GirişBeta bloker intoksikasyonları, tüm intoksikasyon olgularının içerisinde düşük bir yüzde (%0,9) oluşturmakla birlikte mortalite oranı yüksek seyretmektedir (1,2). Lipid çözünürlüğünün yüksek olması ve santral sinir sistemine kolay geçişine bağlı olarak intoksikasyon durumunda; nöbet, solunum depresyonu ve koma gibi ciddi bulgular görülebilir. Kardiyovasküler sistemde; dirençli bradikardi, hipotansiyon ve şok gözlenebilir. Beta bloker intoksikasyonu tedavisinde; insülin + dekstroz, glukagon, sodyum bikarbonat, noradrenalin, adrenalin, dopamin, mekanik destek (pacemaker, ekstra korporeal membran oksijenasyonu, intraaortik balon pompası) ve intravenöz (i.v.) lipid emülsiyon (İLE) tedavisi uygulanmaktadır. Lipid emülsiyonların, lipofilik ajanların yol açtığı kardiyak yan etkileri farklı mekanizmalar ile geriye çevirdiği çeşitli hayvan deneyleri ve olgu sunumları ile gösterilmiştir (3-7). Biz de çeşitli ilaç alımı eşliğinde yüksek doz propranolol alımı sonrasında İLE tedavisi sonucunda başarılı olduğumuz, tedaviye dirençli olguyu sunmayı amaçladık.ABSTRACT Diagnosis and treatment management is difficult in cases of intoxication with multiple drugs. A 29-year-old female patient was admitted to the emergency department with multiple doses of propranolol, biperidene, risperidone and valproic acid for suicidal purposes. She had cardiovascular collapse despite fluid therapy and multiple high-dose vasopressor infusions. Intravenous lipid emulsion (ILE) treatment was administered to the patient who had hypotension that was resistant to hyperinsulinemic euglycemia and glucagon therapy. Hemodynamic stability was achieved after three hours. Intoxication with beta-blockers may be life threatening. Propranolol is a beta-blocker drug that binds highly to plasma proteins and has high lipophilic properties. The classical therapies recommended for severe beta-blocker intoxications may be insufficient, and successful results can be obtained with ILE application. In this case report, we wanted to emphasize that management of multiple drug intoxication is difficult and ILE treatment may be successful in treatment-resistant beta-blocker intoxications.ÖZ Çok sayıda ilaç alınarak meydana gelen intoksikasyonlarda tanı ve tedavi yönetimi zordur. Yirmi dokuz yaşında kadın hasta özkıyım amaçlı aşırı doz propranolol, biperiden, risperidon ve valproik asit alarak çoklu ilaç zehirlenmesi tablosunda acil servise getirildi. Sıvı tedavisi ve çoklu yüksek doz vazopresör infüzyonuna karşın kardiyovasküler kollaps tablosu düzelmedi. Hiperinsülinemik öglisemi ve glukagon tedavisine dirençli hipotansiyonu devam eden olguya intravenöz lipid emülsiyon (İLE) tedavisi uygulandı. Üç saat sonra hemodinamik stabilite sağlandı. Beta blokerler ile olan zehirlenmeler hayatı tehdit edebilen ciddi zehirlenmelerdir. Propranolol, plazma proteinlerine yüksek oranda bağlanan yüksek lipofilik özellik gösteren beta bloker ilaçtır. Ciddi beta bloker zehirlenmelerinde önerilen klasik tedaviler yetersiz kalabilmekte ve İLE uygulaması ile başarılı sonuçlar alınabilmektedi...

Neurological problems (NP) are frequently connected with different critical illnesses in intensive care unit (ICU) patients, and they may have an influence on ICU outcomes. The aim of this study is to examine the effects of NPs on ICU outcomes, especially in pulmonary ICU patients. his is a retrospective observational study comprising adult pulmonary critical care patients who were hospitalized between 2015 and 2019. Frequency of NPs at admission, their impact on mechanical ventilation (MV), ICU out comes, the rate of NP development during ICU stay, and risk factors for them were investigated. A total of 361 patients were included in the study, and 130 of them (36%) had NPs (Group 1). NIV requirement rate in patients with NPs was less than in those without NPs (group 2) and the requirement of MV was significantly more frequent in this group (37% & 19%, p<0.05). The duration of MV and sepsis rate were also  higher in Group 1 (19±27& 8±6 days, p: 0.003, p<0.05). NPs developing after ICU admission increased MV requirement 3 times as an independent risk factor. Risk factors for ICU acquired NPs were the existence of sepsis during admission (OR: 2.01, CI95%:1.02-4, p: 0.045) and longer MV durations before ICU admission (OR: 1.05, CI95%:1.004-41.103, p: 0.033). NPs were not independent risk factors for mortality (OR: 0.67, CI 95%: 0.37-1.240, p: 0.207). NPs did not increase mortality but more frequently caused MV requirement, more extubation failure, and longer ICU stay in this study population. Additionally, our data suggest that having sepsis during admission and a longer length of MV prior to admission may increase the neurological complication rate.

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Objective: In smokers, COVID-19 may have a more severe course due to impaired mucociliary activity, increased permeability, and inflammation of the airway epithelium. However, data on the impact of smoking in patients with COVID-19 pneumonia are conflicting. The study aimed to evaluate the effects of smoking on laboratory parameters, intensive care unit (ICU) length of stay, length of hospital stay, and mortality in COVID-19 patients hospitalized in the intensive careunit. Methods: Medical records of 576 patients who were followed up in the ICU for COVID-19 between January and September 2021 were analyzed retrospectively. Demographic data, comorbidities, laboratory parameters (hemoglobin, white blood cell (WBC), lymphocyte, neutrophil, thrombocyte, AST, ALT, CRP, D-dimer, ferritin, BNP, albumin), ICU and hospital stay of the patients were recorded. The patients were divided into 2 groups according to whether they smoked or not. Results: The data of 576 patients were evaluated in the study. The mean age of the patients was 69±14.8 years, and 53.8% were male. The smoking rate was 30%, and the smoking rate in men was 76.9%. The intensive care unit admission age of smokers was lower than non-smokers (p=0.01). The presence of coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and malignancy was significantly higher in smokers. Among the laboratory parameters, white blood cell count (WBC) and neutrophil were higher in smokers (p=0.01). There was no relationship between ICU length of stay, length of hospital stay, and mortality in smokers (p=0.769, p=0.699, p=0.852, respectively). Conclusion:We did not find any significant association between smoking and COVID-19 mortality. We recommend clinicians to monitor WBC and neutrophil count closely as markers of possible progression to critical illness in patients hospitalized in the ICU due to smoking COVID-19.

Nowadays, orthotopic liver transplantation (OLT) is the most definitive treatment in patients with end stage liver failure. In the early postoperative period after OCT, hemodynamic stabilization, maintenance of oxygenation with mechanical ventilation and weaning, preservation of renal functions and providing hemostasis should be our main targets. Early diagnosis and treatment of complications with an experienced intensive care team is important for graft function and survival. In this review, perioperative intensive care management of OLT patients was discussed according to current literature.