40 results on '"Küçük, Ahmet Oğuzhan"'
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2. Alternative Treatment Method for Crimean Congo Hemorrhagic Fever: Coupled Plasma Filtration and Adsorption
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Tepe, Dilşat, primary, Yılmaz, Gürdal, additional, Küçük, Ahmet Oğuzhan, additional, and Pehlivanlar Küçük, Mehtap, additional
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- 2023
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3. Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy: A Retrospective Observational Study.
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Küçük, Ahmet Oğuzhan, Küçük, Mehtap Pehlivanlar, Pehlivanlar, Ayşegül, Ayçiçek, Olcay, Demir, Ömer, Öztuna, Funda, Bülbül, Yılmaz, and Özlü, Tevfik
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SARS-CoV-2 , *CRITICAL care medicine - Abstract
Objective: This study examined the clinical consequences of pregnancy coexisting with severe acute respiratory syndrome coronavirus 2 in the intensive care unit (ICU). Materials and Methods: The study was designed as a retrospective observational study. After the ethical approval of the local ethics committee, the study was conducted for a period when the number of young coronavirus disease-2019 (COVID-19) cases increased in our country. The patients enrolled in the study were pregnant/puerperal patients followed up in our third-level ICU. Results: The mean age of 35 pregnant women included in the study was 29.57±4.36 years. Twenty-one of the births (80.8%) were preterm births. Twelve (34.3%) patients received invasive mechanical ventilation (IMV), and 5 (41.7%) of these patients were deceased. Twenty-six (74.3%) underwent a cesarean section (C/S). There were 5 (14.3%) patients who needed extracorporeal membrane oxygenation and 3 (8.5%) patients who needed continuous renal replacement therapy. The 28-day neonatal mortality rate for 26 births was 3.8%. The maternal mortality rate in the ICU was 14.3%. Conclusion: The preterm birth rate was high in our pregnant patients followed up in the ICU with a diagnosis of COVID-19. Because of clinical and radiological progression in pregnant women, it is difficult to indicate any gestational week in which maternal outcomes are better to undergo C/S. IMV mortality is not higher than in non-pregnant patients, so endotracheal intubation should not be avoided in appropriate patients, whether pregnancy continues or not. The absence of fully vaccinated patients in the study group revealed the protective effect of vaccination during pregnancy. [ABSTRACT FROM AUTHOR]
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- 2023
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4. Successful Management of Severe Verapamil Overdose with VAECMO
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Özer, Vildan, primary, Küçük, Ahmet Oğuzhan, additional, Eroğlu, Ahmet, additional, Güven, Kibar Yaşar, additional, Ketenci, Hüseyin Çetin, additional, Şahin, Aynur, additional, and Kazzi, Ziad, additional
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- 2022
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5. Effectiveness of Early Combined Rehabilitation in COVID-19 Related ARDS Patients After the Successfull Application of Extracorporeal Membrane Oxygenation: Two Case Reports
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Ertürk, Nurel, primary, Küçük, Ahmet Oğuzhan, additional, Özdoğan, Merve, additional, and Pehlivanlar Küçük, Mehtap, additional
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- 2022
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6. Timeline of critically ill 2019 SARS-CoV-2 cases after onset of illness: Intensive care data from Turkey
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Küçük, Ahmet Oğuzhan, primary, Pehlivanlar Küçük, Mehtap, additional, Pehlivanlar, Ayşegül, additional, Ayaydın Mürtezaoğlu, Sevil, additional, Çoban, Kadir, additional, Semerci, Taha, additional, Topaloğlu, Ömer, additional, Kaya, Armağan, additional, Güler, Özlem, additional, Balçık Savaşer, Semanur, additional, Özhan Akdemir, Büşra, additional, Ayçiçek, Olcay, additional, Öztuna, Funda, additional, Bülbül, Yılmaz, additional, and Özlü, Tevfik, additional
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- 2022
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7. Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV Mortality Prediction Score (IMPRES)
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ÖZLÜ, Tevfik, PEHLİVANLAR KÜÇÜK*, Mehtap, KAYA, Akın, YARAR, Esra, KIRAKLI, Cenk, ŞENGÖREN DİKİŞ, Özlem, KEFELİ ÇELİK, Hale, ÖZKAN, Serdar, BEKTAŞ AKSOY, Hayriye, and KÜÇÜK, Ahmet Oğuzhan
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invasive mechanical ventilation ,Adult ,Aged, 80 and over ,Male ,Adolescent ,Critical Care ,Turkey ,scoring systems ,Age Factors ,prediction ,Middle Aged ,ethics ,Respiration, Artificial ,Severity of Illness Index ,Article ,intubation ,Young Adult ,Cross-Sectional Studies ,Risk Factors ,Humans ,Female ,Prospective Studies ,Aged - Abstract
Background/aim The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results The following cut-off scores were used to indicate mortality risk: 8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total IMPRES scores of greater than 8 (P < 0.001). Conclusion The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data.
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- 2019
8. Pneumothorax and Subcutaneous Emphysema Evaluation in Patients with COVID-19 in the Intensive Care Unit
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Pehlivanlar Küçük, Mehtap, primary, Öksüz Güngör, Burcu, additional, Küçük, Ahmet Oğuzhan, additional, Ayçiçek, Olcay, additional, Türkyılmaz, Atila, additional, Öztuna, Funda, additional, Bülbül, Yılmaz, additional, and Özlü, Tevfik, additional
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- 2021
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9. Effects of Different Gastric Residual Volume Thresholds on Morbidity and Mortality in Patients Receiving Intensive Care
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Çankaya, Esra, primary, Çankaya, Sertaç, additional, Küçük, Ahmet Oğuzhan, additional, and Ulusoy, Hülya, additional
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- 2021
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10. Effects of personality traits on severity of sepsis
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Pehlivanlar Küçük, Mehtap, primary, Küçük, Ahmet Oğuzhan, additional, Kömürcü, Özgür, additional, Dikmen, Yalım, additional, Kadıoğlu, Mustafa, additional, Uzan, Çağdaş Alp, additional, Ergin Özcan, Perihan, additional, Orhun, Günseli, additional, Ünal Akdemir, Neslihan, additional, Eroğlu, Ahmet, additional, İlyas, Yasir, additional, Zeyneloğlu, Pınar, additional, Şahintürk, Helin, additional, Dai Özcengiz, Dilek, additional, Fırat, Ahmet, additional, Aydın, Davut, additional, Özlü, Tevfik, additional, Pehlivanlar, Ayşegül, additional, Kıraklı, Cenk, additional, Acar Çinleti, Burcu, additional, Gök, Funda, additional, Yosunkaya, Alper, additional, Aktaş, Murat, additional, Öztürk, Çağatay Erman, additional, and Ülger, Fatma, additional
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- 2021
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11. Short-term Results of Patients with Spontaneous Subarachnoid Haemorrhage in the Intensive Care Unit: A Single-centre Experience
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Pehlivanlar Küçük, Mehtap, primary, Öztürk, Çağatay Erman, additional, Küçük, Ahmet Oğuzhan, additional, Turunç, Esra, additional, and Ülger, Fatma, additional
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- 2021
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12. The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial
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Küçük, Mehtap Pehlivanlar, primary, Öztürk, Çağatay Erman, additional, İlkaya, Nazan Köylü, additional, Küçük, Ahmet Oğuzhan, additional, Ergül, Dursun Fırat, additional, and Ülger, Fatma, additional
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- 2021
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13. Effects of Hypocaloric Versus Normocaloric Nutrition on Renal Functions and Outcomes in Intensive Care Unit Patients
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Küçük, Ahmet Oğuzhan, primary, Pehlivanlar Küçük, Mehtap, additional, and Ulusoy, Hülya, additional
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- 2021
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14. Türkiye'de yoğun bakım ünitelerinde hekimin mortaliteyi öngörebilme gücü
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Küçük, Mehtap Pehlivanlar, Özlü, Tevfik, Küçük, Ahmet Oğuzhan, Kaya, Akın, Kıraklı, Cenk, Dikiş, Özlem Şengören, Sezgi, Cengizhan, Demir, Melike, Dicle Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Göğüs Hastalıkları Ana Bilim Dalı, Sezgi, Cengizhan, and Demir, Melike
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Mechanical ventilation ,Tahmin ,Mekanik ventilatör ,Intensive care unit ,Mortality ,Yoğun bakım ,Prediction ,Mortalite - Abstract
Giriş: Yoğun bakım hekimleri giderek yoğun bakım hastalarının prognozu ile ilgili karar vermede daha fazla yer almaktadır. Bu çalışma ile; yoğun bakıma hasta triyajı ve hasta takibinde klinisyen öngörüsünün hasta mortalite tahminindeki gücünün değerlendirilmesi amaçlanmıştır. Materyal ve Metod: Bu çalışma Türkiye’nin çeşitli coğrafi bölgelerinde bulunan yoğun bakımlarda 1 Ocak 2017 - 30 Nisan 2017 tarihleri arasında yapılmıştır. Çalışma gözlemsel, çok merkezli, prospektif, kesitsel klinik araştırma olarak planlanmıştır. Bulgular: Çalışma boyunca 37 farklı yoğun bakımdan toplam 1169 entübe hasta takip edilmiştir. Hastaların 530’u (%45.3) eğitim ve araştırma hastanelerinde, 639’u (%54.7) üniversite hastanelerinde yatmaktaydı. Hastayı yoğun bakımda takip edecek hekime, takip başlangıcında hastaların sağ kalım ihtimalleri için bir skor vermeleri istendi. Skorlama “0” en kötü ihtimal, “5” en iyi olacak şekilde 0’dan 5’e kadar toplam 6 skor içermekteydi. Bu dağılıma göre 0 puan verilen 113 hastadan sadece 1 (%0.9) hasta sağ kaldı. Bir puan verilen 207 hastadan 26’sı (%12.6) sağ kaldı. En iyi puan olan 5 puan verilen 49 hastadan ise sadece 3’ü (%6.1) kaybedildi. Sağkalım oranları her puan grubunda diğer gruplara göre istatistiksel anlamlı farklıydı (r: -0.488; p< 0.001). Doktorların klinik gözlemlerine dayalı mortaliteyi tahmin etme skorları birleştirildikten sonra (0 ve 1 puan grupları birleştirilerek “tahmini eksitus”, 4 ve 5 puan grupları birleştirilerek “tahmini sağkalım”) toplam 545 hastanın 320’si tahmini eksitus, 225’i tahmini sağkalım olarak öngörülmüştür. Tahmini skorlamanın mortaliteyi öngörmedeki sensitivitesi %91.56 (95% CI: 87.96-94.37), spesifisitesi %76.89 (%95 CI: 70.8282.23) idi. Yine klinisyenlerin mortalite tahmininin pozitif prediktif değeri %84.93, negatif prediktif değeri %86.50 olarak tespit edildi. Klinisyenler özellikle mortaliteyi öngörmede yüksek bir başarı gösterdiler. Sonuç: Bu çalışma ile yoğun bakımda hasta takip eden hekimlerin mekanik ventilasyon desteğindeki hastalarında, hastayı kabul ettikleri anda, mortalite ile sonlanan kötü prognozu yüksek oranda doğru öngörebildikleri sonucuna varılmıştır. Yoğun bakım mortalite skorlamalarına diğer laboratuar ve klinik parametreler yanında hekimin mortalite tahmini ile ilgili görüşlerine yer verilmesi düşünülmelidir. Introduction: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. Materials and Methods: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. Results: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the “0” the worst probability “5” being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p< 0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. Conclusion: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician’s opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters. Key words: Intensive care unit; mortality; prediction; mechanical ventilatio
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- 2020
15. Türkiye'de yoğun bakım ünitelerinde hekimin mortaliteyi öngörebilme gücü
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Pehlivanlar Küçük, Mehtap, Özlü, Tevfik, Küçük, Ahmet Oğuzhan, Kaya, Akın, Kıraklı, Cenk, Fazlıoğlu, Nevin, Şengören Dikiş, Özlem, and Gürel Durmuş, Zerrin
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Prognostic-Factors ,Mechanical Ventilation ,Physicians ,Admission ,Intensive care unit ,prediction ,Hospital Mortality ,Outcomes ,Multicenter ,mortality - Abstract
ÖZ Türkiye’de yoğun bakım ünitelerinde hekimin mortaliteyi öngörebilme gücü Giriş: Yoğun bakım hekimleri giderek yoğun bakım hastalarının prognozu ile ilgili karar vermede daha fazla yer almaktadır. Bu çalışma ile; yoğun bakıma hasta triyajı ve hasta takibinde klinisyen öngörüsünün hasta mortalite tahminindeki gücünün değerlendirilmesi amaçlanmıştır. Materyal ve Metod: Bu çalışma Türkiye’nin çeşitli coğrafi bölgelerinde bulunan yoğun bakımlarda 1 Ocak 2017 - 30 Nisan 2017 tarihleri arasında yapılmıştır. Çalışma gözlemsel, çok merkezli, prospektif, kesitsel klinik araştırma olarak planlanmıştır. Bulgular: Çalışma boyunca 37 farklı yoğun bakımdan toplam 1169 entübe hasta takip edilmiştir. Hastaların 530’u (%45.3) eğitim ve araştırma hastanelerinde, 639’u (%54.7) üniversite hastanelerinde yatmaktaydı. Hastayı yoğun bakımda takip edecek hekime, takip başlangıcında hastaların sağ kalım ihtimalleri için bir skor vermeleri istendi. Skorlama “0” en kötü ihtimal, “5” en iyi olacak şekilde 0’dan 5’e kadar toplam 6 skor içermekteydi. Bu dağılıma göre 0 puan verilen 113 hastadan sadece 1 (%0.9) hasta sağ kaldı. Bir puan verilen 207 hastadan 26’sı (%12.6) sağ kaldı. En iyi puan olan 5 puan verilen 49 hastadan ise sadece 3’ü (%6.1) kaybedildi. Sağkalım oranları her puan grubunda diğer gruplara göre istatistiksel anlamlı farklıydı (r: -0.488; p< 0.001). Doktorların klinik gözlemlerine dayalı mortaliteyi tahmin etme skorları birleştirildikten sonra (0 ve 1 puan grupları birleştirilerek “tahmini eksitus”, 4 ve 5 puan grupları birleştirilerek “tahmini sağkalım”) toplam 545 hastanın 320’si tahmini eksitus, 225’i tahmini sağkalım olarak öngörülmüştür. Tahmini skorlamanın mortaliteyi öngörmedeki sensitivitesi %91.56 (95% CI: 87.96-94.37), spesifisitesi %76.89 (%95 CI: 70.82- 82.23) idi. Yine klinisyenlerin mortalite tahmininin pozitif prediktif değeri %84.93, negatif prediktif değeri %86.50 olarak tespit edildi. Klinisyenler özellikle mortaliteyi öngörmede yüksek bir başarı gösterdiler. Sonuç: Bu çalışma ile yoğun bakımda hasta takip eden hekimlerin mekanik ventilasyon desteğindeki hastalarında, hastayı kabul ettikleri anda, mortalite ile sonlanan kötü prognozu yüksek oranda doğru öngörebildikleri sonucuna varılmıştır. Yoğun bakım mortalite skorlamalarına diğer laboratuar ve klinik parametreler yanında hekimin mortalite tahmini ile ilgili görüşlerine yer verilmesi düşünülmelidir.
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- 2020
16. Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)
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Pehlivanlar Küçük, Mehtap, primary, Özlü, Tevfik, additional, Küçük, Ahmet Oğuzhan, additional, Kaya, Akın, additional, Kıraklı, Cenk, additional, Şengören Dikiş, Özlem, additional, Kefeli Çelik, Hale, additional, Özkan, Serdar, additional, Bektaş Aksoy, Hayriye, additional, Palabıyık, Onur, additional, Çörtük, Mustafa, additional, Ergün, Recai, additional, Kozanhan, Betül, additional, Erçen Diken, Özlem, additional, Bacakoğlu, Feza, additional, Uzun Kaya, Süheyla, additional, Aksoy, İskender, additional, Cinemre, Hakan, additional, Zerman, Avşar, additional, Özkoçak Turan, Işıl, additional, Fazlıoğlu, Nevin, additional, Yıldırım, Fatma, additional, Günay, Ersin, additional, Akan, Belgin, additional, Arpağ, Hüseyin, additional, Sezgi, Cengizhan, additional, Can, Atilla, additional, Yalçınsoy, Murat, additional, Karaoğlanoğlu, Selen, additional, Şehitoğulları, Abidin, additional, Arslan, Sertaç, additional, Aydemir, Yusuf, additional, Öztürk, Ayperi, additional, Hocanlı, İclal, additional, Salmanoğlu, Musa, additional, Ekici, Aydanur, additional, Ataman, Sena, additional, Edipoğlu, Özlem, additional, Yıldız, Tekin, additional, Doğanay, Zahide, additional, Dağlı, Celalettin, additional, Arslan Aksu, Esra, additional, Zitouni, Burçak, additional, İlksen Eğilez, Ayşe, additional, Şahiner, Yeliz, additional, Korkmaz Ekren, Pervin, additional, İnönü Köseoğlu, Handan, additional, Baydın, Ahmet, additional, Nalbant, Ahmet, additional, Aydın, Davut, additional, Bindal, Ahmet, additional, Balas, Şener, additional, Esen Karamişe, Şule, additional, Araz, Ömer, additional, Acar, Türkan, additional, Kahraman, Hasan, additional, Demir, Melike, additional, Burnik, Cengiz, additional, Çanakçı, Ebru, additional, Bilgin, Cahit, additional, Yağan, Özgür, additional, Aydemir, Semih, additional, Önem, Yalçın, additional, and Gürel Durmuş, Zerrin, additional
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- 2020
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17. The Parameters Affecting Outcome in Drowning Cases in Intensive Care Unit; Eight-Year Retrospective Patient Data
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Pehlivanlar Küçük, Mehtap, primary, Küçük, Ahmet Oğuzhan, additional, Öztürk, Çağatay Erman, additional, Kömürcü, Özgür, additional, Bayrak, İlkay Koray, additional, and Ülger, Fatma, additional
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- 2019
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18. Extracorporeal membrane oxygenation experiences during COVID‑19 pandemic, third wave with younger patients: A retrospective observational study.
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Küçük, Ahmet Oğuzhan, Küçük, Mehtap Pehlivanlar, Ayçiçek, Olcay, Altun, Gökalp, and Özdemir, Ahmet Coşkun
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EXTRACORPOREAL membrane oxygenation , *COVID-19 pandemic , *COVID-19 , *ADULT respiratory distress syndrome , *HOSPITAL admission & discharge - Abstract
OBJECTIVES: In this article, the results of severe coronavirus disease 2019 (COVID‑19) cases followed with extracorporeal membrane oxygenation (ECMO) support in a 3‑month period in the third wave when there were an increased number of cases of young patients in our intensive care unit (ICU) were presented. METHODS: The study was carried out with all COVID‑19 patients who were given ECMO support in our tertiary referral hospital ICU after obtaining the consent of the Ministry of Health Scientific Research Platform and after the approval of the local ethics committee. Patient data were obtained retrospectively from intensive care bedside follow‑up charts and computer records. The demographic and clinical characteristics of the patients were presented in average, median, and percentages. The data of the patients were evaluated and compared with the current literature. RESULTS: ECMO treatment was applied in seven patients who were followed up with severe COVID‑19 pneumonia in the last 3 months. Venovenous extracorporeal membrane oxygenation (VV‑ECMO) was applied to all patients. Five (71.5%) of seven patients were weaned from ECMO. Four (57.2%) of seven patients were discharged from the ICU and hospital in good health. While two of the patients had a cesarean section (C/S) before ECMO, one patient underwent C/S under ECMO. All three newborns were delivered via C/S and all were premature (C/S dates were 35 weeks, 32 weeks, and 27 weeks), and all were discharged from the hospital in good health. CONCLUSION: Our experience shows that ECMO in COVID‑19 patients is a lifesaving treatment option that can be successfully applied in severe acute respiratory distress syndrome cases who do not respond to conventional treatments. [ABSTRACT FROM AUTHOR]
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- 2022
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19. Pneumothorax and Subcutaneous Emphysema Evaluation in Patients with COVID-19 in the Intensive Care Unit.
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Küçük, Mehtap Pehlivanlar, Güngör, Burcu Öksüz, Küçük, Ahmet Oğuzhan, Ayçiçek, Olcay, Türkyılmaz, Atila, Öztuna, Funda, Bülbül, Yılmaz, and Özlü, Tevfik
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PNEUMOTHORAX ,SUBCUTANEOUS emphysema ,INTENSIVE care patients ,COVID-19 ,INTENSIVE care units ,DISEASE risk factors - Abstract
Copyright of Turkish Journal of Intensive Care 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.)
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- 2021
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20. Short-term Results of Patients with Spontaneous Subarachnoid Hemorrhage in Intensive Care Unit: Single-center Experience.
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Küçük, Mehtap Pehlivanlar, Öztürk, Çağatay Erman, Küçük, Ahmet Oğuzhan, Turunç, Esra, and Ülger, Fatma
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INTENSIVE care units ,SUBARACHNOID hemorrhage ,INTRACRANIAL aneurysms ,OPERATIVE surgery ,GLASGOW Coma Scale ,INTERVENTIONAL radiology ,HYPERNATREMIA ,ENDOVASCULAR surgery ,BRAIN surgery - Abstract
Copyright of Turkish Journal of Intensive Care 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.)
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- 2021
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21. The Parameters Affecting the Outcome in Drowning Cases in Intensive Care Unit; Eight Years of Retrospective Patient Data
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Pehlivanlar Küçük, Mehtap, primary, Küçük, Ahmet Oğuzhan, additional, Öztürk, Çağatay Erman, additional, Kömürcü, Özgür, additional, Bayrak, İlkay Koray, additional, and Ülger, Fatma, additional
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- 2019
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22. Yoğun Bakımda Normokalorik veya Hipokalorik Nütrisyonun Renal Fonksiyonlar ve Hasta Sonlanımı Üzerine Etkileri.
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Küçük, Ahmet Oğuzhan, Küçük, Mehtap Pehlivanlar, and Ulusoy, Hülya
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INTENSIVE care units , *RENAL replacement therapy , *HOSPITAL mortality , *CRITICALLY ill , *NUTRITION - Abstract
Objective: Current data in intensive care unit (ICU) suggest that at least 70-100% of patients’ energy have to met, while the effects of hypocaloric nutrition (HN) on patient outcomes are questioned. This study aimed to determine the relationship between renal replacement requirement and other organ failure and patient outcomes in normocaloric and hypocaloric fed patients. Materials and Methods: The data of patients followed up in the intensive care unit between 2003- 2012 were retrospectively evaluated. Normocaloric nutrition (NN) group is determined as patients with 70%-110% of the daily energy requirement was reached, HN group is determined as patients with less than 70% of their daily energy requirement. Patient data were recorded for 14 days. Results: Data of 1,955 patients were evaluated and 92 patients were included to NN group, 199 patients were included to HN group. There was a significant decrease in Sequential Organ Failure Assessment score in the HN group compared to the hospitalization day (p<0.005). Renal replacement therapy was needed in 19 (20.7%) patients in the NN group, whereas renal replacement was performed in 35 (17.6%) patients in the HN group (p=0.643). In the HN group, the number of RIFLE stage-3 days was 460 (25%), and in the NN group it was 157 (15.1%) days (p<0.001). The length of stay in ICU was 16.88±10.88 days in NN group and 11.42±9.11 days in the HN group (p<0.001). There was no significant difference in ICU mortality and 28th day mortality in both groups (p>0.05). Conclusion: There was no difference between NN and HN in critically ill patients in ICU. Although the duration of ICU stay was less in the hypocaloric group, no significant difference was found between low-calorie intake and 28th day and hospital mortality. There is still a need for a prospective, randomized controlled trial on this subject. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
23. Kritik Yoğun Bakım Hastalarında COVID-19 ile İlişkili Fungemi için Risk Faktörleri ve Klinik Özellikler.
- Author
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Küçük, Ahmet Oğuzhan, Yılmaz, Gizem, Küçük, Nejla, Aksoy, Dilşat, Küçük, Mehtap Pehlivanlar, and Yılmaz, Gürdal
- Abstract
Amaç: Hangi kritik Koronavirüs hastalığı-2019 (COVID-19) hastalarının fungal enfeksiyon geliştirme olasılığının daha yüksek olduğu konusu ve olası risk faktörleri belirsizliğini korumaktadır. Özellikle COVID-19 hastalarında invaziv fungal enfeksiyon gelişiminde kortikosteroidlerin ve diğer immün modülatörlerin rolü henüz aydınlatılamamıştır. Bu çalışmanın amacı, kritik COVID-19 hastalarında fungemi ilişkili klinik özellikleri, sonuçları ve risk faktörlerini tanımlamaktır. Gereç ve Yöntem: Etik kurul onamı sonrası üniversite hastanesi düzey 3 yoğun bakım ünitesi COVID-19 tanısı ile kabul edilen 550 hasta tarandı. Hastaların verileri kaydedilerek analizleri sağlandı. Bulgular: Taranan 550 hastadan fungal enfeksiyon tanısı alan 14 hasta çalışmaya dahil. Bu hastaların 5’i kadındı ve yaş ortalaması 55 yıl idi. Hastaların kabul anı karakteristik özellikleri Tablo 1’de gösterildi. Hastalar yüksek Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II ve Ardışık Organ Yetmezliği Değerlendirme Skoruna sahiptiler. Yoğun bakım yatış süresinde hastalara uygulanan tedaviler ve primer, sekonder sonlanımlar Tablo 2’de gösterilmekle beraber fungemi hastalarının %85,7’si kaybedildi. Hastalarda uzun süre hastane ve yoğun bakım yatışı gözlendi. Fungal enfeksiyon anındaki karakteristik özellikler ve fungal enfeksiyona ait bilgiler Tablo 3’te gösterildi. Bu hastalarda enfeksiyon öncesi uzun süre steroid kullanım zamanıyla göze çarparken beraber en sık odak periferik kan en sık üreyen mikroorganizma Candida türleri idi. Sonuç: Çalışmamız sonucunda en sık fungemi etkeni Candida türleri olarak belirlenmiştir. COVID-19 hastalarında normal popülasyonla karşılaştırdığımızda fungemi insidansı 1.000 yoğun bakım günü başına normal popülasyon daha yüksekti. Fungemi saptanan hastalarda %85,7 gibi yüksek mortalite oranları saptandı. Fungemi saptanan hastalarda mortalite için risk faktörleri uzun süre steroid kullanımı, uzun süre yoğun bakım yatışı olarak bulundu. Çalışmanın karşılaştırmalı analizleri yapılmaya devam edilmektedir. Ön analiz sonuçları sunulmuştur. [ABSTRACT FROM AUTHOR]
- Published
- 2022
24. COVID-19 Tanısı Alan Renal Nakilli Hastalarda Yüksek Mortalite, Yoğun Bakım Sonuçları.
- Author
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Küçük, Ahmet Oğuzhan, Küçük, Mehtap Pehlivanlar, Zenger, Alper, and Özlü, Tevfik
- Abstract
Amaç: Solid organ nakli alıcılarında immünosüpresyonun ağır COVID-19 enfeksiyonu için bir risk faktörü olduğu düşünülmekte ve bu hastalarda greft disfonksiyonu, çoklu organ yetmezliği ve mortalite riski normal popülasyona göre artmaktadır. British Transplantation Society (BTS) bu hastalarda immünsüpresif tedavilerde doz azaltımı ve destekleyici tedaviler önermektedir. Bu çalışma ile; daha önce homojen verisi olmayan COVID-19’lu yoğun bakım hasta grubunda renal transplant alıcılarının klinik sonuçları sunulmuştur. Gereç ve Yöntem: Etik kurul onamı sonrası 3. düzey üniversite hastanesi COVID-19 yoğun bakımında Mart 2020-Ocak 2022 arası takip edilmiş 550 hasta retrospektif olarak tarandı ve böbrek nakil alıcısı olan hastalar çalışma grubu olarak belirlendi. Bulgular: Çalışmaya alınan 550 hastanın 15’i renal nakil alıcısı bunlardan 5’i kadındı.Ortalama yaş 52 yıl idi. Yoğun bakım öncesi hastane yatış süresi medyan 4 (IQR: 2-5) gün idi. Renal nakil zamanı COVID-19 tanısından medyan 30 ay (IQR: 11-58) önce idi. Hastaların 13’ü (%86,7) COVID-19 ilişkili ARDS (CARDS) tanısı mevcuttu. Hastaların bazal kreatinin medyan değeri 1,18 (IQR: 1,02-1,46) mg/dL idi. Eksitus olan hastalarda KDIGO evresi daha ileriydi. Hastaların %93,3’ünde pulse steroid tedavisine rağmen progresyon devam etti. Hastaların 12'sinde (%80) periferik kan dolaşımı enfeksiyonu tanısı konuldu. Hastaların demografik özellikleri ve yoğun bakım kabul klinik değerleri Tablo 1’de, uygulanan tedavilerin dağılımı Tablo 2’de, birincil ve ikincil sonlanımlar Tablo 3’te, mortaliteye göre kreatinin trendi Şekil 1’de ve KDIGO trendleri Şekil 2’de verildi. Hastalar medyan 2. günde (0-10) entube edildiler. Entübe edilen hastalarda mortalite %100 idi. Beş (%33,3) hasta yoğun bakımdan taburcu edildi. Yoğun bakım mortalitesi %66,7 idi. Sonuç: COVID-19 tanısı konulan renal transplant alıcılarında CARDS nedeni ile yoğun bakım ihtiyacı geliştiğinde sağkalım oldukça düşüktür. Çalışmamızda hastaların transplantasyon zamanı ile tanı zamanı arasında uzun süre mevcuttu ve çoğunun birden fazla komorbiditesi vardı. CARDS ile takip edilen ve mortal seyreden olguların tamamı IMV ile takip edilen ve KDIGO evresi ileri olan AKI hastalarıydı. Sekonder enfeksiyonların sık görüldüğü bu hasta grubunda immünosüpresif ilaçların yönetimi oldukça önemlidir. Çalışmanın karşılaştırmalı analizleri yapılmaya devam edilmektedir. Ön analiz sonuçları sunulmuştur. [ABSTRACT FROM AUTHOR]
- Published
- 2022
25. Yoğun Bakımda İzlenen Boğulma Olgularında Sonlanımı Etkileyen Parametreler: Sekiz Yıllık Retrospektif Hasta Verileri.
- Author
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Küçük, Mehtap Pehlivanlar, Küçük, Ahmet Oğuzhan, Öztürk, Çağatay Erman, Kömürcü, Özgür, Bayrak, İlkay Koray, and Ülger, Fatma
- Subjects
- *
ADULT respiratory distress syndrome , *INTENSIVE care patients , *CEREBRAL edema , *MULTIPLE organ failure - Abstract
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]
- Published
- 2020
- Full Text
- View/download PDF
26. Erişkin yoğun bakımda mekanik ventilatöre bağlı hastalarda nütrisyonun renal fonksiyon, morbidite, mortalite üzerine etkileri
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Küçük, Ahmet Oğuzhan, Ulusoy, Hülya, and Anesteziyoloji ve Reanimasyon Anabilim Dalı
- Subjects
Anestezi ve Reanimasyon ,Anesthesiology and Reanimation - Abstract
Beslenme desteği yoğun bakım ünitesindeki (YBÜ) tedavinin ana parçası olarak kabul edilmiştir. Yoğun bakım hastalarında ideal kalori alımı hala tartışmalı bir konudur. Bu tartışma yoğun bakım hastalarında düşük kalori alımının zararla sonuçlanacağını ileri süren güncel kanıtların yanı sıra fayda sağlayacağını belirten diğer çalışmalarla daha da alevlenmiştir. ABH'nın genel toplumda görülme sıklığı %1'in altında iken hastanede yatan hastalarda bu oran %2-7, yoğun bakım ünitesinde (YBÜ) takip edilen hastalarda ise % 5-30'a kadar yükselmektedirÇalışmamızın amacı hedef beslenme (Target feeding: TF) ve hipokalorik (Under feeding: UF) beslenmenin yoğun bakım hastalarının renal fonskiyonları üzerindeki etkisini değerlendirmektir.Karadeniz Teknik Üniversitesi Klinik Araştırmalar etik kurul onayı (2013/82) alındıktan sonra 2003 – 2012 yılları arasındaki dönemde Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesi'nde takip ve tedavisi yapılan hastalar incelendi. Hastalar Grup TF (target feeding); günlük verilen enerjinin günlük enerji gereksinimine oranı %70-%110 arası olması, Grup UF ( under feeding) ; günlük verilen enerjinin günlük enerji gereksinimine oranı %70'in altında olması şeklinde iki gruba ayırdık ( Grup TF'de 92 hasta, Grup UF'de ise 199 hasta).Hastaların demografik özellikleri, yoğun bakım yatış süresi, reentübasyon, tekrar yoğun bakım ünitesine yatış, 28inci gün mortalitesi ve yoğun bakım mortalitesi kaydedildi. Yine İlk 14 gün boyunca her gün için hastaların laboratuar parametreleri olarak Kreatinin, BUN, Laktat; hemodinamik takiplerle OAB (ortalama arter basınçları), CVP (santral venöz basınç), Günlük sıvı balansı kaydedildi. Yine 14 gün boyunca hastaların vazopressör kullanımı takip edildi. Güncel bilgiler ışığında böbrek hasarını değerlendirmek için RIFLE, AKIN sınıflama skorları 14 gün boyunca kaydedildi. Hastaların takip edilen 14 gün boyunca RRT tedavisi alıp almadıkları belirlendi.Hastaların demografik verileri açısından fark bulunamadı.28. gün mortalitesi ve yoğun bakım mortalitesi açısından da iki grup arasında istatistiksel olarak anlamlı bir farklılık bulunmadı (p>0,05).Yoğun bakımda kalış süresi Grup UF'de Grup TF'ye göre istatistiksel olarak anlamlı şekilde daha az bulundu (p0,05).The duration of the stay in intensive care unit was found to be statistically less in Group UF than Group TF (p
- Published
- 2016
27. Non-infectious Fever After Acute Spinal Cord Injury in the Intensive Care Unit
- Author
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Ülger, Fatma, primary, Pehlivanlar Küçük, Mehtap, additional, Öztürk, Çağatay Erman, additional, Aksoy, İskender, additional, Küçük, Ahmet Oğuzhan, additional, and Murat, Naci, additional
- Published
- 2017
- Full Text
- View/download PDF
28. Non-infectious Fever After Acute Spinal Cord Injury in the Intensive Care Unit.
- Author
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Ülger, Fatma, Pehlivanlar Küçük, Mehtap, Öztürk, Çağatay Erman, Aksoy, İskender, Küçük, Ahmet Oğuzhan, and Murat, Naci
- Published
- 2019
- Full Text
- View/download PDF
29. Electrical Impedance Tomography Assistance in Difficult Decision Making; “Influenza-A Related Severe ARDS in a Pregnant Woman“.
- Author
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Hatinoğlu, Neslihan, Küçük, Mehtap Pehlivanlar, Küçük, Ahmet Oğuzhan, and Özdemir, Kübra Nur
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ELECTRICAL impedance tomography ,PREGNANT women ,ADULT respiratory distress syndrome ,DECISION making ,INTENSIVE care units ,ELECTRICAL injuries - Abstract
Introduction: Electrical impedance tomography (EIT) is a real-time, non-invasive imaging method that evaluates regional lung ventilation. Although it allows the patient to be monitored at the bedside, it can be a good imaging method especially in pregnant women as it does not contain radiation. Twenty-seven weeks pregnant patient intubated with severe ARDS. The case in which our EIT follow-up played an active role in the decision of radiological progression and delivery. Case: A 28-year-old and 24+4/7 week pregnant woman admitted to our intensive care unit with influenza-A PCR positive ARDS. The patient with bilateral infiltration was started oseltamivir, clarithromycin and methylprednisolone and followed up with high flow oxygen (flow 60 Lt/ min, FiO2 80%).The patient was monitored with EIT because of the concern about computed tomography, which is due to both transport difficulties and pregnancy. An increase in oxygen demand was observed at the 8th hour of hospitalization, and bilateral lung loss was observed in EIT at the same time. The patient, who had confusion and persistent fever, was intubated and emergency cesarean was performed. Linezolid was added after S. aureus was isolated in tracheal aspirate culture. The patient was followed up both daily chest radiograph and EIT. The patient was extubated on the 3rd day of hospitalization and transferred to the service on the 7th day of her hospitalization. Discussion: In the management of pregnant ARDS cases; physicians have to make critical decisions such as birth, termination and intubation. Our patient had severe ARDS and was also 27 weeks pregnant. EIT follow-up was important in the pregnant patient group with limited imaging, since there was no radiation exposure and it gave instant information. This instant information can be used in the pregnant patient population, especially in the follow-up of ARDS patients. These experiences should be supported by multi center studies. [ABSTRACT FROM AUTHOR]
- Published
- 2023
30. Use of Electric Impedance Tomography as a Screening Tool to Determine Effectiveness of Bronchosopy in a VV-ECMO Patient.
- Author
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Hatinoğlu, Neslihan, Küçük, Mehtap Pehlivanlar, Küçük, Ahmet Oğuzhan, and Özdemir, Arif Talha
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ELECTRIC impedance ,MEDICAL screening ,ELECTRICAL impedance tomography ,TOMOGRAPHY ,IONIZING radiation - Abstract
Introduction: Electrical impedance tomography (EIT) is a real-time, noninvasive, bedside evaluation method of regional lung ventilation. EIT screening experience is presented in a patient with VV-ECMO and used bronchoscopy due to atelectasis. Case: A 46-year-old female patient diagnosed with microscopic polyangitis with diffuse bilateral lung infitrations.While being followed with pulse steroid therapy and high flow oxygen, she was intubated after rapid progression and then taken to VV-ECMO. The cause of progression was found to be diffuse pneumonia in the left hemithorax, and meropenem was started rapidly. Steroid therapy of the patient was gradually reduced. Bronchoscopy was performed. EIT monitorization was applied to the patient to evaluate the lung vantilation before and after bronchoscopy. Consistent with the chest radiograph before bronchoscopy, severe vantilation impairment was observed in the left lung, especially in the lower zones. It was observed that left lung ventilation and tidal volumes increased within hours after bronchoscopy. The patient was successfully extubated 3 days after weaning from VV-ECMO and transferred to the service. Discussion: EIT is as a new functional imaging modality that provides instant visualization of the dynamic state of the lung during ventilation. It’s use without using ionizing radiation and in-hospital transport is an important advantage in ECMO as in our patient or in ventilator-dependent patients. In our patient, secretion clearance and removal of atelectasis with bronchoscopy were visualized instantly at the bedside with EIT. Increase in ventilation at the left lung was observed after bronchoscopy. As a result; Bedside EIT monitoring is a method that allows rapid evaluation of ventilation in critically ill patients during bronchoscopy, and it can provide significant benefits in the clinical decisions of patients with VVECMO. [ABSTRACT FROM AUTHOR]
- Published
- 2023
31. Resistant Electrolyte Disorders Due to Extended Meropenem and Colistin Use After Intraabdominal Perforation; Looking to the Right Direction in Etiology! .
- Author
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Çağlayan, Elif, Özdemir, Kübra Nur, Ağırman, Münire, Küçük, Ahmet Oğuzhan, and Küçük, Mehtap Pehlivanlar
- Subjects
WATER-electrolyte imbalances ,INTRA-abdominal infections ,MEROPENEM ,COLISTIN ,ETIOLOGY of diseases ,ESCHERICHIA coli - Abstract
Introduction: Electrolyte imbalance may occur in long-term antibiotic use; especially with meropenem and colistin. Our case, which was followed up with complicated intra-abdominal infection and applied various treatments, is presented to guide our colleagues in clinical practice. Case: An 18-year-old male patient with epilepsy, hypoxic brain admitted to our intensive care unit with status epilepticus. Although antiepileptic treatments were arranged, he was intubated due to his resistant seizures. After PEG was performed due to lack of secretion control and food aspiration history, persistant fever and hypotension occured,and free air in the abdomen was observed in the imaging. In diagnostic laparotomy transfers colon perforation detected and was repaired. Empirical antibiotic therapy was started in the case of intra-abdominal septic shock. Shock resuscitation and cytokine adsorption with oxiris colon were applied to the patient who received high-dose multiple inotropes. In tissue biopsy culture, E. coli and P. aeruginosa were grown. Meropenem 3x1 gr and colistin 2x150 mg were added to the vancomycin-fluconazole treatment. Respiratory support was switched to home mechanical ventilation. On the 45th day of meropenem-colistin, resistant hypokalemia, hypomagnesemia, metabolic alkalosis and hypernatremia developed despite appropriate fluid and electrolyte replacement. Corrected calcium was 14.5 mg/dL, immobility-related hypercalcemia was considered for primery diagnosis. Zometa was administered, and patient was taken to hemodialysis once. After dialysis, corrected calcium decreased from 14.2 mg/dL to 11.1 mg/ dL, sodium decreased from 157 mEq/L to 143 mEq/L. However, it increased again in the follow-up. Considering it might be antibiotic related, meropenem-colistin was discontinued on the 56th day and polymyxin b was started. It was observed that all electrolytes quickly returned to normal values (Graphic 1-3). He was referred to the palliative service on the 110th day of his follow-up. Discussion: Cases of hypokalemia, hypomagnesemia and metabolic alkalosis have been reported in prolonged use of colistin for more than 4 weeks, and also cases of meropenem-associated hypernatremia, hypokalemia and metabolic alkalosis have been reported in different publications like our case report. It should be kept in mind that such side effects may occur depending on the use of meropenem and colistin. [ABSTRACT FROM AUTHOR]
- Published
- 2023
32. Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy; 3rd Level Intensive Care Data from Turkey.
- Author
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Küçük, Ahmet Oğuzhan, Küçük, Mehtap Pehlivanlar, Pehlivanlar, Ayşegül, Demir, Ömer, Ayçiçek, Olcay, Öztuna, Funda, Bülbül, Yılmaz, and Özlü, Tevfik
- Subjects
- *
CRITICAL care medicine , *INTENSIVE care units , *PREGNANCY outcomes , *ABORTION , *SARS-CoV-2 - Abstract
Objective: This study aimed to examine the clinical outcomes of pregnancy and SARS-CoV-2 association in the intensive care unit. Materials and Methods: Pregnant/puerperal patients followed in our tertiary intensive care unit during the 6-month period (March-September 2021). After approved by local ethic committee, the data of all critically ill patients’ data were obtained from retrospective patient records. Results: The mean age of 35 pregnant women was 29.57±4.36 years. None of the 35 patients were fully vaccinated. The median week of birth was 34 (IQR: 26-38) weeks. Twenty-one (80.8%) of these were preterm births. Twelve (34.3%) patients received invasive mechanical ventilator respiratory support. Five (41.7) of these patients died. C/S was applied in 26 (74.3%) of them. There were 5 (14.3%) patients who needed ECMO and 3 (8.5%) patients who needed CRRT. While CPFA was applied to 1 patient, cytokine adsorption was applied to 2 patients. Nine (25.7%) were discharged from the intensive care unit with ongoing pregnancy. The 28- day neonatal mortality rate for 26 births was 3.8%. Thirty (85.7%) of the 35 patients were discharged from the intensive care unit in good health. ICU mortality was 14.3%. Conclusion: The rate of preterm birth increased in our pregnant patients. It is difficult to indicate ideal gestational week for maternal outcomes are better for C/S performed due to clinical and radiological progression in the mother. However, termination of pregnancy generally improves the respiratory parameters of the mother by eliminating the problems caused by the pregnant uterus and increasing respiratory functions. IMV mortality in patients is not higher than normal patient IMV mortality, so intubation should not be avoided in appropriate patients to avoid maternal hypoxemia. The absence of fully vaccinated patients with comorbidities among our patients reveals the protective effect of the vaccine in this patient group. [ABSTRACT FROM AUTHOR]
- Published
- 2022
33. Yoğun Bakımda COVID-19 ve Spontan Pnömotoraks: 4 Olgu ve Literatür Taraması.
- Author
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Yıldız, Nagihan, Mürtezaoğlu, Emine Sevil A., Küçük, Ahmet Oğuzhan, Küçük, Mehtap Pehlivanlar, and Ayçiçek, Olcay
- Abstract
Copyright of Turkish Journal of Intensive Care 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.)
- Published
- 2022
34. Şiddetli COVID-19 ARDS’li Bir Hastada İnvaziv Mekanik Ventilasyon Yerine Ekstrakorporeal Membran Oksijenasyonu Uygulaması: Fully Awake ECMO.
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Argın, Özge and Küçük, Ahmet Oğuzhan
- Abstract
Amaç: Mekanik ventilasyon ile yeterli oksijenasyonun sağlanamadığı COVID-19 hastalarında VV-ECMO kurtarma tedavisi olarak uygulanabilir. Son zamanlarda, bazı seçilmiş olgularda rutin uygulamada yeri olmamasına rağmen P-SILI’yi önlemek adına “fully awake ECMO” uygulaması gündeme gelmiştir. Yoğun bakımda uyanık VV-ECMO uyguladığımız 42 yaşında hasta sunulmuştur. Olgu: Bilinen kronik hastalığı olmayan 42 yaş erkek hasta SARS-CoV-2 PCR pozitifliği (delta varyant) ile yoğun bakıma kabul edildi (Şekil 1). Öncesinde 24 gün serviste takip edildi. Yoğun bakımda HFNC ve aralıklı NIMV uygulandı. Ancak YBÜ kabulünün 6. gününde direçli hipoksi nedeni ile uyanık VV-ECMO kararı alındı. Hastaya entübe edilmeden noninvaziv destek altında (PS: 0, PEEP: 8,TV: 800 mL, SS: 35) fentanyl infüzyonu 2,5 mcg/kg/dk ile sol femoral venden 23 F drenaj kanülü, sağ internal juguler vene 21F dönüş kanülü yerleştirildi. Blood flow: 3,2 lt/dk, sweep gas: 4 lt/dk FiO2 : %100 ile VV-ECMO uygulaması başlatıldı. Başlar başlamaz periferik oksijen saturasyonu %98 olan hastanın hipoksik solunumsal kompansasyon yanıtı azaldı 4/dk solumaya başladı. Opioid alan hastanın solunum depresyonu naloksan ile revers edildi. Hemen ardından GKS: 15, HFNC ile takibe alındı, entübasyon ihtiyacı olmadı, hasta 21. gün ECMO’da ekstübe halde takip edildi. ECMO altında mobilize edildi. (Şekil 2). 14. gününde ECMO FiO2 desteği kapatıldı, süpürücü 5 l/dk, HFNC FiO2 : %70, akım 40 lt/dk ile izlenirken kan gazında kompanse respiratuvar asidozu gelişti. 23. gününde ateş, idrarda Trichosporon asahii görüldü ve tedavisine vorikonazol eklendi. ECMO’nun 21. gününde dekanüle edilen hasta, 3 gün dekanüle halde izlendi. Yoğun bakım takibinin 32. gününde hasta Trichosporon asahii fungemisi nedeni ile septik şok tablosu sonucu kaybedildi. Sonuç: “Fully awake ECMO” stratejisi, hastanın aktif tedaviye katılımını ve mobilizasyonunu mümkün kılar ve ağır sedasyon, paralizi ve uzun süreli MV ile ilişkili komplikasyonları önleyebilir. Bununla birlikte, ECMO ile ilişkili risklerin dikkatli bir şekilde izlenmesi önemlidir ve bu strateji deneyimli ECMO merkezlerinde çok sayıda hasta ile deneyimlenmelidir. [ABSTRACT FROM AUTHOR]
- Published
- 2022
35. Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV Mortality Prediction Score (IMPRES)
- Author
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ÖZLÜ, Tevfik, KÜÇÜK, Mehtap Pehlivanlar, KAYA, Akin, YARAR, Esra, KIRAKLI, Sami Cenk, DİKİŞ, Özlem Şengören, ÇELİK, Hale Kefeli, ÖZKAN, Serdar, AKSOY, Hayriye Bektaş, and KÜÇÜK, Ahmet Oğuzhan
- Subjects
Critical care,ethics,intubation,invasive mechanical ventilation,scoring systems,prediction - Abstract
Background/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results: The following cut-off scores were used to indicate mortality risk: 8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total IMPRES scores of greater than 8 (P < 0.001). Conclusion: The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data.
36. The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye.
- Author
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Gül F, Kasapoğlu US, Sabaz MS, Ay P, Oktay BD, Çalışkan G, Demir N, Sayan İ, Kabadayı F, Altuntaş G, Gümüş A, Kırca H, Şanlı D, Acil F, Dedeoğlu A, Ural SG, Akın Şen İ, Macit Aydın E, Dayanır H, Yelken B, Ceylan İ, Aydın OÖ, Eskidemir G, Aytekin A, Cengiz M, Arslan Ü, Akdağ D, Alay GH, Tekin E, Yarar V, Saracoğlu KT, Gök F, Alparslan V, Tuna V, Yıldız M, Şenoğlu N, Kıraklı C, Yıldırım S, Saçar Kübüç K, Erer A, Gültekin H, Özmen Süner K, Kuzgun Ö, Öztürk ÇE, Karahan A, Deveci O, Ay M, Tüfek Öztan D, Akıncı SB, Yalçın Solak M, Bozbay S, Özçiftçi S, Gönderen K, Küçük AO, Uyan B, Elay G, Boyacı N, Timurkaan M, Karakoç E, Doğan L, Yalçınkaya E, Kazancıoğlu L, Erdal Dönmez G, Yılmaz B, Ergül DF, Boran M, Özkarakaş H, Karakaş B, Ergin Özcan P, Anaklı İ, Bayar MK, Yüksel DY, Akdağ Ş, Pişkin Ö, Temur S, Eyüpoğlu S, Tekir Yılmaz E, Avcı GZ, Turan R, Alkan Bayburt F, Şahintürk H, Güçyetmez B, Alparslan MM, Yarıcı M, Yıldırım F, Yektaş A, Yaman G, Demirkıran O, and Cinel İ
- Subjects
- Humans, Female, Middle Aged, Aged, Aged, 80 and over, Male, Critical Illness, Vaccination, COVID-19 Vaccines therapeutic use, COVID-19 prevention & control
- Abstract
Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear., Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19., Study Design: Multicenter prospective observational clinical study., Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated., Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores ( p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) ( p = 0.004)., Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.
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- 2023
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37. Timeline of critically ill 2019 SARS-CoV-2 cases after onset of illness: Intensive care data from Turkey.
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Küçük AO, Pehlivanlar Küçük M, Pehlivanlar A, Ayaydın Mürtezaoğlu S, Çoban K, Topaloğlu Ö, Kaya A, Güler Ö, Semerci T, Balçık Savaşer S, Özhan Akdemir B, Ayçiçek O, Öztuna F, Bülbül Y, and Özlü T
- Subjects
- Aged, Critical Care, Humans, Male, Middle Aged, Retrospective Studies, SARS-CoV-2, Turkey epidemiology, COVID-19 epidemiology, COVID-19 therapy, Critical Illness epidemiology, Critical Illness therapy
- Abstract
Introduction: This study aimed to evaluate the epidemiological, clinical, laboratory characteristics and treatment and clinical outcomes of severe COVID19 cases from a 3rd degree intensive care unit in Turkey., Materials and Methods: The study was conducted in a level three, 16-bed COVID intensive care unit. The investigation was planned as a retrospective and observational study. Patients who were admitted with COVID-19 pneumonia and respiratory failure in the intensive care unit between March 2020 and March 2021 and followed up due to critical illness were evaluated., Result: A total of 213 patients that were admitted to the intensive care unit with the diagnosis of COVID-19 pneumonia were included in the study. Median age of the patients was 66 (IQR 56.5-74) years, and 134 (62.9%) were males. One hundred and sixty-six (77.9%) of the patients had at least one comorbidity. Patients were followed up mainly with invasive mechanical ventilation [104 (48.8%)] and high flow nasal cannula [67 (31.5%)]. Median number of days was 7 (IQR 4-10) and included the first symptom onset to intensive care admission. The time to intubation was 9 (IQR 4-15) days, and the median day to intensive care discharge was 16 (IQR 11-23). After the symptoms started, first tocilizumab 9 (IQR 5-11) and pulse steroid treatment 8 (IQR 3-11) were found to be close to each other. In total, 95 (44.6%) of the 213 patients died., Conclusions: SARS-CoV-2 associated viral disease can progress after simple symptoms to hospital admission in a median of four days and to intensive care admission requiring intubation in a median of nine days. We believe that a better understanding of the clinical course of COVID-19 and its change between centers can be revealed through sharing information from different countries and centers.
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- 2022
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38. Effect of tocilizumab on intensive care patients with Covid-19 pneumonia, a retrospective cohort study.
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Küçük MP, Küçük AO, Pehlivanlar A, Mürtezaoğlu SA, Çoban K, Kılıç G, Ayçiçek O, Öztuna F, Bülbül Y, and Özlü T
- Subjects
- Antibodies, Monoclonal, Humanized, Critical Care, Humans, Inflammation, Interleukin-6, Retrospective Studies, SARS-CoV-2, Treatment Outcome, Respiratory Insufficiency therapy, COVID-19 Drug Treatment
- Abstract
Background: In this study, the efficacy of an IL-6 antagonist, Tocilizumab, administered in the early period was studied in intensive care patients with COVID-19 pneumonia followed by hypoxic and systemic inflammation not receiving mechanical ventilation support., Methods: Patients with COVID-19 pneumonia who have signs of hypoxia and systemic inflammation and/or who have acute bilateral infiltrates on chest radiograph and who received tocilizumab treatment were compared with the patients who received standard medical therapy. Patients who were followed up with COVID-19 pneumonia and respiratory failure between March 2020 and March 2021 were retrospectively evaluated in the study. A 400 mg - 800 mg iv dose (depending on weight) of Tocilizumab was administered. The primary endpoint was determined as intensive care unit mortality., Results: A total of 213 patients who were admitted with respiratory failure associated with COVID-19 to our third-level intensive care unit were evaluated. Of these patients, the study was conducted with 50 patients in the tocilizumab treatment group and 92 patients in the standard treatment group. During the intensive care period, 26 patients (28.3%) in the standard treatment group and 12 patients (24%) in the group receiving tocilizumab died. The adjusted hazard ratio for mortality in the tocilizumab group was 0.39 (95% confidence interval [CI], 0.186 to 0.808; p = 0.001 by log-rank test). During the intensive care period, 22 patients (24.8%) in the standart treatment group and 16 patients (32%) in the tocilizumab group were intubated. The adjusted hazard ratio for a primary outcome intubation in the tocilizumab group was 0.71 (95% confidence interval [CI], 0.355 to 1.424; p = 0.184 by log-rank test).
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- 2022
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39. Effects of personality traits on severity of sepsis.
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Pehlivanlar Küçük M, Küçük AO, Kömürcü Ö, Dikmen Y, Kadıoğlu M, Uzan ÇA, Ergin Özcan P, Orhun G, Ünal Akdemir N, Eroğlu A, İlyas Y, Zeyneloğlu P, Şahintürk H, Dai Özcengiz D, Fırat A, Aydın D, Özlü T, Pehlivanlar A, Kıraklı C, Acar Çinleti B, Gök F, Yosunkaya A, Aktaş M, Öztürk ÇE, and Ülger F
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- Female, Humans, Length of Stay, Male, Personality, Prospective Studies, Sepsis epidemiology, Shock, Septic
- Abstract
Introduction: The aim of this study was to reveal the effect of the individual's lifestyle and personality traits on the disease process in patients with sepsis and to have clinical predictions about these patients., Materials and Methods: The study was planned as a multi-center, prospective, observational study after obtaining the approval of the local ethics committee. Patients were hospitalized in different intensive care units. Besides demographics and personal characteristics of patients, laboratory data, length of hospital and ICU stay, and mortality was recorded. Two hundred and fifty-nine patients were followed up in 11 different intensive care units. Mortality rates, morbidities, blood analyses, and personality traits were evaluated as primary outcomes., Result: Of the 259 patients followed up, mortality rates were significantly higher in men than in women (p= 0.008). No significant difference was found between the patients' daily activity, tea and coffee consumption, reading habits, smoking habits, blood groups, atopy histories and mortality rates. Examining the personal traits, it was seen that 90 people had A-type personality structure and 51 (56.7%) of them died with higher mortality rate compared to type B (p= 0.038). There was no difference between personalities, in concomitant ARDS occurrence, need for sedation and renal replacement therapies., Conclusions: Among individuals diagnosed with sepsis/septic shock, mortality increased significantly in patients with A-type personality trait compared to other personality traits. These results showed that personal traits may be useful in predicting the severity of disease and mortality in patients with sepsis/septic shock.
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- 2021
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40. [Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)].
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Pehlivanlar Küçük M, Özlü T, Küçük AO, Kaya A, Kıraklı C, Şengören Dikiş Ö, Kefeli Çelik H, Özkan S, Bektaş Aksoy H, Palabıyık O, Çörtük M, Ergün R, Kozanhan B, Erçen Diken Ö, Bacakoğlu F, Uzun Kaya S, Aksoy İ, Cinemre H, Zerman A, Özkoçak Turan I, Fazlıoğlu N, Yıldırım F, Günay E, Akan B, Arpağ H, Sezgi C, Can A, Yalçınsoy M, Karaoğlanoğlu S, Şehitoğulları A, Arslan S, Aydemir Y, Öztürk A, Hocanlı İ, Salmanoğlu M, Ekici A, Ataman S, Edipoğlu Ö, Yıldız T, Doğanay Z, Dağlı C, Arslan Aksu E, Zitouni B, Eğilmez Aİ, Şahiner Y, Korkmaz Ekren P, İnönü Köseoğlu H, Baydın A, Nalbant A, Aydın D, Bindal A, Balas Ş, Esen Karamişe Ş, Araz Ö, Acar T, Kahraman H, Demir M, Burnik C, Çanakçı E, Bilgin C, Yağan Ö, Aydemir S, Önem Y, and Gürel Durmuş Z
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- Adult, Aged, Critical Care statistics & numerical data, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Turkey, Critical Illness mortality, Hospital Mortality trends, Intensive Care Units, Practice Patterns, Physicians' statistics & numerical data, Severity of Illness Index
- Abstract
Introduction: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up., Materials and Methods: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional., Result: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively., Conclusions: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.
- Published
- 2020
- Full Text
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