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Background/Aim: The best course of treatment for children with end-stage kidney disease (ESKD) is renal transplantation (RT), but some pediatric RT recipients are admitted to an intensive care unit (ICU) post-transplant. In the early and late post-operative phases, clinical data about pediatric RT recipients who are admitted to ICU are available. In this study, we aimed to evaluate demographic features, main reasons, and outcomes of pediatric RT patients admitted to the ICU during the early and late post-operative phases. Methods: This study was a cohort study. We analyzed the medical records of pediatric RT recipients (6 months after transplantation. Epileptic seizure (n=6, 31.6%), respiratory failure (n=4, 21.1%), and cardiac diseases (n=2, 10.5%) were among the main reasons for ICU admission. During ICU follow-up, invasive mechanical ventilation was needed for five patients (26.3%), and renal replacement treatment was needed for four patients (21.1%). The mean length of ICU was 12.4 (28.5), and the mean hospital stay was 25.8 (29.4) days. The ICU and hospital survival rates were 78.9% and 97%, respectively, while 3.5% was the hospital mortality rate. Hemorrhagic cerebrovascular disease, acute hepatic failure, and cardiogenic shock secondary to pericardiocentesis were the causes of death in the ICU. Conclusion: Patients mostly had ICU admissions because of epileptic seizures and acute respiratory failure. A multidisciplinary approach involving pediatric nephrologists, transplant surgeons, and an intensive care team successfully manages pediatric RT recipients admitted to the intensive care unit.

Aim: Healthcare professionals working in intensive care unit (ICU) have been in the frontline from the beginning of COVID-19 pandemic. We aimed to evaluate the technical and psychological difficulties encountered by medical doctors working in the ICU of the hospitals within XXX University Faculty of Medicine during this pandemic. Material and Methods: A questionnaire consisting of 52 questions was applied to the medical doctors working in the ICUs of Başkent University affiliated centers. Personal protective equipment (PPE) includes; surgical mask, N95: N95 mask, face shield, glove, overalls, overshoe, goggles, intubation cabin. Results: Out of the 73 ICU physicians who were invited to participate, 62 (84.9%) of them completed the survey. Out of 59.7% of the participants stated that they did not feel safe while caring for the patients. The most common reason for their insecurity was the fear of contamination (70.3%). Out of 69.4% ICU physicians stated that their anxiety level was moderate. It was observed that the anxiety level of ICU physicians decreased as the number of patients followed up increased (p = 0.025), the increase in the number of hospital beds was found to be significantly associated with increased anxiety level (p = 0.015). It was found that the presence of anxiety complaint increased the state of having high anxiety related to COVID-19 disease 28.3 times (p = 0.001). Conclusion: We found that more than half of the physicians participating in our study didn’t have any problem of protective personal equipment (PPE) deficiency, which is one of the most important technical difficulties. Regarding psychological difficulties, we found that doctors who had anxiety complaints before had much more difficulties in managing the pandemic process than others.

Background/Aim: Acute kidney injury (AKI) is a common serious complication associated with morbidity and mortality in critically ill COVID-19 patients. Although there is very limited data on the incidence of AKI in this cohort, conflicting results were recently reported. The incidence of AKI in critically ill COVID-19 patients ranged between 0.5-50% in the early studies. This study aimed to evaluate the incidence and determine the demographic parameters, clinical courses, and outcomes of AKI in critically ill COVID-19 patients admitted to the intensive care unit (ICU).Methods: After ethics committee approval was obtained, critically ill COVID-19 patients admitted to our ICU between June 1- December 30, 2020, were analyzed in this retrospective cohort study. Patients over the age of 18 years who were admitted to the intensive care unit with the diagnosis of COVID-19 or whose real-time polymerase chain reactions (RT-PCR) test were positive were included in the study. Incidence and stages of AKI among the included critically ill COVID-19 patients were evaluated. The patients were divided into two groups according to the presence of AKI to define the risk factors and clinical outcomes. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines based on serum creatinine and urine output. Results: We analyzed seventy-four critically ill confirmed COVID-19 patients. The mean age was 70.7 (14.8) years and 63.5% were male. Thirty-four patients (45.9%) had AKI, 12 patients in stage I (16.2%), 13 patients in stage II (17.6%), and 9 patients in stage III (12.1%). Renal replacement therapy (RRT) was initiated in 28.4% of patients with AKI; 16.2% received intermittent hemodialysis and 12.2%, continuous renal replacement therapy. APACHE II score and GCS at ICU admission were similar in patients with or without AKI (P>0.05), but the SOFA score was significantly higher in patients with AKI (P=0.03). ARDS and shock were significantly higher in patients with AKI than without (P=0.01 and P=0.039, respectively). Compared to the patients without AKI, those with AKI required higher amounts of oxygen therapy (high-flow oxygen therapy, non-invasive mechanical ventilation) and invasive mechanical ventilation (P=0.01 and P

Open heart surgery (OHS) is frequently performed on elderly patients. We aimed to investigate the risk factors associated with prolonged intensive care unit (ICU) stay in elderly patients undergoing open heart surgery.Medical records of all patients ≥ 75 years who underwent OHS (coronary artery bypass grafting (CABG) and/or heart valve surgery) between June 1, 2013, and December 31, 2020, were retrospectively analyzed. Those staying in the ICU longer than five days were determined as prolonged ICU stay. Patients were divided into two groups, according to ICU stay5 days and ≥5 days.Out of the 198 patients included in the study, 130 (65.7%) were male. Seventy patients (35.4%) had prolonged ICU stay. The mean age was higher in patients within the prolonged ICU stay group when compared to the other group (79.9±3.5 years vs.78.1±2.7 years, p0.001). The patients who used statins and angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) in the preoperative period had a shorter ICU stay compared to those who did not (45% vs 31.4%, p=0.04; 57% vs 42.9%, p=0.03). The history of previous thoracic surgery (2.3% vs 10% p=0.03), emergency surgery (12.5% vs 24.5% p=0.04), and preoperative pacemaker usage (0.8% vs 7%, 1 p=0.01) were higher in the group of patients with prolonged ICU stay compared to the other group. Preoperative ejection fraction (EF)% (47.7±11.3 vs 51.1±8.8, p0.001) and hemoglobin level (11.8±1.9 mg/dL vs 12.9±1.6, p0.001) were lower in the group with prolonged ICU stay compared to the other group. Incidence of cardiac arrest (3.9% vs 15.7% p=0.006), presence of arrhythmia (16.4% vs 41.6%,p0.001), frequency of pacemaker and intra-aortic balloon pump (IABP) usage (0 vs 10% p=0.002; 1.6% vs 8.6% p=0.02), and need for renal replacement therapy (3.1% vs 12.9%,p=0.02) were higher in the group with prolonged ICU stay compared to the other group. According to the logistic regression analysis; higher age (OR: 1.225, 95%CI 1.104-1.360, p0.001), preoperative pacemaker usage (OR: 0.100, 95%CI 0.01-0.969, p0.04), preoperative statin non-use (OR: 2.056, 95%CI 1.040-4.066, p0.03) and preoperative low EF (OR: 0.947, 95%CI 0.915-0.981, p=0.002) were determined as independent risk factors for prolonged ICU stay.The incidence of prolonged ICU stay after OHS among patients ≥75 years was 35.4% in our cohort. Higher age, preoperative pacemaker usage, preoperative statin non-use, and low preoperative EF were associated with prolonged ICU stay.

Acute fatty liver of pregnancy (AFLP) is a life-threatening disorder characterized by maternal liver failure, and it occurs in the third trimester of pregnancy or postpartum period. The resultant effects include coagulopathy, electrolyte abnormalities, and the multiple organ dysfunction syndrome (MODS), which may require liver transplantation. Therefore, pregnant women having MODS should be managed in an intensive care unit (ICU) with multidisciplinary inputs to facilitate the appropriate supportive care. We present a successful case report of a pregnant women admitted to the ICU with jaundice and MODS without the need for liver transplantation and organ support therapies. A 20-year-old patient in her first pregnancy at 31 weeks gestation who presented with nausea, vomiting, and jaundice was admitted to our hospital. She was referred from a rural medical center (a center 608 kilometers away) to the ICU due to the possible diagnosis of acute liver failure requiring liver transplantation. Acute physiology and chronic health assessment score was 12, sepsis related organ failure score was 8, and Glasgow coma scale was 15 on ICU admission. AFLP was considered in the patient and an emergency delivery was performed by caesarean section. She recovered with intensive care support after pregnancy delivery without the need for liver transplantation. The patient was discharged from the ICU and hospital after 6 and 10 days, respectively. AFLP should be suspected in the differential diagnosis of a pregnant woman with jaundice and hyperbilirubinemia who is admitted to the ICU in the third trimester of pregnancy or postpartum period. Intensivist should not delay in the diagnosis of AFLP due to its morbid complications and high mortality. Early diagnosis, prompt pregnancy delivery, and intensive care support in the peripartum and postpartum periods may improve maternal and fetal outcomes.

The decrease in social distance together with the normalization period as of June 1, 2020 in our country caused an increase in the number of COVID 19 patients. Our aim was to compare the demographic features, clinical courses and outcomes of confirmed and probable coronavirus disease 2019 (COVID-19) patients admitted to our intensive care unit (ICU) during the normalization period. Critically ill 128 COVID-19 patients between June 1 - December 2, 2020 were analyzed retrospectively. The mean age was 69.7±15.5y (61.7% male). Sixty-one patients (47.7%) were confirmed. Dyspnea (75.0%) was the most common symptom and hypertension (71.1%) was the most common comorbidity. The mean Acute Physiology and Chronic Health Evaluation System (APACHE II) score; Glasgow Coma Score (GCS); Sequential Organ Failure Assessment (SOFA) scores on ICU admission were 17.4 ± 8.2, 12.3 ± 3.9 and 5.9 ± 3.4, respectively. 101 patients (78.1%) received low flow oxygen, 48 had high flow oxygen therapy (37.5%) and 59 (46.1%) had invasive mechanical ventilation. 53 patients (41.4%) had vasopressor therapy and 30 (23.4%) patients had renal replacement therapy (RRT) due to acute kidney injury (AKI). Confirmed patients were more tachypneic (p=0.005) and more hypoxemic than probable patients (p

Objective We aimed to compare minimal flow sevoflurane and desflurane anaesthesia in terms of hemodynamic parameters, body temperature, anaesthetic gas consumption and cost. Methods 120 patients with ASA I-II (>18yo) who underwent elective surgery for longer than 60 min after general anaesthesia were randomized into two groups. The Drager Perseus® A500 workstation was used. Pre-oxygenation was performed for 3 min with 6 L min-1 to 100% oxygen. Fractional inspirium oxygen concentration (FiO2) was reduced to 40%, fresh gas flow was 4 L min-1 after intubation. Sevoflurane or desflurane was started at 1.5 minimal alveolar concentration (MAC). When the MAC value reached 0.9, fresh gas flow was reduced to 0.5 L min-1, FiO2 was increased to 68%. At the end of the surgery, the vaporizer was switched off, the fresh gas flow was increased (4 L min-1, FiO2 100%). When the train-of-four (TOF) ratio was 100%, extubation was carried out. Results There were no differences in patient characteristics and initial hemodynamic parameters of the groups. There were statistically significant differences between the times to reach 0.9 MAC, extubation and eye opening; anaesthetic, O2 and air consumption in both groups. Conclusion With minimal flow, the time to reach target MAC, time to extubation and eye opening were significantly faster for desflurane and anaesthetic, oxygen and air consumption in desflurane anaesthesia were less than sevoflurane. Thus, we can say that desflurane has faster anaesthetic induction and recovery time with lower anaesthetic consumption than sevoflurane.

Introduction The novel coronavirus (SARS-CoV-2) responsible for COVID-19 pandemic caused an unprecedented health care crisis. During pandemic burn centers had to preserve the ongoing burn care in a safe and ethical way. It is crucial to manage inpatients, outpatients, wards and staff carefully to prevent epidemia in burn units. Here, we aimed to report our burn care experience during the six months COVID-19 pandemic. Methods We retrospectively evaluated our ambulatory and hospitalized burn patients during the six months COVID-19 pandemic (from March to September 2020) with respect to the demographic data, wound care, surgery, intensive care management. Based on the model of our infection control team, we formed first to third degree prevention methods while contacting with burn patients in our outpatient clinic, semi-sterile ward (with beds) and intensive care unit (with 4 beds) which were sterilized and ventilated regularly. During hospitalization, we restricted the degree of interaction during multidisciplinary rounds. To screen for nosocomial infections, patients were routinely tested with PCR test. Results 402 burn patients (158 paediatric, 244 adults) were managed as outpatients (n=332;82%) and in patients (n=70; 18%) in our burn centre. Total body surface area percentage of burn in hospitalized patients were 9, 95±2, 76 % in paediatric and 25, 34±3, 49 in adult group. Majority of the burns were scald (86.7% paediatric, 60.5% adults) burns. We successfully performed 66 surgical debridement and grafting procedures. Three adult patients had mechanical ventilation support during follow up and one of them died due to multi organ failure with negative PCR. We detected COVID-19 in 2 patients and both of them were discharged successfully. Conclusions According to our results, when precautions are taken, burn care can be managed successfully without posing any risk to patients during the pandemic period.

Aim: Republic of Turkey Ministry of Health dedicated our hospital as a transplant center during the pandemic period. We admitted probable Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infection (COVID-19) cases and intensive care unit (ICU) patients from other centers, while confirmed COVID-19 cases were transferred to dedicated pandemic hospitals. The aim of this study was to determine the demographic parameters, clinical courses and outcomes of probable COVID-19 patients and to compare survivors with non-survivors admitted to our ICU.Materials and Methods: After Ethics Committee approval, 93 patients admitted to our ICU between March 23 and May 13 were analyzed retrospectively.Results: Mean age was 68.5y (60.2% male). Dyspnea (67.7%) was the most common symptom and hypertension (68.6%) was the most common comorbidity. None of PCR tests for SARS-CoV-2 were positive. Bilateral ground-glass (25.8%) and consolidation (14%) were the most common signs at chest computed tomography. Mean Acute Physiology and Chronic Health Evaluation System (APACHE II) score was 20.2 at ICU admission. Fifty-seven patients (61.3%) had pneumonia findings in lung X-ray or computerized tomography (CT). Thirty-four patients (36.6%) received low flow oxygen, six (9.7%) had high flow nasal oxygen and 27 (29%) had invasive mechanical ventilation. Forty patients (43%) had vasopressor therapy and 24 (25.8%) patients had renal replacement therapy due to acute kidney injury. Laboratory data including D-dimer, C-reactive protein, ferritin, creatinine kinase and procalcitonin were significantly higher in non-survivors when compared to survivors. The overall ICU mortality rate was 44.1%.Conclusions: A triage protocol of Turkish Study of Scientific Board based on clinical, laboratory and radiological findings for probable COVID-19 patients was applied in our center during the pandemic period. So, we ensured the effective usage of scarce ICU resources. The mortality rate of probable COVID-19 patients admitted to our ICU was found to be higher than the predicted mortality rate according to their APACHE-II score.

Various types of extracorporeal membrane oxygenation methods have been used in liver transplant operations. The main indications are portopulmonary or hepatopulmonary syndromes and other cardiorespiratory failure syndromes that are refractory to conventional therapy. There is little literature available about extracorporeal membrane oxygenation, especially after liver transplant. We describe our experience with 2 patients who had living-related liver transplant. A 69-year-old woman had refractory aspergillosis pneumonia and underwent pumpless extracorporeal lung assist therapy 4 weeks after liver transplant. An 8-month-old boy with biliary atresia underwent urgent liver transplant; he received venoarterial extracorporeal membrane oxygenation therapy on postoperative day 1. Despite our unsuccessful experience with 2 patients, extracorporeal membrane oxygenation and pumpless extracorporeal lung assist therapy for liver transplant patients may improve prognosis in selected cases.

OBJECTIVES The goal of this study was to compare the effects of 2 different regimens on blood glucose levels of living-donor liver transplant. MATERIALS AND METHODS The study participants were randomly allocated to the dextrose in water plus insulin infusion group (group 1, n = 60) or the dextrose in water infusion group (group 2, n = 60) using a sealed envelope technique. Blood glucose levels were measured 3 times during each phase. When the blood glucose level of a patient exceeded the target level, extra insulin was administered via a different intravenous route. The following patient and procedural characteristics were recorded: age, sex, height, weight, body mass index, end-stage liver disease, Model for End-Stage Liver Disease score, total anesthesia time, total surgical time, and number of patients who received an extra bolus of insulin. The following laboratory data were measured pre- and postoperatively: hemoglobin, hematocrit, platelet count, prothrombin time, international normalized ratio, potassium, creatinine, total bilirubin, and albumin. RESULTS No hypoglycemia was noted. The recipients exhibited statistically significant differences in blood glucose levels during the dissection and neohepatic phases. Blood glucose levels at every time point were significantly different compared with the first dissection time point in group 1. Excluding the first and second anhepatic time points, blood glucose levels were significantly different as compared with the first dissection time point in group 2 (P < .05). CONCLUSIONS We concluded that dextrose with water infusion alone may be more effective and result in safer blood glucose levels as compared with dextrose with water plus insulin infusion for living-donor liver transplant recipients. Exogenous continuous insulin administration may induce hyperglycemic attacks, especially during the neohepatic phase of living-donor liver transplant surgery. Further prospective studies that include homogeneous patient subgroups and diabetic recipients are needed to support the use of dextrose plus water infusion without insulin.

WOS: 000430617700001, PubMed ID: 29656714, Background: The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey. Methods: A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded. Results: Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1: 4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients. Conclusions: A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality.

Introduction: One day point prevalence study to evaluate patient profile in ICUs was planned by Turkish Thoracic Society Respiratory Failure and Intensive Care Group. Methods: The study was cross-sectional and data were obtained by a questionnaire in participating ICUs on October 26th 2016 for 24 hours. A questionnaire evaluating characteristics of patients in ICU was prepared. A total of 78 units declared to participate in the survey. Results: Ten centers were excluded from the study because they couldn’t participate on study day. A total of 922 patients were enrolled from 68 units. The mean age was 64.8 ± 17.9 (17-99), 58.6% were male. The mean APACHE II, QSOFA and GCS scores on the study day were 18.5 ± 8.8, 1.4 ±1.4 and 10.2 ± 4.3, respectively, and mean length of stay (LOS) was 20 ± 70 days. The patients were admited from emergency room(44%[n=407]), clinics(39%[n=359]) and other ICUs(17%[n=156]).38.5% of patients had Type 1 respiratory failure(RF),35.6% had Type 2 RF. Comorbidity was seen in 80.6% and malignancy rate was 18.8%. On the study day it was found that 52.1% of the patients underwent invasive mechanical ventilation(IMV),12.3% of the patients had non-invasive ventilation(NIV) 29.1% of them had oxygen therapy. Tracheostomy was performed in 19.7% of patients. 70% of the patients had enteral, 20.7% had parenteral nutrition. The discharge rate was 7% while mortality was 1.1% on that day. Discussion: Most of the patients in ICUs are respiratory failure cases admited from emergency department and clinics. Advanced age, presence of comorbidities and cancer are thought to prolong LOS in ICU. For effective use of ICU beds further regulations for patient admission criteria is necessary.

Purpose This study aimed to establish the role of risk factors in the etiology of postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Methods Between September 2001 and March 2008, 1040 patients underwent isolated CABG at our clinic. Nine hundred and eleven of these patients did not have any AF(Non-AF Group) and the other one hundred and twenty-nine had AF (AF Group). A retrospective study was performed for patient, disease and treatment related factors and multivariate analysis was used to identify independent clinical predictors of postoperative AF. Results Postoperative AF was identified in 129 (12.4%) of the patients, and those were significantly older and had significantly higher additive EuroSCORE score as compared with patients without AF. During the postoperative course, patients with postoperative AF also had significantly higher and prolonged (≥6 hours) mechanical ventilation time, longer and prolonged intensive care unit stay and longer hospital stay. Logistic regression analysis revealed that postoperative AF development ratio was 1.690 times higher when the ventilation time was over 6 hours (OR 1.690, 95% CI 1.092-2.615, p = 0.018); 1.240 times higher in the presence of elevated additive EuroSCORE score (OR 1.240, 95% CI1.109-1.385, p = 0.0001); 1.052 times higher in the presence of advanced age (OR 1.052,95% CI 1.031-1.0741, p = 0.0001). Conclusion Analysis of our data reveals that, patient's age, additive EuroSCORE score, and prolonged ventilation are predictors of postoperative AF. Identification of risk factors might lead to better prevention of this problem and its potential consequences. However, to support our investigation and obtain more reliable evidence, prospective randomized controlled trials are needed.

Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used.We retrospectively screened the data of 31 patients who were seen at our center between January 2014 and June 2016. We screened for patients who were admitted tothe intensive care unit before transplant and who required venoarterial extracorporeal membrane oxygenation for circulatory support and postoperative patients who required extracorporeal support. Patient demographics and characteristics, clinical data, and extracorporeal support data were collected from our electronic database and patient medical records.There were 14 patients who required perioperative extracorporeal support. Preoperative support was performed in 3 patients before transplant, and postoperative support was performed in 11 patients after transplant. The mean age was 37.7 years in patients within the preoperative group and 29.7 years in patients within the postoperative group. One patient with preoperative support and 5 with postoperative support were pediatric patients. The main indication for transplant was dilated cardiomyopathy in both groups (100% and 63.7%). Overall mortality rates were 33% in the preoperative group and 63.7% in the postoperative group.For patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort. In addition, extracorporeal support can be used during the posttransplant period as salvage therapy in heart recipients with hemodynamic deterioration. In our experience, preoperative extracorporeal support had lower mortality rates compared with postoperative support.

Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. Among 31 patients who underwent heart transplant between January 2014 and June 2016, we present our experiences with 3 patients who received venoarterial extracorporeal support as a bridge to heart transplant. The first patient was a 51-year-old male with ischemic dilated cardiomyopathy. Transplant was performed after 6 days of extracorporeal support, and the patient was discharged and alive at follow-up. Patient 2 was a 12-yearold girl with dilated cardiomyopathy who presented with cardiac arrest. Extracorporeal support was initiated during cardiopulmonary resuscitation. She had full neurologic recovery and remained on the wait list. She received a transplant 22 days after resuscitation. She survived and was alive at day 220 posttransplant. The third patient was a 50-year-old male with ischemic dilated cardiomyopathy requiring venoarterial extracorporeal support. Percutaneous balloon atrial septostomy was performed for left ventricle venting. He underwent transplant on day 28 after intensive care unit admission. He died 29 days after release from the hospital. Regarding patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort.

The aim was to assess outcomes for pregnancies in which hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome develops and the patient requires transfer for critical care.The cases of women with HELLP syndrome who delivered at our tertiary center or surrounding hospitals and were admitted to the intensive care between January 2007 and July 2012 were retrospectively analyzed. Results were compared for the surviving and non-surviving patients.Among the 77 women with HELLP syndrome, maternal mortality rate was 14% and 24 (30%) of 81 fetuses and newborns died in the perinatal period. The most common maternal complications were disseminated intravascular coagulation (DIC) (n = 22; 29%), acute renal failure (n = 19; 25%), and postpartum hemorrhage (n = 16; 21%). Compared with surviving women, the non-surviving women had higher mean international normalized ratio (INR) (p0.0001); higher mean serum levels of aspartate aminotransferase (AST) (p0.0001); higher alanine aminotransferase (ALT) (p0.0001); higher lactate dehydrogenase (LDH) (p0.0001), and higher bilirubin (p = 0.040) levels; and lower platelet count (p = 0.005).DIC is a major risk factor for maternal outcome among patients with HELLP syndrome who require intensive care. Low platelet count; high AST, ALT, LDH, INR; and total bilirubin are associated with high mortality risk in this patient group. In addition, low platelet count; low fibrinogen level; prolonged activated thromboplastin time; high INR; and high total bilirubin, LDH, blood urea nitrogen, and creatinine are associated with high risk for complications in this patient group.

Objective To identify the risk factors that influence outcome for patients who are diagnosed with septic shock in the emergency department at presentation or within 24 hours after admission to intensive care unit. Methods A retrospective study of 57 adult patients with septic shock was conducted between March 1, 2006 and August 31, 2009. Results The patients were 23 males and 34 females with a median age of 67 years (20 to 92 years). Thirty-three (58%) of 57 patients died in hospital and 24 (42%) survived. Multivariate analysis identified low blood pH (OR Conclusions Several factors signaling poor short-term outcome for this patient group are low blood pH, low serum bicarbonate level, longer duration of symptoms, lower respiratory tract infection and renal failure. MEDS and SOFA scores might be helpful in the ED to stratify patients with septic shock according to mortality risk.

Purpose: The present study was conducted to evaluate the obstetric admissions to the intensive care unit (ICU) in the setting of a tertiary referral hospital in an attempt to identify the risk factors influencing maternal outcome. Materials and Methods: All of the obstetric patients who seeked care for delivery at the emergency department and who were admitted to the ICU between January 2006 to July 2009 were retrospectively identified. The Simplified Acute Physiology Score (SAPS II) was calculated and the maternal mortality rate was estimated for each patient. The mean SAPS II scores and the mean estimated maternal mortality rates for the surviving patients and the nonsurviving patients were compared. Results: Seventy-three obstetric patients were admitted to the ICU. There were 9 maternal deaths and 24 fetal deaths. For the surviving group of patients, the mean SAPS II score was 34 and estimated maternal mortality rate was 20%, whereas for the nonsurviving group of patients, the SAPS II score was 64 and estimated maternal mortality rate was 73%. The difference between the surviving group of patients and the nonsurviving group of patients was statistically significant regarding both the mean SAPS II scores and the mean estimated maternal mortality rates. Conclusions: Pregnancy-induced hypertensive disorders and hemorrhage appear as the major risk factors influencing maternal outcome in obstetric patients. Considering that the use of the SAPS II scores have enabled the reliable estimation of the mortality rates in the present study, the attempts at defining the focus of care for the obstetric patients who bear the major risk factors and who are admitted to the ICU should be carried out under the guidance of the ICU scoring systems such as the SAPS II.

OBJECTIVES Acute kidney injury after pediatric liver transplant is associated with increased morbidity and mortality. Here, we evaluated children with acute kidney injury early posttransplant using KDIGO criteria to determine incidence, risk factors, and clinical outcomes. MATERIALS AND METHODS In this retrospective cohort study, medical records of all patients < 16 years old who underwent liver transplant from April 2007 to April 2017 were reviewed. RESULTS Of 117 study patients, 69 (59%) were male and median age at transplant was 72 months (range, 12-120 mo). Forty children (34.2%) had postoperative acute kidney injury, with most having stage 1 disease (n = 21). Compared with children who had acute kidney injury versus those who did not, preoperative activated partial thromboplastin time (median 35.6 s [interquartile range, 32.4-42.8 s] vs 42.5 s [interquartile range, 35-49 s]; P = .007), intraoperative lactate levels at end of surgery (median 5.3 mmol/L [interquartile range, 3.3-8.6 mmol/L] vs 7.9 mmol/L [interquartile range, 4.3-11.2 mmol/L]; P = .044), and need for open abdomen (3% vs 15%; P= .024) were significantly higher. Logistic regression analysis revealed that preoperative high activated partial thromboplastin time (P= .02), intraoperative lactate levels at end of surgery (P = .02), and need for open abdomen (P = .03) were independent risk factors for acute kidney injury. Children who developed acute kidney injury had significantly longer intensive care unit stay (7.1 ± 8.5 vs 4.4 ± 5.4 days, P= .04) and mortality (12.8% vs 1.8%; P = .01). CONCLUSIONS Early postoperative acute kidney injury occurred in 34.2% of pediatric liver transplant recipients, with patients having increased mortality risk. High preoperative activated partial throm-boplastin time, high intraoperative end of surgery lactate levels, and need for open abdomen were shown to be associated with acute kidney injury after pediatric liver transplant.

The objective of this study was to compare the block durations and haemodynamic effects associated with intrathecal levobupivacaine or bupivacaine in elderly patients undergoing transurethral prostate surgery. Eighty patients were prospectively randomised to receive plain 1.5 ml levobupivacaine 0.5% (group levobupivacaine) or 1.5 ml plain bupivacaine 0.5% (group bupivacaine) in combination with fentanyl 0.3 ml (15 microg) for spinal anaesthesia. The time to reach T10 and peak sensory block level, and to maximum motor block were significantly shorter in group bupivacaine compared to group levobupivacaine (p < 0.05). Peak sensory block level was also significantly higher in group bupivacaine. In group bupivacaine, mean arterial pressure was significantly lower than group levobupivacaine, starting from 10 min until 30 min after injection (p < 0.05). Hypotension and nausea were less common in group levobupivacaine than group bupivacaine (p < 0.05). Because of the better haemodynamic stability and fewer side-effects associated with levobupivacaine, it may be preferred for spinal anaesthesia in elderly patients.

In this randomized, double-blind study, we aimed to compare the effectiveness of lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus in patients undergoing cesarean section.One hundred and eight parturients (American Society of Anesthesiologists [ASA] I-II status) requesting neuraxial analgesia by a combined spinal-epidural (CSE) technique were recruited for this study. A CSE technique was performed and anesthesia was achieved with fentanyl 25 microg and hyperbaric bupivacaine 12 mg. Patients were randomly allocated to three groups, each with 36 participants. Immediately following delivery, patients received either lornoxicam 8 mg IV (group L; n = 36), ondansetron 8 mg IV (group O; n = 36), or normal saline 2 ml IV (group P; n = 36). Pruritus, pain, and nausea and vomiting scores were recorded during the initial 24 h postoperatively.The incidence of pruritus was significantly lower in group O from 4 to 12 h postoperatively when compared to that in group L and group P. According to the pruritus grading system we used, the number of patients without pruritus was significantly higher in group O when compared to that in group L and group P. The number of patients experiencing moderate pruritus was significantly lower in group O when compared to that in group P.We observed that the administration of 8 mg IV lornoxicam failed to prevent intrathecal fentanyl-induced pruritus in parturients. Also, our data confirmed that ondansetron is likely to attenuate intrathecal fentanyl-induced pruritus.

Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients.Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen.The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [interquartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P = .052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P = .001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to 8 patients [25.8%]; P = .004]).Percutaneous dilational tracheotomy with bronchoscopic guidance is an efficacious and safe technique for maintaining airways in solidorgan transplant recipients who require prolonged mechanical ventilation, resulting in possible improvements in ventilatory mechanics and patient comfort.

We evaluated late intensive care unit admission in liver transplant recipients to identify incidences and causes of acute respiratory failure in the postoperative period and to compare these results with results in patients who did not have acute respiratory failure.We retrospectively screened the data of 173 consecutive adult liver transplant recipients from January 2005 through March 2015 to identify patients with late admission (30 d posttransplant) to an intensive care unit. Patients were divided into 2 groups: patients with and without acute respiratory failure. Acute respiratory failure was defined as severe dyspnea, respiratory distress, decreased oxygen saturation, hypoxemia or hypercapnia on room air, or need for noninvasive or invasive mechanical ventilation. Demographic, laboratory, clinical, and respiratory data were collected. Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores; lengths of intensive care unit and hospital stays; and hospital mortality were assessed.Among 173 patients, 37 (21.4%) were admitted to an intensive care unit, including 22 (59.5%) with acute respiratory failure. The leading cause of acute respiratory failure was pneumonia (n = 19, 86.4%). Patients with acute respiratory failure had significantly lower levels of albumin before intensive care unit admission (P = .003). In patients with acute respiratory failure, severe sepsis and septic shock were more frequently observed and tracheotomy was more frequently performed (P = .041).Acute respiratory failure developed in 59.5% of liver transplant recipients with late intensive care unit admission. The leading cause was pneumonia, with this group of patients having higher requirements for invasive mechanical ventilation and tracheotomy, longer stays in an intensive care unit, and higher mortality.

Every year, 500.000 mothers die from pregnancy-related complications, and 99% of these deaths occur in low- and middle-income countries [1]. These maternal deaths occur from complications associated with pre-eclampsia or eclampsia; hemolysis elevated liver enzymes, and low platelet (HELLP) syndrome, or other hypertensive disorder of pregnancy [2].

The main goal of 2-stage liver transplant is to provide time to obtain a new liver source. We describe our experience of 3 patients with 3 different clinical conditions. A 57-year-old man was retransplanted successfully with this technique due to hepatic artery thrombosis. However, a 38-year-old woman with fulminant toxic hepatitis and a 5-year-old-boy with abdominal trauma had poor outcome. This technique could serve as a rescue therapy for liver transplant patients who have toxic liver syndrome or abdominal trauma. These patients required intensive support during long anhepatic states. The transplant team should decide early whether to use this technique before irreversible conditions develop.

Study objective: To determine the effects of intra-operative low-dose dexmedetomidine infusion on postoperative morphine consumption, pain, sedation and patient satisfaction in patients undergoing septorhinoplasty. Method: Fifty adult patients were randomised to receive either dexmedetomidine (a loading dose of 1 μg kg−1 for the first ten minutes and a maintenance dose of 0.2 μg kg−1 h−1 afterwards, Group D) or 0.9% saline in the same manner (Group C) after induction of anaesthesia. At the end of the operation, the infusions were discontinued. After extubation, patient controlled analgesia was started intravenously. Results: Patients in Group D consumed 47% less morphine than patients in Group C during the first 24 h and had a lower cumulative morphine consumption at all times after starting patient controlled analgesia (7.08 mg vs. 8.56 mg at 2 h (p < 0.05), 10.84 mg vs. 14.0 mg at 4 h (p < 0.05), 13.56 mg vs. 18.28 mg at 6 h (p < 0.05) and 17.96 mg vs. 33.72 mg at 24 h (p < 0.05), respectively ...

Background: We evaluated the effect of oral clonidine on postoperative vomiting (POV) in children undergoing strabismus surgery. Methods: Eighty ASA physical status I children aged 3–12 years were randomly assigned to one of two groups in a double-blinded manner. One hour before surgery, each patient in the clonidine group (n=40) received clonidine 4 µg kg−1 in apple juice 0.2 ml kg−1, and each of the controls (n=40) received apple juice 0.2 ml kg−1 only. The protocol for general anesthesia was propofol-sevoflurane in N2O/O2. A paracetamol suppository was administered in each case to prevent postoperative pain. Patient responses during 0–48 h after anesthesia were recorded as complete (no POV, no antiemetic rescue required), retching, vomiting, or rescue antiemetic. Results: There were no significant differences between the clonidine and control groups regarding the number of patients with complete response (21 vs. 18, respectively) retching (10 vs. 14, respectively), vomiting (19 vs. 22, respectively), or rescue antiemetic (9 vs. 12, respectively) during the first 48 h. Conclusion: Oral premedication with clonidine 4 µg kg−1 did not reduce the rate of POV in the children undergoing strabismus surgery.

Purpose. The size 1 I-gel, recommended for small infants and neonates weighing 2–5 kg, has recently been released. There are no prospective studies available that assess the insertion conditions, sealing pressures, or ventilation quality of it. This study was designed to compare the performance of recently released size 1 I-gel with size 1 ProSeal LMA.Methods. Fifty infants and neonates, ASA I-II were included in this prospective, randomized, and controlled study. Patients were divided into two groups for placing I-gel or ProSeal LMA. The primary outcome was airway leak pressure, and secondary outcomes included insertion time, insertion success and conditions, initial airway quality, fiberoptic view of the larynx, and complications.Results. There were no significant differences in terms of airway leak pressure between the I-gel (27.44±5.67) and ProSeal LMA (23.52±8.15) (P=0.054). The insertion time for the I-gel was shorter (12.6±2.19 s) than for the ProSeal LMA (24.2±6.059 s) (P=0.0001). Insertion success and conditions were similar in groups. We encountered few complications.Conclusion. Our study demonstrates that the size 1 I-gel provided an effective and satisfactory airway as the size 1 ProSeal LMA. It may be a good alternative supraglottic airway device for use in small infants and neonates. This trial is registered with: ClinicalTrials.govNCT01704118.

Cedecea spp., which are the member of Enterobacteriaceae family, is frequently isolated from sputum, but their clinical importance is not clear. This report presents a pneumonia case caused by Cedecea lapagei. An 18 year old, cachectic, spastic and epileptic male patient with oral and nasal bleeding was admitted to the hospital and underwent artificial respiration after epileptic convulsions. On the third day of hospitalization Chest X-ray revealed opacities in the right lobe. Tracheal aspirate’s direct microscopic examination revealed leukocytes and gram-negative bacilli. Bacteria isolated from tracheal aspirate culture was identified as Cedecea lapagei by the BBL Crystal Enteric/ Nonfermenter ID kit (Becton Dickinson, USA) which was confirmed by the Vitek identification system (Biomerieux, France). Upon the initiation of intravenous sulbactam/cefoperazone and amikacin combination therapy, the signs of infection decreased in intensity. In this case, tracheal intubation and aspiration of the secretions let the bacteria cause pneumonia. This report supports the fact that Cedecea lapagei is a causative agent of pneumonia as shown in rare cases in the literature.

Objectives: The aim of this study was to investigate the effects of sevoflurane and propofol used in electroconvulsive therapy (ECT) on hemodynamic variables and duration of seizure activity and recovery profiles. Methods: Sixteen patients who were not premedicated, with a mean age 27.1 years, were enrolled in this prospective open trial, receiving a total of 64 ECT treatments. Each patient was given the following 2 anesthetic regimens in random order: In group S, anesthesia was induced with 7% sevoflurane in 100% oxygen at 6 L min -1 fresh gas flow until the loss of consciousness and 1.5 mg kg -1 propofol in group P. Adequate muscle relaxation was achieved with suxamethonium, 1.0- 1.2 mg kg -1 . Noninvasive mean arterial pressure (MAP) and heart rate (HR) values, duration of motor seizure activity, and recovery times were recorded. Results: The mean motor seizure duration was significantly longer with sevoflurane (mean [SD]: 43.09 [16.6] s) than with propofol (28.91 [7.9] s; P < 0.05). The MAP 1 minute and 10 minutes after ECT (101.25 [7.5] mm Hg and 100.16 [11.0] mm Hg, respectively) was significantly increased compared with before ECT (94.56 [6.9] mm Hg) in sevoflurane group (P < 0.05). Time to spontaneous breathing, eye opening and obeying commands, and changes in MAP and HR during and after ECT were similar in both regimens. Conclusion: Induction with 7% sevoflurane allows prolonged duration of motor seizures in ECT. We concluded that induction of anesthesia with sevoflurane inhalation is a reasonable alternative for patients undergoing ECT.