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    2009 H1N1 Influenza and Experience in Three Critical Care Units
    (IVYSPRING INT PUBL, 2011) Teke, Turgut; Coskun, Ramazan; Sungur, Murat; Guven, Muhammed; Bekci, Taha T.; Maden, Emin; Alp, Emine
    Aim: We describe futures of ICU admission, demographic characteristics, treatment and outcome for critically ill patients with laboratory-confirmed and suspected infection with the H1N1 virus admitted to the three different critical care departments in Turkey. Methods: Retrospective study of critically ill patients with 2009 influenza A(H1N1) at ICU. Demographic data, symptoms, comorbid conditions, and clinical outcomes were collected using a case report form. Results: Critical illness occurred in 61 patients admitted to an ICU with confirmed (n=45) or probable and suspected 2009 influenza A(H1N1). Patients were young (mean, 41.5 years), were female (54%). Fifty-six patients, required mechanical ventilation (14 invasive, 27 non-invasive, 15 both) during the course of ICU. On admission, mean APACHE II score was 18.7 +/- 6.3 and median PaO2/FIO2 was 127.9 +/- 70.4. 31 patients (50.8%) was die. There were no significant differences in baseline PaO2/FIO2 and ventilation strategies between survivors and nonsurvivors. Patients who survived were more likely to have NIMV use at the time of admission to the ICU. Conclusion: Critical illness from 2009 influenza A(H1N1) in ICU predominantly affects young patients with little major comorbidity and had a high case-fatality rate. NIMV could be used in 2009 influenza A (H1N1) infection-related hypoxemic respiratory failure.
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    Are spontaneous peak flow rates predictors of weaning?
    (AVES, 2015) Bahar, Ilhan; Baldane, Suleyman; Elay, Gulseren; Coskun, Ramazan; Gundogan, Kursat; Guven, Muhammet; Sungur, Murat
    Objective: Numerous parameters have been suggested for the prediction of weaning from mechanical ventilation; however, these parameters have limited success in the prediction of weaning outcome. This study aims to assess the success of peak flow rates [spontaneous peak inspiratory flow rate (SPIF) and spontaneous peak expiratory flow rate (SPEF)] that were measured during a spontaneous breathing trial (SBT) for the prediction of weaning outcome. Material and Methods: Patients who were managed and who received mechanical ventilation support for at least 24 h in the Internal Medicine and General Surgery Intensive Care Units of Erciyes University, School of Medicine between March, 2011 and May, 2012 were included in this study. Over 30 min, SPIF and SPEF values were measured during SBT in patients who were spontaneously breathing through a T-tube. Patients who tolerated the 30-min SBT were extubated. Patients who did not require reintubation for 48 h after extubation were considered as successful weaning, whereas those who required re-intubation were considered as weaning failure. Results: The study was completed with a total of 36 patients with 11 patients in the failure group and 25 in the success group. In both the groups, the area under curve (AUC) was calculated for each minute via ROC analysis using minute SPIF and SPEF values that were measured during SBT. The maximum AUC was calculated at 23 min for SPIF (0.564; 95% CI: 0.363-0.764) and at 9 min for SPEF (0.542; 95% CI: 0.316-0.3769). When the cut-off value for SPIF was accepted as >26.7 l/min at 23 min, sensitivity and specificity were calculated as 72.0% and 48.0%, respectively. When the cut-off value for SPEF was accepted as >24.7 l/min at 9 min, sensitivity and specificity were calculated as 63.6% and 48.0%, respectively. Conclusion: We believe that minute SPIF measurement, which has better sensitivity, and minute SPEF measurement, which has better specificity, compared with the available traditional predictors may be used as potential bedside weaning predictors when evaluated in comprehensive studies.
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    Spontan Tepe Akım Hızları Weaning Belirteci Midir?
    (2015) Bahar, İlhan; Baldane, Süleyman; Elay, Gülseren; Coşkun, Ramazan; Gündoğan, Kürşat; Güven, Muhammet; Sungur, Murat
    Amaç: Mekanik ventilatörden ayırmada kullanılan birçok parametre mevcuttur. Ancak bu parametrelerin sonucu tahmin etme başarısı sınırlıdır. Bu çalışmadaki amacımız spontan solunum denemeleri (SBT) sırasında, spontan ekspiratuar (SPEF) ve spontan inspiratuar (SPİF) tepe akım hızlarının weaning başarısını tahminde etkisini ölçmekti.Gereç ve Yöntemler: Çalışmaya, Mart 2011 ile Mayıs 2012 yılları arasında Erciyes Üniversitesi Tıp Fakültesi Genel Cerrahi ve Dahili Yoğun bakımlarında en az 24 saat mekanik ventilatör (MV) tedavisi alan hastalar alındı. Spontan soluyan hastalar 30 dakika boyunca T parçası aracığıyla spontan solunum çalışması (SBT)'na alındı ve SPIF ve SPEF değerleri ölçüldü. Hastalar 30 dakika boyunca SBT'yi tolere ettiyse ekstübe edildiler. Hastalar ekstübasyondan sonra 48 saat içinde tekrar entübe olmaları durumunda başarısız weaning olarak değerlendirildi.Bulgular: Çalışma 36 hasta ile tamamlandı, 11 hasta başarısız oldu, 25 hasta başarılı oldu. Her iki grupta da eğri altında kalan alan (AUC),SBT sırasında ölçülen dakikalık SPEF ve SPEF değerleri dakikalık ROC analizi ile hesaplandı. Maksimum AUC değeri 23. dakikada SPIF için (0,564; %95 CI: 0,363-0,764) ve 9. dakika SPEF değeri . SPIF için 23. dakikada kesim değeri 26,7 litre/dakika, hesaplanan sensitivite ve spesifite değerleri sırasıyla %72 ve %42 olarak bulundu. SPEF için 9. dakika kesim değeri 24,7 litre/dakika, sırasıyla sensitivite ve spesifite değerleri %63,6 ve %48 olarak bulundu. Sonuç: Biz çalışmamızda geleneksel weaning prediktörleriyle karşılaştırdığımızda ,dakikalık SPIF ölçümlerinin en iyi spesifiteye, dakikalık SPEF ölçümlerinin de en iyi sensitiviteye sahip olduğunu belirledik Bu konuda daha geniş çalışmalara ihtiyaç vardır.