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Öğe Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use at home for chronic respiratory failure(Turkish Assoc Tuberculosis & Thorax, 2016) Ozsancak Ugurlu, Aylin; Berk Takir, Huriye; Ergan, Begum; In, Erdal; Ozyilmaz, Ezgi; Ertan Edipoglu, Ozlem; Acarturk, Eylem; Gulec Balbay, Ege; Gorek Dilektasli, Asli; Kivanc, Tulay; Korkmaz Ekren, Pervin; Sarinc Ulasli, Sevinc; Dogrul, Ilgaz; Yilmazel Ucar, Elif; Olgun, Sehnaz; Devran, Ozkan; Ergun, Recai; Karakurt, ZuhalIntroduction: To define approach of pulmonologists in Turkey to noninvasive mechanical ventilation ( NIV) use for chronic respiratory failure ( CRF), the most currently applied technique for home mechanical ventilation. Patients and Methods: A 38-question survey, developed and tested by the authors, was distributed throughout Turkey to 2205 pulmonologists by e-mail. Results: Twenty-seven percent of the pulmonologists responded ( n= 596). Domiciliary NIV was reported to be prescribed by 340 physicians [ 57.1% of all responders and 81% of pulmonologists practicing NIV at clinical practice ( n= 420)]. NIV prescription was associated with physician's title, type of hospital, duration of medical license, total number of patients treated with NIV during residency and current number of patients treated with NIV per week ( p< 0.05). Main estimated indications were listed as chronic obstructive pulmonary disease ( median, 25-75 percentile of the prescriptions: 75%, 60-85), obesity hypoventilation syndrome ( 10%, 2-15), overlap syndrome ( 10%, 0-20) and restrictive lung disease ( 5%, 2-10). For utilization of NIV at home, Bilevel positive airway pressure-spontaneous mode ( 40%, 0-80) and oronasal mask ( 90%, 60-100) were stated as the most frequently recommended mode and interface, respectively. Pressure settings were most often titrated based on arterial blood gas findings ( 79.2%). Humidifier was stated not to be prescribed by approximately half of the physicians recommending domicilliary NIV, and the main reason for this ( 59.2%) was being un-refundable by social security foundation. Conclusion: There is a wide variation in Turkey for prescription of NIV, which is supposed to improve clinical course of patients with CRF. Further studies are required to determine the possible causes of these differences, frequency of use and patient outcomes in this setting.Öğe Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use in acute respiratory failure(Turkish Assoc Tuberculosis & Thorax, 2015) Ugurlu, Aylin Ozsancak; Ergan, Begum; Takir, Huriye Berk; In, Erdal; Ozyilmaz, Ezgi; Edipoglu, Ozlem Ertan; Acarturk, Eylem; Balbay, Ege Gulec; Dilektasli, Asli Gorek; Kivanc, Tulay; Ekren, Pervin Korkmaz; Ulasli, Sevinc Sarinc; Dogrul, Ilgaz; Ucar, Elif Yilmazel; Olgun, Sehnaz; Devran, Ozkan; Ergun, Recai; Karakurt, ZuhalIntroduction: Noninvasive mechanical ventilation (NIV) has been increasingly used worldwide for acute respiratory failure (ARF), especially in patients with chronic lung disorders. We aimed to define the approach of pulmonologists in Turkey to NIV use for ARF management. Materials and Methods: A 38-question survey, developed and tested by authors, was distributed by e-mail to a total of 2.205 pulmonologists in Turkey. Results: Response rate was 27% (n=596). Seventy-one percent of responders were practicing NIV in clinic. NIV use was found to be associated with responder's academic title, age, duration of medical license, type of physician's hospital and its region, patient load, NIV experience during residency, and duration of NIV and intensive care unit (ICU) experience (p<0.001). Based on sub-group analysis of responders using NIV, median number of NIV patients followed-up per week was 4 [interquartile range (IQR): 2-6]. Most of the NIV users reported employment of wards (90%) and/or ICUs (86%) to follow-up patients, while 8.4% of the responders were applying NIV only in ICU's. Chronic obstructive lung disease (COPD) (99.5%), obesity hypoventilation syndrome (93.7%) and restrictive lung disease (89.4%) were the most common indications. Majority of NIV users (87%) were applying NIV to > 60% of patients with COPD, and success rate in COPD was reported as over 60% by 93% of users. Oronasal mask (median and IQR 90, 80-100%, respectively) and home care NIV ventilators (median and IQR 50, 10-85%, respectively) were the most commonly utilized equipment. Conclusion: NIV use in ARF varies based on hospital type, region and, especially, experience of the physician. Although consistent with guidelines and general practice, NIV use can still be improved and increased.Öğe Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers(Bilimsel Tip Publishing House, 2018) Ediboglu, Ozlem; Mocin, Ozlem Yazicioglu; Ozyilmaz, Ezgi; Salturk, Cuneyt; Onalan, Tugba; Seydaoglu, Gulsah; Celikel, Turgay; Arikan, Huseyin; Ataman, Sena; Kirakli, Cenk; Ozcelik, Zerrin; Kultufan, Sema; Kara, Iskender; Kara, Atilla; Dagli, Emine; Bulbul, Selma Duru; Kahveci, Kadriye; Dincer, Metin; Senoglu, Nimet; Ozkarakas, Huseyin; Bahar, Ilhan; Cengiz, Melike; Ramazanoglu, Atilla; Celik, Burcu; Gaygisiz, Ummugulsun; Kir, Gulay; Bindal, Ahmet; Akan, Belgin; Turan, Isil Ozkocak; Yildirim, Fatma; Basarik, Burcu; Ulukan, Zeliha Arslan; Efe, Serdar; Sungur, Murat; Temel, Sahin; Izdes, Seval; Hosgun, Derya; Karadeniz, Nurhan; Tuncay, Eylem; Goksenoglu, Nezihe Ciftarslan; Irmak, Ilim; Datli, Utku; Zerman, Avsar; Akdag, Devrim; Ozdemir, Levent; Elay, Gulseren; Karacayir, Yucel; Topeli, Arzu; Hanci, Pervin; Kaya, Esat Kivanc; Guven, Pinar; Sazak, Hilal; Aydemir, Semih; Aygencel, Gulbin; Aydemir, Yusuf; Doganay, Zahide; Komurcu, Ozgur; Hanci, Volkan; Karakoc, Emre; Sozutek, Didem; Coskun, Guven; Ates, Gungor; Tiryaki, Civan; Soyturk, Ayse Nur; Girgin, Nermin Kelebek; Caliskan, Gulbahar; Biyikli, Oben; Gokmen, Necati; Koca, Ugur; Ciledag, Aydin; Suner, Kezban Ozmen; Cinel, Ismail; Arslantas, Mustafa Kemal; Gul, Fethi; Ergun, Recai; Yilmaz, Nafiye; Altintas, Defne; Talan, Leyla; Yalcinsoy, Murat; Gullu, Mehmet Nezir; Ozcan, Perihan Ergin; Orhun, Gunseli; Savran, Yusuf; Tokur, Murat Emre; Akpinar, Serdar; Sen, Pelin; Gursel, Gul; Serifoglu, Irem; Gedik, Ender; Balbay, Oner Abidin; Akbas, Turkay; Cesur, Sinem; Yolacan, Hulya; Sagmen, Seda Beyhan; Ekren, Pervin Korkmaz; Bacakoglu, Feza; Ergan, Begum; Gunay, Ersin; Sariaydin, Muzaffer; Saglam, Dursun Ali; Karakurt, Sait; Eryuksel, Emel; Oztuna, Funda; Murtezaoglu, Emine Sevil Ayaydin; Cinemre, Hakan; Nalbant, Ahmet; Yagmurkaya, Oznur; Mandal, Tugba; Ikidag, BelginOBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.Öğe Evaluation of nephrotoxicity and prognosis in patients treated with colistin due to hospital-acquired pneumonia(Turkish Assoc Tuberculosis & Thorax, 2017) Korkmaz Ekren, Pervin; Toreyin, Zehra Nur; Berk Takir, Huriye; Kalamanoglu Balci, Merih; Gaygisiz, Ummugulsum; Gursel, Gul; Ergan, Begum; Yalcin, Aslihan; Salturk, Cuneyt; Aydogdu, Muge; Ergun, Recai; Guven, Pinar; Ulubay, Gaye; Gurun Kaya, Aslihan; Celtik, Aygul; Uluer, Hatice; Bacakoglu, Feza; Sayiner, AbdullahIntroduction: Colistimethate sodium (CMS) is frequently used in the treatment of nosocomial multidrug-resistant gram-negative infections. Nephrotoxicity is the most important side effect. The aim of this study is to evaluate the effect of colistin on nephrotoxicity and to assess prognosis in patients treated with CMS due to hospital-acquired pneumonia (HAP). Materials and Methods: Patients treated with CMS for HAP due to multidrug-resistant Pseudomonas aeruginosa or Acinetobacter baumannii were included in this cohort study. Results: We evaluated 281 patients treated with two different brands of CMS whose administration dose is different: imported (n=58, low dose/kg) and domestic (n=223, high dose/kg). Nephrotoxicity developed in 175 patients (62.3%). The median age (73 vs. 66 years, p=0.004) and mortality rates were higher (66.9% vs. 52.8%, p=0.022) in patients having nephrotoxicity. The patients receiving high dose/kg had higher nephrotoxicity rate (67.7% vs. 41.4%, p < 0.001). The clinical, bacteriological response and mortality rates of the whole group were 52.0%, 61.0%, 61.6%, respectively. The clinical and bacteriological response rates were similar in the different dose groups. Multivariate analysis showed that nephrotoxicity was associated with domestic brand depending on use of high dose (OR=3.97), advanced age (beta=0.29, p=0.008), male gender (OR=2.60), hypertension (OR=2.50), red blood cells transfusion (OR=2.54), absence of acute kidney injury (OR=10.19), risk stage of RIFLE (OR=11.9). Conclusion: Nephrotoxicity is associated with the use of high dose colistin, age, gender, hypertension, red blood cells replacement and RIFLE stage. The mortality rate is higher in patients developing nephrotoxicity.Öğe A multicenter randomized trial for the effectiveness of structured discharge and follow-up protocol on readmission rate in COPD patients receiving LTOT/NIV: one-year interim analysis.(European Respiratory Soc Journals Ltd, 2018) Ergan, Begum; Goktalay, Tugba; Ergun, Pinar; Yilmaz, Dicle; Ocakli, Birsen; Gurgun, Alev; Demirci, Nilgun; Elverisli, Fatih; Ucar, Elif Yilmazer; Durmaz, Ali; Dilektasli, Asli Gorek; Aksoy, Emine; Elmas, Funda; Kokturk, Nurdan; Aytekin, Fuat; Akgun, Metin; Ozyilmaz, Ezgi; Cetinoglu, Ezgi Demirdogen; Tuncay, Eylem Acarturk; Tasbakan, Sezai; Balbay, Oner; Demir, Ahmet Ugur; Ergun, Recai; Savci, Sema; Karakurt, Zuhal; Ekinci, Banu; Gemicioglu, Bilun; Yorgancioglu, ArzuÖğe The Role of Aerolized Colistin in the Treatment of Hospital-Acquired Pneumonia: Experience of Multicenter From Turkey: Erratum (vol 44, pg e304, 2016)(Lippincott Williams & Wilkins, 2018) Ekren, Pervin Korkmaz; Toreyin, Nur; Takir, Huriye Berk; Balci, Merih Kalamanoglu; Gaygisiz, Ummugulsum; Gursel, Gul; Ergan, Begum; Yalcin, Aslihan; Salturk, Cuneyt; Aydogdu, Muge; Ergun, Recai; Guven, Pinar; Ulubay, Gaye; Kaya, Aslihan Gurun; Celtik, Aygul; Uluer, Hatice; Bacakoglu, Feza; Sayiner, Abdullah
