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    Comparison of the Clinical Effects of Ibuprofen and Paracetamol Used for Analgesic Purposes in Endoscopic Retrograde Cholangiopancreatography in Geriatric Patients
    (Taiwan Soc Geriatric Emergency & Critical Care Medicine-Tsgecm, 2020) Dogan, Guvenc; Kayir, Selcuk
    Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure that is used to visualize the biliary pancreatic ductal system following the intravenous (IV) injection of an opaque contrast medium. Ibuprofen, a propionic acid derivative, has analgesic, anti-inflammatory, and antipyretic features similar to a non-selective cyclooxygenase inhibitor. In this study, we aimed to evaluate the effect of ibuprofen on geriatric patients with ERCP. Methods: A total of 80 patients and age > 65 years, were included in the study. Participants were divided into three groups: group P (n = 27) was administered a 1000 mg/100 ml paracetamol infusion 30 minutes (min) before the procedure; group I (n = 28) was administered a 400 mg/100 ml ibuprofen IV infusion 30 min before the procedure; and group C (n = 25), a control group, was not administered analgesics before the procedure. Results: Group I was found to have a significantly lower intraoperative fentanyl dose than group P and C. The intraoperative propofol dose was lowest in group I and highest in group C. While visual analog scale (VAS) scores demonstrated no significant differences among the groups in the first 15 min after the procedure; group I was found to have significantly lower VAS levels in 30 min after the procedure. Conclusion: The present study compared the effects of ibuprofen and paracetamol administered prior to the ERCP procedure with results demonstrating a reduction in the dose of intraoperative narcotics with intravenous ibuprofen. Copyright (C) 2020, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
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    EVALUATION OF RISK FACTORS AND COMORBITIES OF THE ORTHOPEDIC PATIENTS TREATED IN INTENSIVE CARE UNIT
    (Carbone Editore, 2019) Dogu, Cifiangir; Mutlu, Nevzai Mehmef; Turan, Sualp; Karaca, Onur; Kayir, Selcuk; Turan, Isil Ozkocak
    Introduction: The aim of this study is to investigate the comorbidities of orthopedic patients followed up in intensive care unit and to investigate the comorbid relationship of complications requiring intensive care. Material and methods: Ankara Numune Research Hospital Intensive care patients over the age of 18 admitted from the operating room and from orthopedic service were reviewed retrospectively between January 2010-December 2014. Results: 69 males and 98 females were postoperative patients in a total of 283 patients.28% of these patients were trauma patients and 62.3% were accepted after total hip prosthesis operations.The average age of postoperatively accepted patients was 73.5 years and preoperative was 61.5 years.The mean APACHE II score was similar.21% of postoperative patients have chronic obstructive pulmonary disease (COPD),while 18% of those without surgery had COPD(p=0.024).The need of close monitoring for intensive care admission was 62% in preoperative patients and 47% in postoperative patients(p=0.014).Symptomatic electrolyte imbalance was higher in preoperativ patients(p=0.027). The rate of vasopressors required hypotension was 11% in postoperative patients and 3% in non-operated patients (p=0.021).Charlson scores of postoperative patients were higher than those without surgery (p=0.001). Conclusion: Orthopedic patients who have high risk factors and comorbidities, we think that the consultation of the relevant branches and the initiation of treatment follow-ups in the early period may be useful in preventing intensive care requirement in the preoperative period.
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    Global Scientific Outputs of Brain Death Publications and Evaluation According to the Religions of Countries
    (Springer, 2020) Dogan, Guvenc; Kayir, Selcuk
    In 1950s, the concept of brain death, which began to be discussed primarily in terms of medicine and then in terms of religion, law, and ethics, became a central topic in all world countries as it was an early diagnosis of death. Despite the fact that brain death (BD) diagnosis is of importance for benefitting from organ and tissue transplantation of patients in the world, the literature still involves no bibliometric studies that made a holistic evaluation of the publications about this issue. The present study aims to investigate the top-cited articles about BD published between 1980 and 2018, identify the citation collaboration of the journals, demonstrate the collaboration between the countries, define the relationship between organ transplantation and BD, and reveal the latest developments and trend topics about this issue. In addition, this study aims to investigate the relationship between religions of countries and brain death publication productivity. Documents for bibliometric analysis were downloaded from Web of Science. The literature search was performed using the keywords brain death/dead during 1980-2018. The correlations between gross domestic product (GDP), Human Development Index (HDI) and publication productivity of the countries on BD were investigated with Spearman's correlation coefficient. There was a high-level, statistically significant correlation between the number of publications and GDP, and HDI and the number of publications about BD (r = 0.761, p < 0.001; r = 0.703, p < 0.001). The USA was the top country in terms of publication productivity, which was followed by developed countries such as Germany, Japan, France, and Spain. However, the contribution of the undeveloped or developing countries such as China, Brazil, Turkey, Iran, and South Africa was found to be considerably important. While many people in the world die with undamaged organs, many other people die needing those organs. Therefore, it is considered that the collaborations and thus multidisciplinary studies about BD should be increased in the world countries, and the countries should be involved in bigger collaborations instead of little clusters. Especially, Muslim countries should be encouraged to do research and publish studies about the issues of brain death and organ transplantation.
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    Importance of the National Early Warning Score (NEWS) at the time of discharge from the intensive care unit
    (Tubitak Scientific & Technical Research Council Turkey, 2020) Dogu, Cihangir; Dogan, Guvenc; Kayir, Selcuk; Yagan, Ozgur
    Backround/aim: To identify, at an early stage of intensive care, patients who will require readmission to the intensive care unit (ICU) based on their National Early Warning Score (NEWS-d) at discharge. Materials and methods: Overall, 536 patients aged >18 years who stayed at a tertiary ICU for >24 h were included. Patients who readmitted and not readmitted to the intensive care within 48 h after discharge were compared. Results: Mean patient age was 64.26 +/- 18.50 years and 252 (44.7%) patients were male. Mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 21.86 +/- 8.74; mean NEWS-d was 4.48 +/- 2.53. Forty-nine (9.1%) were readmitted to ICU. The reasons for initial admission, age, and NEWS-d vvalues were significantly different between the 2 groups. The NEWS-d values of the readmitted group were significantly higher (9.16 +/- 1.05) than nonreadmitted group (4.01 +/- 2.13). Based on receiver operation curve analysis, sensitivity and specificity were 98% and 95%, respectively, considering a NEWS-d cut-off value of 7.5 as the limit value for estimating readmission. Conclusion : A NEWS-d value of >7.5 demonstrated high sensitivity and specificity in identifying the risk of readmission for patients being discharged from ICU.
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    The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients
    (Cureus Inc, 2018) Kayir, Selcuk; Ulusoy, Hulya; Dogan, Guvenc
    Background/aims Sedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients. Material and methods We made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013. Patients were divided into two groups, including Group P (continuous infusion of sedative agent) and Group D (daily sedation interruptions - daily recovery). Demographics, mechanical ventilation time, stay at intensive care unit, hospitalization period, time of first weaning, success of weaning, ventilator-related pneumonia (VRP), total doses of drugs, re-intubation frequency, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) scores and mortality rates of patients were compared. Ramsay Sedation Score (RSS) was used to evaluate the level of sedation. Considering that ideal sedation level is 3 with RSS, RSS < 3 is considered as mild sedation, while RSS > 3 is considered as deep sedation. Results There was no difference between demographics of patients. Mechanical ventilation period was significantly longer in Group P than Group D (p < 0.001). When stay at ICU unit was considered, ICU stay was significantly longer in Group P than Group D (p < 0.001). No statistically significant difference was found between two groups with respect to hospitalization period. In inter-group comparison, time to start first weaning was significantly late in Group P than Group D (p < 0.05). There was no difference between groups in terms of frequency of success of weaning and mortality rate (p > 0.05). In inter-group comparison the frequency of reintubation viewed in Group D was significantly less than in Group P (p < 0.05). Considering development of VRP, it was significantly more common in Group P in comparison with Group D (p < 0.05). No statistically significant difference was found between groups in terms of doses of sedative agents (p > 0.05). Considering doses of opioid analgesics, the total dose of fentanyl was significantly higher in Group P than Group D (p = 0.04), while no difference was found for doses of morphine (p > 0.05). Again, no statistical difference was found in doses of muscle relaxant agents (p > 0.05). Conclusion It was observed that the sedation technique with daily interruption is superior to continuous infusion of sedatives. Accordingly, we believe that daily weaning will make positive contributions to patients who are mechanically ventilated at intensive care unit.
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    The evolution of the regional anesthesia: a holistic investigation of global outputs with bibliometric analysis between 1980-2019
    (Korean Pain Soc, 2020) Kayir, Selcuk; Kisa, Alperen
    Background: This study used bibliometric analysis of articles published about the topic of regional anesthesia from 1980-2019 with the aim of determining which countries, organizations, and authors were effective, engaged in international cooperation, and had the most cited articles and journals. Methods: All articles published from 1980-2019 included in the Web of Science database and found using the keywords regional anesthesia/anaesthesia, spinal anesthesia/anaesthesia, epidural anesthesia/anaesthesia, neuraxial anesthesia/ anaesthesia, combined spinal-epidural, and peripheral nerve block in the title section had bibliometric analysis performed. Correlations between the number of publications from a country with gross domestic product (GDP), gross domestic product (at purchasing power parity) per capita (GDP PPP), and human development index (HDI) values were investigated with the Spearman correlation coefficient. The number of articles that will be published in the future was estimated with linear regression analysis. Results: Literature screening found 11,156 publications. Of these publications, 6,452 were articles. The top 4 countries producing articles were United States of America (n = 1,583), Germany (585), United Kingdom (510), and Turkey (386). There was a significant positive correlation found between the GDP, GDP PPP, and HDI markers for global countries with publication productivity (r = 0.644, P < 0.001; r = 0.623, P < 0.001, r = 0.542, P < 0.001). The most productive organizations were Harvard University and the University of Toronto. Conclusions: This comprehensive study presenting a holistic summary and evaluation of 6,452 articles about this topic may direct anesthesiologists, doctors, academics, and students interested in this topic.
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    TRACHEOTOMY AMONG PATIENTS IN GERIATRIC AGE GROUP TREATED IN INTENSIVE CARE UNITS
    (Gunes Kitabevi Ltd Sti, 2019) Dogu, Cihangir; Kayir, Selcuk; Dogan, Guvenc; Ekici Akdagli, Arzu; Ozciftci, Serhat; Yagan, Ozgur
    Introduction: In intensive care units, numerous geriatric patients are mechanically ventilated, and those with prolonged mechanical ventilation show high mortality. Such geriatric patients may greatly benefit from tracheotomy because it facilitates pulmonary care, increases patient comfort and helps wean them off mechanical ventilation. Materials and Method: A total of 70 mechanically ventilated geriatric patients were includ-ed. Patients' electronic data, file records, age, sex, mechanical ventilation requirement, Acute Physiology and Chronic Health Evaluation II score, intubation and intensive care unit stay durations, discharge status and complications were examined. Results: The mean patient age was 78.6 +/- 7.4 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 27.0 +/- 5.9. Tracheotomy was performed after a mean duration of 34.8 +/- 17 days, and the mean intensive care unit stay duration was 94 +/- 54 days. Major and minor haemorrhage were observed in 1 (1.4%) and 3 (4.2%) patients, respectively. Total 53 (76%) patients died, 8 (11%) patients were discharged and 9 (13%) patients are still hospitalized. Conclusion: The reluctance of geriatric patients' relatives to perform tracheotomy affects the time of procedure and duration of intensive care unit stay.