31 research outputs found
Sepsis-Induced Myocardial Depression and Takotsubo Syndrome
No full textSepsis induced temporary myocardial dysfunction characterized as impairment of myocardial contraction is an important cause of mortality and morbidity in intensive care units. Takotsubo syndrome (TS) is temporary ballooning and dysfunction of the apical part of left ventricle without significant stenosis of coronary arteries. Recently, it was suggested that impairment in regional catecholamine distribution caused by stress factors and excessive cardiac sympathetic activity mechanism play role in sepsis such as other causes of TS. Additionally, vasopressor agents (as noradrenaline) which are widely used in sepsis treatment may be triggering factor. Serial case reports of sepsis associated TS are reported, however pathophysiology, diagnosis and treatment strategies of these two different syndromes is not obvious
Tacrolimus and acute kidney injury in early postoperative stage after liver transplantation.
No full textThe Effect of Standardized Interviews on Organ Donation
No full textObjectives: Organ donation is the most important stage for organ transplant. Studies reveal that attitudes of families of brain-dead patients toward donation play a significant role in their decision. We hypothesized that supporting family awareness about the meaning of organ donation, including saving lives while losing a loved one, combined with being informed about brain death and the donation process must be maintained by intensive care unit physicians through standardized interviews and questionnaires to increase the donation rate. Materials and Methods: We retrospectively evaluated the final decisions of families of 52 brain-dead donors treated at our institution between 2014 and 2017. Data underwent descriptive analyses. The standard interview content was generated after literature search results were reviewed by the authors. Previously, we examined the impact of standardized interviews done by intensive care unit physicians with relatives of potential brain-dead donors regarding decisions to donate or reasons for refusing organ donation. After termination of that study, interviews were done according to the intensivist's orientation, resulting in significantly decreased donation rates. Standardized interviews were then started again, resulting in increased donation rates. Results: Of 17 families who participated in standardized interviews, 5 families (29.4%) agreed to donate organs of their brain-dead relatives. In the other group of families, intensivists governed informing the families of donation without standardized interviews. In this group of 35 families, 5 families (14.3%) approved organ donation. The decision regarding whether to agree to organ donation was statistically different between the 2 family groups (P < .05). Conclusions: Conducting a standard interview between relatives of brain-dead donors and the intensivists, facilitating visits between relatives and the brain-dead patients, and informing relatives about the donation process resulted in an increased rate of organ donation compared with routine protocols
Prognostic Value of the Lactate-Albumin Difference in Predicting 30-Day Mortality in Critically Ill Patients
No full textThe effects of pneumoperitoneum and patient position on the perfusion index and pleth variability index during laparoscopic bariatric surgery
No full textObjective: Limited data are available on the use of the perfusion index (PI) and the pleth variability index (PVI) during laparoscopic bariatric suigery. We investigated the effects of pneumoperitoneum and the reverse Trendelenburg position on these indices. Materials and Methods: PI, PVI, heart rate (HR), blood pressure, SpO(2) and ventilation parameters were recorded before anaesthesia induction (T0), 5 min after endotracheal intubation (T1), immediately before surgery, after the patient had been in the reverse Trendelenburg position for 5 min (T2), after inflating the abdomen with CO2 in reverse Trendelenburg (T3), after the abdomen had been deflated (T4) and 5 min after extubation (T5). Results: General anaesthesia induced an increase in the PI (P<.001), and a decrease in the PVI (P=.002). The PI and PVI values were not affected during T2 or T3. Pneumoperitoneum caused an increase in mean arterial pressure (MAP) and a decrease in HR. PVI and MAP decreased during 14, but the PI and IHR remained unchanged. PVI, HR and MAP increased during T5. Conclusion: Our data suggest that the reverse Trendelenburg position and pneumoperitoneum did not affect the PI or PVI values, whereas deflation decreased the PVI in morbidly obese patients under general anaesthesia
LACTATE-ALBUMIN DIFFERENCE IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS
No full textObjective: Sequential Organ Failure Assessment (SOFA) score, lactate, and lactate-albumin difference values obtained at admission to surgical and medical intensive care units are evaluated for cutoff values and predictive significance on mortality. Material and Method: Data between 2001 and 2012 were extracted from MIMIC-III database. Adult patients admitted to the medical and surgical intensive care unit for the first time were evaluated. The significances of the SOFA score, maximum lactate, and lactate-albumin difference values in predicting mortality were analyzed, and cutoff values are determined. Results: Non-survivors had higher lactate, higher lactate - albumin difference, and lower albumin values than survivors (p<0.001, for all). In surgical intensive care units, lactate, lactate - albumin difference, length of hospital and intensive care unit stays were higher, but 30- and 90-day mortalities were lower than medical intensive care units. SOFA scores were similar (p=0.30). The area under the receiver operating characteristic curve (AUC) of SOFA score (AUC = 0.776, 95% CI: 0.735-0.817) and the cutoff value were greater in the surgical intensive care unit than the medical one (AUC=0.762, 95% CI: 0.745-0.780). The AUC of overall lactate - albumin difference (AUC=0.713, 95% CI: 0.695-0.731) was larger than overall maximum lactate (AUC=0.680, 95% CI: 0.662-0.699) on the first day. Both the maximum lactate and lactate - albumin difference cutoff values were higher in the surgical intensive care unit. Conclusion: Lactate - albumin difference's predictor value of mortality was superior to initial minimum albumin and maximum lactate values. Different cutoff values of the SOFA score, lactate - albumin difference, and maximum lactate should be used in medical and surgical intensive care units
Effectiveness of the Analgesia Nociception Index Monitoring in Patients Who Undergo Colonoscopy with Sedo-Analgesia
No full textObjective: The objective of this study was to improve the patient comfort and safety during procedures done under anaesthesia and sedation. The analgesia nociception index (ANI) noninvasively provides information on the nociception-antinociception balance, and it can be used to assess analgesia objectively. We aimed to compare the effects of analgesia management with conventional methods and with ANI monitoring on total opioid consumption, sedation and analgesia levels in patients who underwent colonoscopy using sedo-analgesia. Methods: Adult patients (n=102), scheduled for procedural sedation, were prospectively analysed. After the induction with propofol and ketamine, infusions of propofol (2 mg kg(-1) h(-1)) and remifentanil (0.05 mcg kg(-1) min(-1)) were started. In Group A, remifentanil infusions were titrated to maintain the ANI value between 50 and 70, whereas in Group C, analgesic requirements were met according to the attending anaesthetist's intention. The heart rate, blood pressure, respiratory rate, SpO(2), BIS, Numeric Rating Scale (NRS) and Ramsay Sedation Scale were monitored. Complications, analgesics consumption, duration of the procedure, demographic information, NRS and the Modified Aldrete Score were evaluated. Results: A total remifentanil amount used in Group A was 66.51 +/- 47.87 mcg and 90.15 +/- 58.17 mcg in Group C (p=0.011); there was no difference in total amounts of ketamine and propofol given. There was a negative correlation between ANI and NRS scores of Group A patients at Minute 0 at the level of 0.402, which was significant statistically (p=0.003). Conclusion: Opioid consumption was diminished when ANI monitoring was used, and thus the patient safety was improved. Further studies with longer procedure times and with a greater number of patients are required to demonstrate whether there is a difference in side effects and recovery times
