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Amaç: Bu araştırmada, hastanemizde palyatif bakım servisi kurulduktan sonra akciğer kanseri nedeni ile ölen hastaların ölüm yerlerinin palyatif servise kaydığının gösterilmesi hedeflenmiştir. Gereç ve Yöntem: Çalışma 2017-2020 yılları arasında 4 yıllık retrospektif kesitsel çalışma olarak Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesinde yapıldı. Çalışma döneminde tanıları akciğer kanseri olan ve hastanede ölen hastalar çalışmaya alındı. Hastaların demografik verileri, yatış nedenleri, ek hastalıkları, hemogram, biyokimya değerleri, hastane içinde yer değişimleri, solunum destekleri (invaziv ve noninvaziv mekanik ventilasyon, oksijen) medikal tedavileri, ölüm yerleri, en çok dört ölüm nedenleri hastane mortalite verilerinden kayıt edildi. Veriler tanımlayıcı analiz ile özetlendi. Yıllar içindeki değişim kayıt edilen veriler ile karşılaştırıldı. Bulgular: Çalışma döneminde akciğer kanseri nedeni ile 15.552 hasta yatırıldı ve bu hastalardan ölen hasta sayısı 1896 (%12) olarak saptandı. Ölen 1896 hastanın 834’ü yani %44’ünün ilk yatış yeri palyatif bakımdı, bu hastalardan sadece 19’u tekrar yoğun bakıma sevk edildi. Palyatif servise yatışta yıllar içinde istatistiksel olarak anlamlı artış izlendi (p

To evaluate the utility of neutrophil–lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis. A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cutoff value via ROC analysis. Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34–4.31) vs. 2.29 (1.67–3.23), p = 0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p = 0.001). ROC analysis revealed an NLR cutoff value of ≥2.39 (AUC (95% CI): 0.70 (0.62–0.79), p < 0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥2.39 (74.0 vs. 47.0%, p = 0.002). Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.

The diaphragm is the most significant muscle involved in breathing. There are very few studies and cases evaluating sleep-related breathing disorders in diaphragmatic pathologies. This study compares preoperative and postoperative polysomnography (PSG) and pulmonary function test (PFT) results in diaphragmatic pathologies. The study included 28 patients who underwent video-assisted mini-thoracotomy (VATS) due to diaphragm eventration and paralysis between January 2014 and October 2019. Pulmonary function tests (PFT) and polysomnography (PSG) were performed preoperatively in all patients, and PSG and PFT were repeated 2 months after the surgery. Twenty-five of the 28 patients were found to have apnea–hypopnea index (AHI) ≥ 5 (89%). A significant decrease in the preoperative TST, stage 3, and REM periods was observed. Nineteen of these patients (76%) were supine isolated or supine dominant. There was a marked improvement in AHI and PFT values after the surgery. Only five patients required a PAP device. Doctors should perform PSG in patients with diaphragm pathologies, and these patients should be operated on after considering the comorbidities when OSA is detected.

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to cause major mortality and morbidity worldwide even after a year of its emergence. In its early days, hypertension, diabetes, and cardiovascular diseases were noted as poor prognostic factors, while obesity gained attention at a later stage. In the present study, unfavorable clinical outcomes (transfer to the intensive care unit, invasive mechanical ventilation, and mortality) were investigated in obese patients with COVID-19. MATERIALS AND METHODS: In this retrospective study we analyzed patients with positive polymerase chain reaction test in tertiary care hospital between March-May 2020. They were divided into 3 groups according to body mass index (BMI) as normal, overweight, and obese (BMI: 18.5 - 24.99 kg/m², 25 - 29.99 kg/m², and ≥ 30 kg/m², respectively). We compared clinical features and laboratory findings of these groups and recorded adverse clinical outcomes. Multivariate logistic analysis was performed for unfavorable outcomes. RESULTS: There were 99 patients (35%), 116 (41%), and 69 patients (24%) in the normal-weight, overweight, and obese group, respectively. Among all patients, 52 (18%) patients were transferred to the intensive care unit (ICU), 30 (11%) patients received invasive mechanical ventilation (IMV), and 22 patients (8%) died. Obese patients had minimum 1 more comorbidity than normal BMI patients (73% vs. 50%, P = 0.002), and a longer median (interquartile range [IQR]) duration of hospitalization (8 [5 - 12] vs. 6 [5 - 9]) days, P = 0.006). Obese participants had higher concentrations of serum C-reactive protein, procalcitonin, ferritin than non-obese patients (P

Amaç: Bu çalışmada akut hiperkapnik solunum yetmezliği (AHSY) tanısı ile yoğun bakım ünites (YBÜ)’inde noninvaziv mekanik ventilasyon (NIMV) uygulamasına ilk saatlerde iyi yanıt alınan, ancak nazal oksijene geçildikten kısa süre sonra tekrar ciddi solunumsal asidoz gelişen hastaların analizini yapmayı planladık. Gereç ve Yöntem: Ocak 2009-Nisan 2010 tarihleri arasında, AHSY (pH45 mmHg) nedeniyle YBÜ’de takip edilen ve uygulanan ilk 1-4 saatlik NIMV tedavisine yanıt veren 139 hastanın verisi retrospektif olarak incelendi. Hastalar, NIMV tedavisi sonlandırıldıktan sonraki takiplerinde rebound hiperkapni gelişen (grup 1) ve gelişmeyen (grup 2) olmak üzere iki gruba ayrıldı. Hastaların demografik özellikleri, AHSY nedenleri, NIMV uygulama süreleri, arteriyel kan gazı (AKG) değerleri, APACHE-II ve SOFA skorları, hastanede yatış süresi (gün), invaziv mekanik ventilatör (İMV) ihtiyacı ve yaşam durumları kaydedildi. Grupların özelliklerini karşılaştırmada numerik veriler için nonparametrik Mann-Withney-U testi ve kategorik veriler için Ki-kare testi kullanıldı. Bulgular: Çalışmaya 139 hasta dâhil edildi. Grupların demografik özellikleri ve NIMV süreleri, YBÜ ve hastane kalış süreleri arasında fark bulunmadı. Grup 1’de toraks deformitesi-kas hastalıkları (grup 1’de %8,6; grup 2’de %1,2) ve obezite hipoventilasyon sendromu (OHS) (grup 1’de %17,2; grup 2’de %9,9) daha fazla iken; grup 2’de parankimal akciğer hastalıkları fazla (grup 1’de %6,9; grup 2’de %18,5) idi. Her iki grup için evde oksijen ve NIMV cihazı kullanıyor olma durumları benzerdi. Grupların pH ve PaCO2 değerleri YBÜ’ye kabul esnasında benzerken, ilk kontrolde grup 1’de grup 2’ye göre belirgin düzelme varken (sırasıyla p

Objective COVID-19 has spread worldwide and leads to an increased risk of mortality. We aimed to analyze what actions have been effective in fighting COVID-19 in Turkey with a comparison to pandemic-affected countries. Methods This was a retrospective observational cross-sectional study. The Republic of Turkey Ministry of Health official web page includes data reported daily from 11 March to 26 April. Global COVID-19 data were recorded daily from https://www.worldometers.info/coronavirus/country/. Data were analyzed for 31 days according to Intensive Care Unit (ICU) admission, intubation and mortality rates. Segmented regression analysis was used. The results from COVID-19-affected countries were compared with the results from Turkey for the first 65 days. Results In total, 889.742 tests were performed (positive=110.130 [12.37%]). The mortality rate was 2.55% (n=2805) on 27 April 2020. The annual percent change (APC) values of the cases showed 5 segments ([23.1], [14.7] [11.4], [3.7], [0.7]; each p=0.001). ICU admission showed 4 segments (APC: [3.1, p=0.001], [-2.2, p=0.10], [-7.6, p=0.001], [-4.5, p=0.001]). The decline of APC for intubation rates showed 5 segments (APC: [1.1, p=0.10], [-1.1,p=0.001], [-2.0, p=0.001], [-0.4, p=0.40], [-2.7, p=0.001]). The mortality rates showed 4 segments (APC: [-6.3, p=0.001], [8.4, p=0.001], [0.2, p=0.30], [1.4, p=0.001]). Deaths were reported per 1 million individuals for the first 65 days: Spain 11.6%, Italy 11.4%, UK 11.3%, France 11.1%, USA 10.3%, Germany 8.4%, Iran 8.2%, Turkey 7.5%, South Korea 4.1% and China 2.4%. Conclusion Public health policies and protocols to combat COVID-19 helped control the spread and decrease positive cases and mortality rates in Turkey. Turkey managed COVID-19 better than Spain, Italy, UK, France, USA and Turkey managed COVID-19 similarly to Germany and Iran. China and South Korea were best at managing COVID-19.

Introduction Palliative care is a multidisciplinary therapy formed by physical, social, psychological, cultural and spiritual support of patients and families. The aim of the present study is to compare the survival rates of the intensive care unit (ICU) and palliative care unit (PCU). Materials and methods A retrospective observational cohort study was performed using the database of an intensive care unit. Patients with terminal illness admitted to the intensive care unit or palliative care unit were included in the study. Demographic data, comorbidities, time of admission, discharge and death were recorded. The survival estimation was completed using Kaplan Meier survival analysis. Result A total of 112 patients were included in the study. Patients were divided into two groups where 60 patients (53.6%) were in Group ICU and 52 (46.4%) were in Group PCU. The Kaplan-Meier estimation of survival curves showed that the overall median time was 29 days. This result demonstrated that 50% of the patients was survived longer than 29 days, in which it was 12 days and 38 days for Group ICU and Group PCU, respectively (𝜒2= 3.475, p= 0.062). The cost of either intensive care unit or palliative care unit did not show any difference (p= 0.902). Conclusions The present study showed that long-term survival rates are similar in intensive care unit and palliative care unit.

BACKGROUND-AIM Noninvasive mechanical ventilation (NIV) failure rate is reported to be 5%-60% of intensive care unit (ICU) patients. Despite all precautions and well-known reasons, the risk factors of NIV failure are unclear for chronic obstructive pulmonary disease (COPD) with acute respiratory failure (ARF). The aim of this study was to examine risk factors for NIV failure in COPD patients with ARF, other than well defined. METHODS The retrospective cohort study was done in ICU of a chest disease hospital. All consecutive COPD patients with hypercapnic ARF were enrolled in study. Demographics, comorbidities, arterial blood gases, reasons of ARF and length of ICU stay were recorded. NIV success was defined as discharge from ICU and NIV failure was defined as need for intubation or died during NIV. Patients were grouped into; NIV failure and success. The groups were compared and NIV failure risk factors were analyzed. RESULTS About 265 NIV success and 142 NIV failure patients were enrolled into the study. Logistic regression test showed the risk factors for NIV failure; higher APACHE-II (≥ 29) (OR:11.71, CI95%4.39-31.18, P

Tracheostomy is life-saving procedure in critical care patients which require long-term mechanical ventilation (MV) and an alternative to endotracheal intubation.(1,2) The factors affecting the survival of tracheostomized patients are not clearly known. The aim of this study was to investigate the factors affecting intensive care unit (ICU) and long-term mortality in the tracheostomized patients due to respiratory failure. A retrospective observational cohort study was planned between January 2016-2019 in tertiary ICU. Each patient underwent percutaneous and surgical tracheostomy was included. Demographic characteristics, diagnoses, causes of tracheostomy, comorbidities, Charlson and APACHE 2 scores, culture antibiogram results, ICU day and mortality (1-3 and 12 months) were recorded. In the analysis of the data, appropriate statistical tests and analyzes were used. 115 of 3620 patients admitted to tertiary ICU and underwent percutaneous and surgical tracheostomy due to respiratory failure between January 2016-2019 were included. 75 (65%) of the patients were male and median age was 68±14 years. Hospital mortality was higher in the group with Acinetobacter baumannii growth (p=0.04). According to Kaplan-Meier survival analysis, long-term follow-up of Acinetobacter baumanii growth did not affect survival (p=0.938). Patients with cerebro-vascular accident (CVA) had lower survival in long-term follow-up (p [Med-Science 2020; 9(1.000): 1-5]

BACKGROUND Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD). AIM/OBJECTIVE The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)). METHODS Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated. RESULTS 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P

This study was designed to evaluate the influence of gender on the inhaler technique of subjects on inhaler therapy and to determine the factors predicting the correct inhaler technique and a change of inhaler device. METHODS: A total of 568 adult subjects (276 male, 292 female) on inhaler therapy were included in this cross-sectional, observational study. Data on sociodemographic characteristics, inhaler therapy, subject-reported difficulties, and technician-reported errors in inhaler technique were recorded. RESULTS: A change of inhaler device was noted in 71.0\% of male subjects and 77.4\% of female subjects, and this was based on the physicians' decision in most cases (41.7\% and 51.7\%, respectively). A higher percentage of female subjects reported difficulties with using inhalers (63.7\% vs 40.6\%, P < .001). Overall, having received training on the inhaler technique was associated with a higher likelihood of correct inhaler technique (odds ratio 12.56, 95\% CI 4.44-35.50, P < .001) and a lower risk of device change (odds ratio 0.46, 95\% CI 0.27-0.77, P = .004). CONCLUSIONS: Errors in the inhaler technique, including inhalation maneuvers and device handling, were common in subjects on inhaler therapy. Subject-reported difficulties with using inhalers were more prevalent among female subjects, whereas errors in the inhaler technique identified by direct observation were similarly high in both genders. Overall, a lack of training on the inhaler technique predicted a higher likelihood of errors in the inhaler technique and a change of inhaler device.

Background/aim: While C-reactive protein (CRP) is a well-studied marker for predicting treatment response and mortality in sepsis, it was aimed to assess the efficacy of the neutrophil lymphocyte ratio (NLR) as a predictor of mortality and treatment response in sepsis patients in the intensive care unit (ICU). Materials and methods: In this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shock on the 1st day of ICU stay, and then subgrouped according to mortality. Patient demographics, acute physiologic and chronic health evaluation II and sequential organ failure assessment scores, NLR and CRP (on the 1st, 3rd, and last day in the ICU), microbiology data, antibiotic responses, ICU data, and mortality were recorded. Receiver operating characteristic (ROC) curves for the area under curve (AUC) were calculated for the inflammatory markers and ICU severity scores for mortality.Results: Of the 591 (65% male) enrolled patients, 111 (18.8%) were nonsurvivors with shock, 117 (19.8%) were survivors with shock, 330 (55.8%) were survivors without shock, and 33 (5.6%) were nonsurvivors without shock. On the 1st day of ICU stay, the NLR and CRP were similar in all of the groups. On the 3rd day of antibiotic response, the NLR was increased (11.8) in the nonresponsive patients when compared with the partially responsive (11.0) and responsive (8.5) patients. If the NLR was ≥15 on the 3rd day, the mortality odds ratio was 6.96 (CI: 1.4?34.1, P < 0.017). The NLR and CRP on the 1st, 3rd, and last day of ICU stay (0.52, 0.58, 0.78 and 0.56, 0.70, 0.78, respectively) showed a similar increasing trend for mortality. Conclusion: The NLR can predict mortality and antibiotic responsiveness in ICU patients with sepsis and septic shock. If the NLR is >15 on the 3rd day of postantibiotic initiation, the risk of mortality is high and treatment should be reviewed carefully.

Background: Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung diseases (COPD). There are limited data about RDW levels in COPD exacerbation. Aim/Objective: The association of the RDW levels with the severity of the acute exacerbation of COPD (AECOPD) were evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU). Methods: Cross sectional retrospective study designed in tertiary chest dieases hospital. COPD patients admitted to hospital outpatiens-clinic, ward and ICU due to AECOPD were included. Patients demographics, RDW, C-reactive protein (CRP), biochemistry values were recorded. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11-0.15% (normal). Neutrophile to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Recorded values were compared according to where AECOPD was treated. Results: 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RWD values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (p

Introduction: COPD exacerbations have a heterogeneous structure and eosinophilic (E)and noneosinophilic(NE) endotypes cause different phenotypes and severity of exacerbation. It is known that different results on the correlation of CRP and neutrophil lymphocyte ratio(NLR) in the endotype of E and NE-COPD. In this study,we aimed to determine whether 1,3,5,7 days of NLR and CRP values were similar in the E and NE endotype in AECOPD treatment follow-up, which was required to stay in the intensive care unit(ICU). Methods: A retrospective observational cohort study designed with AECOPD patients who were hospitalized in ICU.Patients were divided as eosinophilic(peripheral blood eosinophilia(PBE)>2%) and noneosinophilic(PBE≤2%) according to acute exacerbation endotype. Patients: demographics, comorbidities,1,3,5,7day total blood count,CRP values were recorded.NLR, platelet lymphocyte ratio(PLR) and PLT/MPV were calculated. Correlation of daily CRP and NLR values of endotype groups were compared. Results: A total of 68 patients,E (16%) and NE(84%) were included. The mean age,smoking,BMI and APACHE II score were similar in to groups.In the eosinophilic group, both the hospital and the ICU stay were shorter (p=0.007 vs p=0.040).CRP9s follow-up value and change were similar in both endotypes. The follow-up values and change of NLR were significantly higher in noneosinophilic COPD(p=0.014). Conclusion:In the study, NE-AECOPD treatment follow-up,which requires ICU stay, NLR would be more effective than CRP.

Introduction: There is no evidence about the best strategy to wean patients with acute hypercapnic respirtaory failure (AHRF) from a successful noninvasive ventilation (NIV) treatment. Aim: A multicenter RCT to compare the effectiveness of 3 different strategies in terms of successful rate of weaning and duration of NIV; as well as mortality, length of stay (LOS) in hospital, respiratory ICU (RICU) and ICU. Methods: 197 adult patients successfully treated with NIV for AHRF were prospectively randomized to gradual decrease in duration of NIV (A, n=66), gradual decrease in duration and level of ventilator support (B, n=64), or abrupt discontinuation of NIV (C, n=67). Results: Baseline characteristics were similar in terms of age, gender, body mass index, smoking status, Charlson comorbidity and APACHE II scores, vitals and arterial blood gas findings at enrollment (p>0.05); except for higher incidence of pneumonia and cardiovascular comordities, lower pCO2 level and incidence use of home long-term oxygen-therapy in Group C (p There was no difference between groups for NIV weaning success rates (p>0.05). The median duration of total NIV use after randomization and LOS in RICU was shorter in Group C (p However there was no significant differences in other secondary outcomes. Conclusion: Even though abrupt interruption may reduce NIV and RICU stay duration, all tested strategies are similarly effective in terms of NIV weaning success.

Non-invasive ventilation (NIV) is a mainstay of management of chronic respiratory failure in many disorders which are known to cause abnormal airway secretion clearance. Currently, there is no guidance regarding either the secretion handling during NIV use or the role of NIV in secretion management in these patients. The aim of this document was to provide an overview of the various techniques available in the management of respiratory secretions and their use in conjunction with NIV. Literature search was performed using the keywords, “(secretion OR secretions) AND (noninvasive ventilation OR NIV)” on PubMed and EMBASE. The search yielded 1681 and 509 titles from PubMed and EMBASE, respectively. After screening, 19 articles were included in this review. Suggestions of the expert panel were formulated by mutual consensus after reviewing the relevant literature. The draft of the expert panel’s suggestions was circulated among all authors via electronic mail for comments. Any conflicts were resolved by mutual discussion to achieve agreement. The final document was approved by all. This document by the International Network for Airway Secretions Management in NIV describes various airway secretion clearance techniques. It provides the expert panel’s suggestions for the use of these techniques in conjunction with NIV for patients with muco-obstructive and neuromuscular disorders.

The choice of treatment according to the inflammation type in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been of recent interest. This study investigated the role of novel biomarkers, hospital outcomes, and readmission rates in the first month in patients with eosinophilic or neutrophilic AECOPD.We conducted a retrospective observational cohort study in a Chest Teaching Hospital with hospitalized AECOPD patients. Subjects' characteristics, hemogram results, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), platelet/mean platelet volume (PLT/MPV), length of hospital stay, mortality, and steroid use were recorded. Eosinophilic AECOPD defined as peripheral blood eosinophilia (PBE) was2% and neutrophilic AECOPD as PBE ≤2%. Readmission within 28 days of discharge was recorded.Of 2727(31.5% females) patients, eosinophilic AECOPD was found in 510 (18.7%) patients. Leucocytes, CRP, NLR, and PLR were significantly higher in neutrophilic AECOPD than in eosinophilic AECOPD (p0.001). Steroid use and mortality rate were 45% and 0.6% in eosinophilic AECOPD and 71%, and 1.4% in neutrophilic AECOPD, respectively (p=0.001, p=0.19). Age75 years, albumin2.5 g/dL, CRP50 mg/dL, and PLT/MPV20×103 were found to be risks factors for hospital mortality (p0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p0.001).NLR, PLR, and CRP levels were higher in neutrophilic AECOPD compared with eosinophilic AECOPD. These markers decreased with treatment in neutrophilic AECOPD. A PLT/MPV ratio of20×103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD.

Birsen Ocakli, Eylem Acarturk, Emine Aksoy, Sinem Gungor, Fulya Ciyiltepe, Selahattin Oztas, Ipek Ozmen, Meltem Coban Agca, Cuneyt Salturk, Nalan Adiguzel, Zuhal Karakurt Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: The aim of this study was to evaluate the impact of exposure to biomass smoke vs cigarette smoke on serum inflammatory markers and pulmonary function parameters in patients with chronic respiratory failure (CRF).Patients and methods: A total of 106 patients with CRF divided into age and gender-matched groups of cigarette-smoke exposure (n=55, mean [SD] age: 71.0 [12.0] years, 92.7% were females) and biomass smoke exposure (n=51, mean [SD] age: 73.0 [11.0] years, 94.1% were females) were included in this retrospective study. Data on patient demographics (age and gender), inflammatory markers, including neutrophil-to-lymphocyte ratio, C-reactive protein, platelet/mean platelet volume ratio, arterial blood gas analysis, and pulmonary function test findings, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were obtained from medical records.Results: Carbon dioxide partial pressure levels were significantly higher in the biomass smoke exposure than in the cigarette smoke exposure group (mean [SD] 51.0 [8.0] vs 47.0 [8.0] mmHg, p=0.026, respectively). Spirometry revealed similarly low levels for FEV1 (%) (38.0 [16.0] vs 40.0 [12.0]%) and FVC (%) (45.0 [19.0] vs 39.0 [19.0]%) in cigarette-smoke and biomass smoke exposure groups, whereas biomass smoke exposure was associated with significantly higher FEV1/FVC (75.0 [14.0] vs 58.0 [12.0]%, p=0.001), lower FVC (mL) (mean [SD] 744.0 [410.0] vs 1,063.0 [592.0] mL, p=0.035) and lower percentage of patients with FEV1/FVC 70% and more prominent loss of vital capacity than cigarette smoke exposure seems to indicate the likelihood of at least 18 years of biomass exposure to be sufficiently high to be responsible for both obstructive and restrictive pulmonary diseases. Keywords: biomass exposure, cigarette smoke, inflammatory markers, spirometry, chronic respiratory failure

Introduction We aimed to assess the relationship between peripheral eosinophilia and neutrophil/lymphocyte ratio with hospital admissions and re-admissions with chronic obstructive pulmonary disease (COPD) exacerbations. Materials and methods An observational cohort study was carried out in a tertiary teaching hospital. Subjects with previously diagnosed COPD and who were admitted as outpatients with acute exacerbations were included. The subjects' characteristics, complete blood count (CBC) parameters, neutrophil to lymphocyte rate (NLR), C-reactive protein (CRP), mean platelet volume (MPV) on admission and re-admission within the first 28 days. Patients were grouped according to their peripheral blood eosinophilia levels; group 1, > 2% (eosinophilic), group 2, ≤ 2% (non-eosinophilic or neutrophilic). The recorded data from the two groups were compared. Result 1490 eligible COPD subjects were enrolled. Approximately 42% were classified as eosinophilic. The non-eosinophilic group had a significantly higher leukocyte count, neutrophil percentage, and NLR than the eosinophilic group. The NLR value in patients with repeat re-admissions was higher than the average, i.e., 4.50 (p= 0.001). MPV and CRP measured on admission and re-admission were similar in both groups. The rate of hospital re-admission within 28 days was significantly higher in patients with a non-eosinophilic attack. Conclusions When a patient is admitted to outpatients with a NLR greater than 4.50 and with a non-eosinophilic exacerbation they have an increased risk of re-admission in the first month. Higher NLR values and non-eosinophilic exacerbations may be helpful for the early detection of potential acute attacks in COPD patients, and may be indicators for antibiotic management.

OBJECTIVES: The aim of this study is to investigate the factors affecting cost in patients with severe community-acquired pneumonia (CAP) who were admitted to the intensive care unit (ICU). MATERIALS AND METHODS: This retrospective cohort study was conducted between January 2013 and December 2016. A total of 291 sequential patients with severe CAP were included in the study. Patients’ demographic and clinical data; the need for invasive mechanical ventilation or non-invasive mechanical ventilation; intensive care severity (ICU) scores, including Acute Physiology and Chronic Health Evaluation (APACHE II), Sepsis-related Organ Failure Assessment, Quick SOFA, pneumonia severity index (PSI); and Confusion, Urea, Respiratory Rate, and Blood Pressure-65 (CURB-65) scores were obtained from medical records and recorded for all cases. RESULTS: The mean age of 291 patients was 68.4±16.8 years, and 61% were female. The median length of ICU stay was 7 days. Forty-six percent of patients had chronic obstructive pulmonary disease (COPD), and 42% had hypertension. The mean cost of each hospitalization was US$ 2722 (TL 5578). The highest cost was found in the group of patients aged 50–59 years, and the lowest cost was found in the patients aged 20 points), and CURB-65 score were higher. The presence of COPD, atrial fibrillation, congestive heart failure, hypoalbuminemia, mental state deterioration, in-hospital mortality, severe sepsis, septic shock, mechanical ventilation requirement, and haloperidol and vasopressor usage were associated with higher cost, while the use of florokinolon was associated with lower cost. CONCLUSION: The presence of certain comorbidities and high disease severity in patients with severe CAP hospitalized in ICU increase the cost of inpatient treatment. The need for mechanical ventilation during treatment and the presence of sepsis/septic shock are additional factors that increase the cost.

Objective Most exacerbations are mild to moderate, and antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is recommended for patients with severe exacerbations or severe underlying chronic obstructive pulmonary disease (COPD). Therefore, we aimed to investigate the patient factors that are associated with the prescription of antibiotics for inappropriate indication in AECOPD. Material and methods This study was an observational cross-sectional study conducted in an outpatient clinic. The patients diagnosed with AECOPD and prescribed an antibiotic by a pulmonary physician were enrolled in the study. These prescriptions were documented by the pharmacist who asked the patient about the three cardinal symptoms. Appropriate and inappropriate prescription groups were defined by the types of exacerbations, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD report. Results There were 138 patients, predominantly male (83%), with a mean age of 64 (±9) years. A total of 64% of the prescriptions were appropriate; however, there were 50 (36%) patients with inappropriate antibiotic prescription according to the mentioned criteria. When we compared the patient factors between the appropriate and inappropriate antibiotic prescriptions, there was no statistically significant difference in terms of age, Forced expiratory volume in first second % (FEV1%) predicted, FEV1 ml, forced vital capacity (FVC) ml, FEV1/FVC, and amount (packs/year) of smoking (p>0.05 for all parameters). FVC% was statistically significantly lower in the appropriate antibiotic prescription group compared with that in the inappropriate antibiotic prescription group (p=0.049). Conclusion This study shows that most pulmonary physicians have a tendency to prescribe antibiotics for AECOPD according to the defined GOLD criteria. However, some of the physicians also prefer to prescribe antibiotics self-directedly, irrespective of the GOLD criteria. A physician-based questionnaire can be completed for future studies to define the underlying reasons for antibiotic prescription demands for cases of mild AECOPD.

Objective Pulmonary embolism (PE) is a serious pathology with high rates of morbidity and mortality. Studies regarding the efficacy of new inflammatory markers as a predictor of mortality in PE have thus far been limited. This study aimed to evaluate the predictive value of platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), platelet/mean platelet volume (PLT/MPV), and C-reactive protein (CRP) on short-term and long-term mortality in patients with PE. Material and methods A retrospective, observational cohort study was carried out in a tertiary teaching hospital. Patients with PE hospitalized in the pulmonology ward were enrolled. Their characteristics, hemogram parameters, PLR, NLR, CRP levels, PLT/MPV on admission, and mortality were recorded. The predictive accuracies of inflammatory markers were determined through receiver operating characteristic curves. The risk factors for mortality were further analyzed with Cox regression analysis. Results A total of 828 patients with PE were included in the study. The 1-month mortality was 1%, and the 1-year mortality was 8.5%. An NLR value above 6 was associated with an almost 13-fold increase in short-term (30-day) mortality. We found that an NLR above 3.15 and age were independent risk factors for long-term (1-year) mortality. The other inflammatory markers, namely PLR and CRP, were not found to be associated with long-term mortality. Conclusion PE is a serious condition in the elderly. Elevated NLR values appear to be a good and feasible predictor of inflammation, which can be correlated with higher mortality over both the short-term and long-term periods.

Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysis was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279–2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454–0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142–23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046–5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216–0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037–0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Hilal Altinoz,1 Nalan Adiguzel,2 Cuneyt Salturk,2 Gokay Gungor,2 Ozlem Mocin,2 Huriye Berk Takir,2 Feyza Kargin,2 Merih Balci,2 Oner Dikensoy,1 Zuhal Karakurt2 1Pulmonary Division, Acibadem University School of Medicine, 2Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey Abstract: Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD), but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV) had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI). The first group consisted of subjects with BMI between 20 and 30kg/m2, and the second group consisted of subjects with BMI >30kg/m2. Data obtained at the first month’s visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT), and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30kg/m2, while 80 subjects had BMI >30kg/m2. The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects (P=0.67). Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such patients was found to be related to a better survival. Keywords: chronic respiratory failure, survival, body mass index, mortality, therapy

Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries. info:eu-repo/semantics/publishedVersion

Emine Aksoy, Zuhal Karakurt, Sinem Gungor, Birsen Ocakli, Ä°pek Ozmen, Elif Yildirim, Eylem Tuncay, Meltem Coban Agca, Nezihe Ciftaslan Goksenoglu, Nalan Adigüzel Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey Background: Complete blood count parameters provide novel inflammatory markers, namely neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). We aimed to assess any differences in these novel inflammatory markers according to exacerbation severity in patients with COPD in both eosinophilic and neutrophilic endotypes. Method: This retrospective cross-sectional study was conducted at a tertiary education hospital. Previously diagnosed COPD patients admitted to the hospital with acute COPD exacerbation (AECOPD) were enrolled into the study. Patients were grouped according to COPD endotype, eosinophilic (peripheral blood eosinophil rate ≥2%) and neutrophilic (peripheral blood eosinophil rate

Background/aim: Cancer patients frequently need intensive care support due to respiratory failure. We aimed to evaluate the predictors of mortality in cancer patients who were admitted to the intensive care unit (ICU). Materials and methods: This study was performed in the ICUs of two centers between 1 January 2008 and 31 December 2015. Demographic data, cancer type, causes of respiratory failure, comorbidities, APACHE II scores, treatments, and mortality rates were recorded. Results: A total number of 583 cancer patients (477 males) were enrolled from the two centers. Of those, 472 patients had lung cancer (81%), while 111 had extrapulmonary malignancies (19%), having similar mortality rates. Causes of respiratory failure were mostly invasion of the cancer itself in 84% of cases and due to infection in 12%. ICU mortality rate was 53% and the 1-year mortality rate was 80%. APACHE II scores were significantly higher in nonsurvivors (P < 0.001). One-year survival was found to be significantly shorter in females than males (9 days vs. 12 days) in patients with lung cancer. Conclusion: Mortality rates of cancer patients who need ICU support are higher than overall ICU mortality. High APACHE II scores and female sex seem to be related to mortality in these patients.

INTRODUCTION An increased risk of cardiovascular complications has been defined in community-acquired pneumonia (CAP), but limited data is available for patients with severe CAP. OBJECTIVE The aim of the present study was to define the prevalence, characteristics, risk factors and impact on mortality of acute cardiac events in patients with severe CAP during short and long term. METHOD This investigation was a multicenter, retrospective cohort sudy of patients with severe CAP. Cardiac events were defined as cardiac arrhytmia, congestive heart failure and myocardial infarction. A logistic regression analysis was performed to identify predictors for acute cardiac events and mortality. RESULTS Of 373 patients (mean age 68 ± 16, 61.4% male), 56 (15%) developed a cardiac event (43 arrhythmia, 11 congestive heart failure and 2 myocardial infarction). Patients who developed an acute cardiac event were older, had more severe disease, pleural effusion, hypoalbuminemia, hyponatremia and more acidosis. Also, beta-blocker and diuretic use were more significant in these patients. In-hospital mortality was significantly higher in patients who developed cardiac events (29.6% vs 11%, P