Yoğun Bakımdaki Kritik Hastalarda Akut Böbrek Hasarında Renal Replasman Tedavisi Kararı ve Zamanlaması

Yoğun bakım ünitelerinde YBÜ takip edilen kritik hastalarda gelişen akut böbrek hasarı ABH önemli bir morbidite ve mortalite nedenidir. Bu hastalarda yapılan renal replasman tedavilerinin RRT başlatılmasında hangi kriterlerin kullanılacağı ve tedavinin ne zaman başlatılacağı soruları net olarak cevaplanmış değildir. Bu derlemede YBÜ’de RRT başlangıcını belirleyen faktörler incelendi. Ayrıca hastaların üre-kreatinin seviyeleri, idrar çıkışı-sıvı yükü, YBÜ yatışı ile RRT başlangıcı arasında geçen süre, prognostik faktörler ve bazı belirteçlere göre başlatılan erken ve geç RRT çalışmaları incelendi. Sonuçta YBÜ’de kritik hastalarda RRT başlangıcını belirleyen kriterler ve bu kriterlerin eşik değerlerinin kişiselleştirilmesi gerektiği düşünüld

Mortality Risk Factors of Acinetobacter baumannii Infections in a Medical Intensive Care Unit: A 2-Year Survey

Introduction: Acinetobacter baumannii is considered to be a nosocomial pathogen gradually becoming more important around the world and in Turkey, particularly for patients in intensive care units (ICUs). In this study, we endeavored to overview the general characteristics of the inpatients who were treated in our ICU and diagnosed with A. baumannii infection, and particularly to determine risk factors of patients with mortal A. baumannii infection. Materials and Methods: This retrospective study was conducted in the nine-bed medical ICU of a 900-bed tertiary university hospital and was designed to include a two-year period (April 2007-April 2009). Characteristics of the patients before their admission to ICU and during their stay were examined, and factors related to A. baumannii infection together with factors affecting mortality were determined. Results: One hundred and twenty-nine patients were included in the study. Mean age of the patients was 63.05 (± 17.28) years, and 59.7% of the patients were males. The majority of the patients were admitted to the ICU from both emergency service and internal medicine clinics due to respiratory failure or sepsis. Forty-seven point three percent of patients (47.3%) were immunosuppressive. One hundred and sixty-three A. baumannii isolates were identified in 129 patients. A. baumannii was mostly isolated from tracheal aspirate cultures (70.5%) followed by bloodstream or central catheter cultures (16%). On average, 89% of isolates were resistant to ciprofloxacin and 94.5% to imipenem. Seventy-three percent of patients (n= 108) were diagnosed as pneumonia or ventilator-associated pneumonia (VAP), 15% (n= 22) as bloodstream infection, 8.7% (n= 13) as skin/soft tissue infection, and 3.3% (n= 5) as urinary tract infection. Ninety-eight patients (76%) who were infected by A. baumannii died. Factors affecting mortality according to univariate analysis were listed roughly in terms of Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, length of hospital stay before ICU, the clinic from which the patient was transferred to the ICU, applied invasive procedures (mechanical ventilation, catheters, dialysis, etc.), complications in the ICU, and antibiotics used previously. According to multivariate analysis, the most significant risk factors for mortality were application of invasive mechanical ventilation, sepsis in the ICU and admission from internal medicine clinics. Conclusion: Resistant A. baumannii infections are among the major medical challenges worldwide, in Turkey, and in our ICU. The mortality rate is high, and different risk factors affect the mortality rate in A. baumannii infections. According to our study, application of invasive mechanical ventilation, sepsis in the ICU and admission from internal medicine clinics were the major risk factors for mortality in our A. baumannii-infected ICU patients

Submassive pulmonary thromboembolism as a first sign of occult adenocarcinoma

Venous thromboembolism is one of the most common complications of cancer, which also contributes to mortality in cancer patients. Venous thromboembolism can be observed as the first manifestation of occult cancer. We present the case of a 54-year-old woman with deep vein thromboembolism and pulmonary embolism as the first signs of cancer, who was subsequently diagnosed with disseminated adenocarcinoma, most likely originated from the pancreatico-biliary system

The role of maximum compressed thickness of the quadriceps femoris muscle measured by ultrasonography in assessing nutritional risk in critically-ill patients with different volume statuses.

In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status

Cyclospora cayetanensis in Two Immunocompetent Patients in Istanbul

Cyclospora cayetanensis is a frequently reported microorganism which causes diarrhea in both immunocompromised and immunocompetent patients. Despite new information on this emerging pathogen, significant gaps remain in our knowledge. There is a need to accurately diagnose and get information because the coccidian parasites are nearly never diagnosed, even upon the clinician’s request. Two immunocompetent patients with Cyclospora cayetanensis infections were presented and literatur was reviewed in this manuscript

Catheter Associated Urinary Tract Infection: Is It Possible to Prevent?

Introduction: Catheter associated urinary tract infections (CAUTI) is the most common infections, and Candida spp. is the most common pathogen in this infection in our medical intensive care unit (ICU). In this paper, we aimed to present the prevention efforts and results of these efforts for CAUTI in our medical ICU. Materials and Methods: The results of invasive device related infection surveillance in our medical ICU between August 01, 2010 and July 31, 2011 were evaluated retrospectively. Since CAUTI were the most common infection, routine practices of procedures in the unit were checked and faults were detected by our hospital infection control committee practitioners. After the training of ICU staff for the prevention of CAUTI, a package of some measures and interventions (CAUTI prevention bundle) were set in the ICU. After having trained and set the prevention bundle, six-months active prospective infection surveillance was conducted and incidence of CAUTI was recalculated. Results: Between August 01, 2010 and July 31, 2011, 47 CAUTI cases occurred in 39 patients. The incidence density of CAUTI was calculated as 16.9 per 1000 catheter days. The most common etiological agents (n= 56) were Candida spp. (n= 32, 57%), enterococci (n= 8, 14%), Klebsiella spp. (n= 5, 9%), and Pseudomonas spp. (n= 5, 9%), respectively. In July 2011, staff training and a new prevention package were set. Between August 01, 2011 and January 31, 2012, active prospective infection surveillance was conducted. In this period, urinary catheter utilization ratio was reduced to 0.79 from 0.86, and 19 CAUTI were detected in 16 patients. The incidence density of CAUTI was calculated as 13.9 per 1000 catheter days. After the prevention bundle, no Candida spp. -related UTI was detected in the ICU. The isolated microorganisms from CAUTI (n= 20) were Klebsiella spp. (n= 5, 25%), enterococci (n= 5, 25%), Pseudomonas spp. (n= 4, 20%) and Escherichia coli (n= 3, 15%), respectivelyv. Conclusion: Staff training and application of a prevention bundle in the ICU resulted in a decrease in urinary catheter utilization ratios and CAUTI incidence. Candida spp. was also not detected in CAUTI in this period. We didn’t understand why only this prevention bundle was effective to prevent Candida spp. related UTI

Yoğun Bakım Hastalarında Eritrosit Transfüzyonunun Mortalite Üzerine Etkisi

Amaç: Yoğun bakım hastalarında kısıtlı eritrosit transfüzyon (ET) stratejisinin mortaliteyi azalttığını gösteren bir çok çalışma vardır. Biz de yoğunbakım ünitemizde (YBÜ) yapılan ET’lerin genel özelliklerini, nedenlerini,morbidite ve mortalite üzerine etkilerini incelemeyi amaçladık.Gereç ve Yöntemler: Haziran 2012-Temmuz 2013 tarihleri arasında İçHastalıkları YBÜ’de yatan hastaların dosyaları retrospektif olarak incelendi. Yoğun bakımda 24 saatten fazla yatan hastalar çalışmaya dahiledilirken; akut koroner sendromu olan hastalar, gebeler, yatışta aktif GISvb. kanaması olan hastalar ve YBÜ’ye yatış öncesi son bir hafta içindeET alan hastalar çalışma dışı bırakıldı. Hastaların demografik özellikleri,yatış GKS, APACHE II, SOFA, RIFLE skorları, ek hastalıkları, yatış tanıları,yatış anındaki sepsis varlığı, ET sayısı, transfüzyonun yapıldığı hemoglobin düzeyi, transfüzyon yapılma nedeni kaydedildi. Hastalar ET yapılanve yapılmayan olarak iki gruba ayrıldı. Gruplar özellikleri ve yoğunbakımdaki morbiditeler ve mortalite açısından karşılaştırıldı.Bulgular: Çalışmaya alınan 77 hastanın %65’i (50) erkek; median yaş 63[54,5-74] idi. Yirmi dokuz (%37,6) hastaya ET yapılırken 48 hastaya yapılmadı. Her iki grup demografik özellikler, yatışta hastalık ağırlık ve organyetmezlik skorları açısından ve altta yatan hastalıkları açısından benzerdi. Eritrosit transfüzyonu yapılan grupta yatış sebebi olarak sepsis/ septikşokun daha fazla olduğu görüldü (%75,9 vs %43,8; p=0,009) ve bu gruptasepsis süresinin daha uzun olduğu tespit edildi (3 [2-4,5] gün vs 1 [0-2]gün; p=0,0001). Eritrosit transfüzyonu yapılan hastaların bazal hemoglobin seviyesi 6,7 [6,2-7,4] idi. En sık hemoglobin seviyesinin düşük olmasınedeniyle (%75,8) ve perfüzyonu artırmak (%48,3) amacıyla ET yapıldığıtespit edildi. Eritrosit transfüzyonu yapılan grupta YBÜ’de sepsis(p=0,0001) ve fungal ajanlarla sepsis geliştirme (p=0,016) sıklığı, mekanikventilasyon uygulama sıklığı (p=0,004), mekanik ventilasyonda kalmasüresi (p=0,001) ve diğer kan ürünlerinin kullanılma oranı (p=0,01) transfüzyon yapılmayan gruba göre daha fazlaydı. Eritrosit transfüzyonuyapılan grupta hastanede kalış süresi anlamlı olarak daha uzundu (27gün vs 6,5 gün, p=0,008). Eritrosit tranfüzyonu yapılan grupta mortaliteanlamlı olarak daha yüksekti (%62 vs %25; p=0,002).Sonuç: YBÜ’mizde eritrosit transfüzyonu yapılan hastalarda mortalitenindaha yüksek olduğu görüldü. Bu çalışmanın sonuçlarının doğrulanmasıiçin daha fazla sayıda hastanın dahil edildiği, çok merkezli ve prospektifçalışmalara ihtiyaç olduğu sonucuna varıldı.</p