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    Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units
    (Galenos Publ House, 2021) Gundogan, Kursat; Akbudak, Ismail Hakki; Hanci, Pervin; Halacli, Burcin; Temel, Sahin; Gullu, Zuhal; Inci, Kamil
    Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P<.001), lactate level >2 mmol/L (2.78 [1.93-4.01], P<.001), age >= 60 years (2.45 [1.48-4.06)], P<.001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P=.003), vasopressor treatment (1.94 [1.32-2.84], P=.001), positive fluid balance of >= 600 mL/day (1.68 [1.21-2.34], P=.002), PaO2/FiO(2) ratio of <= 150 mmHg (1.66 [1.18-2.32], P=.003), and ECOG score >= 1 (1.42 [1.00-2.02], P=.050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.
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    Effects of end-expiratory lung volume versus PaO2 guided PEEP determination on respiratory mechanics and oxygenation in moderate to severe ARDS
    (Taylor & Francis Inc, 2022) Rollas, Kazim; Hanci, Pervin; Topeli, Arzu
    Background: There is no ideal method for determination of positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) patients. We compared the effects of end-expiratory lung volume (EELV)-guided versus PaO2-guided PEEP determination on respiratory mechanics and oxygenation during the first 48 hours in moderate to severe ARDS. Methods: Twenty-two patients with moderate to severe ARDS admitted to an academic medical ICU were assigned to PaO2-guided (n = 11) or to EELV-guided PEEP determination (n = 11) group. First, an incremental PEEP trial was performed by increasing PEEP by 3 cmH(2)O steps from 8 to 20 cmH(2)O and in each step EELV and lung mechanics were measured in both groups. Then, oxygenation and respiratory mechanics were measured under the determined PEEP at 4, 12, 24, and 48th hours. Results: After the incremental PEEP trial, over the 48 hours of the study period, in the EELV-guided group PaO2 and PaO2/FiO(2) increased (p = 0.04 and p = 0.02; respectively), whereas they did not change in PaO2-guided group (p = 0.09 and p = 0.27; respectively). In all patients, the median value of EELV change (Delta EELV) during incremental PEEP trial was 25%. In patients with Delta EELV > 25% (n = 11) PaO2, PaO2/FiO(2) and Cs increased over time in 48 hours (p = 0.03, p < 0.01, and p = 0.04; respectively), whereas they did not change in those with Delta EELV <= 25% (n = 11) (p = 0.73, p = 0.51, and p = 0.73; respectively). Conclusion: Compared to PaO2-guided PEEP determination, EELV-guided PEEP determination resulted in greater improvement in oxygenation over time. Patients who had > 25% improvement in EELV during a PEEP trial had greater improvement in oxygenation and compliance over 48 hours. Supplemental data for this article is available online at
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    Extracorporeal Carbondioxide Removal in Near Fatal Asthma Attack: A Case Report
    (Soc Turkish Intensivists - Sti, 2023) Hanci, Pervin; Erer, Cansin
    Objective: Status asthmaticus is seen in 3-10 % of asthma patients and can cause near-fatal asthma attacks. A near-fatal asthma attack is defined as a severe exacerbation of asthma that may require mechanical ventilation associated with respiratory arrest, altered consciousness, and/or PaCO2 over 50 mmHg. Invasive mechanical ventilation is required in 30% of patients, and mortality is 8% in these patients. Although mechanical ventilation can often provide adequate oxygenation and ventilation, ventilator-associated lung injury may occur due to increased dynamic hyperinflation of the lung. Extracorporeal methods are indicated in patients whose respiratory failure couldn't be healed with mechanical ventilation. This report presents a near-fatal asthma attack patient managed with an extracorporeal carbon dioxide removal filter (ECCO2R). Case: A 22-year-old female patient with asthma was admitted to the emergency department with shortness of breath. Besides pharmacological treatment, the patient was deteriorated and intubated. The patient was admitted to the ICU. Blood gas analysis showed respiratory and metabolic acidosis (pH: 6.9, PaCO2: 132 mmHg, PaO2:99 HCO3: 19.5 mmol/L). Bilateral hyperinflation was seen on Chest X-Ray (image), and severe respiratory wheezing was heard in both lungs. Mechanical ventilator settings (PCV mode, FiO2:50%, PEEP:0 cmH2O, Pinspiryum:35 cmH2O, respiratory rate: I/E:1/3.5) were made to prevent barotrauma. Otopeep was measured as six cmH2O with an expiratory hold maneuver. The maximum tidal volume was measured as 250 ml. ECCO2R system was initiated for ongoing respiratory acidosis with a 4 L/min sweep gas flow. Half an hour after starting the ECCO2R system, blood gas analysis was normal (pH: 7.40, PaCO2: 36 mmHg, PaO2:184 mmHg, HCO3:23 mmol/L ). On day 4, the bronchospasm was resolved completely, and respiratory system compliance increased. The sweep gas flow rate was titrated down, and the device support was discontinued on day 5. The patient was extubated after a successful spontaneous breathing trial on day six and discharged.Result: Extracorporeal devices could be helpful in near-fatal asthma attack that is hard to manage with invasive mechanical ventilation. In cases where oxygenation can be maintained with a mechanical ventilator, and persistent hypercapnia is present, patients could benefit from ECCO2R.
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    Mucormycosis in a Patient with Uncontrolled Diabetes Mellitus
    (Galenos Yayincilik, 2022) Inal, Mehmet Turan; Memis, Dilek; Hanci, Pervin; Gunbay, Gokhan; Keles, Samet; Mert, Habibe Tulin Elmaslar; Garip, Ruveyde
    Mucormycosis; is a rapidly progressive fungal infection due to filamentous fungi of the mucoraceae family. In this case report, we aimed to present the diagnosis and treatment modalities of a patient who developed rhinoorbital mucormycosis. A 54-year-old patient with a history of hypertension applied to the emergency department with a complaint of wound in the mouth that started four days ago. In the examinations performed here, the patient was diagnosed with diabetic ketoacidosis. In the examination of the patient, it was found that there was a necrotic wound on the left hard palate, a necrotic wound extending from the left inferior turbinate to the nasopharynx, and hyphae in the nasal passage. The patient underwent an aggressive debridement operation on the third day, due to the growth in the fungal culture. In the following clinical examination of the patient, ketone in the urine became negative, and his acidosis status improved. On the same day, the patient was treated with a positive coronavirus disease-2019 (COVID-19) polymerase chain reaction. After 15 days of treatment, the patient died due to COVID-19 pneumonia. Mucormycosis should be doubtful in patients presenting with uncontrolled diabetes mellitus and severe sinoorbital infection. All physicians following diabetic ketoacidosis should be vigilant against this rapidly progressing disease with high mortality.
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    The Use of High-Flow Nasal Oxygen Therapy in the Management of Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Feasibility Study
    (Aves, 2022) Hanci, Pervin; Ocal, Serpil; Kaya, Esat Kivanc; Topeli, Arzu
    OBJECTIVE: This study investigated the efficacy of high-flow nasal oxygen therapy in patients with severe acute exacerbation of chronic obstructive pulmonary disease admitted to the intensive care unit. MATERIAL AND METHODS: Totally, 23 patients were enrolled in the study. High-flow nasal oxygen therapy was administered with a predefined protocol. Vital signs, Visual Analog Scale for dyspnea, and arterial blood gas parameters were recorded at the beginning under low-flow oxygen support therapy and the 1st, 6th, 12th, and 24th hours of high-flow nasal oxygen therapy. High-flow nasal oxygen therapy duration, intensive care unit length of stay, and intensive care unit, in-hospital, and 60-day mortality were recorded as outcomes and compared according to the presence of pneumonia upon admission. RESULTS: In 12 patients (52.2%), pneumonia was present. High-flow nasal oxygen therapy was applied for a median of 57 hours [49.2-104.5]. Overall decreases were detected in heart rate (P=.001), respiratory rate (P<.001), and Visual Analog Scale for dyspnea (P=.001) during the first 24 hours of the therapy. Although there was an increase in PaCO2 (P=.001), pH increased (P<.001) over time too. No change in partial arterial oxygen pressure (P=.63) and partial arterial oxygen pressure/fraction of inspired oxygen ratio (P=.22) was noted. Nineteen patients (77%) were successfully weaned from high-flow nasal oxygen therapy. While the high-flow nasal oxygen therapy failure rate was 23%, the in-hospital and 60-day mortality rates were 8.6%. Outcomes were not different between patients with and without pneumonia. CONCLUSION: High-flow nasal oxygen therapy was efficient in relieving respiratory distress and well-tolerated with no adverse outcome in severe acute exacerbation of chronic obstructive pulmonary disease patients admitted to the intensive care unit.