BackgroundHypothermia has been used in cardiac surgery for many years for neuroprotection. Mild hypothermia (MH) [body temperature (BT) kept at 32–35°C] has been shown to reduce both mortality and poor neurological outcome in patients after cardiopulmonary resuscitation (CPR). This study investigated whether patients who were expected to benefit neurologically from therapeutic hypothermia (TH) also had improved cardiac function.MethodsThe study included 30 patients who developed in-hospital cardiac arrest between September 17, 2012, and September 20, 2013, and had return of spontaneous circulation (ROSC) following successful CPR. Patient BTs were cooled to 33°C using intravascular heat change. Basal BT, systolic artery pressure (SAP), diastolic artery pressure (DAP), mean arterial pressure (MAP), heart rate, central venous pressure, cardiac output (CO), cardiac index (CI), global end-diastolic volume index (GEDI), extravascular lung water index (ELWI), and systemic vascular resistance index (SVRI) were measured at 36°C, 35°C, 34°C and 33°C during cooling. BT was held at 33°C for 24 hours prior to rewarming. Rewarming was conducted 0.25°C/h. During rewarming, measurements were repeated at 33°C, 34°C, 35°C and 36°C. A final measurement was performed once patients spontaneously returned to basal BT. We compared cooling and rewarming cardiac measurements at the same BTs.ResultsSAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). DAP values during rewarming (basal temperature, 34°C, 35°C and 36°C) were lower than during cooling. MAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). CO and CI values were higher during rewarming than during cooling. GEDI and ELWI did not differ during cooling and rewarming. SVRI values during rewarming (34°C, 35°C, 36°C and basal temperature) were lower than during cooling (P < 0.05).ConclusionsTo our knowledge, this is the first study comparing cardiac function at the same BTs during cooling and rewarming. In patients experiencing ROSC following CPR, TH may improve cardiac function and promote favorable neurological outcomes.
Pneumothorax is a common occurrence in intensive care unit (ICU)'s. Whereas causes of traumatic pneumothorax is generally blunt and penetrating traumas, iatrogenic pneumothorax may occur after procedures like central venous catheterization, positive-pressure mechanical ventilation and thoracentesis.Method: This study evaluated the data from 69 patients diagnosed with pneumothorax and followed up and treated in the ICU between the dates 01.01.2013 and 01.01.2015. The records were used to establish the patients' age, sex, Body Mass index and cause of pneumothorax, as well as the time of insertion of chest tube, total duration of chest tube and ICU length of stay. Pneumothorax patients were evaluated in two groups based on their etiologies as Traumatic Pneumothorax group (Group T) and Iatrogenic Pneumothorax group. Results:The pneumothorax incidence in our intensive care unit was found to be 2.53%, and all of the cases were acquired pneumothorax. Fifty-seven out of 69 cases were traumatic, most having developed bilaterally compared to the cases in the iatrogenic group, diagnosed with Computerized Tomography of Thorax and had a higher rate of thoracentesis. In Group T, chest tube was inserted earlier and mechanical ventilation duration and ICU length of stay were shorter. Conclusion:Pneumothorax is one of main emergency events in ICU patients. Even though it is rare, it should be diagnosed early. Our study confirms that pneumothorax in ICU is always acquired and mostly traumatic. Traumatic pneumothorax is associated with shorter mechanical ventilation duration and shorter ICU length of stay compared to iatrogenic pneumothorax.
Amaç: Çalışmamızda kardiyopulmoner resüsitasyon (KPR) sonrası terapötik hipotermi (TH) uygulanan ve uygulanmayan hastalarda gelişen enfeksiyon sıklığının, en sık izole edilen mikroorganizmaların belirlenmesi, TH'nin mortalite ve morbiditeye etkisinin saptanması amaçlandı. Gereç ve Yöntem: Çalışmamızda başarılı KPR uygulanmış 44 hastanın dosyası retrospektif olarak incelendi. Hastalar TH uygulanan (n=20) ve uygulanmayan (n=24) olmak üzere iki gruba ayrıl-dı. Hastaların 1, 3, 5, 7 ve 9. günlerdeki lökosit sayısı, C-reaktif protein (CRP) değerleri kaydedildi. Hastaların demografik verileri, yoğun bakım ünitesinde (YBÜ) yatış süreleri, kültür pozitifliğinin ilk gerçekleştiği gün, hangi kültür veya kültürlerde üreme olduğu, kültürlerde üreyen mikroorganizmalar, hastaların YBÜ'den taburculuk halleri kaydedildi. Bulgular: Gruplar karşılaştırıldığında hastaların demografik verileri ve Glaskow koma skoru (GKS) ortalamaları açısından anlamlı fark bulunmamıştır. Gruplar arasında yoğun bakım takiplerinin ilk 10 gününde gerçekleşen kültür pozitifliği, kan, derin trakeal aspirat (DTA) ve idrar kültüründe üreme oranları açısından anlamlı fark bulunmamıştır. Gruplar arasında mortalite oranları açısından anlamlı fark bulunmamasına rağmen, TH uygulanan grupta YBÜ'de yatış süresi anlamlı olarak düşük bulunmuştur. Gruplar arasında 1, 3, 5, 7 ve 9. gün lökosit sayıları arasında anlamlı fark tespit edilmemiştir. TH uygulanan grubun 1. gün CRP değeri TH uygulanmayan gruptan anlamlı olarak düşük bulunmuştur. Diğer günlerdeki CRP değerleri arasında anlamlı fark bulunmamıştır. Sonuç: Gruplar arasında mortalite oranları arasında anlamlı fark bulunmamasına karşın, TH uygulanmış grupta YBÜ'de yatış süresi daha kısa bulunmuştur. Bu nedenle biz, nörolojik açıdan birçok olumlu etkisi olduğu ispatlanmış TH uygulamasının KPR sonrası yoğun bakımda takip edilen hastalarda uygulanması gerektiğini düşünmekteyiz. Anahtar kelimeler: Kardiyopulmoner resüsitasyon, terapötik hipotermi, enfeksiyon, mortalite, morbidite ABSTRACT:Retrospective evaluation of the effect of therapeutic hypothermia application on infectious complications Objective: Our study aims at determining infection frequency in patients receiving or not receiving therapeutic hypothermia (TH) after cardiopulmonary resuscitation (CPR), detecting the microorganisms most frequently isolated, and measuring the effect of TH on mortality and morbidity. Material and Method: We examined retrospectively the files of 44 patients receiving successful CPR. Patients were separated into two groups: the ones receiving (n=20) and not receiving (n=24) TH. Their leucocyte numbers and C-reactive protein (CRP) values were recorded in the 1 st , 3 rd , 5 th , 7 th and 9 th day. Their demographic data, hospitalization period in intensive care unit (ICU), the first day that culture positivity occurred, in which culture(s) reproduction occured, which microorganisms reproduced in these cultures, and discharge state of the patients from ICU were recorded. Results: No significant difference was found in patients' de...
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