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

Mortalitesi Üzerine Etkisi The Effect of Protocol Guided Therapy to Severe Sepsis Mortality

Aim: The aim of our study was to investigate the effect of protocol-based therapy to the severe sepsis patients and to investigate the accordance with this protocol. Patients and Methods: According to the evidence based guideline therapy, ‘Severe Sepsis Treatment Protocol’ was evaluated in order to lead the therapy of severe sepsis and septic shock patients. Before starting to our study, all the intensive care stuffs were informed about the diagnostic criteria for sepsis and severe sepsis (Appendix 1). One hundred and forty eight severe sepsis and septic shock patients that underwent therapy between 2003-2004 at Sadi Sun Intensive Care Unit were investigated retrospectively to create our Retrospective Group (RG). The study group was performed on 62 severe sepsis patients, that had underwent ‘Severe Sepsis Treatment Protocol’ based therapy at the same intensive care unit, between June 2005- June 2006 named as Prospective Group (PG). The mortality rate was compared between two groups. The treatment compliances at the first 6 hours and 24 hours has been evaluated in group PG. Results: Mortality rate was lower in PG, but this difference was not statistically significant (p>0.204). The accordance to the protocol of the first 6 hour therapy bundle and the 24 hour therapy bundle was found %84.46 and %59.54 respectively. Conclusion: Our study shows that, protocol-based therapy decreases the mortality in severe sepsis and septic shock patients. (Journal of the Turkish Society Intensive Care 2011; 9: 90-8

Enteral Nutrition Target of Critical Patients in The Intensive Care Unit

Amaç: Beslenme desteği, yoğun bakım ünitesindeki (YBÜ) hastaların tedavisinin önemli bir parçası olup enteral beslenme ilk tercih edilen yoldur. Bu çalışmada, yoğun bakım ünitemize başvuran hastalar için beslenme desteği başlama zamanı, beslenme hedefine ulaşma düzeyi, bunun sürdürülebilirliği ve hedefe ulaşmada karşılaşılan nedenlerin araştırılması planlandı.Çalışma planı: Çalışmaya Acil Yoğun Bakım Ünitesinde 01.01.2017 ve 31.12.2018 tarihleri ​​arasında takip edilen 18-90 yaş arası yetişkin hastalar dahil edildi ve çalışma retrospektif olarak planlandı. Hastaların demografik özellikleri, beslenme desteği başlama zamanı, hedefe ulaşma zamanı, enteral beslenme sırasında karşılaşılan beslenmeyi durdurma nedenleri değerlendirildi.Bulgular: 152 hasta analiz edildi ve enteral beslenen 49 hasta araştırıldı. Hastalarda enteral beslenme desteği nazogastrik tüp (% 93) ve perkütan endoskopik gastrostomi (PEG) (% 7) ile sağlandı. Enteral beslenmeye başlama süresi ortalama 10.3 (± 8.6) saat olarak bulundu. Hedefe ulaşmak için ortalama süre, hastaların %96'sında 14,1 (± 5,9) saat olarak gözlendi. 2 hastada, kusma ve aşırı gastrik rezidü volüm nedeniyle hedef doza ulaşılamadı. Otuz (% 61) hastada beslenme sırasında problem yaşandı ve enteral beslenme kesintiye uğradı.Sonuç: 48 saatten fazla yoğun bakımda yatan kritik hastalar yetersiz beslenme için risk altında sayılmalıdır. Yoğun bakıma yatan hastalarda, ağızdan alım yoksa 48 saat içinde enteral beslenmeye başlanılması önerilir (erken enteral beslenme). Anahtar Sözcükler: erken enteral beslenme, beslenme hedefi, malnütrisyo

Comparison of the effects of standard and diabetes-specific dietary products on tight blood glucose control in critically lll patients

Amaç: Beslenme desteği, yoğun bakım tedavisinin bir parçasıdır. Çalışmamızda hiperglisemikkritik yoğun bakım hastalarında diyabete özgü enteral ürün ile standart enteral ürünün sıkı kan şekerikontrolü ve insülin ihtiyacı üzerine etkilerini araştırdık.Gereç ve Yöntem: Çalışma prospektif, randomize, “cross over” karşılaştırmalı çalışma olarakplanlandı. Enteral ürün alımını tolere eden hastalarda günlük alması gereken kalori gereksinimleri25 kcal x vücut ağırlığı olarak hesaplandı. Kalori gereksinimleri 21 saate bölünerek saatlik kaloriihtiyaçları ve beslenme ürünü volümü hesaplandı. Seksen hasta 2 gruba ayrılarak 1. gruba ilk 24saatte ISOSOURCE® Standart, 2. gruba ise Novasource® Diabet verildi. İkinci 24 saatte 1. grubaNovasource® Diabet, 2. gruba ise ISOSOURCE® Standart verildi. Kan şekeri düzeyini 80-150 mg/dL düzeyinde tutacak şekilde intravenöz yoldan insülin infüzyonu verildi. Dört saatte bir kan şekeridüzeyi arter kan gazı alınarak ölçüldü.Bulgular: Çalışmamızda en yüksek, en düşük, ortalama ve medyan kan glukoz değerleri ile toplaminsülin, ortalama insülin düzeyleri ve insülin doz değişiklik sayısı kaydedildi. En yüksek, en düşükve ortalama kan glukoz değerleri açısından her iki ürün arasında anlamlı bir fark bulunmadı. Her ikigrupta medyan kan glukoz düzeyleri karşılaştırıldığında sayısal olarak anlamlı görülse de istatistikselolarak anlamlı bir fark bulunamadı.Sonuç: Diyabetik olmayan kritik hastalarda diyabete özgü ürünün sıkı kan şekeri kontrolünde çok büyük bir katkısı olmadığı sonucuna varıldı.Objective: Nutritional support is a part of intensive care unit therapy. In our study, we investigated the effects of diabetes-specific enteral formula and standard enteral formula on tight blood glucose control and insulin requirement in hyperglycemic intensive care unit patients.Materials and Methods: The study was planned as a prospective, randomized, crossover comparative study. The daily caloric requirements for patients who tolerated enteral product intake were calculated as 25 kcal x body weight. Calorie requirements were divided into 21 hours and hourly calorie needs and nutrient volume were calculated. Eighty patients were divided into two groups. First group received ISOSOURCE (R) Standard and second group received Novasource (R) Diabetes in the first 24 hours. In the second 24 hours, group 1 received Novasource (R) Diabetes, while Group 2 received Isosource (R) Standard. An intravenous insulin infusion was given to maintain the blood glucose level at 80-150 mg/dL. Blood glucose level was measured every 4 hours by taking arterial blood gas. Maximum, minimum, mean and median blood glucose levels, total insulin, mean insulin levels and the number of insulin dose changes were recorded.Results: No statistically significant difference was observed between two groups in terms of maximum, minimum and mean blood glucose levels. When compared, median blood glucose levels were numerically significant, but were not statistically significant in both groups.Conclusion: It was concluded that diabetes-specific enteral formula did not contribute significantly to tight blood glucose control in non-diabetic critical patients

Comparison of Active and Passive Humidifiers on Mechanical Ventilation

Objective: To research the effectiveness on humidifying, respiratory mechanics, bacterial colonization and infection rates of continuous usage for 96 hours of active and passive humidifiers which are used for heating and moisturizing the inspired gases in patients under mechanical ventilation. Materials and Methods: Adult patients who are expected to support at least 4 days under mechanical ventilation, excluding patients with primary lung disease and sepsis, are included in the research. Patients are separated in two groups as a passive humidifier group (heat moisture exchange filter) (n=16) and an active humidifier group (n=14). In passive humidifier group, humidifier is used continuously for 96 hours without change. In active humidifier group moisturizing is obtained by using sterile distilled water in heated humidifier. Patients whose demographic characteristics were recorded and first 24 hour APACHE II scores were calculated, were taking chest X-Ray’s daily. Respiratory mechanics measurements were recorded twice a day which were watched in Servo300A ventilators respiratory mechanics monitor, in patients under volume controlled ventilation. The amount of moisture and liquidity of the secretion in endotracheal tube were recorded and scored visually. The endotracheal aspiration samples at the beginning and at the end of 96th hour and respiratory circuits ventilator side sample taken at 96th hour were studied microbiologically. Cultures and colonial counts were studied at Cerrahpasa Medical Faculty Microbiology Laboratory. Results: There were no significant difference in two groups by demographic data, APACHE II scores and illness diagnoses. In passive humidifier group, respiratory mechanics showed no significant difference between the beginning and the 4th day (p>0.05). In active humidifier group when MAP, PEEPtot, EEF, Rins, Rexp values showed no significant difference between the beginning and the 4th day but PIP values showed significant differences between 3rd and 4th day, dynamic compliance value showed significant differences between first and 3rd – 4th day and first-4. day (p>0.05). Each two groups showed no difference in moisturizing and secretion density (p>0.05).There was no endotracheal occlusion in any patients. There were no significant differences in bacteriological studies of endotracheal aspirate and circuit samples taken from patients in both groups. Conclusion: Our findings showed that passive humidifiers used for 96 hours without changed, do not loose their effectiveness and do not increase airway resistance and end-expiratory flow and do not cause bacterial colonization. (Journal of the Turkish Society of Intensive Care 2010; 8: 54-60