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Catheter related infections and colonizations of single / multiple lumen central venous catheters in critically ill patients
(2002) Ayanoglu H.Ö.; Derbent A.; Moral A.R.
The aim of this study is to evaluate the central venous catheter infections or colonizations in our "Reanimation Unit" and the effects of lumen number or existence of parenteral nutrition (PEN) on the incidence. During a period of two years (1994-1995), 789 microbiologic samples from 263 central venous catheters placed to critically ill patients of various etiologies in our "Reanimation Unit" were examined. The microbiologic results of 3 samples including the 5 cm of the catheter tip, catheter skin exit site swab and peripheral blood culture at the same time were altogether taken into account for each catheter. A catheter was removed if an infection related to it was suspicious, or an infection without any evident source existed, if the catheter was occluded or it was not required anymore. The data evaluated consisted of microbiologic results and the patients' APACHE II scores, the SIRS criteria at the removal day, duration of catheterization, the number of lumens catheter had and whether parenteral nutrition was given via the catheter. The statistical analyses were performed by using Student's t test and the Chi square test. The catheter infection rate was 37/ 263 (14.1%) and the catheter colonization rate was 58/ 263 (22.1%). This study shows us that multi-lumen central venous catheters or PEN via central catheters do not cause catheter colonization or infection when compared with single lumen catheters without PEN respectively. Catheter colonizations are mostly seen in SIRS patients whereas catheter infections might not be primary cause of sepsis in the critically ill.
Effect of fluconazole prophylaxis on fungal colonisation in ICU patients
(1994) Moral A.R.; Tumbay E.; Ulusoy B.; Aksoy N.; Cevik A.; Inci R.
In this study, the effect of fluconazole prophylaxis on the incidence of fungal (yeast) colonization in multidisciplinary ICU patients were investigated. A total of 252 patients were mycologically screened in the first week of their hospitalization and followingly once every week. The specimens studied were blood (from venous route and from central venous catheter) urine catheter, endotracheal tubes, oral cavity, nares, skin and rectal swabs. The fungus isolated was candida. 91 received fluconazole 100 mg/day IV or enterally for prophylaxis and 161 served as the control group. Total number of samples in study was 2852 and 1723 of these samples were from the control group, 27.5% being positive. 1129 samples were taken from the prophylaxis group while 18.8% were positive. In conclusion, prophylactic treatment with 100 mg/day fluconazole significantly decreases the incidence of fungal colonization in ICU patients (p<0.01).
The effect of granulocyte colony-stimulating factor on mortality rate in experimental sepsis [DENEYSEL SEPSISTE GRANULOSIT KOLONI-STIMULAN FAKTOR UYGULANMESININ MORTALITEYE ETKISI]
(1996) Ayanoglu H.O.; Canturk Z.; Koca U.; Moral A.R.
Neutrophils have an important role in the initial phase of host defense. One of the growth factors, Granulocyte Colony-Stimulating Factor (G-CSF) enhances neutrophil counts and functional capacity. The aim of this study was to investigate the effect of recombinant human (rh) G-CSF on mortality rate in an experimental sepsis model performed by 'Cecal Ligation and Puncture' (CLP) in rats. Totally 48 rats were separated into 3 groups and SF alone (Group I) or antibiotic alone (Group II) or antibiotic + G-CSF (Group III) were injected 24 hours before CLP procedure. The calculated absolute neutrophil counts of the blood samples taken by cardiac puncture at the 24th hour after CLP were significantly higher in Group III when compared to the other groups and the control samples which were taken before the study period (p<0.05). At the end of the seven days observation period the mortality rate of antibiotic + G-CSF injected Group III was 26.7 % and was significantly lower than the other two groups (p<0.05). No significant difference was observed in between the mortality rates of 75 % in Group I and 70 % in Group II (p>0.05). Further investigations are necessary for G-CSF to be used widely in clinical pratice.
The effect of n-acetylcysteine on oxidative stress in induced hemorrhagic shock model in rats [Ratlarda Oluşturulan Hemorapk Şok Modelinde N-Asetilsistein'in Oksidatif Stres Üzerine Olan Etkisi]
(2009) Eriş O.; Çankayali I.; Sezer E.; Solak L.; Demirag K.; Moral A.R.
Aim:It was brought forward that reactive oxygen species (ROS) released by the activation of the immuno-inflamatory mediators in the late period of the hemorrhagic shock lead to multiple organ failure. For this reason in our study investigation of the effects of n-acetylcysteine (NAC); one of the antioxidant agents with approved free radical collecting property was aimed. Material and Methods: Sixteen adult Winstar rats were randomly divided into two groups. Blood samples were withdrawn within 15 minutes from mechanically ventilated rats in which hemorrhagic shock model was induced. After 60 minutes of hemorrhagic shock, autologous blood and crystalloid infusions were given until the mean arterial pressure reached to 80-90 mmHg in Group I. In the Group 2, N-acetylcysteine 150 mg/kg IV were given concomitantly with autologous blood and crystalloid infusions. After the end of one hour period, malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) levels in blood samples obtained before and after the hemorrhagic shock were measured. Results: When changes in MDA, SOD and CAT values relative to baseline and intergroup comparisons of these changes occurring in these parameters were considered, any statistically significant difference was not detected. Conclusion: It was observed that in moderate hemorrhagic shock model where MAP was kept between 50 and 55 mmHg, any increase in ROS was not detected ,and NAC did not have any protective effect in this experimental model. It is concluded that in order to clarify this issue different hemorrhagic shock models where MAP values are maintained at lower levels are needed.
The effect of pralidoxime on blood catecholamine levels in experimental Organophosphate Intoxication [Deneysel organik fosfor zehirlenmesinde pralidoksimin kan katekolamin düzeyine etkisi]
(2009) Çankayali I.; Demirag K.; Eriş O.; Solak I.; Ersöz B.; Moral A.R.
Aim: Although the clinical symptoms of organophosphate intoxication show up as cholinergic hyperactivity due to muscarinic receptor activation, the symptoms of sympathetic hyperactivity through nicotinic receptors and its central effects can also be seen clinically. Activation of the sympathoadrenal system leads to the emergence of some immunologic reactions, hemodynamic instability and additional undesirable problems and prolongation of the therapy. In our study investigation of the effects of acetylcholinesterase enzyme reactivator pralidoxime (PAM) on sympathetic hyperactivity was aimed. Material and Method: Seventeen Wistar rats were randomly divided into two groups. After induction of anesthesia, tracheotomy and catheterization of the internal carotid artery were performed. Drugs were injected into the rats as follows: Group I (n=9; 70 mg kg -1 IP DDVP+10 mg kg -1 IP Atropine) Group II (n=8; 70 mg kg -1 IP DDVP+10 mg kg -1 IP Atropine+ 40 mg kg -1 PAM). Plasma levels of epinephrine, norepinephrine and dopamine were measured. Biochemical and hemodynamic data were analyzed statistically, and p<0.05 was accepted as statistically significant. Results: Blood catecholamine levels and hemodynamic findings were not statistically different between groups. Conclusion: We conclude that in organophosphate intoxications PAM has no effect on the development of sympathomimetic hyperactivity mediated via blood nicotinic receptors.
The effects of branched-chain amino acids on the oxygen consumption in patients with metabolic stress [Metabolik stresli hastalarda dallanmis zincirli aminoasitlerin oksijen tuketimine etkisi]
(1999) Sakarya M.; Mert S.; Moral A.R.
In recent years, there has been a much controversy about the feasibility of amino acid solutions with a high content of branched-chain amino acids (BCAA: leucine, isoleucine, valine) in fields of hepatic failure, trauma, obtaining a better nitrogen balance, low morbidity and low mortality. The aim of this study was to establish the effects of BCAA infusions on the oxygen consumption (VO2) in patients with metabolic stress. We studied nine patients who were mechanically ventilated suffering from acute respiratory failure. Muscle relaxants, sedation and volum controlled mechanical ventilatory support were applied to all patients. Daily energy supply was obtained with standard enteral formulas 1 kcal/mL. In addition to daily energy requirement, 0,5 g/kg amino acid solution which contains % 45 BZAA was infused parenterally in 6 hours. Before (I) and after (II) 6 hours infusion VO2 were calculated with thermodilution technique via pulmonary arterial catheter. Wilcoxon was used for statistically comparisons. We conclude that, although the statistical difference was non-significant between two measurements there seems to be a relative increase of VO2 consumption with the use of BCAA and this may be important in the ICU for critically ill patients with poor oxygen supply.
The effects of dobutamine on oxygen consumption and energy expenditure in nonseptic and septic patients [Dobutamin'in septik olmayan ve septik hastalarda oksijen ve enerji tuketimi uzerine etkisi]
(1997) Sakarya M.; Ulukaya E.; Cevik A.; Moral A.R.
In this study, the effects of dobutamine infusion, given at 3 µg/kg/min and 6 µg/kg/min, on oxygen consumption (VO2) and energy expenditure (EE) were evaluated in ten nonseptic and ten septic patients. Each dose of dobutamine was infused for 30 minutes. All patients were monitorized with both a radial artery and a pulmonary artery catheter. Cardiac output was measured using thermodilution technique. VO2 and EE were calculated before debutamine infusion as control, and at the end of each dose dobutamine infusion. The mean EE of control, after 3 µg/kg/min and 6 µg/kg/min of dobutamine were 1850±108, 2086±157, 2067±100 kcal/day, respectively, in nonseptic patients; 1781±104, 1905±103, 1985±101 kcal/day, respectively, in septic patients. Compared with control measurements, EE increased by 11% in response to maximum dose of dobutamine infusion in two groups. There were no differences between the nonseptic and septic patients. We conclude that the additional energy demands imposed by dobutamine infusion needs to be taken into account to determine the energy requirements of critically ill patients.
The effects of standard and branched chain amino acid enriched solutions on thermogenesis and energy expenditure in unconscious care patients
(Churchill Livingstone, 2004) Cankayali I.; Demirag K.; Kocabas S.; Moral A.R.
Background & Aims: This study aims to compare the effects of standard and branched chain amino acid enriched solutions on thermogenesis and energy expenditure in unconscious and mechanically ventilated intensive care patients. Designs: The study was carried out at multidisciplinary intensive care unit. Twenty unconscious and mechanically ventilated patients (18-65 years of age) were included in the study. Patients were hemodynamically stable and all received continuous enteral nutrition. Energy expenditure was calculated using the Harris-Benedict Equation for all of the patients. Patients were randomly assigned to receive a 4 h infusion of 0.4 g/kg protein as amino acid solution. Group I (n = 10) received standard amino acid solution and group II (n = 10) received branched chain amino acid enriched solution. Energy expenditure, oxygen consumption and carbon dioxide production were measured by indirect calorimetric method every 30 min during the 4 h infusion period and 3 h thereafter. Rectal temperature was recorded concomitantly with the metabolic measurements throughout the study. Results: There was a statistically significant increase in body temperature during the infusion of amino acid solution between 30 and 210 min in group I and between 30 and 120 min in group II (P < 0.05). We observed a significant increase in energy expenditure at 30, 150, 180 and 210 min in group I and at 30-240 min in group II (P < 0.05). There were no differences between the two groups in terms of thermogenesis or energy expenditure values during the study (P > 0.05). Conclusion: Thermogenesis and energy expenditure values were increased during the parenteral infusion of both standard amino acid and branched chain amino acid enriched solutions in unconscious intensive care patients without any significance in between. © 2003 Elsevier Ltd. All rights reserved.
The evaluation of diagnostic accordance between plain radiography and bone scintigraphy for the assessment of sternum and rib fractures in the early period of blunt trauma.
(2001) Erhan Y.; Solak I.; Kocabas S.; Sözbilen M.; Kumanlioglu K.; Moral A.R.
OBJECTIVE: To evaluate the diagnostic accordance between scintigraphy and radiography in the early period following blunt thoracic trauma. DESIGN: Double-blind, prospective clinical study. METHODS: Thirty-four adult patients with blunt thoracic trauma were examined by plain radiography and scintigraphy within 24 hours of trauma. RESULTS: Radiography displayed pathologies in 25 (73.5%), while scintigraphy suggested pathologies in 24 (70.5%) patients. Rib fractures were identified radiographically in 16 (47%) and scintigraphically in 17 (50%) patients. Lateral radiograph of the sternum showed fracture in 10 (52.6%), while scintigraphy suggested fracture in 14 (73.6%) patients with suspected sternal trauma. CONCLUSION: Scintigraphy gave better results in the evaluation of sternal fractures during the early period of thorax trauma. Conventional plain radiography is thought to be the initial imaging modality, because it saves time and shows hemothorax or pneumothorax besides the osseous abnormality.
Neuromuscular functions on experimental acute methanol intoxication
(AVES İbrahim KARA, 2015) Moral A.R.; Çankayalı İ.; Sergin D.; Boyacılar Ö.
Objective: The incidence of accidental or suicidal ingestion of methyl alcohol is high and methyl alcohol intoxication has high mortality. Methyl alcohol intoxication causes severe neurological sequelae and appears to be a significant problem. Methyl alcohol causes acute metabolic acidosis, optic neuropathy leading to permanent blindness, respiratory failure, circulatory failure and death. It is metabolised in the liver, and its metabolite formic acid has direct toxic effects, causing oxidative stress, mitochondrial damage and increased lipid peroxidation associated with the mechanism of neurotoxicity. Methanol is known to cause acute toxicity of the central nervous system; however, the effects on peripheral neuromuscular transmission are unknown. In our study, we aimed to investigate the electrophysiological effects of experimentally induced acute methanol intoxication on neuromuscular transmission in the early period (first 24 h). Methods: After approval by the Animal Experiment Ethics Committee of Ege University, the study was carried out on 10 Wistar rats, each weighing about 200 g. During electrophysiological recordings and orogastric tube insertion, the rats were anaesthetised using intra-peritoneal (IP) injection of ketamine 100 mg kg-1 and IP injection of xylazine 10 mg kg-1. The rats were given 3 g kg-1 methyl alcohol by the orogastric tube. Electrophysiological measurements from the gastrocnemius muscle were compared with baseline. Results: Latency measurements before and 24 h after methanol injection were 0.81±0.11 ms and 0.76±0.12 ms, respectively. CMAP amplitude measurements before and 24 h after methanol injection were 9.85±0.98 mV and 9.99±0.40 mV, respectively. CMAP duration measurements before and 24 h after methanol injection were 9.86±0.03 ms and 9.86±0.045 ms, respectively. Conclusion: It was concluded that experimental methanol intoxication in the acute phase (first 24 h) did not affect neuromuscular function. © 2015 by Turkish Anaesthesiology and Intensive Care Society.
Nutritional risk of hospitalized patients in Turkey
(2009) Korfali G.; Gündogdu H.; Aydintug S.; Bahar M.; Besler T.; Moral A.R.; Oguz M.; Sakarya M.; Uyar M.; Kiliçturgay S.
Background & aims: We conducted a multicentre study to assess nutritional risk at hospital admission, hospital-associated iatrogenic malnutrition and the status of nutritional support in Turkish hospitals. Methods: A database which allowed for online submission of hospital and patient data was developed. A nutritional risk screening system (NRS-2002) was applied to all patients and repeated weekly in patients with hospital stays greater than one week and no invasive procedures. Patient-specific nutritional support was recorded during the study period. Results: Thirty-four hospitals from 19 cities contributed data from 29,139 patients. On admission, 15% of patients had nutritional risk. Nutritional risk was common (52%) in intensive care unit patients and lowest (3.9%) in otorhinolaryngology patients. Only 51.8% of patients with nutritional risk received nutritional support. Nutritional risk was present in 6.25% of patients at the end of the first week and 5.2% at the end of the second week, independent of nutritional support. In patients with nutritional risk on admission who were hospitalized for two weeks and received nutritional support, the NRS-2002 score remained ?3 in 83% of cases. Conclusions: Nutritional risk is common in hospitalized Turkish patients. While patients at nutritional risk often do not receive nutritional support when hospitalized, nutritional risk occurs independent of nutritional support. © 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.
Putaminal necrosis after methanol intoxication [2]
(1997) Moral A.R.; Ayanoglu H.O.; Erhan E.
[No abstract available]
Recurrent spontaneous pneumothorax during the recovery phase of ARDS due to H1N1 infection
(Galenos Publishing House, 2013) Bor C.; Demirag K.; Uyar M.; Çankayali I.; Moral A.R.
The pregnant patients are prone to influenza A (H1N1) virus infection, which may rapidly progress to lower respiratory tract infection and subsequent respiratory failure and acute respiratory distress syndrome (ARDS). Pneumothorax might develop in ARDS under mechanical ventilation. But post-ARDS pneumothorax in spontaneously breathing patient has not been reported in the literature. We report a 31-year old pregnant woman infected with influenza A (H1N1) virus and progressed to ARDS. Mechanical ventilation with high PEEP improved patient's gas exchange parameters within 3 weeks. However spontaneous pneumothorax was developed one week after she weaned off the ventilator. After successful drainage therapy, the patient was discharged. However she re-admitted to the hospital because of a recurrent pneumothorax one week later. She was discharged in good health after being treated with negative continuous pleural aspiration for 10 days. Influenza might cause severe pulmonary infection and death. In addition to diffuse alveolar damage, sub-pleural and intrapulmonary air cysts might occur in influenza-related ARDS and may lead to spontaneous pneumothorax. This complication should always be considered during the recovery period of ARDS and a long-term close follow-up is necessary. © Trakya University Faculty of Medicine.
Relationship of oxygen delivery and consumption during short term dobutamine infusion in septic and non-septic patients [Septik ve septik olmayan hastalarda kisa sureli dobutamin uygulamasinda oksijen sunumu - Tuketimi iliskisi]
(1998) Ulukaya S.; Ulukaya E.; Ayanoglu H.O.; Sakarya M.; Moral A.R.
In this study it was aimed to compare the increase in oxygen consumption in response to the increase in oxygen delivery after short term infusion of dobutamine in two groups of patients including 10 septic (Group I) and 9 non- septic (Group II) patients in our Reanimation Clinic. Both groups patients are elected from patients who had neuromuscular blockade, sedation and mechanical ventilatory support for acute respiratory failure, the septic group consisted of the patients having the two or more of the sepsis criteria. After maintaining standard monitoring the heart rate, MAP, MPAP, PCWP, CVP, Q measurements and arterial and mixed venous blood gas analysis together with CaO2, CvO2, a-vDO2, DO2, VO2, ERO2 calculations were performed. The measurements before the dobutamine infusion were recorded as the control values and the measurements were repeated after 30 minutes infusion of 3 µg/kg/min dobutamine and again after another 30 minutes infusion of 6 µg/kg/min infusion of dobutamine, in the septic group, the DO2 values increased from baseline values 954±192 mL/min/m2 to 1185±195 and to 1360±199 mL/min/m2 (p<0.01), and VO2 values increased from 246±41 mL/min/m2 to 1185±195 and to 1360±199 mL/min/m2 (p<0.01), and VO2 values increased from 246±41 mL/min/m2 to 1185±195 and to 1360±199 mL/min/m2 (p<0.01), and VO2 values increased from 246±41 mL/min/m2 to 270±45 and to 283±48 mL/min/m2 (p<0.05) respectively. In the septic group, DO2 values, increased from 940±222 mL/min/m2 to 1255±216 mL/min/m2 and to 1361±230 mL/min/m2 (p<0.01) and VO2 values increased from 269±50 mL/min/m2 mL/min/m2 and to 294±50 mL/min/m2 to 302±75 mL/min/m2 mL/min/m2 and to 294±47 mL/min/m2 (p<0.05) respectively. The DO2 increase in both groups were similar after the infusion dose was increased to 6 µg/kg/min, whereas the VO2 values in the non-septic group decreased without statistical significance when compared to the septic group (p>0.05). As a result lineer relation 'pathological oxygen delivery-consumption relationship' in the septic group and biphasix relation 'physiological oxygen delivery-consumption relationship' was found in the septic group.
Retrospective review of critically ill obstetrical patients: A decade's experience [Kritik obstetrik hastalari{dotless}n retrospektif degerlendirilmesi: On yi{dotless}lli{dotless}k deneyim]
(2011) Şimşek T.; Eyigör C.; Uyar M.; Karaman S.; Moral A.R.
Aim: To investigate the reasons for the admission of obstetrical patients to the intensive care unit (ICU) and their clinical outcomes, to compare the roles of the current scoring systems in estimating the mortality of these patients, and to determine adverse prognostic factors in critically ill obstetrical patients. Materials and methods: Data were retrospectively obtained from obstetrical patients admitted to the ICU in our institution between January 1999 and April 2009. Demographic characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, and Glasgow Coma Scale (GCS) score of patients at the time of their first ICU admission were recorded. Patients were divided into 2 groups for comparison: Group 1, patients who died in the ICU, and Group 2, patients who were discharged from the ICU. Results: Preeclampsia, eclampsia, and the hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP) were the most common diagnoses requiring ICU admission (65.1%). APACHE II, SOFA, and GCS values were significantly worse in Group 1 patients compared with Group 2 patients (P < 0.05). Conclusion: Scoring systems help to determine the probability of mortality in obstetrical patients. Utilizing these scoring systems may prevent both the unnecessary admission of low-risk patients and delayed ICU care for critically ill patients. © TÜBİTAK.

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