Researcher: Şentürk, Evren
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Şentürk, Evren
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Publication Metadata only Thoracic surgery in patients with previous lung resection(Springer International Publishing, 2020) Gil, Manuel Granell; Kawagoe, Izumi; Broseta, Ana; Giner, Laura; Şentürk, Mert; Şentürk, Evren; Faculty Member; School of Medicine; 48359Thoracic surgery in patients with a previous lung resection is a very difficult challenge for thoracic surgeons and anesthesiologists. Before to start the anesthetic induction we have to assess the anatomic airway changes, the cardiopulmonary fitness, lung mechanical function and lung parenchymal function. Chest radiograph and CT scan preoperative assessment it’s necessary to decide which is the optimal airway devices including DLT, bronchial blockers or both to perform a lung isolation or a selective lobar blockade guided by fiberscope to avoid tracheobronchial damage. Protective ventilation and permissive hypercapnia is very important to manage these patients. Moreover, it’s necessary to apply a protective ventilation but if anesthesiologists needed have to be ready to use other methods to improve the gas exchange as high frequency ventilation and extracorporeal ventilatory assistance among others.Publication Metadata only Is poliomyelitis sequelae a disadvantage for recovery from Covid-19 ARDS: a case report(Turkish Neuropsychiatry assoc-Turk Noropsikiyatri Dernegi, 2022) N/A; N/A; N/A; N/A; Topaloğlu, Mahir; Turan, Zeynep; Tekin, Süda; Şentürk, Evren; Taşkıran, Özden Özyemişçi; Doctor; Doctor; Faculty Member; Faculty Member; Faculty Member; N/A; N/A; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; 42146; 48359; 133091We present a case with acute respiratory distress syndrome due to COVID-19 who had poliomyelitis sequelae. He was hospitalized in the intensive care unit and supported by non-invasive mechanical ventilation for 7 days. IL-6 inhibitor was administered due to cytokine storm. No steroid or sedative agents were administered. Early mobilization was performed in the intensive care unit. one month after discharge, physical examination revealed COVID-19 infection did not cause significant changes in muscle strength and physical performance in this patient with poliomyelitis sequelae. It is important to promote early mobilization in the intensive care unit to prevent post-intensive care syndrome in COVID-19 acute respiratory distress syndrome.Publication Metadata only Physical rehabilitation in intensive care unit in acute respiratory distress syndrome patients with COVID-19(Edizioni Minerva Medica, 2021) N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; Taşkıran, Özden Özyemişçi; Turan, Zeynep; Tekin, Süda; Şentürk, Evren; Topaloğlu, Mahir; Yurdakul, Fatma; Ergönül, Önder; Çakar, Nahit; Faculty Member; Doctor; Faculty Member; Faculty Member; Doctor; Doctor; Faculty Member; Faculty Member; School of Medicine; N/A; School of Medicine; School of Medicine; N/A; N/A; School of Medicine; School of Medicine; KUH Hospital; 133091; N/A; 42146; 48359; N/A; N/A; 110398; 198906Background: The risk of muscle weakness is high in the survivors of acute respiratory distress syndrome with COVID-19 following discharge from intensive care unit. AIM: To evaluate the effects of early rehabilitation program in intensive care unit in patients with acute respiratory distress syndrome secondary to COVID-19. Design: The design of the study is observational. SETTING: The setting of the study is inpatient Population: Thirty-five patients with acute respiratory distress syndrome secondary to COVID-19 were enrolled. Methods: This study was performed in an intensive care unit of a university hospital. Early rehabilitation program consisting of passive or active range of motion exercises and neuromuscular electrical stimulation in addition to standard intensive care (N.=18) compared to standard intensive care (N.=17). Primary outcome was hand grip strength following discharge. RESULTS : Rehab group had higher prevalence of chronic pulmonary diseases and neurologic diseases. There was no difference in hand grip or manual muscle strength following discharge between rehab and non-rehab groups. No adverse event was noted. Conclusions: The results did not support the beneficial effects of early rehabilitation in intensive care unit on improving muscle strength. More patients with pulmonary and neurologic diseases in rehab group might impede the impact of rehabilitation on outcomes. On the other hand, these comorbidities underline the role and need of rehabilitation. It is safe both for the patients and the health care workers when necessary precautions are taken. Clinical Rehabilitation Impact: This study guide how to rehabilitate patients with acute respiratory distress syndrome with COVID-19 during intensive care unit in a safe way.Publication Metadata only Postoperative care of the thoracic patient(Elsevier, 2021) Gök, Funda; Şentürk, Mert; Şentürk, Evren; Faculty Member; School of Medicine; 48359This chapter focuses principally on the organization of postoperative care of the thoracic patient. Unfortunately, evidence-based guidelines regarding this period is not well-defined or supported by a sufficient number of studies addressing the different challenges. The anesthesiologist is an important part of the multidisciplinary context of perioperative medicine, directly involved in the decisions made during the pre-and intraoperative periods which can affect the postoperative outcome. One of such decisions is the question where to send the patient after surgery: Scoring systems do not help much while local conditions play an important role; overall, there is a decrease in the requirement of the intensive care unit for postoperative care. Enhanced Recovery After Surgery (ERAS) protocols have obtained a very important new step to help the philosophy of perioperative medicine; current ERAS protocols for thoracic surgery are welcome (constituting another chapter in this book); but unfortunately, still more suggestion-based than evidence-based. Management of chest tubes is another postoperative issue where newer suggestions aim to achieve a faster recovery without increasing the risk. Improvements in technology help to deal with the challenges: Regarding the postoperative period, two new tools have to be underlined: Ultrasound is now used routinely for many purposes, with abilities and advantages beyond chest x-ray. Thermodilution techniques have been considered to have very limited—if any—indications; current findings have shown that it can be helpful for evaluation of the right ventricular function. These devices and new studies can change our paradigms regarding the fluid therapy to keep the patient safely in euvolemic status. The scope of these innovations is also beyond the fluid therapy. Mechanical ventilation is unphysiologic, and can cause complications (ventilator associated lung injury [VALI] and ventilator associated pneumonia [VAP]). Therefore it is indicated only in patients in whom a gas exchange is indeed impossible with other approaches. In these cases, ventilation should be even more protective than general suugestions: even lower tidal volumes, rather no recruitment maneuver etc. To avoid the disadvantages of mechanical ventilation, newer approaches, such as noninvasive ventilation and high-flow oxygen therapy are now used more frequently. In most extreme cases, exceptional solutions like extracorporeal lung support or differential lung ventilation can be indicated. As patients after thoracic surgery comprise a spesific group for mechanical ventilation, weaning also plays a more important role. Each center has to define a protocol for weaning, based both on scientific evidence and on center-specific prerequisites. Electronic data recording systems can help to follow these protocols.Publication Metadata only The association between Acinetobacter baumannii infections and the COVID-19 pandemic in an intensive care unit(Nature Publishing Group (NPG), 2022) N/A; Boral, Jale; Pınarlık, Fatihan; Can, Füsun; Ekinci, Güz; Kuşkucu, Mert Ahmet; Ergönül, Önder; Genç, Zeliha; İrkören, Pelin; Kapmaz, Mahir; Çakar, Nahit; Şentürk, Evren; Yurdakul, Fatma; Dikenelli, Bilge; Tekin, Süda; PhD Student; PhD Student; Faculty Member; Master Student; Faculty Member; Faculty Member; Nurse; Doctor; Doctor; Faculty Member; Faculty Member; Doctor; Doctor; Faculty Member; Koç Üniversitesi İş Bankası Enfeksiyon Hastalıkları Uygulama ve Araştırma Merkezi (EHAM) / Koç University İşbank Center for Infectious Diseases (KU-IS CID); Graduate School of Health Sciences; Graduate School of Health Sciences; School of Medicine; Graduate School of Health Sciences; School of Medicine; School of Medicine; N/A; N/A; N/A; School of Medicine; School of Medicine; N/A; N/A; School of Medicine; Koç University Hospital; N/A; N/A; 103165; N/A; N/A; 110398; N/A; N/A; N/A; 198906; 48359; N/A; N/A; 42146We aimed to describe the increased rate of Acinetobacter baumannii infections during the COVID-19 pandemic and define its significance within the last five years. This study was performed in a tertiary hospital with 280 beds and included all patients infected with A. baumannii in the intensive care unit between January 1, 2018, and June 30, 2022. A. baumannii-infected patients in the intensive care unit 27 months before the pandemic and 27 months during the pandemic were included. Pulsed-field gel electrophoresis was performed to assess clonal relatedness. The infection control measures were specified based on the findings and targeted elimination. In total, 5718 patients were admitted to the intensive care unit from January 1st, 2018, to June 30th, 2022. A. baumannii infection was detected in 81 patients. Compared to the pre-pandemic era, the rate of A. baumannii infection during the pandemic was 1.90 times higher (OR: 1.90, 95% CI: [1.197, 3.033]). Clonality assessment of multidrug-resistant A. baumannii samples revealed eight clusters with one main cluster comprising 14/27 isolates between 2021 and 2022. The case fatality rate of the pre-pandemic and pandemic era was not different statistically (83.33% vs. 81.48%, p=0.835). Univariate analysis revealed the association of mechanical ventilation (p=0.002) and bacterial growth in tracheal aspirate (p=0.001) with fatality. During the COVID-19 pandemic, potential deficits in infection control measures may lead to persistent nosocomial outbreaks. In this study, the introduction of enhanced and customized infection control measures has resulted in the containment of an A. baumannii outbreak.Publication Open Access Appropriate use of tocilizumab in COVID-19 infection(Elsevier, 2020) Keske, Şiran; Sait, Bilgin; Çimen, Cansu; Çelebi, İrfan; Palaoğlu, Erhan; N/A; Tekin, Süda; İrkören, Pelin; Kapmaz, Mahir; Ergönül, Önder; Uğur, Semra; Şentürk, Evren; Çakar, Nahit; Çağlayan, Benan Niku; Tabak, Levent; Bakır, Veli Oğuzalp; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; Graduate School of Sciences and Engineering; N/A; N/A; N/A; 110398; N/A; 48359; N/A; 230719; N/A; N/AObjective: this study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. Methods: all patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, D-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. Results: forty-three patients were included: 70% were male; the median age was 64 years (minimum– maximum: 27–94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, D-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. Conclusion: earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and D-dimer, and decrease in % lymphocytes.Publication Open Access Effects of short-term hyperoxic ventilation on lung, kidney, heart, and liver in a rat model: a biochemical evaluation(Kare Yayıncılık, 2021) Aksu, Uğur; Ulugöl, Halim; Sungur, Mukadder Orhan; Vardar, Kübra; Şentürk, Mert; Toraman, Fevzi; Şentürk, Evren; Faculty Member; School of Medicine; 48359Background: despite studies on the adverse effects of hyperoxia, its use is still recommended by the World Health Organization. The aim of this study was to test the possible harmful effects of hyperoxia on the lung, kidney, heart, and liver in a rat mechanical ventilation model. Methods: male Wistar rats were randomly assigned into two groups (n=6/group): Normoxic (FiO(2): 0.3) or hyperoxic (FiO(2): 1.0) ventilation for 4 h. The injury was evaluated in bronchoalveolar lavage (BAL), blood, lung, liver, kidney, and heart was evaluated in terms of cell surface integrity, extracellular matrix (sialic acid, syndecan-1), osmotic stress (free hemoglobin), and redox homeostasis-lipid peroxidaation (malondialdehyde). BAL and wet/dry weight ratio were also evaluated for cellular permeability. Results: four hours of hyperoxic ventilation did not lead to significant changes in (1) sialic acid, syndecan-1, (2) malondialdehyde levels and wet/dry weight ratio in liver, kidney, heart, and lung compared to normoxic ventilation. Conclusion: mechanical ventilation with hyperoxia seems to have almost similar effects compared to ventilation with normoxia. However, the long term effect of hyperoxia should be evaluated. / Amaç: hiperoksinin olumsuz etkileri üzerine yapılan çalışmalara rağmen, Dünya Sağlık Örgütü (WHO) hiperoksinin kullanımını önermektedir. Bu çalışmanın amacı sıçan mekanik ventilasyon modelinde hiperoksinin akciğer, böbrek, kalp ve karaciğer üzerindeki olası olumsuz etkilerini test etmektedir. Gereç ve yöntem: erkek Wistar sıçanlar dört saat boyunca normoksik (FiO2: 0.3) veya hiperoksik (FiO2: 1.0) ventile edilerek iki gruba (n=6/grup) ayrıldı. Hasar hücre yüzey bütünlüğü, ekstraselüler matriks (sialik asit, sindekan-1), ozmotik stres (serbest hemoglobin) ve redoks homeostazisi-lipit peroksidasyonu (malondialdehit) açısından bronkoalveolar lavaj, kan, akciğer, böbrek, kalp ve karaciğer örneklerinde değerlendirildi. Ayrıca bronkoalveolar lavaj ve ıslak/kuru ağırlık oranı ile hücre geçirgenliği değerlendirildi. Bulgular: dört saatlik hiperoksik ventilasyon sialik asit, sindekan-1, malondialdehit düzeylerinde ve organların ıslak kuru ağırlıklarında anlamlı bir değişikliğe neden olmadı. Tartışma: hiperoksik ventilasyonun normoksik ventilasyona benzer bir etki gösterdiği görülmektedir. Ancak, hiperoksinin uzun vadeli etkileri değerlendirilmelidir.Publication Open Access The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients(Dove Medical Press, 2018) Atasever, Ayşe Gülşah; Özcan, Perihan Ergin; Kasalı, Kamber; Abdullah, Taner; Orhun, Günseli; N/A; Şentürk, Evren; Faculty Member; School of MedicineBackground: Gastrointestinal (GI) motility disorders in intensive care patients remain relatively unexplored. Nowadays, the frequency, risk factors and complications of GI dysfunction during enteral nutrition (EN) become more questionable. Aim: To evaluate the frequency, risk factors and complications of GI dysfunction during EN in the first 2 weeks of the intensive care unit (ICU) stay and to identify precautions to prevent the development of GI dysfunction and avoid complications. Methods: In this prospective observational study, we deliberately targeted at-risk patients. A total of 137 patients who received nasogastric tube feeding in an ICU of a tertiary hospital were enrolled. Results: The incidence of GI dysfunction that was found to be 63% which was associated mainly between MDR bacteria positivity and negative fluid balance. Diarrhea was observed in 36 patients (26%) and on 147 patient-days (incidence rate, 5.5 per 100 patient-days). The median day of diarrhea onset was 6 days after the initiation of EN. Forty patients (29%) presented with constipation (85% during the first week). Fifty patients (36%) exhibited upper digestive intolerance on 212 patient-days (incidence rate, 7.9 per 100 patient-days), after a median EN duration of 6 days (range, 2-14 days). Logistic regression analysis revealed MDR bacteria growth in the culture (OR, 1.75; 95% CI, 1.15-2.67; P=0.008) and negative fluid balance (OR, 0.57; 95% CI, 0.34-0.94; P=0.03) as the risk factors for GI dysfunction. We also showed that GI dysfunction was associated with high SOFA score, hypo-albuminemia, catecholamine use, and prolonged length of stay (LOS). GI dysfunction, on the other hand, can cause some complications including inadequate nutrition, and newly developed decubitus ulcers. Conclusion: GI dysfunction should be considered a clinical predictor of inadequate nutrition and prolonged LOS. In addition, the most dramatic risk for GI dysfunction was observed in patients with MDR bacteria growth in the culture and patients in negative fluid balance. Intensivists provide appropriate nutrition for patients, as well as prompt intervention and the development of treatment strategies in the event of GI dysfunction.