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Article ; Online: Elevated strong ion gap: A predictor of the initiation of continuous renal replacement therapy in acute kidney injury.

Gucyetmez, Bulent / Sarikaya, Zeynep Tugce / Tuzuner, Filiz

The American journal of the medical sciences

2023 Volume 367, Issue 2, Page(s) 112–118

Abstract: Background: There is no optimal timing for continuous renal replacement therapy (CRRT) in acute kidney injury (AKI). AKI is a reason for the increased unmeasured anions, which refers to the increased organic acids in the blood, and they can be detected ... ...

Abstract	Background: There is no optimal timing for continuous renal replacement therapy (CRRT) in acute kidney injury (AKI). AKI is a reason for the increased unmeasured anions, which refers to the increased organic acids in the blood, and they can be detected by calculating strong ion gap (SIG). SIG level at the moment of the AKI diagnosis may be a predictor for the initiation of CRRT. Methods: Patients who were diagnosed with AKI in the first week of the intensive care unit (ICU) period were included in this prospective observational study. At the moment of the AKI diagnosis, blood gas samples were recorded, and SIG was calculated. Results: The median level of SIG at the moment of the AKI diagnosis of CRRT (+) patients was significantly higher than CRRT (-) patients (7.4 and 3.2 mmol L Conclusions: Increased SIG at the moment of the AKI diagnosis in patients with AKI may be a predictive marker to initiate CRRT.
MeSH term(s)	Humans ; Continuous Renal Replacement Therapy ; Renal Replacement Therapy ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/therapy ; Intensive Care Units ; Prospective Studies ; Retrospective Studies
Language	English
Publishing date	2023-11-20
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	82078-7
ISSN	1538-2990 ; 0002-9629
ISSN (online)	1538-2990
ISSN	0002-9629
DOI	10.1016/j.amjms.2023.11.012
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Article: The evaluation of cardiac functions in deep Trendelenburg position during robotic-assisted laparoscopic prostatectomy.

Kılınç, Emir / Yildirim, Serap Aktas / Ulugöl, Halim / Büyüköner, Elif Eroğlu / Güçyetmez, Bülent / Toraman, Fevzi

Frontiers in medicine

2023 Volume 10, Page(s) 1273180

Abstract: Objective: This study aimed to demonstrate the reliability of the cardiac cycle efficiency value through its correlation with longitudinal strain by observing the effect of the deep Trendelenburg position.: Design: A prospective, observational study.! ...

Abstract	Objective: This study aimed to demonstrate the reliability of the cardiac cycle efficiency value through its correlation with longitudinal strain by observing the effect of the deep Trendelenburg position. Design: A prospective, observational study. Setting: Single center. Participants: Between May and September 2022, the hemodynamic parameters of 30 patients who underwent robotic assisted laparoscopic prostatectomy under general anesthesia were prospectively evaluated. Measurements and main results: All invasive cardiac monitoring parameters and longitudinal strain achieved transesophageal echocardiography were recorded in pre-deep Trendelenburg position (T3) and 10th minute of deep Trendelenburg position (T4). Delta values were calculated for the cardiac cycle efficiency and longitudinal strain (values at T4 minus values at T3). The estimated power was calculated as 0.99 in accordance with the cardiac cycle efficiency values at T3 and T4 (effect size: 0.85 standard deviations of the mean difference: 0.22, alpha: 0.05). At T4, heart rate, pulse pressure variation, cardiac cycle efficiency, dP/dt and longitudinal strain were significantly lower than those at T3 ( Conclusion: Although the absence of significant changes in mean arterial pressure and cardiac index after Trendelenburg position suggests that cardiac workload has not changed, changes in cardiac cycle efficiency and longitudinal strain indicate increased cardiac workload due to increased ventriculo-arterial coupling.
Language	English
Publishing date	2023-09-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2023.1273180
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Article: The Relationship Between Decreased CD-8 T-Cells and Mortality in Patients with COVID-19 Pneumonia in the Intensive Care Unit, A Retrospective Study.

Sarıkaya, Zeynep Tuğçe / Güçyetmez, Bülent / Sesin Kocagöz, Ayşe / Telci, Lütfi / Akıncı, İbrahim Özkan

Turkish journal of anaesthesiology and reanimation

2023 Volume 51, Issue 3, Page(s) 227–234

Abstract: Objective: CD-8 T-cells are responsible for the clearance of virally infected cells. In patients with Coronavirus disease-2019 (COVID-19) pneumonia, there are quantitative reductions and functional impairments in T-cells. Low CD-8 T-cell levels cause ... ...

Abstract	Objective: CD-8 T-cells are responsible for the clearance of virally infected cells. In patients with Coronavirus disease-2019 (COVID-19) pneumonia, there are quantitative reductions and functional impairments in T-cells. Low CD-8 T-cell levels cause worse clinical situations. In this study, the relationship between decreased CD-8 T-cells and mortality in patients with COVID-19 pneumonia in the intensive care unit (ICU) was investigated. Methods: In this multicenter retrospective study, 277 patients were analyzed. Demographic data, ICU admission scores, blood gas levels, laboratory samples, and outcomes were recorded. Statistical Package for the Social Sciences version 28 was used for statistical analysis. Results: Two hundred forty of 277 patients were included in the study. The mortality rate was 43.3%. In non-survivors, median values of age, Charlson comorbidity index, Acute Physiology and Chronic Health Evaluation II (APACHE-II), procalcitonin, leukocyte count, neutrophil count, neutrophil-lymphocyte count ratio, and duration of invasive mechanical ventilation were significantly higher, whereas median values of PaO Conclusion: According to our findings, age, APACHE-II, and CD-8 T-cell levels seem to be independent risk factors for mortality in patients with COVID-19 pneumonia in the ICU.
Language	English
Publishing date	2023-07-17
Publishing country	Turkey
Document type	Journal Article
ISSN	2667-677X
ISSN	2667-677X
DOI	10.4274/TJAR.2022.22959
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Article: Effect of the Duration of Restrictive Fluid Therapy on Acute Kidney Injury in Robot-Assisted Laparoscopic Prostatectomy.

Aktas Yildirim, Serap / Sarikaya, Zeynep Tugce / Dogan, Lerzan / Gucyetmez, Bulent / Turkeri, Levent / Toraman, Fevzi

Journal of personalized medicine

2023 Volume 13, Issue 12

Abstract: Background: In robot-assisted laparoscopic prostatectomy (RALP), restrictive fluid therapy (RFT) is often utilized until the vesicourethral anastomosis (console period) is completed. RFT can cause acute kidney injury (AKI). Thus, RFT prolongation in ... ...

Abstract	Background: In robot-assisted laparoscopic prostatectomy (RALP), restrictive fluid therapy (RFT) is often utilized until the vesicourethral anastomosis (console period) is completed. RFT can cause acute kidney injury (AKI). Thus, RFT prolongation in surgeries that utilize the Trendelenburg position and pneumoperitoneum may increase the risk of postoperative AKI. We aimed to evaluate the effect of RFT duration on postoperative AKI. Methods: Forty-four patients who underwent RALP were included in this prospective observational study. Patients were divided into two groups according to the RFT duration (Group I, RFT duration ≤ 3 h, and Group II, RFT duration >3 h). AKI was diagnosed and staged according to the Kidney Disease Improving Global Outcomes criteria (KDIGO) using patients' serum creatinine levels after the first 24 h postoperatively. Hemodynamic parameters were monitored using the pressure recording analytical method. Results: The AKI incidence was significantly higher in Group II than in Group I (45.5% vs. 9.1%; Conclusion: RFT prolongation in RALP may increase the risk of developing AKI.
Language	English
Publishing date	2023-11-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm13121666
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Article: Arterial Elastance: A Predictor of Hypotension Due to Anesthesia Induction.

Aktas Yildirim, Serap / Sarikaya, Zeynep Tugce / Dogan, Lerzan / Ulugol, Halim / Gucyetmez, Bulent / Toraman, Fevzi

Journal of clinical medicine

2023 Volume 12, Issue 9

Abstract: Background: Hypotension is common after anesthesia induction and may have adverse outcomes. The aim of this study was to investigate whether arterial elastance (Ea) is a predictor of post-induction hypotension.: Methods: Between January and June 2022, ...

Abstract	Background: Hypotension is common after anesthesia induction and may have adverse outcomes. The aim of this study was to investigate whether arterial elastance (Ea) is a predictor of post-induction hypotension. Methods: Between January and June 2022, the hemodynamic parameters of 85 patients who underwent major surgery under general anesthesia were prospectively evaluated. The noncalibrated pulse contour device MostCare (Vytech, Vygon, Padua, Italy) was used to measure hemodynamic parameters before and after anesthesia induction. The duration of the measurements was determined from one minute before induction to 10 min after induction. Hypotension was defined as a greater than 30% decrease in mean arterial pressure from the pre-induction value and/or systolic arterial pressure of less than 90 mmHg. The patients were divided into post-induction hypotension (-) and (+) groups. For the likelihood of post-induction hypotension, a multivariate regression model was used by adding significantly different pre-induction parameters to the post-induction hypotension group. Results: The incidence of post-induction hypotension was 37.6%. The cut-off value of the pre-induction Ea for the prediction of post-induction hypotension was ≥1.08 mmHg m Conclusion: Pre-induction Ea showed excellent predictability of hypotension during anesthetic induction and identified patients at risk of general anesthesia induction-related hypotension.
Language	English
Publishing date	2023-04-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12093155
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Article: Hypotension after Anesthesia Induction: Target-Controlled Infusion Versus Manual Anesthesia Induction of Propofol.

Yildirim, Serap Aktas / Dogan, Lerzan / Sarikaya, Zeynep Tugce / Ulugol, Halim / Gucyetmez, Bulent / Toraman, Fevzi

Journal of clinical medicine

2023 Volume 12, Issue 16

Abstract: Background: Post-induction hypotension frequently occurs and can lead to adverse outcomes. As target-controlled infusion (TCI) obviates the need to calculate the infusion rate manually and helps safer dosing with prompt titration of the drug using ... ...

Abstract	Background: Post-induction hypotension frequently occurs and can lead to adverse outcomes. As target-controlled infusion (TCI) obviates the need to calculate the infusion rate manually and helps safer dosing with prompt titration of the drug using complex pharmacokinetic models, the use of TCI may provide a better hemodynamic profile during anesthesia induction. This study aimed to compare TCI versus manual induction and to determine the hemodynamic risk factors for post-induction hypotension. Methods: A total of 200 ASA grade 1-3 patients, aged 24 to 82 years, were recruited and randomly assigned to the TCI (n = 100) or manual induction groups (n = 100). Hemodynamic parameters were monitored with the pressure-recording analytic method. The propofol dosage was adjusted to keep the Bispectral Index between 40 and 60. Results: Post-induction hypotension was significantly higher in the manual induction group than in the TCI group (34% vs. 13%; Conclusion: TCI induction with propofol provided better hemodynamic stability than manual induction, and the presence of hypertension, a decrease in the pre-induction SVI, and the CPO could predict post-induction hypotension.
Language	English
Publishing date	2023-08-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12165280
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Article ; Online: Different Types of Intraoperative Hypotension and their Association with Post-Anesthesia Care Unit Recovery.

Dogan, Lerzan / Yildirim, Serap Aktas / Sarikaya, Tugce / Ulugol, Halim / Gucyetmez, Bulent / Toraman, Fevzi

Global heart

2023 Volume 18, Issue 1, Page(s) 44

Abstract: Background: The underlying causative mechanism leading to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, resulting in different types of IOH. Consequently, the incidence, severity, and postoperative ... ...

Abstract	Background: The underlying causative mechanism leading to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, resulting in different types of IOH. Consequently, the incidence, severity, and postoperative complications associated with IOH types may differ. This study explores the association between IOH types and post-anesthesia care unit (PACU) recovery, with a focus on duration and complications. Methods: From May 2022 to December 2022, we included 4776 consecutive surgical patients aged ≥18 who underwent elective surgery with planned overnight stays at Acibadem Altunizade Hospital and received general anesthesia. Post-induction hypotension (pIOH) was defined as a decrease in blood pressure during the first 20 minutes after anesthesia induction, while maintenance intraoperative hypotension (mIOH) referred to a decrease in blood pressure occurring after the 20th minute following induction, with or without preceding pIOH. Results: Among the included patients, 22.13% experienced IOH, with a higher prevalence observed among females. Patients with mIOH exhibited higher rates of bleeding, transfusions, hypothermia, longer stays in the PACU, and increased oxygen requirements. The duration of anesthesia did not increase the likelihood of IOH. Multivariate logistic regression analysis revealed that ephedrine usage, hypothermia, the need for additional analgesics, nausea, and vomiting were factors associated with longer PACU duration. Older patients (≥65), patients with ASA≥2 status, those undergoing major surgery, experiencing unexpected bleeding, and exhibiting hypothermia at the end of anesthesia had a higher likelihood of requiring vasopressor support. Conclusions: Patients experiencing hypotension, particularly during the maintenance of anesthesia, are more prone to complications in the PACU and require closer monitoring and treatment. Although less common, mIOH has a more significant impact on outcomes compared to other factors affecting PACU recovery. The impact of mIOH on PACU duration should not be overlooked in favor of other factors. Registration: Clinicaltrials.gov identifier: NCT05671783.
MeSH term(s)	Female ; Humans ; Hypothermia ; Intraoperative Complications/epidemiology ; Postoperative Complications/epidemiology ; Anesthesia, General/adverse effects ; Hypotension/epidemiology ; Hypotension/etiology ; Retrospective Studies
Language	English
Publishing date	2023-08-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2629633-0
ISSN	2211-8179 ; 2211-8160
ISSN (online)	2211-8179
ISSN	2211-8160
DOI	10.5334/gh.1257
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Article ; Online: Base-excess chloride; the best approach to evaluate the effect of chloride on the acid-base status: A retrospective study.

Gucyetmez, Bulent / Tuzuner, Filiz / Atalan, Hakan Korkut / Sezerman, Uğur / Gucyetmez, Kaan / Telci, Lutfi

PloS one

2021 Volume 16, Issue 4, Page(s) e0250274

Abstract: To practically determine the effect of chloride (Cl) on the acid-base status, four approaches are currently used: accepted ranges of serum Cl values; Cl corrections; the serum Cl/Na ratio; and the serum Na-Cl difference. However, these approaches are ... ...

Abstract	To practically determine the effect of chloride (Cl) on the acid-base status, four approaches are currently used: accepted ranges of serum Cl values; Cl corrections; the serum Cl/Na ratio; and the serum Na-Cl difference. However, these approaches are governed by different concepts. Our aim is to investigate which approach to the evaluation of the effect of Cl is the best. In this retrospective cohort study, 2529 critically ill patients who were admitted to the tertiary care unit between 2011 and 2018 were retrospectively evaluated. The effects of Cl on the acid-base status according to each evaluative approach were validated by the standard base excess (SBE) and apparent strong ion difference (SIDa). To clearly demonstrate only the effects of Cl on the acid-base status, a subgroup that included patients with normal lactate, albumin and SIG values was created. To compare approaches, kappa and a linear regression model for all patients and Bland-Altman test for a subgroup were used. In both the entire cohort and the subgroup, correlations among BECl, SIDa and SBE were stronger than those for other approaches (r = 0.94 r = 0.98 and r = 0.96 respectively). Only BECl had acceptable limits of agreement with SBE in the subgroup (bias: 0.5 mmol L-1) In the linear regression model, only BECl in all the Cl evaluation approaches was significantly related to the SBE. For the evaluation of the effect of chloride on the acid-base status, BECl is a better approach than accepted ranges of serum Cl values, Cl corrections and the Cl/Na ratio.
MeSH term(s)	APACHE ; Acid-Base Equilibrium/physiology ; Acid-Base Imbalance/blood ; Acid-Base Imbalance/diagnosis ; Acid-Base Imbalance/physiopathology ; Aged ; Chlorides/blood ; Critical Illness ; Female ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Lactic Acid/blood ; Linear Models ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin, Human/metabolism ; Sodium/blood ; Tertiary Care Centers
Chemical Substances	Chlorides ; Lactic Acid (33X04XA5AT) ; Sodium (9NEZ333N27) ; Serum Albumin, Human (ZIF514RVZR)
Language	English
Publishing date	2021-04-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0250274
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Article ; Online: Arterial Elastance

Serap Aktas Yildirim / Zeynep Tugce Sarikaya / Lerzan Dogan / Halim Ulugol / Bulent Gucyetmez / Fevzi Toraman

Journal of Clinical Medicine, Vol 12, Iss 3155, p

A Predictor of Hypotension Due to Anesthesia Induction

2023 Volume 3155

Abstract	Background: Hypotension is common after anesthesia induction and may have adverse outcomes. The aim of this study was to investigate whether arterial elastance (Ea) is a predictor of post-induction hypotension. Methods: Between January and June 2022, the hemodynamic parameters of 85 patients who underwent major surgery under general anesthesia were prospectively evaluated. The noncalibrated pulse contour device MostCare (Vytech, Vygon, Padua, Italy) was used to measure hemodynamic parameters before and after anesthesia induction. The duration of the measurements was determined from one minute before induction to 10 min after induction. Hypotension was defined as a greater than 30% decrease in mean arterial pressure from the pre-induction value and/or systolic arterial pressure of less than 90 mmHg. The patients were divided into post-induction hypotension (−) and (+) groups. For the likelihood of post-induction hypotension, a multivariate regression model was used by adding significantly different pre-induction parameters to the post-induction hypotension group. Results: The incidence of post-induction hypotension was 37.6%. The cut-off value of the pre-induction Ea for the prediction of post-induction hypotension was ≥1.08 mmHg m −2 mL −1 (0.71 [0.59–0.82]). In the multivariate regression model, the likelihood of postinduction hypotension was 3.5-fold (1.4–9.1), increased by only an Ea ≥ 1.08 mmHg m −2 mL −1 . Conclusion: Pre-induction Ea showed excellent predictability of hypotension during anesthetic induction and identified patients at risk of general anesthesia induction-related hypotension.
Keywords	general anesthesia ; post-induction hypotension ; arterial elastance ; ventriculoarterial coupling ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Effect of the Duration of Restrictive Fluid Therapy on Acute Kidney Injury in Robot-Assisted Laparoscopic Prostatectomy

Serap Aktas Yildirim / Zeynep Tugce Sarikaya / Lerzan Dogan / Bulent Gucyetmez / Levent Turkeri / Fevzi Toraman

Journal of Personalized Medicine, Vol 13, Iss 12, p

2023 Volume 1666

Abstract	Background: In robot-assisted laparoscopic prostatectomy (RALP), restrictive fluid therapy (RFT) is often utilized until the vesicourethral anastomosis (console period) is completed. RFT can cause acute kidney injury (AKI). Thus, RFT prolongation in surgeries that utilize the Trendelenburg position and pneumoperitoneum may increase the risk of postoperative AKI. We aimed to evaluate the effect of RFT duration on postoperative AKI. Methods: Forty-four patients who underwent RALP were included in this prospective observational study. Patients were divided into two groups according to the RFT duration (Group I, RFT duration ≤ 3 h, and Group II, RFT duration >3 h). AKI was diagnosed and staged according to the Kidney Disease Improving Global Outcomes criteria (KDIGO) using patients’ serum creatinine levels after the first 24 h postoperatively. Hemodynamic parameters were monitored using the pressure recording analytical method. Results: The AKI incidence was significantly higher in Group II than in Group I (45.5% vs. 9.1%; p = 0.016). In both groups, all patients who developed AKI were KDIGO stage 1 and all recovered on the second postoperative day. At the end of the console period, the heart rate and arterial elastance were significantly higher, whereas the stroke volume index was significantly lower in Group II than in Group I ( p = 0.041, p = 0.016, and p < 0.001, respectively). Although the amounts of fluid administered before and after the anastomosis were similar between the groups, the total amount of fluid administered was significantly different ( p < 0.001). There was a significant negative correlation between RFT duration and the total amount of fluid administered (r 2 = 0.43, p < 0.001). RFT duration of >3 h, total fluid administration of ≤3.3 mL/kg/h, and stroke volume index (SVI) at the end of the console period of ≤32 mL/m 2 increased the risk of AKI by 12.0 times (1.7–85.2) ( p = 0.013). Conclusion: RFT prolongation in RALP may increase the risk of developing AKI.
Keywords	acute kidney injury ; robot-assisted laparoscopic prostatectomy ; restrictive fluid therapy ; stroke volume index ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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