Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use at home for chronic respiratory failure [Türkiye'de kronik solunum yetmezliğinde evde noninvaziv mekanik ventilasyon kullanımına göğüs hastalıkları doktorlarının yaklaşımı]

PubMedID: 27266279Introduction: To define approach of pulmonologists in Turkey to noninvasive mechanical ventilation (NIV) use for chronic respiratory failure (CRF), the most currently applied technique for home mechanical ventilation. Patients and Methods: A 38-question survey, developed and tested by the authors, was distributed throughout Turkey to 2205 pulmonologists by e-mail. Results: Twenty-seven percent of the pulmonologists responded (n=596). Domiciliary NIV was reported to be prescribed by 340 physicians [57.1% of all responders and 81% of pulmonologists practicing NIV at clinical practice (n= 420)]. NIV prescription was associated with physician’s title, type of hospital, duration of medical license, total number of patients treated with NIV during residency and current number of patients treated with NIV per week (p< 0.05). Main estimated indications were listed as chronic obstructive pulmonary disease (median, 25-75 percentile of the prescriptions: 75%, 60-85), obesity hypoventilation syndrome (10%, 2-15), overlap syndrome (10%, 0-20) and restrictive lung disease (5%, 2-10). For utilization of NIV at home, Bilevel positive airway pressure-spontaneous mode (40%, 0-80) and oronasal mask (90%, 60-100) were stated as the most frequently recommended mode and interface, respectively. Pressure settings were most often titrated based on arterial blood gas findings (79.2%). Humidifier was stated not to be prescribed by approximately half of the physicians recommending domicilliary NIV, and the main reason for this (59.2%) was being un-refundable by social security foundation. Conclusion: There is a wide variation in Turkey for prescription of NIV, which is supposed to improve clinical course of patients with CRF. Further studies are required to determine the possible causes of these differences, frequency of use and patient outcomes in this setting. © 2016, Ankara University. All rights reserved

Bina İçi Yönlendirme Sistemlerinde Kullanılan En Kısa Yol Algoritmalarının Afet ve Acil Durum Yönetimi Açısından Değerlendirilmesi

Mimari açıdan karmaşık ve içinde fazla sayıda insanın bulunacağı şekilde tasarlanan ofis veya eğitim binaları gibi yapılarda, herhangi bir doğal afette ve/veya acil durumda büyük ölçekte can kayıpları ve yaralanmalar yaşanabilmektedir. Ayrıca, bir afet/acil durum sonrasında değişen bina koşulları ardışık afetleri ve/veya tehlikeleri (örneğin deprem sonrası çıkan yangınlar) tetikleyebilmektedir. Etkin bir bina içi yönlendirme sistemi, afetlerde/acil durumlarda yaşanan problemleri en aza indirgeyerek can kayıplarını azaltmada kritik bir öneme sahiptir. Bina içi yönlendirmede amaç, bina içersinde bulunan kişilerin, afetlerden/acil durumlardan ve tetiklenebilecek ardışık tehlikelerden en az etkilenecek şekilde en kısa yoldan güvenli bölgelere yönlendirilmeleridir. Bu amaçla bina içi yönlendirme sistemlerinde en kısa yol (EKY) algoritmaları kullanılmaktadır. Literatürde, araştırmacıların yönlendirme sistemlerini oluştururken hangi EKY algoritmasını tercih etmeleri gerektiği yönünde bir boşluk bulunmaktadır. Bu çalışma bulgularının, bina içi yönlendirme sistemi geliştirme çalışmalarında en uygun algoritmanın seçimine kılavuzluk etmesi hedeflenmektedir. Literatürdeki bina içi yönlendirme çalışmaları araştırılarak en sık kullanılan EKY algoritmalarının afet sonrası oluşan yeni yapı koşullarında kısa yol belirlemedeki performansları incelenmiştir. Yönlendirme sistemlerinde kullanılacak olan EKY algoritmalarının sağlamaları gereken özellikler belirlenen altı adet ölçüt ışığında afet/acil durum yönetimi bakış açısıyla kıyaslaması yapılmıştır. Ayrıca, afetlerde/acil durumlarda kullanılabilecek bina içi yönlendirme sistemlerinden beklenenleri en uygun şekilde sağlayan EKY algoritması üzerine tartışma ve öneriler sunulmuştur

NMR and enzymatic catalysis in organic media

The NMR tube is the reactor itself containing enzyme suspended in pure liquid substrates. On-line monitoring of differents species evolution as a function of time is carried out. Various forms of water are identified suggesting partition phenomena. Time course of the reaction and water activity evolution are determined simultaneously

High-flow nasal cannula versus non-invasive ventilation for acute hypercapnic respiratory failure in adults: a systematic review and meta-analysis of randomized trials

Background: Non-invasive ventilation (NIV) with bi-level positive pressure ventilation is a first-line intervention for selected patients with acute hypercapnic respiratory failure. Compared to conventional oxygen therapy, NIV may reduce endotracheal intubation, death, and intensive care unit length of stay (LOS), but its use is often limited by patient tolerance and treatment failure. High-flow nasal cannula (HFNC) is a potential alternative treatment in this patient population and may be better tolerated. Research question: For patients presenting with acute hypercapnic respiratory failure, is HFNC an effective alternative to NIV in reducing the need for intubation? Methods: We searched EMBASE, MEDLINE, and the Cochrane library from database inception through to October 2021 for randomized clinical trials (RCT) of adults with acute hypercapnic respiratory failure assigned to receive HFNC or NIV. The Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias. We calculated pooled relative risks (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with corresponding 95% confidence intervals (CI) using a random-effects model. Results: We included eight RCTs (n = 528) in the final analysis. The use of HFNC compared to NIV did not reduce the risk of our primary outcome of mortality (RR 0.86, 95% CI 0.48-1.56, low certainty), or our secondary outcomes including endotracheal intubation (RR 0.80, 95% CI 0.46-1.39, low certainty), or hospital LOS (MD - 0.82 days, 95% CI - 1.83-0.20, high certainty). There was no difference in change in partial pressure of carbon dioxide between groups (MD - 1.87 mmHg, 95% CI - 5.34-1.60, moderate certainty). Interpretation: The current body of evidence is limited in determining whether HFNC may be either superior, inferior, or equivalent to NIV for patients with acute hypercapnic respiratory failure given imprecision and study heterogeneity. Further studies are needed to better understand the effect of HFNC on this population

Pneumonia severity indices predict prognosis in coronavirus disease-2019.

Background. - Early recognition of the severe illness is critical in coronavirus disease-19 (COVID-19) to provide best care and optimize the use of limited resources

Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use at home for chronic respiratory failure [Türkiye'de kronik solunum yetmezliğinde evde noninvaziv mekanik ventilasyon kullanımına göğüs hastalıkları doktorlarının yaklaşımı]

PubMed ID: 27266279Introduction: To define approach of pulmonologists in Turkey to noninvasive mechanical ventilation (NIV) use for chronic respiratory failure (CRF), the most currently applied technique for home mechanical ventilation. Patients and Methods: A 38-question survey, developed and tested by the authors, was distributed throughout Turkey to 2205 pulmonologists by e-mail. Results: Twenty-seven percent of the pulmonologists responded (n=596). Domiciliary NIV was reported to be prescribed by 340 physicians [57.1% of all responders and 81% of pulmonologists practicing NIV at clinical practice (n= 420)]. NIV prescription was associated with physician’s title, type of hospital, duration of medical license, total number of patients treated with NIV during residency and current number of patients treated with NIV per week (p< 0.05). Main estimated indications were listed as chronic obstructive pulmonary disease (median, 25-75 percentile of the prescriptions: 75%, 60-85), obesity hypoventilation syndrome (10%, 2-15), overlap syndrome (10%, 0-20) and restrictive lung disease (5%, 2-10). For utilization of NIV at home, Bilevel positive airway pressure-spontaneous mode (40%, 0-80) and oronasal mask (90%, 60-100) were stated as the most frequently recommended mode and interface, respectively. Pressure settings were most often titrated based on arterial blood gas findings (79.2%). Humidifier was stated not to be prescribed by approximately half of the physicians recommending domicilliary NIV, and the main reason for this (59.2%) was being un-refundable by social security foundation. Conclusion: There is a wide variation in Turkey for prescription of NIV, which is supposed to improve clinical course of patients with CRF. Further studies are required to determine the possible causes of these differences, frequency of use and patient outcomes in this setting. © 2016, Ankara University. All rights reserved