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Allergic Reaction During Hydatid Cyst Operation: Case Report
(Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2008) Inal, Mehmet Turan; Memisi, Dilek; Akin, Fatih; Sezer, Y. Atakan
Hydatid disease is a parasitic infection caused by echinococcus granulosus and echinococcus alveolaris. This infection is characterized by cyst formation and the liver is the most commonly involved organ. Hydatid cysts can rupture during surgical operation and allergic reaction may occur. In this case report, we presented a patient who developed an allergic reaction characterized by urticaria during the operation of a hidatic cyst in the liver.
Assessment of the Heath Worers Knowledge About Nutrition in an University Hospital
(Galenos Yayincilik, 2010) Inal, Mehmet Turan; Memis, Dilek; Kargi, Murat; Sut, Necdet
Objective: Clinicians must know the definitions of malnutrition for diagnose and early treatment. This study assessed the knowledge of anesthesia residents, surgery residents and intensive care nurses about nutrition that are usually studied on the patients with malnutrition. Materials and Methods: We applied a inquiry to 80 residents and nurses working in an university hospital. The inquiry was consist of 20 questions about nutritional aspects, oral/enteral nutrition and parenteral nutrition. The one-way ANOVA, Kruskal-Wallis and chi-squre tests were used to compare variables between groups. Results: Anaesthesists group scored significantly than other groups in questions about nutritional aspects. Statistically difference was detected between anaesthesists group and intensive care nurses group (p<0.05). Surgery residents group scored more than other groups in oral/enteral nutrition questions, and statistically difference was detected between surgery residents group and surgery intensive care nurses group (p<0.05). Anaesthesists group scored significantly than other groups in questions about parenteral nutrition. Statistically difference was detected between anaesthesists group and intensive care nurses group (p<0.05). Conclusion: Knowledge about nutrition among residents and nurses was poor. Clear diagnosis and definition of nutrition and malnutrition must he defined clearly by all disciplines during training of the residents and intensive care nurses.
Barotrauma during apnea testing for brain death. Barotrauma and apnea testing
(Reial Acad Medicina Illes Balears, 2022) Inal, Mehmet Turan; Memis, Dilek; Ceritoglu, Ece Burcak; Karakas, Hilal; Simsek, Osman; Yanik, Fazli
The apnea test is used for the diagnosis of brain death. Various complications have been reported to have developed during the apnea test. A 44-year-old woman was hospitalized in the intensive care unit due to unconsciousness due to a posterior inferior carotid artery aneurysm. On the forty-ninth day of her hospitalization in the intensive care unit, the patient had no motor response and all brain stem reflexes were negative. Brain death was considered in the patient, but subcutaneous emphysema and bilateral pneumothorax developed within minutes during the apnea test. The patient underwent bilateral tube thoracostomy. The patient could not be diagnosed with brain death and died on the fiftieth day of her hospitalization. This report emphasizes that multiple complications can be observed during the apnea test and underlying mechanisms and therapeutic approaches are discussed.
CAN BE A PREFERABILITY BETWEEN INDUCTION ANESTHETIC AGENTS FOR FRACTURE SURGERY. HISTOPATHOLOGICAL AND BIOMECHANICAL APPROACH ON RATS
(World Scientific Publ Co Pte Ltd, 2023) Kuyubasi, Sabit Numan; Inal, Canan; Inal, Sermet; Inal, Mehmet Turan; Deger, Aysenur; Gok, Kadir; Oner, Suleyman Kaan
As the effect of many medical agents such as nonsteroidal anti-inflammatory drugs or antibiotics were investigated on bone fracture healing, there is no study about the anesthetic agents when compared histopathologically and biomechanically. We asked the question that if a superiority can be between them since we operate many fractures and see the delayed or nonunions. Although different anesthetic agents are used in general anesthesia, the effects of these substances on bone fracture healing are not clear. Here, we intended to research different anesthetic agents on fracture union in rats. The study was done between January 2020 and November 2021 in a university animal research laboratory. Totally 48 male Wistar-Albino rats weighing 250-300g were seperated into 3 groups as Tiyopental Na in Group 1, Ketamin in Group 2 and Propofol in Group 3. For anesthesia; 40, 100, 100mg/kg of single dosages were injected intraperitoneally, respectively. A shaft fracture was created bilaterally to the tibia of all rats. Kirschner (K) wire is used for the fixation of fractures. Biomechanical and histopathological examination in bones is performed at the end of the first and second months in terms of fracture healing. It has been found that the fracture union in group 1 was statistically signifigant higher than group 3 at the end of the first and second months histopathologically (P = 0.006, P = 0.002). It is also found there is a statistically significant difference between groups 1 and 3 after the second month biomechanically (P = 0.013). Although the union was higher in group 1 than group 2 histopathologically and biomechanically after the first and second months, there was no statistically significant difference (P = 0.376, 0.039; P = 0.028, 0.867). There was a general trend in the decrease of union measurements starting from group 1 to 3 at the end of the first and second month both histopathologically and biomechanically. In this study, it is found that there was a positive consistency between histopathological and biomechanical results with respect to bone union. They supported each other. Fracture healing is stronger in rats that were anesthetized by using thiopental than those using ketamine and propofol, we think that this may affect the choice of anesthetic agent and further studies are needed.
Comparing pulse pressure variation and pleth variability index in the semi-recumbent and trendelenburg position in critically ill septic patients
(Mre Press, 2017) Karadayi, Selman; Karamanlioglu, Beyhan; Memis, Dilek; Inal, Mehmet Turan; Turan, F. Nesrin
Introduction. Dynamic tests for predicting fluid responsiveness have generated increased interest in recent years. One of these tests, pulse pressure variation (PPV), is a parameter calculated from respiratory variations of pulse pressure. Another test, pleth variability index (PVI), is based on respiratory variations of the perfusion index and can be measured non-invasively by pulse oximeter. Previous studies have shown that both tests are valuable in determining fluid responsiveness. Methods. In this observational prospective study, our aim was to compare the PVI and PPV in order to identify a convenient tool for determining fluid responsiveness. Our study was performed in a surgical and reanimation intensive care unit. We enrolled one hundred mechanically ventilated adult patients diagnosed with sepsis. Exclusion criteria included brain death, spontaneous breathing, cardiac arrhythmia, and impaired peripheral circulation. We measured the PPV by arterial monitorization and the PVI by using Masimo Radical 7 in the 45 degrees semi-recumbent position (SP) and then 15 degrees Trendelenbug position (TP). We performed correlation and ROC analysis using a >13% fluid responsiveness cut-off value for the PPV and >14% for the PVI. Results. Between the SP and the TP, we did not observe significant decreases in PPV (from 14.17 +/- 10.57 to 12.66 +/- 9.64; p > 0.05), while we did observe significant decreases in PVI (from 21.91 +/- 13.99 to 20.46 +/- 14.12; p < 0.05). The PPV fluid responsiveness cut-off value in the SP and TP was 20% (78.95% sensitivity, 77.05% specificity) and 18% (76.67% sensitivity, 72.46% specificity), respectively. The PVI fluid responsiveness cut-off value in the SP and TP was 20% (80.49% sensitivity, 81.03% specificity) and 16% (81.25% sensitivity, 62.69% specificity), respectively. The area under the ROC of the PPV and PVI was 0.843 and 0.858 in the SP, respectively, and 0.760 and 0.747 in the TP, respectively. The PPV and PVI were correlated in the SP (r = 0.578; p = 0.001) and the TP (r = 0.517; p = 0.001). Conclusions. Our results showed that the PPV and PVI were correlated independent of position change in sepsis patients. Both tests appear to be equivalently reliable. However, the ability of the PPV and PVI to predict fluid responsiveness decreased in the TP in our study.
Comparison of different tests to determine difficult intubation in pediatric patients
(Elsevier Science Inc, 2014) Inal, Mehmet Turan; Memis, Dilek; Sahin, Sevtap Hekimoglu; Gunday, Isil
Background: The difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality. Objective: To assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients. Design: Prospective analysis. Measurements and results: Data were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured. Results: The sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61%) and 5.5 cm (sensitivity, 61.54%; specificity, 99.11%). The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test. Conclusion: These results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
Comparison of extubation times between protocolized versus automated weaning systems after major surgery in the intensive care unit
(Pharmamed Mado Ltd, 2012) Inal, Mehmet Turan; Memis, Dilek; Yildirim, Ilker
Background. Prolonged mechanical ventilation is associated with adverse clinical outcomes for critically ill patients. Objective. To assess the the extubation times of protocolised versus automated weaning systems in patients after major surgery in intensive care unit. Design. Retrospective analysis. Measurements and results. We analyzed 70 patients with major abdominal or pelvic surgery. Patients that were used Draeger Evita2 Dura for weaning process named as the C (control) group (n=35) and patients that were used Draeger Evita2 XL Smartcare/PS named as the SC group (n=35). A physician evaluate the patient every 5 or 10 minutes in group C. Gender, age, weight, operation time, operation type, the total volume of intravenous infusion, bleeding, total dose of propofol, fentanyl citrate, rocuronium during surgery and extubation time were all recorded. All side effects included reintubation, bleeding, stroke, death, postoperative myocardial infarction were all recorded. The partial oxygen pressure (Pa02) and partial carbondioxide pressure (PaC02) were recorded before and after extubation. Results. Demographic data and operative data were similar between groups (p>0.05). The extubation time was similar between groups (SC group versus C group: 191,14+/-79,1 min versus 188,29+/-51,47 min, p=0,534. There was significant decrease in arterial PO2 and increase in arterial PCO2 after extubation in all groups. No side effects were observed. Conclusion. In conclusion, although we found no differences between SmartCare and control groups, the evaluating of the patient increased the workload in the control group. We think that SmartCare decreased the workload. Thus, it can be recommended for weaning process of patients after major surgery in intensive care unit.
COMPARISON OF TRUVIEW EVO2 LARYNGOSCOPE WITH MACINTOSH LARYNGOSCOPE ON PATIENTS UNDERGOING CAESAREAN SECTION
(Nobel Ilac, 2016) Inal, Mehmet Turan; Memis, Dilek; Yandim, Tarik; Ersoz, Sule
Objective: A significant part of developing complications from anaesthesia during caesarean section is related to airway management. The goal of this study was to determine the efficiency of the TruView EVO2 laryngoscope compared with the Macintosh laryngoscope on patients undergoing caesarean section. Material and Method: One hundred patients requiring endotracheal intubation for caesarean delivery were divided into two groups: Group T, using the TruView EVO2 laryngoscope (n=50), and Group M, using the Macintosh laryngoscope (n=50). The view of the glottis evaluating Cormack-Lehane classification, the intubation time, the success rate, the number of intubation attempts, the blood on blade, minor laceration, dental/airway trauma, and the lowest peripheral oxygen saturation during intubation attempts were noted. Results: The view with the TruView EVO2 laryngoscope was better than the view with the Macintosh laryngoscope, using the Cormack-Lehane classification (p<0.05) for evaluation. The intubation time was 6.0 +/- 1.9 sec in group M and 13.8 +/- 3.3 sec in group T (p<0.001). The success rate was 100% in all groups. The number of intubation attempts was 46/2/2 in group T and 45/3/2 in group M (p>0.05). Blood on blade was detected in five patients in group T and in four patients in group M. Minor laceration was detected in four patients in group T and in three patients in group M. No statistically difference was detected in the incidence of complications. The lowest peripheral oxygen saturation during intubation attempts was 99.14 +/- 0.67 in group T and 99.00 +/- 0.72 in group M (p>0.05). Conclusion: The TruView EVO2 laryngoscope provides better laryngeal views and similar peripheral oxygen saturations and complication rates when compared with the Macintosh laryngoscope; thus, it can be used for intubation in obstetric patients.
Comparison of TruView EVO2 with Miller laryngoscope in paediatric patients
(Lippincott Williams & Wilkins, 2010) Inal, Mehmet Turan; Memis, Dilek; Kargi, Murat; Oktay, Zumral; Sut, Necdet
Background Except for neonates and specific malformations in children, management of the paediatric airway is not a major problem for the anaesthetist. Miller laryngoscope was traditionally used for paediatric intubation. The TruView EVO2 system is a recently introduced device with a unique blade that provides a wide and magnified laryngeal view. Objective To assess the value of the TruView EVO2 laryngoscope with that of Miller laryngoscope in paediatric patients. Design Prospective analysis. Measurements and results Fifty 2-8-year paediatric patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Miller (Group M, n = 25) and TruView EVO2 laryngoscope (Group T, n = 25). Preoperative airway evaluation was performed by using the Mallampati scores. The Intubation Difficulty Scale (IDS), the duration of the tracheal intubation procedure, the rate of successful placement of the endotracheal tube in the trachea, the view of the glottis according to the Cormack and Lehane grading criteria, number of intubation attempts, mean arterial pressure (MAP) and heart rate (HR) before and after intubation, lowest peripheric oxygen saturation during intubation attempts and all complications (minor laseration, dental or other airway trauma) were all recorded. Results Preoperative Mallampati scores and the IDS scores were similar between the Miller and TruView EVO2 laryngoscope. The average time for laryngoscopy was 6.36 perpendicular to 0.99 s in group M and 13.8 perpendicular to 7.99 s in group T (P < 0.001). The TruView EVO2 laryngoscope improved the Cormack and Lehane glottic view compared with the Miller laryngoscope. The HR change (difference before and after) in group M was significantly lower than that in group T (P < 0.001). However, the MAP change was similar between groups. The lowest peripheric oxygen saturation during intubation attempts was different between groups, 99.4 +/- 0.57% in group M and 97.6 perpendicular to 2.41% in group T (P < 0.001). Conclusion The results suggest that when compared with the Miller laryngoscope, the TruView EVO2 laryngoscope appears to improve the view of the larynx but requires a longer time for tracheal intubation. The IDS scores were similar; thus, the TruView EVO2 laryngoscope can be a good alternative to traditionally used Miller laryngoscope. Eur J Anaesthesiol 2010; 27: 950-954
Continuous spinal anesthesia application in a patient with high cardiac risk
(Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2007) Colak, Alkin; Inal, Mehmet Turan; Arar, Cavidan; Oguzhan, Nihal; Pamukcu, Zafer
Regional techniques are preferred to general anesthesia in lower-extremity surgery. Especially in elderly patients with high cardiac risk, the main objective is to supply sufficient anesthesia preserving hemodynamic stability. A 63-year-old female patient in whom emergency right leg amputation above the knee was planned, was treated for myocardial infarction without ST elevation 6 days ago. She had type 2 diabetes mellitus for 15 years, and hypertension for 10 years. She underwent a coronary bypass operation for two vessels and mitral annuloplasty two years ago and right leg amputation below the knee two months ago. An intrathecal cathater was placed at the right lateral position from L3-4 intervertebral space through the cathater by the needle technique. After cerebrospinal fluid flow was observed, we administered 2,5 mg 0.5% bupivacaine. Anesthesia was maintained by performing 2.5 mg of bupivacain every five minutes at a total dose of 7.5 mg until adequate sensory block was reached. The patient was given a supine positione after the sensory block reached T-10 level. The patient was hemodynamically stable during-the-operation and did not require additional drug from the catheter. The patient was sent to the ward after removing spinal cathater at the end of a one hour operation. In conclusion, especially in old patients with high cardiac risk, we think that continuous spinal anesthesia should be the method of choice for anesthesia in lower-extremity surgery.
Determining the efficiency of different malnutrition tests in septic patients
(Reial Acad Medicina Illes Balears, 2021) Inal, Mehmet Turan; Memis, Dilek; Tek, Seyda Cigdem; Uyar, Ahmet Senol; Ozel, Muhammet Fatih; Ciftci, Taner; Turan, Fatma Nesrin
Background and aims: Malnutrition is frequently detected in septic patients and is important cause of mortality. Methods: Numerical rating Scale 2002, Nutrition risk in the critically ill score and adductor pollicis thickness measurement are used to determine malnutrition in 287 septic patients. Results: The mean age was 66,57 +/- 16,31 years. The mean APACHE II score was 16,19 +/- 8,20 while the mean SOFA score was 5,89 +/- 3,49. To NRS 2002 test 171 was accepted as high malnutrition risk while 116 patients was accepted as low malnutrition risk. According to Nutric test, the risk of malnutrition was found to be low in 144 patients and found to be high in 143 patients. The mean APTM was detected as 20,20 +/- 2,21 mm. The cuff-off point for APTM was found as <= 21 mm. Conclusions: high risk of malnutrition was frequently observed in patients with sepsis and mortality was higher in high risk patients. Higher sensitivity was achieved when the tests were combined with each other. As a result, we recommend the use of malnutrition screening tests in patients with sepsis and combining the tests with each other.
The Effects of Different Insufflation Pressures on Cerebral Oxygen Saturation in Patients Undergoing Laparoscopic Cholecystectomy
(Springer India, 2020) Inal, Mehmet Turan; Memis, Dilek; Sezer, Atakan; Turan, Nesrin
A pneumoperitoneum during laparoscopic procedures has deleterious effects on cerebral perfusion and oxygenation. Our aim was to assess the effects of different insufflation pressures on cerebral oxygen saturation (rSO(2)) using a noninvasive INVOS Cerebral Oximeter (Somanetics Corporation, USA) system. One hundred patients scheduled for laparoscopic cholecystectomy were included and divided into two groups: a 10 mmHg pneumoperitoneum group (group I) and a 14 mmHg pneumoperitoneum group (group II). The rSO(2)measurements were obtained preinsufflation, after insufflation, every 15 min after insufflation, and 10 min after desufflation. Hemodynamic variables and anesthesia and surgery times were recorded. Between the two groups, there were no statistically significant differences in terms of age, sex, weight, anesthesia times, or surgery times (p > 0.05). The hemodynamic variables were similar in the two groups (p > 0.05). The rSO(2)value changed over time, with a statistically significant between-group difference (p = 0.001). The preinsufflation rSO(2)value was 70.07 +/- 7.73 in group I and 72.21 +/- 6.58 in group II, with no significant between-group difference (p > 0.05). After insufflation, the rSO(2)value decreased to 69.60 +/- 7.74 in group I and 64.41 +/- 6.48 in group II, and the distinction was statistically significant (p < 0.001). A high-pressure pneumoperitoneum was associated with a greater decrease in rSO2 as compared to a low-pressure pneumoperitoneum. Thus, we suggest the use of a low-pressure pneumoperitoneum in patients with central nervous system pathologies.
Effects of intra-abdominal pressure on liver function assessed with the LiMON in critically ill patients
(Cma-Canadian Medical Assoc, 2011) Inal, Mehmet Turan; Memis, Dilek; Sezer, Y. Atakan; Atalay, Meltem; Karakoc, Abdullah; Sut, Necdet
Background: Intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with significant morbidity and mortality in critically ill patients. Our aim was to assess the effects of IAH on liver function using the noninvasive liver function monitoring system LiMON and to assess the prognostic value of IAP in critically ill patients. Methods: We conducted a retrospective analysis of critically ill patients who were treated in the intensive care unit (ICU). The IAP and indocyanine green plasma disappearance rate (ICG-PDR) measurements were made within 24 hours after admission to the ICU and repeated 12 hours later. Intra-abdominal pressure was measured via a Foley bladder catheter, and ICG elimination tests were conducted concurrently using the LiMON. Results: We included 30 critically ill patients (17 women and 13 men aged 28-89 yr) in our analysis. Statistical analysis showed that the baseline IAP values were significantly higher among nonsurvivors than survivors (19.38 [standard deviation; SD 2.08] v. 13.07 [SD 0.99]). The twelfth-hour IAP values were higher than baseline measurements among nonsurvivors (21.50 [SD 1.96]) and lower than baseline measurements among survivors (11.71 [SD 1.54]); the difference between groups was significant (p < 0.001). The baseline ICG-PDR values were significantly lower among nonsurvivors than survivors (10.86 [SD 3.35] v. 24.51 [SD 6.78]), and the twelfth-hour ICG-PDR values were decreased in all groups; the difference between groups was significant (p < 0.001). Conclusion: Our results suggest that measurement of ICG-PDR with the LiMON is a good predictor of the effects of IAP on liver function and, thus, can be recommended for the evaluation of critically ill patients.
The effects of levosimendan vs dobutamine added to dopamine on liver functions assessed with noninvasive liver function monitoring in patients with septic shock
(W B Saunders Co-Elsevier Inc, 2012) Memis, Dilek; Inal, Mehmet Turan; Sut, Necdet
Background: Septic shock is the leading causes of death in intensive care units. In addition to generous fluid administration, inotropic agents are commonly used to improve cardiac output. The effects of inotropic agents on regional blood flow remains unknown. Objective: The aim of this study was to assess the effects of levosimendan vs dobutamine added to dopamine on liver functions assessed using noninvasive liver function monitoring (LiMON) in patients with septic shock. Design: Prospective analysis. Measurements and results: We analyzed 30 patients with septic shock who were treated in an intensive care unit. Indocyanine green plasma disappearance rate (ICG-PDR) was conducted concurrently using the LiMON system. A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus. Results: Statistical analysis showed that the variation of hemodynamic variables was different between groups. In our results, the increase in systolic blood pressure, diastolic blood pressure, and mean arterial pressure was significantly higher in levosimendan group than in dobutamine group (P < .05). There was a decrease in before-and after-infusion ICG-PDR values in dobutamine group (20.38 +/- 4.83 vs 20.34 +/- 5.30), and no statistical difference was detected (P = .649). There was an increase in before-and after-infusion ICG-PDR values in levosimendan group (18.70 +/- 2.59 vs 21.65 +/- 3.20), and a statistical difference was detected (P = .001). There was statistical difference between groups (P = .000). Conclusion: These results suggest that levosimendan added to dopamine improves systemic hemodynamics and increases splanchnic perfusion assessed using the user-friendly noninvasive bedside system LiMON in patients with septic shock compared with dobutamine. Crown Copyright (C) 2012 Published by Elsevier Inc. All rights reserved.
Effects of polygeline and hydroxyethyl starch solutions on liver functions assessed with LIMON in hypovolemic patients
(W B Saunders Co-Elsevier Inc, 2010) Inal, Mehmet Turan; Memis, Dilek; Karamanlioglu, Beyhan; Sut, Necdet
Background: Hypovolemia is a common clinical entity in critical patients, and adequate volume replacement therapy seems to be essential for maintaining tissue perfusion. However, it is still uncertain which solution is most appropriate for fluid resuscitation. Objective: The aim of this study was to investigate the effects of fluid resuscitation with 3.5% polygeline versus 6% hydroxyethyl starch solutions on hemodynamic functions and liver functions assessed with a noninvasive liver function monitoring system (LIMON) in hypovolemic patients. Design: This study is a prospective randomized clinical trial. Measurements and Results: Thirty hypovolemic patients (intrathoracic blood volume index, <850mL/m(2)) were randomized into hydroxyethyl starch (mean molecular weight, 130 000 Da) and polygeline (mean molecular weight, 30 000 Da) groups (15 patients each). Indocyanine green plasma disappearance elimination (ICG-PDR) were conducted concurrently using LIMON. A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus. For fluid resuscitation, 500 mL of colloid was given to the patients. Repeated hemodynamic and ICG-PDR measurements were done at baseline, after infusion, and then at 30 minutes after infusion. Results: Intrathoracic blood volume index and systolic, diastolic, and mean blood pressures increased significantly after infusion and remained elevated for 30 minutes after infusion, but there was no significant difference between the 2 groups. Indocyanine green plasma disappearance elimination values were similar in both groups with no significant difference between the two. Conclusion: Increasing intrathoracic blood volume index and hemodynamic variables by fluid loading is not associated with a significant change in ICG-PDR. (C) 2010 Elsevier Inc. All rights reserved.
Evaluation of Pre-Delirium Score in Intensive Care Patients
(Galenos Yayincilik, 2018) Inal, Mehmet Turan; Memis, Dilek; Inal, Volkan; Uyar, Ahmet Senol; Tek, Seyda Cigdem; Ciftci, Taner; Efe, Serdar
Objective: Delirium is frequently seen in intensive care patients and causes prolongation of mechanical ventilation and intensive care stay. In intensive care patients, the pre-delirium score is a test used to detect delirium. We aimed to determine the prognostic value of the pre-delirium score in patients who stayed more than 24 hours in our intensive care unit. Materials and Methods: Between January 1, 2016 and December 31, 2016, pre-delirium scores were calculated for all patients stayed more than 24 hours in surgery, reanimation and internal medicine intensive care units. Pre-delirium score >= 50 was accepted as group 1 and <50 was accepted as group 2. The groups were compared with each other in terms of gender, age, Acute Physiology and Chronic Health Evaluation (APACHE II) scores, duration of hospitalization and mortality rates. Results: While a high pre-delirium score was determined in 196 patients (39.2%), a low pre-delirium score was determined in 304 cases (60.8%) (group 2). In group 1, the mean age was 68.47 +/- 15.83 years and the mean APACHE II score was 22.47 +/- 7.75; in group 2 the mean age was 59.18 +/- 18.48 years and the mean APACHE II score was 15.71 +/- 7.87, which was found significantly higher than group 1 (p<0.05). In group 1, the duration of hospitalization was 19.93 +/- 23.46 days and the mortality rate was 65.3%; in group 2, the duration of hospitalization was 13.02 +/- 20.01 days and the mortality rate was 40.5%. Significant difference determined in terms of duration of hospitalization and mortality (p<0.05). Conclusion: Early recognition and treatment of delirium will lead to significant improvements in the prognosis of intensive care unit patients. We think that the predelirium score can also be used as an important prognostic test in intensive care unit patients.
Evaluation of the prognostic value of plasma clearance rate of indocyanine green and Pitt bacteremia score in patients with sepsis
(Galenos Yayincilik, 2010) Inal, Mehmet Turan; Memis, Dilek; Sut, Necdet
Objective: Sepsis is frequently seen in intensive care unit patients, representing an important cause of mortality. Prediction of prognosis in patients with sepsis is of particular importance. We investigated the relationship of plasma clearance rate of indocyanine green (ICG-PDR) and Pitt bacteremia score with prognosis in sepsis. Materials and methods: We retrospectively evaluated 100 patients whose ICG-PDR values were measured noninvasively with the LiMON system and Pitt bacteremia scores were determined within the first 24 hours of admission to intensive care unit. All the patients were diagnosed with sepsis before receiving intensive care. ICG-PDR values and Pitt bacteremia scores were compared between patients who died (n=48; mean age 62.4 16.5 years) or survived (n=52; mean age 60.8 +/- 18.2 years) during intensive care stay. Results: Compared to survivors, the mean ICG-PDR was significantly lower (21.1 +/- 5.4%/min vs. 13.9 +/- 6.4 %min; p<0.001) and the mean Pitt bacteremia score was significantly higher (4.9 +/- 2.0 vs. 10.2 +/- 1.7; p=0.000) in patents who died during intensive care treatment. In ROC analysis, the area under the curve was 0.819 for ICG-PDR, and 0.955 for Pitt bacteremia score. The optimal cut-off points for ICG-PDR and Pitt bacteremia score were 14.8%/min and 7, respectively. ICG-PDR and Pitt bacteremia score predicted mortality with a sensitivity of 75% and 97.9%, and specificity of 92.3% and 92.3%, respectively. Conclusion: Our findings show that both ICG-PDR and Pitt bacteremia score are effective markers in predicting survival of patients with sepsis and can be used in the evaluation of disease severity.
The impact of nutritional risk screening 2002 and subjective global assessment upon prognosis for intensive care patients
(Mattioli 1885, 2016) Gultekin, Ahmet; Memis, Dilek; Inal, Mehmet Turan; Uzundere, Osman; Turan, F. Nesrin
Aims: The assessment of nutritional status aims to specify individuals and communities that are malnourished or under malnutrition risk, to develop healthcare programs aimed at meeting society's needs in the wake of the assessment. Subjective Global Assessment (SGA) and Nutritional Risk Screening (NRS) 2002 is assessed for intensive care patients, it turns out to be indicative of their prognosis simply and effectively. Methods: The age, weight, body mass index (BMI), APACHE II, SOFA score, biochemical parameters (albumin, prealbumin, total lymphocyte levels), triceps thickness from anthropometric measurements were recorded during the hospitalization process. The patients were classified as nutritionally risk (NRS2002 +) or nutritionally risk-free (NRS2002 -) after NRS2002 assessment. According to SGD, the patients were categorized as well-fed (SGD-A), slightly or moderately malnourished (SGD-B), and heavy malnourished (SGD-C). The nutritional changes in the patient were categorized as NRS2002 -/SGD A (good nutrition), NRS2002 +/SGD B (slight or moderate malnutrition), or NRS2002 -/SGD C (severe malnutrition). Results: It is found that 49,8% of the patients were in the well-fed group, 42,2% of them in the slightly-moderately malnourished group, and 8% of them in the heavy-malnourished group. While the rate of malnutrition increases as the patients' age increases, and as their weight and BMI decrease, albumin, prealbumin, total lymphocyte, triceps skinfold thickness values decrease as malnutrition increases. For the patients with higher malnutrition rate, the duration of stay in the intensive care unit and mechanic ventilators and the mortality rate increase. Conclusions: We found that mortality increased with malnutrition. The nutritional status should be followed, and a treatment plan should be drawn up in critical care patients. Thus; SGA, NRS 2002 and other objective methods for assessing nutritional status with high sensitivity and specivity can be recommended for evaluation of critically ill patients.
Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit
(W B Saunders Co-Elsevier Inc, 2010) Memis, Dilek; Inal, Mehmet Turan; Kavalci, Gulsum; Sezer, Atakan; Sut, Necdet
Background: This study assessed the analgesic efficacy, side effects, and time to extubation of intravenous paracetamol when administered as an adjuvant to intravenous meperidine after major surgery in intensive care unit (ICU). Material: Patients were randomized postoperatively into 2 groups in ICU. Patients received either 100 mL of serum saline intravenous (IV) every 6 hours and IV meperidine (n = 20 group M) or IV paracetamol 1 g every 6 hours and IV meperidine (n = 20, group MP) into a peripheral vein for 24 hours. Behavioral Pain Scale (BPS) is used until extubation, and visual analog score (VAS) is used after extubation. When BPS and VAS values were more than 4, meperidine, I mg/kg IV, was administered and noted in 2 groups. Pain scores, total meperidine consumption, time to extubation, sedation scores, and side effects are 24-hour postoperatively noted. Results: Behavioral Pain Scale and VAS scores are significantly lower in group paracetamol-meperidine at 24 hours (P<.05). In group MP, postoperative meperidine consumption (76.75 +/- 18.2 mg vs. 198 +/- 66.4 mg) and extubation time (64.3 +/- 40.6 min vs. 204.5 +/- 112.7 min) were lower than in group M (P<.01). In addition to, postoperative nausea-vomiting and sedation scores were significantly lower in group MP when compared with group M (P<.05). Conclusion: We have demonstrated important clinical benefits by the addition of 4 g/d of paracetamol to meperidine after major surgery. This benefit has been shown in a range of patients under routine clinical conditions and therefore has important practical consequences in ICU. These data suggest that intravenous paracetamol is a useful component of the multimodal analgesia model, especially after major surgery. (C) 2010 Elsevier Inc. All rights reserved.
Investigation of Intraabdominal Pressure Increase and Related Risk Factors in Intensive Care Patients
(Galenos Publ House, 2018) Ugur, Huseyin; Inal, Mehmet Turan; Memis, Dilek; Turan, Nesrin
Objective: Elevated intraabdominal pressure (IAP) is an important factor that increases morbidity and mortality in intensive care unit patients. In this study, it was aimed to investigate the risk factors related to IAP increase in intensive care unit patients. Materials and Methods: One hundred twenty five patients who stayed more than 24 hours in surgical and reanimation intensive care unit were included into the study. All patiens age, sex, body mass index, APACHE II and SOFA scores were recorded. IAP measurements were performed during the intensive care unit stay, intraabdominal hypertension (IAH) was approved by a sustained or repeated pathological elevation in IAP >= 12 mmHg. Abdominal compartment syndrome (ACS) was accepted as a sustained IAP >20 mmHg that is associated with new organ dysfunction. All patients' duration of mechanical ventilator, intensive care unit stay and prognosis were determined. Risk factors for IAP such as trauma, sepsis, multiple blood transfusions, ileus, acidosis and pneumonia were all recorded. Result: In the study 45 patients were diagnosed with IAP and 5 patients with ACS. There was no difference in terms of IAH and ACS according to gender and age of the patients. Patients with high body mass index, multiple transfusions, sepsis and pneumonia, were found to have higher IAH (p<0.05) and no difference was found in terms of ACS. There was no significant difference in terms of IAH and ACS in patients with trauma. IAH and ACS were found significantly higher in patients with ileus (p<0.05). Significant difference was determined in terms of ACS for acidosis in patients who participate to the study (p<0.05). Patients who had IAH had higher APACHE II and SOFA scores, longer intensive care and mechanical ventilation (p<0.05). Conclusion: High body mass index, sepsis, multiple transfusion, ileus, acidosis and pneumonia are important risk factors for development of IAH and ACS, we recommend that patients should be monitored more carefully in the presence of these risk factors.

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