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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 ; 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: 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: 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: 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: 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: Serum Vitamin D Level at ICU Admission and Mortality.

Atalan, Hakan Korkut / Güçyetmez, Bülent

Turkish journal of anaesthesiology and reanimation

2017 Volume 45, Issue 4, Page(s) 193–196

Abstract: Objective: Vitamin D is a fat-soluble vitamin that plays a major role in the regulation of bone and calcium metabolism and has effects on the immune and cardiovascular systems. Vitamin D deficiency is commonly seen in the general population as well as ... ...

Abstract	Objective: Vitamin D is a fat-soluble vitamin that plays a major role in the regulation of bone and calcium metabolism and has effects on the immune and cardiovascular systems. Vitamin D deficiency is commonly seen in the general population as well as in critically ill patients and is reported to be associated with increased mortality and morbidity. Our aim was to determine the relationship between vitamin D level at ICU admission and mortality. Methods: A total of 491 patients admitted to the ICU between January 2014 and January 2015 were evaluated retrospectively. The patients who were under 18 years old, had elective surgery, or whose serum vitamin D levels and outcomes were unknown were excluded. The patient's age, gender, APACHE II score, number of organ dysfunction, serum vitamin D level at ICU admission and outcomes were recorded. Results: Vitamin D level was low (<25 ng dL Conclusion: Vitamin D deficiency is commonly seen in intensive care patients. Although it is not an independently decisive factor for mortality, it might be related with poor clinical status at ICU admission. The APACHE II score and number of organ dysfunction are still important parameters for increased mortality.
Language	English
Publishing date	2017-08-01
Publishing country	Turkey
Document type	Journal Article
ISSN	2667-677X
ISSN	2667-677X
DOI	10.5152/TJAR.2017.60234
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Article: The effects of the chloride:sodium ratio on acid-base statusand mortality in septic patients.

Atalan, Hakan Korkut / Güçyetmez, Bülent

Turkish journal of medical sciences

2017 Volume 47, Issue 2, Page(s) 435–442

Abstract: Background/aim: Calculation of the chloride:sodium (Cl: Materials and methods: In our two-center study, 434 patients who were diagnosed with sepsis were included. The patients were divided into three groups: low (<0.75), normal (≥0.75, <0.80), and ... ...

Abstract	Background/aim: Calculation of the chloride:sodium (Cl Materials and methods: In our two-center study, 434 patients who were diagnosed with sepsis were included. The patients were divided into three groups: low (<0.75), normal (≥0.75, <0.80), and high (≥0.80) Cl Results: In the low and high groups, ICU mortality was significantly higher than in the normal group (29.3%, 37.1%) (P = 0.005). There was a negative correlation between the Cl:Na Conclusion: The Cl
MeSH term(s)	APACHE ; Acid-Base Equilibrium/physiology ; Acidosis/blood ; Acidosis/mortality ; Acidosis/physiopathology ; Adult ; Aged ; Aged, 80 and over ; Blood Gas Analysis ; Critical Illness ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Sepsis/blood ; Sepsis/mortality ; Sepsis/physiopathology ; Sodium Chloride/blood ; Young Adult
Chemical Substances	Sodium Chloride (451W47IQ8X)
Language	English
Publishing date	2017-04-18
Publishing country	Turkey
Document type	Journal Article ; Multicenter Study
ZDB-ID	1183461-4
ISSN	1303-6165 ; 1300-0144
ISSN (online)	1303-6165
ISSN	1300-0144
DOI	10.3906/sag-1602-100
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Article ; Online: C-Reactive Protein and Hemogram Parameters for the Non-Sepsis Systemic Inflammatory Response Syndrome and Sepsis: What Do They Mean?

Gucyetmez, Bulent / Atalan, Hakan K

PloS one

2016 Volume 11, Issue 2, Page(s) e0148699

Abstract: Objectives: Sepsis is one of the most common reasons of increased mortality and morbidity in the intensive care unit. The changes in CRP levels and hemogram parameters and their combinations may help to distinguish sepsis from non-sepsis SIRS. The aim ... ...

Abstract	Objectives: Sepsis is one of the most common reasons of increased mortality and morbidity in the intensive care unit. The changes in CRP levels and hemogram parameters and their combinations may help to distinguish sepsis from non-sepsis SIRS. The aim of this study is to investigate the CRP and hemogram parameters as an indicator of sepsis. Methods: A total of 2777 patients admitted to the ICU of two centers between 2006-2013 were evaluated retrospectively. The patients were diagnosed as SIRS (-), non-sepsis SIRS and sepsis. The patients who were under 18 years old, re-admitted, diagnosed with hematological disease, on corticosteroid and immunosuppressive therapy, SIRS (-), culture negative, undocumented laboratory values and outcomes were excluded. 1257 patients were divided into 2 groups as non-sepsis SIRS and sepsis. The patients' demographic data, CRP levels, hemogram parameters, length of ICU stay and mortality were recorded. Results: 1257 patients were categorized as non-sepsis SIRS (816, 64.9%) and sepsis (441, 35.1%). In the multivariate analysis, the likelihood of sepsis was increased 3.2 (2.2-4.6), 1.7 (1.2-2.4), 1.6 (1.2-2.1), 2.3 (1.4-3.8), 1.5 (1.1-2.1) times by the APACHE II≥13, SOFA score≥4, CRP≥4.0, LymC<0.45 and PLTC<150 respectively (p<0.001 p = 0.007 p = 0.004 p<0.001 p = 0.027). The likelihood of sepsis was increased 18.1 (8.4-38.7) times by the combination of CRP≥4.0, lymC<0.45 and PLTC<150 (P<0.001). Conclusions: While WBCC, NeuC, Neu%, NLCR and EoC are far from being the indicators to distinguish sepsis from non-sepsis SIRS, the combinations of CRP, LymC and PLTC can be used to determine the likelihood of sepsis.
MeSH term(s)	APACHE ; Adult ; Aged ; Biomarkers ; Body Fluids/microbiology ; C-Reactive Protein/analysis ; Diagnosis, Differential ; Elective Surgical Procedures/statistics & numerical data ; Emergencies ; Female ; Hospital Mortality ; Humans ; Intensive Care Units/statistics & numerical data ; Length of Stay/statistics & numerical data ; Leukocyte Count ; Male ; Mean Platelet Volume ; Middle Aged ; Platelet Count ; Retrospective Studies ; Sepsis/blood ; Sepsis/diagnosis ; Severity of Illness Index ; Systemic Inflammatory Response Syndrome/blood ; Systemic Inflammatory Response Syndrome/diagnosis
Chemical Substances	Biomarkers ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2016-02-10
Publishing country	United States
Document type	Comparative Study ; Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0148699
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