A Current Overview of Intensive Care Subspeciality Education in Turkey: What Do Educational Staff, Subspecialty Residents and Specialists Think?

Objective: Intensive care subspecialty programs have been opened in many medical faculties and training-research hospitals in our country, and intensivists who have graduated are working in the field. The aim of this study aimed to collect information about the status of intensive care subspecialty education and the working conditions of intensive care specialists working in the field. Materials and Methods: After obtaining the ethics committee approval, three questionnaires for intensive care subspecialty educational staff (ES), research assistants (RA), and graduated specialists (PG) were prepared through the Google Survey and published on social media. In the questionnaires, the status of education and working conditions in the field after graduation were questioned. The descriptive statistics method was used for analysis. Results: The questionnaires were answered by 38 ES, 99 RA, and 46 PG. Fifty-four percent of the ES were between the ages of 51 and 60 and 65.8% were women. Fifty-one percent of ES were working in a university hospital. Forty-seven percent of full-time ES were working in the department of anesthesiology and reanimation subdepartment of intensive care, and the rate of participation of all partner clinics in the program was 86.5%. Twenty-seven (71.1%) of the ES thought that the TUKMOS core training program should be changed. The main specialty of 54.5% of RAs were anesthesiology and reanimation, and 52% of them were studying at a state university. The rate of those who were on duty at the hospital was 87.8%, and the rate of those who described the rotation training as “medium” was 36.5%. Sixty-five percent of the PGs were anesthesiology and reanimation specialists, and 64.4% said that they would like to primarily work in training and research hospitals in terms of efficiency and qualit; 87% of them stated that intensive care specialists should be able to work in any kind of intensive care unit, 69.6% thinks that the education they receive is sufficient. Conclusion: We believe that evaluating and sharing the data of this study may cause positive changes in intensive care subspecialty education and post-graduate working conditions

Sepsisli Hastalarda Transfüzyonu Belirlemede Şok İndekslerinin Rolü

Amaç: Şok indeksleri özellikle hemorajik şok durumunda transfüzyonu ön görmede kullanılmaktadır. Ancak sepsis hastalarında transfüzyonu belirlemek için şok indekslerinin kullanımı konusunda yeterli çalışma yoktur. Çalışmamızda Yoğun bakım ünitesine (YBÜ) yatan sepsis ve septik şoktaki hastalarda şok indeksi (SI), modifiye şok indeksi (MSI) ve yaş şok indeksinin (YSI) hastaların eritrosit transfüzyonunu ön görmede kullanılabilirliğinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmamız Anesteziyoloji ve Yoğun Bakım Ünitesi Kliniğinde 1 Kasım 2017 ile 31 Aralık 2018 tarihleri arasında retrospektif hasta verileri değerlendirilerek yapıldı. Hastaların yaşları, cinsiyetleri, eşlik eden hastalıkları, akut fizyoloji ve kronik sağlık değerlendirme (APACHE II) skoru, mekanik ventilasyon süresi, yatış süresi, hemoglobulin değerleri, SI, MSI, YSI, eritrosit transfüzyon verileri kayıt edildi. Bulgular: Çalışmaya 225 hasta dahil edildi. Şok indeksi, MSI, YSI düzeyleri eritrosit transfüzyonu gerektiren hastalarda gerektirmeyen hastalara göre istatistiksel olarak anlamlı yüksekti (p<0,05). Şok indeksi için ROC (receiver operating characteristic) eğrisi altındaki alan 0,691'dir (% 95 güven aralığı (GA): 0,626 - 0,751 P = 0,0002). Transfüzyon için SI eşik değeri 0,98’dir (duyarlılık: %86,8, %95 GA: 71,9-95,5, özgüllük: %46,52, %95 GA: 39,2-53,9). MSI için ROC eğrisi altındaki alan 0,666’dır (% 95 GA: 0,601-0,728 P = 0,0012). Transfüzyon için MSI eşik değeri 1,67’dir (duyarlılık: %57,9 %95 GA: 40,8-73,7, özgüllük: %72,7, %95 GA: 65,7-79). Yaş SI için ROC eğrisi altındaki alan 0,639’'dur (% 95 GA: 0,572-0,702 P = 0,0076). Transfüzyon için YSI eşik değeri 102,85’tir (duyarlılık: %39,5, %95 GA: 21,4-56,6, özgüllük: %89,8, %95 GA: 84,6-93,8). Sonuç: Sepsis hastalarında şok indeksleri transfüzyon ihtiyacını belirlenmede kullanılabilir. Ancak şok indeksleri ile beraber ek parametrelerin kullanılması gerekmektedir

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Legal responsibilities of anesthesia and reanimation specialist: Liabilitiesi under the Turkish penal code no. 5237

Günümüzde hekimlerin sanatlarını uygularken, sadece en güncel tıbbi bilgi becerileri takip etmeleri ve edinmeleri yeterli değildir. Tıp uygulamaları nın diğer dayanakları olan tıp hukuku ve tıbbi etik de, mesleğimizin uygulanması sırasında belirleyici olmaktadır. Tıbbi uygulamalarımız sırasında hukuksal sorunlarla karşı karşıya kalınmaması için tıp biliminin genel kabul görmüş ilke ve kurallarına, anestezi ve reanimasyon alanında belirlenmiş olan standart uygulamalara uygun hareket edilmesinin yanı nda, hekimlik mesleğinin etik değerlerine uyulması ve mesleğimiz ile ilgili mevzuatın bilinmesi de önem taşımaktadır. Tüm toplumlarda, toplumu ve toplum düzenini korumak amacıyla “ceza” adı verilen yaptırım sistemleri uygulanır. Ceza; işlendiği nesnel olarak kanıtlanmış bir suçun karşı lığı olarak uygulanır. Sadece suçu işleyenlere yöneliktir. Yargısal bir kararla hükmedilir. Yasal düzenlemelerle belirlenebilir. Türkiye’de suçlar ve bunların cezaları, 1 Haziran 2005 tarihinden itibaren, 5237 numaralı yeni Türk Ceza Kanunu (TCK) ile düzenlenmektedir. 5237 numaralı TCK’nın 4. maddesi ile “kanunları bilmemenin mazeret sayılmayacağı” açık ve net olarak belirtilmiştir. Hekimler tıbbi uygulaması sı- rasında “mesleki acemilik-yetersizlik”, “dikkatsizlik”, “tedbirsizlik”, “özen eksikliği” veya “talimatlara uymamak” gibi nedenlerle hastaya zarar verebilir. Hekimler bu durumda yasal olarak “kusurlu” sayı labilirler. Dolayısıyla tüm hekimler, mesleği ile ilgili hukuksal, yasal ve cezai sorumlulukları; bu sorumluluklar dışına çıkması halinde uygulanabilecek yaptırımların neler oldu- ğunu bilmelidir. Yazımızda 5237 numaralı Yeni Türk Ceza kanununu getirdiği yükümlülükler ışığında Anesteziyoloji ve Reanimasyon uzmanının yasal sorumlulukları özetlenecektir.In our day, it is not enough for doctors to merely follow and obtain the latest medical knowledge and skills while they perform their art. Other bases of medical practice, medical law and medical ethics, are also determinants in the profession. In addition to complying with the generally accepted principles and rules of medicine and the standard implementations of anesthesia and reanimation, it is of primary importance for doctors so as not to come face to face with legal issues during medical practice to also follow the ethical values of the profession and be informed about the relevant laws. All societies is applied the sanctions system, wich called “penalty”, because of maintain order communities and society. Criminal business objective as is a proven crime shall be implemented as money. Process is aimed at crime only. A judicial decision is dominating. Law and may be determined by law Crime and punishment in Turkey is organized by the new Turkish Penal Code (TPC) number 5237, since the 1st June 2005. 4th articles in penal code of 5237 was stated “an excuse for not knowing the law is being considered”, open and clearly. Physicians may be harm the patient such as “professional ineptitude-deficiency”, “careless”, “imprudence,” or “lack of care” in their medical practice. Physicians can be considered legally “defective” in this case. Therefore, all physicians should be aware of, about the legal profession, legal and criminal responsibility and what sanctions this responsibility can be applied in case of out order. This article summarizes the legal responsibilities of Anesthesia and Reanimation experts in light of the New Turkish Penal Code No. 5237

Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy

Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery. Resumo: Ventilação não invasiva é uma modalidade de tratamento aceita tanto em exacerbações agudas de doenças respiratórias quanto em doença pulmonar obstrutiva crônica. É comumente usada em unidades de terapia intensiva ou para suporte respiratório pós-cirúrgico em salas de recuperação pós-anestesia. Este relato descreve o suporte intraoperatório em ventilação não invasiva para bloqueio do neuroeixo em cirurgia abdominal alta de emergência. Keywords: Non-invasive ventilation, Regional anesthesia, Chronic obstructive pulmonary disease, Palavras-chave: Ventilação não invasiva, Anestesia regional, Doença pulmonar obstrutiva crônic

The importance of red cell distribution width (RDW) in patient follow up in intensive care unit (ICU)

Objective: In this study we aimed to determine the effect of RDW on mortality by comparing the temporal changes in RDW level in deceased and surviving ICU patients. Materials and method: This study was retrospectively conducted in 776 patients admitted to intensive care unit between 01.01.2013 and 31.12.2013. Age, sex, clinical diagnosis, comorbid conditions, RDW levels at intensive care admission and discharge, duration of intensive care stay, and mortality rate were evaluated. Kolmogorov Smirnov, student t-test, Mann Whithey u test, and Chi-square test were used for data analysis. The results were provided at a confidence interval of 95% and a significance level of p 0.05). The deceased patients had significantly increasing RDW levels whereas the surviving patients had significantly reducing RDW levels (p < 0.05). There was a significant correlation between the magnitude of RDW increment and duration of hospital stay in the deceased patients (p < 0.05). Conclusion: The results of this study suggest that RDW, with known association with mortality, can be used as a simple marker for patient follow-up and monitorization of effectiveness of the administered therapies in ICU

Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy

Abstract Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery

Evaluation of risk factors and comorbities of the orthopedic patients treated in intensive care unit

*Karaca, Onur ( Aksaray, Yazar )Introduction: The aim of this study is to investigate the comorbidities of orthopedic patients followed up in intensive care unit and to investigate the comorbid relationship of complications requiring intensive care. Material and methods: Ankara Numune Research Hospital Intensive care patients over the age of 18 admitted from the operating room and from orthopedic service were reviewed retrospectively between January 2010-December 2014. Results: 69 males and 98 females were postoperative patients in a total of 283 patients.28% of these patients were trauma patients and 62.3% were accepted after total hip prosthesis operations.The average age of postoperatively accepted patients was 73.5 years and preoperative was 61.5 years.The mean APACHE II score was similar.21% of postoperative patients have chronic obstructive pulmonary disease (COPD),while 18% of those without surgery had COPD(p=0.024).The need of close monitoring for intensive care admission was 62% in preoperative patients and 47% in postoperative patients(p=0.014).Symptomatic electrolyte imbalance was higher in preoperativ patients(p=0.027). The rate of vasopressors required hypotension was 11% in postoperative patients and 3% in non-operated patients (p=0.021).Charlson scores of postoperative patients were higher than those without surgery (p=0.001). Conclusion: Orthopedic patients who have high risk factors and comorbidities, we think that the consultation of the relevant branches and the initiation of treatment follow-ups in the early period may be useful in preventing intensive care requirement in the preoperative period...

Akut zehirlenme olgularının geriye yönelik değerlendirmesi, Zonguldak, Türkiye

Amaç: Bu çalışmanın amacı Türkiye’nin kuzey batısında yer alan Zonguldak şehrinde Zonguldak Karaelmas Üniversite Hastanesi Acil Servisi’ne başvuran akut zehirlenme olgularını bireysel, nedensel ve klinik özelliklerine göre değerlendirmektir. Gereç ve Yöntemler: Zonguldak Karaelmas Üniversite Hastanesi Acil Servisi’ne başvuran (Mart 2003-Aralık 2006) 295 akut zehirlenme olgusu geriye yönelik değerlendirildi. Bulgular: Acil servise başvuran 4166 hastadan 295’i zehirlenme olgusu idi. Zehirlenme olgularının % 67,5’i kadındı. Yaş ortalaması 22,5±15,9 idi. Zehirlenen olguların mevsimsel dağılımında yaz mevsiminde yoğunluk olduğu gözlendi (% 29,8). İntihar amaçlı zehirlenme, olguların çoğunluğunda başlıca etiyoloji olarak gözlendi (% 59,7). Tıbbi ilaçlar zehirlenmelerin başlıca nedeni idi (% 63,7).Bunu korozivler (% 12,9), karbon monoksit (% 10,2), organofosfatlı insektisidler (% 5,8), mantar (% 3,4), alkol (% 1,36) ve fare zehiri (süpervarfarinler) (% 0,3) izledi. Olguların % 21,4’ü yalnızca sertralin ile zehirlenmişti. Zehirler başlıca gastrointestinal sistem yolu ile alınmış idi (% 87,8). Olguların % 59,7’si hastanede yatarak tedavi aldı. Hastanede ortalama yatış süresi 2,8 ± 5,0 gün idi. Yoğun bakıma alınma oranı % 58,6 idi. Mortalite oranı % 2,7 idi. Karbon monoksit en sık ölüm nedeniydi. 282 olgu sekelsiz taburcu edilirken 5 olgu sekel ile taburcu edildi. Sonuç: İntihar amaçlı ve kaza ile ortaya çıkan zehirlenmeler; etiyolojik, bireysel ve klinik farklılıklara sahiptir. Bu farklılıkların acil servis ve reanimasyon bölümlerinde çalışanların eğitiminde tartışılmasının gerektiği düşüncesindeyiz.Aim: The aim of this study was to evaluate etiological, demographical and clinical characteristics of cases with acute poisoning referred to the Emergency Medical Service (EMS) of Zonguldak Karaelmas University Hospital in Zonguldak, a City in the West Black Sea Region of Turkey. Materials and Methods: Two-hundred and ninety-five cases with acute intoxication referred to the Emergency Department of Zonguldak Karaelmas University Hospital between March 2003 and December 2006 were analyzed retrospectively. Result