Researcher:
Çakar, Nahit

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Nahit

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Çakar

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2019 - 201912020 - 202210

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    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; 198906
    Background: 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.
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    Relationship between arterial oxygen tension and mortality of patients in intensive care unit on mechanical ventilation support
    (Turkish Assoc Trauma Emergency Surgery, 2019) Kaydu, Ayhan; Orhun, Günseli; Çakar, Nahit; Faculty Member; School of Medicine; 198906
    Background: Although there are studies demonstrating hyperoxia may be an independent risk factor for increased mortality and morbidity, this issue remains unclear. Our research then aimed to examine the relationship between arterial oxygen tension, arterial carbon dioxide tension, and in-hospital mortality of critically ill patients in intensive care unit (ICU).
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    Driving pressure is a risk factor for ards in mechanically ventilated subjects without ards
    (Daedalus Enterprises for the American Association for Respiratory Therapy, 2021) Roca, Oriol; Peñuelas, Oscar; Muriel, Alfonso; García-De-Acilu, Marina; Laborda, César; Sacanell, Judit; Riera, Jordi; Raymondos, Konstantinos; Du, Bin; Thille, Arnaud W.; Ríos, Fernando; González, Marco; Del-Sorbo, Lorenzo; Del Carmen Marín, Maria; Soares, Marco Antonio; Pinheiro, Bruno Valle; Nin, Nicolas; Maggiore, Salvatore M.; Bersten, Andrew; Amin, Pravin; Suh, Gee Young; Abroug, Fekri; Jibaja, Manuel; Matamis, Dimitros; Zeggwagh, Amine Ali; Sutherasan, Yuda; Anzueto, Antonio; Esteban, Andrés; Frutos-Vivar, Fernando; N/A; Çakar, Nahit; Faculty Member; School of Medicine; 198906
    Background: driving pressure (ΔP) has been described as a risk factor for mortality in patients with ARDS. However, the role of ΔP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between ΔP on the first day of mechanical ventilation with the development of ARDS. Methods: this was a post hoc analysis of a multicenter, prospective, observational, international study that included subjects who were on mechanical ventilation for > 12 h. Our objective was to evaluate the association between ΔP on the first day of mechanical ventilation with the development of ARDS. To assess the effect of ΔP, a logistic regression analysis was performed when adjusting for other potential risk factors. Validation of the results obtained was performed by using a bootstrap method and by repeating the same analyses at day 2. Results: a total of 1,575 subjects were included, of whom 65 (4.1%) developed ARDS. The ΔP was independently associated with ARDS (odds ratio [OR] 1.12, 95% CI 1.07-1.18 for each cm H2O of ΔP increase, P < .001). The same results were observed at day 2 (OR 1.14, 95% CI 1.07-1.21; P < .001) and after bootstrap validation (OR 1.13, 95% CI 1.04-1.22; P < .001). When taking the prevalence of ARDS in the lowest quartile of ΔP (≤9 cm H2O) as a reference, the subjects with ΔP > 12-15 cm H2O and those with ΔP > 15 cm H2O presented a higher probability of ARDS (OR 3.65, 95% CI 1.32-10.04 [P = .01] and OR 7.31, 95% CI, 2.89-18.50 [P < .001], respectively). Conclusions: in the subjects without ARDS, a higher level of ΔP on the first day of mechanical ventilation was associated with later development of ARDS.
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    Simplified calculation of mechanical power for pressure controlled ventilation in COVID-19 ards patients
    (Edizioni Medico Scientifiche, 2022) Asar, Sinan; Acicbe, Ozlem; Sabaz, Mehmet S.; Kucur Tulubas, Evrim; Hergunsel, Gulsum O.; Cukurova, Zafer; Canan, Emral; Çakar, Nahit; Faculty Member; School of Medicine; 198906
    Background: Mechanical power (MP) is a promising tool for guidance of lung protective ventilation. Different equations have been proposed to calculate MP in pressure control ventilation (PCV). The aim of this study is to introduce an easy to use MP equation MPpcv(m-simpl) and compare it to an equation proposed by Van der Meijden etal. (MPpcv) which considered as the reference equation in PCV. Methods: Ventilatory parameters of 206 COVID-19 ARDS patients recorded between 24-72 hours after admission to intensive care unit. The PCV data from these patients were retrospectively investigated. MP in PCV was calculated with a modified eq nation (MPpcv(m-simpl)) derived from the equation (MPpcv) ofVan der Meijden al: 0.098xRRxAVx(PEEP ; Delta P-insp insp - 1). The results from MPpcv(slope), MPpcv(simpl), and MPpcv(m-simpl), were compared to MP(pcv )at 15 cmH(2)O center dot s/L inspiratory resistance levels by univanable regression and Bland-Altman analysis. Results: Inspiratory resistance levels at 15 cmH(2)O s/L was found to be correlated between the power values calculated by MPpcv(simpl)/MPpcv(m-simpl),and the MPpcv(slope)/MPpcv based on univariable logistic regression (R-2 >98) analyses. In the comparison of all patients average MP values computed by the MPpcv(m-simpl) equation and the MPpcv reference equation. Bland-Altman analysis mean difference and p values at 15 cmH(2)O inspiratory resistance values (J/min) were found to be MPpcv(m-simpl) vs MPpcv =-0,04 (P=0.014); MPpcv(slope) vs. MPpcv =0.63 (P<0.0001); MPpcv(simpl) vs. MPpcv =0.64 J/min (P<0.0001), respectively. Conclusions: The results of this study confirmed that the MP(pcv(m-simpl) )equation can be used easily to calculate MP at bedside in pressure control ventilated COVID-19 ARDS patients.
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    Bedside dynamic calculation of mechanical power: a validation study
    (W B Saunders Co-Elsevier Inc, 2020) Asar, Sinan; Acicbe, Özlem; Çukurova, Zafer; Hergünsel, G. Oya; Canan, Emral; N/A; Çakar, Nahit; Faculty Member; School of Medicine; Koç University Hospital; N/A; 198906
    Purpose: To develop an equation to calculate the bedside dynamic mechanical power (MPdyn) for modern ventilators using the Work of Breathing ventilator (WOBv) parameter. Materials and methods: We developed an equation based on mechanical power values, which is equal to WOBv x minute volume. To measure mechanical power with this equation forty adult patients, hospitalized with the diagnosis of Acute Respiratory Distress Syndrome and underwent invasive mechanical ventilation, were used. To be able compare our results with Gattinoni's standart mechanical power equation (MPstd) the contribution of the PEEP was included in our equation. Then results obtained from MP(dy)(n )and MPstd were compared using univariable regression and Bland-Altman analysis. This comparison was performed at different I:E ratios, PEEP levels and tidal volumes. Results: Analysis of the results for each condition showed that MPdyn, and MPstd equation correlated with R-2 >= 0.98. Additionally, there was no statistically significant difference between MPdyn and MPstd for patient power means were 0.04 J/min (p = .42) using Bland-Altman analysis. Conclusions: Physicians can easily calculate mechanical power by using MPdyn at the bedside of patients on volume control mode. (C) 2020 Elsevier Inc. All rights reserved.
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    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; 42146
    We 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.
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    PublicationOpen 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/A
    Objective: 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.
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    PublicationOpen Access
    Bortezomib induced pulmonary toxicity: a case report and review of the literature
    (e-Century Publishing Corporation, 2020) Kalyon, Hakan; Özbalak, Murat; Örnek, Serdar; Keske, Şiran; Zeren, Handan; Kurtoğlu, Burçin Sağlam; Tabak, Levent; Çakar, Nahit; Aytekin, Saide; Bölükbaşı, Yasemin; Ferhanoğlu, Ahmet Burhan; Faculty Member; Faculty Member; Doctor; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; N/A; N/A; 198906; N/A; 216814; 18320
    Bortezomib is widely used in the treatment of Multiple Myeloma. While the most common side effects are neurological and gastrointestinal related complications, severe pulmonary problems are rarely described. The present case is a 72-year old male with multiple myeloma, who received Lenalidomide, Bortezomib, and Dexamethasone (RVD) combination regimen. He underwent 30 Gy palliative radiotherapy to the thoracic 5-9 and lumbar L1-3 vertebra due to pain and fracture risk. During the third cycle, he was admitted to hospital with dyspnea and dizziness. The thoracic CT revealed bilateral pleural effusions, a diffuse reticular pattern on the parenchyma, and ground-glass opacities that were compatible with drug-induced lung injury. The microbiological and molecular analysis excluded infectious disease, and lung biopsy confirmed the diagnosis of Bortezomib Lung Injury. The time from the first dose of Bortezomib to the lung injury was 57 days, and it was five days from the last dose of Bortezomib. His symptoms were refractory to IV steroids and supportive care. Our patient was lost despite steroids and intensive care support. Even Bortezomib induced lung injury is a rare adverse effect, based on high mortality rate, we would like to emphasize the clinical importance of this clinical scenario in light of the published literature and our presented case.
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    Management of COVID-19 cases in Kosova
    (Design Oriented Community (DOC), 2022) Ahmeti, Salih; Namani-Avdiu, Sadije; Berisha, Lindita Ajazaj; Vishaj, Arben; Sadik, İzzet; Alimusaj, Mentor; Hoti, Faik; Ahmet, Hysen; Sait, Bilgin; Keske, Şiran; Çakar, Nahit; Ergönül, Önder; Faculty Member; Faculty Member; Faculty Member; Koç Üniversitesi İş Bankası Enfeksiyon Hastalıkları Uygulama ve Araştırma Merkezi (EHAM) / Koç University İşbank Center for Infectious Diseases (KU-IS CID); School of Medicine; Koç University Hospital; 125555; 198906; 110398
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    Comparison of respiratory and hemodynamic parameters of COVID-19 and non-COVID-19 ARDS patients
    (Jaypee Brothers Medical Publishers, 2021) Asar, Sinan; Acicbe, Özlem; Sabaz, Mehmet S.; Tontu, Furkan; Canan, Emral; Çukurova, Zafer; Çakar, Nahit; Faculty Member; School of Medicine; 198906
    Background: COVID-19 can cause a clinical spectrum from asymptomatic disease to life-threatening respiratory failure and acute respiratory distress syndrome (ARDS). There is an ongoing discussion whether the clinical presentation and ventilatory parameters are the same as typical ARDS or not. There is no clear understanding of how the hemodynamic parameters have been affected in COVID-19 ARDS patients. We aimed to compare hemodynamic and respiratory parameters of moderate and severe COVID-19 and non-COVID-19 ARDS patients. These patients were monitored with an advanced hemodynamic measurement system by the transpulmonary thermodilution method in prone and supine positions. Patients and methods: data of 17 patients diagnosed with COVID-19 and 16 patients diagnosed with other types of diseases with moderate and severe ARDS, mechanically ventilated, placed in a prone position, had advanced hemodynamic measurements with PICCO, and stayed in the intensive care unit for more than a week were analyzed retrospectively. Patient characteristics and arterial blood gases analysis recorded at admission and respiratory and advanced hemodynamic parameters during the first week were compared in prone and supine positions. Results: no difference was observed in the respiratory parameters including respiratory system compliance between COVID-19 and non-COVD-19 patients in prone and supine positions. In comparison of advanced hemodynamic parameters in the first week of intensive care, the extravascular lung water and pulmonary vascular permeability indexes measured in supine position of COVID-19 ARDS patients were found to be significantly higher than non-COVID-19 patients. Duration of prone position was significantly longer in patients diagnosed with COVID-19 ARDS. Conclusions: the results of this study suggested that COVID-19 ARDS is a variant of typical ARDS with a different pathophysiology.