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    The effect of HA330 hemoperfusion adsorbent method on inflammatory markers and end-organ damage levels in sepsis: a retrospective single center study
    (Verduci Publisher, 2022) Erkurt, M. A.; Sarici, A.; Ozer, A. B.; Kuku, I; Bicim, S.; Aydogan, M. S.; Kose, A.
    OBJECTIVE: In this study, we aimed at evaluating the impact of HA330 hemoperfusion adsorbent application on inflammatory markers and end-organ damage markers in patients with sepsis/septic shock. PATIENTS AND METHODS: Patients who were diagnosed with sepsis/septic shock and treated with HA330 hemoperfusion adsorbent in addition to the standard treatment were included in this retrospective study conducted at Inonu University Turgut Ozal Medical Center between January 1, 2019 and January 1, 2021. RESULTS: A total of 150 patients were included in the study. The mean +/- SD age of the patients was 51.9 +/- 17.7 years. 102 patients (68%) were in septic shock. Mean +/- SD APACHE II scores were 15.3 +/- 4.8. The need for mechanical ventilation was noted in 64 patients (42.7%). WBC, neutrophil count, hemoglobin, platelet count, BUN, creatinine, AST, ALT, CRP and procalcitonin levels were measured before and after the procedure. Overall, 104 patients (69.3%) died median (min-max) 2.5 (1-114) days after the cytokine adsorption, while 46 patients (30.7%) recovered from sepsis and were discharged. The increase in BUN levels and decrease in platelet count after the procedure were statistically significant ( p= 0.001, 0.041, respectively) in the overall study population. The laboratory findings in 46 survivors indicated significantly decreased AST and ALT levels after cytokine adsorption compared to baseline pre-treatment levels. WBC, neutrophil count, CRP, procalcitonin, BUN and creatinine values were also decreased after cytokine adsorption in survivors, whereas the change was not statistically significant. There was also a non-significant tendency for an increase in platelet count and hemoglobin levels after cytokine adsorption compared to pre-treatment values in these patients. CONCLUSIONS: Although no effect of HA330 hemoperfusion application on inflammatory markers and end- organ damage markers was demonstrated in our study, we used the HA330 hemoperfusion adsorbent method as a last resort in terminal patients with a mortality rate of approximately 90% and for whom antibiotic treatment did not benefit. Therefore, multicenter, prospective studies are needed to clarify the effect of early HA330 hemoperfusion use in the treatment of sepsis.
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    Inhaled nitric oxide as rescue therapy in severe ARDS cases due to COVID-19 pneumonia: a single center experience
    (Verduci Publisher, 2023) Bicakcioglu, M.; Kalkan, S.; Duzenci, D.; Yalcinsoy, M.; Dogan, Z.; Ozer, A. B.
    OBJECTIVE: Inhaled NO (iNO) has been recommended as rescue therapy in acute respiratory stress syndrome (ARDS) cas-es. In this study, we aimed to demonstrate the efficacy of iNO as a rescue therapy in patients with severe ARDS due to COVID-19.PATIENTS AND METHODS: This retrospec-tive study included patients with ARDS due to COVID-19 who were treated with iNO between March 2020 and January 2022 in the intensive care unit (ICU) of Inonu University. Patients' files were reviewed retrospectively, and de-mographic data, APACHE II and Sequential Or-gan Failure Assessment (SOFA) scores, initia-tion day of iNO and duration of iNO treatment, length of stay in hospital/ICU, blood biochem-istry values, complete blood counts, inflamma-tory parameters, arterial blood gas values, lac-tate, PaO2/FiO2 ratios, anti-inflammatory drugs and outcome were recorded.RESULTS: Data from 16 patients were reached. iNO was given at a dose of 20 ppm continuously. The mean duration of treatment with iNO was 3.5 days. All patients took the prone position except a single patient. While all patients received steroid therapy, four pa-tients received anti-cytokine therapy, and five patients received intravenous immunoglobulin therapy. All patients were in severe ARDS with a mean PaO2/FiO2 ratio of 58 before iNO ther-apy. A significant increase in PaO2/FiO2 val-ues was detected with the use of iNO (p<0.05). While three patients (19%) were discharged from the ICU, thirteen patients died.CONCLUSIONS: In our study, it was deter-mined that iNO applied as a rescue treatment in patients with severe ARDS improved oxygen-ation. Although the effect of iNO on survival was low, it may be interpreted as clinically signifi-cant considering the severity of the general clin-ical condition of the patients.
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    Management of mechanical ventilation in a morbidly obese patient with COVID-19-induced ARDS
    (Verduci Publisher, 2021) Demircan, S.; Disli, Z. Korkmaz; Kalkan, S.; Ozer, A. B.
    Coronavirus disease 2019-induced acute respiratory distress syndrome (AR-DS) is more severe in morbidly obese patients. Mechanical ventilation differs between obese and non-obese patients. We examined these differences in an obese (body mass index = 47 kg/m(2)) 32-year-old patient followed up in our clinic. The patient was admitted to the intensive care unit due to respiratory failure. Recruitment maneuvers were performed in pressure-controlled ventilation mode. The optimal positive end-expiratory pressure was 25 cm H2O. The inspiratory pressure was adjusted to 45 cm H2O to provide a tidal volume of 6 ml/kg and driving pressure <= 15. The patient was discharged with full recovery.
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    Tracheomediastinal emphysema after tracheostomy in a post-COVID-19 patient: a case report
    (Verduci Publisher, 2022) Bicakcioglu, M.; Demircan, S.; Yucel, A.; Ozer, A. B.
    OBJECTIVE: There are no reports of tracheomediastinal fistula development after tracheostomy. CASE REPORT: A 72-year-old female patient with post acute COVID-19 was transferred to our intensive care unit. After two unsuccessful weaning attempts, a tracheostomy was performed at hospitalization on day 32. The patient's body mass index was 35 kg/m2 and she had a narrow neck anatomy. A percutaneous tracheostomy was performed using the Griggs method without any problems. Pneumothorax, pneumomediastinum, subcutaneous emphysema, and hemorrhage were not observed. Twenty-two days after the tracheostomy, the patient developed subcutaneous emphysema and experienced a sudden decrease in oxygen saturation. Bedside anterior-posterior chest X-ray did not detect pneumothorax and a tracheoesophageal fistula was found via esophageal endoscopy. A tracheomediastinal fistula was observed just below the cannula distal end via computed tomography. CONCLUSIONS: There are multiple reasons why a tracheomediastinal fistula could develop after tracheostomy. Therefore, this condition should be considered in cases of sudden subcutaneous emphysema and oxygen deterioration following tracheostomy.