Seher Yanatma

Background: Stroke is a neurological emergency characterized by acute focal injury to the central nervous system caused by vascular events. Although rare, pregnancy-associated stroke represents a major cause of maternal morbidity and mortality, with an incidence of approximately 30–34 per 100,000 pregnancies. Hypertensive disorders and the hypercoagulable state of pregnancy are leading risk factors. Case Report: We present the case of a 26-year-old gravida 3 para 1 woman at 26 weeks and 5 days of gestation with a history of chronic hypertension, who was admitted with sudden-onset left-sided weakness and facial asymmetry. Neuroimaging revealed acute ischemic lesions in the right lentiform nucleus, parietal and parieto-occipital lobes, and a thrombus in the inferior cerebral vein. The patient was managed in the intensive care unit with therapeutic anticoagulation (enoxaparin) and close maternal-fetal monitoring. Fetal viability and well-being were preserved, and corticosteroids were administered for lung maturation. Multidisciplinary follow-up ensured stabilization, and the patient was discharged in good condition with recommendations for continued neurological and obstetric care. Conclusion: Pregnancy-associated stroke is a rare but potentially life-threatening condition that requires prompt recognition, rapid neuroimaging, and a multidisciplinary approach to optimize maternal and fetal outcomes. This case highlights the importance of timely intervention and coordinated care in managing neurological emergencies during pregnancy.

Background/Objectives: Under Turkish law, brain death is determined by two physicians, one of whom is a specialist in anaesthesiology and reanimation or intensive care, a responsibility residents assume soon after qualifying. We assessed whether residents’ confidence matches their accuracy, and whether the decision to initiate determination is influenced by the family’s attitude toward organ donation. Methods: Cross-sectional web-based survey of a national convenience sample of anaesthesiology and reanimation residents in Türkiye. Ten knowledge statements and three clinical vignettes combined the answer and the respondent’s confidence in one choice; the primary outcome was the high-confidence error rate. In an embedded participant-blinded randomised vignette, participants were allocated 1:1 to a medically identical scenario describing the family as favourable or opposed to donation. Results: A total of 206 residents were analysed. They answered 80.9% of items correctly but endorsed only 64.2% with confidence; confident answers were correct in 90.8% of instances versus 63.3% of non-confident answers (p < 0.001). The mean high-confidence error rate was 5.9 ± 7.3%, yet 50.5% committed at least one such error, and these errors clustered in four domains. In this exploratory comparison, initiation of determination did not differ between arms (85.6% versus 87.4%; adjusted odds ratio 1.29, 95% CI 0.54–3.05). Only 18.0% felt prepared to serve on a determination board; in univariable and sensitivity analyses, preparedness was associated with case exposure and formal instruction but not with knowledge score. Conclusions: Residents answered most items correctly and were appropriately cautious, yet fewer than one in five felt prepared; self-reported preparedness is not a measure of clinical competence. Supervised clinical exposure, correction of specific misconceptions and communication training are priorities for future intervention studies.

Background: Older adults constitute a growing and heterogeneous proportion of intensive care unit (ICU) admissions, and early risk stratification in this group remains difficult. The lactate-to-albumin ratio (LAR) is a composite biomarker that combines a marker of acute metabolic derangement with one of physiological reserve, and has shown prognostic value in several critical care settings. Its performance in geriatric ICU patients, and specifically whether it adds information to established severity scores, has not been established. Methods: We conducted a retrospective, single-centre cohort study of consecutive patients aged ≥ 65 years admitted to the mixed medical–surgical ICU of a tertiary referral hospital in Türkiye between January 2024 and July 2025. LAR was calculated as serum lactate (mmol/L) divided by serum albumin (g/dL), from samples obtained within the first 6 h of ICU admission. The primary outcome was all-cause 28-day mortality. Discrimination was assessed by area under the receiver operating characteristic curve (AUC), and curves were compared using the DeLong test. Multivariable logistic regression assessed whether LAR was independently associated with mortality after adjustment for age, sex, Clinical Frailty Scale (CFS), SOFA, APACHE II and C-reactive protein (CRP). Results: Of 296 screened admissions, 294 were analysed; 98 patients (33.3%) died within 28 days. Non-survivors had higher admission LAR than survivors [1.37 (IQR 0.84–2.50) vs. 0.62 (IQR 0.46–0.99), p < 0.001]. LAR discriminated 28-day mortality with an AUC of 0.793 (95% CI 0.740–0.846), significantly better than serum lactate alone (AUC 0.746; ΔAUC 0.047, 95% CI 0.021–0.074, p = 0.0005) and serum albumin alone (AUC 0.656; ΔAUC 0.137, 95% CI 0.061–0.213, p = 0.0004). APACHE II discriminated considerably better than LAR (AUC 0.924, 95% CI 0.893–0.955; ΔAUC 0.131, 95% CI 0.080–0.181, p < 0.001). Adding LAR to APACHE II did not significantly improve discrimination (AUC 0.929 vs. 0.924; ΔAUC 0.006, 95% CI −0.0001 to 0.0115, p = 0.055; likelihood ratio test p = 0.098). On univariable analysis LAR was strongly associated with mortality (OR 2.17, 95% CI 1.63–2.88, p < 0.001), but after full adjustment this association was no longer statistically significant (adjusted OR 1.29, 95% CI 1.00–1.66, p = 0.052). APACHE II (adjusted OR 1.36, 95% CI 1.21–1.52, p < 0.001) and CRP (adjusted OR 1.06 per 10 mg/L, 95% CI 1.01–1.11, p = 0.015) remained independently associated with mortality. Conclusions: In critically ill older adults, admission LAR discriminates 28-day mortality better than either of its components alone and is strongly associated with mortality on unadjusted analysis. However, it did not add significant discriminatory information to the APACHE II score, and it was not independently associated with mortality after adjustment for illness severity. LAR may be useful as a rapidly available early indicator where a full severity score is not yet computable, but on these data it does not complement APACHE II.

Aim Targeted temperature management (TTM) is a core component of post-cardiac arrest care. Its effectiveness in improving survival and neurological outcomes remains debated, especially in resource-limited settings such as Türkiye. This study aimed to evaluate the impact of TTM on 28-day mortality, lactate clearance, and neurological recovery in cardiac arrest patients admitted to an intensive care unit (ICU). Methods This retrospective cohort study included 61 adult patients who achieved return of spontaneous circulation (ROSC) following cardiac arrest and were admitted to the ICU of a tertiary care hospital in Türkiye. After 1:4 propensity score matching based on demographic and clinical variables, 45 patients (9 in the TTM group and 36 in the control group) were included in the analysis. The primary outcome was 28-day mortality. Secondary outcomes included lactate clearance, change in Glasgow Coma Scale (GCS), and Cerebral Performance Category (CPC) score at discharge. Results There was no statistically significant difference in 28-day mortality between groups (44.4% vs. 69.4%, P = .261). However, TTM was associated with significantly greater lactate clearance (54.2% vs. 39.7%, P = .038) and improved CPC scores (P = .042). No significant difference was observed in the change in GCS. Post-hoc power analysis for mortality was 18%. Conclusion While TTM did not significantly reduce short-term mortality, it was associated with improved metabolic and neurological outcomes. These findings emphasize the importance of considering functional recovery endpoints and suggest that even in middle-income settings, TTM can be beneficial when properly implemented.

Background/Objectives: Trauma remains a leading global cause of mortality and morbidity, particularly in low- and middle-income countries. Multitrauma patients often require intensive care and exhibit high mortality rates. Prognostic scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Revised Trauma Score (RTS) are widely used to predict outcomes; however, their performance in middle-income settings like Turkey has not been well established. This study aimed to evaluate the prognostic accuracy of APACHE II and RTS in predicting intensive care unit (ICU) mortality among multitrauma patients. Methods: This retrospective observational study was conducted in the General ICU of Diyarbakır Gazi Yaşargil Training and Research Hospital between January 2022 and December 2024. Adult patients (≥18 years) with multitrauma involving at least two anatomical regions were included. Demographic data, clinical scores (APACHE II, RTS, Sequential Organ Failure Assessment [SOFA], Injury Severity Score [ISS], Trauma and Injury Severity Score [TRISS]), laboratory parameters, complications, and outcomes were recorded. Univariate and multivariate logistic regression analyses identified independent predictors of ICU mortality. Receiver operating characteristic (ROC) analysis assessed the discriminatory ability of prognostic scores. Results: A total of 145 patients were analyzed, with an ICU mortality rate of 13.1%. Non-survivors had significantly higher APACHE II (27 ± 4 vs. 13 ± 6, p < 0.001) and SOFA scores (7 [4–13] vs. 2 [1–6], p < 0.001) and lower RTS (4.2 ± 1.7 vs. 7.2 ± 1.1, p < 0.001). Acute kidney injury, sepsis, septic shock, and mechanical ventilation were more frequent among non-survivors (p < 0.01 for all). In multivariate analysis, APACHE II (odds ratio [OR]= 1.54, 95% confidence interval [CI] 1.16–2.04, p = 0.003) and RTS (OR = 0.36, 95% CI 0.16–0.81, p = 0.013) were independent predictors of ICU mortality. ROC analysis showed excellent prognostic performance for APACHE II (area under the curve [AUC] = 0.959) and RTS (AUC = 0.888). Conclusions: In this retrospective single-center cohort, APACHE II and RTS were independently associated with ICU mortality and demonstrated good discriminatory performance for early risk stratification in critically ill multitrauma patients. The lower mortality observed in our cohort should be interpreted cautiously, as it may also reflect differences in case-mix, injury severity, ICU admission practices, and referral patterns. These findings require external validation in larger multicenter cohorts before broader generalization. Future studies should also validate the identified cut-off values and further investigate the prognostic role of biomarkers such as procalcitonin.

Objective: Invasive pulmonary aspergillosis (IPA) is a life-threatening fungal infection that predominantly affects immunocompromised individuals. Environmental exposure to large amounts of construction dust following natural disasters may also increase the risk of invasive fungal infections. We aimed to present a fatal case of IPA that developed in an earthquake survivor rescued from prolonged entrapment under collapsed buildings. Methods: A female earthquake victim with no known chronic disease or history of immunosuppressive therapy was admitted to the intensive care unit (ICU) after prolonged entrapment under rubble, cardiac arrest, and severe crush-related complications. Clinical findings, microbiological results, imaging studies, treatment course, and outcome were retrospectively reviewed. Results: The patient developed septic shock, acute kidney injury requiring renal replacement therapy, and persistent respiratory failure. Despite broad-spectrum antimicrobial therapy, fever and hypoxemia persisted. Thoracic computed tomography revealed multiple pulmonary nodular lesions and consolidations suggestive of invasive fungal infection. Aspergillus fumigatus was isolated from endotracheal aspirate cultures on the 17th day of ICU admission. Voriconazole therapy was initiated; however, the patient died on the 35th day of ICU hospitalization. Conclusion: IPA should be considered in critically ill survivors of natural disasters, even in the absence of classical host-related risk factors. Early recognition of invasive fungal infections in patients exposed to substantial environmental dust and debris may facilitate timely antifungal treatment and potentially improve outcomes.

Objective: To evaluate the prognostic value of arterial pH at ICU admission for short-term survival after cardiac arrest. Materials and Methods: This single-center observational study included 60 adults (≥18 years) admitted to the ICU between May 2024 and June 2025 after successful resuscitation with return of spontaneous circulation (ROSC). Clinical, demographic, and laboratory data were collected. Survivors and non-survivors at day 7 were compared using logistic regression and ROC analyses to determine independent predictors of mortality. Results: The mean age was 61 ± 17 years, and 43% of patients were women. Seven-day mortality was 51.7%. Non-survivors were older and had higher APACHE II scores, lactate and procalcitonin levels, longer CPR-to-ROSC intervals, lower arterial pH values, and shorter ICU stays (all p < 0.05). In multivariable logistic regression analysis, age, higher APACHE II score, elevated procalcitonin levels, and lower arterial pH were independently associated with 7-day mortality. Lower arterial pH remained significantly associated with mortality (OR: 1.53; 95% CI: 0.93–2.86; p = 0.044). ROC analysis yielded an AUC of 0.668, with an optimal pH cut-off value of 7.13 (sensitivity 61.3%, specificity 75.9%). Conclusion: Lower arterial pH at ICU admission independently predicts 7-day mortality after cardiac arrest, emphasizing the importance of early recognition and correction of acidosis in post-resuscitation care

Yoğun bakım ünitelerindeki hastaların büyük bir kısmı, dinlenme halindeyken bile ağrı çekmektedir. Bu durum, hastaların tedavi süreçlerini zorlaştıran fizyolojik ve psikolojik komplikasyonlara yol açabilir. Ağrının etkili bir şekilde değerlendirilip yönetilmesi, yalnızca hastaların konforunu artırmakla kalmaz, aynı zamanda enfeksiyon, solunum yetmezliği ve kardiyovasküler stres gibi riskleri de azaltır. Geleneksel yöntemlerin yanı sıra, ultrason rehberliğinde gerçekleştirilen bölgesel anestezi teknikleri, daha güvenli ve etkili bir alternatif sunar. Bu teknikler, özellikle cerrahi sonrası dönemde ağrı kontrolü sağlamak için önemlidir. Ayrıca, multimodal analjezi yaklaşımları opioid bağımlılığını azaltarak hastaların daha hızlı mobilize olmasına ve uzun vadeli sonuçların iyileştirilmesine katkıda bulunur. Patients in intensive care units often experience significant pain even at rest, posing challenges to their recovery and care. Effective pain assessment and management are crucial not only for improving patient comfort but also for mitigating risks such as infection, respiratory failure, and cardiovascular stress. Beyond traditional methods, ultrasound-guided regional anesthesia techniques offer safer and more effective solutions for pain control, particularly in postoperative settings. Multimodal analgesic strategies also play a key role in reducing opioid dependency, promoting faster mobilization, and improving long-term outcomes.

Ağrının Tarihçesi Ahmet DÜZGÜN Ağrı ve Genetik Ali İhsan YÜREKLİ Yoğun Bakım Hastalarında Ağrı Biyokimyası Cemal NAS Yoğun Bakımda Ağrı Fizyolojisi Bedih BALKAN Ağrı Mekanizmaları ve Ağrıya Yaklaşım Mehmet ERTARGIN Yoğun Bakımda Ağrı Değerlendirmesi Ali Kendal OĞUZ Yoğun Bakım Ünitesinde Kullanılan Ağrı Değerlendirme Ölçekleri Maşallah ÇAKIRER Yoğun Bakım Hastalarında Ağrı ve Etik Abdulkadir YEKTAŞ Yoğun Bakımda Akut Ağrı Tedavisi ve Analjezikler Kaan KARA Kronik Ağrı Sendromlu Hastanın Yoğun Bakım Ünitesinde Takibi Burhan Sami KALIN Yoğun Bakım’da Ağrı Tedavi Yöntemleri Erhan GÖKÇEK Yoğun Bakımda Kullanılan Girişimsel Ağrı Yöntemleri Seher YANATMA Yoğun Bakımda Ağrılı Hastaya Psikiyatrik Yaklaşım Ahmet DEMİRDAĞ Kevser ERDOĞAN Yoğun Bakımda Yatan Kanser Hastaları ve Palyatif Bakım Hastalarında Ağrı Tedavisi Abid KARAGÖZ