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    Efficiency of silver coated urinary catheter in catheter-associated urinary tract infection in critical care unit
    (AVES, 2010) Teke T.; Yavuz Z.; Atalay H.; Maden E.; Solak Y.; Uzun K.
    Aim: Urinary tract infection (UTI) is the most prevalent cause of nosocomial infections, with an incidence of 40%. The incidence of urosepsis occurs in approximately 16% of the ICU patient populations. The purpose of this study was to determine the efficacy of a silver coated urinary catheter in prevention of catheter-associated UTI. Material and Methods: We investigated 21 patients (mean age with 71.4±9.0 year and 14 M, 7 F) foley silicon urinary catheter and 20 patients (mean age with 67.6±8.7 year and 15 M, 5 F) with silver coated urinary catheter. In all patients, foley urinary catheters were changed with silver coated catheter in critical care unit. Results: The most common cause of infection was Klebsiella (33%). The susceptibility of gram negative microorganisms against antimicrobial agents were amicacin, piperacillin-tazobactam and carbapenem. The cost of antibiotic was higher in foley catheter group than silver coated group (p<0.001). Conclusion: Silver coated urinary catheter is expensive, it is cost effect according to urinary infection and antibiotic cost.
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    Evaluation of adrenal function in chronic obstructive pulmonary disease patients receiving invasive and noninvasive mechanical ventilation
    (AVES, 2010) Atalay H.; Teke T.; Yavuz Z.; Maden E.; Kiyici A.; Solak Y.; Uzun K.
    Stress and severe disease states in the intensive care unit (ICU) cause release of adrenocorticoid hormone from the hypophysis and cortisol from the adrenal cortex by activating hypothalamo-pituitary adrenal axis. While adrenal insuffi ciency (AI) is seen in less than 0.01% of the normal population, its frequency is over 28% of cases in intensive care units (ICU). The aim of this study was to evaluate adrenal function in 36 cases with COPD, in pulmonary diseases ICU, receiving invasive mechanical ventilation (IMV) (n:23) and noninvasive mechanical ventilation (NIMV) (n:13). For this purpose, after obtaining a blood sample for baseline cortisol level, 1mg ACTH was given to patients in the fi rst day of admission to ICU. Cortisol levels were checked at the 30th and 60th minutes of ACTH test. Of all cases, mean age was 67.3±9.2, duration of hospitalization 12.9±9.3 days, APACHE II score 20.9±5.4, systolic blood pressure (bp) 103.5±28.2 mmHg, diastolic bp 64.6±19.2, mean arterial blood pressure 81.5±20.5 mmHg, sodium 138.3 ±6.3, potassium 4.3±1.2, urea 83.8±62.5 and creatinine was1.38±0.9 respectively. According to baseline cortisol levels, AI was present in 22 (45%) patients. Of these cases, 11 were in NIMV and 11 in IMV groups. When the baseline, 30th minute and 60th minute cortisol levels were compared, a statistically signifi cant difference was present (p<0.05, for all). In conclusion, we consider that adrenal insuffi ciency is encountered frequently in COPD patients with respiratory failure and further studies are needed tobetter delineate this association.
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    Oxidative stress and antioxidant status in bronchoalveolar lavage fluid, plasma and erythrocyte of critically mixed ill with respiratory failure
    (2008) Büyükbaş S.; Uzun K.; Demirkapi E.; Başarali K.
    Aim: Increased oxidative stress is a significant part of pathogenesis of various lung diseases. In this trial, it is aimed to determine the role of oxidative stress in patients receiving mechanical ventilation for respiratory failure (RF). Methods: The oxidative stress was evaluated by determining plasma, bronchial fluid and erythrocyte levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), ascorbic acid, alpha-tocopherol, uric acid (UA) and nitric oxide (NO) in 25 critically ill patients with RF. Twenty five patients without RF was evaluated as control group. Results: Oxidative stress (MDA, NO) levels of plasma, erythrocyte and BAL fluid in mixed critically ill with respiratory failure were higher than control group. Antioxidant levels of plasma, erythrocyte and BAL fluid in mixed critically ill with respiratory failure were lower than control group. In all parameters, there was no statistically difference as exitus and survivors in critically mixed patients. Conclusion: Oxidative stress was higher in respiratory failure than control group.
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    A pregnant case with severe influenza a (H1N1) virus infection-related ARDS [Şiddetli i?nfluenza a (H1N1)'ya ba?lı ARDS gelişen gebe]
    (TIP ARASTIRMALARI DERNEGI, 2011) Teke T.; Duran U.; Maden E.; Gezginç K.; Yavşan M.D.; Uzun K.
    Pregnant women are more susceptible to influenza and pregnancy may enhance the severity of the illness. In this article, we reported a 37-year-old pregnant woman with ARDS related to severe influenza A (H1N1) virus infection. A 37-year-old pregnant woman at 36 weeks gestation was admitted to our ICU with rapidly worsening dyspnoea. She had tachycardia, tachypnoea and severe hypoxia (PaO2/FiO2=104). A diagnosis severe H1N1 infection-related ARDS was made and treated with oseltamivir, broad-spectrum antibiotics, bronchodilators and NIV. Her nasopharyngeal swab was positive for H1N1. One day later, her hypoxia remained severe, and she was intubated and MV was commenced. Simultaneously, the patient gave birth to a healthy boy by emergency cesarean delivery. Her condition gradually improved. Pregnant women with severe H1N1 infection-related ARDS may be successfully treated with oseltamivir and mechanical ventilation.
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    Thyroid hormon levels in patients with acute exacerbation of chronic obstructive pulmonary disease
    (2007) Uzun K.; Atalay H.; Inal A.
    Aim; The severity of airway obstruction in chronic obstructive pulmonary diseases (COPD) is associated with impairment of thyroid gland function. Methods; We evaluated thyroid abnormalities in patients with COPD and relationship between pulmonary function tests, arterial blood gases and thyroid functions. Results; There was no significant difference in mean levels of TSH, FT3 and FT4 between COPD and control group. Serum level of TSH was lower than normal limits in 20 of 62 patients with COPD. Serum level of FT3 was higher than normal limits in 2 of 20 patients with lower TSH level. In control group, TSH was lower than normal limits in 2 patients, but FT3 was normal in these patients. There was significant difference according to percentage of cases with TSH less than minimum values and FT3 higher than maximum values between COPD and control group. Conclusion; we have demonstrated that both clinic and subclinic hyperthyroidism were higher in patients with COPD exacerbations than cases without COPD.
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    Unexplained acute respiratory distress syndrome after varicocele surgery; report of a case [Varikosel operasyonundan sonra gelişen ve etyolojisi izah edilemeyen bir akut solunum sıkıntısı sendromu olgusu]
    (Ankara University, 2011) Teke T.; Maden E.; Korkmaz C.; Metineren R.; Uzun K.
    Acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure that is associated with several clinical disorders including direct pulmonary injury and indirect pulmonary injury. Vascular surgical patients are at risk for ARDS. A 23-year old man was admitted to our respiratory intensive care unit with short of breath, cyanosis and agitation which was developed acutely after varicocele operation under epidural anesthesia lasted for one hour. Bupivacain, fen-tanyl, remifentadyl and midazolam were used for epidural anesthesia. Oxygen saturation was 81% while breathing oxygen at FiO2 of 0.5. Arterial blood gas analysis showed hypoxemia with respiratory alkalosis with a PaO2/FiO2 score of 100. A chest radiograph demonstrated bilateral alveolar opacities. Bedside echocardiography was performed which revealed no evidence of global hypokinesia, all the chambers were normal, left ventricular ejection fraction was 65%. A diagnosis of ARDS was made and the patient was initiated on noninvasive mechanical ventilation. He was gradually weaned off the NIMV and discharged after a total hospital stay of four days. We report an ARDS case due to unexplained etiology after va-ricocele operation under epidural anesthesia and managed successfully with noninvasive mechanical ventilation.
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    Weaning failure from mechanical ventilation
    (AVES, 2010) Uzun K.
    Mechanical ventilation (MV) is a life-supporting modality that is used in a signifi cant proportion of patients in ICUs. The discontinuation or withdrawal process from MV is an important clinical issue. It has been estimated that as much as 42% of the time that a medical patient spends on a mechanical ventilator is during the discontinuation process. About 70% to 80% of patients who require MV for respiratory failure will be extubated after a trial of spontaneous breathing once the precipitating process has been corrected. It was found that approximately 15% of patients failed an initial attempt of weaning from mechanical ventilation. Prolonged MV is associated with a host of complications (eg, infection, gastrointestinal bleeding, and deep venous thrombosis). Under these circumstances, the clinical focus should include a search for all of the possible reasons that may explain the ventilator dependency.