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- MakaleYayıncıda açık erişim2016Comparison of Effects of Separate and Combined Sugammadex and Lipid Emulsion Administration on Hemodynamic Parameters and Survival in a Rat Model of Verapamil Toxicity
Tulgar, Serkan; Kose, Halil Cihan; Piroglu, Isilay Demir; Karakilic, Evvah; Ates, Nagihan Gozde; Demir, Ahmet; Gergerli, Ruken; Guven, Selin; Piroglu, Mustafa Devrim
Background: Toxicity of calcium channel blockers leads to high patient mortality and there is no effective antidote. The benefit of using 20% lipid emulsion and sugammadex has been reported. The present study measured the effect of sugammadex and 20% lipid emulsion on hemodynamics and survival in a rat model of verapamil toxicity. Material/Methods: In this single-blinded randomized control study, rats were separated into 4 groups of 7 rats each: Sugammadex (S), Sugammadex plus 20% lipid emulsion (SL), 20% lipid emulsion (L), and control (C). Heart rates and mean arterial pressures were monitored and noted each minute until death. Results: Average time to death was 21.0 +/- 9.57 minutes for group C, 35.57 +/- 10.61 minutes for group S, 37.14 +/- 16.6 minutes for group L and 49.86 +/- 27.56 minutes for group SL. Time to death was significantly longer in other groups than in the control group (p<0.05). Conclusions: Verapamil overdose is has a comparatively high mortality rate and there is no effective antidote. Treatment generally involves gastric decontamination and symptomatic treatment to counteract the drug's negative effects. In animal studies sugammadex and lipid emulsion had a positive effect on survival in patients with calcium channel blocker toxicity. Sugammadex and intralipid increased survival in a rat model of verapamil toxicity. The combination of both drugs may decrease cardiotoxicity. Sugammadex alone or combined with 20% lipid emulsion reduce the need for inotropic agents. The mechanism requires clarification with larger studies.
- MakaleYalnız künye2016MODIFIED KDIGO FOR PREDICTING MORTALITY IN ICU PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY FOR ACUTE RENAL FAILURE: KDIGO-URINARY OUTPUT VS. KDIGO-SERUM CREATININE LEVEL
Tulgar, Serkan; Cakiroglu, Basri; Cevik, Banu Eler; Karakilic, Evvah; Ates, Nagihan Gozde; Gergerli, Ruken; Ozdemir, Erman
Introduction: Acute Renal Injury (ARI) is a constant problem for patients in intensive care and Continuous Renal Replacement Therapy (CRRT) is an ever-more important part of acute renal injury (ARI) treatment. Various criteria have been used for the diagnosis and classification of acute renal failure, including RIFLE (Risk-Injury-Failure-Loss-End stage), AKIN (Acute Kidney Injury Network) and most recently KDIGO (Kidney Disease: Improving Global Outcomes). Many studies have only evaluated urinary output or serum creatinine when categorizing ARI. Our aim was to determine the predictors of mortality in intensive care patients treated with CRRT and to compare mortality with ARI level as determined by KDIGO-Serum Creatinine (KDIGO-SCr) and KDIGO-urinary output (KDIGO-UO) Materials and methods: This retrospective study was performed on intensive care patients receiving CRRT at our institute between January 2010-December 2011. Patient files were reviewed and demographic data, hospitalization time, laboratory findings, CRRT commencement and ARI levels were noted. Results: Seventy patients were included in the study. Mortality was found to be associated with patients' age, Glascow Coma Scale (GCS) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score and adjusted predicted death rate. (p<0,01). Receiver Operating Curve (ROC) area under the curve was statistically significant for determination of mortality using KDIGO-SCR (p<0.01) although the same was not true for KDIGO-UO (p>0.05). Conclusions: We believe that RIFLE, AKIN, KDIGO criteria are each good predictors of mortality. In the case of KDIGO criteria, based solely on serum creatinine or urinary output, KDIGO-SCr was found to be a better predictor of mortality when compared to KDIGO-UO.
- MakaleYalnız künye2016Do early procalcitonine levels aid in predicting mortality in burn patients?
Piroglu, Isilay Demir; Tulgar, Serkan; Piroglu, Mustafa Devrim; Thomas, David Terence; Karakilic, Evvah; Gergerli, Ruken; Ates, Nagihan Gozde; Demir, Ahmet
Aim: Burn patients in intensive care units (ICU) are at high risk of mortality. Our aim in this stuy is to evaluate the use of first 48 hour procalcitonin level (PCT), C-reactive protein (CRP) and APACHE II score for the prediction of mortality in burn patients admitted to ICU. Material and method: Files of patients with burns admitted to a tertiary centre's burn unit were retrospectively analysed and those with procalcitonin and C-reactive protein level measurements and APACHE II scores within first 48 hours of admittance were included in this study. Patients with comorbidities that would effect PCT and CRP levels such as chronic renal or liver failure were excluded from the study. Patients PCT, CRP and APACHE II scores were compared with the outcome of patients. Results: Seventy patients were included in this study. While CRP levels were lower in patients that were deceased, PCT levels were significantly higher in these patients. In patients with APACHE II score > 20 and PCT > 2 ng/ml, mortality was statistically very significantly higher compared with other patients. Logistical regression analysis showed that high PCT levels and APACHE II scores were important at predicting mortality in these patients. Conclusion: High PCT levels within 48 hours of burns is a predictor of mortality in these patients. Additional studies are required to correctly determine the cut-off value. A modified scoring system including APACHE II and PCT may be useful for better predicting mortality, although larger multi-centered studies are required.