Browsing by Author "Çivi, M"

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    Diagnostic and prognostic value of procalcitonin and sTREM-1 levels in sepsis
    Bayram, H; Tünger, Ö; Çivi, M; Yüceyar, MH; Ulman, C; Horasan, GD; Çetin, CB
    Background/aim: Sepsis is still a major cause of morbidity and mortality despite the improvements in diagnosis and treatment. The aim of this study was to investigate the values of procalcitonin and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the differential diagnosis of patients with sepsis and noninfectious systemic inflammatory response syndrome (NI-SIRS) and measure their importance in the prognosis of patients with sepsis. Materials and methods: This prospective study included 41 NI-SIRS and 33 sepsis patients hospitalized in Celal Bayar University Hospital, Manisa, Turkey. Blood samples were taken from NI-SIRS patients on days 0 and 3 and from sepsis patients on days 0, 3, 4, 7, and 14. Clinical status of the patients was determined with the SOFA scoring system. Results: The SOFA scoring system and procalcitonin and sTREM-1 measurements were significant in the differential diagnosis of sepsis and NI-SIRS patients. The SOFA scoring system was considered the most important indicator in determining the prognosis of sepsis patients. Procalcitonin and sTREM-1 levels increased progressively in nonsurvivors and decreased in survivors, but changes were statistically insignificant. Conclusion: In the differentiation of sepsis and NI-SIRS, and evaluation of the prognosis of sepsis, combined measurements of procalcitonin and sTREM-1 levels are important.
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    Immune and inflammatory role of hydroxyethyl starch 130/0.4 and fluid gelatin in patients undergoing coronary surgery
    Öztürk, T; Onur, E; Cerrahoglu, M; Çalgan, M; Nizamoglu, F; Çivi, M
    Objectives: Compare the effects on inflammatory (TNF-alpha, IL-6, IL-8 and IL-10) and immunologic (CD3(+), CD4(+), CD8(+), CD11b(+), CD16(+)/56(+) T cells and total lymphocyte concentration) variables of hydroxyethyl starch 130/0.4, 4% modified fluid gelatin, or crystalloid when used as volume replacement fluids for acute normovolemic hemodilution (a blood conservation technique) in coronary artery bypass graft patients. Methods: Thirty patients undergoing coronary artery bypass graft surgery were randomized to receive Isolyte S (R) (Group ISO), 6% hydroxyethyl starch 130/0.4 (Group HES) or 4% modified gelatin solution (Group GEL) for acute normovolemic hemodilution. Blood samples were taken immediately after induction of anaesthesia (T0), and 2 h (T1), 12 h (T2), 24 h (T3), and 48 h (T4) after separation from cardiopulmonary bypass. TNF-alpha, IL-6, IL-8 and IL-10 levels were determined with commercially available ELISA kits. CD3(+) (mature T cells), CD4(+) (T helper cells), CD8(+) (suppressor cytotoxic T cells), CD16(+)/56(+) (natural killer lymphocytes), and CD11b(+) (Mac-1, adhesion receptor) levels were measured using flow-cytometry reagents. The CD4(+):CD8(+) ratio was calculated. Results: Between-group comparisons showed significantly higher levels of TNF-alpha at T1 (2 h after weaning from cardiopulmonary bypass) in Group HES compared to Group ISO (p = 0.003). IL-8 was significantly lower in Group HES than Group GEL at T1 (p = 0.0005). IL-10 was significantly higher in Group HES than in Group GEL at T1 (p = 0.0001). The CD4(+):CD8(+) ratio in Group ISO was significantly lower than that in Group HES at T2 (p = 0.003). CD11b(+) levels in Group HES were also higher than those in Group GEL and group ISO at T2, but not significantly. CD16/56(+) levels in Group HES were higher than those in Group GEL at T2 (p < 0.003). No excessive hemorrhage occurred in any patient. Mediastinal drainage during the first 24 h after surgery in Group HES (347 +/- 207 mL) was not significantly different from that of Group GEL (272 +/- 177 mL) or Group ISO (247 +/- 109) (p > 0.05). Conclusion: Hydroxyethyl starch 130/0.4 reduced pro-inflammatory responses and increased anti-inflammatory responses to a greater degree than gelatin solution and isolyte S (R). The use of hydroxyethyl starch, compared to gelatin solution and isolyte S (R), resulted in less decrease in the CD4(+):CD8(+) ratio, suggesting less immunosuppression. (C) 2014 Elsevier Ltd. All rights reserved.
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    Evaluation of hemostatic changes using thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgery
    Topçu, I; Çivi, M; Öztürk, T; Keles, GT; Çoban, S; Yentür, EA; Okçu, G
    The effects of Ringer lactate, 6% hydroxyethyl starch (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% hydroxyethyl starch 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (alpha), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the alpha angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the alpha angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, alpha angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.
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    Thromboelastography in the evaluation of coagulation disorders in patients with sepsis
    Kiliç, Y; Topçu, I; Bambal, H; Çivi, M
    Aim: Unbalanced hemostasis and disseminated intravenous coagulopathy serve as key participants in organ dysfunction and disability. In this study we evaluated the coagulation profiles of patients diagnosed with systemic inflammatory syndrome (SIRS)-sepsis and multiple organ dysfunction syndrome. We also researched coagulation in sepsis by comparing thromboelastography (TEG) data with those of nonsepsis patients to determine the usefulness of the TEG device. Materials and methods: Data were collected from 55 anesthesiology and surgery intensive care unit (ICU) patients: 21 with SIRS-sepsis (Group S) and 34 patients without SIRS-sepsis (Group C). Blood samples were taken upon admission to the ICU (t1) and on day 3 of the ICU stay (t2). TEG data (R = reaction time, K = coagulation time, a = alpha angle, and MA = maximum amplitude) were recorded. TEG parameters were compared with routine coagulation and hemogram studies. Results: The mean R value in Group C was higher than that of Group S at both t1 and t2. Group S had a significantly lower K value and higher alpha angle at t1 compared to Group C (P < 0.05). Conclusion: Hypercoagulability was observed in SIRS-sepsis patients in the ICU, as measured with TEG. We believe that TEG will be a useful tool in the evaluation of coagulation disorders developing in septic critically ill patients.
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    The effects of lornoxicam on brain edema and blood brain barrier following diffuse traumatic brain injury in rats
    Topçu, I; Gümüser, G; Bayram, E; Aras, F; Çetin, I; Temiz, C; Çivi, M
    BACKGROUND In this experiment, the effects of lornoxicam on brain edema and the blood brain barrier (BBB) following diffuse traumatic brain injury (TBI) were studied. METHODS Twenty adult male Wistar albino rats were anesthetized, and experimental closed head trauma was induced by the Marmarou method. After head injury, the rats were randomly divided into two groups: Group I was the control group, to which 2 ml saline was administered intraperitoneally, and Group II was the lornoxicam group, to which 2 ml 1.3 mg kg(-1) lornoxicam was administered intraperitoneally. Twenty-four hours after head trauma, 99 mTc pentetate (DTPA) was injected at a dose of 37 MBq, and posterior planar images of each rat were obtained using an Infinia gamma camera. After imaging of BBB permeability, brain tissues were dissected from the cranium. The brain water content (BWC) of each sample was calculated using the wet-dry method. RESULTS The lesion/background (L/b) ratio of Group I was 3.76 +/- 0.46 and 3.02 +/- 0.66 for early (5th min) and late (60th min) imaging, respectively. In Group II, the L/b ratios were 3.52 +/- 0.96 and 2.63 +/- 0.63 for early and late imaging, respectively (p>0.05). BWC was 79.6 +/- 2.5% and 77.5 +/- 1.1% for Groups I and II, respectively (p<0.05). CONCLUSION In this rat model of TBI, lornoxicam reduced brain edema but did not affect BBB permeability.
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    Our Experience with Percutaneous and Surgical Tracheotomy in Intubated Critically Ill Patients
    Ülkümen, B; Eskiizmir, G; Tok, D; Çivi, M; Çelik, O
    Objective: Open surgical tracheotomy (OST) and percutaneous dilatational tracheotomy (PDT) are commonly used for securing airway in intubated critically ill patients. The purpose of this study was to compare the safety of OST and PDT, particularly in intubated critically ill patients. Methods: The medical records of intubated critically ill patients who underwent tracheotomy between August 2006 and July 2017 were analyzed retrospectively. Minor and major complication rates were compared according to the tracheotomy technique. Preoperative intubation time, postoperative decannulation time, reason for hospitalization, and demographic data, including the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, were evaluated. Results: A total of 332 cases were enrolled into the study. The minor and major complication rates for both techniques were 27.2%, 8.8%, 9.7% and 3.2%, respecti-vely. Minor and major complication rates were higher in the OST group (p=0.01, p=0.03, respectively). The rate of every single complication was also compared on groups' basis. Accidental decannulation (p=0.02) and pneumothorax (p=0.05) were found to be significantly frequent in the OST group. There was no impact of the preoperative intubation time on the minor (p=0.20) and major complication (p=0.29) rates found. There was no statistically significant difference regarding the postoperative decannulation time (p=0.32). Also, there was no statistically significant difference between two groups in terms of the APACHE II (p=0.69) and SOFA (p=0.37) scores. However, a statistically significant difference between the groups in terms of overall survival was found, in favor of PDT (p<0.001). Conclusion: This study revealed that PDT is safer than OST, particularly in intubated critically ill patients.
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    Acute Kidney Injury Incidence According to The RIFLE Criteria and Risk Factors in Critically Ill Patients
    Karagoz, P; Kefi, A; Dündar, PE; Canan, S; Çivi, M
    Objective: In our study, it was aimed to investigate the relationship between RIFLE classification and the risk factors such as acute renal failure incidence, kidney failure in terms of comorbid conditions, critical conditions before and after hospitalization, if any, genetic predispositions, drug use, scores on administration day to the hospital and mortality in intensive care unit patients. Material and Method: A total of 200 patients hospitalized in anesthesiology and reanimation intensive care unit (ICU) between March 1, 2012 and March 31, 2013 were prospectively evaluated. The patients with a history of established chronic renal failure or hemodialysis, under 18 years of age and the patients hospitalized in ICU less than 48 hours were excluded. Data of the patients regarding age, gender, body mass index (BMI), diagnosis at the hospitalization, history of any operation, smoking status, medications, durations of ICU stay and mechanical ventilation, SOFA and APACHE II scores on the 1st day, the worst RIFLE score during the hospitalization, medical status at the end were recorded. The patients whom creatinine levels were not increased significantly and/or GFR and urine output were not decreased were accepted as out of RIFLE. Results: Age, BMI, diagnosis at the hospitalization, smoking status, presence and duration of chronic disease, analgesia, antibiotic and diuretic usages, presences bleeding and hypotension episodes, mechanical ventilation and total ICU hospitalization durations, SOFA and APACHE II scores on the 1st day were found to be significantly related to RIFLE classification. Gender, history and type of operation, type of chronic disease, glucocorticoids, HES, radiocontrast drug administration, renal stone disease, familial renal disease history were not found significantly related. Increased RIFLE scores were found to be related with increased mortality. Conclusion: We concluded that recognizing the factors leading to renal injury/failure and usage of RIFLE classification in daily care of patients are important to decrease mortality and morbidity of ICU patients by increasing the awareness.