Dicle Birtane

Background and Objectives: Acute kidney injury (AKI) is highly prevalent among critically ill patients receiving invasive mechanical ventilation (IMV) and is associated with adverse outcomes. Mechanical power (MP) reflects the total energy delivered to the respiratory system, but its association with AKI in mechanically ventilated critically ill patients remains incompletely understood. Few studies have examined the relationship between MP and AKI development. Materials and Methods: Adult patients with MP data available for each of the first five consecutive days of IMV constituted the study population. MP and ventilatory parameters were recorded during this period. Factors independently associated with AKI were identified using multivariable logistic regression. The discriminative performance of MP for AKI and continuous renal replacement therapy (CRRT) use was evaluated. Results: Among 924 patients, 605 (65.5%) developed AKI. MP was consistently higher in patients who developed AKI during the first five days of IMV (11.45 ± 2.88 vs. 9.48 ± 2.50 J/min; p < 0.001). Although PEEP, peak inspiratory pressure, driving pressure, respiratory rate, and FiO₂ were higher in the AKI group, tidal volume and respiratory system compliance did not differ significantly. In multivariable analysis, higher mean MP (OR = 1.330, 95% CI 1.235–1.432; p < 0.001), greater mean fluid balance (OR = 1.477, 95% CI 1.225–1.780; p < 0.001), older age, and trauma were independently associated with AKI. MP showed moderate discrimination for AKI (AUC = 0.681), with an optimal cutoff of 10.38 J/min. For CRRT use, MP showed significant but limited discrimination (AUC = 0.624; 95% CI, 0.584–0.664; p < 0.001). Conclusions: In critically ill patients receiving IMV, higher MP remained associated with AKI after adjustment for measured covariates. The 10.38 J/min threshold is hypothesis-generating and requires external validation.

Sepsis involves dynamic inflammatory and endothelial responses, and the timing of extracorporeal therapies such as therapeutic plasma exchange (TPE) may influence clinical outcomes. However, the optimal timing of TPE remains unclear. This retrospective single-center observational study included adult patients with sepsis or septic shock who underwent TPE in the intensive care unit between January 1, 2017 and August 1, 2025. Patients were categorized as early (≤ 48 hours after diagnosis) or late (> 48 hours). The primary outcome was 28-day mortality. Secondary analyses evaluated longitudinal changes in biomarkers and laboratory parameters. Eighty-eight patients were included (early n = 39; late n = 49). Overall 28-day mortality was 40.9% (36/88). Kaplan–Meier analysis demonstrated no significant difference in 28-day survival between the groups (log-rank P = .91). In multivariable Cox regression adjusted for Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II, TPE timing was not independently associated with 28-day mortality (hazard ratio 0.90, 95% confidence interval 0.44–1.83, P = .76). Across the overall cohort, significant temporal changes were observed in C-reactive protein and lactate dehydrogenase levels during TPE treatment. Early TPE initiation was not associated with improved 28-day survival. Observed biomarker trajectories should be interpreted cautiously given the retrospective design, limited sample size, and potential residual confounding.

Aim: Postoperative intensive care unit (ICU) care after pancreaticoduodenectomy (PD) is essential for managing perioperative complications. This study evaluated ICU outcomes, mortality, reoperation, and major postoperative complications following PD.Material and Methods: This retrospective cohort study included patients undergoing PD between January 1, 2015, and August 1, 2025, who required postoperative ICU admission. Postoperative ICU admission was reserved for selected high-risk patients based on perioperative clinical assessment. Descriptive statistical analyses were performed. Demographic characteristics, comorbidities, need for continuous renal replacement therapy (CRRT), length of ICU stay, reoperation rates, major postoperative complications, and mortality were analyzed.Results: A total of 80 patients fulfilled the inclusion criteria among the 179 who underwent PD. The cohort had a median age of 65 years, with males constituting the majority of the population (53,66.2%). Common comorbidities included hypertension, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, and almost all patients were categorized as ASA physical status III. Preoperative epidural catheterization was performed in 22 patients (27%). Reoperation was required in 3 patients (3.8%), CRRT was required in 3 patients (3.8%), and 8 patients (10%) required ICU readmission, while ICU mortality occurred in 7 patients (8.8%).Conclusion: Due to its complexity, PD is frequently linked to notable morbidity and mortality rates and typically requires close postoperative monitoring in the ICU. This descriptive analysis provides insight into postoperative ICU outcomes following pancreaticoduodenectomy. Early recognition of clinical deterioration during postoperative ICU monitoring may facilitate timely intervention and potentially improve clinical outcomes.

Aims: Early brain computed tomography following cardiac arrest can reveal alterations in gray–to-white matter differentiation, offering potentially important prognostic insights into neurological outcomes. This study examined the relationship between gray-to-white matter ratio (GWR) metrics and survival. Methods: Patients managed in the intensive care unit after cardiopulmonary resuscitation (CPR) between 2015 and 2025 were retrospectively reviewed. Patients aged >18 years, with witnessed in-hospital or out-of-hospital CPR and those with cranial CT scans within the first 48 hours after cardiac arrest, were included. To assess the association with survival, GWR measurements were calculated in six different regions across both hemispheres. Results: Overall, normal-range GWR measurements were observed across the cohort, with no statistically significant impact on survival outcomes. Independent risk factors for two-day survival were age (OR 1.039; p=0.005), absent pupillary light reflex (OR 5.43; p

Objective: A rare case of coinfection of Plasmodium falciparum and Aspergillus Fumigatus from travel to Tanzania is presented in this report. Methods: A-43-year-old, Turkish male patient who travelled to Tanzania for business without any malaria prophylaxis was admitted to hospital with high fever (39.5 degrees C), weakness, nausea and vomiting and dyspnea when returned to Turkey. The patient had been treated in intensive care unite for sepsis and multi organ dysfunction as a result of the delayed malaria diagnosis. In addition to the presence of thrombocytopenia, anemia, metabolic acidosis, acute respiratory distress syndrome, hepatosplenomegaly and acute renal failure, aspergillus fumigatus emerged as a secondary opportunistic infection. Consent was obtained from the patient’s family to publish and all patient specific information has been identified, as a case report and negligible risk to the patient; formal ethics approval was not required because it posed negligible risk to the patient. Results: He was treated with therapeutic plasma exchange seven times, prone position for 36 hours, continued renal replacement therapy for 72 hours, three cycles of artesunate, artemether lumefantrine for three days, with clindamycin and doxycycline. Additionally, meropenem for empirical antibiotherapy, and voriconazole and amphotericin b for Aspergillus were used. Conclusion: This case report showed that malaria should be suspected in patients with febrile illness and that travel history to a malaria-endemic region and when fever recurs during the treatment process, secondary opportunistic infections should be considered in addition to malaria. Pulmonary aspergillosis can be seen in people with supressed immune systems and should also be considered in patients with plasmodium falciparum. Since it has been shown that complications may continue even after the parasite load is eliminated, the addition of extracorporeal treatments to antimalarial therapy may be effective in reducing mortality.

Objective: This case series aims to present the clinical characteristics, diagnostic processes, treatment strategies, and outcomes of patients with methanol intoxication treated in the intensive care unit (ICU). Methods: Eight male patients, aged between 31 and 75 years, who were treated in the ICU for methanol intoxication within three weeks, were included. Their medical histories, clinical findings, laboratory results, treatments, and prognoses were described. Results: The patients presented with a variety of symptoms such as visual loss, nausea, vomiting, abdominal pain, altered mental status, and respiratory distress. All patients had a history of consuming homemade alcohol, although in some cases the exact source and amount of alcohol were unknown. Arterial blood gas analyses revealed metabolic acidosis with elevated lactate levels. Negative blood ethanol levels, along with increased anion and osmolar gaps, supported the diagnosis of methanol intoxication. Patients received intravenous ethanol infusion, hemodialysis, and appropriate ICU supportive treatments. Three patients died (37.5%), while five survived. Conclusion: This case series emphasizes the importance of prompt intervention in emergencies such as methanol intoxication. Early diagnosis and administering antidotes like ethanol and hemodialysis improve survival rates. Preventing the production of counterfeit alcohol and raising public awareness of its dangers should be key priorities.

Nekrotizan pankreatit mortalite ve morbiditesi yüksek olan, tedavisi konusunda belirsizlikler içeren, önemli bir pankreatit türüdür ve etiyolojisinde hipertrigliseridemi de olabilmektedir. Bölüm; hipertrigliseridemiye sekonder gelişen akut pankreatit olgumuzun yoğun bakım ünitesinde tedavi sürecini içermektedir. 35 yaş, erkek, ek hastalığı olmayan nekrotizan pankreatit hastası çoklu organ yetmezliği sebebiyle yoğun bakım ünitesine interne edilmiş ve 18 gün invaziv mekanik ventilasyon ile desteklenmiştir.16 seans plazma değişimi, 1 kez sürekli renal replasman tedavisi, hedeflenmiş terapötik ısı yönetimi, trigliserit düşürücü medikal tedavi, çoklu antibiyoterapi uygulanmış, ileri hemodinamik monitörizasyon ile yakın takip edilmiştir. Servis taburculuğu ardından sırasıyla girişimsel radyoloji tarafından perkütan drenaj ve genel cerrahi tarafından açık cerrahi ile nekroze koleksiyon drene edilmiştir. Uzayan tedavi süreci, servis yatışları sonunda (5 ay) kazanılmış güçsüzlük gelişen hasta fizik tedavi ve rehabilitasyon servisinde 2 ay yatırılarak tedavi edilip, bir yılın sonunda aktif yaşamına dönebilmiştir. Necrotizing pancreatitis is a severe form of pancreatitis with high mortality and morbidity rates and remains a clinical challenge due to uncertainties in its management. Hypertriglyceridemia may also be among its etiological factors. This chapter presents the treatment process of a case of acute pancreatitis secondary to hypertriglyceridemia managed in the intensive care unit. A 35-year-old, male patient with no known comorbidities was admitted to the ICU with necrotizing pancreatitis and multiple organ failure, requiring invasive mechanical ventilation support for 18 days. The patient underwent 16 sessions of plasma exchange, a single session of continuous renal replacement therapy (CRRT), targeted therapeutic temperature management, triglyceride-lowering medical treatment, and multiple antibiotic regimens, and was closely monitored using advanced hemodynamic monitoring techniques. Following discharge from the ICU, the patient underwent percutaneous drainage performed by interventional radiology and subsequently open surgical necrosectomy performed by general surgery. After a prolonged hospitalization period (5 months), the patient developed acquired weakness and was transferred to a physical therapy and rehabilitation unit, for 2 months. At the end of one year, the patient was able to return to an active lifestyle.

Background: In critically ill patients, tracheostomy decisions are driven by heterogeneous and dynamic clinical trajectories, and no universally accepted scoring system exists to reliably predict tracheostomy requirement. An accurate and interpretable prediction model could help earlier decision-making and potentially reduce prolonged mechanical ventilation (MV) and failed weaning. Methods: In this retrospective study, data from 6507 mechanically ventilated intensive care unit (ICU) patients were analyzed using an electronic clinical decision support system; 1049 patients required tracheostomy and 5458 did not. The primary outcome was the prediction of tracheostomy occurrence during ICU stay based on invasive mechanical ventilation (IMV) parameters obtained within the first five days. The secondary outcome was the identification of the most influential parameters guiding tracheostomy decision-making during early IMV. Ten machine learning algorithms were developed using an 80/20 train–test split. Model performance was assessed using discrimination, calibration, and clinical performance metrics. Explainability was evaluated using SHapley Additive exPlanations (SHAP) analysis. Results: Among all models, Gradient Boosting demonstrated strong discrimination and calibration performance (AUROC 0.92, AUPRC 0.56, specificity 97%, F1 score 0.46, Brier score 0.078). In the Gradient Boosting model, feature importance analysis demonstrated that secretion count was the strongest predictor of tracheostomy requirement, accounting for 14.72% of the model’s predictive contribution. This was followed by lactate level (6.12%), arterial pH (3.74%), and peak airway pressure (3.57%). SHAP-based analyses consistently identified secretion count as the strongest predictor of tracheostomy requirement, followed by lactate level, Glasgow Coma Scale (GCS), and arterial pH. In addition, SHAP provided clinically interpretable insights into the direction and magnitude of the effects of individual predictors. Conclusions: Machine learning models integrating early-phase ventilatory and physiological data may enable clinically meaningful prediction of tracheostomy requirement. The combination of strong performance and explainability suggests potential utility as a decision-support tool in critically ill patients requiring prolonged MV.

Background and Objectives: Neuroleptic malignant syndrome (NMS) is a rare but high-mortality clinical condition. The aim of this study was to describe the demographic characteristics, clinical and laboratory findings, management strategies, and clinical outcomes of adult patients with NMS treated in an adult intensive care unit. Materials and Methods: This retrospective descriptive study included adult patients admitted to a tertiary care ICU with a diagnosis of NMS. Data were obtained from medical records and included demographic characteristics, suspected NMS-related drug exposures, clinical and laboratory findings at ICU admission, disease severity indicators, treatments administered, and clinical outcomes. Continuous variables were expressed as median and interquartile range (IQR), and categorical variables as number and percentage. Results: A total of 42 patients were included. The median age was 48 years (IQR: 24.1–75.5), and 61.9% were male. Atypical antipsychotics were the most frequently implicated agents (69.0%). Altered mental status was observed in 92.9% of patients, tachycardia in 61.9%, and hyperthermia in 47.6%. Creatine kinase levels >1000 U/L were present in 57.1%, and leukocytosis in 71.4%. Mechanical ventilation was required in 59.5% of patients. Acute kidney injury developed in 31%, and continuous renal replacement therapy (CRRT) was initiated in 21.4%. Bromocriptine was administered in 54.8% of cases, dantrolene in 4.8%, and amantadine in 11.9%. The ICU mortality rate was 9.5%. Conclusions: Patients with neuroleptic malignant syndrome often present with a severe clinical course requiring advanced organ support in the intensive care unit. However, with early diagnosis and appropriate intensive care management, mortality can be maintained at acceptable levels.