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    Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units
    (Aves, 2021) Gundogan, Kursat; Akbudak, Ismail Hakki; Hanci, Pervin; Halacli, Burcin; Temel, Sahin; Gullu, Zuhal; Yuksel, Recep Civan
    Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P<.001), lactate level >2 mmol/L (2.78 [1.93-4.01], P<.001), age >= 60 years (2.45 [1.48-4.06)], P<.001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P=.003), vasopressor treatment (1.94 [1.32-2.84], P=.001), positive fluid balance of >= 600 mL/day (1.68 [1.21-2.34], P=.002), PaO2/FiO(2) ratio of <= 150 mmHg (1.66 [1.18-2.32], P=.003), and ECOG score >= 1 (1.42 [1.00-2.02], P=.050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.
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    Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study
    (W B Saunders Co-Elsevier Inc, 2023) Gundogan, Kursat; Sahin, Gulsah G.; Ergul, Serap S.; Ozer, Nurhayat T.; Temel, Sahin; Akbas, Turkay; Ercan, Talha
    Background/Objectives: Thiamine plays a pivotal role in energy metabolism. The aim of the study was to deter-mine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations.Subjects/Methods: This observational study was performed in 15 medical ICUs. Serial whole blood TPP concen-trations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. Results: A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all).Conclusions: Our results show that 18% of these critically ill patients exhibited low whole blood TPP concen-trations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.
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    Nutritional practices in medical intensive care units: Multicenter, one-day point prevalence study* Pratiques nutritionnelles dans les unités de soins intensifs médicaux : étude de prévalence ponctuelle multicentrique sur une journée
    (Masson Editeur, 2023) Ferlicolak, Leyla; Altintas, Neriman Defne; Halacli, Burcin; Temel, Sahin; Cakin, Ozlem; Turkoglu, Melda; Comert, Bilgin
    Background/Aim. - Nutritional planning is an important aspect of Intensive Care Unit (ICU) care. The present study aimed to evaluate the nutritional practices adopted in medical ICUs in Turkiye and to investigate their compliance with current international guidelines. Methods. - This multicenter, cross-sectional study was performed on a predetermined study date. Centers were required to fill three groups of questionnaires: One on ICU characteristics and facilities, one on patients included, and one on outcomes of patients. Forms on patients had questions on demographics and their nutritional status. Results. - A total of 12 sites participated and 132 patients were recorded in the study and 109 patients were included in analyses. The median age was 72 [57-83] years and 55 (50%) of them was female. The median APACHE II score was 23 [18-29], median SOFA score was 6 [4-9] and median BMI was 25.32 [21.22-29.38]. More than 50% of patients were fed enterally; for most, it was started within the first 24 hours of admission. On the study day, the median energy intake of the patients during the last 24 hours was 21.62 [15.9-27.3] kcal/kg and the median amount of protein intake was 1.02 [0.7-1.3] g/kg, representing 83.1% and 78.9% of the targets, respectively. A total of 64 (58.7%) patients were alive on the 28th day of the study, of them 23 (21.1% of all patients) were still in the ICU.