Person: GÜL, FETHİ
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GÜL
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FETHİ
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Publication Metadata only Transmission route of acinetobacter baumannii infection in earthquake survivors(2023-05-07) GÜL, FETHİ; Ciğeroğlu A., Bilir A., Kutlu Ç., Sabaz M. S., Gül F.Publication Metadata only Hemoadsorption therapy for earthquake victims with crush injury(2023-05-07) GÜL, FETHİ; Kandemir E., Kutlu Ç., Bilir A., Gül F.Introduction: Recently, a huge earthquake struck south-eastern Turkey causing the death of tens of thousands of people. In this case report, we share our experience of usage of extracorporeal hemoadsorption filter in two patients with crush injury and acute kidney injury.Case: A 59 year-old male patient was under rubble for 24 hours with his left leg trapped. The patient was transported to our hospital on the second day after the incident. At the admission, he had cardiac arrest with the rhythm of ventricular fibrillation. He was defibrillated two times and resuscitated for 30 minutes. Serum potassium, phosphorus levels were 8.5 mEq/L, 9 mg/dL respectively. Intravenous calcium,dextrose+insulin was given immediately and continuous renal replacement therapy was started. Initial creatine kinase (CK) level was 82000 U/L. He has undergone an urgent surgery for amputating his left leg which was necrotic. The day after his admission, extracorporeal hemoadsorption therapy (JAFRON-HA330) was started five hours a day for five consecutive days. CK levels gradually decreased to 60187-46852-16954-11600 U/L in daily order. Vasopressors were stopped on the third day of admission. A 32-year-old male patient had been extricated after 24 hours of entrapment. He had fifteen minutes of CPR following a cardiac arrest from hyperkalemia. Initial levels of CK, potassium, phosphorus were 72116 U/L, 6.5 mEq/L, 7.3 mg/dL respectively. CRRT with hemadsorption filter (Jafron® HA330) was started. CK levels gradually decreased to levels of 64271-35670-25441-12475-10469 U/L in daily order. He got free of vasopressors on the third day and extubated on the fourth day of admission.Discussion: Crush injury is a hyperinflammatory state with circulating cytokines causing multisystemic organ dysfunctions. Hemoadsorption techniques may adsorb molecules which potentially play a role during pathogenesis of rhabdomyolysis.The use of hemoadsorption therapy in our patients with severe traumatic rhabdomyolysis was associated with a significant reduction in plasma concentrations CK so it is a potentially attractive adjunctive treatment for this condition.Publication Metadata only The role of the thrombolytic therapy in acute ıschemic stroke: Two case reports(2023-05-07) GÜL, FETHİ; Bilir A., Şahin N. O., Oktay B. D., Gül F.Publication Metadata only Yoğun bakım ünitesinde konvelesan plazma kullanımının covid-19 hastalarında mortalite üzerindeki etkisi(2022-03-17) GÜL, FETHİ; BİLGİLİ, BELİZ; CİNEL, İSMAİL HAKKI; Sabah M. S., Gül F., Bilgili B., Kaplan S. T., Oktay B. D., Cinel İ. H.Publication Metadata only An unusual presentation of hydatid disease with isolated cardiac cysts: A case report(2023-05-07) GÜL, FETHİ; Kandemir E., Bilir A., Kutlu Ç., Kan M., Gül F.Publication Metadata only The diagnostic impact of transesophageal echocardiography in a patient after post-cardiac arrest syndrome(2023-05-07) GÜL, FETHİ; Oktay B. D., Şahin N. O., Korkmaz G., Gül F.Introduction: The impairment of coagulation and fibrinolysis processes may be observed after cardiac arrest. Echocardiography is important for determining the causes of the cardiac origin of pulmonary embolism, and, simultaneously, mobile thrombi can be rarely visualized in the ventricule. In this report, we present a case of the intraventricular mobil thrombus that we detected with trans-esophageal echocardiography (TEE) in a patient who underwent CPR for 35 minutes after out of hospital cardiac arrest. Case: A 54-year-old male patient with coronary artery disease (CAD) and 2-vessel stents was admitted to the emergency service after cardiac arrest. He was admitted to the intensive care unit (ICU) and targeted temperature management could not be applied since it was too late. Brain MRI revealed hypoxic ischemic encephalopathy. Due to recurrent Grampositive infections despite appropriate antibiotic treatment, in addition to other screening tests, a bedside TEE performed by an intensivist revealed a 27x23 mm mobile thrombus in the left ventricle (Figure 1). Surgical intervention methods were not considered by cardiovascular surgens, then antithrombotic treatment was administered. After the achievement of infection control with effective antibiotherapy, the patient was discharged to the palliative center on the 99th day of hospitalization with the tracheostomy and percutaneous endoscopic gastrostomy Discussion: It is crucial that elucidation of the culprit of the recurrent infections in intensive care patients and focal control should be ensured as soon as possible. In our patient, we investigate the presence of vegetation in heart with the TEE following recurrent Gram-positive cocci growth in blood cultures. Guidelines recommend TEE as the first test for suspected infective endocarditis, usually combined with TTE, so we think that intensivists should use it more widely in intensive care practice.Publication Metadata only Drainage insufficiency should be sought and addressed during extracorporeal membrane oxygenation (ECMO)(2023-05-07) GÜL, FETHİ; Gül F.Publication Metadata only Extracorporeal CO2 removal in a COPD patient with hypercarbic respiratory failure(2023-05-07) GÜL, FETHİ; Guliyeva T., Saymaz N. A., Kaya E. B., Sabaz M. S., Gül F.Introduction: Extracorporeal carbon dioxide removal (ECCO2R) is a respiratory support technique that provides only decarboxylation with low blood flow (0.3-1.0 L/min) without making a significant difference in blood oxygenation. In this report, we planned to present our clinical experience with ECCO2R in a patient who developed hypercarbic respiratory failure due to exacerbation of chronic obstructive pulmonary disease (COPD).Case: A 74-year-old male patient with hypertension and diabetes, who used a BiPAP device and oxygen concentrator at home due to COPD, presented to the emergency department with shortness of breath and respiratory distress. During the follow-up, the patient who had a hypercapnia and admitted to the intensive care unit (ICU). The VV-ECCO2R (multi ECCO2R ®-Fresenius Medical Care) was started on the 3rd day of hospitalization for the patient who needed NIMV for an average of 16-18 hours per day and remain hypercarbic despite NIMV support. The extracorporeal blood flow was set at 200 mL/min and maintained stable, while the sweep gas flow was adjusted to be 3-5 L/min according to the PCO2 value. The patient was followed with high flow oxygen support without need for NIMV from beginning of the ECCO2R. The patient, whose hypercarbia regressed, was weaned from ECCO2R at the 40th hour (Table 1). The oxygen support was maintained with a simple face mask and he was transferred to the service on the 13th day of hospitalization.Discussion: Current evidence regarding the use of ECCO2R in patients with obstructive diseases remains limited. Patient selection, type of ECCO2R device used and anticoagulation strategy seem important in order to benefit from ECCO2R. In our patient with severe exacerbation of COPD, we decided to treat the respiratory acidosis by removing CO2 with an artificial lung. The use of ECCO2R allowed avoiding intubation and invasive mechanical ventilation and finally he was discharged from the ICU.Publication Metadata only The Role of the extracorporeal CO2 removal in a patient who had a near-fatal asthma attack(2023-05-06) GÜL, FETHİ; Sabaz M. S., Kaya B. E., Kamilova N., Balcı Ö. F., Gül F.[OP-195]The Role of the Extracorporeal CO2 Removal in a Patient Who Had a Near-fatal Asthma AttackMehmet Süleyman Sabaz1, Batuhan Kaya2, Nuray Kamilova2,Ömer Faruk Balcı2, Fethi Gül11Marmara University Faculty of Medicine, Department of Anesthesiology andReanimation, Division of Intensive Care, İstanbul, Turkey2Marmara University Faculty of Medicine, Department of Anesthesiology andReanimation, İstanbul, TurkeyIntroduction: Extracorporeal carbon dioxide removal (ECCO2R) is a respiratory support method that solely offers decarboxylation withminimal blood flow (0.3-1.0 L/min). Here we present the ECCO2R treatment in a patient who was intubated due to hypercarbic respiratory failure afteran asthma attack.Case: A 18-year-old male patient with a diagnosis of asthma admitted to the emergency room with respiratory distress. He was suffering with persistent wheezing and dyspnea. Physical examination showed decreased auscultation in both lungs. Chest X-ray was normal and the blood gas analysis showed a deep respiratory acidosis (Ph: 6.98, pCO2: 162 mmHg, pO2: 208 mmHg, HCO3: -26.4, BE: -1.6). The patient was intubated and admitted to the intensive care unit (ICU). He was treated with budesonide+ salbutamol + ipatropiumbromide + theophylline + intravenous steroid and magnesium sulfate during that period. Neuromuscular blocking agent was added to treatment in addition to deep sedation due to ongoing bronchospasm. Hypercapnia and respiratory acidosis was persist despite high mechanical ventilatory support (PEEP: 10 cmH2O, Psupport: 35 cmH2O, respiratory rate: 30, FiO2:%40). The VV-ECCO2R (multi ECCO2R®- Fresenius Medical Care) was started on the 2nd day of hospitalization.The extracorporeal blood flow was set at 300-350 mL/min, while the sweep gas flow was adjusted to be 3-6 L/min according to the pCO2 value.Unfractionated heparin was used for systemic anticoagulation. In timeshypercarbia regressed gradually, blood gas parameters improved andventilatory supports decreased (Table 1). He was successfully weaned fromthe ECCO2R on the 5th day and then extubated. He was discharged to theward with nasal oxygen support.Discussion: Most asthma attacks can be treated but some patients remainuncontrolled despite adequate therapy. The use of ECCO2R has been shownfor the possibility of earlier extubation after severe asthma attack whoneed invasive-mechanical ventilation. In our patient, who was sufferingfrom life-threathening asthma attack and finally discharged from the ICU,VV-ECCO2R corrected hypercapnia and acidosis, allowed the reduction ofother supportive measures and the favored the weaning from mechanicalventilation.Keywords: ECCO2R, extracorporeal carbon dioxide removal, asthma attack,hypercapniaPublication Metadata only Parenteral ve enteral beslenme(Güneş Tıp Kitabevi, 2022-10-01) GÜL, FETHİ; Gül F., Altuntaş G.