Scoring systems are used for mortality and morbidity rating in intensive care conditions, prognosis prediction, standardization of scientific data and the monitoring of clinical quality. The aim of this study was to retrospectively analyze the efficacy of APACHE II (Acute Physiology and Chronic Health Evaluation), APACHE IV and SAPS (Simplified Acute Physiology Score) III prognostic scorings in the prediction of mortality and disease severity of patients admitted to the Anesthesia and Reanimation Clinic Intensive Care Unit (ICU) in Bakırköy Dr. Sadi Konuk Training and Research Hospital according to general and specific diagnoses. A total of 1896 patient files were included in the study. With the exception of single system or head trauma patient groups, a statistically significant difference was found in the mortality prediction rates in all other diagnosis groups (P < 0.05). The discrimination calculated with AUROC fields was sufficient in all groups, and calibration was evaluated as good except for the neurological and neurosurgical patient group. In respect of standard mortality prediction, APACHE II and IV were good in cases of sepsis, and SAPS III made almost exact predictions for cardiovascular diseases, APACHE II for neurological diseases, and APACHE IV for gastrointestinal system diseases. From the results of this study, it was seen that different scoring systems vary in predictions according to the diagnoses, therefore, it can be recommended that the diagnosis should be taken into account more when applying scoring systems.

The aim of our study is to evaluate the impact of early vs. late initiation of continuous renal replacement therapy (CRRT), defined by clinical information system (CIS) software using an early warning algorithm based on acute kidney injury network (AKIN) stages, on survival outcome of critically ill intensive care unit (ICU) patients with acute kidney injury (AKI). Of 1144 patients (mean [SD] age: 61.3 [17.9] years, 57.7% were males) hospitalized in ICU over a 2‐year‐period from January 2016 to December 2017, a total of 272 patients who had developed AKI requiring CRRT were included in this retrospective cross‐sectional study. Data on patient demographics (age, gender), reason for ICU hospitalization, AKIN stage, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, indications for CRRT, and time of CRRT initiation with respect to AKIN early warning algorithm were retrieved from hospital records and the CIS software database. Survivorship status was assessed based on total, in‐hospital and 90‐day post‐discharge mortality rates and analyzed with respect to CRRT onset before vs. after AKIN alarm. CRRT was initiated before the AKIN alarm in 41(15.0%) patients, and after the AKIN alarm in 231(85.0%) patients involving treatment within 0–24 h of alarm in 146 (63.2%) patients and within 24–120 h of alarm in 85 (36.8%) patients. Mortality occurred in 175 (64.3%) patients involving 25 (61.0%) out of 41 patients who received CRRT before AKIN alarm and 150 (64.9%) out of 231 patients who received CRRT after AKIN alarm. Mortality rate was significantly higher in those who received CRRT 24–120 h vs. 0–24 h after the AKIN alarm (82.4% vs. 54.8%, P < 0.001). Pre‐ and post‐CRRT SOFA scores were significantly lower in patients who received CRRT 0–24 h vs. 24–120 h after the AKIN alarm (P = 0.009 and P = 0.004, respectively), while pre‐CRRT APACHE II scores were significantly lower in patients who received CRRT before vs. after the AKIN alarm (P = 0.008). In conclusion, our findings indicate the potential role of using AKIN stage‐based early warning system in guiding time to start CRRT and improved survival in critically ill patients with AKI, provided that the CRRT was initiated within the early (first 24 h) of the alarming AKIN Stage II–III events. Future well‐designed clinical trials addressing early vs. late initiation of CRRT in critical care patients with AKI are needed to find and answer to the ongoing controversy and help clinicians in refining their indications for starting CRRT.

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Background/Aim: Candidemia is a common cause of bloodstream infections in critically ill patients, resulting in high mortality and morbidity. This retrospective case-control study was designed to identify epidemiological characteristics and risk factors for candidemia in an intensive care unit. Methods: A total of 166 patients hospitalized in the intensive care unit between January 2013 and December 2017 were included in this case-control study. Candidemia was defined as at least one positive blood culture for Candida spp. with fever or other clinical findings consistent with infection. Patients who acquired candidemia more than 48 hours after admission represented the case group (n=83). Control group (n=83) consisted of case-matching patients who were hospitalized during the same period and did not develop candidemia. Results: In the candidemia group Candida albicans (57.8%) was the most common species, followed by Candida glabrata (13.3%) and Candida parapsilosis (12%). The rate of C. albicans decreased from 69.2% to 50% during the five-year study period. Out of 83 candidemia infections, 36 (43.4%) were associated with central venous catheters. C. parapsilosis had an increasing rate in parallel with central venous catheter-associated candidemia rates. When comparing cases and controls, in univariate analysis, Sequential Organ Failure Assessment (SOFA) score, blood transfusion, central venous catheter placement, intubation, gastrointestinal surgery and total parenteral nutrition were significantly more common in the candidemia group (P<0.05 for each). The rate of the patients whose Candida scores were higher or equal to 3, was significantly higher in candidemia group (P=0.03). According to the multivariate analysis, SOFA scores (P<0.001, OR:1.25, 95% CI:1.15-1.37), gastrointestinal surgery (P=0.03, OR:2.60, 95% CI:1.10-6.12), central venous catheter (P=0.04, OR:2.62, 95% CI:1.05-6.57) and total parenteral nutrition (P=0.02, OR:2.61, 95% CI:1.12-6.06) were independent risk factors for candidemia, while enteral feeding (P=0.02, OR:0.27, 95% CI:0.09-0.80) was protective against. Conclusion:The result of our study is an evidence of the changing epidemiology of candidemia, which showed a shift towards non-albicans Candida spp. over the years. The increasing rate of C. parapsilosis and central venous catheter-associated candidemia has highlighted the need for more attention to the central line care and hand hygiene. Our study also revealed that critically ill patients with high SOFA score, gastrointestinal surgery, central venous catheter, and total parenteral nutrition have an elevated risk for developing candidemia. Unless necessary, limitation of total parenteral nutrition, and ensuring the earlier implementation of enteral feeding may be protective from candidemia.

Amaç: Obezite cerrahisinde, epidural analjezi ve transversus abdominal plan (TAP) blok ile yapılan multimodal ağrı yönetimi postoperatif etkili bir analjezi sağlayarak, opioidlerin kullanım sıklığını azaltır ve opioid kullanımına bağlı oluşan yan etkileri en aza indirir. Fakat obez hastalarda hem epidural hem de TAP bloğunu uygulamak teknik olarak zordur, bazen imkansızdır. TAP bloğunun laparoskopik olarak yapılması bu teknik zorluğa bir çözüm olabilir. Bu çalışmada laparoskopik sleeve gastrektomide laparoskopik TAP bloğunun teknik başarısı ve etkinliği değerlendirildi. Yöntemler: Bu çalışma prospektif olarak randomize, çift kör ve plasebo kontrollü olarak dizayn edildi. Laparoskopik sleeve gastrektomi (LSG) uygulanan hastalarda iki taraflı petit ve subkostal alana 30 cc bupivakain (Grup M) veya salin (Grup S) TAP infiltrasyonu uygulandı. Çalışmaya 165 hasta dahil edildi. Tüm hastalara postoperatif hasta kontrollü analjezi cihazı uygulandı ve postoperatif 1. ve 8. saatlerde iv tenoxicam 20 mg IV uygulandı. Çalışmaya katılan bütün hastaların; analjezik gereksinimi, ortalama ağrı skoru, vital parametreleri ve bulantı, kusma durumları postoeratif 1., 6. ve 24. saatte objektif bir gözlemci tarafından kayıt edildi. Bulgular: Yaş, vücüt kitle indeksi, ortalama ameliyat süresi, cinsiyet açısından gruplar arasında fark saptanmadı (p>0,05). Görsel analog ölçeği skoru değerlendirildiğinde, kontrol grubunda (Grup S) 1., 6. ve 24. saatlerin ortalama puanları, Grup S'den istatistiksel olarak anlamlı derecede yüksek bulundu (p=0,009, p=0,002). Sonuç: Morbid obez hastalarda multimodal analjezi kullanılarak opioid ilişkili yan ekilerin azalması dikkat çekicidir. Bu çalışmada, LSG operasyonlarında laparoskopik TAP bloğun yüksek oranda başarı ile uygulanabileceği ve postoperatif opioid tüketimini azalttığı gösterilmiştir.

F or patients diagnosed with sepsis or septic shock, an empirical broad-spectrum therapy with one or more antimicrobial agents is recommended to cover all possible pathogens (bacterial, fungal or viral agents). [1] The majority of current studies have focussed on the development and prevention of antimicrobial resistance. [2,3] Empirical antibiotic regimens should be selected based on the local resistance characteristics, the risk of development of the Objectives: The present study aimed to monitor the effects of antibiotic use under the guidance of culture and procalcitonin in patients admitted to the intensive care unit (ICU) due to sepsis or septic shock. Methods: This prospective, cross-sectional, clinical trial was conducted on patients admitted with sepsis or septic shock to Dr. Sadi Konuk Training and Research Hospital Anesthesia and Reanimation Clinic Intensive Care Unit between 01.01.2018 and 30.06.2018. For each patient a record was made of demographic data, reason for hospitalization reasons, PCT, C-reactive protein (CRP), blood leukocyte levels (WBC), lymphocyte percentages, neutrophil percentages, platelet (Plt) counts on admission, in the 72 nd hour and on the 7 th day, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at the time of hospitalization and discharge, Sequential Organ Failure Assessment (SOFA) scores and modes of discharge (exitus, recovery). The blood, tracheal aspirate, urine and/or tissue cultures of the patients were followed. The patients who met the criteria underwent DE. Results: The study included a total of 186 patients, comprising 102 (54.8%) males and 84 (45.2%) females, with a mean age of 66.64±17.6 years. DE was applied to 97 patients (52%) in the first 72 hours. Culture positivity obtained in the first 72 hours was higher in patients who underwent DE (OR=3.1, 1.6-6.5, CI=95%, p=0.001). It was seen that patients who underwent DE with culture positivity had a shorter stay in the intensive care unit (p=0.046). When the procalcitonin levels were analyzed, no statistically significant difference was found between the culture-positive DE group and the culture-negative DE group. Conclusion: In conclusion, the culture results guide the DE management in patients who are followed up with the clinical picture of infection in the intensive care unit. It is thought that PCT monitoring can be used as a guideline for the discontinuation of broad-spectrum antibiotics in culture-negative infectious patients. There is a need for more extensive studies related to this subject to investigate survival outcomes.

Objective: Therapeutic plasma exchange (TPE) is currently indicated as an alternative treatment regimen in a number of guidelines for various medical conditions. In this article we retrospectively reviewed cases who underwent TPE in Bakırköy Dr. Sadi Konuk Training and Research Hospital intensive care unit between 2007 and 2016 and compared the findings to the current reports in the literature. Methods: A total of 80 cases were treated with TPE between 2007 and 2016 in our intensive care unit. Information on demographic variables, therapeutic indications, catheterized veins, complications during the procedure, number of sessions, replacement products used and survival data was collected. In addition, preand post-procedure serum triglyceride, cholesterol and amylase levels were also collected in acute pancreatitis cases associated with hypertriglyceridemia. Results: A total of 501 TPE sessions were performed on 80 cases comprising 35 neurology, 18 hematology, 12 hypertriglycemic acute pancreatitis and 7 acute hepatic insufficiency patients, along with 8 cases with less common indications including sepsis, hyperthyroidism resistant to medical therapy and toxic epidermal necrolysis. The age of the subjects ranged between 12 and 82 years (mean; 45.08 ± 14.67 years). Sixteen (23.19%) cases died before the completion of the planned sessions. Pre-and post-procedure serum triglyceride, cholesterol and amylase levels were significantly different in acute pancreatitis cases (p < 0.05). Conclusion: Timely implementation of TPE in applicable indications may be helpful in preventing morbidity and mortality in a wide spectrum of disorders.

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