Barotrauma Associated with Mechanical Ventilation

Amaç: Barotravma sıklığı, koruyucu mekanik ventilasyon (MV) stratejilerinin kullanılmasıyla azalmaktadır. Bu çalışmada; kliniğimiz 3. seviye yoğun bakım ünitesi (YBÜ)'nde invaziv MV uygulanan olgularda, barotravmanın gelişme sıklığı, tedavi ve prognozunun literatür eşliğinde tartışılması amaçlanmıştır.Gereç ve Yöntemler: Çalışmaya Ocak 2008-Aralık 2014 tarihleri arasında yatan olgular dahil edilmiştir. Barotravma gelişen olgular retrospektif olarak gözden geçirilmiştir. Bulgular: Yedi yıl süresince YBÜ'de yatan 1341 olgudan 861'ine invaziv MV tedavisi uygulanmış, toplam 19 olguda (%2,2) barotravma saptanmıştır. Olguların; %73,7'si erkek olup, yaş ortalaması 63,2±18,2, ortanca APACHE II skoru 18, ortanca invaziv MV süresi 168 saat bulunmuştur. Başvuruda; olguların %57,9'unda Akut Solunum Zorluğu Sendromu (ARDS) saptanmış olup, en sık (%47,4) volüm kontrol modu kullanılmıştır. Barotravma ortanca 8. günde gelişmiş, barotravma gününde; olguların %84,2'sinde pnömoni saptanmış, en sık (%47,4) basınç destekli mod uygulanmıştır. Olguların tümünde mediasten amfizemi, 16 (%84,2)'sında pnömotoraks (3'ünde bilateral), 11 (%57,9)'inde ciltaltı amfizemi mevcuttu. Pnömotoraks gelişen olguların, 15 (%83,3)'ine tüp torakostomi ve kapalı sualtı drenajı uygulanmıştır. İlk 24 saat içindeki mortalite oranı %26,3 iken, total mortalite %100 olarak saptanmıştır.Sonuç: İnvaziv MV uygulanan olgularımızda barotravma görülme sıklığı düşük olmakla beraber, prognozun kötü olduğu saptanmıştır.Objective: The incidence of barotrauma in patients who received mechanical ventilation (MV) has decreased due to protective MV strategies. This study aimed to assess the incidence, treatment, and prognosis of barotrauma in patients who received MV in our tertiary intensive care unit (ICU) and to discuss with the literature. Material and Methods: Patients hospitalized between January 2008 and December 2014 were assessed. Those who had barotrauma were retrospectively analyzed. Results: Invasive MV was performed in 861 of 1341 patients. Barotrauma was seen in 19 (2.2%) patients. These patients' (mean age, 63.2±18.2 years; 14 males) median APACHE II score was 18, and their median duration of MV was 168 h. Acute Respiratory Distress Syndrome(ARDS) was diagnosed in 57.9% of the patients at admission, and volume-controlled ventilation was mostly used (47.4%). Barotrauma occurred on day 8 (median; range, day 4-21). Pneumonia was diagnosed in 84.2% of the patients. Pressure support ventilation was mostly used (47.4%) at the time of barotrauma. All patients had pneumomediastinum. Pneumothorax was diagnosed in 16 (84.2%) patients (bilaterally in 3 patients). Subcutaneous emphysema was seen in 11 patients (57.9%). Pneumothorax was treated by tube thoracostomy in 15 patients (83.3%). While the mortality rate was 26.3% in first 24 h, the overall mortality rate was 100%. Conclusion: The incidence of barotrauma was lower among our ICU patients who received MV, but the prognosis of these patients was poor

Evaluation of Traffic Accident Risk in In-City Bus Drivers: The Use of Berlin Questionnaire

WOS: 000436167400005PubMed ID: 29755810OBJECTIVES: Traffic accidents associated with high mortality rate may produce serious problems especially in highways. Obstructive sleep apnea (OSA) has been associated with a high risk for traffic accidents due to excessive daytime sleepiness even in in-city drivers. In the present study, it was aimed to evaluate the rate of OSA symptoms and to identify risk factors associated with traffic accidents in in-city bus drivers. MATERIAL AND METHODS: A self-administered questionnaire including demographic and anthropometric features, sleep and work schedules, Berlin questionnaire, Epworth sleepiness score (ESS), and history of traffic accidents was used. RESULTS: The questionnaire was conducted for 1400 male bus drivers (mean age, 38.0 +/- 6.4 y, body mass index, 27.8 +/- 3.9 kg/m(2)). A total of 1058 (75.6%) drivers had one or more accidents while driving bus. According to the Berlin questionnaire, 176 (12.6%) drivers were found to have high OSA risk and the accident rate was 83.0% in high-risk group, whereas 74.5% of low-risk drivers had accidents (p=0.043). The drivers with a history of traffic accident were older (p=0.030), had higher ESS (p=0.019), and were more in the high-risk OSA group according to the Berlin questionnaire (p=0.015). In multivariate linear regression analysis, traffic accident was associated with only Berlin questionnaire (p=0.015). CONCLUSION: The present results support that city bus drivers with high OSA risk according to Berlin questionnaire have increased accident rates. Therefore, we suggest using Berlin questionnaire for screening sleep apnea not only in highway drivers but also in in-city bus drivers

Pulmonary Rehabilitation Response in Elderly and Younger Patients With COPD

CHEST Annual Meeting -- OCT 22-26, 2016 -- Los Angeles, CAWOS: 000400118602240CHES

Comparison of Eosinophilic and Non-eosinophilic Cases with Chronic Obstructive Pulmonary Disease (COPD) in terms of Clinical Arrival, Exacerbations, Quality of Life and Response to Treatment: A Prospective Study

European-Respiratory-Society (ERS) International Congress -- SEP 28-OCT 02, 2019 -- Madrid, SPAINWOS: 000507372403105[No abstract available]European Respiratory So