26 results on '"Küçük, Mehtap Pehlivanlar"'
Search Results
2. Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy: A Retrospective Observational Study.
- Author
-
Küçük, Ahmet Oğuzhan, Küçük, Mehtap Pehlivanlar, Pehlivanlar, Ayşegül, Ayçiçek, Olcay, Demir, Ömer, Öztuna, Funda, Bülbül, Yılmaz, and Özlü, Tevfik
- Subjects
- *
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]
- Published
- 2023
- Full Text
- View/download PDF
3. Alternative Treatment Method for Crimean Congo Hemorrhagic Fever: Coupled Plasma Filtration and Adsorption.
- Author
-
Tepe, Dilşat, Yılmaz, Gürdal, Küçük, Ahmet Oğuzhan, and Küçük, Mehtap Pehlivanlar
- Subjects
HEMORRHAGIC fever ,DISSEMINATED intravascular coagulation ,MULTIPLE organ failure ,CORONARY artery disease ,INTENSIVE care units ,GASTROINTESTINAL hemorrhage ,THYROID crisis - 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
- 2023
- Full Text
- View/download PDF
4. Effectiveness of Early Combined Rehabilitation in COVID-19 Related ARDS Patients After the Successfull Application of Extracorporeal Membrane Oxygenation: Two Case Reports.
- Author
-
Ertürk, Nurel, Küçük, Ahmet Oğuzhan, Algın, Merve Özdoğan, and Küçük, Mehtap Pehlivanlar
- Subjects
EXTRACORPOREAL membrane oxygenation ,CORONAVIRUS diseases ,COVID-19 ,REHABILITATION ,INTENSIVE care units ,TREATMENT programs - 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
- Full Text
- View/download PDF
5. The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial
- Author
-
Küçük, Mehtap Pehlivanlar, primary, Öztürk, Çağatay Erman, additional, İlkaya, Nazan Köylü, additional, Küçük, Ahmet Oğuzhan, additional, Ergül, Dursun Fırat, additional, and Ülger, Fatma, additional
- Published
- 2021
- Full Text
- View/download PDF
6. Türkiye'de yoğun bakım ünitelerinde hekimin mortaliteyi öngörebilme gücü
- Author
-
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
- Subjects
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
- Published
- 2020
7. Extracorporeal membrane oxygenation experiences during COVID‑19 pandemic, third wave with younger patients: A retrospective observational study.
- Author
-
Küçük, Ahmet Oğuzhan, Küçük, Mehtap Pehlivanlar, Ayçiçek, Olcay, Altun, Gökalp, and Özdemir, Ahmet Coşkun
- Subjects
- *
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]
- Published
- 2022
- Full Text
- View/download PDF
8. Pneumothorax and Subcutaneous Emphysema Evaluation in Patients with COVID-19 in the Intensive Care Unit.
- Author
-
Küçük, Mehtap Pehlivanlar, Güngör, Burcu Öksüz, Küçük, Ahmet Oğuzhan, Ayçiçek, Olcay, Türkyılmaz, Atila, Öztuna, Funda, Bülbül, Yılmaz, and Özlü, Tevfik
- Subjects
- *
PNEUMOTHORAX , *SUBCUTANEOUS emphysema , *INTENSIVE care patients , *COVID-19 , *INTENSIVE care units , *DISEASE risk factors - Abstract
Objective: Pneumothorax (PNX) and subcutaneous emphysema (SCE) have increased in importance as a frequently occurring complication. This study aimed to reveal the frequency, timing, and possible risk factors in patients with PNX and SCE who are followed up with coronavirus disease-2019 (COVID-19) diagnosis in our tertiary intensive care unit (ICU). Materials and Methods: All patients with confirmed COVID-19 who were followed up and treated in our unit between August 8, 2020, and February 20, 2021, in a 16-bed tertiary ICU and who developed PNX and SCE during their hospitalization were included. Results: PNX and SCE developed in 16 (9.6%) of 165 patients who were followed up in our ICU due to COVID-19. Of these 16 patients, 3 (18.8%) survived. The median age of patients was 66.5 years (interquartile range: 58.5-75.5). Diabetes mellitus was the most common comorbidity in patients with PNX and SCE. Additionally, 12 (75%) patients had a smoking history. Of 15 (93.8%) patients who developed PNX, 4 (25%) were bilateral, and SCE developed in 9 (56.3%) patients. Twelve (75%) patients with PNX and SCE were under invasive mechanical ventilation, 3 (18.8%) under spontaneous breathing, and 1 (6.2%) under non-invasive mechanical ventilation treatment. The number of oxygen support days until the time PNX and SCE developed was 9 (6.25-17) days in the whole group, the median time was 6 days in the survival group and 9 days in the non-survival group. Conclusion: In the COVID-19 pandemic, complications, such as PNX and SCE, are more frequently observed (9.5%) than in the general intensive care population and the later period of intensive care admission (median 9 days). Smoking is defined as a risk factor in most of these patients; however, increased PNX rates are thought to be related to both COVID-19 pneumonia and parenchymal damage due to cytokine storms. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
9. Short-term Results of Patients with Spontaneous Subarachnoid Hemorrhage in Intensive Care Unit: Single-center Experience.
- Author
-
Küçük, Mehtap Pehlivanlar, Öztürk, Çağatay Erman, Küçük, Ahmet Oğuzhan, Turunç, Esra, and Ülger, Fatma
- Subjects
- *
INTENSIVE care units , *SUBARACHNOID hemorrhage , *INTRACRANIAL aneurysms , *OPERATIVE surgery , *GLASGOW Coma Scale , *INTERVENTIONAL radiology , *HYPERNATREMIA , *ENDOVASCULAR surgery , *BRAIN surgery - Abstract
Objective: Few studies have evaluated patients with spontaneous subarachnoid haemorrhage (sSAH) from an intensivist perspective. This study aimed to report the results of patients with sSAH in a high-volume centre monitored by a team experienced in the fields of brain surgery, interventional radiology and intensive care. Materials and Methods: Data of patients with sSAH followed up between January 2014 and July 2018 in the intensive care unit (ICU) were retrieved from ICU patient observation charts, file records and hospital automated information system. Results: This study enrolled 150 patients, of which 61 (40.7%) patients died despite receiving intensive care. Mortality rates between patients with (42.8%) and without (40%) vasospasm were comparable (p=0.917). Vasospasm developed in 37.8% of the 45 patients who underwent endovascular coiling and in 19.2% of those who underwent neurosurgical clipping (p=0.044). The median times that elapsed before endovascular or surgical procedures were 2.5 [interquartile range (IQR): 2-5] days in the surviving group and 2 (IQR: 1-5) days in the deceased group (p=0.164). Blood sodium and blood chloride levels were significantly higher in the deceased group from the third day onward. The median blood sodium level exceeded 142 mEq/L in the deceased group, but was lower than 142 mEq/L on the same day in the surviving group. Conclusion: The results of this study suggest that Glasgow coma scale (GCS) at admission to the ICU is one of the important factors that affect treatment success. GCS is an important independent factor in selecting the timing or type of treatment (surgical clipping/endovascular coiling) and medical treatments such as nimodipine in patients with sSAH requiring intensive care. In addition, the incidence of vasospasm was higher in patients who underwent endovascular coiling. Increased sodium and chloride values during follow-up are the only parameters significantly associated with mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
10. Spurious Hypoxemia in an Intensive Care Patient with Hyperleukocytosis Secondary to Acute Leukemia.
- Author
-
Hekimoğlu, Muhammet Faruk, Mürtezaoğlu, Sevil Ayaydın, and Küçük, Mehtap Pehlivanlar
- Subjects
INTENSIVE care patients ,OXYGEN saturation ,ACUTE leukemia ,HYPOXEMIA ,ACUTE myeloid leukemia - Abstract
Copyright of Respiratory Case Reports is the property of LookUs Scientific 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
- 2021
- Full Text
- View/download PDF
11. Yoğun Bakımda Normokalorik veya Hipokalorik Nütrisyonun Renal Fonksiyonlar ve Hasta Sonlanımı Üzerine Etkileri.
- Author
-
Küçük, Ahmet Oğuzhan, Küçük, Mehtap Pehlivanlar, and Ulusoy, Hülya
- Subjects
- *
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
12. COVID-19 Tanısı Alan Renal Nakilli Hastalarda Yüksek Mortalite, Yoğun Bakım Sonuçları.
- Author
-
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
13. Kritik Yoğun Bakım Hastalarında COVID-19 ile İlişkili Fungemi için Risk Faktörleri ve Klinik Özellikler.
- Author
-
Küçük, Ahmet Oğuzhan, Yılmaz, Gizem, Küçük, Nejla, Aksoy, Dilşat, Küçük, Mehtap Pehlivanlar, and Yılmaz, Gürdal
- 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
14. Yoğun Bakımda İzlenen Boğulma Olgularında Sonlanımı Etkileyen Parametreler: Sekiz Yıllık Retrospektif Hasta Verileri.
- Author
-
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
15. Mikrobiyota ve Yoğun Bakım.
- Author
-
Küçük, Mehtap Pehlivanlar and Ülger, Fatma
- Subjects
- *
PATHOGENIC microorganisms , *INFLAMMATORY bowel diseases , *INTENSIVE care units , *HUMAN body , *SPECIES diversity - Abstract
It is estimated that there are a total of 1014 microorganisms colonized in many organs and tissues in the human body. It is also estimated that there are trillions of bacteria in the human body, almost 10 times that of host cells. This new life association, which we define as microbiomes, has been shown to be essential for protection against enteric and systemic pathogens through many direct and indirect (immunologically mediated) mechanisms in preclinical studies. Dysbiosis or imbalance in the homeostasis of the intestinal microbiota has been associated with many different diseases such as diabetes, obesity, inflammatory bowel disease and rheumatoid arthritis. In general, intestinal microbiota in patients with sepsis following intensive care unit (ICU) follow-up is characterized by lower diversity and commensal species (such as Faecalibacterium, Blautia, Ruminococcus) and an increase in strains such as Escherichia, Shigella, Salmonella, Enterococcus, C. difficile or Staphylococcus. Current treatment methods are based on two principles, either to reduce the excess proliferation of potentially pathogenic microorganisms (decolonization strategies) or to re-supply the pool of beneficial organisms. As in all areas, research on microbiota-targeted treatment strategies in ICU continues. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
16. Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism.
- Author
-
Küçük, Mehtap Pehlivanlar, Öztuna, Funda, Abul, Yasin, Özsu, Savaş, Kutlu, Merih, and Özlü, Tevfik
- Published
- 2019
- Full Text
- View/download PDF
17. Prognostic evaluation of cases with thoracic trauma admitted to the intensive care unit: 10-year clinical outcomes.
- Author
-
Küçük, Mehtap Pehlivanlar, Küçük, Ahmet Oğuzhan, Aksoy, İskender, Aydın, Davut, and Ülger, Fatma
- Subjects
ARTIFICIAL respiration ,LENGTH of stay in hospitals ,HOSPITAL admission & discharge ,CHEST injuries ,INTENSIVE care units ,MULTIVARIATE analysis ,PATIENTS ,PEDIATRICS ,REGRESSION analysis ,COMORBIDITY ,DISCHARGE planning ,TREATMENT effectiveness ,RETROSPECTIVE studies ,HOSPITAL mortality ,TRAUMA severity indices ,ODDS ratio ,PROGNOSIS ,DIAGNOSIS ,THERAPEUTICS - Abstract
Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing 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
- 2019
- Full Text
- View/download PDF
18. Yoğun Bakımda Multidisipliner Yaklaşımla Tedavi Edilen, Mortalitesi Yüksek Bir Olgu: Meningokoksik Menenjit.
- Author
-
Küçük, Mehtap Pehlivanlar, Yılmaz, Esmeray Mutlu, Aydın, Davut, Ülger, Fatma, and Esen, Şaban
- Abstract
Meningococcemia is a highly mortal disease that can cause septic shock and multiple organ failure, which can be accompanied by sudden onset, rapid course, purpura fulminans and diffuse intravenous coagulation tables. Mortality increases when meningococcal causes to meningitis. The fact that it is the cause of neurological sequelae and extremity losses even in the recovering cases makes the support provided by the intensive care unit quite important in the management of cases. A case with meningococcal meningitis with high mortality, who was successfully treated through the use of supportive methods, such as monitorization, mechanical ventilation practices with new modalities, plasmapheresis and sympathetic ganglion blockage, has been presented in company with the literature. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
19. Electrical Impedance Tomography Assistance in Difficult Decision Making; “Influenza-A Related Severe ARDS in a Pregnant Woman“.
- Author
-
Hatinoğlu, Neslihan, Küçük, Mehtap Pehlivanlar, Küçük, Ahmet Oğuzhan, and Özdemir, Kübra Nur
- Subjects
- *
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
20. Use of Electric Impedance Tomography as a Screening Tool to Determine Effectiveness of Bronchosopy in a VV-ECMO Patient.
- Author
-
Hatinoğlu, Neslihan, Küçük, Mehtap Pehlivanlar, Küçük, Ahmet Oğuzhan, and Özdemir, Arif Talha
- Subjects
- *
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
21. Resistant Electrolyte Disorders Due to Extended Meropenem and Colistin Use After Intraabdominal Perforation; Looking to the Right Direction in Etiology! .
- Author
-
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
22. Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy; 3rd Level Intensive Care Data from Turkey.
- Author
-
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
23. Yoğun Bakımda COVID-19 ve Spontan Pnömotoraks: 4 Olgu ve Literatür Taraması.
- Author
-
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
24. 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
-
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.
25. Effect of tocilizumab on intensive care patients with Covid-19 pneumonia, a retrospective cohort study.
- Author
-
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).
- Published
- 2022
- Full Text
- View/download PDF
26. Management of Acute Respiratory Distress Syndrome with H1N1 Influenza Virus in Pregnancy: Successful Mechanical Ventilation and Weaning with Airway Pressure Release Ventilation.
- Author
-
Küçük MP, Öztürk ÇE, İlkaya NK, Eyüpoğlu S, Ülger F, and Şahinoğlu AH
- Abstract
In pregnancy, infection with H1N1 influenza virus may produce symptoms similar to infection with seasonal influenza virus. Patients may rarely come with a clinical condition causing severe acute respiratory distress syndrome (ARDS) and death. Therefore, mechanical-ventilation strategies to manage these events are vital. We report a case of ARDS after an infection with H1N1 influenza A in a 33-year-old patient pregnant at 27-weeks. The ARDS was successfully managed by airway pressure release ventilation (APRV). APRV can be used successfully as an alternative to conventional mechanical ventilation modes in pregnant patients experiencing severe respiratory failure., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.
- Published
- 2018
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.