Comparison of the efficacy and safety of regional citrate versus systemic heparin anticoagulation on continuous renal replacement therapy with critically ill patients: A retrospective study

Sürekli renal replasman tedavisinin (SRRT) etkinliği ekstrakorporeal devrenin sürdürülebilmesi için etkin bir antikoagülasyona bağlıdır. Çoklu organ yetmezliği olan kritik hastalarda SRRT hayat kurtarıcıdır. SRRT’de antikoagülasyon olarak kullanılan rejyonel sitrat antikoagülasyonu (RSA) ve sistemik heparin antikoagülasyonu (SHA) tercihi sitratın akümülasyonunun tehlikeleri in-vivo etkinliğinin öngörülememesi ve SHA’nın kanama komplikasyonları nedeniyle halen tartışmalıdır. Bağımsız değişkenleri en aza indirerek RSA'ya karşı SHA'nın SRRT üzerindeki etkisini ve güvenliğini değerlendirmek için yapılan bu çalışma; aynı hastaların her iki koagülasyon yönteminin farklı zamanlarda kullanıldığı ilk diyalizlerine ait parametreler karşılaştırarak gerçekleştirildi. 2018 Eylül ve 2019 Eylül ayları arasında SRRT uygulanan 102 hasta incelenmiş çeşitli nedenlerden dolayı antikoagülasyon yöntemi değiştirilen 11 hasta çalışmaya dahil edilmiştir. Çalışmamızda RSA yöntemi SRRT’de kullanıldığına SHA yöntemi kullanılmasına göre filtre ömrünün (%95 CI: [1.25-53.29]; p= 0,042) ve ultrafiltrasyon hızının (%95 CI: [9.43-64.20]; p=0,013) istatistiksel olarak anlamlı bir şekilde arttığı gözlendi. Bununla birlikte grupların başlangıç ve bitiş elektrolit, üre,kreatinin ve pH değerleri arasında anlamlı fark tespit edilmedi (p>0,05). RSA özellikle kanama komplikasyonu olabilecek SRRT yapılacak kritik hastalarda SHA yerine kullanılabilecek güvenli ve etkili antikoagülasyon yöntemidir.The efficacy of continuous renal replacement therapy (CRRT) depends on effective anticoagulation to maintain the extracorporeal circuit. CRRT is crucial in critically ill patients with multiple organ failure. The choice of regional citrate anticoagulation (RCA) and systemic unfractionated heparin anticoagulation (SHA) used as anticoagulation in CRRT is still controversial because of the citrate accumulation, the unpredictability of citrate’s in-vivo efficacy and the bleeding complications of SHA. The purpose of this study was to evaluate the effect and safety of RCA versus SHA on CRRT by minimizing the independent variables, was conducted by comparing the first dialysis of the same patients using both methods at different times. Between September 2018 and September 2019, 102 patients who underwent CRRT were examined and 11 patients whose anticoagulation method was changed due to various reasons were included in the study. The filter life time (95% CI: [1.25-53.29]; p=0,042) and ultrafiltration rate (95% CI: [9.43-64.20]; p=0,013) is statistically higher in RCA group. However no significant differences were observed via initial and final values of electrolyte, urea, creatinine and, pH in two groups (p>0,05). RCA is a safe and effective anticoagulation method that can be used especially in critically ill patients undergoing CRRT who may have bleeding complications

Hospital-Acquired Pneumonia

Key points Hospital-acquired pneumonia has a major impact in terms of mortality and morbidity. Empirical treatment approach is still the best course of action. Prevention is of critical importance. Educational aims To improve knowledge of HAP management. To better understand the epidemiological basis for the correct empirical therapy of HAP Summary HAP still has a major impact in terms of mortality and morbidity among hospitalised patients. Early appropriate antibiotic therapy is associated with a reduction in mortality and improved outcome. Although, in most cases, an empirical approach is still the rule, taking into account the risk factors, the severity of illness and length of stay before the pneumonia onset can better target antibiotic therapy. The patient9s follow-up course, in terms of microbiological, clinical and radiological monitoring, is important. Prevention strategies are of critical importance and are based on the understanding of the epidemiology and pathogenesis of HAP. Routine efforts for the prevention of HAP should be directed towards obtaining effective surveillance and infection-control programmes, including staff education, use of proper isolation techniques and infection-control practices. This review aims to increase understanding of these points to allow improved knowledge and treatment of HAP

Comparison of hemodynamic effects of atracurium and vecuronium in heart valve diseases

Çalışmamız, açık kalp cerrahisi uygulanacak ASA II-III grubuna giren 16-60 yaş arasındaki 28 olgudan oluşan iki grup üzerinde uygulandı. Premedikasyonda 0.1 mg/kg. Morfin ve 0.005 mg/kg. Skopolamin intramüsküler yoldan verildi. Her iki gruba da indüksiyonda 5 yug/kg. Fentanil, 0.3 mg/kg. Etomidat ve % 100 0^ uygulanırken, kas gevşetici olarak I. gruba 0.1 mg/kg. Vekuronyum, II. gruba 0.6 mg/kg. Atrakuryum verildi. Farklı iki kas gevşeticisinin hemodinâmik etkilerini gözlemlemek amacıyla ilaçlar verilmeden önce (indüksiyon öncesi) ve ilaçlar uygulandıktan sonra (indüksiyon sonrası), kalb hızı,, ortalama arter basıncı,. kalb debisi, kardiak indeks, ortalama pulmoner arter basıncı, pulmoner kapiller wedge basıncı, ipulmoner vasküler direnç ve sistemik vasküler direnç değerleri ölçülerek kaydedildi. Elde edilen veriler hem grup içinde hem de gruplararası olmak üzere karşılaştırılarak istatistiksel yönden değerlendirildi. İndüksiyon öncesi ve indüksiyon sonrası hemodinâmik veriler karşılaştırıldığında; Vekuronyum grubunda kalb hızı ve pulmoner vasküler direnç değerleri, Atrakuryum grubunda - 43 - ise kalb hızı, ortalama arter basıncı, kalb debisi ve kardiak indeks.değerleri istatistiksel olarak anlamlı bir azalma gösterdi (p0.05). Her iki grupta da kas gevşeticinin neden olduğu bazı hemodinamik parametre değişiklikleri klinik olarak iyi tolere. edildi ve herhangidir tedavi gerektirmedi. Ayrıca disritmi, myokard infarktüsü bulguları.ve kardiak arreste rastlanılmadı. Elde ettiğimiz veriler sonucunda; mitral stenozu ve mitral yetmezliği olgularında kalb hızı bakımından her iki ilacın birbirine, üstünlüğünün olmadığı,, ancak Vekuronyum’un özellikle . mitral stenozunda. kalb debisi ve kardiak indeksi değiştirmemesi, aort yetmezliği ve aort, stenozu olgularında ise ortalama arter-basıncında değişikliğe yol açmaması nedeniyle tercih, edilmesinin uygun olacağı kanısına varıldı

The effect of music on delirium, pain, sedation and anxiety in patients receiving mechanical ventilation in the intensive care unit

OBJECTIVES: To examine the effects of music for patients under mechanical ventilation support in the intensive care unit on their delirium, pain, sedation, and anxiety. RESEARCH METHODOLOGY/DESIGN: A single-blind, randomized, controlled trial. SETTING: The study was conducted with delirium positive patients between August 2020 and September 2021 in the medical/surgical intensive care unit of a university hospital in Turkey. METHODS: The study sample was selected through a simple and stratified randomization method; patients who met the inclusion criteria were assigned to the music, noise reduction or control group. The data were collected by using a Confusion Assessment Method for the ICU (CAM-ICU), CAM-ICU-7, Critical Care Pain Observation Tool (CPOT), Richmond Agitation-Sedation Scale (RASS), Facial Anxiety Scale (FAS), PRE-DELIRIC model, and Glasgow Coma Scale (GCS). The interventions were repeated twice a day for five days. RESULTS: A total of 36 patients were included, with 12 patients in each group. Significant decreases were found in the severity of delirium and pain and the level of sedation and anxiety in the music compared to the other groups (p \u3c 0.05). The number of patients with delirium and the number of days with mechanical ventilation was found to be significantly lower in the music group compared to the other groups (p \u3c 0.05). CONCLUSION: Music intervention may be used as a nursing intervention to control delirium, pain, need for sedation and anxiety in intensive care unit patients. However, additional studies with larger sample is needed to validate findings

Amitriptyline Cardiac Toxicity Treated with Hemoperfusion

Tricyclic antidepressant intoxication is frequently encountered among children and adults due to widespread use of the drugs. Amitriptyline is among the major tricyclic antidepressants. It affects the cardiovascular, respiratory and central nervous system. In the treatment of amitriptyline intoxication, various treatments such as gastric lavage, activated charcoal, bicarbonate infusion, antiarrhythmic, and anticonvulsant drug usage were applied. Here, we reported a patient with severe amitriptyline intoxication who did not respond to these treatments but dramatically improved with hemoperfusion. A 33 year-old woman applied to the emergency service half an hour later ingesting 2000 mg of amitriptyline as a suicide attempt. On admission, her Glasgow coma scale (GCS) was 10, blood pressure was 100/60 mmHg, heart rate was 160 beats/min. Wide QRS and ventricular tachycardia was seen in the Electrocardiography (ECG) results. Having her GCS regressed to 7, she was intubated and admitted to intensive care unit after the initial treatments. Hemoperfusion was commenced within half an hour. While hemoperfusion was continuing, her ECG was seen to turn to sinus tachycardia. Her cardiovascular and neurological status returned to normal on the 2nd day and she was discharged from the intensive care unit on the 4th day. Besides hemoperfusion is not recommended due to high protein binding and large volume of distribution in classical treatment of amitriptyline overdose, current reports representing efficacy of hemoperfusion are also accumulating. After ingestion, tricyclic antidepressants are absorbed rapidly and reach to their effective concentration in the tissues, especially by the lung, the brain and the heart. Hence, hemoperfusion performed in early stage of ingestion is an effective treatment and in cases that do not respond to conventional therapies, it should be considered that this method can be used in the early period

Evaluation of a clinical pulmonary infection score in the diagnosis of ventilator-associated pneumonia

The most important dilemma in the diagnosis of ventilator-associated pneumonia (VAP) based on only clinical findings is overdiagnosis. The aim of the study is to prospectively evaluate the Clinical Pulmonary Infection Score (CPIS) in relation to VAP diagnosis. Design. Prospective, in a cohort of mechanically ventilated patients. Setting. The intensive care unit of a university hospital. Patients. Fifty patients, on mechanical ventilation therapy for more than 48 hours, suspected of having VAP were enrolled in the study and bacteriologic confirmation was done by bronchoalveolar lavage (BAL) culture. Interventions. Bronchoscopy with BAL fluid culture after establishing a clinical suspicion of VAP in patients having no prior antibiotic therapy or no change in current antibiotic therapy within last three days before BAL. CPIS scores during diagnosis were 6±2 (3-9) (median±QR, maximum-minimum) and it was 7±2 (2-9) at the 72nd hour, in 41 cases with a diagnosis of VAP. In cases with no diagnosis of VAP, the CPIS scores were found to be 6±2 (4-8) and 5±3 (2-7), respectively. There was no significant difference between the VAP group and the non-VAP group at diagnosis, but was significant at 72nd hour (respectively, p=0.551 and p=0.025). CPIS scores during diagnosis were 6±3 (4-8) (median± QR, maximum-minimum) and 7±4 (2-8) at the 72nd hour, in 14 cases with a diagnosis of early-onset VAP. In cases with a diagnosis of late-onset VAP, the CPIS scores were found to be 6±2 (3-9) and 7±2 (3-9), respectively. There was no significant difference between the early-onset VAP group and the late-onset VAP group. In conclusion, the CPIS results should be evaluated carefully in the clinical setting during the diagnosis

Hospital Acquired Pneumonia

In this study, we present hospital acquired pneumonia cases hospitalized at Uluda¤ University School of Medicine in 1997. In the clinics covered by the surveillance system 10 983 patients were followed up, and hospital acquired pneumonia was observed in 163 (1.4%) patients. Hospital acquired pneumonia was found to be the second common cause of nosocomial infections with the rate of 23.9%. Ventilator-associated pneumonia was found in 70% of all the cases involved in the study. Hospital acquired pneumonia was seen in 9.5% of cases in ICU, whilst only 0.5% of the cases was from other clinics

Thyroid Storm in Postoperative Delirium Etiology: Case Report

Delirium is an acute organic brain syndrome of different physical and pathophysiological etiologies characterized by a disturbance in consciousness with accompanying change in cognition. Delirium causes prolonged length of stay in hospital and intensive care unit, also increased morbidity and mortality. Thyroid storm is a severe, life-threatening type of thyrotoxicosis and is one of a few endocrine disorders that cause delirium. It is mostly occured suddenly after acute infection, surgical stress or trauma. This condition occurs due to excess production of thyroid hormone and 20-50% mortality rate depends on early diagnosis and treatment. In this study it was aimed to present the diagnosis and treatment of a previously unknown hyperthyroid patient who underwent suspension laryngoscopy under general anesthesia and was post-operatively admitted to the intensive care unit because of pulmonary edema and proceeded to develop severe delirium caused by hyrotoxicosis