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Objectives: We investigated the effects of endotracheal tubes with subglottic drainage (SGAETT) on the incidence of ventilator-associated pneumonia (VAP) in patients with chronic obstructive pulmonary disease (COPD) undergoing coronary artery bypass grafting (CABG). Methods: The patients were assigned to one of two groups. Group 1 patients used a SGAETT (n=94); Group 2 controls received standard endotracheal tubes (n=100). The demographic data, number of coronary bypasses performed, and cross clamp (CC) and cardiopulmonary bypass (CPB) durations were recorded. Endotracheal aspiration samples were obtained from patients with suspected VAP in the intensive care unit (ICU). Intubation time, length of ICU and hospital stays, erythrocyte transfusion volume, enteral nutrition needs, transportation needs, and reintubation and sedation needs were recorded. Results: The VAP rate was 6.8% in Group 1 and 19% in Group 2 (p<0.05). Group 1 patients had lower body weight, smoking, and transportation needs; Group 1 patients also had shorter ICU and hospital stays but demonstrated a greater average body surface area, higher mean pulmonary arterial pressure, more-frequent peptic ulcers, higher mean pulmonary arterial pressure, and Group 1 patients were more likely to have ejection fractions (EFs) less than 40% (p<0.05). A logistic regression analyses found SGAETT independently reduced VAP independently (OR: 0.037) (p<0.05). Conclusion: SGAETT reduces the incidence of VAP in patients with COPD undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Objective: This study was planned to evaluate effectiveness of cardiac surgery score (CASUS) system used for the prediction of mortality after the cardiac surgery and to compare it with EuroSCORE, a tested and approved method. Method: Fifty patients over the age of 18 who came to the intensive care unit (ICU) after open heart surgery and stayed in the ICU for more than 48 hours were prospectively included in the study. After the preoperative EuroSCORE evaluation of the patients, CASUS scoring systems were used for risk scoring from postoperative 0 day to the service or up to the 6th postoperative day (or possible mortality) in patients whose stay in ICU was prolonged. We evaluated the place of both models in the prediction of ICU mortality. Results: The study was conducted with 50 patients- 21 female, 29 male-, aged between 19 and 79 years (mean age: 60.38±12.50). Five (10%) cases exited.The areas under the ROC curve were estimated as follows: EuroSCORE, 45.3%; and for CASUS 0,1, and 2. day scores AUCs of ROC curve were 66,9%, 64,7%, and 79,8%, respectively. The CASUS 2nd day score was found to be valuable in predicting mortality (p<0.01). A statistically significant relationship was observed between the days of stay in the ICU and mortality. Conclusion: Our results show that the rate of the accurate prediction of mortality of CASUS is insufficient on postop 0th and 1st day; however CASUS score on postoperative 2nd day has sufficient.predictive accuracy EuroSCORE is not found effective in the prediction of mortality. It is observed that if the duration of stay in ICU is prolonged, it statistically significantly increases the risk of mortality. [ABSTRACT FROM AUTHOR]

Objective: TThe application of mechanical support devices such as extracorporeal membrane oxygenatior (ECMO) has increased with the increase in complex cardiac surgery operations in congenital heart diseases. Despite significant advances in ECMO techniques and methods, the prognosis is still poor. The aim of this study is to show the relationship between organ dysfunction and mortality in patients with veno-arterial (VA) ECMO after pediatric cardiac surgery. Method: Sixty-three patients in the pediatric cardiac ICU who had VA-ECMO and followed up up to 48 hours in our clinic, were retrospectively included in the study and two groups were formed as follows: Group 1: Patients exited within 30 days (n: 47), Group 2: Survived patients (n: 16). Along with the demographic data of the patients, ECMO placement time, creatinine, BUN (blood urea nitrogen), ALT (alanine aminotransferase), AST (aspartate aminotransferase), bilirubin, albumin and platelet counts were recorded. Results: While 36 patients (57.1%) left ECMO in our study group, 16 of these patients (16/63,25.4%) were discharged. A total of 47 patients (47/63, 74.6%) died. Although the number of patients who underwent univentricular repair (26/47,55.31%) in Group 1 was higher (n=5:31.25%) than Group 2, this difference was not significant (p>0.05). Postoperative ECMO was implanted in 27 patients (57.44%) in Group 1 and 4 patients (31.25%) in Group 2, and this difference was statistically significant (p<0.02). While levels of creatinine, BUN, ALT, AST were higher in Group 1 patients who had higher mortality rates, albumin and platelet values were lower than Group 2 (p<0.05). Conclusion: It has been determined that organ dysfunction parameters were found to be effective in showing mortality, mortality rates were higher among patients in whom ECMO was placed postoperatively. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the risk factors in atrial fibrillation (AF), which is the most common rhythm disorder observed after coronary artery bypass graft (CABG) surgery, and to show whether there is a correlation between C-reactive protein (CRP) and AF. Methods: A total of 250 patients who would undergo coronary artery surgery were retrospectively included in the study. Demographic data, peroperative and postoperative variables of all patients, daily CRP and AF follow-ups until the 6th postoperative day and treatment protocols of AF patients were recorded. Results: AF was detected in 43 (17.2%) of the patients who were followed up. It was found that there was a statistically significant relationship in the multivariate analysis between advanced age, hypertension (HT) and use of preoperative calcium channel blocker and AF (p<0.05). CRP values reached the highest value on the 2nd postoperative day. Although AF was seen in 14 patients (5.6%) in this period, no relation was found between increased CRP levels and the development of AF (p>0.05). It was observed that the length of intensive care and hospital stay of patients with AF was statistically significantly longer (p<0.05). Conclusion: It was found that older hypertensive patients who preoperatively used calcium channel blocker had a higher risk of developing AF. Duration of ICU and hospital stay was longer, and no correlation was found between AF and CRP. [ABSTRACT FROM AUTHOR]

Objective: Ventilator-associated pneumonia (VAP) are among common infections encountered in intensive care units. The high mortality rate is important due to prolonged hospital stay and increased hospital costs. In this study, we aimed to determine the risk factors associated with VAP in patients who had undergone open heart surgery. Method: In this study, a total of 599 patients (178 female, and 421 male) who underwent elective open heart surgery were prospectively included in this study. Patients who could not be extubated after 48 hours were divided into two groups. Group 1: Patients with clinical suspicion of VAP and bacterial growth in their endotracheal aspirates (ETA) (n=29) Group 2: Control group (n=570). Results: In univariate analysis, age, Chronic Obstructive Pulmonary Disease (COPD) Pulmonary Hypertension (PHT), history of myocardial infarction (MI), low ejection fraction (EF), prolonged cross- clamp and pump times, inotropic support, presnce of intra-aortic balloon pump (IABP) and use of hemofiltration, atrial fibrillation, reintubation, enteral nutrition with nasogastric tube, reoperation, neurologic dysfunction, steroid use, blood and blood product use, hypoalbuminemia and presence of decubitus ulcer were detected as risk factors for VIP. According to logistic regression analysis duration of intubation longer than 72 hours, reintubation, COPD, previous MI, steroid use, AF neurologic dysfunction were determined as independent risk factors for VAP. Conclusion: In the patient population consisting of patients with cardiac surgery, keeping the invasive mechanical ventilator support as short as possible, reducing the need for reintubation by extubation in optimal time, ensuring complete haemodynamic stability, preoperative preparation of the patient preoperatively, prevention of postoperative haemodynamic instability during surgery, and reduction of VAP. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the incidence and risk factors associated with sepsis in pediatric patients who underwent congenital heart surgery. Method: A total of 289 patients were prospectively enrolled in this study. Patients were divided into two groups according to the Society of Critical Care Medicine (SSCM) diagnostic criteria as Group I including 28 patients who fulfilled the criteria for sepsis and Group II including 261 patients without diagnosis of sepsis. Demographic information, type of operation, complexity, duration of preoperative hospitalization (>5 days) and intensive care unit (ICU) stay, requirement for mechanical ventilation (MV), history of pulmonary hypertension (PHT), and requirement for emergency surgery, total cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times. During the postoperative period delayed sternal closure, duration of mechanical ventilation, the need for reintubation, and need for reoperation were also recorded. Results: The incidence of sepsis was 4.74%. The mortality rate in septic patients was 32%. Factors associated with sepsis were younger age, low body weight, duration of preoperative hospitalization and ICU stay, preoperative requirement for MV, palliative and emergency interventions, history of PHT, prolonged MV, reintubation, and reoperation. Multivariate analysis identified reintubation and duration of MV as the major risk factors for sepsis. Conclusion: Serious infectious problems, such as sepsis, are encountered due to inadequate development of immune resistance mechanisms in pediatric patients. Appropriate preoperative preparation of patients for surgery, reducing the length of stay in the hospital and in the ICU, and reducing the need for reintubation by extubating the patients for an optimal period, would reduce the mortality rate due to sepsis. [ABSTRACT FROM AUTHOR]

Background This study aimed to describe the learning curve of the extracardiac Fontan procedure in a single center and to analyze the changes in clinical applications and outcomes. Methods A retrospective chart review of all extracardiac Fontan patients in a single tertiary care center was undertaken. Patients with a diagnosis of hypoplastic left heart syndrome and those who had undergone a lateral tunnel modification, intra/extracardiac Fontan, Kawashima procedure, or inferior vena cava-to-azygous vein connection were excluded from the analysis. Results Between May 2004 and February 2018, data of 159 extracardiac Fontan patients were analyzed. The median age was 5.5 years (range 4.5–8.2 years). Based on a cumulative sum analysis, a hinge point was determined to divide the cohort into 2 phases. Phase 1 (n = 70) represented the first learning phase and phase 2 (n = 89) represented the later phase. Mortality decreased in phase 2 (2/89; 2%) compared to phase 1 (10/70; 14%; p = 0.004). Two (3%) patients had extracorporeal membrane oxygenation in phase 1, and 5 (6%) in phase 2 (p = 0.47). More patients in phase 2 underwent a prior bidirectional Glenn procedure (83/89 vs. 57/70; p = 0.02), fenestration (80/89 vs. 9/70; p < 0.001), and pulmonary artery reconstruction (37/89 vs. 2/70; p < 001). Conclusions This study shows that increased use of extracorporeal membrane oxygenation, strict implementation of the three-stage management plan, routine fenestration, and a low threshold for pulmonary artery reconstruction may be associated with decreased mortality in the extracardiac Fontan procedure. [ABSTRACT FROM AUTHOR]

Objective: This study aims to analyze the effects of two different positive end- expiratory pressure (PEEP) levels during single lung ventilation with low tidal volume (TV) on respiration and hemodynamics in patients undergoing thoracotomy. Material and Methods: After the Hospital Education Planning Board approval and written consent were obtained 40 patients scheduled for thoracotomy were enrolled in the study. When all patients were intubated with double- lumen endotracheal tube and one-lung ventilation (OLV) was initiated, the patients were randomized into two groups. Group 1 (n: 20) consisted of patients who underwent lung ventilation with 6 ml/kg TV and 5 cm H2O PEEP; and Group 2 (n: 20) consisted of patients who underwent lung ventilation with 6 ml/ kg TV and 10 cm H2O PEEP. Arterial blood gas samples were obtained from the patients during the study, and mean arterial pressure, heart rate, partial oxygen pressure (pO2), partial carbondioxide pressure (pCO2), peak airway pressures (PİP), plateau pressure values were recorded at 7 different time points namely T0: Supine position, before the induction, T1: double lung ventilation after induction, T2: OLV 15 minutes, T3: OLV 30 minutes, T4: OLV 45 minutes, T5: pre-extubation, supine position, T6: Postoperative 6th hour. Results: Mean arterial pressure and heart rate values were significantly lower at T1, T2, T3 ve T4 time points in Group 2; however, this decrease was within physiological limit. Group 2 patients had significantly higher PaO2 and lower PaCO2 values. At time points of T2, T3 and T4 when the patients were under OLV, PiP and plateau pressures in Group 2 patients were significantly higher (p<0.05). Conclusion: It was concluded that delivery of low tidal volume and 10 cm H2O PEEP to the ventilated lung during thoracotomy made positive contributions to oxygenation without any adverse effects on hemodynamic, and respiratory mechanisms. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A baby case of haematogenous rib osteomyelitis that was caused by Leuconostoc lactis was presented. The patient had high fever and an abscess formation on the right scapula. Diagnosis was made with the results of blood, bone and abscess cultures, pathological findings of the involved rib and direct bone graphies. The patient was treated succesfully with cefotaxime for 6 weeks. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Widespread application of on-pump revascularization procedures is increasing due to the thought of elimination of untoward effects of cardiopulmonary circuit. Thus, whether off-pump coronary artery surgery eliminates side effects especially related to respiratory functions is still controversial. Although many previous studies have evaluated these respiratory functions, daily comparison of 12 parameters was not included in any of the studies. The aim of our prospective study was to ascertain whether off-pump coronary operation improves pulmonary functions and postoperative recovery period when compared with on-pump technique and whether early discharge of patients with off-pump surgery is the result of respiratory improvement. Methods: Eighteen patients in each group were included: on-pump group underwent coronary revascularization with cardiopulmonary bypass and off-pump with stabilization. Respiratory function tests and arterial blood gas analyses were performed preoperatively and daily after operation function tests included forced expiratory volume (FEV) in 1 s, forced vital capacity (FVC), expiratory reserve volume, vital capacity, quotient of FEV in 1 s to FVC, maximal voluntary ventilation (MVV), tidal volume, and forced midexpiratory flow. Blood gas analyses included partial arterial oxygen and carbon dioxide pressure, arterial pH and hematocrit (Hct). Results: Preoperative pulmonary functions and arterial blood gases were not statistically significant between groups except MVV and partial arterial oxygen pressure. MVV was slightly higher in on-pump group and partial arterial oxygen pressure was slightly lower in on-pump group. During postoperative first day Hct (P=0.004) and FEV in 1 s (P=0.049) values and third day partial arterial oxygen pressure (P=0.011) and Hct (P=0.011) values were lower in on-pump group. Mean extubation, duration in postoperative suit and hospital discharge times, mean blood loss were not statistically significant between groups postoperatively. Conclusion: Pulmonary functions and arterial blood gases were not improved in off-pump patients when compared with on-pump patients. Patients going to be surgically revascularized should not be altered to off-pump surgery merely with the hope of improving respiratory functions with off-pump technique. As the postoperative stay times at surgical theatre and hospital is not different and the extubation times were similar, early discharge of patients with off-pump surgery cannot be related merely to better preservation of respiratory functions. [Copyright &y& Elsevier]