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    Predictors of postoperative prolonged mechanical ventilation after left ventricular assist device surgery
    (2020) Sahinturk, Helin; Atar, Funda; Ozdemirkan, Aycan; Sezgin, Atilla; Zeyneloglu, Pinar; Pirat, Arash
    Aim: Prolonged mechanical ventilation (PMV) after cardiovascular surgeries is associated with morbidity and mortality. The aim of the study was to determine the risk factors for postoperative PMV (PPMV) after left ventricular assist device (LVAD) surgery.Material and Methods: We retrospectively analyzed the data of patients who underwent LVAD surgery between 2011 and 2016. Prolonged mechanical ventilation was defined as postoperative tracheal extubation 24 hours after the patient is admitted to the ICU. Patients were divided into two groups whether they were extubated within 24 hours of surgery or extubated after 24 hours following surgery.Results: During the study period, a total of fifty-seven patients were admitted to ICU. Fifty-seven patients’ data were screened. The mean age of the 57 patients enrolled was 44.6 ± 16.1 years. Of them, 82% were male, and 54 (95%) patients had dilated cardiomyopathy diagnosis. A total of 26 (46%) patients required PPMV. The two groups were similar in terms of demographics, duration of surgery, postoperative LVAD flow rates, presence of preoperative MV, infections, and circulatory support devices (p > 0.05). Patients who required PPMV underwent more revision surgeries [14 (54%) vs. 2 (7%), p 0.001] and had higher incidences of acute kidney injury (AKI) on the first day after the surgery [13 (50%) vs. 4 (13%), p = 0.003] compared with those who did not require PPMV. Furthermore, the patients who required PPMV also required more renal replacement therapies postoperatively [12 (46%) vs. 5 (16%), p = 0.02] and had longer intensive care unit stay (30.1±25.2 days vs. 14.0 ±11.4 days, p = 0.002) and had higher hospital mortality (58% vs. 35%, p = 0.043) and 30-day mortality (38% vs. 16%, p = 0.042) than those who did not require PPMV. Logistic regression analysis revealed postoperative AKI as an independent risk factor for PPMV (OR = 0.223, 95% CI 0.067–0.743, p = 0.015).Conclusion: Our results revealed that almost half of the patients who underwent LVAD surgery required PPMV. AKI on the first day following surgery is an independent risk factor for PPMVs.
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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.