Objective: To describe the causes of intubation in patients who have been diagnosed with middle cerebral artery (MCA) infarction requiring mechanical ventilation (MV) by evaluating the clinical and radiologic features in the neurological intensive care unit (NICU). Materials and Methods: The patients with MCA infarction who required MV in the NICU were evaluated retrospectively. All patients’ age, sex, risk factors of stroke, lesion topography, etiology and treatment of stroke, cause of intubation, percentage of extubation, death/discharge status were recorded. Results: It is found that between June 1st, 2009, and December 31st, 2015, 91 patients with stroke with MCA infarction were mechanically ventilated in the NICU. Fifty patients were intubated with neurologic causes and 40 patients needed intubation due to cardiopulmonary problems. One patient was treated in the NICU after surgery for a diaphragmatic hernia. Conclusion: The patients with MCA infarction who are followed up on a mechanical ventilator have poor prognosis. This group of patients constitutes elderly individuals who are at risk for vascular and organ failure. Their follow-up must be conducted in NICUs.
DOI : 10.4274/tnd.08108 Anahtar Kelimeler :
Ischemic stroke, mechanical ventilation, middle cerebral artery, neurological intensive care unit
Cilt: 24 Sayı: 2 Sayfa: 126 - 129
Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; ) and need for invasive mechanical ventilation (6.7 vs 36.6%; ) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% ( ). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50–1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96–463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01–0.98) were found as independent predictors of mortality. Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.
Objective:Although many new interventions including changes in diagnostic policies are performed to increase the rates of diagnosis of brain death (BD) and organ donation in recent years in Turkey, data about the longitudinal effects are limited. The aim of this study was to understand the current status of organ donation in İzmir and to find out whether new regulations have any effect on the diagnosis of BD and organ donation rates.Materials and Methods:All patients diagnosed with BD between January 2001 and December 2016 in a tertiary university hospital were included, and patient data and organ donation status were collected from medical records.Results:There were 303 patients diagnosed with BD during the study period. The most common reason in the pediatric group (n=42) was traumatic brain injury (42.9%) and 12 of these patients (28.6%) became organ donors. In the adult patient group (n=261), the most common reason was intracranial hemorrhage (39.8%) and 97 patients (37.2%) became organ donors. The rate of BD diagnosis increased over the years (from 0.59% to 0.67% after legal regulation), but there was no increase in organ donation rate (39.5 vs 26.5%). The most common cause of ineligibility for donation was refusal by patient’s relatives in both pediatric and adult patients (83.3% and 86.6% respectively).Conclusion:This study shows that although the diagnosis of BD has increased over the years, organ donation rates are still low in İzmir. New strategies aiming to increase awareness and change the perception of organ donation should be planned as soon as possible.
Şu anda, beslenme ve COVID-19 arasında optimum etkileşimi önermek için yeterli veri yoktur. Geçmişte influenza pandemilerinde yetersiz beslenme ve kıtlık, genç popülasyon da dahil olmak üzere yüksek hastalık şiddeti ve mortalite ile ilişkili olarak bulunmuştur. Nutrisyon tedavisi, SARS-CoV-2 enfeksiyonu hastalarında meydana gelebilecek komplikasyonları ve olumsuz sonuçları azaltma potansiyeline sahip olup tedavinin ayrılmaz bir parçasıdır. Yetersiz beslenmenin önlenmesi, teşhisi ve tedavisi, COVID-19 hastalarının tedavisine rutin olarak dahil edilmelidir. Covid-19 enfeksiyonunda nutrisyon yönetimi hakkında birçok belirsizlik devam etmekte olup öneriler şu an için ESPEN ve ASPEN yönergelerine, uzman görüşlerine ve klinik deneyimlere dayanmaktadır.