Intensive Care Units In Turkey Research Articles

Clinical and Laboratory Features of Culture-positive Neonatal Sepsis: A 5-year Single-center Experience at Tertiary Neonatal Intensive Care Unit in Turkey

Clinical and Laboratory Features of Culture-positive Neonatal Sepsis: A 5-year Single-center Experience at Tertiary Neonatal Intensive Care Unit in Turkey

Short-Term Results of Preterm Infants and Comparison with the Recent International Network: Obtained from a Level III Neonatal Intensive Care Unit in Turkey

Short-Term Results of Preterm Infants and Comparison with the Recent International Network: Obtained from a Level III Neonatal Intensive Care Unit in Turkey

Factors Influencing Morbidity and Mortality Rates in Tertiary Intensive Care Units in Turkey: A Retrospective Cross-Sectional Study.

The objective of this study was to determine the correlation between the prognosis of patients admitted to a tertiary intensive care unit (ICU) and the admitted patient population, intensive care conditions, and the workload of intensive care staff. This was a retrospective cross-sectional study that analyzed data from all tertiary ICUs (a minimum of 40 and a maximum of 59 units per month) of eight training and research hospitals between January 2022 and May 2023. We compared monthly data across hospitals and analyzed factors associated with patient prognosis, including mortality and pressure injuries (PIs). This study analyzed data from 54,312 patients, of whom 51% were male and 58.8% were aged 65 or older. The median age was 69 years. The average number of tertiary ICU beds per unit was 15 ± 6 beds, and the average occupancy rate was 83.57 ± 19.28%. On average, 7 ± 9 pressure injuries (PI) and 10 ± 7 patient deaths per unit per month were reported. The mortality rate (18.66%) determined per unit was similar to the expected rate (15-25%) according to the Acute Physiology and Chronic Health Evaluation (APACHE) II score. There was a statistically significant difference among hospitals on a monthly basis across various aspects, including bed occupancy rate, length of stay (LOS), number of patients per ICU bed, number of patients per nurse in a shift, rate of patients developing PI, hospitalization rate from the emergency department, hospitalization rate from wards, hospitalization rate from the external center, referral rate, and mortality rate (p < 0.05). Although generally reliable in predicting prognosis in tertiary ICUs, the APACHE II scoring system may have limitations when analyzed on a unit-specific basis. ICU-related conditions have an impact on patient prognosis. ICU occupancy rate, work intensity, patient population, and number of working nurses are important factors associated with ICU mortality. In particular, data on the patient population admitted to the unit (emergency patients and patients with a history of malignancy) were most strongly associated with unit mortality.

The effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position: A quasi-experimental study.

The aim of this study was to research the effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position. This study was a non-randomized and non-controlled, quasi-experimental repeated measures study. The study was conducted with 50 intensive care patients aged 18 and over in a general surgery intensive care unit in Turkey. With each patient in the supine position, the bed head was raised to an angle of 0°, 20°, 30°, and 45° without a pillow, and the hemodynamic parameters of central venous pressure, systolic and diastolic blood pressure, heart rate, breathing rate, and peripheral oxygen saturation were recorded after 0 and 10 min. It was found that the mean central venous pressure value measured at min 0 and 10 was higher when the intensive care patients' bed head angle was raised to 45° than when the bed head was at an angle of 0° or 20° (p < .05). It was found that the patients' other hemodynamic parameters were not affected by different bed head angles. It was concluded as a result of this research that in intensive care patients in the supine position, only central venous pressure was affected by bed head angle, and that central venous pressure measurement can be reliably made at a bed head angle of 30°.

Stenotrophomonas maltophilia outbreak originating from a pull-out faucet in a pediatric intensive care unit in Turkey: Insights from clinical records and molecular typing

Nosocomial Stenotrophomonas maltophilia-relatedcases are rising and pose a threat to immunocompromised patients. Twelve patients from our pediatric intensive care unit (PICU) presented with S maltophilia-associatedbloodstream infection. This outbreak investigation includes 12 patients from PICU between the ages of 2 months and 4 years (mean 16 months, 7 male). To identify the origin, samples from all possible sources throughout the hospital were collected and ran through DNA isolation and Pulse Field Gel Electrophoresis. 120 samples were collected during the outbreak. 31 samples (26%) were positive for S maltophilia. 30 S maltophilia isolates were analyzed, 10 different genotypes were identified. Clustering isolates were grouped into 3 different clusters (tolerance and optimization 1.0, cutoff 90%). The largest cluster was genotype 1, which included 19 isolates, those belong to patients' samples and a sample from a pull-out faucet inside the PICU. The Pull-out faucet was the origin of the bloodstream infection. Pull-out faucets allow biofilm production, due its structure. Pulse Field Gel Electrophoresis identifies the transmission dynamics of the outbreak, with its high discriminatory power. Water sources should be monitored on a regular basis. Pull-out faucets enable bacterial overgrowth; therefore, we recommend water surveillance during outbreak investigations.

Impact of lockdown and visiting restrictions for COVID-19 on breast milk and short-term morbidities in a tertiary neonatal intensive care unit in Turkey

Objective: In the COVID-19 pandemic era, visiting restrictions and lockdown measures have been leaded to serious concerns in breastfeeding and maternal-infant interaction. We aimed to evaluate the effects of visiting restrictions as no physical visits allowed period (March 13th and June 20th, 2020) on feeding with breast milk, breastfeeding and associated morbidities. Material and Methods: Neonates admitted to neonatal intensive care unit in pre-COVID-19 pandemic and during strict visiting restrictions constituted control and study groups. Results: Study and control groups included 197 and 193 mother-baby dyads. Study group had insignificant lower gestational age, birthweight and higher prematurity rate. Median first enteral feeding and first breast milk days were similar. First enteral feeding with breast milk was insignificantly higher in control group. Median breast milk percentage at full enteral feeding (FEF) did not differ. Median time of FEF, FEF with only breast milk and intravenous fluid duration were higher in study group (p&amp;lt;0.050). Full enteral feeding with breast milk during NICU stay was less in study group (78.1 vs 87%, p&amp;lt;0.050) while at discharge there was no difference (78.1% vs 81.3%). Feeding intolerance was insignificantly higher in study group (23.8% vs 14.6%). Median duration of NICU stay was higher in study group but not significant (13.5 vs 12 d, p&amp;gt;0.050). Conclusion: No visits allowed period leaded to impaired breastfeeding, breast milk supply and associated morbidities. Parents should be informed about breastfeeding and breast milk in prenatal period, after birth and during NICU stay in COVID-19 era as before and precautions should be taken.

Perinatal and Neonatal Outcomes of Refugee Infants in a Tertiary Hospital in Turkey.

Background Worldwide, the immigration problem has been increasing due to conflicts. In recent years, Turkey accepted more than 3.8 million refugees from many countries, principally Syria. Aims In this study, we aimed to evaluate the prenatal features and neonatal outcomes of refugees and Turkish controls hospitalized in a tertiary neonatal intensive care unit in Turkey. Materials and methods This retrospective case-control study included comparative data related to populations based on whether they were refugees or not. Their perinatal and neonatal "outcomes" were compared. Results Among the 254 analyzed neonates, 127 were born to refugee mothers, and 127 controls were born to non-refugee Turkish mothers. The refugee rate in our hospitalized neonates was nine, a young mother's age (p=0.010) with a higher rate of adolescent pregnancies at OR 2.78 (95% CI 0.96-8.05) (p=0.032), and consanguineous marriage at OR 0.57 (95% CI 0.32-1.02) (p=0.031) in comparison to non-refugees. The incidence of ABO incompatibility-related hemolytic jaundice (p=0.013) was higher in the refugees. The rate of formula feeding in the first month of life was significantly higher at OR 0.49 (95% CI 0.25-0.92) (p=0.027) in neonates born to refugee mothers. Despite lower perinatal care rates in refugees at OR 7.23 (95%CI 4.12-12.69) (<0.001), preterm morbidities did not differ between refugees and non-refugee preterm infants ≤32 gestational age (p>0.05). Conclusion The importance of breast milk must be strongly encouraged to initiate and promote exclusive breastfeeding for the infants of refugees. Race is still an important risk factor for ABO incompatibility-related hemolytic jaundice. Providing high-quality healthcare is sufficient to prevent worse outcomes in refugee neonates.

Potential Drug-drug Interactions in Intensive Care Units in Turkey: A Point Prevalence Study

Potential Drug-drug Interactions in Intensive Care Units in Turkey: A Point Prevalence Study

Caregiving experiences of nurses working in a newly established intensive care unit during the COVID-19 pandemic: A qualitative study.

The coronavirus disease 2019 (COVID-19) has adversely affected intensive care nurses; for instance, they have fought against an unknown disease, and their workload has increased. In addition, the COVID-19 pandemic has led intensive care nurses to work in new settings and with new teams. The aim of this study was to explore and describe the caregiving experiences of nurses who were working in a new COVID-19 intensive care unit in Turkey and providing care for patients infected with SARS-CoV-2. In this descriptive qualitative study, semi-structured interviews were held from 22 July to 31 August 2020 and were recorded and analysed based on thematic analysis. The researchers followed the COREQ checklist in reporting the study. From interviews held with 11 nurses, four main themes (uncertainty and challenges in the 'danger zone', emotional and psychosocial changes, professional effects of the pandemic and being ready for a future pandemic) were derived from 11 sub-themes. The new setting and the ever-changing team make caring for the COVID-19 patient even more difficult. A good organization, an experienced permanent team, a known setting and good working conditions are essential to be prepared for possible pandemics in the future.

Comparison of the healthcare-associated infections in intensive care units in Turkey before and during COVID-19

BackgroundSecondary bacterial infections are an important cause of mortality in patients with coronavirus disease 2019 (COVID-19). All healthcare providers acted with utmost care with the reflex of protecting themselves during the COVID-19 period. We aimed to compare the rates of ventilator-associated pneumonia (VAP) and bloodstream infections (BSIs) in our intensive care units (ICUs) before and during the COVID-19 outbreak surges.MethodsThis multicenter, retrospective, cross-sectional study was performed in six centers in Turkey. We collected the patient demographic characteristics, comorbidities, reasons for ICU admission, mortality and morbidity scores at ICU admission, and laboratory test data.ResultsA total of 558 patients who required intensive care from six centers were included in the study. Four hundred twenty-two of these patients (males (62%), whose mean age was 70 [IQR, 58–79] years) were followed up in the COVID period, and 136 (males (57%), whose mean age was 73 [IQR, 61–82] years) were followed up in the pre-COVID period. BSI and VAP rates were 20.7 (19 events in 916 patient days) and 17 (74 events in 4361 patient days) with a −3.8 difference (P = 0.463), and 33.7 (31 events in 919 patient days) and 34.6 (93 events in 2685 patient days) with a 0.9 difference (P = 0.897), respectively. The mortality rates were 71 (52%) in pre-COVID and 291 (69%) in COVID periods.ConclusionProtective measures that prioritize healthcare workers rather than patients and exceed standard measures made no difference in terms of reducing mortality.

Determination of Nursing Sensitive Indicators for Intensive Care Units in Turkey: A Qualitative Study

Introduction: Assessment of the quality of health services continues to be one of the top research areas from past to present. The development of nursing-sensitive indicators is one of the critical elements in assessing the quality of nursing care. This study aims to determine the nursing-sensitive indicators for intensive care unit (ICU)s.&#x0D; Methods: This research was conducted between May 2017 and October 2017 using a descriptive qualitative research phenomenological design. The research was assessed by the qualitative research paradigm based on Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethics committee approval of the study and written permissions from the selected hospitals were obtained. The research was performed with in-depth face-to-face interviews with 12 participants from three different hospitals and nursing education institutions through a semi-structured interview form. During the interviews, voice recordings were taken with prior permission, and the recordings obtained were deciphered word by word and evaluated with content analysis.&#x0D; Results: As a result of the research, four main themes were created; the patient-focused outcome indicators, the nurse-focused outcome indicators, the nursing-focused process/intervention indicators, and the organizational-focused structural indicators. Under these main themes, nursing-sensitive indicators have been determined.&#x0D; Conclusion: Nosocomial infections and pressure ulcers were the two-leading nursing-sensitive indicators. This research suggests developing policies and procedures for forming a national database specific to nursing, including nursing-sensitive indicators.

Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience

AbstractThe objective of this study was to identify the characteristics of nonsurvivors in a pediatric intensive care unit (PICU) in Turkey. This is a retrospective analysis of patients who died in a tertiary PICU over a 6-year period from 2016 to 2021. Data were drawn from electronic medical records and resuscitation notes. Mode of death was categorized as failed cardiopulmonary resuscitation (F-CPR) or brain death. Among the 161 deaths, 136 nonsurvivors were included and 30.1% were younger than 1 year. Severe pneumonia, respiratory failure, and acute respiratory distress syndrome (ARDS) (31.6%) were the most common primary diagnoses. The most common mode of death was F-CPR (86.8%). More than half of the subjects had been admitted from pediatric emergency departments (58.1%), and more than half (53.7%) had died within 7 days in the PICU. Patients admitted from pediatric emergency departments had the lowest frequency of comorbidities (p &lt; 0.001). Severe pneumonia, respiratory failure, and ARDS diagnoses were significantly more frequent in those who died after 7 days (p &lt; 0.001), whereas septicemia, shock, and multiple organ dysfunction were more common among those who died within the first day of PICU admission (p &lt; 0.001). It may be important to note that patients referred from wards are highly likely to have comorbidities, while those referred from pediatric emergency departments may be relatively younger. Additionally, patients with septicemia, shock, or multiple organ dysfunction were more likely to die earlier (within 7 days), especially compared with those with severe pneumonia, respiratory failure, or ARDS.

Rectus abdominis and rectus femoris muscle thickness in determining nutritional risk in critically ill patients: a prospective cohort study in Turkey

ObjectivesMalnutrition is a clinical condition that is frequently seen in critically ill patients in the intensive care unit (ICU). Although there are many scoring systems and tools used to determine...

The Factors Affecting the Postnatal Bonding of Mothers Whose Babies were Admitted to the Neonatal Intensive Care Unit During the COVID-19 Pandemic.

COVID-19 pandemic has created challenges for sick preterm babies and their parents. This study aimed to explore the factors affecting the postnatal bonding of mothers who were not permitted to visit and touch their babies who were in the neonatal intensive care unit during the COVID-19 pandemic. This is a cohort study conducted in a tertiary neonatal intensive care unit in Turkey. The participants consisted of mothers who were offered full rooming in with their baby (group 1, n = 32) and mothers whose newborns had been admitted to the neonatal intensive care unit immediately after delivery and were hospitalized for at least 7 days (group 2, n = 44). The Turkish versions of Beck Anxiety Inventory, Edinburgh Postpartum Depression Scale, Adjustment Disorder-New Module 8, and Postpartum Bonding Questionnaire were applied to mothers. Tests were performed once in group 1 at the end of the first postpartum week (test1) and twice in group 2 before the baby was discharged from the neonatal intensive care unit (test1) and 2 weeks after the discharge (test2). None of the Beck Anxiety Inventory, Edinburgh Postpartum Depression Scale, Adjustment Disorder-New Module 8, and Postpartum Bonding Questionnaire scores was abnormal. Although the scales were within normal ranges, Postpartum Bonding Questionnaire 1 and Postpartum Bonding Questionnaire 2 had statistically significant correlation with gestational week (r = -0.230, P = .046; r = -0.298, P = .009), Edinburgh Postpartum Depression Scale score (r = 0.256, P = .025; r = 0.331, P = .004), hospitalization (r = 0.280, P = .014; r = 0.501, P < .001), and neonatal intensive care unit anxiety (r = 0.266, P = .02; r = 0.54, P < .001). Postpartum Bonding Questionnaire 2 had statistically significant correlation with birth weight (r = -0.261, P = .023). Low gestational week and birth weight, increased maternal age, maternal anxiety, high Edinburgh Postpartum Depression Scale scores and hospitalization negatively affected maternal bonding. Although all self-reporting scale scores were low, being in the neonatal intensive care unit and not being able to visit (touch) the baby is a major stressor.

Workplace violence against physicians in intensive care units in Turkey: A cross-sectional study.

Background Although there are many studies on violence against physicians in the literature, there are few studies on violence against physicians working in intensive care units (ICUs). We aimed to investigate the frequency, type and underlying factors of violence against physicians working in ICUs in Turkey in the past 1 year. Methods We collected data by sending a questionnaire about violence against physicians working in ICUs via e-mail and WhatsApp between 1 and 15 May 2022. IBM SPSS Statistics V.24.0 was used for data analysis. The chi-square test and Fisher precision test were used to compare categorical data. Results Over one-third (38.6%) of the 354 physicians participating in our study reported that they had been exposed to violence in the past year, while 20.7% reported that they had been exposed to violence more than once in the past year. There was a significant relationship between the frequency of exposure to violence, female gender, age group, title, subspecialization status, working style and duration of working in the ICU (p<0.05). There was no relationship between the working area, type of hospital and ICU and exposure to violence (p>0.05). The presence of restriction and control points at the entrance to ICUs prevented violence (p<0.05). Conclusion Physicians working in ICUs encounter violence against them. The frequency of violence increased after the Covid-19 pandemic. A significant relationship was found between the frequency of violence and female gender, age group, title, subspecialization status, working style and duration of working in ICUs.

Mobilization Levels of Cardiac Surgery Patients in the Early Postoperative Period

Introduction: Early mobilization after cardiac surgery positively affects the improvement of the physical, social, and psychological functions of patients. This study was carried out to evaluate the mobilization levels of cardiac surgery patients in the early postoperative period with the ICU-Mobility Scale (IMS). Methods: This descriptive and observational study was conducted with 104 patients and 15 nurses between February and June 2021 in a cardiovascular surgery intensive care unit in Turkey. Data were collected with an information form and the IMS. Results: A statistically significant relationship was found between the time the patients reached the 1st, 3rd, 4th, 6th, 7th, and 8th levels of the IMS in the intensive care unit and the American Society of Anesthesiologists (ASA) score, cardiopulmonary bypass time, aortic cross-clamping time, operation time, and intubation time (p < 0.05). In addition, nurses reported that they had a little difficulty and high satisfaction during the application of the scale. Conclusion: Mobilization after cardiac surgery is affected by some factors during and after surgery. The IMS is an inexpensive, easy, and effective method that can be used to evaluate and classify the mobilization levels of patients in the intensive care unit after cardiac surgery.

Monitoring, control and reduction of bioaerosols in the intensive care unit in Turkey

Maintaining high indoor air quality in hospitals is important for protecting the health of both personnel and patients. In this study, the results of air quality monitoring carried out in the intensive care unit of a hospital in Bolu, Turkey, are discussed. Air disinfection devices were used to reduce the concentrations of bacteria. A 4-week sampling programme was implemented. In the first and the last weeks of the sampling, the disinfection devices were turned off, while in the second and third weeks, they were turned on. Bioaerosols were collected, and their indoor levels were determined by counting all plate colonies and bacterial types were identified by matrix-assisted laser desorption/ionisation–time of flight mass spectrometry. The highest levels of bacteria were measured in the mornings and before the air disinfection devices were turned on. Doctors did their rounds at approximately nine to ten o’clock. The dominant bacteria in the air samples examined were Staphylococcus hominis, Micrococcus luteus, Staphylococcus capitis, Staphylococcus epidermidis, Corynebacterium afermentans and Staphylococcus haemolyticus. The results showed that the air disinfection devices were effective in decreasing the concentration of microorganisms between 83.4 and 55% in the intensive care unit, which is very important for the healthcare staff and patients, particularly during pandemics.

Dysphagia in the Intensive Care Units in Turkey: A Cross-sectional Survey Study

Dysphagia in the Intensive Care Units in Turkey: A Cross-sectional Survey Study

Standardize enfeksiyon oranı: Türkiye’de yoğun bakım ünitelerinde ulusal invaziv araç ilişkili enfeksiyon modellerini hala güvenilir bir şekilde kullanabilir miyiz?

Objective: Standardized infection ratio (SIR) for ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) has been calculated using formulas obtained from the national models in Turkey since 2016. we aimed to evaluate the current usability of the national models by using 2020 data and whether the models need to be updated. Methods: The database used for The National HAI Surveillance Network Summary Report 2020 was used for remodelling. For each type of infection, remodeling was performed with 2020 data using the variables in the national models. The number of CLABSIs, CAUTIs and VAPs was the dependent variable for each negative binomial model with a logarithmic link function. Incidence rate ratios (IRRs) from the repeated models were compared with the national models using 95% confidence intervals. Results: In each model, all variables in the national models were again statistically significant (ps<0.05). Although the IRRs were similar for most of the risk factors, the size of the risk for some of them changed significantly between the national models and our models. In the national VAP and CAUTI model, the reference category for hospital type was private hospitals, while in our models, it was state hospitals. In addition, the IRRs for CAUTI in state hospitals, training and research hospitals and university hospitals were significantly lower than in the national model. Conclusion: It is necessary to update the coefficients used in the calculation of the predicted infection numbers in the SIR formulas, especially for VAP and CAUTI.

Increased Severe Cases and New-Onset Type 1 Diabetes Among Children Presenting With Diabetic Ketoacidosis During First Year of COVID-19 Pandemic in Turkey

IntroductionThere have been some significant changes regarding healthcare utilization during the COVID-19 pandemic. Majority of the reports about the impact of the COVID-19 pandemic on diabetes care are from the first wave of the pandemic. We aim to evaluate the potential effects of the COVID-19 pandemic on the severity of diabetic ketoacidosis (DKA) and new onset Type 1 diabetes presenting with DKA, and also evaluate children with DKA and acute COVID-19 infection.MethodsThis is a retrospective multi-center study among 997 children and adolescents with type 1 diabetes who were admitted with DKA to 27 pediatric intensive care units in Turkey between the first year of pandemic and pre-pandemic year.ResultsThe percentage of children with new-onset Type 1 diabetes presenting with DKA was higher during the COVID-19 pandemic (p < 0.0001). The incidence of severe DKA was also higher during the COVID-19 pandemic (p < 0.0001) and also higher among children with new onset Type 1 diabetes (p < 0.0001). HbA1c levels, duration of insulin infusion, and length of PICU stay were significantly higher/longer during the pandemic period. Eleven patients tested positive for SARS-CoV-2, eight were positive for new onset Type 1 diabetes, and nine tested positive for severe DKA at admission.DiscussionThe frequency of new onset of Type 1 diabetes and severe cases among children with DKA during the first year of the COVID-19 pandemic. Furthermore, the cause of the increased severe presentation might be related to restrictions related to the pandemic; however, need to evaluate the potential effects of SARS-CoV-2 on the increased percentage of new onset Type 1 diabetes.