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1.
Subst Use Misuse ; 59(5): 743-751, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38321759

RESUMO

Background: The recent increase in workload and stress experienced by healthcare workers (HCW) is a significant global concern. Mindfulness enables one to be aware of emotions, thoughts, and present moment experiences. Objectives: The primary objective of this research is to investigate the correlates between smoking, occupational stress, and mindful awareness levels, among HCWs within the private healthcare sector. This study was conducted at a tertiary-level university-affiliated hospital in Istanbul between January - February 2023. 208 HCW participated, yielding a response rate of 20%. The participants were requested to complete a 61-item questionnaire consisting of demographics, General Work Stress Scale(GWS), Mindful Attention Awareness Scale (MAAS) and Test to Assess the Psychological Dependence on Smoking (TAPDS). Results: Smokers had significantly higher levels of mean GWS scores than nonsmokers. The mean MAAS scores of smokers were the lowest in the group with the highest scores of psychological dependence; it was highest in the group with the lowest scores. A negative correlation was found between general work stress and mindful awareness levels and between psychological dependence on smoking and mindfulness levels. HCWs aged 45 and older had significantly lower general stress than others. Conclusion: This study showed that the general work stress levels of smoker HCWs were higher than those of nonsmokers. Mindful awareness level was the lowest in the group, with the highest scores in psychological dependence on smoking. There was a negative correlation between psychological dependence on smoking and both work stress and mindful awareness levels. This study demonstrated that high work stress and low mindful awareness levels are not only related to each other but also to high psychological dependence on smoking.


Assuntos
Atenção Plena , Estresse Ocupacional , Humanos , Atenção/fisiologia , Fumar , Fumar Tabaco , Conscientização/fisiologia
2.
Turk J Med Sci ; 48(4): 744-749, 2018 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-30119149

RESUMO

Background/aim: Cancer patients frequently need intensive care support due to respiratory failure. We aimed to evaluate the predictors of mortality in cancer patients who were admitted to the intensive care unit (ICU). Materials and methods: This study was performed in the ICUs of two centers between 1 January 2008 and 31 December 2015. Demographic data, cancer type, causes of respiratory failure, comorbidities, APACHE II scores, treatments, and mortality rates were recorded. Results: A total number of 583 cancer patients (477 males) were enrolled from the two centers. Of those, 472 patients had lung cancer (81%), while 111 had extrapulmonary malignancies (19%), having similar mortality rates. Causes of respiratory failure were mostly invasion of the cancer itself in 84% of cases and due to infection in 12%. ICU mortality rate was 53% and the 1-year mortality rate was 80%. APACHE II scores were significantly higher in nonsurvivors (P < 0.001). One-year survival was found to be significantly shorter in females than males (9 days vs. 12 days) in patients with lung cancer. Conclusion: Mortality rates of cancer patients who need ICU support are higher than overall ICU mortality. High APACHE II scores and female sex seem to be related to mortality in these patients.


Assuntos
Cuidados Críticos , Mortalidade Hospitalar , Hospitalização , Unidades de Terapia Intensiva , Neoplasias/mortalidade , Insuficiência Respiratória/mortalidade , APACHE , Idoso , Estudos de Coortes , Comorbidade , Feminino , Humanos , Infecções/complicações , Infecções/mortalidade , Infecções/terapia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/patologia , Neoplasias/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Fatores Sexuais , Análise de Sobrevida , Sobreviventes
3.
Tuberk Toraks ; 65(4): 271-281, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29631525

RESUMO

INTRODUCTION: Colistimethate sodium (CMS) is frequently used in the treatment of nosocomial multidrug-resistant gram-negative infections. Nephrotoxicity is the most important side effect. The aim of this study is to evaluate the effect of colistin on nephrotoxicity and to assess prognosis in patients treated with CMS due to hospital-acquired pneumonia (HAP). MATERIALS AND METHODS: Patients treated with CMS for HAP due to multidrug-resistant Pseudomonas aeruginosa or Acinetobacter baumannii were included in this cohort study. RESULT: We evaluated 281 patients treated with two different brands of CMS whose administration dose is different: imported (n= 58, low dose/kg) and domestic (n= 223, high dose/kg). Nephrotoxicity developed in 175 patients (62.3%). The median age (73 vs. 66 years, p= 0.004) and mortality rates were higher (66.9% vs. 52.8%, p= 0.022) in patients having nephrotoxicity. The patients receiving high dose/kg had higher nephrotoxicity rate (67.7% vs. 41.4%, p< 0.001). The clinical, bacteriological response and mortality rates of the whole group were 52.0%, 61.0%, 61.6%, respectively. The clinical and bacteriological response rates were similar in the different dose groups. Multivariate analysis showed that nephrotoxicity was associated with domestic brand depending on use of high dose (OR= 3.97), advanced age (ß= 0.29, p= 0.008), male gender (OR= 2.60), hypertension (OR= 2.50), red blood cells transfusion (OR= 2.54), absence of acute kidney injury (OR= 10.19), risk stage of RIFLE (OR= 11.9). CONCLUSIONS: Nephrotoxicity is associated with the use of high dose colistin, age, gender, hypertension, red blood cells replacement and RIFLE stage. The mortality rate is higher in patients developing nephrotoxicity.


Assuntos
Antibacterianos/efeitos adversos , Colistina/análogos & derivados , Infecção Hospitalar/tratamento farmacológico , Insuficiência Renal/induzido quimicamente , Injúria Renal Aguda/induzido quimicamente , Adulto , Idoso , Antibacterianos/administração & dosagem , Estudos de Coortes , Colistina/administração & dosagem , Colistina/efeitos adversos , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/tratamento farmacológico , Prognóstico
4.
COPD ; 11(6): 627-38, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24915105

RESUMO

Acute respiratory failure (ARF) can necessitate mechanical ventilation and intensive care unit (ICU) admission in patients with COPD. We evaluated the reasons COPD patients are admitted to the ICU and assessed long-term outcomes in a retrospective cohort study in a respiratory level-III ICU of a teaching government hospital between November 2007 and April 2012. All COPD patients admitted to ICU for the first time were enrolled and followed for 12 months. Patient characteristics, body mass index (BMI), long-term oxygen therapy (LTOT), non-invasive ventilation (LT-NIV) at home, COPD co-morbidities, reasons for ICU admission, ICU data, length of stay, prescription of new LTOT and LT-NIV, and ICU mortality were recorded. Patient survival after ICU discharge was evaluated by Kaplan-Meier survival analysis. A total of 962 (710 male) patients were included. The mean age was 70 (SD 10). The major reasons for ICU admission were COPD exacerbation (66.7%) and pneumonia (19.7%). ICU and hospital mortality were 11.4%, 12.5% respectively, and 842 patients were followed-up. The new LT-NIV prescription rate was 15.8%. The 6-month 1, 2, 3, and 5-year mortality rates were 24.5%, 33.7%, 46.9%, 58.9% and 72.5%, respectively. Long-term survival was negatively affected by arrhythmia (p < 0.013) and pneumonia (p < 0.025). LT-NIV use (p < 0.016) with LTOT (p < 0.038) increase survival. Pulmonary infection can be a major reason for ICU admission and determining outcome after ICU discharge. Unlike arrhythmia and pneumonia, LT-NIV can improve long-term survival in eligible COPD patients.


Assuntos
Arritmias Cardíacas/complicações , Cuidados Críticos/estatística & dados numéricos , Progressão da Doença , Pneumonia/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/mortalidade , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/estatística & dados numéricos , Pneumonia/mortalidade , Pneumonia/terapia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Turquia/epidemiologia
5.
In Vivo ; 37(1): 310-319, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36593057

RESUMO

BACKGROUND/AIM: Lung transplantation is a life-saving procedure for patients with end-stage lung diseases. T-Cell receptor excision circle (TREC) is circular DNA produced during T-cell receptor gene rearrangement in the thymus and indicates naive T-cell migration from the thymus. Therefore, its levels represent thymic T-cell output. Post-transplant lymphocyte kinetics correlate with graft tolerance. The aim of this study was to investigate T-lymphocyte kinetics in the early recovery period after lung transplantation. For this purpose, copy numbers of TREC were determined in patients with a lung transplant. In addition, TREC copy numbers were evaluated according to age, diagnosis and the forced expiratory volume in 1 second (FEV1) of lung transplant patients. MATERIALS AND METHODS: Peripheral blood samples were taken from patients aged 23 to 59 years who underwent lung transplantation at the Thoracic Surgery Clinic, Kartal-Kosuyolu High Specialization Educational and Research Hospital. This study included peripheral blood samples from 11 lung transplant patients (comprising four with chronic obstructive pulmonary disease, three with idiopathic pulmonary fibrosis, one with cystic fibrosis, one with silicosis and two with bronchiectasis; three females in total). Samples were taken at three different timepoints: Before transplant, and 24 hours and 7 days post transplant. TREC copy numbers were analyzed with real time reverse transcriptase-polymerase chain reaction. RESULTS: Post-transplant TREC numbers and density values were higher compared to pre-transplant values, although these differences were statistically insignificant. TREC copy numbers were found to be significantly higher in patients younger than 45 years compared to patients older than 45 years. At 24 hours after the transplant, the average TREC copy number/peripheral blood mononuclear cells of the cases with an FEV1 value of or below 50% was found to be statistically significantly higher than that of cases with an FEV1 value above 50% (p=0.046). There was no statistically significant difference in TREC copy numbers between male and female patients or by diagnostic group. CONCLUSION: TREC copy numbers can be evaluated as a prognostic marker for lung transplantation. There is a need for multicenter studies with more patients.


Assuntos
Transplante de Pulmão , Linfócitos T , Humanos , Masculino , Feminino , Rearranjo Gênico do Linfócito T , Leucócitos Mononucleares , Variações do Número de Cópias de DNA , Timo , Receptores de Antígenos de Linfócitos T
6.
Tuberk Toraks ; 59(3): 221-6, 2011.
Artigo em Turco | MEDLINE | ID: mdl-22087517

RESUMO

Acute internal problems in the respiratory intensive care unit (ICU) and risk factors affecting mortality in the acute treatment applications were investigated. All patients in 20-bed intensive care unit for chest diseases enrolled to this prospective observational cohort study during 2008. Patients were classified as living in group 1 and deaths in group 2. Demographics and acute internal problems (arrhythmias, acute kidney-liver failure, dopamine, doputamin, perlinganit infusion) were recorded. Multiple regression analysis was performed for factors affecting mortality. There were 603 patients during the study period, group 1, n= 503 (83.4%), group 2, n= 100 (16.6%). Both groups were similar in terms of age and gender. Odds ratio (OR), 95% confidence interval (CI), p value for internal problems of acute risk factors for mortality were found as; septic shock OR: 22.52, CI 8.11-62.57, p< 0.000; need of perlinganit infusion OR: 9.28, CI: 1.61-53.37, p< 0.012; the presence of arrhythmia, OR: 7.81, CI: 3.46-17.65, p< 0.000; acute renal failure, OR: 2.88, CI: 1.24-6.65, p< 0.013 and the need for dopamine OR: 2.83, CI: 1.06-7.65, p< 0.037, respectively. Internal problems such as cardiac and renal dysfunction can devolop in respiratory ICU patients with pulmonary diseases and these problems constitude additional risk factors for mortalitiy. While the number of ICU is increasing with new health policies, each internal requirement and personnel equipped to treat the problem quickly must be considered.


Assuntos
Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Insuficiência Respiratória/mortalidade , Injúria Renal Aguda/complicações , Injúria Renal Aguda/mortalidade , Idoso , Arritmias Cardíacas/complicações , Arritmias Cardíacas/mortalidade , Causas de Morte , Estudos de Coortes , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Insuficiência Respiratória/etiologia , Fatores de Risco , Choque Séptico/complicações , Choque Séptico/mortalidade
7.
Gen Thorac Cardiovasc Surg ; 69(3): 577-579, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32997235

RESUMO

Here, we report a 54-year-old man who underwent double-sleeve left upper lobectomy for lung cancer and his postoperative course was complicated with COVID-19 pneumonia. Five days after his discharge from hospital, he was re-admitted with mild fever and bilateral multiple ground glass opacities on his chest CT. PCR testing confirmed COVID-19 infection and he was treated according to policies established by our nation's health authority. He is still receiving adjuvant chemotherapy and remains well at 3 months after the operation.


Assuntos
COVID-19/etiologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Pneumonia Viral/etiologia , RNA Viral/análise , SARS-CoV-2/genética , COVID-19/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Tomografia Computadorizada por Raios X
8.
Tuberk Toraks ; 58(3): 278-85, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21038138

RESUMO

Patients with influenza A (H1N1) virus infection have been admitted to intensive care units (ICU) due to development of severe respiratory failure. We described the clinical and epidemiologic characteristics of the 19 patients admitted to ICU due to influenza A (H1N1) virus infection. Study design is a descriptive case series in a third level-20 bed respiratory ICU at training hospital in Istanbul/Turkey. Influenza A (H1N1) virus infection was laboratory confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR). We collected data concerning demographic, epidemiologic and clinical characteristics of the patients, treatment mortality and outcome. From November 10 to December 31 2009, a total of 19 patients; 7 laboratory confirmed, 12 with high clinical suspicion were treated at ICU. Among 12 patients with high clinical suspicion; 3 patients had negative RT-PCR testing for influenza A (H1N1) virus, 9 patients had no tests. Mean age was 41.6 ± 11.9 (range 21 to 61). Median number of lung zone involvement was 4 (IQR= 3-4). Median PaO2/FiO2 was 105 (IQR= 85-165). Mean severity (APACHE II) and organ failure score (SOFA) were 13 ± 4 and 4.0 ± 1.3 respectively. Non-invasive mechanical ventilation (68.4%, n= 13), invasive mechanical ventilation (21.1%, n= 4) and nasal cannula oxygen (31.5%, n= 6) were implicated. The median length of ICU stay was 6 (IQR= 4-8). Oseltamivir therapy was given as 75 mg bid to 12 patients and 150 mg bid to 7 obese patients. ICU mortality rate was 21.1%. Presenting patients with pneumonia and acute respiratory failure due to influenza A (H1N1) virus infection were treated predominantly and successfully with non invasive mechanical ventilation. Clinicians should be aware of pulmonary complications of influenza A (H1N1) virus infection and that patients can be treated with non invasive mechanical ventilation paying attention to protective measures for health care providers.


Assuntos
Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Turquia/epidemiologia , Adulto Jovem
9.
Tuberk Toraks ; 57(3): 348-51, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19787476

RESUMO

Legionella pneumonia has a serious clinical course and requires treatment at intensive care unit. The need for mechanical ventilation is one of the determinants of prognosis. Mortality rate is higher in patients treated with mechanical ventilation. Non-invasive positive pressure ventilation (NPPV) provides mechanical ventilation without endotracheal intubation and decreases the incidence of ventilator associated pneumonia. It is a treatment modality for patients with hypoxia due to community acquired pneumonia. The present case was admitted to intensive care unit with a diagnosis of legionella pneumonia, and his hypoxemic respiratory failure was successfully treated with NPPV.


Assuntos
Infecções Comunitárias Adquiridas/terapia , Doença dos Legionários/terapia , Pneumonia Bacteriana/terapia , Respiração com Pressão Positiva/métodos , Ventilação Pulmonar/fisiologia , Adulto , Humanos , Legionella pneumophila , Masculino , Resultado do Tratamento
10.
Clin Respir J ; 12(1): 234-240, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27329014

RESUMO

INTRODUCTION: We have used Oki stents for a number of different indications. After discovering that there are limited reports in the literature on these stents, we were motivated to share our experiences in Oki stenting. OBJECTIVES: While there is vast knowledge on double Y-stents, the Oki stent is a relatively recent development in pulmonology. Here, we demonstrate that stenting of the right secondary carina using an Oki stent should be considered for obstructions in this region. METHODS: We placed 13 mm × 10 mm × 9 mm Oki stents in six patients under general anesthesia via rigid bronchoscopy. RESULTS: Three cases were post-transplant patients with malacia, stenosis, and bronchopleural fistula. One case had an airway obstruction due to malignant disease, another case had a right aortic arc and aberrant left subclavian artery anomaly, and the final case had bronchopleural fistula. No serious complications were observed during stent placement. CONCLUSIONS: Oki stents can safely be used for many clinical conditions. Patients benefit greatly from stenting; however, two of our cases died due to infection, and one case died due to malignancy.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Broncoscopia/métodos , Stents , Procedimentos Cirúrgicos Torácicos/métodos , Adulto , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Aorta Torácica/anormalidades , Fístula Brônquica/complicações , Fístula Brônquica/diagnóstico , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia Torácica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico
11.
J Psychopharmacol ; 21(6): 665-7, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17092960

RESUMO

Hyponatraemia is a very rare but potentially fatal complication of SSRIs and citalopram therapy, especially during the first weeks of treatment and for those who concomitantly use medications known to cause hyponatraemia. We present a 54-year-old hypertensive female patient who was admitted to the hospital with drowsiness, paresthesia, fatigue, nausea, vomiting and visual hallucinations and who was diagnosed to have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to citalopram. All her presenting symptoms disappeared after discontinuation of citalopram therapy, fluid restriction and a careful hypertonic saline infusion. This case suggests that SIADH may develop among hypertensive patients, especially when they use diuretics or follow a salt restricted diet.


Assuntos
Antidepressivos de Segunda Geração/efeitos adversos , Citalopram/efeitos adversos , Depressão/tratamento farmacológico , Dieta Hipossódica/efeitos adversos , Hipertensão/dietoterapia , Síndrome de Secreção Inadequada de HAD/etiologia , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Depressão/complicações , Diuréticos/efeitos adversos , Feminino , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Síndrome de Secreção Inadequada de HAD/induzido quimicamente , Pessoa de Meia-Idade , Fatores de Risco
12.
Wien Klin Wochenschr ; 128(3-4): 95-101, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26542131

RESUMO

BACKGROUND: Nosocomial pneumonia (NP) and ventilator associated pneumonia (VAP) have been associated with financially significant economic burden and increased case fatality rate in adult intensive care units (ICUs). This study was designed to evaluate case fatality rate among patients with NP and VAP in a respiratory ICU. METHODS: In 2008-2013, VAP and NP in the ICUs were included in this retrospective single-centre cohort study. Data on demographics, co-morbidities, severity of illness, mechanical ventilation, empirical treatment, length of hospital stay and laboratory findings were recorded in each group, as were case fatality rate during ICU admission and after discharge including short-term (28-day) and long-term (a year) case fatality rate. RESULTS: A total of 108 patients with VAP (n = 64, median (IQR) age: 70 (61-75) years, 67.2% were men) or NP (n = 44, median (IQR) age: 68 (62-74) years, 68.2% were men) were found. Appropriate empirical antibiotic therapy was identified only in 45.2 and 42.9% of patients with VAP and NP, respectively. Overall case fatality rate in VAP and NP (81.3 vs 84.1), ICU case fatality rate (42.2 vs 45.5%), short-term case fatality rate (15.6 vs 27.3%) and long-term case fatality rate (23.4 vs 11.4%) were similar between VAP and NP groups along with occurrence 50% of case fatality rate cases in the first 2 months and 90% within the first year of discharge. Multivariate analysis showed that chronic obstructive pulmonary disease (COPD) (HR: 3.15, 95% CI: 1.06-9.38; p = 0.039) and presence of septic shock (HR: 3.83, 95% CI: 1.26-11.60; p = 0.018) were independently associated with lower survival. CONCLUSION: In conclusion, our findings in a retrospective cohort of respiratory ICU patients with VAP or NP revealed high ICU, short- and long-term case fatality rates within 1 year of diagnosis, regardless of the diagnosis of NP after 48 h of initial admission or after induction of ventilator support. COPD and presence of septic shock are associated with high fatality rate and our findings speculate that as increasing compliance with infection control programs and close monitoring especially in 2 months of discharge might reduce high-case fatality rate in patients with VAP and NP.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Infecção Hospitalar/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Associada à Ventilação Mecânica/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Choque Séptico/mortalidade , Distribuição por Idade , Idoso , Áustria/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Taxa de Sobrevida
13.
Turk Thorac J ; 17(1): 7-14, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29404115

RESUMO

OBJECTIVES: The objective of this study was to evaluate the intensive care unit (ICU) and long-term mortality in sepsis patients with/without thrombocytopenia on the fifth day of ICU admission. MATERIALS AND METHODS: The retrospective observational cohort study was performed in a teaching hospital, and patients with sepsis who stayed more than 4 days in the ICU between January 2012 and December 2012 were included. Patients were divided into two groups according to thier platelet count at fifth day of ICU stay: Group 1, < 150.000/µL; Group 2, >150.000/µL. Patients having thrombocytopenia on admission were excluded. The patients' characteristics, comorbid diseases, body mass index, arterial blood gas analysis and blood biochemistry results, SIRS criteria, Acute Physiological and Chronic Health Evaluation Score II (APACHE II), implication of invasive and non-invasive mechanical ventilation, use of sedation, nutrition information, and culture results of microbiological samples were recorded. The groups were compared according to the recorded data. Logistic regression analysis was performed for ICU mortality; the Kaplan-Meier test was used to evaluate 12-month survival after ICU discharge. RESULTS: During the period, 1003 patients were admitted to the ICU; 307 sepsis patients were included in the study. Group 1 (n= 67) and Group 2 (n=240) had similar patient characteristics and sepsis findings. The groups had similar ICU and hospital stays; mortality was higher in Group 1 than in Group 2 (40.3% vs. 17.5%, respectively, p< 0.001). Fifth day thrombocytopenia, septic shock, male gender, and low albumin levels were found to be risk factors of ICU mortality; the respective odds ratios, 95% confidence intervals, and p values for these factors were 3.03, [1.15-7.45], p= 0.025; 4.97, [1.79-13.86], p= 0.002; 3.61, [1.27-10.23], p= 0.001; and 0.19, [0.07-0.52], p= 0.001. Follow-up after a year indicated that 124 out of 238 (52.1%) patients died, and 50% of the deaths occurred in the first 2 months. Kaplan-Meier analysis revealed no statistically significant effects of thrombocytopenia at ICU day 5 on 12-month mortality after ICU discharge. CONCLUSION: Higher rates of septic shock and mortality were seen in sepsis patients with thrombocytopenia in the ICU. The measurement of thrombocytopenia in the ICU, which is easy and low-cost, may help to predict mortality. Thus, precautions can be taken early in patient treatment and follow-up. As we know, early intervention is crucial in the approach to sepsis.

14.
Int J Chron Obstruct Pulmon Dis ; 11: 1895-901, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27578969

RESUMO

Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD), but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV) had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI). The first group consisted of subjects with BMI between 20 and 30 kg/m(2), and the second group consisted of subjects with BMI >30 kg/m(2). Data obtained at the first month's visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT), and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m(2), while 80 subjects had BMI >30 kg/m(2). The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects (P=0.67). Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such patients was found to be related to a better survival.


Assuntos
Serviços de Assistência Domiciliar , Pulmão/fisiopatologia , Ventilação não Invasiva , Obesidade/complicações , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Índice de Massa Corporal , Tolerância ao Exercício , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/efeitos adversos , Ventilação não Invasiva/mortalidade , Obesidade/mortalidade , Obesidade/fisiopatologia , Modelos de Riscos Proporcionais , Fatores de Proteção , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Turquia , Teste de Caminhada
15.
Turk Thorac J ; 16(1): 28-32, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29404074

RESUMO

OBJECTIVES: Patients with various severities are cared for in the intensive care unit (ICU) by an experienced ICU physician. We aimed to assess whether there is any difference in intubated ICU patient management when undertaken by a 24-hour intensivist versus a periodic experienced specialist in the ICU. MATERIAL AND METHODS: A retrospective, cross-sectional, observational study was done in a tertiary teaching hospital ICU. Patients receiving invasive mechanical ventilation (IMV) were classified into: group 1, managed by an experienced ICU pulmonary specialist during night shifts in 2006-2007, and group 2, managed by an intensivist around the clock in 2011. Patients were excluded if they were <18 years old, tracheostomized, or transferred from another ICU. Patient demographics and ICU data (IMV duration, sedation doses and duration, weekend extubation, ICU severity score [APACHE II], length of ICU stay, and mortality) were recorded, and groups were compared. RESULTS: In group 1, 131 of 215 IMV patients were included in the study, and in group 2, 294 of 374 patients were included. The sedation infusion rate, duration of IMV, self-extubation rate, and lenght of stay (LOS) of ICU were significantly increased in group 1 compared with group 2 (72.5% vs. 40.8%, p<0.0001; 152 vs. 68 hours, p<0.001; 24.4% vs. 13.9%, p<0.006; 13 vs. 8 days, p<0.0001, respectively). The weekend extubation rate and APACHE II scores were significantly lower in group 1 compared with group 2 (7.1% vs. 25.3%, p<0.0001; 22 vs. 25, p<0.017, respectively). Mortality rates were similar in the two groups (35.9% vs. 37.4%, p=0.76). CONCLUSION: A 24-hour intensivist appears to be better for decreasing IMV duration and LOS in the ICU. These results may be useful to address decreasing morbidity and, as a result, cost of ICU stays by 24-hour intensivist coverage, especially for patients with IMV.

16.
Turk Thorac J ; 16(2): 53-58, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29404078

RESUMO

OBJECTIVES: We aimed to evaluate the independent association between total parenteral nutrition (TPN) and nosocomial infection and intensive care unit (ICU) mortality in patients with severe pulmonary sepsis. MATERIAL AND METHODS: The present study was designed as a retrospective observational cohort study. We enrolled all patients with severe sepsis due to pulmonary infections who stayed more than 24 h in the respiratory ICU between January 2009 and December 2010. We recorded demographic characteristics, ICU severity scores, Acute Physiologic and Chronic Health Evaluation II (APACHE II) and first day Sequential Organ Failure Assessment (SOFA) score in the ICU, TPN because of intolerance to enteral feeding, ICU data, and mortality. To evaluate the risk factors for mortality, we performed adjusted logistic regression test for TPN, nosocomial infection, and SOFA in the model. RESULTS: Five hundred and fifty patients (males=375, females=175) with severe sepsis were involved in the study during the study period. The median and interquartile range (IQR) of age, APACHE II, and SOFA score at the time of admission to the ICU were 65 years (53-73), 20 (16-25), and 4 (3-6), respectively. Mortality rate was 18% (n=99). Adjusted odds ratio (OR), confidence intervals (CI) 95%, and p values of TPN, nosocomial infection, and first day SOFA score for mortality were as follows: OR:3.8, CI:2.3-6.1, p<0.001; OR:2.4, CI: 1.4-3.9, p<0.001; and OR: 1.3, CI:1.2-1.4, p<0.001, respectively. CONCLUSION: Nosocomial infection and the need for TPN because of intolerance of enteral nutrition (EN) is associated with a higher mortality rate in patients with severe sepsis in the ICU. Rational use of antibiotics and application of hospital acquired infection control program will further reduce mortality.

17.
Artigo em Inglês | MEDLINE | ID: mdl-26648713

RESUMO

INTRODUCTION: The objective of this study was to compare the change in 6-minute walking distance (6MWD) in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV) due to chronic hypercapnic respiratory failure (CHRF) caused by different etiologies. METHODS: This retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD]), between January 2011 and January 2012. The results of arterial blood gas (ABG) analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA) and multiple linear regression (MLR) analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group). RESULTS: A total of 105 patients with a mean age (± standard deviation) of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical analysis. There were no significant differences between groups in the baseline and delta values of ABG and spirometry findings. Both univariate ANOVA and MLR showed that the OHS group had the lowest baseline 6MWD and the highest decrease in 1 year (linear regression coefficient -24.48; 95% CI -48.74 to -0.21, P=0.048); while the KS group had the best baseline values and the biggest improvement under home NIMV (linear regression coefficient 26.94; 95% CI -3.79 to 57.66, P=0.085). CONCLUSION: The 6MWD measurements revealed improvement in exercise capacity test in CHRF patients receiving home NIMV treatment on long-term depends on etiological diagnoses.


Assuntos
Tolerância ao Exercício , Serviços de Assistência Domiciliar , Pulmão/fisiopatologia , Ventilação não Invasiva/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/fisiopatologia , Adulto , Idoso , Gasometria , Distribuição de Qui-Quadrado , Doença Crônica , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Recuperação de Função Fisiológica , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Fatores de Risco , Espirometria , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Caminhada
18.
Clin Hemorheol Microcirc ; 26(4): 265-71, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12122232

RESUMO

The effects of statins have been investigated mostly in hyperlipidemic states so far. We analysed blood cholesterol, triglyceride, albumin, fibrinogen and gammaglobulin levels, haematocrite, hemoglobin, erythrocyte, leukocyte and platelet counts, blood and plasma viscosity and erythrocyte rigidity in 12 rabbits fed on a normal diet (chow) which were given 1 mg/kg/day atorvastatin for 4 weeks. Compared to the baseline levels, erythrocyte rigidity (k=0.12+/-0.05 vs. k=0.7+/-0.02) and gammaglobulin levels (1.03+/-0.23 g/dl vs. 0.78+/-0.27 g/dl) decreased significantly (p=0.008 and p=0.025, respectively). Blood lipids, hematological variables, blood and plasma viscosity did not change statistically. Our findings imply that in a normolipemic state, statins given in low doses may improve erythrocyte rigidity without altering blood lipids in short term. Decreased plasma gammaglobulin levels may be reflecting their immunomodulatory effects.


Assuntos
Anticolesterolemiantes/farmacologia , Hemorreologia , Ácidos Heptanoicos/farmacologia , Pirróis/farmacologia , Animais , Anticolesterolemiantes/administração & dosagem , Atorvastatina , Viscosidade Sanguínea/efeitos dos fármacos , Deformação Eritrocítica/efeitos dos fármacos , Ácidos Heptanoicos/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases , Lipídeos/sangue , Pirróis/administração & dosagem , Coelhos , gama-Globulinas/metabolismo
19.
Multidiscip Respir Med ; 9(1): 8, 2014 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-24495706

RESUMO

BACKGROUND: The safety of beta-blockers as a heart rate-limiting drug (HRLD) in patients with acute respiratory failure (ARF) due to chronic obstructive lung disease (COPD) has not been properly assessed in the intensive care unit (ICU) setting. This study aims to compare the use of beta-blocker drugs relative to non-beta-blocker ones in COPD patients with ARF due to heart rate-limiting with respect to length of ICU stay and mortality. METHODS: We performed a retrospective (January 2011-December 2012) case-control study in a level III ICU in a teaching hospital. It was carried out in a closed ICU by the same intensivists. All COPD patients with ARF who were treated with beta-blockers (case group) and non-beta-blocker HRLDs (control group) were included. Their demographics, reason for HRLD, cause of ARF, comorbidities, ICU data including acute physiology and chronic health evaluation (APACHE II) score, type of ventilation, heart rate, and lengths of ICU and hospital stays were collected. The mortality rates in the ICU, the hospital, and over 30 days were also recorded. RESULTS: We enrolled 188 patients (46 female, n = 74 and n = 114 for the case and control groups, respectively). Reasons for HRLD (case and control group, respectively) were atrial fibrillation (AF, 23% and 50%), and supraventricular tachycardia (SVT, 41.9% and 54.4%). Patients' characteristics, APACHE II score, heart rate, duration and type of ventilation, and median length of ICU-hospital stay were similar between the groups. The mortality outcomes in the ICU, hospital, and 30 days after discharge in the case and control groups were 17.6% versus 15.8% (p > 0.75); 18.9% versus 19.3% (p > 0.95) and 20% versus 11% (p > 0.47), respectively. CONCLUSIONS: Our results suggest that beta-blocker use for heart rate control in COPD patients with ARF is associated with similar ICU stay length and mortality compared with COPD patients treated with other HRLDs.

20.
Respir Care ; 58(5): 850-7, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23107072

RESUMO

BACKGROUND: Acquiring 6-min walk test (6MWT) data from patients undergoing noninvasive mechanical ventilation due to chronic hypercapnic respiratory failure is limited. We aimed to assess whether the actual 6-min walk distance (6MWD) or the percent predicted 6MWD is a better reflection of the respiratory function of patients using home noninvasive ventilation (NIV) due to chronic hypercapnic respiratory failure. METHODS: This was a cross-sectional observational study. The 6MWT was performed in subjects using home NIV. Diagnoses were grouped as COPD, obesity hypoventilation syndrome (OHS), kyphoscoliosis, and parenchymal lung disease. Sex, age, and body mass index (BMI) were used to calculate ideal 6MWD. Male: 1,140 m - (5.61 × BMI) - (6.94 × age), and subtract 153 m for the lower limit of normal. Female: 1,017 m - (6.24 × BMI) - (5.83 × age), and subtract 139 m for the lower limit of normal. The 6MWD and percent-of-predicted 6MWD were compared relative to arterial blood gas, spirometry values, and diagnosis. RESULTS: The 6MWT was performed in 144 subjects, median (IQR) age 62 y (55-71 y). The male/female ratio, median (IQR) 6MWD, and percent-of-predicted 6MWD values were: COPD 32/6, 316 m (226-390 m), and 59.4% (42.5-68.9%); OHS 24/28, 303 m (240-362 m), and 73.0% (63.0-82.0%); kyphoscoliosis 16/7, 420 m (318-462 m), and 70.5% (56.0-75.2%); and parenchymal lung disease 19/12, 333 m (273-372 m), and 67.1% (46.7-74.7%). The correlation of percent-of-predicted 6MWD with spirometry and arterial blood gas values were better than with the actual 6MWD. CONCLUSIONS: The percent-of-predicted 6MWD was better correlated with respiratory function than actual 6MWD for subjects using home NIV due to chronic hypercapnic respiratory failure with COPD, OHS, kyphoscoliosis, and parenchymal lung disease.


Assuntos
Teste de Esforço , Insuficiência Respiratória/fisiopatologia , Caminhada/fisiologia , Adulto , Idoso , Gasometria , Índice de Massa Corporal , Doença Crônica , Estudos Transversais , Feminino , Humanos , Cifose/complicações , Doenças Pulmonares Intersticiais/complicações , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva , Síndrome de Hipoventilação por Obesidade/complicações , Síndrome de Hipoventilação por Obesidade/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Escoliose/complicações , Espirometria
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