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Delirium is an organic dysfunction including the brain’s inflammatory response to injury, hormonal effects and changes in neurotransmission and neural network. Delirium is one of the major causes of weaning difficulty in intensive care unit (ICU) patients. In this case report, we tried to explain the successful weaning procedure in a patient using quetiapine after trying all treatment options due to delirium in the ICU. This report emphasizes that second-generation antipsychotics should be kept in mind in patients who cannot be disconnected from the mechanical ventilator due to delirium.

Objective:As a result of advanced mechanical ventilation and hemodynamic support applications, the duration of intensive care stay is prolonged. Investigation of effective causes of prolonged ICU stay is important in terms of effective use of intensive care units.Materials and Methods:Patients who were hospitalized for more than 24 hours in the ICU during one year were included into the study. Age, gender, Body Mass index, hospitalization, location (emergency, operating room, service), presence of operation, presence of emergency / elective operation, need for vasopressor, Glaskow coma score (GCS), Full Outline of Unresponsiveness score (FOUR), Acute Physiology and Chronic Health Evaluation score, simplified acute physiology (SAPS III) score, hemogram profile, biochemical profile and coagulation profile values were recorded. All patients were classified as stay in the intensive care unit for shorter than 14 days and 14 days and more. We tried to investigate factors affecting prolonged admission by comparing these values.Results:Advanced age, high urea value, low GCS, low FOUR score, high SAPS III value, need for MV and need for vasoactive agent were found to be effective factors in prolonged intensive care hospitalization.Conclusion:We think that extensive studies should be done in this area as more effective use of intensive care units may be possible as a result of trying to reveal the factors affecting prolonged intensive care.

Tracheal ruptures are one of the life-threatening situations in critical care unit and can be formed after trauma, intubation, tracheotomy, bronchoscopy or spontaneously. Significant risk factors for tracheal rupture include urgent intubation, use of stilet, high cuff pressure, recurrent intubation attempts, double lumen endotracheal tubes, very thick endotracheal tubes, female gender, short height, older age, tracheomalacia, tracheal stenosis, congenital tracheal abnormalities and chronic steroid therapy. Among these risk factors, corticosteroids can cause rupture by inhibiting collagen synthesis and reducing connective tissue stability. In this case report, a case with spontaneous recurrent tracheal rupture was defined and the underlying mechanisms and therapeutic approach to this complication that could be seen in patients using chronic steroids were discussed.

Posterior reversible encephalopathy (PRES) syndrome is a clinical-radiological condition characterized by headache, changes in consciousness, epilepsy and visual disturbances, and usually occurs in the posterior parietal and occipital regions with vasogenic edema due to different etiologic factors. Risk factors include preeclampsia/eclampsia as well as hypertension, human immunodeficiency virus infection, organ transplantation, immunosuppressive and cytotoxic therapy, and analgesics. Treatment is usually aimed at correcting the cause of PRES. The aim of this case report was to present the characteristics of PRES, which was secondary to eclampsia in two cases, to discuss the differential diagnosis and to review the literature.

Objective: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of death worldwide with a continued rising mortality rate, and it represents a major socioeconomic burden. The aim of this study was to examine the costs of acute exacerbation of COPD patients admitted to two different university hospital intensive care units. Material and Methods: We analyzed 156 patients (128 male and 28 female) who were admitted for treatment of acute exacerbations of COPD from January 1, 2005 to June 15, 2008. Results: The mean age of the patients was 68.2 years. The mean length of hospitalisation stay was 10.4 days. The costs were different between survivors and non-survivors. There was a statistically significant difference between survivors and non-survivors groups in all costs except bed costs, laboratory costs, radiology costs and consultation costs. Conclusion: These results suggest that the cost of patients with acute exacerbations of COPD represents a considerable economic burden for the health care system in Turkey. Turkish Başlık: Kronik Obstrüktif Akciğer Hastalığı Akut Alevlenmesi Olan Hastaların İki Üniversite Hastanesi Anahtar Kelimeler: Kronik obstrüktif akciğer hastalığı; akut alevlenme; maliyet analizleri Amaç: Kronik obstrüktif akciğer hastalığı (KOAH) dünya çapında ölümlerin ana nedeni olup, mortalite hızı sürekli yükselmekte ve önemli sosyoekonomik yük oluşturmaktadır. Bu çalışmada iki farklı üniversite hastanesi yoğun bakım ünitesinde KOAH akut alevlenmesi olan hastaların maliyetlerinin incelenmesi hedeflenmiştir. Gereç ve Yöntemler: 1 Ocak 2005 ile 15 Haziran 2008 tarihleri arasında KOAH akut alevlenmesi nedeniyle tedavi olan 156 hasta (128 erkek ve 28 kadın) analiz edilmiştir. Bulgular: Hastaların ortalama yaşı 68.2 olarak bulunmuştur. Ortalama hastanede kalış süresi 10.4 gün olarak saptanmıştır. Sağ kalan ve ölen hastaların maliyetleri birbirlerinden farklı bulunmuştur. Sağ kalanlar ve ölen hastalar arasında yatak ücreti, laboratuar ücreti, radyoloji ücreti ve konsültasyon ücretleri dışındaki diğer tüm tedavi maliyetlerinde istatistiksel farklılık saptanmıştır. Sonuç: KOAH akut alevlenmesi olan hastaların tedavi maliyetlerinin Türk sağlık sistemi içinde hatırı sayılır yer oluşturduğunu düşünmekteyiz., Amaç: Kronik obstrüktif akciğer hastalığı (KOAH) dünya çapında ölümlerin ana nedeni olup, mortalite hızı sürekli yükselmekte ve önemli sosyoekonomik yük oluşturmaktadır. Bu çalışmada iki farklı üniversite hastanesi yoğun bakım ünitesinde KOAH akut alevlenmesi olan hastaların maliyetlerinin incelenmesi hedeflenmiştir. Gereç ve Yöntemler: 1 Ocak 2005 ile 15 Haziran 2008 tarihleri arasında KOAH akut alevlenmesi nedeniyle tedavi olan 156 hasta (128 erkek ve 28 kadın) analiz edilmiştir. Bulgular: Hastaların ortalama yaşı 68.2 olarak bulunmuştur. Ortalama hastanede kalış süresi 10.4 gün olarak saptanmıştır. Sağ kalan ve ölen hastaların maliyetleri birbirlerinden farklı bulunmuştur. Sağ kalanlar ve ölen hastalar arasında yatak ücreti, laboratuar ücreti, radyoloji ücreti ve konsültasyon ücretleri dışındaki diğer tüm tedavi maliyetlerinde istatistiksel farklılık saptanmıştır. Sonuç: KOAH akut alevlenmesi olan hastaların tedavi maliyetlerinin Türk sağlık sistemi içinde hatırı sayılır yer oluşturduğunu düşünmekteyiz.

Trakya Üniversitesi Hastanesi (TÜH) Merkez Yoğun Bakım Ünitesi (MYBÜ)'nde kullanılan antibiyotiklerin hastane infeksiyon (Hİ) etkeni mikro-organizmalara etkinliği ve antibiyotik kullanımı ile hastane infeksiyonu gelişimi arasındaki ilişkinin belirlenmesi amaçlandı. Hastalar prospektif olarak laboratuvara ve hastaya dayalı, aktif sürveyans yöntemiyle değerlendirildi. Mikro-organizmaların tanımlanması ve antibiyotik duyarlılıklarının belirlenmesi TÜH Mikrobiyoloji Laboratuvarı'nda yapıldı. Merkez Yoğun Bakım Ünitesi'ne dokuz ayda yatırılan 135 hastadan 36 Acinetobacter cinsi bakteri, 25 Pseudomonas aeruginosa, bir Stenotrophomonas maltophilia, 20 Candida cinsi maya, sekiz Enterobacteriaceae üyesi, 25 Staphylococcus kökeni, beş Enterococcus kökeni olmak üzere 120 mikro-organizma izole edildi. Acinetobacter türlerine karşı sefaperazon/sulbaktam, P. aeruginosa kökenlerine karşı piperasilin/tazobaktam ve meropenem en etkili antibiyotikler olarak belirlendi. Gram-pozitif bakterilerde vankomisin direnci saptanmadı, ancak Staphylococcus aureus kökenlerinin %85'i metisiline dirençli idi. Hastane infeksiyonu gelişimi ile antibiyotik kullanılması arasında anlamlı ilişki bulunmadı. Uygun dozda ve sürede, YBÜ'nün florasına uygun antibiyotik kombinasyonları ampirik tedavide kullanılmalı, hastaların kültür sonucuna göre tedavi tekrar düzenlenmeli ve antibiyotik kullanımına infeksiyon uzmanına danışılarak karar verilmelidir., The aim of this study was to determine the antibiotics used in the Intensive Care Unit (ICU) of Trakya University Hospital, their effect on the microorganisms isolated as nosocomial infection agents and the relation between the antibiotic consumption and hospital infections. The patients hospitalized in ICU were evaluated prospectively with the active surveillance method based on the labor-atory and patients. The identification of microorganisms and antimicrobial susceptibilities tests were made the in Microbiology Laboratory of Trakya University Hospital. Thirty six Acinetobacter spp, 25 Pseudomonas aeruginosa, one Stenotrophomonas maltophilia, 20 Candida spp, eight bacteria belonging to Enterobectericeae, 25 Staphylococcus spp, five Enterococcus spp, in total 120 microorganisms were isolated. The most effective antibiotic against Acinetobacter spp. was cefoperasone/sulbactam, and to P. aeruginosa piperacillin/tazobactam and meropenem. The vancomycin resistance was not detected in gram positive bacteria, but 85% of Staphylococcus aureus strains were resistant to meticilline. No relation between the antibiotic usage and nosocomial infections was found. The antibiotics should be used in appropriate dosage and for appropriate periods, the combination of appropriate antibiotics according to the ICUs' flora should be used in empiric treatment and the treatment should be rearranged according to the reports of cultures. The antibiotics should be given following consultation with infectious disease specialists.