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    Brain death: Our experiences in intensive care unit
    (2019) Yesiler, Fatma Irem; Kosovali, Behiye Deniz; Bayar, Mustafa Kemal
    Aim: The aim of this study was to examine patients retrospectively with brain death (BD) who were diagnosed in our intensive care unit (ICU). Material and Methods: This retrospective descriptive study evaluated 24 patients with diagnosed BD in the ICU between January 2012 and December 2015 using digital patient records. We registered demographic, clinical and laboratory findings, Acute Physiology and Chronic Health Evaluation System (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, Glasgow Coma Score (GCS), development of complications, donation rate, time of BD diagnosis and length of ICU stay. Results: Twenty-four patients (11 males, 13 females) with BD whose ages were between 24–83 years old. The etiologies of BD diagnosis were medical causes in 20 cases (83.3 %) and traumatic causes in 4 cases (16.7 %). Subarachnoid haemorrhage due to a cranial aneurysm was the most common cause of ICU admission (n = 6). The mean APACHE II score was 16 ± 5.2, GCS was 4.25 ± 2.5, and the SOFA score was 8.4 ± 3.5 on ICU admission. The mean time of BD diagnosis was 147.8 ± 19 hours and the mean length of ICU stay was 8.8 ± 7.7 days. Confirmatory tests (cranial angiography, cranial Doppler, cranial CT angiography) were performed on 16 patients. The acceptance rate for organ donation was 45.8% (n = 11). Conclusion: The intensivist should target to both confirm and declare the diagnosis of BD in the shortest time and increase the number of organs transplanted per donor.
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    Triage and management of probable Covid-19 patients in the intensive care unit during the pandemic period
    (2021) Yesiler, Fatma Irem; Kandemir, Emre; Akmatov, Nursultan; Kandemir, Tunay; Yanik Yalcin, Tugba; Sahinturk, Helin; Gedik, Ender; Zeyneloglu, Pinar
    Aim: Republic of Turkey Ministry of Health dedicated our hospital as a transplant center during the pandemic period. We admitted probable Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infection (COVID-19) cases and intensive care unit (ICU) patients from other centers, while confirmed COVID-19 cases were transferred to dedicated pandemic hospitals. The aim of this study was to determine the demographic parameters, clinical courses and outcomes of probable COVID-19 patients and to compare survivors with non-survivors admitted to our ICU. Materials and Methods: After Ethics Committee approval, 93 patients admitted to our ICU between March 23 and May 13 were analyzed retrospectively. Results: Mean age was 68.5y (60.2% male). Dyspnea (67.7%) was the most common symptom and hypertension (68.6%) was the most common comorbidity. None of PCR tests for SARS-CoV-2 were positive. Bilateral ground-glass (25.8%) and consolidation (14%) were the most common signs at chest computed tomography. Mean Acute Physiology and Chronic Health Evaluation System (APACHE II) score was 20.2 at ICU admission. Fifty-seven patients (61.3%) had pneumonia findings in lung X-ray or computerized tomography (CT). Thirty-four patients (36.6%) received low flow oxygen, six (9.7%) had high flow nasal oxygen and 27 (29%) had invasive mechanical ventilation. Forty patients (43%) had vasopressor therapy and 24 (25.8%) patients had renal replacement therapy due to acute kidney injury. Laboratory data including D-dimer, C-reactive protein, ferritin, creatinine kinase and procalcitonin were significantly higher in non-survivors when compared to survivors. The overall ICU mortality rate was 44.1%. Conclusions: A triage protocol of Turkish Study of Scientific Board based on clinical, laboratory and radiological findings for probable COVID-19 patients was applied in our center during the pandemic period. So, we ensured the effective usage of scarce ICU resources. The mortality rate of probable COVID-19 patients admitted to our ICU was found to be higher than the predicted mortality rate according to their APACHE-II score.