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Öğe Comparing spinal blockade effectiveness and maternal hemodynamics using 25 gauge and 29 gauge spinal needles with the same volumetric flow rate in patients undergoing caesarean section(Taylor & Francis Inc, 2017) Ciftci, Taner; Daskaya, Hayrettin; Efe, SerdarSpinal needles with different diameters can be used to prevent side effects in patients undergoing spinal anaesthesia. However, the velocity of local anaesthetic changes through the spinal needle depending on the diameter of it. Local anaesthetic injection velocity has been reported to be associated with the spinal block level. We aimed to compare spinal needles of different diameters with the same local anaesthetic volumetric flow rate in terms of spinal blockade and hemodynamics in obstetric patients. Eighty-four patients received spinal anaesthesia by either a 25G needle or 29G with the same volumetric flow rate. Block levels, adverse effects, ephedrine given and a success rate of spinal anaesthesia were significantly higher in 25G than in 29G (p<.05). Athough the use of 29G was associated with a low level of block, a sufficient block level was generated for caesarean section. Furthermore, in spite of the technical difficulty, use of 29G was accompanied by a decreased incidence of maternal hypotension, bradycardia and a lowered ephedrine administration.Impact statementLocal spinal anaesthetic injections at faster flows cause turbulent flow leading to lower anaesthesia concentrations.The control of spinal anaesthesia levels has some difficulties due to anatomical repositioning, especially in pregnant patients.Also, it can cause frequent hemodynamic complications including hypotension and bradycardia, complications that may also have inadvertent effects on foetus.In this study, we showed that smaller diameter spinal needles provided safer spinal anaesthesia levels and a lower incidence of hemodynamic complications.Öğe Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers(Bilimsel Tip Publishing House, 2018) Efe, SerdarOBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.Öğe 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, SerdarObjective: 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.Öğe Extracorporeal carbon dioxide removal (ECCO2R) in COPD and ARDS patients with severe hypercapnic respiratory failure. A retrospective case-control study(Tubitak Scientific & Technological Research Council Turkey, 2021) Inal, Volkan; Efe, SerdarBackground/aim: Treatment of severe hypercapnic respiratory failure (HRF) has some challenges in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS), especially when lung protective ventilation (LPV) strategies are required. Extracorporeal CO2 removal (ECCO2R) therapy is an emerging option to manage hypercapnia while allowing LPV in these cases. However, further data on ECCO2R use is still needed to make clear recommendations. Materials and methods: This study was conducted on patients admitted to intensive care unit (ICU) between January 1st, 2016 to December 31st, 2019. The medical records were retrospectively scanned in institutional software database. Patients who received invasive mechanic ventilation (iMV) support due to severe HRF related to COPD or ARDS were included in the analyses. Patients were grouped according to treatment approaches as that ECCO2R therapy in addition to conventional treatments and conventional treatments alone (controls). Groups were compared for 28-day survival, iMV duration, and length of stay (LOS). Results: ECCO2R therapy was noted in 75 of the cases among included 395 patients (COPD n = 256, ARDS n = 139) out of scanned 1715 medical records. The survival rate of ECCO2R patients was 68% and significantly higher than 58% survival rate of controls (p = 0.025), with relative risk reduction (RRR) = 0.16, absolute risk reduction (ARR)= 0.10, number need to treat (NNT) = 10, and odds ratio (OR) = 1.5. In addition, iMV duration (12.8 +/- 2.6 vs. 17.1 +/- 4.9 days, p = 0.007) and LOS (16.9 +/- 4.1 vs. 18.9 +/- 5.5 days, p = 0.032) were significantly shorter than controls. Repeated measure analyses showed that LPV settings were successfully provided by 72 h of ECCO2R therapy. Subgroup analyses according to diagnoses of COPD and ARDS also favored ECCO2R. Conclusion: ECCO2R therapy significantly improved survival, iMV duration and LOS in patients with severe HRF due to COPD or ARDS, and successfully provided LPV approaches. Further studies are needed to assess promising benefits of ECCO2R therapy.Öğe Predictive ability of shock index in survival of ICU admitted emergency surgery patients: A retrospective cohort study(Turkish Assoc Trauma Emergency Surgery, 2022) Inal, Volkan; Efe, Serdar; Ademoglu, ZelihaBACKGROUND: Shock index (SI) is defined as the ratio of heart rate to systolic blood pressure and is a feasible and reliable tool to assess patients' circulatory status in emergency conditions. Its efficiency was shown in hemorrhagic shock, sepsis, trauma, and emergency triages. This study was planned to evaluate predictive ability of SI on 28-day survival of intensive care unit (ICU) admitted emergency surgery (eSurg) patients. METHODS: The study was conducted in a 20-bed capacity ICU of a University Hospital. Medical records of patients who were admitted to ICU after an eSurg between January 1, 2017, and December 31, 2019, were retrospectively scanned. Patients with age <18 and >90, elective surgeries, no written consents, missing data, and lost to follow-up were excluded from the study. Patients age, gender, surgery type, associated medical comorbidity, ICU mechanic ventilatory (MV) length, length of stay (LOS), and 28-day survival status were recorded. Selected pre-operative (pre-op) and post-operative (post-op) laboratory parameters (hemoglobin [Hb], platelet count, international normalized ratio [INR], and pH) were collected, sequential organ failure assessment and SI scores were calculated. Data were statistically processed with 95% confidence interval and p<0.05 significance in relation to survival. RESULTS: Patient survival rate was 95%. Abdominal and gastrointestinal surgeries constituted 47% of the cases. The most frequent comorbidities were cardiovascular and pulmonary diseases. In statistical analyses, neither surgery type nor associated medical con-dition was related to patient outcome. The mean LOS was 2.3 days. The mean MV length was about 23 h and significantly shorter in survived patients (p<0.001, t=-7.5). The higher post-op Hb levels were related to the higher survival (p=0.020, t=2.4). Post-op higher INR levels were found as a negative prognostic factor for survival (p=0.025, t=-2.3). Both pre-op and post-op pH levels were significantly related to patient survival (p=0.001, t=1.9 and p<0.001, t=7.1). The lower post-op SI scores were predictive to the shorter MV lengths (p=0.010, t=1.9). A significant relation was presented between lower pre-op and especially post-op SI scores and patients' survival (p=0.001, t=-1.6 and p=0.001, t=-2.9). CONCLUSION: This study presented that SI scores successfully predicted patients' survival in ICU admitted eSurg patients. We believe that the SI forgotten in the dusty shelves of the literature does not get the importance it deserves. SI is a simplistic, reliable, and highly cost-effective assessment tool. Larger prospective RCTs should be planned to assess feasibility and reliability of SI in different patient populations.Öğe Prognostic Significance of Critical Patients' Platelet Indexes in Mixed Type Critical Care Unit(Turkish Soc Medical & Surgical Intensive Care Medicine, 2019) Efe, Serdar; Asker, Ismail; Inal, VolkanIntroduction: Thrombocyte indexes (TIN) are biological markers of thrombocyte morphology and function. In critical patients, few studies evaluated TIN relation with disease severity and prognosis. Aim: In this study, we objected to evaluate TIN as a routine feasible parameter at respect of clinical significance to predicting mortality, even though thrombocyte count and functions were prone to alter by variable conditions of critical care unit patients. Materials and methods: Data of 314 patients those with objected parameters out of 347 retrospectively evaluated for TIN relation with clinical surveillance and demographics, in a ten bed capacity mixed-type tertiary CCU in between Jan 1st - 31st Dec 2016. Results: Patients', 194 male (62%), mean age was 62.7 +/- 16.9 (19-86) and APACHE II score was 18.9 +/- 8.5, mean length of stay (LOS) was 9.1 (1-182) days and with 43% mortality. The mean thrombocyte volume (MPV) and dispersion width (PDW) indexes were both correlated each other and positively with disease severity, on the other hand negatively with thrombocyte count. The higher plateletcrit (PCT) levels otherwise lower MPV and PDW were found in males, and also showed relatively lower mortality rates (37.6%<44.1%) (p<0.01). Increrased PDW levels and lower thrombocyte counts were related to higher mortality, in addition to this, PCT<0.17 levels showed 2x higher mortality risk compared to PCT>0.32. Both PDW/PLT and PDW/PCT ratios related to mortality too (p<0.001, p<0.001), otherwise with relatively lower coefficients (r: 0,11, r: 0,10). Conclusion: TIN in mixed type CCUs was assumed as PDW and PCT could be included to disease severity scoring system prognostic biomarkers, like thrombocyte counts.Öğe A Retrospective Analysis of Quality Indicators in a Mixed-type Tertiary Center Intensive Care Unit(Turkish Soc Medical & Surgical Intensive Care Medicine, 2018) Efe, Serdar; Sak, Istiklal; Inal, VolkanObjective: We aimed to take a snapshot to assess critical care specific quality indicators and performance of our critical care patients' management course and to have some clues to improve our total quality as the first step of the Total Quality Management course. Material and Methods: The demographic and clinical data of 347 patients admitted to our tertiary center 10-bed mixed-type critical care unit between Jan 1, 2016 and Dec 31, 2016 were retrospectively analyzed at respect of designated quality indicators, herein by Pabon Lasso's Method. Results: The patients' mean age was 65 +/- 16 years, average LOS was 8.9 +/- 16 days, bed turnover rate was 34.7, occupancy rate was 98.3%, mean APACHE II score was 23 +/- 9, and standardized mortality rate was < 1 (0.97). The readmission rate after 48 h of discharge was 2.6%. The post-discharge 90-day mortality rate was 5.1%, post-operative 48th h mortality rate was 2.2%, central venous catheter rate (CVC) was 82%, CVC related blood stream infections were 12.7%, invasive mechanic ventilator (IMV) rate was 71%, IMV-days was 6.5 +/- 3 days, and VAP rate was 12.7%. Conclusion: The common quality indicators are not assumed and are objected to compare the inter-ICUs' differences, on the other hand, could provide useful information about deficient or inefficient points of data to improvable clinics' own performance.