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Öğe Comparison of the effects of clinical observation and protocol-based weaning on antioxidant stress factors(NLM (Medline), 2022) Erdoğan, Cem; Kızılaslan, Deniz; Tunay, Burcu; Karaaslan, Pelin; Ülfer, Gözde; Yiğitbaşı, Türkan; Demiraran, Yavuz; Öz, HüseyinBACKGROUND: We aimed to compare the effects of observation of the physician (POB) or by adhering to the protocol-based (PB) weaning methods on total antioxidant capacity (TAC) and total oxidative stress (TOS) levels and weaning success levels. METHODS: Our study was conducted on patients admitted from the emergency department between January 2015 and January 2018 in the intensive care unit of our hospital. During the spontaneous breathing trial (SBT), when one of the criteria specified in developed, SBT was terminated and the previous mechanical ventilator parameters were returned. The patient was planned to be taken to SBT again the next morning. If the SBT was successful, extubation was decided. The extubation decision based on physician observation was made according to the patient's state of consciousness and adequate chest expansion during the daily visit. RESULTS: The decrease in TAC average value before and after extubation was found to be significant in the POB group patients (p=0.001). The decrease in the average TAC value of the PB group patients before and after extubation was found to be significant (p=0.03). CONCLUSION: In our study, TAC values were found to be higher in the PB group than in the POB group, and in addition, the reintubation rate was found to be lower. We think that the management of weaning as a PB may contribute to maintaining the balance between TAC and TOS and reduce the rate of reintubation.Öğe Do neutrophil-lymphocyte ratio and platelet-lymphocyte ratio have a role in determining mortality in intensive care patients undergoing plasmapheresis? Single-center experience(Wiley, 2023) Sadri, Sevil; Çavuşoğlu, Güneş; Tunay, BurcuIntroduction: Plasmapheresis is a frequently used procedure that removes the pathogenic components from circulation. We aimed to evaluate the relationship between plasmapheresis, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and mortality in the intensive care unit (ICU) between 2014 and 2021. Methods: Forty-nine patients (27 females and 22 males) were included. Demographic characteristics, laboratory values of the day of admittance to the ICU, APACHE II scores, and length of stay were recorded. Results: The mean age was 52.73 ± 16.93. APACHE II value (p = 0.003; p < 0.01), NLR ratio (p = 0.001; p < 0.01) and PLR ratio (p = 0.001; p < 0.01) of the surviving group were lower than those of the deceased group, which was statistically significant. Conclusion: As high PLR and NLR levels suggest increased mortality in the ICU population, attention should be paid for increased NLR and PLR when plasmapheresis is decided on in the ICU.Öğe Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study(2024) Loiodice, Ambre; Bailly, Sébastien; Ruckly, Stéphane; Yılmaz, Mesut; Tunay, Burcu; Çakmak, Rümeysa; Hamid, HythamObjectives: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We aimed to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients who survived at least 1 day after the onset of HA-BSI. Methods: We used individual data from a prospective, observational, multicentre, and intercontinental cohort study (Eurobact2). We included patients who were followed for ≥1 day and for whom time-to-appropriate treatment was available. We used an adjusted frailty Cox proportional-hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for the primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups. Results: Among the 2418 patients included in 330 centres worldwide, 28-day mortality was 32.8% (n = 402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n = 477/1192) in inadequately treated patients (p < 0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (adjusted Hazard Ratio (aHR), 0.83; 95% CI, 0.72–0.96; p 0.01). The estimated population attributable fraction of 28-day mortality of inadequate therapy was 9.15% (95% CI, 1.9–16.2%). Discussion: In patients with HA-BSI admitted to the ICU, the population attributable fraction of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used when hypothesizing the possible benefit of any intervention aiming at reducing the time-to-appropriate antimicrobial therapy in HA-BSI.Öğe Epidemiology and risk factors of 28-day mortality of hospital-acquired bloodstream infection in Turkish intensive care units: A prospective observational cohort study(NLM (Medline, 2023) Aslan, Abdullah Tarık; Tabah, Alexis; Koylu, Bahadır; Köylü, Bahadır; Kaya Kalem, Ayşe; Aksoy, Firdevs; Erol, Çiğdem; Karaali, Rıdvan; Tunay, Burcu; Güzeldağ, Seda; Batirel, Ayşe; Dindar, Emine Kübra; Akdoğan, Özlem; Bilir, Yeliz; Akova, MuratOBJECTIVES: To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. METHODS: The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. RESULTS: Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n?=?599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n?=?329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n?=?93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival. CONCLUSIONS: Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.Öğe Evaluation of prognostic factors associated with intensive care unit mortality in patients with hematopoietic stem cell transplantation(Anaesthesia, Pain and Intensive Care, 2022) Tunay, Burcu; Sadri, SevilBackground & objective: Although the outcome of patients admitted to ICUs have considerably improved in recent years, hematopoietic stem cell transplantation (HSCT) continues to be significantly associated with mortality.We studied the prognostic factors associated with ICU mortality after HSCT. The Acute Physiological and Chronic Health Evaluation II (APACHE II) was used as a prognostic scoring system.Methods: Within the scope of the research, the clinical and laboratory data of 52 patients who were admitted to the ICU after undergoing HSCT between 2013 and 2019 were analyzed retrospectively.Results: Mortality risk was found to be 4.22 times higher in patients who received mechanical ventilation (MV) within the first 24 h (P = 0.047), 18.37 times higher in patients who received total parenteral nutrition (TPN) support (P = 0.007), and 158.17 times higher in recipients of vasopressor drug support compared to those who did not (P < 0.001). It was found that a one unit increase in GCS score decreased mortality risk by 0.58 fold (P = 0.015). Additionally, a one unit increase in heart rate was found to increase mortality risk by 1.03 fold (P = 0.010). Whereas, one unit increases in systolic blood pressure or diastolic blood pressure decreased the mortality risk by 0.91 and 0.92 fold, respectively (P = 0.001 and P = 0.002). Mortality was not associated with APACHE II or graft-versus-host disease. Conclusion: Receiving MV, TPN or vasopressor treatment, and having lower GCS, higher heart rate, lower systolic and diastolic blood pressure were associated with an increase in the risk of ICU mortality in HSCT recipients admitted to the ICU.Öğe Investigation of inflammation-related parameters in patients with candidemia hospitalized in the intensive care unit: A retrospective cohort study(NLM (Medline), 2022) Tunay, Burcu; Aydın, SeldaBACKGROUND: Candidemia is the most common invasive fungal disease in intensive care units (ICUs). OBJECTIVE: We aimed to investigate cases of candidemia infection developing in the ICU and factors associated with mortality due to this infection. MATERIALS AND METHODS: This is a retrospective study including patients admitted to a tertiary university hospital ICU between January 2012 and December 2020. Patients over 18 years of age who had candida growth in at least one blood culture taken from central or peripheral samples (>48?h after admission to the ICU) without concurrent growth were evaluated. RESULTS: The study group consisted of 136 patients with candida. Eighty-seven (63.97%) patients were male, with a median age of 69.5 (59-76.5) years. The 7-day mortality rate was 35.29%, while the 30-day mortality rate was 69.11%. As a result of multiple logistic regression analysis, after adjusting for age and malignancy, high APACHE II score and low platelet-lymphocyte ratio (PLR) - were found to be significant factors in predicting both 7-day and 30-day mortality. CONCLUSION: In this study, PLR and APACHE II scores were shown to be independent predictors of mortality in patients with candidemia in the ICU.Öğe Küçük hücreli dışı akciğer kanseri olgularının yoğun bakım mortalitesini öngörmede APACHE II ve MPM II-0 skorlarının rolleri: 8 yıllık deneyimimiz(2022) Tunay, Burcu; Erdoğan, CemAmaç: Küçük hücreli dışı akciğer kanseri (KHDAK) tüm akciğer kanseri olgularının yaklaşık %85’ini oluşturmaktadır. Bu çalışmada, KHDAK’lı hastaların yoğun bakım ünitesi (YBÜ) mortalite riskini öngörmede, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II (APACHE II) ve Mortalite Tahmin Modeli II-0 (MPM II-0) skorlama sistemlerinin, tümörle ilgili klinik ve demografik bazı özelliklerin tahmin güçlerinin araştırılması amaçlandı. Gereç ve Yöntemler: Retrospektif olan bu çalışmaya YBÜ’ye kabul edilmiş 186 KHDAK’lı hasta dahil edildi. Hastaların klinik ve demografik özellikleri, skorlama puanları, tümör özellikleri ve YBÜ sonlanımları hastanemiz veri tabanından elde edildi. Bulgular: Çalışmaya 135 erkek ve 51 kadın hasta dahil edildi. Hastaların yaş ortalaması 66,47±12,03 yıldı. Taburcu olan ve eksitusla sonlanan gruplarda yaş (p=0,237) ve cinsiyet (p=0,768) açısından anlamlı farklılık yoktu. MPM II-0’ın kesim noktası >58 alındığı zaman, duyarlılığı %75,9, seçiciliği %84,6 olarak bulundu. Çoklu regresyon analizinde rekürrens/progresyonun (p<0,001), APACHE II skoru >20’nin (p=0,010) ve MPM II skoru >58’in (p<0,001) bağımsız mortalite öngörücüleri oldukları, operasyon sonrası YBÜ’ye alınmanın (p=0,001) ise tek bağımsız sağkalım öngörücüsü olduğu görüldü. Sonuç: KHDAK’lı hastalarının YBÜ mortalite tahmini yapılırken APACHE II ve MPM II-0 skorlarının değerlendirilmesini ve tümör rekürrens/progresyonunun dikkate alınmasını öneririz. Bununla beraber, KHDAK’lı hastaların YBÜ mortalitesinde etkili faktörlerin belirlenmesi amacıyla; çok merkezli, prospektif ve daha fazla olası parametrenin dahil edildiği geniş kapsamlı çalışmalara ihtiyaç vardır.Öğe The modified glasgow prognostic score (MGPS) and the mortality prediction MODEL II (MPM II) CAN predict mortality in patients with breast cancer admitted to intensive care: A retrospective cohort study(Lippincott Williams and Wilkins, 2022) Ölmez, Ömer Fatih; Tunay, Burcu; Bilici, Ahmet; Bayramgil, Ayberk; Çavuşoğlu, Güneş Dorukhan; Öz, Hüseyin[Abstract Not Available]
