Hilmi Demirkıran - Academia.edu (original) (raw)

Papers by Hilmi Demirkıran

Cureus

Sepsis bundle compliance is not clear. We evaluated rates of compliance with sepsis bundle protoc... more Sepsis bundle compliance is not clear. We evaluated rates of compliance with sepsis bundle protocols among health care providers in Turkey. Methods Our study was carried out retrospectively. Forty-five intensive care units (ICU) participated in this study between March 2, 2018 and October 1, 2018. Results One hundred thirty-eight ICUs were contacted and 45 ICUs agreed to participate. The time taken for the diagnosis of sepsis was less than six hours in 384 (59.8%) patients, while it was more than six hours in 258 (40.2%) patients. The median [interquartile range (IQR)] times for initial antibiotic administration, culturing, vasopressor initiation, and second lactate measurement were 120.0 (60-300) minutes, 24 (12-240) minutes, 40 (20-60) minutes, and 24 (18-24) hours, respectively. The rate of compliance with tissue and organ perfusion follow-up in the first six hours was 0%. The rates of three-and six-hour sepsis bundle protocol compliance were both 0%. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. Conclusions The rate of compliance with sepsis bundle protocols was evaluated in Turkey for the first time and determined to be 0%.

Turkish Journal of Geriatrics-Turk Geriatri Dergisi, 2020

1 Van Yuzuncu Yil University Faculty of Medicine, Department of Anesthesiology and Reanimation, V... more 1 Van Yuzuncu Yil University Faculty of Medicine, Department of Anesthesiology and Reanimation, Van, Turkey 2 Istanbul Medipol University Mega Hospitals Complex, Department of Anesthesiology and Reanimation, Istanbul, Turkey 3 Recep Tayyip Erdogan University Faculty of Medicine, Department of Anesthesiology and Reanimation, Rize, Turkey 4 Private OFM Antalya Hospital, General Intensive Care Unit, Antalya, Turkey 5 Biruni University Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey 6 Sakarya University Faculty of Medicine, Anesthesiology and Intensive Care Unit, Sakarya, Turkey 7 Private Corlu Vatan Hospital, General Intensive Care Unit, Tekirdag, Turkey 8 Van Yuzuncu Yil University Faculty of Medicine, Department of General Surgery, Van, Turkey 9 Van Yuzuncu Yil University Faculty of Medicine, Department of Neurology, Van, Turkey 10 Hatay Mustafa Kemal University Tayfur Ata Sokmen Faculty of Medicine, Department of Anesthesiology and Reanimation, Ha...

Van Medical Journal, 2018

Purpose: This study aimed to determine anesthesiarelated mortality and intraoperative mortality (... more Purpose: This study aimed to determine anesthesiarelated mortality and intraoperative mortality (IOM) incidences and the associated risk factors. Material and Methods: The operations between the years of 2010-2019 were retrospectively reviewed. It was found that 87 of 351,930 patients who were anesthetized in the last 10 years died. Each patient who died was recruited into one of the patient/condition-related, surgical-related, or anesthesia-related mortality groups. Patient characteristics were determined as age, gender, ASA PS score, and comorbidities. Surgical procedures were classified as minor/intermediate, major, and major complex. Anesthesia type was recorded. Operative time, the requirement for vasopressor and the invasive monitoring were determined. Results: The incidence of IOM and anesthesia-related mortality were 2.47 and 0.28 per 10,000 patients, respectively. The IOM group had a higher rate of out-ofhours work, surgical emergency, prolonged operative time, high comorbidity rate, high ASA PS score, major complex surgeries, use of VP, and invasive monitoring. Surgical emergency (p: 0.000), use of VP (p: 0.002), and invasive monitoring (p: 0.000) were independent determinants of IOM. Major complex surgeries (p: 0.007), surgical emergency (p: 0.000), use of VP (p: 0.002), and invasive monitoring (0.000) were potentially associated factors in anesthesia-related mortality. Conclusion: The incidence of IOM and anesthesia-related mortality were 2.47 and 0.28 per 10,000 patients, respectively. The fact that anesthesia-related mortality was associated with drug administration is important for the development of preventive measures. Primary prevention may play a key role in reducing the high fatality. These results indicate the need for improving medical perioperative practices in high-risk and emergency patients.

The Turkish Journal of Geriatrics, 2020

Eastern Journal Of Medicine, 2019

In the patients who have perioperative renal failure risk, anesthetical substances should be choo... more In the patients who have perioperative renal failure risk, anesthetical substances should be choosen with caution to protect the function of kidneys. Ketamine, an anesthetic induction agent, is generally used in patients with severe hypotension or respiratory depression. We aimed to evaluate the different doses of ketamine's effects on ischemia/reperfusion (I/R) damage mediated by free radicals in rats. Materials and methods: In this study, 42 Wistar albino male rats were splitted randomly into 7 different groups. In the ketamine group, ketamine was applied intraperitoneally (IP) in different doses (3 mg kg‫-‬ 1 , 10 mg kg‫-‬ 1 , 30 mg kg‫-‬ 1 , 60 mg kg‫-‬ 1 , 80 mg kg‫-‬ 1) on the 45 th minutes. Clamps were opened at the end of 60 minutes ischemia period. At the end of the reperfusion period, renal tissue and blood sample s were taken from the rats. In the plasma samples, pro-inflammatory biomarkers [Interleukin (IL)-1β, IL-6, tumour necrosis factor alpha (TNF-α)] were analysed. In renal tissue samples, antioxidating activities [Superoxide dismutase (SOD), glutathione perox idase (GPx) and nitric oxide (NO)] and lipid peroxidation product "Malondialdehyde (MDA)" levels were studied biochemically. Renal tissue damage was evaluated histopathologically. There were no differences among the beneficial effects of ketamine given gro ups (10-30-60-80 mg kg‫-‬ 1 doses) before reperfusion in the way of antioxidant activities, pro-inflammatory markers and lipid peroxidation product. When ketamin was applied in 3 mg kg‫-‬ 1 there were beneficial effects on tissues in the way of SOD, GPx, NO, MDA values and histopathologically (p<0.05). Some studies have shown that ketamine has little anti-inflammatory properties. This animal study has shown that ketamine in low doses significantly reduces the I/R injury in rats (p<0.05).

Eastern Journal Of Medicine, 2018

Hanging is used worlwide for suicide. It is generally ends with sudden death. But if the person i... more Hanging is used worlwide for suicide. It is generally ends with sudden death. But if the person is reached in a short time after hanging attempt, the patient can be saved. But we may come across some medical problems like pulmonary edema, cervical vertebra instability, impaired cognitive functions. 28 year old female patient had been taken to our hospital after incomplete hanging attempt with suicide intention. While she was in our hospital she had pulmonary complication. She had mechanical ventilation need. We supported her with mechanical ventilation both invasively and noninvasively. After 4 days of mechanical ventilation support she was discharged to the psychi atry clinic without any sequel.

Eastern Journal Of Medicine

Ventilator-Associated Pneumonia (VAP) is defined as a nosocomial infection which develops within ... more Ventilator-Associated Pneumonia (VAP) is defined as a nosocomial infection which develops within 48-72 hours after receiving mechanical ventilator (MV) support (1). The incidence of VAP varies among countries and is between 8.7-38.6% in Turkey. Although there were differences between hospitals ABSTRACT Ventilator-associated pneumonia (VAP) is a nosocomial infection that can develop in patients receiving mechanical ventilator (MV) support. VAP has a high mortality rate and cost due to prolonged hospitalisation. Some procedures have s hown that VAP can be prevented. However, the incidence of VAP is still high in Turkey. In this study, we aim to investigate how increased compliance with VAP prevention bundle training for health personnel affects the incidence of VAP, the onset day of VAP , the duration of mechanical ventilation, and mortality rates. This prospective case control study was started after obtaining permission from the Van Yuzuncu Yil University (VYYU) Medicine School Ethics Committee. It was conducted between November 2017 an d June 2018 at the Anesthesiology and Reanimation Intensive Care Unit (ICU) of the Dursun Odabaş Medical Center, VYYU Medicine School. In this study, the study group (VAP prevention bundle group after healthcare staff training) included 68 patients who rec eived MV support. The control group consisted of 100 patients who received the VAP prevention bundle between January 2016 and June 2017 in the anaesthesia ICU. The Centers for Disease Control and Prevention (CDC) criteria were used for the diagnosis of VAP. In both groups, compliance with the Prevention Bundle, the incidence of VAP, the onset day of VAP, the duration of mechanical ventilation, th e day of tracheostomy operation and mortality rates were recorded. Patient groups were compared statistically. The demographic data, diagnosis and cultured microorganisms in VAP patients were similar and there was no statistically significant difference. The effect of four parameters [Endotracheal tube with subglottic secretion drainage (SSD-ETT), 0.12% chlorhexidine oral care, peptic ulcer prophylaxis and deep venous thrombosis (DVT) prophylaxis] that were included in the VAP Prevention bundle could not be evaluated separately because of the mean fit. The mean fit in holding the bed head position at an angle of 30°-45° was 100% in the VAP Prevention bundle group, while in the control group the average was 90.67% (85-100%). The relationship between this and the development of VAP was statistically significant (p=0.036). ETT cuff pressure of 20-25 cm H2O was maintained at 97.96% in the VAP Prevention Bundle group and at 93.13% in the control group. The difference between the groups according to the accordance to the ETT cuff pressure was statistically significant (p=0.01). In our study, VAP was detected in 12 patients (17.6%) in the study group and 9 patients (9%) in the control group. There was no statistically significant difference between the groups in terms of VAP or the duration of mechanical ventilation support (30.29 ± 24.5/26.11±15.47). No early development of was seen in either group (first four days after MV support). It was determined that all VAP attacks developed after the fifth day of MV support. For 1000 ventilator days, onset of VAP was 13.1 days in the VAP prevention bundle group and 4.29 days in the control group, which was not statistically significant (p = 0.96). Although the mean number of days of VAP-developing groups in relation to MV was 44.83 ± 30.845/82.22 ± 55.432, it was not statistically significant. In the VAP prevention bundle group, the mean day of application of tracheostomy was 7.09 ± 7.12 while it was 16.67 ± 9.11 in the control group; this difference between the groups was statistically significant. Although the mortality rate was increased in patients with VAP, it was not statistically significant. However, mortality rates were significantly lo wer in patients without VAP as compared to the control group (p<0.05). Implementation of the VAP prevention bundle group did not decrease the incidence of VAP in our clinic. It was found that stri ct compliance to the all parameters of the prevention bundle didn't reduce the VAP incidence in ICUs but it was prolonged the onset time of VAP. But the carrying out the VAP prevention bundle to the patients with mechanical ventilatory support reduced the mortality rates. We think that the present VAP prevention bundle should be revised in the way of use of s tress ulcer prophylaxis.

Eastern Journal Of Medicine

Current Therapeutic Research, 2010

Cureus

Sepsis bundle compliance is not clear. We evaluated rates of compliance with sepsis bundle protoc... more Sepsis bundle compliance is not clear. We evaluated rates of compliance with sepsis bundle protocols among health care providers in Turkey. Methods Our study was carried out retrospectively. Forty-five intensive care units (ICU) participated in this study between March 2, 2018 and October 1, 2018. Results One hundred thirty-eight ICUs were contacted and 45 ICUs agreed to participate. The time taken for the diagnosis of sepsis was less than six hours in 384 (59.8%) patients, while it was more than six hours in 258 (40.2%) patients. The median [interquartile range (IQR)] times for initial antibiotic administration, culturing, vasopressor initiation, and second lactate measurement were 120.0 (60-300) minutes, 24 (12-240) minutes, 40 (20-60) minutes, and 24 (18-24) hours, respectively. The rate of compliance with tissue and organ perfusion follow-up in the first six hours was 0%. The rates of three-and six-hour sepsis bundle protocol compliance were both 0%. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. Conclusions The rate of compliance with sepsis bundle protocols was evaluated in Turkey for the first time and determined to be 0%.

Turkish Journal of Geriatrics-Turk Geriatri Dergisi, 2020

1 Van Yuzuncu Yil University Faculty of Medicine, Department of Anesthesiology and Reanimation, V... more 1 Van Yuzuncu Yil University Faculty of Medicine, Department of Anesthesiology and Reanimation, Van, Turkey 2 Istanbul Medipol University Mega Hospitals Complex, Department of Anesthesiology and Reanimation, Istanbul, Turkey 3 Recep Tayyip Erdogan University Faculty of Medicine, Department of Anesthesiology and Reanimation, Rize, Turkey 4 Private OFM Antalya Hospital, General Intensive Care Unit, Antalya, Turkey 5 Biruni University Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey 6 Sakarya University Faculty of Medicine, Anesthesiology and Intensive Care Unit, Sakarya, Turkey 7 Private Corlu Vatan Hospital, General Intensive Care Unit, Tekirdag, Turkey 8 Van Yuzuncu Yil University Faculty of Medicine, Department of General Surgery, Van, Turkey 9 Van Yuzuncu Yil University Faculty of Medicine, Department of Neurology, Van, Turkey 10 Hatay Mustafa Kemal University Tayfur Ata Sokmen Faculty of Medicine, Department of Anesthesiology and Reanimation, Ha...

Van Medical Journal, 2018

Purpose: This study aimed to determine anesthesiarelated mortality and intraoperative mortality (... more Purpose: This study aimed to determine anesthesiarelated mortality and intraoperative mortality (IOM) incidences and the associated risk factors. Material and Methods: The operations between the years of 2010-2019 were retrospectively reviewed. It was found that 87 of 351,930 patients who were anesthetized in the last 10 years died. Each patient who died was recruited into one of the patient/condition-related, surgical-related, or anesthesia-related mortality groups. Patient characteristics were determined as age, gender, ASA PS score, and comorbidities. Surgical procedures were classified as minor/intermediate, major, and major complex. Anesthesia type was recorded. Operative time, the requirement for vasopressor and the invasive monitoring were determined. Results: The incidence of IOM and anesthesia-related mortality were 2.47 and 0.28 per 10,000 patients, respectively. The IOM group had a higher rate of out-ofhours work, surgical emergency, prolonged operative time, high comorbidity rate, high ASA PS score, major complex surgeries, use of VP, and invasive monitoring. Surgical emergency (p: 0.000), use of VP (p: 0.002), and invasive monitoring (p: 0.000) were independent determinants of IOM. Major complex surgeries (p: 0.007), surgical emergency (p: 0.000), use of VP (p: 0.002), and invasive monitoring (0.000) were potentially associated factors in anesthesia-related mortality. Conclusion: The incidence of IOM and anesthesia-related mortality were 2.47 and 0.28 per 10,000 patients, respectively. The fact that anesthesia-related mortality was associated with drug administration is important for the development of preventive measures. Primary prevention may play a key role in reducing the high fatality. These results indicate the need for improving medical perioperative practices in high-risk and emergency patients.

The Turkish Journal of Geriatrics, 2020

Eastern Journal Of Medicine, 2019

In the patients who have perioperative renal failure risk, anesthetical substances should be choo... more In the patients who have perioperative renal failure risk, anesthetical substances should be choosen with caution to protect the function of kidneys. Ketamine, an anesthetic induction agent, is generally used in patients with severe hypotension or respiratory depression. We aimed to evaluate the different doses of ketamine's effects on ischemia/reperfusion (I/R) damage mediated by free radicals in rats. Materials and methods: In this study, 42 Wistar albino male rats were splitted randomly into 7 different groups. In the ketamine group, ketamine was applied intraperitoneally (IP) in different doses (3 mg kg‫-‬ 1 , 10 mg kg‫-‬ 1 , 30 mg kg‫-‬ 1 , 60 mg kg‫-‬ 1 , 80 mg kg‫-‬ 1) on the 45 th minutes. Clamps were opened at the end of 60 minutes ischemia period. At the end of the reperfusion period, renal tissue and blood sample s were taken from the rats. In the plasma samples, pro-inflammatory biomarkers [Interleukin (IL)-1β, IL-6, tumour necrosis factor alpha (TNF-α)] were analysed. In renal tissue samples, antioxidating activities [Superoxide dismutase (SOD), glutathione perox idase (GPx) and nitric oxide (NO)] and lipid peroxidation product "Malondialdehyde (MDA)" levels were studied biochemically. Renal tissue damage was evaluated histopathologically. There were no differences among the beneficial effects of ketamine given gro ups (10-30-60-80 mg kg‫-‬ 1 doses) before reperfusion in the way of antioxidant activities, pro-inflammatory markers and lipid peroxidation product. When ketamin was applied in 3 mg kg‫-‬ 1 there were beneficial effects on tissues in the way of SOD, GPx, NO, MDA values and histopathologically (p<0.05). Some studies have shown that ketamine has little anti-inflammatory properties. This animal study has shown that ketamine in low doses significantly reduces the I/R injury in rats (p<0.05).

Eastern Journal Of Medicine, 2018

Hanging is used worlwide for suicide. It is generally ends with sudden death. But if the person i... more Hanging is used worlwide for suicide. It is generally ends with sudden death. But if the person is reached in a short time after hanging attempt, the patient can be saved. But we may come across some medical problems like pulmonary edema, cervical vertebra instability, impaired cognitive functions. 28 year old female patient had been taken to our hospital after incomplete hanging attempt with suicide intention. While she was in our hospital she had pulmonary complication. She had mechanical ventilation need. We supported her with mechanical ventilation both invasively and noninvasively. After 4 days of mechanical ventilation support she was discharged to the psychi atry clinic without any sequel.

Eastern Journal Of Medicine

Ventilator-Associated Pneumonia (VAP) is defined as a nosocomial infection which develops within ... more Ventilator-Associated Pneumonia (VAP) is defined as a nosocomial infection which develops within 48-72 hours after receiving mechanical ventilator (MV) support (1). The incidence of VAP varies among countries and is between 8.7-38.6% in Turkey. Although there were differences between hospitals ABSTRACT Ventilator-associated pneumonia (VAP) is a nosocomial infection that can develop in patients receiving mechanical ventilator (MV) support. VAP has a high mortality rate and cost due to prolonged hospitalisation. Some procedures have s hown that VAP can be prevented. However, the incidence of VAP is still high in Turkey. In this study, we aim to investigate how increased compliance with VAP prevention bundle training for health personnel affects the incidence of VAP, the onset day of VAP , the duration of mechanical ventilation, and mortality rates. This prospective case control study was started after obtaining permission from the Van Yuzuncu Yil University (VYYU) Medicine School Ethics Committee. It was conducted between November 2017 an d June 2018 at the Anesthesiology and Reanimation Intensive Care Unit (ICU) of the Dursun Odabaş Medical Center, VYYU Medicine School. In this study, the study group (VAP prevention bundle group after healthcare staff training) included 68 patients who rec eived MV support. The control group consisted of 100 patients who received the VAP prevention bundle between January 2016 and June 2017 in the anaesthesia ICU. The Centers for Disease Control and Prevention (CDC) criteria were used for the diagnosis of VAP. In both groups, compliance with the Prevention Bundle, the incidence of VAP, the onset day of VAP, the duration of mechanical ventilation, th e day of tracheostomy operation and mortality rates were recorded. Patient groups were compared statistically. The demographic data, diagnosis and cultured microorganisms in VAP patients were similar and there was no statistically significant difference. The effect of four parameters [Endotracheal tube with subglottic secretion drainage (SSD-ETT), 0.12% chlorhexidine oral care, peptic ulcer prophylaxis and deep venous thrombosis (DVT) prophylaxis] that were included in the VAP Prevention bundle could not be evaluated separately because of the mean fit. The mean fit in holding the bed head position at an angle of 30°-45° was 100% in the VAP Prevention bundle group, while in the control group the average was 90.67% (85-100%). The relationship between this and the development of VAP was statistically significant (p=0.036). ETT cuff pressure of 20-25 cm H2O was maintained at 97.96% in the VAP Prevention Bundle group and at 93.13% in the control group. The difference between the groups according to the accordance to the ETT cuff pressure was statistically significant (p=0.01). In our study, VAP was detected in 12 patients (17.6%) in the study group and 9 patients (9%) in the control group. There was no statistically significant difference between the groups in terms of VAP or the duration of mechanical ventilation support (30.29 ± 24.5/26.11±15.47). No early development of was seen in either group (first four days after MV support). It was determined that all VAP attacks developed after the fifth day of MV support. For 1000 ventilator days, onset of VAP was 13.1 days in the VAP prevention bundle group and 4.29 days in the control group, which was not statistically significant (p = 0.96). Although the mean number of days of VAP-developing groups in relation to MV was 44.83 ± 30.845/82.22 ± 55.432, it was not statistically significant. In the VAP prevention bundle group, the mean day of application of tracheostomy was 7.09 ± 7.12 while it was 16.67 ± 9.11 in the control group; this difference between the groups was statistically significant. Although the mortality rate was increased in patients with VAP, it was not statistically significant. However, mortality rates were significantly lo wer in patients without VAP as compared to the control group (p<0.05). Implementation of the VAP prevention bundle group did not decrease the incidence of VAP in our clinic. It was found that stri ct compliance to the all parameters of the prevention bundle didn't reduce the VAP incidence in ICUs but it was prolonged the onset time of VAP. But the carrying out the VAP prevention bundle to the patients with mechanical ventilatory support reduced the mortality rates. We think that the present VAP prevention bundle should be revised in the way of use of s tress ulcer prophylaxis.

Eastern Journal Of Medicine

Current Therapeutic Research, 2010