Person: KAHVECİ, FERDA ŞÖHRET
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KAHVECİ
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FERDA ŞÖHRET
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Publication Incidence, characteristics and risk factors of delirium in the intensive care unit: An observational study(Wiley, 2022-01-03) ERBAY DALLI, ÖZNUR; KELEBEK GİRGİN, NERMİN; Girgin, Nermin Kelebek; Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0003-2282-0846; 0000-0002-5882-1632; ABI-1236-2020Aims and Objective To investigate the incidence, characteristics and risk factors of delirium in the ICU. Background Identifying the risk factors of delirium is important for early detection and to prevent adverse consequences. Design An observational cohort study conducted according to STROBE Guidelines. Method The study was conducted with patients who stayed in ICU >= 24 h and were older than 18 years. Patients were assessed twice daily using the RASS and CAM-ICU until either discharge or death. Cumulative incidence was calculated. Demographic/clinical characteristics, length of stay and mortality were compared between patients with and without delirium. A logistic regression model was used to investigate risk factors. Results The incidence of delirium was 31.8% and hypoactive type was the most frequent (41.5%). The median onset of delirium was 3 days (IQR = 2) with a mean duration of 5.27 +/- 2.32 days. Patients with delirium were significantly older, had higher APACHE-II, SOFA and CPOT scores, higher blood urea levels, higher requirements for mechanical ventilation, sedation and physical restraints, longer stays in the ICU and higher mortality than those without delirium. The logistic regression analysis results revealed that a CPOT score >= 3 points (OR = 4.70, 95% CI: 1.05-20.93; p = .042), physical restraint (OR = 10.40, 95% CI: 2.75-39.27; p = .001) and ICU stay >= 7 days (OR = 7.26, 95% CI: 1.60-32.84; p = .010) were independent risk factors of delirium. Conclusions In this study, the incidence of delirium was high and associated with several factors. It is critical that delirium is considered by all members of the healthcare team, especially nurses, and that protocols are established for improvements. Relevance to the clinical practice Based on the results of this study, delirium could be decreased by preventing the presence of pain, prudent use of physical restraints and shortening the ICU stay.Publication Evaluation of the combination treatments with intravenous fosfomycin for carbapenem-resistant Klebsiella pneumoniae(Assoc Medica Brasileira, 2023-01-01) ÖNAL, UĞUR; Tüzemen, Nazmiye Ülkü; TÜZEMEN, NAZMİYE ÜLKÜ; Kaya, Pınar Küçükdemirci; KELEBEK GİRGİN, NERMİN; KÜÇÜKDEMİRCİ KAYA, PINAR; İŞÇİMEN, REMZİ; ÖZAKIN, CÜNEYT; Özakın, Cüneyt; Kahveci, Ferda Şöhret; KAHVECİ, FERDA ŞÖHRET; Akalın, Halis; AKALIN, EMİN HALİS; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0003-3544-3509; 0000-0002-8428-8245; 0000-0002-5882-1632; 0000-0001-7530-1279; JCO-3678-2023; AAU-8952-2020; A-4290-2018OBJECTIVE: The aim of this study was to evaluate the combination treatments with intravenous fosfomycin for carbapenem-resistant Klebsiella pneumoniae infections in a tertiary-care center.METHODS: Between December 24, 2018 and November 21, 2022, adult patients diagnosed with bloodstream infection or ventilator-associated pneumonia due to culture-confirmed carbapenem-resistant Klebsiella pneumoniae in the anesthesiology and reanimation intensive care units were investigated retrospectively.RESULTS: There were a total of 62 patients fulfilling the study inclusion criteria. No significant difference was recorded in 14-and 30-day mortality among different types of combination regimens such as fosfomycin plus one or two antibiotic combinations. Hypokalemia (OR:5.651, 95%CI 1.019- 31.330, p=0.048) was found to be a significant risk factor for 14-day mortality, whereas SOFA score at the time of diagnosis (OR:1.497, 95%CI 1.103- 2.032, p=0.010) and CVVHF treatment (OR:6.409, 95%CI 1.395-29.433, p=0.017) were associated with 30-day mortality in multivariate analysis.CONCLUSION: In our study, high mortality rates were found in patients with bloodstream infection or ventilator-associated pneumonia due to carbapenem-resistant Klebsiella pneumoniae, and no significant difference was recorded in 14-and 30-day mortality among different types of combination regimens such as fosfomycin plus one or two antibiotic combinations.Publication Amitriptyline cardiac toxicity treated with hemoperfusion(Galenos Yayincilik, 2017-04-01) Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; Ünlü, Nurdan; Çalışkan, Gülbahar; İşçimen, Remzi; İŞÇİMEN, REMZİ; Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; AAH-7250-2019; HKP-2533-2023; KFQ-1825-2024Tricyclic antidepressant intoxication is frequently encountered among children and adults due to widespread use of the drugs. Amitriptyline is among the major tricyclic antidepressants. It affects the cardiovascular, respiratory and central nervous system. In the treatment of amitriptyline intoxication, various treatments such as gastric lavage, activated charcoal, bicarbonate infusion, antiarrhythmic, and anticonvulsant drug usage were applied. Here, we reported a patient with severe amitriptyline intoxication who did not respond to these treatments but dramatically improved with hemoperfusion. A 33 year-old woman applied to the emergency service half an hour later ingesting 2000 mg of amitriptyline as a suicide attempt. On admission, her Glasgow coma scale (GCS) was 10, blood pressure was 100/60 mmHg, heart rate was 160 beats/min. Wide ORS and ventricular tachycardia was seen in the Electrocardiography (ECG) results. Having her GCS regressed to 7, she was intubated and admitted to intensive care unit after the initial treatments. Hemoperfusion was commenced within half an hour. While hemoperfusion was continuing, her ECG was seen to turn to sinus tachycardia. Her cardiovascular and neurological status returned to normal on the 2nd day and she was discharged from the intensive care unit on the 4th day. Besides hemoperfusion is not recommended due to high protein binding and large volume of distribution in classical treatment of amitriptyline overdose, current reports representing efficacy of hemoperfusion are also accumulating. After ingestion, tricyclic antidepressants are absorbed rapidly and reach to their effective concentration in the tissues, especially by the lung, the brain and the heart. Hence, hemoperfusion performed in early stage of ingestion is an effective treatment and in cases that do not respond to conventional therapies, it should be considered that this method can be used in the early period.Publication Sepsis episodes caused by pressure injuries in critical illness: A retrospective observational cohort study(Hmp, 2023-11-01) Kaya, Pınar Küçükdemirci; Kaya, Murad; Girgin, Nermin Kelebek; Kahveci, Ferda S.; Akalın, Emin Halis; İsçimen, Remzi; KÜÇÜKDEMİRCİ KAYA, PINAR; KAYA, MURAD; KELEBEK GİRGİN, NERMİN; KAHVECİ, FERDA ŞÖHRET; AKALIN, EMİN HALİS; İŞÇİMEN, REMZİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi.; 0000-0002-8428-8245; 0000-0002-5882-1632; JGB-6637-2023; CYJ-4124-2022; DTU-3148-2022; IMY-6211-2023; AAU-8952-2020; DWL-9897-2022BACKGROUND: Critically -ill patients (CIPs) with pressure injuries (PIs) may develop bloodstream infections (BSIs). PURPOSE: To identify predisposing factors and discuss diagnosis and management of sepsis -related PIs in CIPs. METHODS: The records of CIPs in the intensive care unit (ICU) between January 1, 2014, and January 1, 2020, with PI with sepsis -diagnoses and with different site cultures that were positive concurrent with bloodstream -cultures were retrospectively reviewed. RESULTS: Ninety-one sepsis episodes were included in the study. Low albumin level ( U = 382.00, P = .006), renal failure (odds ratio [OR], 0.108 [95% CI, 0.015-0.783]; P = .025), and length of ICU stay ( U = 130.00, P < .001) were identified as risk factors of BSIs due to PIs. The probability of BSI during a sepsis episode was lower in CIPs with PIs with higher C -reactive protein levels ( U = 233.00, P < .001) and whose injury resulted from trauma or surgery (OR, 0.101 [95% CI, 0.016-0.626]; P = .014). The mortality was higher in CIPs with PI -induced BSIs (OR, 0.051 [95% CI, 0.008-0.309]; P = .001). CONCLUSIONS: Pressure injury -induced sepsis was associated with a high risk of 28 -day mortality. The findings suggest that CIPs with PI are at increased risk of BSIs if they have low albumin levels, renal -failure, and prolonged ICU stay during sepsis episodes.Publication Analysis of acute adult poisoning cases among patients admitted to the emergency department in Bursa, Turkey(Galenos Yayınevi, 2009-01-01) Demircan, Celaleddin; Kahveci, Ferda; Engindeniz, Zülfi; Kıyıcı, Murat; Girgin, Nermin Kelebek; Ercan, İlker; Tekce, Hikmet; Özdemir, Fatma; Özyurt, Gurayten; DEMİRCAN, CELALEDDİN; KAHVECİ, FERDA ŞÖHRET; Engindeniz, Zülfi; KIYICI, MURAT; KELEBEK GİRGİN, NERMİN; ERCAN, İLKER; Tekce, Hikmet; ÖZDEMİR, FATMA; Özyurt, Gurayten; Uludağ Üniversitesi/Tıp Fakültesi/Dahili Tıp Bilimleri Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji ve Hepatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0003-4820-2288; 0000-0003-1874-5097; 0000-0002-3208-6211; 0000-0002-2382-290X; HJZ-4470-2023; AAG-9356-2021; JBJ-5787-2023; AAI-4213-2021; AAH-7250-2019; ABF-2367-2020; JGP-4019-2023; JKS-7683-2023; JKO-9428-2023Purpose: The aim of this study was to define the epidemiological features such as age, sex, toxic substance, suicide, and mortality rates of the adult poisoning cases among patients admitted to the Emergency Department (ED) of Uludag University Medical Faculty Hospital.Materials and Methods: Records of acute adult poisoning cases at the ED within a one-year period (June 1, 2002 - May 31, 2003) were evaluated retrospectively. Data were compared to those of similar studies from Turkey and around the world.Results: In total 430 (1.96%) of 21,934 patients admitted to the ED during the study period suffered acute poisoning. Of these patients 259 (60.2%) were women and 171 (39.8%) were men and the mean age of the patients was 29.9. Patients were exposed to different types of toxic substances: drugs (47.4%), pesticides (10.7%), toxic gases (10%), corrosives (6.5%), alcohol (3.5%), food (15.8%), toxic substances of animal origin (3.0%), and others (3.0%). In all, 29.8% of the patients were admitted to hospital, 22.3% were transferred to other hospitals, and 47.9% were discharged from the ED, and the overall mortality rate was 1.2%. In addition, 54.9% of the poisonings were suicide attempts and within this group the women to men ratio was 2.2 and the most common toxic substance was a drug (85.2%).Conclusion: Our results were similar to those of previous studies from this country as acute poisonings are more common in women and younger ages, most of them were suicide attempts, and the mortality rate was low. Our transfer rate was high and this may necessitate the organization of short-term observation of these patients.Publication Experience of pandemic influenza A (H1N1) 2009(Aves, 2012-12-01) Kebabçı, Nesrin; Akalın, Halis; Bölük, Gülçin; Oğuz-Ayarcı, Ayşe; Kazak, Esra; Topal, Uğur; Yorulmaz, Hakan; Akköse, Şule; Özvatan-Şener, Tülay; Aslan, Emel; Köprücüoğlu, Duygu; Heper, Yasemin; Yılmaz, Emel; Kahveci, Ferda; Mıstık, Reşit; Helvacı, Safiye; Kebabçı, Nesrin; AKALIN, EMİN HALİS; Bölük, Gülçin; Oğuz-Ayarcı, Ayşe; KAZAK, ESRA; Topal, Uğur; Yorulmaz, Hakan; Akköse, Şule; Özvatan-Şener, Tülay; Aslan, Emel; Köprücüoğlu, Duygu; HEPER, YASEMİN; YILMAZ, EMEL; KAHVECİ, FERDA ŞÖHRET; Mıstık, Reşit; Helvacı, Safiye; Uludağ Üniversitesi/Tıp Fakültesi/İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0001-7530-1279; 0000-0002-3894-1231; 0000-0003-4820-2288; FCW-3335-2022; AAU-8952-2020; KFT-0453-2024; FOZ-1105-2022; AAG-8459-2021; JLP-0593-2023; EIO-1059-2022; EJV-1316-2022; FQE-4671-2022; EJJ-4181-2022; FGO-0266-2022; AAH-6506-2021; HJZ-6992-2023; AAG-9356-2021; DFY-3761-2022; EXQ-2687-2022Objective: Pandemic influenza A (H1N1) 2009 first appeared in April, 2009 in Mexico and affected the entire world. The objective of this study is to analyze epidemiological, clinical and laboratory findings of probable or confirmed pandemic inluenza A (H1N1) 2009 adult cases who were admitted to our clinic.Methods: Eighty-five patients with pandemic influenza A (H1N1) 2009 admitted to Uludag University Hospital between November 3, 2009 and January 22, 2010 were retrospectively evaluated.Results: Of the 85 cases, 44 (51.8%) were females and 41 (48.2%) were males. The median age was 33 (17-82). 16 of cases (18.8%) were assessed as accurate, and 69 (81.2%) as probable cases of influenza. Pneumonia was diagnosed in 17 (20%) patients by evaluating clinical findings and chest X-ray. Eleven of the cases were treated in the Intensive Care Unit. Seventy-one (83.5%) of the cases were treated by oseltamivir. Mean duration of treatment was 10 days. The mortality rate of the cases was 4.7%.Conclusions: Pandemic influenza A (H1N1) 2009 perpetuates its epidemic potential as in the past years. The disease is frequently accompanied by pneumonia during its course.Publication A retrospective evaluation of critically ill patients infected with H1N1 influenza A virus in Bursa, Turkey, during the 2009-2010 pandemic(Makerere Univ, 2015-01-01) Nermin, Kelebek Girgin; Remzi, İşçimen; Zeynep, Akoğul; İlker, Çimen; Meltem, Öner Torlar; Güven, Özkaya; Ferda, Kahveci; Halis, Akalın; KELEBEK GİRGİN, NERMİN; İŞÇİMEN, REMZİ; Akoğul, Zeynep; Çimen, İlker; Torlar, Meltem Öner; ÖZKAYA, GÜVEN; KAHVECİ, FERDA ŞÖHRET; AKALIN, EMİN HALİS; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; AAH-7250-2019; FTV-1495-2022; EIE-4319-2022; JOR-4047-2023; FMO-2967-2022; EZV-3846-2022; CPT-2668-2022; EZJ-5901-2022Background: H1N1 influenza A virus infections were first reported in April 2009 and spread rapidly, resulting in mortality worldwide. The aim of this study was to evaluate patients with H1N1 infection treated in the intensive care unit (ICU) in Bursa, Turkey.Methods: Demographic characteristics, clinical features, and outcome relating to H1N1 infection were retrospectively analysed in patients treated in the ICU.Results: Twenty-three cases of H1N1 infection were treated in the ICU. The mean age of patients was 37 years range: (1782). Fifteen patients were female (65.2%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 19 range: (5-39). The most common symptoms were dyspnea (73.9%), fever (69.6%), and cough (60.9%). Mechanical ventilation was required for all patients. Oseltamivir and antibiotics were administered to all patients. Six (26.1%) patients died. APACHE II scores were higher in the deceased 28.5 range: [16-39] vs. 14 range: [5-28] in survivors; p = 0.013).Conclusion: When compared to the literature, the demographic, epidemiological, and clinical characteristics were similar in the cases we encountered. The mortality rate was high despite the use of appropriate treatment. We believe that the high mortality is related to higher APACHE II scores. The H1N1 virus should be considered in community acquired pneumonia, especially in younger patients presenting with severe pneumonia.Publication The effect of music on delirium, pain, sedation and anxiety in patients receiving mechanical ventilation in the intensive care unit(Elsevier Sci Ltd, 2023-02-16) Dallı, Öznur Erbay; Yıldırım, Yasemin; Aykar, Fisun Şenuzun; Kahveci, Ferda; ERBAY DALLI, ÖZNUR; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Sağlık Bilimleri Fakültesi/İç Hastalıkları Hemşireliği Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı/Yoğun Bakım Bölümü.; 0000-0003-2282-0846 ; ABI-1236-2020; CYR-2043-2022Objectives: To examine the effects of music for patients under mechanical ventilation support in the intensive care unit on their delirium, pain, sedation, and anxiety. Research methodology/design: A single-blind, randomized, controlled trial. Setting: The study was conducted with delirium positive patients between August 2020 and September 2021 in the medical/surgical intensive care unit of a university hospital in Turkey. Methods: The study sample was selected through a simple and stratified randomization method; patients who met the inclusion criteria were assigned to the music, noise reduction or control group. The data were collected by using a Confusion Assessment Method for the ICU (CAM-ICU), CAM-ICU-7, Critical Care Pain Observation Tool (CPOT), Richmond Agitation-Sedation Scale (RASS), Facial Anxiety Scale (FAS), PRE-DELIRIC model, and Glasgow Coma Scale (GCS). The interventions were repeated twice a day for five days. Results: A total of 36 patients were included, with 12 patients in each group. Significant decreases were found in the severity of delirium and pain and the level of sedation and anxiety in the music compared to the other groups (p < 0.05). The number of patients with delirium and the number of days with mechanical ventilation was found to be significantly lower in the music group compared to the other groups (p < 0.05). Conclusion: Music intervention may be used as a nursing intervention to control delirium, pain, need for sedation and anxiety in intensive care unit patients. However, additional studies with larger sample is needed to validate findings.Publication Guillain-barre syndrome and human immunodeficiency virus(Aves, 2014-04-01) Girgin, Nermin Kelebek; İsçimen, Remzi; Yılmaz, Emel; Kahveci, S. Ferda; Kutlay, Oya; KELEBEK GİRGİN, NERMİN; İŞÇİMEN, REMZİ; YILMAZ, EMEL; KAHVECİ, FERDA ŞÖHRET; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı/Yoğun Bakım Ünitesi.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Mikrobiyoloji Anabilim Dalı.; 0000-0003-4820-2288; AAG-9356-2021; AAH-7250-2019; HKP-2533-2023; AAI-8104-2021Guillain-Barre syndrome (GBS) is an acute disease characterised by symmetrical muscle weakness, loss of sensation and reflex. There is usually a viral infection at the beginning of the disease. Here, we report a GBS case which did not respond to any treatment strategy at first and was diagnosed as Human Immunodeficiency Virus positive (HIV+) during the search for the aetiology. A 32-year-old male patient who presented to a medical centre with symptoms of gait disturbance and arm and leg numbness was found to have albuminocytologic dissociation upon cerebrospinal fluid examination. After the diagnosis of GBS, immunoglobulin G (IVIG) therapy (400 mg kg(-1) day-1 5 days) was started as a standard therapy. This therapy was repeated due to a lack of improvement of symptoms. During this therapy, the patient was sent to our clinic with symptoms of respiratory failure and tetraplegia. He was conscious, cooperative, haemodynamically stable and his arterial blood gas analyses were: pH: 7.28, PaO2 : 74.4 mmHg, PCO2 : 63.8 mmHg. He was intubated, mechanically ventilated and underwent plasmapheresis. After the investigation of aetiology, HIV(+), CD4/ CD8: 0.17, absolute CD4: 71 cells mL(-1) were detected and antiretroviral therapy was started. The patient died from multiple organ failure due to sepsis on day 35. In conclusion, HIV infection should be kept in mind in GBS patients, especially those not responding to routine treatment. As a result, not only could the patient receive early and adequate treatment, but also HIV infection transmission would be avoided.Publication Infection control principles in intensive care unit: International standardstu(Galenos Yayincilik, 2007-01-01) Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.