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    Prolonged Stay in the Intensive Care Unit: A Retrospective Analysis of Six Years
    (Galenos Publ House, 2023) Baran, Onur; Sahin, Ayhan; Gultekin, Ahmet; Arar, Cavidan
    Aim: A prolonged intensive care unit stay (ICU) is associated with many factors and causes various problems. This study aims to evaluate the clinical characteristics and the factors that led to the stay of the patients treated in the ICUs for 30 days and more. Materials and Methods: The data of 178 patients were analyzed retrospectively. Those with an ICU stay of 7-29 days (n=89) were assigned as ICU stay day <30 days - Group 1 and those with a stay of 30 days and more (n=89) were assigned as ICU stay day >= 30 days - Group 2. The factors related to a prolonged ICU stay were investigated in this study. The data obtained from the hospital data system were compared. Results: The age and gender distributions of the 178 patients were not statistically different between the two groups (p=0.355 and p=0.758, respectively). The group with an ICU stay of >= 30 days had a significantly higher tracheostomy rate (p<0.05) than the group with an ICU stay of <30 days. In this study, percutaneous endoscopic gastrostomy procedures were used more frequently on patients who stayed in the ICU for 30 days or more than on those who stayed for less than 30 days (p=0.000). Conclusion: Prolonged ICU stay are caused by multiple factors, and palliative care units and home care facilities must be used frequently to make the best use of ICU beds and to prevent prolonged ICU stays, which cause increased mortality and negative financial outcomes.
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    The Clinical Outcomes of Ultrasonography Usage in Percutaneous Dilatational Tracheostomy in the Intensive Care Unit
    (Galenos Publ House, 2023) Baran, Onur; Sahin, Ayhan; Arar, Makbule Cavidan
    Aim: Preprocedural ultrasonographic examination of the upper airway anatomy is an effective method for deciding on a tracheostomy procedure, such as percutaneous or surgical tracheostomy. We aimed to compare the effects of superficial cervical plexus block (CPB) with translaryngeal block with those of local anesthesia infiltration to the incision site for percutaneous tracheostomy in terms of hemodynamic parameters, gag reflex, and anesthetic requirement. In addition, we evaluated the effect of preprocedural ultrasonography assessment compared with that of anatomical landmark examination in terms of reducing the risk of procedure -related complications. Materials and Methods: A total of 148 patients aged at the range of 18-99 years, who were indicated for percutaneous tracheostomy in the intensive care unit, were enrolled in the study. The data intended for this study were obtained from the hospital's electronic patient database through retrospective scanning between 2018 and 2022. Patients who underwent ultrasonography for the evaluation of the related anatomical structures and superficial CPB with a translaryngeal block were assigned to the ultrasonography group (n=74), whereas those who underwent an anatomical landmark technique and local anesthetic infiltration to the procedure site were assigned to the traditional group (n=74). Results: The patients' age and sex distributions did not differ significantly between the traditional and ultrasonography groups (p>0.05). In the ultrasonography group, the preprocedural, midprocedural, and postprocedural heart rates were significantly higher than in the traditional group (p<0.05). In the ultrasonography group, the mean preprocedural arterial pressure decreased significantly during and after the procedure (p<0.05). The mean arterial pressure decreased during the procedure and the postprocedural arterial pressure was significantly higher (p<0.05) in the ultrasonography group than in the traditional group. Conclusion: Although ultrasonography-guided percutaneous tracheostomy takes more time to perform than traditional anatomical landmark percutaneous tracheostomy, we claim that the procedure is much safer and provides better clinical outcomes.
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    The Effect of Ventilation Mode in Anesthesia on Renal Mobility During Retrograde Intrarenal Surgery: A Single-Blind Randomized Study
    (Urol & Nephrol Res Ctr-Unrc, 2023) Dogan, Cagri; Akgul, Murat; Sahin, Ayhan; Yazici, Cenk Murat; Sahin, Mehmet Fatih; Altin, Enes; Keles, Anil
    Purpose: Renal mobility can present challenges for surgeons during stone fragmentation. The respiratory setup of the mechanical ventilator during RIRS might affect renal mobility. This study aimed to evaluate the effect of high ventilation (HV) and standard ventilation (SV) modes on renal mobility during RIRS.Materials and Methods: Patients who underwent RIRS at a single center between November 2020 and November 2021 were retrospectively included in the study. Renal mobility was measured under fluoroscopic view in HV and SV modes during retrograde pyelography. The surgeon, who was blind about mechanical ventilation modes, was asked to assess the renal movement grade. After the ventilation mode was changed, the surgeon reassessed renal mobility. The data and the surgeon's assessment were recorded and compared to each other.Results: A total of 86 patients with a mean age of 48.6 +/- 15.7 years were included in the study. There was a significant difference between the SV and HV modes in terms of renal mobility in fluoroscopic view (17.1 +/- 6.1 mm and 13.6 +/- 5.2mm, respectively; p = 0.007). According to the surgeon's assessments, the grade of renal mobility was found to be significantly higher in the SV group 2.8 +/- 1.1 compared to the HV group 2.2 +/- 0.8 (p = 0.001). Renal movement increased significantly under fluoroscopic vision as the renal grading of the surgeon increased (p = 0.013). This data demonstrated that the surgeon's assessment of renal mobility was significantly correlated with fluoroscopic kidney movement.Conclusion: Kidney movement was decreased significantly in HV mode during RIRS according to both fluoroscopic findings and surgeon assessment. Most surgeries of mobile kidneys were performed in HV mode, due to the surgeon's preference.
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    Unlocking safety: Ultrasound's role in tracheostomy
    (Elsevier Sci Ltd, 2024) Baran, Onur; Sahin, Ayhan; Arar, Cavidan
    Ultrasound imaging has become a valuable tool in Percutaneous Dilatational Tracheostomy (PDT), aiding in airway assessment and management. However, the risk of complications, including bleeding, highlights the importance of careful pre-procedural evaluation and management to ensure patient safety. A 75-year-old female with hypoxic encephalopathy required prolonged mechanical ventilation and was scheduled for PDT. Prior to the procedure, ultrasound identified two vascular structures anterior to the laryngotracheal region, prompting consultation with the ENT surgery department and cancellation of the procedure at the bedside. Subsequent tracheostomy in the operating room proceeded without incident.