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Objective: Hypercoagulopathy related to hyperinflammation may be responsible for mortality and organ failure in coronavirus disease-2019 (COVID-19) patients. Abnormal coagulation profiles were associated with poor outcomes. In this study, we aimed to evaluate the prognostic value of antithrombin (AT) levels in critically ill COVID-19 patients on the intensive care unit (ICU) admission. Materials and Methods: Four hundred ten critically ill COVID-19 patients were retrospectively analyzed. Inflammatory and conventional coagulation parameters as well as AT activity levels were recorded on the ICU admission. The clinical outcomes of patients were analyzed. Results: AT levels on the ICU admission were significantly lower in non-survivors than survivors (77.9% vs. 82.5%; p=0.027). Besides AT, D-dimer values of non-survivors were significantly higher than survivors (2775 vs. 1495 µg/L; p<0.001). The cut-off levels for AT and D-dimer were 70.5% and 1585 µg/L, respectively. When AT and D-dimer were analyzed together, mortality estimation was better than only D-dimer or AT. Conclusion: Low AT levels may be indicative of severe disease and mortality together with high D-dimer levels in COVID-19 patients. Diagnosing and managing AT deficiency in COVID-19 patients could be beneficial for survival. So AT level measurements should be included in the routine panel of laboratory investigation. [ABSTRACT FROM AUTHOR]

Objective: Tocilizumab (TCZ) is a recombinant humanized anti-interleukin-6 receptor monoclonal antibody that is beneficial in critically ill coronavirus disease-2019 (COVID-19) patients. However, the clinical efficacy and safety of immunosuppressants (including TCZ, sarilumab and anakinra) in COVID-19 patients are not yet known. These treatments may predispose patients to infection. The aim of this study was to find any connection between the use of TCZ and increased secondary bacterial infections. Materials and Methods: In this study, we conducted retrospective analyses of secondary bacterial infections in COVID-19 patients in the intensive care unit (ICU). This study included patients with laboratory-confirmed COVID-19 infection or clinically and radiologically confirmed COVID-19 infections who were admitted to the university hospital adult ICUs between March 2020 and January 2022. Demographic data, recent exposure and travel history, clinical symptoms or signs, laboratory findings, and comorbidities were recorded. Microbial cultures from tracheal aspirates, blood, and urine were obtained at admission and throughout the hospital stay. The patients who received TCZ treatment noted and analyzed for seconder infections. Blood cultures were taken at least 48 hours after the first dose of TCZ. Results: We found that 80 patients (%37) had positive culture samples at admission, and most of these cases were admitted to the ICU from various hospital wards. The analyzed data showed that the TCZ group had a higher incidence of positive culture samples (75% vs. 35%, p=0.0001). The results showed that culture of TCZ taken patients had more incidence with methicillin resistance Staphylococcus aureus, Klebsiella spp. and Acinetobacter spp. (p=0.0001). Infection and mortality rates were much higher than those in the usual care group. Conclusion: Secondary infections and sepsis are major risk factors for mortality. The pathogens detected were drug resistant and had a lower chance of treatment. The benefit of TCZ treatment was lost in these patients because of secondary infections. Future studies are needed to help determine the risks of TCZ treatments. [ABSTRACT FROM AUTHOR]

Objective: This study aims to determine the risk factors affecting the development of pressure injuries for inpatients in the intensive care unit, to determine the nursing interventions conducted to prevent pressure injuries, and to detect healing of the pressure injuries. Materials and Methods: This follow up-longitudinal type study was conducted with 48 patients at an Intensive Care Unit in a public hospital between 01.09.2018 and 30.11.2018. Study data were collected using the Braden scale for predicting pressure injury risk, pressure injury assessment form, and pressure injury healing assessment form. Results: Patients who had a hospitalization duration of 15 or more days, were supported with mechanical ventilators, were unconscious, were fed enterally, were immobile in bed, had an albumin level of 2.5 g/dL or below, or had a hemoglobin level of 10 g/dL or below had significantly more pressure injuries (p<0.05). No significant difference was found with nursing interventions (positioning, massaging, using barrier cream, moisturizing the skin, keeping the bed linen dry and stretched) performed in the clinic and the development of a pressure injury or healing of pressure injuries present during admission to the clinic (p>0.05). Conclusion: The main risk factors for developing pressure injuries in inpatients in the intensive care units were enteral feeding, consciousness or unconsciousness, and level of hemoglobin. More pressure ulcers occurred on patients who were positioned and whose skin was moistened because nurses applied interventions to patients with a high risk of pressure ulcers. Additionally, there was no improvement in the healing of the compression injuries. [ABSTRACT FROM AUTHOR]

Objective: Management of the intensive care process by family caregivers and high levels of hope may have positive effects on the recovery process of the intensive care unit (ICU) patients. This study analyzes the relationship between the levels of hope and anxiety in family caregivers of patients in ICUs. Materials and Methods: Family caregivers of the patients, who were hospitalized at seven adult ICUs in city İstanbul, constituted the universe of the study. A sample of the study comprised 99 voluntary family caregivers. Descriptive and sociodemographic Information form, the Dispositional Hope scale, and State-Trait Anxiety scale were used for data collection. One-Way analysis of variance, independent sample t-test, and Pearson’s correlation was used for data analysis. Results: In the study, the hope levels of the participants were found to be “high” and their anxiety levels were found to be “moderate.” Patients’ age, and the family caregivers’ marital status, and levels of education and income did not affect the levels of hope and anxiety. However, age, the changes in family relations and life at home, and being sufficiently informed about the patient’s condition influenced the levels of anxiety and hope in family caregivers. Conclusion: There was a negative relationship between the levels of hope and anxiety in family caregivers of the adult ICU patients. [ABSTRACT FROM AUTHOR]

Objective: The benefit of medical interventions applied in terminal patients who have no hope of recovery and whose death is thought to be approaching is still a controversial issue. In this study, it was aimed to analyze the terminal stage patients hospitalized in the intensive care unit. Materials and Methods: The general characteristics and laboratory results of 61 end-stage patients admitted to the adult intensive care unit of university hospital between December 2016 and may 2017 were examined. Life expectancy, mortality rates, factors affecting mortality, and costs per patient were evaluated according to the palliative prognostic index (PPI) and palliative care admission score (PCAS) of the patients. Results: Exitus patients had an average of 13.83 days of intensive care stay and patients who survived had a mean 30.69 days (p<0.05). The PCAS was not statistically significant between ex and alive patients. Exitus patients had a PPI of 6.48, whereas survivors had a PPI of 3.73, (p<0.05). Exitus patients had a mean palliative life expectancy of 3.78 days, whereas the palliative life expectancy of surviving patients was 71.42 days (p<0.05). The most common primary disease for intensive care admission is malignancy, with 33 patients. The average cost of treatment for exitus patients was $3654,50, while the cost of treatment for surviving patients was $7053,38 (p<0.05). Conclusion: End-stage patients should be admitted to the palliative care unit or hospice using prognostic scoring systems. The bed capacity in intensive care units should be used for patients who have a chance to be treated. It is thought that unnecessary health expenditures can be avoided by hospitalizing terminal patients in palliative care units and hospices. [ABSTRACT FROM AUTHOR]

Objective: Patients in pediatric intensive care units are more likely to develop serious nosocomial infections due to comorbidities, longer and more invasive procedural treatments, and the development of immunosuppression. We described Candida infections, management, morbidity and mortality in critically ill pediatric patients. Materials and Methods: A retrospective single-center study includes patients aged 1 month-18 years treated against candidemia from January to December 2021. This included those who had blood cultures of Candida species growth. We excluded patients with infection Candida in endotracheal aspiration and/or urinary specimens, etc. The demographic characteristics, medical histories, comorbidities, length of stay, need for mechanical ventilation supports, laboratories, relationship use of catheters and total parenteral nutrition, treatment periods, antifungal response/ resistance, duration of treatment and adverse effects, morbidities/mortalities. Results: In this study, the total mortality rate was 40.7%, and the mortality rate due to candidemia was detected at 44.4%, but the correlation between candidemia and mortality was not significant (p=0.975). However, 18.5% of them are caused by nosocomial. The mortality risk did not change for subtypes (p=0.975). No significant correlation was found when mortality (p=0.07) and central venous catheter infection (p=0.563) were compared using total parenteral nutrition. Conclusion: In our study, in which 27 patients were followed up for nosocomial candidemia, the rate of candidemia was found to be higher in patients with comorbidity, long-term mechanical ventilation support, central venous catheter use, long hospital stay, parenteral nutritional support, and high Pediatric Risk of Mortality III score. C. parapsilosis was detected most frequently in our Candida subtype unit with a rate of 59.3%. The fluconazole 8 (29.6%), amphotericin B 18 (66.7%) and voriconazole 1 (3.7%) patients were initiated. At this treatment time, only 4 (14.8%) patients developed organ failure. In our study, we detected a total mortality rate of 40.7%. However, 18.5% of them were caused by nosocomial candidemia. Considering all these reasons, we believe that our risk factors, diagnosis, treatment, follow-up, and management process will contribute to the literature. [ABSTRACT FROM AUTHOR]

Objective: This study was planned to evaluate the clinical features and outcomes of patients hospitalized in intensive care units (ICUs) on-hours [workdays (WD)] and out of hours [time-off (TO)]. Materials and Methods: Ethics committee approval was obtained for this study. Patients hospitalized in adult ICUs between July 2021 and January 2022 were retrospectively evaluated. The patients were divided into two groups: those who were accepted during on-hours (group WD, WD 08.00 am-05.00 pm) and out of hours (group TO; WD-05.01 pm-07.59 am, weekends, and all public holidays). The groups were compared in terms of patient characteristics and intensive care outcomes. Results: Of the 173 patients included in the study, 69.94% (n=121) were hospitalized during out-of-hours and 30.05% (n=52) during on-hours. The median age of the patients was 70.3±9.5 years, 58.4% were male and 41.6% were female. The number of patients hospitalized in TO was statistically significantly higher than the number of patients in WD (p=0.04). There was no significant difference between the two groups in terms of demographic data, except that chronic renal failure (18.2%, p=0.024) was more common as a comorbidity in TO patients. The need for continuous renal replacement therapies treatment, which is one of the reasons for ICU admission, was found to be significantly higher in TO patients (p=0.048). The length of stay in the ICU and intubation period was higher in group TO (p=0.006, p=0.022). It resulted in death in 34.1% of the patients. There was no significant difference in mortality and discharge between the groups. Conclusion: In our study, the clinical outcome was found to be similar in patients followed up in ICUs under WD and TO conditions. This result; This can be attributed to the fact that the shift team is not different in our hospital, the number of experienced health personnel is high, and the necessary diagnostic procedures are not delayed. [ABSTRACT FROM AUTHOR]

Objective: The World Health Organization has emphasized that as there is no specific anti-coronavirus disease-2019 (COVID-19) treatment, supportive care according to disease severity is important. Previous studies have shown that acute kidney injury (AKI) develops in 30% of severe COVID-19 patients followed up in intensive care units and most these require renal replacement therapy. This study aimed to evaluate the COVID-19 prognosis, renal function, and organ systems of adult, severe COVID-19 patients treated with continuous renal replacement therapy (CRRT) and the effects on secondary hemophagocytic lymphohistiocytosis with the additional application of absorption filters. Materials and Methods: A retrospective examination was made of the data of COVID-19 patients who applied for CRRT between 11.03.2020 and 15.06.2021. The demographic data of the patients were recorded together with the renal function test results before and after CRRT, and the biochemical parameters were included in the COVID-19 prognosis. Results: Positive changes were determined in the kidney functions with CRRT applied to patients who developed AKI. No statistically significant difference was observed in the biochemical parameters included in the COVID-19 prognosis. In the 14 patients who applied with hemoabsorption, the need for short-term inotropic support was reduced. In our study, the mortality of the patients who were treated with CRRT was 95% (2 patients transferred to the ward), while the average intensive care unit stay was 18.2±11 days. While improvement was detected in renal function tests with CRRT applied to patients with AKI, no statistically significant difference was found in biochemical parameters in the prognosis of COVID-19. While mortality was 92.8% in 14 patients who underwent hemoabsorption, a short-term improvement was observed in the need for inotropes in these patients. Conclusion: Although vaccinations are expected to definitively eliminate COVID-19, for critical COVID-19 patients for whom the treatment options are limited, it would seem rational to adopt immunomodulator strategies including extracorporeal blood purification and supportive treatment such as CRRT. The results of this study have shown that CRRT applied to severe COVID-19 patients who develop AKI is an effective treatment for kidney failure. However, the effect on the progression of COVID-19 could not be clearly shown. [ABSTRACT FROM AUTHOR]

Objective: Indirect calorimetry (IC) is considered the gold standard in the accurate determination of energy consumption in intensive care patients. This study compared measured energy expenditure (MEE) with estimated energy expenditure (EEE), calculated from predictive equations, in mechanically ventilated patients. Materials and Methods: This study was conducted on 40 patients hospitalized in our medical/ surgical intensive care unit. Twenty four-hour energy consumption measured by IC and energy consumption calculated by adding correction factors for actual and corrected weights using HarrisBenedict, Schofield, Ireton-Jones and Swinamer equations were compared. Results: MEE was 2697.9±606.0 kcal/day. All of the EEE values, calculated using equations were moderately correlated with MEE and correlations were stronger with adjusted body weights, however, Bland-Altman statistics represent wide limits of agreement. From another perspective, EEE corresponding to between 80% and 110% of MEE was considered an adequate feeding range and provided the best levels of proficiency using adjusted body weight and Long factors; however, at least, 20% of patients remained at under-or overfeeding risk. Conclusion: It was concluded that the estimation equations are unreliable in determining energy consumption in mechanically ventilated intensive care patients due to wide limits of agreement. Estimates falling in the range of 80-110% of MEE also indicate the possibility of malnutrition. Our study supports previous studies, which indicated that nutrition management requires an individual approach. [ABSTRACT FROM AUTHOR]

Objective: This methodological study was conducted in order to carry out the adaptation and validation of the “PRE-DELIRIC score” prediction of delirium model in Türkiye among patients hospitalized in the intensive care unit (ICU). Materials and Methods: The research involved 172 patients treated in the intensive care units of a training and research hospital between October 2019 and April 2020. The study data were collected using (1) a data collection form to determine the participants’ descriptive characteristics, (2) the PRE-DELIRIC score, and (3) the Confusion Assessment Method for the ICU (CAM-ICU). Receiver operating characteristic (ROC) analysis and diagnostic screening tests were applied for the purpose of determining cut-off points for the groups. The scores’ sensitivity and specificity were calculated. Significance was evaluated at the p<0.05 level. Results: A statistically significant association was determined between the cut-off point obtained for the PRE-DELIRIC score (≥7.58%) and the study groups (p=0.003). Patients with PRE-DELIRIC scores of 7.58 or higher exhibited a 7.404-fold greater risk of being CAM-ICU-positive [odds ratio: 7.404; 95% confidence interval (CI): 1.638-33.469]. The area under the ROC curve was 64.9% (95% CI: 0.538-0.760), and the standard error was 5.6% (p=0.044). Conclusion: The PRE-DELIRIC score yielded reliable results in this study. It appears significant for patients with a likelihood of developing delirium within the ICU, and its use is recommended as a functional score that is easily applied and calculated. [ABSTRACT FROM AUTHOR]

Objective: This research was conducted to determine the pain behaviors and physiological parameters of patients connected to mechanical ventilators in the postoperative surgical intensive care unit. Materials and Methods: This study was conducted descriptively and observationally with 176 patients. The introductory information form, physiological parameters follow-up form, behavioral pain scale (BPS), and Ramsey sedation scale were used to collect data. Descriptive statistics, TwoWay variance in repeated measures, Friedman analysis, post-hoc Bonferroni analysis, One-Way variance analysis, Kruskal-Wallis analysis, and Spearman correlation analysis were used. Results: The mean arterial pressure (MAP), heart rate and mean BPS scores increased (p<0.001), and oxygen saturation decreased during aspiration, wound care, and position change (p<0.001). Additionally, while a moderate, positive correlation was found between BPS and MAP and heart rate during wound care (r=0.447; p=0.001, r=0.306; p=0.033). A moderate negative correlation was found between oxygen saturation and BPS during aspiration (r=-0.389; p=0.000). Conclusion: It has been revealed that individuals connected to mechanical ventilators experience pain during wound care, position change and aspiration. Physiological parameters and behavioral symptoms resulting from pain should be analyzed together. Pain should be relieved with pharmacological and non-pharmacological nursing interventions in pain management. [ABSTRACT FROM AUTHOR]

Objective: Bronchoscopy is important for the diagnosis and treatment planning of patients in the intensive care unit, especially for infectious conditions. However, increasing evidence is reported in recent guidelines showing that bronchoscopic sampling is not superior compared with endotracheal aspirate (ETA). This study aimed to evaluate the contribution of bronchoscopic sampling to antibiotic treatment and its effect on intensive care mortality. Materials and Methods: This retrospective observational study evaluated the data of 75 patients who were followed up under invasive mechanical ventilation using the intensive care fiberoptic bronchoscopy (FB) database. Results: The mean age of patients was 66.0±15.4 years, and 28 (37.32%) were female and 47 (62.7%) were male. The mean acute physiology and chronic health evaluation-II score was 23.1±6.2. Median FB timing was 7.0 (2.0-15.0) days after the intensive care unit admission. Indications for FB were infection evaluation in 44 patients, airway evaluation in 26 patients, hemoptysis-alveolar hemorrhage in 3 patients, and interstitial lung disease suspicion in 2 patients. Active immune suppression was present in 24 (32%) patients. Evaluation of ETA results revealed bacterial and fungal growth in 31 patients (41.3%). After FB sampling, 41 patients (54.6%) were found to have bacterial and fungal growth, and treatment was changed in 16 (21.3%) patients with FB sampling. However, no significant relationship was found between the change of treatment after FB and mortality in the intensive care unit (p=0.250). Conclusion: Our study has two important results. First, ETA and FB sampling results were found to be similar. Second, no correlation was found between treatment change after FB in the late period and mortality in intensive care. The application of FB, which is an invasive procedure, could be the right approach in selected patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the environmental stressors perceived by patients admitted to the surgical intensive care unit. Materials and Methods: This is a descriptive and cross-sectional study. The sample of the study comprised 83 patients hospitalized in the surgical intensive care unit. Data were obtained from the Patient Information Form and the Intensive Care Unit Environmental Stressor scale. Results: Patients hospitalized in the surgical intensive care unit identified the most critical stressors as experiencing pain, inability to sleep, lack of privacy, getting bored, and short family and friends visit time, whereas the minor stressful factors were identified as hearing phone sounds, nurses who are more concerned with bedside devices than the patients, and constantly looking at the ceiling. Conclusion: Environmental stressors affecting patients in the intensive care unit should be identified and eliminated. This initiative will prevent new stress-related health problems and improve patient quality care. [ABSTRACT FROM AUTHOR]

Objective: Since the coronavirus disease-2019 (COVID-19) pandemic caused respiratory failure in many patients, oxygen delivery methods had to be diversified, and their numbers increased. High flow nasal cannula (HFNC), which has been shown beneficial in acute respiratory failure previously, also came to the fore. We investigated the efficacy of HFNC on patients hospitalized in intensive care units due to COVID-19. Materials and Methods: We retrospectively screened the patients followed up in the intensive care unit due to COVID-19. Patients treated with HFNC performed the study group. We analyzed the relationships among demographics, laboratory results, treatment modalities, complications, and outcomes. Results: Among the 330 patients including mean ventilation duration with HFNC was 7.84 days. One hundred seventy (51.5%) patients were intubated during HFNC treatment. Only 5 of them were extubated. Intubated patients had higher mean HFNC duration [9.74 days - minimum (min): 2, maximum (max): 49] compared to non-intubated patients (6.05 days - min: 1, max: 30). There was a significant relationship between mortality and age [Odds ratio (OR): 1.04], Acute Physiology and Chronic Health Evaluation-II score (OR: 1.35), having cancer (OR: 3.89), receiving non-invasive ventilation (OR: 5.94), and presence of secondary bacterial infection (OR: 44.6). Conclusion: HFNC, whose benefit in acute respiratory failure has been proven, is also widely and successfully used in COVID-19 patients. Comprehensive randomized studies are required to demonstrate the effect of HFNC use on intubation requirement and mortality. [ABSTRACT FROM AUTHOR]

Objective: The patients admitted to coronavirus disease-2019 (COVID-19) intensive care units (ICUs) with the suspicion of COVID-19 in the first four months of the pandemic were evaluated both in diagnostics and according to periods of the pandemic. Materials and Methods: The data of 1,430 patients admitted to the COVID-19 ICUs were recorded with the same algorithm in a single-center retrospectively. Patients were classified as COVID-19 and non-COVID-19 patients according to polymerase chain reaction results, radiological and clinical findings. Also, COVID-19 patients were compared as dying and surviving. Additionally, the data of patients admitted to COVID-19 ICUs during the onset of the pandemic and during the normalization period were also compared. Results: Of 1,430 patients, 630 were included in the COVID-19 group and 800 in the non-COVID-19 group. While there was a significant difference in the mean age of the groups, there was no difference between the genders (p=0.001, p=0.262 respectively). The age in the COVID-19 and deceased group was higher than that in the survivors (p<0.001). The most common presenting symptom was dyspnea (51.2%), while hypertension’s most common comorbidity (51.2%). During the normalization period, the rate of patients admitted to the ICU with the diagnosis of COVID-19 and the mortality rates in the ICU was higher. Conclusion: The initial period of the pandemic was spent understanding COVID-19, which entered our lives as a mystery at the same time. It was a guiding period for us to treat patients more effectively while protecting the community and healthcare professionals. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to investigate the correlation between the inferior vena cava collability index (IVC-CI) used in the evaluation of fluid volume and the nutrition risk index (NRI), prognostic nutrition index (PNI), geriatric nutrition risk index (GNRI) and controlling nutritional status scoring (CONUT) used in the evaluation of malnutrition. Materials and Methods: This study is a prospective observational study. Demographic data, laboratory data, body mass indexes (BMI), NRI, PNI, GNRI and CONUT in the first 24 hours of admission to the intensive care unit of 96 critically ill patients admitted to the tertiary intensive care unit with assisted invasive mechanical ventilator support. and IVC-CI values were recorded. Patients with an IVC-CI >45% were evaluated as hypovolemia. Of the patients, 61 (63.5%) patients with an IVC-CI value of 45%≥ were group 1, and 35 (36.5%) patients with an IVC-CI value of >45% were determined as group 2. Correlation between the IVC-CI and malnutrition scores was investigated between the groups. Results: In our prospective observational study, there was a statistically significant difference in admission to ICU between hypovolemic (IVC-CI; >45%) and non-hypovolemic (IVC-CI; ≤45%) critical intensive care patients according to all four nutritional scores (NRI, PNI, GNRI and CONUT). More severe malnutrition was detected in the hypovolemic patient group. In addition; there was a statistically significant difference between hypovolemic and non-hypovolemic groups according to IVC-CI (%) in the laboratuvar values [BMI, lymphocyte count (103 /uL), neutrophillymphocyte ratio, creatinine (mg/dL), albumin (g/dL), CRP albumin ratio, total cholesterol (mg/dL), triglyceride (mg/dL), urea (mg/dL), total bilirubin (mg/dL), prealbumin (mg/dL), LDH albumin ratio, potassium (mEq/L), procalcitonin, lactate (mmol/L)]. According to the correlation analysis, we found a statistically significant correlation between IVC-CI (%) and NRI, PNI, GNRI and CONUT scores. Conclusion: As a result of our study, we found that there is a significant correlation between IVC-CI, which is a radiological imaging method and used as a dynamic parameter in the evaluation of fluid volume, and NRI, PNI, GNRI, and CONUT scores used in the evaluation of malnutrition [ABSTRACT FROM AUTHOR]

Introduction: Severe acute respiratory syndrome-coronavirus 2 is the last member of β-coronaviruses to cause coronavirus disease-2019 (COVID-19), which has left deep traces in human history with pandemic effect over the last three decades. Nevertheless, an established approach associated with high intensive care unit (ICU) mortality and predicting disease’s poor prognosis has yet to be implemented. We sought to investigate parameters determining worse outcomes among patients hospitalized in ICU for COVID-19. Materials and Methods: Two hundred and seventy consecutive COVID-19 patients were retrospectively included in this single-center study. Baseline characteristics, risk factors, laboratory values, and therapies received by each individual were gathered from hospital’s registry. ICU mortality was the primary endpoint, while the secondary endpoint was a composition of acute renal failure, pulmonary thromboembolism, cerebrovascular events, and acute coronary syndromes. Regression analyses were run to determine which factors had an independent association with endpoints. Results: Mean age of the entire population was 68.4±13.2 years, with 174 males. Those who died had a significantly older age, lower systolic blood pressure, and a higher heart rate than survivors. Also, former had a higher likelihood of stroke, chronic renal disease, and atrial fibrillation. When laboratory findings were analyzed, it was discovered that numerous parameters in deceased individuals were impaired. Except for unfractionated heparin and LMWH, medications used to treat COVID-19 were comparable between two groups (Table 1). Multivariable logistic regression analysis showed that age, oxygen saturation, stroke history, LDH, and LMWH treatment had an independent relationship with primary endpoint; age, systolic blood pressure, stroke history, and troponin, on the other hand, were the determinants of secondary endpoint (Table 2). Additionally, ROC analysis demonstrated that LDH (AUC: 0.743, 95% CI: 0.684-802) was the best predictor of primary endpoint, whereas troponin (AUC: 0.793, 95% CI: 0.741-846) was the best determinant of secondary endpoint (Figure 1). Conclusion: We found that a variety of clinical and laboratory indicators are linked to poor ICU outcomes in COVID-19 [ABSTRACT FROM AUTHOR]

Introduction: Hospital-acquired anemia (HAA) is common, especially in the most intensive care patients (ICP). Several literature series suggest that patients who develop HAA have increased mortality and morbidity compared with those who do not. The cause of HAA is likely multifactorial; iatrogenic blood loss,impaired erythropoiesis, bleeding episodes all can lead to HAA in ICP. Little research has focused on HAA, which develops during ICU admission of ARDS patients. The objective of this study was to investigate the incidence HAA, as well as its relationship with mortality, in COVID-19 associated ARDS patients admitted to ICU. Materials and Methods: We retrospectively analyzed all adult COVID-19 ARDS patients admitted to our ICU between January 2020 and December 2021 (n=1,007). Patients with missing data (n=7) or who have a length of ICU stay of less than 24 hours (n=10) were excluded. In addition, patients with chronic anemia at admission (n=445) were also excluded, because main focus of the study was development of HAA. Anemia is defined as a hemoglobin (Hgb) value <12 g/dL in women and <13 g/dL in men by WHO. HAA was defined as a nadir Hgb value during the course of ICU stay meeting WHO criteria. We further grouped Hgb by degree into mild anemia (Hgb >11 and <12 g/dL in women, >11 and<13 g/dL in men), moderate anemia (Hgb >9 and ≤11 g/dL) and severe anemia (Hgb ≤9 g/dL). COVID-19 ARDS is diagnosed when the patient with confirmed COVID-19 infection meets the Berlin 2012 ARDS diagnostic criteria. Baseline patient characteristics, admission Hgb and lactate levels, lengths of ICU stay and in-hospital mortality of patients who developed HAA were compared with those who did not develop HAA. We further stratified the patients based on the severity of HAA. Results: HAA developed in 373 (68.4%) patients. Characteristics and mortality rates of patients with and without HAA are presents in Table 1. Table 2 shows the data of the patients by presence and severity of HAA. Conclusion: Development of HAA is common and associated with higher in-hospital mortality. Patients who developed severe HAA has the highest mortality rates (73.1%). Hospitals must raise awareness of HAA. [ABSTRACT FROM AUTHOR]

Introduction: Low hemoglobin levels are associated with an increased risk of mortality in intensive care (ICU) patients. The underlying reason is due to the limitation in oxygen delivery to the tissues caused by a reduction in the number of oxygen carrying erythrocytes. This study aimed to examine the relationship between hemoglobin drop (DHgb= admission hemoglobin-nadir hemoglobin), nadir hemoglobin levels (NdrHgb; the lowest hemoglobin value during ICU stay) and mortality in COVID ARDS patients admitted to intensive care. Materials and Methods: This was a prospective non-randomized study of consecutive COVID ARDS patients who had at least two determinations of hemoglobin level (the first on admission) separated by 24 hours and an ICU stay <14 days. Admission hemoglobin (AdmHgb), NdrHgb and DHgb levels were analyzed. Data on blood transfusions were also collected. Results: Although high DHgb and low NdrHgb levels were significantly associated with mortality in univariate analysis of patients, this was not sustained in multivariate analysis. The area under the ROC curve (AUC) of DHgb was 0.577, with a cut-off value of 1.9 g/dL, sensitivity and specificity were 50.7%, and 65.2%, respectively. NdrHgb had a cut-off value of 10.7 g/ dL, with an AUC of 0.423, sensitivity and specificity of 50%. Conclusion: Our results showed that DHgb and low NdrHgb levels are both predictive markers for mortality with moderate sensitivity and specifity. We recommend further studies evaluating a simple scoring model based on DHgb and NdrHgb for predicting mortality. [ABSTRACT FROM AUTHOR]

Objective: The number of cancer cases and mean life expectancy are increasing with improvements in diagnosis and treatment options. This increase creates the need for intensive care units (ICUs) for cancer patients. This study aimed to determine the risk factors associated with admission of cancer patients to the ICU, intensive care prognosis, and mortality rates and cost per patient. Materials and Methods: In this study, we analyzed the data of cancer patients who were followed up in Pamukkale University Faculty of Medicine, Anesthesiology ICU. The variables that were analyzed included intensive care prognosis, mortality rates, risk factors affecting mortality, and cost per patient. ICU patient’s folders, epicrisis reports, and follow-up documents of 251 patients with solid or systemic malignancies who were admitted to the ICU of Pamukkale University Faculty of Medicine, Anesthesiology Department for a period of two-years were analyzed. Results: The most common reason for admission to ICU for patients with solid or systemic malignancies was respiratory failure 63.34% (n=159) followed by sepsis 16.33% (n=41) and cardiac arrest 5.17% (n=13). According to the cancer staging of the patients, 58.5% (n=147) were classified as stage 4 and 16.3% (n=41) as stage 3. The cost per patient per day in the ICU ranged from 186.86 Turkish Liras (TL) to 4407.39 TL and the mean cost was 1628.49±524.12 TL. The mortality rate among these cancer patients was 89.2%. Conclusion: Most of the cancer patients died in the ICU with high medical expenses. When patients are evaluated for admission to the ICU, the patient’s primary physician and ICU physician should reach a consensus as to whether the patient is in a terminal condition or not and whether palliative care should be administered to them. [ABSTRACT FROM AUTHOR]

Objective: This study aims to determine the distribution of microorganisms isolated from urine cultures collected from patients treated in the intensive care unit (ICU) of our hospital in the last 4 years and to conduct a study on antibiotic resistance in Gram-negative bacterial isolates. Materials and Methods: In this study, the distribution of microorganisms in urine cultures sent to the microbiology laboratory of our hospital, collected from patients who stayed in the ICU between July 2014 and July 2018, and the resistance profiles of Gram-negative bacteria to antibiotics were evaluated retrospectively. Results: No microorganism growth was observed in 692 (74.4%) of 930 urine samples sent from the ICU. Sixty-three (25.6%) of the cultures positive for microorganisms were Gram-positive bacteria, 64 (26.8%) were Candida strains, and 113 (47.4%) were Gram-negative bacteria. Strains of Escherichia coli and Klebsiella pneumoniae had the highest sensitivity to the antibiotic imipenem, whereas Pseudomonas aeruginosa strains (100%) were the most sensitive to tobramycin. Proteus spp. strains were generally susceptible to antibiotics; however, a high rate of resistance was seen in Acinetobacter spp. strains. Regarding extended-spectrum beta-lactamase production, 28 E. coli (53.8%) and 13 K. pneumoniae (46.4%) strains were found to be positive. Conclusion: Our results show an increase in microbial resistance, especially among Acinetobacter strains. Variations in the results of microorganism distribution and susceptibility clearly show the importance of every center reviewing their own data to make the correct choice of an empirical treatment. [ABSTRACT FROM AUTHOR]

Objective: The relationship between age and the development and outcome of sepsis and septic shock is unclear, especially in adults. There are few studies about the incidence, prognosis and mortality rates of sepsis in elderly and very elderly patients. In this study, we aimed to determine the effect of age on the outcome of sepsis and septic shock in elderly and very elderly intensive care unit (ICU) patients. Materials and Methods: This study was a retrospective observational study conducted in our medical ICU. Two hundred elderly and very elderly patients with sepsis and septic shock were included in this study. Results: The mortality rate related to sepsis and septic shock was 61.5% (123 patients). The most common site of infection was lung (56.5%, 113 patients), followed by urinary tract (35%, 70 patients). There was no significant difference between the elderly (61.2%, 82 patients) and the very elderly (62.1%, 41 patients) patients in terms of ICU mortality related to sepsis and septic shock (p>0.05). Sequential Organ Failure Assessment score on ICU admission [1.195 odds ratio (OR) and 1.052-1.358 95% confidence interval (CI), p=0.006], requirement of invasive mechanical ventilation on ICU admission (4.330 OR and 1.529-12.258 95% CI, p=0.006), renal impairment at the end of the ICU follow-up (6.457 OR and 1.795-23.233 95% CI, p=0.004) and the disability to feed orally in ICU (0.064 OR and 0.018-0.226 95% CI, p=0.0001) were found as independent risk factors for ICU mortality. Conclusion: According to our study, there was no significant difference between the elderly and the very elderly ICU patients with sepsis and septic shock in terms of mortality rates. However, the presence of organ damage during ICU admission and the development of complications during ICU stay significantly affected mortality. [ABSTRACT FROM AUTHOR]

Objective: Patients hospitalized in pediatric intensive care units require various rates of respiratory and oxygen support therapies. Invasive and non-invasive treatment methods are used as respiratory support treatment, and new technologies are being used in oxygen delivery systems. This study aimed to investigate the success and complication rates of high flow nasal cannula oxygen (HFNCO) therapy in the pediatric intensive care unit. Materials and Methods: In this study, demographic characteristics, treatment processes and success/complication rates of the patients treated with HFNCO between 01.02.2018 and 01.02.2019 in the pediatric intensive care unit of Pediatric Clinic of University of Health Sciences Turkey, Adana City Training and Research Hospital were evaluated retrospectively. Results: The mean age of 131 patients included in the study was 41.82±46.88 months. The indications for hospitalization of the patients to pediatric intensive care unit or the reasons for starting HFNCO treatment were as follows: pneumonia in 59.5%, asthma/bronchiolitis in 14.5%, sepsis in 6.9%, post-extubation stridor/respiratory distress in 16.8% and other causes in 2.3%. HFNCO treatment was evaluated as successful in 90.8% of the patients and unsuccessful in 9.2%. Complications were seen in five patients (3.8%), pneumothorax in four patients, and abdominal distension in one patient. Conclusion: Studies on HFNCO therapy in terms of therapeutic efficacy, safety, and indications for use are not yet sufficient in quantity and terms of scientific evidence. To evaluate the efficacy and complications of HFNCO treatment, multicenter randomized controlled trials are needed in different patient groups. [ABSTRACT FROM AUTHOR]

Objective: Pneumothorax (PNX) and subcutaneous emphysema (SCE) have increased in importance as a frequently occurring complication. This study aimed to reveal the frequency, timing, and possible risk factors in patients with PNX and SCE who are followed up with coronavirus disease-2019 (COVID-19) diagnosis in our tertiary intensive care unit (ICU). Materials and Methods: All patients with confirmed COVID-19 who were followed up and treated in our unit between August 8, 2020, and February 20, 2021, in a 16-bed tertiary ICU and who developed PNX and SCE during their hospitalization were included. Results: PNX and SCE developed in 16 (9.6%) of 165 patients who were followed up in our ICU due to COVID-19. Of these 16 patients, 3 (18.8%) survived. The median age of patients was 66.5 years (interquartile range: 58.5-75.5). Diabetes mellitus was the most common comorbidity in patients with PNX and SCE. Additionally, 12 (75%) patients had a smoking history. Of 15 (93.8%) patients who developed PNX, 4 (25%) were bilateral, and SCE developed in 9 (56.3%) patients. Twelve (75%) patients with PNX and SCE were under invasive mechanical ventilation, 3 (18.8%) under spontaneous breathing, and 1 (6.2%) under non-invasive mechanical ventilation treatment. The number of oxygen support days until the time PNX and SCE developed was 9 (6.25-17) days in the whole group, the median time was 6 days in the survival group and 9 days in the non-survival group. Conclusion: In the COVID-19 pandemic, complications, such as PNX and SCE, are more frequently observed (9.5%) than in the general intensive care population and the later period of intensive care admission (median 9 days). Smoking is defined as a risk factor in most of these patients; however, increased PNX rates are thought to be related to both COVID-19 pneumonia and parenchymal damage due to cytokine storms. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease-2019 (COVID-19) pandemic has turned into a global health issue in a short time because of its increasing mortality and high infection rate. Since thoracic computed tomography (CT) cannot be performed and it is not possible to transfer COVID-19 patients followed-up in the intensive care unit (ICU), follow-up, and diagnosis using lung ultrasound (LUS) has been highly advantageous nowadays. The aim of this study was to assess the correlation between the thoracic CT score and LUS score and to determine their association with mortality. Materials and Methods: Patients admitted to the ICU, diagnosed to have COVID-19 pneumonia, underwent an initial thoracic CT examination and who underwent LUS during admission to the ICU were included in the study. The clinical parameters, demographic characteristics, prognosis, LUS, and thoracic CT scores of the patients were recorded prospectively. The survivors and deceased patients’ demographic characteristics were compared. Results: The mean age of the 29 patients included in this study was 61.93±14.21 years, and the male-to-female ratio was 18/11 (62.1%/37.9%). A strong positive correlation was between the thoracic CT score and LUS score (r=0.964; p<0.001). The thoracic CT and LUS scores of the survivors were 15.5±2.7 and 27.3±4.9, respectively, while those of the deceased patients were 14.1±3.4 and 25.6±5.8, respectively, and the two groups found no significant difference. Conclusion: A strong positive correlation was found between the thoracic CT score and LUS score of COVID-19 patients admitted to the ICU. This result shows that LUS is easily preferred for patients who require imaging for diagnosis and follow-up under intensive care conditions. The mortality rates of COVID-19 patients could not be predicted by either thoracic CT score or LUS score. [ABSTRACT FROM AUTHOR]

The patient underwent intensive care after an acute abdominal surgery due to intestinal perforation. The patient was examined for postoperative muscle weakness, and the differential diagnosis was studied. Guillain-Barré syndrome is an acute inflammatory demyelinating polyneuropathy. Infection, surgery, and transplantation have been cited in its etiology. History, clinical examination and follow-up, laboratory tests, and electrophysiological studies are important in its diagnosis, as well as differential diagnosis. Intravenous immunoglobulin and plasmapheresis are the mainstays of care, and supportive care is important for long-term treatment. In this case report, an intensive care unit approach was discussed, in which the surgical paradigm and gastrointestinal stromal tumor were thought of as a rare paraneoplastic complication. [ABSTRACT FROM AUTHOR]

Objective: Enteral feeding is often limited by gastrointestinal intolerance. However, there is no consensus on the threshold value of gastric residual volume (GRV) on adjusting the enteral feeding rate. This study aimed to determine the effects of GRV thresholds of 150 mL and 250 mL on reaching calorie and protein targets and to determine gastric intolerance in patients receiving intensive care and enteral feeding. Materials and Methods: In this retrospective study, patients who were treated and followed in the intensive care unit (ICU) of our clinic between 2008 and 2017 were examined for 14 days after hospitalisation. Caloric values, protein values, presence of gastric intolerance, morbidity, and mortality factors of the patients, who were divided into two groups with 150 mL (group 1) and 250 mL (group 2) GRV thresholds, were examined. Results: The amounts of calories and proteins provided after 14 days were significantly higher in group 2 (p<0.001), and the cumulative calorie and protein deficits were significantly less in group 2 (p<0.001). As regards morbidity and mortality, no significant difference was observed in aspiration pneumonia, anaemia, disseminated intravascular coagulation, septic shock, reintubation, intensive care mortality, 28th day mortality, and number of mechanical ventilation-free days between the two groups. The incidence of nosocomial infection (p=0.002) and ventilator-associated pneumonia (p<0.001) was significantly higher and the duration of mechanical ventilation (p<0.001) and length of stay in the ICU (p<0.001) was significantly longer in group 2 than in group 1. No statistically significant difference was observed between the two groups in terms of the development of gastrointestinal intolerance during follow-up (p=0.896). Conclusion: Target nutritional values were reached in both groups. No pathological side effects of excessive intervention were observed in the group with lower tolerance. Similarly, no valuable morbidity or mortality result was obtained for the 250 mL threshold. [ABSTRACT FROM AUTHOR]

Objective: Intraoperative hypothermia causes increased bleeding, increased transfusion risks, long of intensive care unit stay and subsequently higher medical costs. This study aimed to determine the effects of hypothermia on perioperative bleeding and intensive care unit stay duration in patients undergoing major oncological urology surgery. Materials and Methods: Following approval of this study by the ethics committee, demographic characteristics, surgery type, operation time, lowest perioperative body temperature, hemodynamic parameters, the use of heating blanket during surgery, the amount of bleeding and transfusion, postoperative long of intensive care unit stay in patients who underwent open major urological surgery during 2015-2018 were retrospectively evaluated. Esophageal probe was used for temperature monitoring following anesthesia induction and a body temperature of <36 °C was considered to indicate hypothermia. Results: A total of 68 patients without a heating blanket (n=57) and using a heating blanket (n=11) were included in the study. The intraoperative lowest recorded body temperature was 32.1 °C, and hypothermia (<36 °C) developed in 63.6% of patients for whom heating blankets were used and in 94% of patients for whom heating blankets were not used. The amount of intraoperative bleeding was significantly low in patients for whom heating blanket was used (p=0.03). Conclusion: Perioperative hypothermia is a very frequent and preventable clinical condition that increases long of intensive care unit stay, mortality, and morbidity in geriatric patients and in patients undergoing major surgery. Based on our results, less bleeding and decreased need for intensive care unit stay were noted owing to the prevention of intraoperative hypothermia. [ABSTRACT FROM AUTHOR]

Extracorporeal blood purification (EBP) therapies, using oXiris® haemofilter, are popular and used globally in intensive care units for management of patients with septic acute kidney injury (AKI). Herein, we present a case of an immunocompromised renal transplant recipient with sepsis and AKI who was treated with continuous renal replacement therapy (CRRT) using oXiris® haemofilter. A 45-year-old female who underwent cadaveric renal transplantation in 2015 was admitted due to septic shock secondary to Escherichia coli urinary tract infection (bacteraemia) and acute respiratory distress syndrome (ARDS). Her acute physiology and chronic health assessment score was 23, sepsis-related organ failure score was 11 and Glasgow coma scale was 15. She was intubated because of moderate ARDS and administered vasopressors due to hemodynamic instability. For immunosuppressive therapy, methylprednisolone (40 mg q12h) was administered. Antimicrobial therapies, including intravenous meropenem, linezolid, trimethoprim-sulfamethoxazole, voriconazole and oseltamivir, were administered. She exhibited metabolic acidosis and septic AKI and was classified as Kidney Disease Improving Global Outcomes stage 3. Therefore, CRRT with oXiris® haemofilter was administered at the 11th hour after admission. A full recovery of transplant renal function and diuresis was observed 7 days after admission. She was transferred to ward after 9 days and discharged after 2 weeks, without the requirement of RRT. EBP is proposed as an adjuvant therapy for sepsis and AKI. Solid organ transplant recipients with septic AKI may benefit from early usage of oXiris® haemofilter with CRRT as a novel approach for improving survival and clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the reasons for the hospitalisation of Syrian patients in an intensive care unit (ICU), the development of sepsis, relevant causes of pathogens and mortality rates. Materials and Methods: We conducted this study between 2012 and 2016. Patient information was analysed retrospectively from records and files in the information system. Results: During the study period, 139 Syrian patients were hospitalised in an ICU. The most common ICU diagnoses were respiratory tract infection (29 patients: 20.9%) and trauma (26 patients: 18.7%). Of these patients, 35 were diagnosed with sepsis during their treatment in the ICU. Acinetobacter baumannii and Escherichia coli were isolated in the culture of the patients with sepsis (17, 12, respectively). A. baumannii was most common in tracheal cultures and E. coli in urine cultures. In addition, seven patients were diagnosed with sepsis on their first admission to the hospital. H1N1 was detected in two patients, Streptococcus pneumoniae in three, Haemophilus influenzae in one, and Staphylococcus aureus and aspergilloma in another patient. While 45 of 139 patients died, 28 of 35 patients diagnosed with sepsis died. Acute Physiologic Assessment and Chronic Health Evaluation II scores, the duration of mechanical ventilation, the number of days spent in the ICU was all higher in the deceased patients than in the surviving patients (p<0.001, p<0.001, p<0.001, respectively). Conclusion: Respiratory diseases were the most common causes of Syrian patients’ hospitalisation in the ICU and for developing sepsis. For these patients, sepsis remained an important factor for mortality. [ABSTRACT FROM AUTHOR]

Objective: Acinetobacter baumannii is an opportunistic pathogen that causes healthcare-associated infections in hospitalised patients in intensive care units. A. baumannii can quickly develop resistance to antimicrobials through different mechanisms. Infections caused by multidrug-resistant (MDR) isolates have high morbidity and mortality and require long-term hospitalisation. Colistin is one of the last antimicrobials that can be used against MDR A. baumannii isolates. Due to the increase of these isolates, the use of colistin has increased worldwide. Our study aimed to investigate colistin resistance rates, minimum inhibitory concentration (MIC) values and plasmid-mediated resistance genes in isolates from the blood cultures of patients hospitalised in intensive care units. Materials and Methods: A total of 97 A. baumannii isolates from blood culture samples were included in our study. MIC values of the isolates were investigated by the broth microdilution method according to The European Committee for Antimicrobial Susceptibility Testing recommendations. Colistin resistance gene regions mcr 1-5 were studied by polymerase chain reaction. Results: Eight (8.2%) of the A. baumannii isolates were resistant, and 89 (91.8%) were sensitive. The colistin MIC50 value was 0.5 μg/mL, and its MIC90 value was 2 μg/mL. The plasmid-mediated mcr gene regions (1-5 mcr genes) investigated for the risk of horizontal spread of colistin resistance could not be determined. Conclusion: Colistin is an important antimicrobial that can still be used effectively to treat infections due to A. baumannii isolates in our intensive care units. However, to prevent the development of resistance against colistin, irrational antibiotic use should be prevented, and treatment according to antimicrobial susceptibility test results is required. In addition, we believe that it is important to take the necessary infection control measures to prevent the colonisation of resistant isolates in hospitals. [ABSTRACT FROM AUTHOR]

The cause of impairment in respiratory functions after open heart surgery is multifactorial. A 67-year-old female patient admitted to the intensive care unit (ICU) was intubated after mitral valve replacement and tricuspid annuloplasty. She was extubated on the first postoperative (post-op) day. On post-op day 5, the patient was re-admitted to the ICU due to respiratory distress and tachypnea. Non-invasive mechanical ventilation (NIMV) support and dobutamine 5 mcg/kg/min were started. Prior to diagnosis of septic shock, tazocin 3x4.5 grams was administered. The patient was intubated on the post-op day 6 because of the increase in respiratory distress. She was extubated on the post-op day 7, and NIMV commenced. On the 8th post-op day, she was consulted to the ear, nose and throat (ENT) department because of sore throat. Widespread mucosal aphthous lesions were observed in the uvula, soft and hard palate, mandible inner mucosa and alveolar process. Galactomannan was detected positive in bronchoalveolar lavage and treatment with fluconozole started. On post-op day 15, the patient was discharged. That same night, she was admitted to the ICU again due to sudden respiratory distress and was placed on NIMV support, but the patient whose respiratory distress increased and was unconscious was intubated. The next day, direct laryngoscopy was performed by the ENT department under operating room conditions, and a 3x4 cm polypoid lesion was removed from the vocal cord level. However, after 2 days, the patient was re-examined by direct laryngoscopy, necrotic crusts were removed under the cricoid cartilage posteriorly in the subglottic region. The patient recovered from post-op respiratory distress, was extubated on the 18th post-op day and his support with NIMV continued. The patient was discharged on the 33rd post-op day. Laryngeal granuloma and subglottic strictures should be considered in patients with post-op respiratory distress, no matter how short the intubation period is. [ABSTRACT FROM AUTHOR]

Objective: Iatrogenic anemia is an overlooked entity in daily practice. It is known that iatrogenic anemia is associated with increased morbidity and mortality, especially in intensive care unit patients. COVID-19 caused excessive intensive care hospitalizations due to acute respiratory failure. We sought to investigate iatrogenic anemia and its results in COVID-19 patients followed in intensive care unit. Materials and Methods: We retrospectively reviewed the adult patients who were hospitalized in ICU for COVID-19 longer than 14 days. Individuals younger than 18 or who had major bleeding, or postoperative patients were excluded. The remaining 112 patients took part in study. We collected the demographic data, comorbidities, laboratory results, and total amount of blood samples taken in intensive care follow-up in mililiters (mL). Results: The mean age of participants was 71.3 (min: 23, max: 100). Male/ female ratio was 1.8. The most common comorbidity was hypertension (60), coronary heart disease (29), and diabetes mellitus (26), The median length of ICU stay is 19 days (min: 14, max: 58). 66 (58.6%) patients have died. Mean Hb was decreased from 13.9 (±SD: 1.67) to 9.74 (±SD: 1.98) g/dL. In the end, 65 (90.2%) of males and 38 (95.0%) of females were anemic. On a total of 2545 hospitalization days, an average of 27.6 mL of blood was drawn in 7.4 sampling tubes per patient day. Biochemistry tests were the most common reason. We observed that more blood was drawn from intubated patients than non-intubated patients, resulting in a greater reduction in hemoglobin levels (463 mL, 2 g/dL, 677 mL, 3.9 g/ dL, respectively) (p<0.001). Conclusion: Excessive blood sampling is still a significant problem in ICUs associated with poor outcomes. Considering that most COVID-19 patients are admitted to ICU due to acute respiratory failure, it is vital to keep hemoglobin levels as high as possible to maintain oxygenation. [ABSTRACT FROM AUTHOR]

Objective: Nutritional support is a part of intensive care unit therapy. In our study, we investigated the effects of diabetes-specific enteral formula and standard enteral formula on tight blood glucose control and insulin requirement in hyperglycemic intensive care unit patients. Materials and Methods: The study was planned as a prospective, randomized, crossover comparative study. The daily caloric requirements for patients who tolerated enteral product intake were calculated as 25 kcal x body weight. Calorie requirements were divided into 21 hours and hourly calorie needs and nutrient volume were calculated. Eighty patients were divided into two groups. First group received ISOSOURCE® Standard and second group received Novasource® Diabetes in the first 24 hours. In the second 24 hours, group 1 received Novasource® Diabetes, while Group 2 received Isosource® Standard. An intravenous insulin infusion was given to maintain the blood glucose level at 80-150 mg/dL. Blood glucose level was measured every 4 hours by taking arterial blood gas. Maximum, minimum, mean and median blood glucose levels, total insulin, mean insulin levels and the number of insulin dose changes were recorded. Results: No statistically significant difference was observed between two groups in terms of maximum, minimum and mean blood glucose levels. When compared, median blood glucose levels were numerically significant, but were not statistically significant in both groups. Conclusion: It was concluded that diabetes-specific enteral formula did not contribute significantly to tight blood glucose control in non-diabetic critical patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the eye problems and risk factors encountered by patients in intensive care units and to evaluate the eye care awareness of healthcare workers in these units. Materials and Methods: In this study, 186 eyes of 93 patients without ophthalmological consultations were examined prospectively and observationally. The patients were evaluated for dry eye, hypertonic solution use, eyelid/eyelash hygiene, blink reflex, corneal pathology and eye care consultations. The ventilation type, length of hospitalization, Glasgow Coma scale score and sedation status were also evaluated. The presence of dry eye was evaluated according to gender, ventilation type, hypertonic solution use, Glasgow Coma scale score and hospitalization diagnosis. Additionally, patients were evaluated according to the risk factors of corneal pathologies. Results: The mean age of the patients was 63.53±22.06 (18-96) years and male/female ratio was 51/42. The mean length of hospitalization was 42.19±92.73 (7-203) days and the mean Glasgow Coma scale score was 9.35±4.34. Dry eye was detected in 30 (32.3%) patients. A higher rate of dry eye was detected in the mechanically ventilated and sedated patients, but the difference was not statistically significant (p=0.243 and p=0.384). Various corneal disorders were detected in 18 patients (19.35%). The sedation rate and length of hospitalization were higher in these patients, but the difference was not statistically significant (p=0.66 and p=0.126). However, Glasgow Coma scale score was significantly lower (p=0.027). The eyelid hygiene was adequate in 78 patients (83.9%) and inadequate in 15 patients (16.1%). Ophthalmological consultations were required for 29 patients (31.2%), but only 11 (37.9%) of these patients received consultations. Of 18 patients who were not consulted, 11 had punctate corneal epithelial defects, four had purulent conjunctivitis and three had keratitis. Conclusion: Eye disorders are quite common in intensive care unit inpatients. Increasing eye care awareness by providing eye care training to healthcare professionals focused on maintaining these patients' vital functions will help prevent the emergence of eye diseases. [ABSTRACT FROM AUTHOR]

Objective: The number of patients with COVID-19 has rapidly increased, thereby exceeding the capacities of health systems and causing serious losses in affected countries because of the rapid spreading potential, high virulence, and lack of vaccine and proven antiviral therapy. This may indicate the importance of protocol-based treatments in maintaining the treatment process accurately, with minimal errors. This study aimed to present the results of a protocol-based treatment prepared in accordance with the “Surviving Sepsis Campaign COVID-19 treatment guideline.” Materials And Methods: This retrospective and prospective study used data of five hospitals. Intensive care and treatment approaches were carried out in accordance with the “COVID-19 approach protocol” prepared according to the “Surviving Sepsis Campaign COVID-19 treatment guideline.” Results: A total of 1143 patients admitted to five hospitals were hospitalized with a prediagnosis of COVID-19, and 115 patients needed intensive care. Among them, patients without COVID-19 were excluded and the remaining 77 patients were evaluated. In this study, 9 (11.7%) of the 77 patients were lost. While the mortality rate did not differ by sex (p=0.661), the mean age of deceased patients was significantly higher (p=0.006). Considering their comorbidities, the mortality rates of patients with hypertension, chronic renal failure, and cancer were significantly higher (p=0.034, p=0.014, and p=0.007, respectively). Conclusion: The mortality rate in this series may suggest that the treatments performed in line with the “Survival in Sepsis Campaign COVID-19 treatment guideline” are useful. However, when the causes of mortality and morbidity were evaluated, good observation of neurological, infective, respiratory, and immune complications may be considered the main factor in reducing mortality and should be included in the guideline. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 outbreak has been threatening the entire world for approximately 4 months. Healthcare management is one of the most important precautions to be taken for the successful management of this epidemic. Evidence-based estimates are of great importance in solving these problems. In this study, as of the first week of April, we provide a description of Turkey according to the indicators of the COVID-19 outbreak in each city and an evaluation of the relationship between the population density of each province and the number of cases. Additionally, we calculate the change in the new case rate and aim to estimate the number of intensive care beds and the number of intubations needed on a day-to-day basis. Materials and Methods: The outbreak indicators and number of tests announced by the Ministry of Health of the Turkish Republic day-by-day were used. A Poisson regression model was used for data analysis. In addition, a new algorithm was proposed to estimate healthcare needs. Results: The relationship between urban density and the total number of cases was found to be statistically significant (r=0.464, p<0.001). When the density increased by one person, the total number of cases was estimated to increase by one. Minor changes were observed in the rate of new cases within the daily tests between March 29 and April 5. The total numbers of intensive care patients, intubated patients, patients quarantined at home or hospitalized in the normal service, and recovered patients, as well as the total case numbers were used in the calculations. By using the total forecasted cases, the service infrastructure requirements to be provided in hospitals, such as the number of beds and the number of intubations, were estimated and given in tables. Conclusion: When priorities are questioned in the coming days, it should not be forgotten that these types of studies will be helpful to solve important health problems. [ABSTRACT FROM AUTHOR]

Objective: Drowning is a common and important cause of accidental deaths. Complications and mortality rates are high in patients requiring intensive care unit (ICU) support. The aim of our study was to determine the clinical course and treatment efficacy of a limited number of patients with acute respiratory failure and multiorgan failure due to drowning. Materials and Methods: Patients who were hospitalized >24 hours in the ICU between January 2010 and August 2018 and who met the inclusion criteria were retrospectively analyzed. Results: Of 103 patients admitted to the emergency department over an 8-year period, 13 required intensive care support. Five patients (38.4%) died and eight patients (61.5%) were discharged. Steroids were used in six patients (46.2%), but no statistically significant difference was found in terms of mortality (p=0.592). The presence of diffuse cerebral edema in five patients (38.5%) was associated with a statistically higher mortality rate compared to six patients (46.2%) with normal findings (p=0.003). Mechanical ventilation was performed with synchronized intermittent mandatory ventilation mode in nine patients (69.2%) and with airway pressure-release ventilation (APRV) mode in four patients (31.8%). According to our clinical observations, apparent radiological improvement was detected in patients who received mechanical ventilation with APRV mode. Conclusion: Neither steroids nor prophylactic antibiotherapy are found effective on mortality rates. In addition to these ineffective interventions, mechanical ventilation strategies, the degree of metabolic acidosis at admission and the neurological status of the patient may be considered as variable clinical parameters that may affect patient outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the frequency of intensive care unitacquired paresis (ICU-AP) and predisposing factors for muscle weakness in our ICU patients. Materials and Methods: A prospective observational study was conducted in a 25-bed ICU of a tertiary hospital. Patients who were cooperated with muscle strength examination, stayed in ICU more than three days and had no preexisting neuromuscular disorder were included in the study. The diagnosis of hospitalization, need for mechanical ventilation, comorbidities, length of ICU stay, mobilization level, discharge status, and Sequential Organ Failure Assessment (SOFA) were recorded. Manual muscle strength test was assessed according to Medical Research Council scale. Handgrip and finger pinch strength values were recorded. Results: Forty-two patients completed muscle strength examination. ICU-AP was determined in 16 (38.09%) patients. Length of ICU stay, mechanical ventilation rate, SOFA score and frequency of decubitus ulcers were higher in patients with ICU-AP (p<0.05). There was a significant relationship only between mechanical ventilation and ICU-AP Conclusion: ICU-AP is a common problem in critically ill patients and influences outcomes of patients. Patients without mechanical ventilation may develop ICU-AP and mechanical ventilation can be determined as one of the risk factors for muscle weakness. [ABSTRACT FROM AUTHOR]

Objective: In this study, it was aimed to determine vancomycin resistance mechanisms, virulence genes and clonal relationships of 23 vancomycin-resistant Enterococcus faecium (VREfae) strains isolated from patients admitted to intensive care unit of Hatay State Hospital. Materials and Methods: Minimal inhibitor concentration (MIC) values of vancomycin were determined by E-test and antimicrobial susceptibility of the strains was determined by disc diffusion method. The clonal relationship among VREfae isolates was determined by pulsed-field gel electrophoresis (PFGE). Additionally, vancomycin resistance (vanA, vanB, vanC, vanD, vanE and vanG) and virulence genes (asa1, esp, gelE, hyl and cylA) were investigated by polymerase chain reaction (PCR) method. Results: All isolates harbored vanA gene and 17 isolates (73.9%) were positive for at least one virulence gene. The most common virulence gene was esp, which was detected in nine isolates alone and in two isolates together with hly gene. The hly gene was detected in five isolates alone and the other virulence genes (asa1, gelE and cylA) were not observed in any isolates tested. All isolates showed multidrug resistance phenotype. Vancomycin MIC values of the isolates were found to be ≥256 μg/mL by E-test. PFGE analysis revealed 14 different pulsotypes in five clusters (A, B, C, D and E). The presence of identical PFGE patterns indicated that there was a crosstransmission at hospital settings. Conclusion: Continuous surveillance of resistance patterns and molecular characteristics of VRE are needed to reduce the prevalence of infections caused by VRE and to take effective control measures in hospitals. [ABSTRACT FROM AUTHOR]

Takotsubo cardiomyopathy (TC) is a disease mimicking Acute Coronary syndrome with electrocardiographic changes as well as temporary, reversible regional wall motion defect in the apical and middle segments of the left ventricle. It may be associated with emotional and physical stress caused by serious medical discomfort or surgical stress. Although it is more common in postmenopausal women, it is thought that stress-induced catecholamine discharge causes TC. Intensive care patients are at high risk for emotional and physical stress due to various factors such as multisystem diseases and problems due to prolonged hospitalization. In this case report, we aimed to present the characteristics of TC following long-term intensive care follow-up of our patient who was paraplegic due to cervical trauma and conscious, and to discuss the differential diagnosis and evaluate the literature. [ABSTRACT FROM AUTHOR]

Introduction: As in the whole world, the elderly population is increasing in Turkey and more geriatric patients are hospitalized in intensive care units (ICUs). ICUs are places where expensive treatments are made and resources must be used well. There are not enough studies in Turkey on the ICU hospitalization rates and treatment outcomes of elderly patients, whose comorbidities added and life expectancy rate decreases with age. In this study, we aimed to investigate the demographic and clinical characteristics of elderly patients admitted to the ICU. Materials and Methods: The medical records of the elderly patients (≥65 years old) in the ICU (July -December 2022) were retrospectively reviewed. Medical records were analyzed for age, gender, comorbidities, APACHE II scores, and outcomes.The patients were compared by dividing them into 2 groups as survived and nonsurvived. Results: A total of 843 patients were admitted to ICU during the study period, 40% (n=339) of the patients were ≥65 years old, 7.2% (n=61) were ≥85 years old. A total of 188 patients (55.5%) required invasive mechanical ventilation (IMV), 172 patients (50.7%) received at least one vasoactive drug, and 36 patients (10.6%) required hemodialysis. The mortality rate was 41.6%. The requirament for inotropic support, hemodialysis, and IMV were significantly higher in the nonsurvived group (p=0.000 for all). The mean ICU length of stay was 14.5 days (range 1-129). Data for survived and non-survived groups are summarized in Table 1. Conclusion: High APACHE-II score, the requirement for inotropic support, hemodialysis, and IMV were found to be significantly higher in the nonsurvived group. When the response to maximal treatment isnot sufficient and survival chances with satisfactory conditions are almost non-existent, should the decision of therapeutic limitation be applied frequently? In order to answer this question, we think that more studies are needed about these topics in Turkey. These patients, who poor response to advanced treatment options, seem to have a substantial effect on ICU capacity [ABSTRACT FROM AUTHOR]

Introduction: Anisocoria may develop due to physiological, pharmacological or neurological pathology. Neurological reasons which lead to pathological anisocoria are cases regarding sympathetic or parasympathetic innervation. In this article, we aimed to present a case of pharmacological anisocoria which is developed as a result of inhaler therapy containing ipratropium. Cases: Case 1; a 95 years old female patient. She was admitted to the hospital with dyspnea and general condition disorder. The patient was treated with bronchodilator containing ipratropium bromide, and on the sixth day of hospitalization, the left eye was mydriatic and there was no light reflex. There were direct and indirect light reflexes in the right eye, and the pupil diameter was normal. Case 2; a 68 years old male patient. He applied to the emergency department with confusion and general condition disorder. The patient was transferred to our intensive care unit with the diagnosis of upper gastrointestinal system bleeding. On the 11th day of his hospitalization, the patient was started on an inhaler containing ipratropium bromide, and 3 days later anisocoria was detected. His right eye was mydriatic. There was no light reflex. Cranial imaging was normal in both patients. The treatments of the patients whose history was uncharacteristic and no cause was found to explain anisocoria were compared. It was determined that nebulizer treatment containing ipratropium was applied to both patients. In the test with 1% pilocarpine solution for the differential diagnosis of pharmacological mydriasis, minimal pupil constriction was observed in the affected eye for both patients. After discontinuation of inhaler therapy; after 4 days in case 1 and after 3 days in case 2, the pupils were isochoric and light reflexes were normal. Discussion: In the differential diagnosis of anisocoria developing during intensive care follow-up, iatrogenic pharmacological side effects originating from the inhaler should be kept in mind as well as intracranial pathologies. The easy-to-perform pilocarpine test can prevent advanced diagnostic procedures and increased costs. [ABSTRACT FROM AUTHOR]

Introduction: The impairment of coagulation and fibrinolysis processes may be observed after cardiac arrest. Echocardiography is important for determining the causes of the cardiac origin of pulmonary embolism, and, simultaneously, mobile thrombi can be rarely visualized in the ventricule. In this report, we present a case of the intraventricular mobil thrombus that we detected with trans-esophageal echocardiography (TEE) in a patient who underwent CPR for 35 minutes after out of hospital cardiac arrest. Case: A 54-year-old male patient with coronary artery disease (CAD) and 2-vessel stents was admitted to the emergency service after cardiac arrest. He was admitted to the intensive care unit (ICU) and targeted temperature management could not be applied since it was too late. Brain MRI revealed hypoxic ischemic encephalopathy. Due to recurrent Grampositive infections despite appropriate antibiotic treatment, in addition to other screening tests, a bedside TEE performed by an intensivist revealed a 27x23 mm mobile thrombus in the left ventricle (Figure 1). Surgical intervention methods were not considered by cardiovascular surgens, then antithrombotic treatment was administered. After the achievement of infection control with effective antibiotherapy, the patient was discharged to the palliative center on the 99th day of hospitalization with the tracheostomy and percutaneous endoscopic gastrostomy Discussion: It is crucial that elucidation of the culprit of the recurrent infections in intensive care patients and focal control should be ensured as soon as possible. In our patient, we investigate the presence of vegetation in heart with the TEE following recurrent Gram-positive cocci growth in blood cultures. Guidelines recommend TEE as the first test for suspected infective endocarditis, usually combined with TTE, so we think that intensivists should use it more widely in intensive care practice. [ABSTRACT FROM AUTHOR]

Introduction: Glycaemic variability (GV) refers to the fluctuations in blood glucose levels over time. In intensive care patients, glycaemic variability can have significant clinical implications, including increased mortality and morbidity 1. This study was conducted to contribute to accumulating data on the subject and to reveal the situation in our intensive care patient population. Materials and Methods: Patients admitted to the Internal Medicine Intensive Care Unit between January 2015 and August 2020 were retrospectively screened through the hospital database. Demographic characteristics of patients, comorbidities, APACHE II scores, and estimated mortality rates according to this score; the mean amplitude of glycaemic excursions (MAGE) 2 and SOFA scores from the daily blood glucose measurement values from the first day of ICU admissions to discharge or 28th day of the intensive care unit stay; usage of insulin, corticosteroid, vasopressor, and beta-blocker therapy, length of stay and 28-day mortality status has been recorded. Results: One hundred thirty-six patients were enrolled in the study and grouped into high GV (n=70) and low GV (n=66) using mean MAGE 65 mg/dL as the cut-off point. There wasn’t any difference between groups in age, gender, comorbidity, APACHE II, mean SOFA scores, applied corticosteroid, vasopressor, and beta-blocker treatments, intensive care unit length of stay, and mortality (Table 1). Insulin therapy was used more frequently in patients with high GV (74.3%) than in patients with low GV (36.4) (p<0.001). When the mean MAGE was compared according to 28-day mortality, MAGE was found to be higher in nonsurvivors (78.8±32.2) than in survivors (65.4±22.5) (t=-2.78, p=0.005). In the ROC analysis performed for mortality estimation of GV, AUC was 0.611 (p=0.02) (MAGE >61 mg/dL, sensitivity 68.5%, specificity 50%). Conclusion: In our study, glycemic variability predicted mortality moderately. Tight glycemic control is an important goal in critical care management that improves outcomes and reduces complications. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to compare the procalcitonin/albumin ratio, with the previously proven APACHE II score, which is easily applicable in predicting 30-day mortality rates. Materials and Methods: Of the 184 patients, >18 aged, hospitalized between December, 2021-April, 2022 was performed. Gender, comorbidity, mortality within 30 days, hospitalization days, procalcitonin, albumin, CRP and APACHE II scores were obtained. Procalcitonin/albumin and CRP/ albumin values were created by dividing these two values. The group with mortality within 30 days was determined as the main group, while the group without mortality within 30 days was determined as the control group. These values were compared with the APACHE II score values in predicting mortality, and specificity and sensitivity were determined. Results: Of the 184 patients included in the study, 47.8% were female and 52.2% were male, with a mean age of 65.5±18.3 years (median 69). There was no significant difference in age and gender in the group with and without mortality within 30 days. The 30-day mortality rate was 37% (n=68). Albumin value was significantly lower in the group with mortality within 30 days compared to the group without mortality; procalcitonin, procalcitonin/albumin, APACHE II value at 30 days were significantly higher than the group without mortality. CRP, CRP/albumin value did not differ significantly. Significant efficacy of albumin, procalcitonin, procalcitonin/albumin 0.160 cut-off value and APACHE II were observed in predicting patients with and without mortality within 30 days. Significant effectiveness of procalcitonin/albumin value was observed. Conclusion: It was found that the procalcitonin/albumin ratio was significantly associated with the estimation of 30-day mortality in patients hospitalized in ICU. [ABSTRACT FROM AUTHOR]

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, multitrauma, 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 gammaglutamyl 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. [ABSTRACT FROM AUTHOR]