treatments to be applied after future earthquakes. Therefore, this study aims to provide information regarding the …

Introduction and aimIntellivent-ASV (I-ASV, Hamilton C6) is a mechanical ventilation mode using a closed loop mechanism. It provides real-time monitoring of transcutaneous arterial blood oxygen saturation (SpO2) and end-tidal carbon dioxide (ETCO2). If the operator sets the target values of SpO2 and ETCO2, the ventilator automatically adjusts the settings for oxygenation (FiO2 and PEEP) and ventilation (target minute ventilation, tidal volume, and ventilation frequency). In this study, we aimed to compare I-ASV with the P-SIMV mode, which is one of the conventional modes, in terms of mortality, lung mechanics, length of stay in the intensive care unit (ICU), and hospital stay in patients who are intubated in the ICU.Patients and methodsA prospective observational design was used for our research, and 64 patients were enrolled. These patients were followed up on 32 in I-ASV mode and 32 in P-SIMV mode. On the …

PurposeIn an effort to better manage critically ill patients hospitalised in the intensive care unit (ICU) after experiencing multiple traumas, the present study aimed to assess whether plasma levels of intestinal epithelial cell barrier proteins, including occludin, claudin-1, junctional adhesion molecule (JAM-1), tricellulin and zonulin, could be used as novel biomarkers. Additional potential markers such as intestinal fatty acid-binding protein (I-FABP), d-lactate, lipopolysaccharide (LPS) and citrulline were also evaluated. We also aimed to determine the possible relationships between the clinical, laboratory, and nutritional status of patients and the measured marker levels.MethodsPlasma samples from 29 patients (first, second, fifth and tenth days in the ICU and on days 7, 30 and 60 after hospital discharge) and 23 controls were subjected to commercial enzyme-linked immunosorbent assay (ELISA) testing.ResultsOn first …

Objective: The aim of this study was to investigate the effect of percutaneous tracheotomy on mortality and length of stay in the intensive care unit (ICU) for patients with COVID-19-associated acute respiratory distress syndrome (ARDS). Materials and Methods: This study included patients with coronavirus disease-19 (COVID-19-associated) acute respiratory distress syndrome who were treated with invasive mechanical ventilation in a pandemic intensive care unit. Patients admitted to the pandemic intensive care unit between March and July 2021 were retrospectively reviewed. Patients who underwent percutaneous tracheotomy and did not have a tracheotomy during the follow-up were statistically compared in terms of laboratory and clinical characteristics such as mortality and length of stay in the intensive care unit. Results: The study included 102 orotracheally intubated patients diagnosed with COVID-19 acute respiratory distress syndrome. The number of tracheotomized and not-tracheotomized patients was 34 and 68, respectively. The mean age of the patients was 60.39±14.10 years. The mean time to perform percutaneous tracheotomy was 7.94±6.11 days. There was no significant difference in mortality rate between the two groups (p= 0.298). However, patients who underwent tracheotomy had a longer length of stay in the intensive care unit compared to those who did not (35.00±24.60 days vs 13.20±11.69 days, p< 0.001).Conclusion: Our study found no statistically significant difference in mortality rate between the two groups in our study. Additionally, the length of stay in the intensive care unit was not better in tracheotomized patients …

Objective Coronaviruses that cause respiratory infections in humans are known to be neuropathogenic. The purpose of this study is to determine whether there is an association between the severity of viral pneumonia and anxiety and depression levels in patients admitted to an intensive care unit (ICU) with coronavirus disease 2019 (COVID-19). Methods Prospective study of 165 patients, patients were divided into two groups (intubated and non-intubated) according to whether they were intubated during follow-up. Results Of 165 patients included, 70 were intubated after the first 7 days of follow-up. The Generalized Anxiety Disorder-7 (GAD-7) score was 10.37±3.75 (p < 0.001) in these patients. The length of ICU stay was 25±22.3 days (p < 0.001), and the length of overall hospital stay was 28.28±23.37 days, significantly longer than in patients who were not intubated (p < 0.001). The Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment Score scores, as well as GAD-7 and Patient Health Questionnaire-9, were positively associated with length of ICU stay and length of hospital stay (p < 0.01). Conclusion The presence and exacerbation of anxiety and depression symptoms can provide information about the aggravation and progression of the underlying disease.

Objective: The aim of our study was to examine the impact of percutaneous tracheotomy on mortality in patients with COVID-19-associated acute respiratory distress syndrome and length of stay in the intensive care unit.Methods: The patients with COVID-19-associated acute respiratory distress syndrome treated on invasive mechanical ventilation in the pandemic intensive care unit were included in this study. Patients admitted to the pandemic intensive care unit between March and July 2021 were retrospectively reviewed. Patients who underwent a percutaneous tracheotomy and did not have a tracheotomy during the follow-up were statistically compared in terms of laboratory and clinical characteristics such as mortality and length of stay in the intensive care unit. Results: The study included one hundred and two orotracheal intubated patients diagnosed with COVID-19 acute respiratory distress syndrome. The number of tracheotomized and nottracheotomized patients was 34 and 68, respectively. The mean age of the patients was 60.39±14.10 years. Percutaneous tracheotomy was performed at a mean of 7.94±6.11 days. There was no significant difference in the mortality rate between the two groups (p= 0.298). The length of stay in the intensive care unit was longer in patients who underwent tracheotomy (35.00±24.60 days vs 13.20±11.69 days, p< 0.001). Conclusion: There was no statistically significant difference in mortality between the two groups in our study. Also, the length of stay in the intensive care unit was not better in tracheotomized patients. Although tracheotomy has some advantages in other severe lung diseases, its effect on …

Background:Acute phase reactants and inflammation biomarkers such as ferritin, procalcitonin, C-reactive protein (CRP), and complete blood count parameters (White blood cell, platelet count) are usually used to evaluate and monitor the disease severity and treatment response of systemic inflammatory diseases. In addition to these parameters, Immature granulocytes (IG) that increase during systemic infection, hematological malignancy, and drug treatments (such as chemotherapy and glucocorticoids) are important parameters for evaluating systemic inflammation. The sensitivity and specificity of IG are as high as the abovementioned inflammatory biomarkers for monitoring disease severity and treatment response.Aim:The aim of the study is to evaluate the relationship between IG count and the need for mechanical ventilation and mortality in patients hospitalized in the intensive care unit (ICU) due to …

Objective: Sepsis is a clinical condition that requires urgent treatment. Most patients with sepsis require intensive care. There is a high mortality rate. The primary aim of the present study was to examine risk factors for mortality in patients with sepsis or septic shock in a medical intensive care unit (ICU). The secondary objective was to analyze the demographic and clinical characteristics of these patients.Materials and Methods: This prospective study was conducted in a medical ICU. Patients diagnosed with sepsis according to the international consensus definition (Sepsis-3) and requiring ICU treatment were included in the study. Demographic and clinical characteristics were recorded and analyzed.Results: A total of 134 patients with sepsis were enrolled in the study. The mean age was 60±18 years and 49% were male. The most frequent reasons for admission to the ICU were respiratory failure (45.5%) and shock (44%). Gram-negative bacteria were present in 48%, Gram-positive bacteria in 15%, fungus in 8%, and there was no culture positivity in 29% of the patients. The in-hospital mortality rate was 51%. The need for vasopressor drugs (odds ratio [OR]: 4.612, 95% confidence interval [CI]: 1.273–16.781) or mechanical ventilation (OR: 25.312, 95% CI: 4.225–151.852) was an independent risk factor for mortality. Conclusion: Patients treated in the ICU for sepsis or septic shock had a high mortality rate. The need for vasopressor drugs or mechanical ventilation was an independent risk factor for mortality.

Safra taşı ve alkol kullanımı akut pankreatitin (AP) en yaygın iki nedenidir. Hipertrigliseridemi (HTG) ise nadir görülen ancak iyi bilinen akut pankreatit nedenlerindendir. Kliniği diğer akut pankreatitlerden farklı değildir. HTG’ye sekonder pankreatit olgularında bir veya daha fazla ikincil faktörün (kontrolsüz diyabet, alkolizm vb.) varlığı söz konusudur. Tedavisi diğer pankreatitlerin tedavisine benzemektedir. HTG'li diyabetik hastalarda insülin infüzyonu, trigliserit düzeylerini hızla düşürebilir. Aferez kullanımı ise hala deneysel olup HTG pankreatitinin yönetimindeki rolünü açıklığa kavuşturmak için daha iyi tasarlanmış çalışmalara ihtiyaç vardır. Olgu: 39 yaşında erkek hasta karın ağrısı, bulantı, kusma şikâyeti ile acil serviste görüldü. Hastanın özgeçmişinde diabetes mellitus ve hiperli-pidemi mevcuttu. Fizik muayenede, batında distansiyon, epigastrik bölgede hassasiyet ve Murphy bulgusu pozitifti. Abdomen bilgisayarlı tomografisi AP ile uyumlu, trigliserit (TG) düzeyi 9884 mg/dL idi. Hasta, HTG-AP olarak kabul edildi; hidrasyon, insülin infüzyonu ve plazmaferez tedavisi uygulandı. Ancak TG seviyesinde etkili bir düşme olmaması nedeni ile 3 gün lipid aferezi uygulandı. Hastanın TG seviyesinde 673 mg/dL'ye kadar düşme sağlandı. Sonuç: HTG-AP’de TG düzeylerini efektif olarak normal seviyelere çekmek AP progresyonunu önlemede çok önemli olup lipid aferez yöntemi alternatif ve etkin bir yöntemdir.

İntroduction Sildenafil is a phosphodiesterase 5 enzyme inhibitor used in the treatment of erectile dysfunction and pulmonary hypertension. The use of sildenafil with nitrates is well known to cause myocardial ischemia. However, patients with a history of hypotension, arrhythmia, previous myocardial infarction, or stroke should be given sildenafil carefully. A few cases have been reported in the literature related to ischemic stroke and transient ischemic attack due to sildenafil use. Case report We report a case of middle cerebral artery (MCA) infarction after two tablets sildenafil in a 57-year-old male patient with no underlying disease. In the diffusion MRI (magnetic resonance imaging) imaging of the patient, acute diffusion limitation was observed in the left frontal lobe and parietal lobe starting from the centrum semiovale level and also in the MCA supply area affecting the medial section of the temporal lobe. We believe that this infarction is caused by the development of severe hypotension due to alcohol use with sildenafil. Conclusion Not only availability of hypotension, history of MI and stroke, health care providers should also give attention prescribing sildenafil in the case of cigarette and alcohol use.

Datura stramonium is grown widely in some regions of Turkey. Datura stramonium seed is used in the treatment of various diseases such as constipation and acne and causes anticholinergic toxicity when taken in overdose. In the literature, patients presenting with mild symptoms are the majority, and intensive care follow-up is often not required for these patients. In this case report, we present a 50-year-old male patient who received around 200 Datura stramonium seeds for the treatment of chronic constipation. When the patient admitted to the emergency department, he was unconscious, and his pupils were dilated. The patient who had severe vomiting and contractions was intubated. With the diagnosis of anticholinergic syndrome, physostigmine 0.5 mg (one dose) and 1 mg (two times) were administered to the patient with central nervous system findings. The patient who developed sepsis due to aspiration pneumonia during the follow-up stayed in the intensive care unit for 40 days with the support of mechanical ventilator for 37 days. The patient was discharged after 26 days of treatment in the physical therapy service. Accidental ingestion of Datura stramonium seed used for herbal therapy in high doses may cause life-threatening consequences due to its anticholinergic effects or complications related to these effects.

Objective: This study aims to investigate the characteristics and outcomes of patients infected with SARS-CoV-2 admitted to the intensive care unit (ICU).Materials and Methods: This study was performed retrospectively in a medical ICU. All patients admitted to were either laboratory-confirmed or clinically probable COVID-19 patients, and all patients admitted to our ICU during this period were enrolled in the study.Results: We enrolled 47 patients. The mean age was 68.4±13.4 years and 66% of patients were male. The most common co-morbidities were hypertension (66%) and cardiovascular diseases (40%). The mean APACHE II score was 22.4±8.5, and the first-day median SOFA score was 5 (range: 1–12). Hydroxychloroquine was the most common drug prescribed (78.7%). All patients received at least one antibiotic other than Azithromycin as the most common drug was Piperacillin-Tazobactam (63.8%). Among 47 patients, 55.3%(28 patients) who were admitted to the ICU needed invasive mechanical ventilation. Prone positioning was used in 23%(6 patients) of mechanically ventilated patients. The mean positive end-expiratory pressure (PEEP) was 10±3 cm H2O. The median PaO2/FiO2 ratio was 200 (range, 91–458). The most common ventilator mode was SIMV-PSV volume-controlled mode. ICU mortality rate was 34%(16 patients).Conclusion: The most common reason to admit SARS-CoV-2 infected patients to our ICU was acute respiratory failure and hypoxemia during the first month of pandemics. COVID-19 patients have a high mortality rate when they develop severe disease.