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    Evaluation of the effect of morphological structure on dilatational tracheostomy interference location and complications with ultrasonography and fiberoptic bronchoscopy
    (MDPI, 2024) Bulut, Esin; Yıldız, Ülkü Arslan; Cengiz, Melike; Yılmaz, Murat; Kavaklı, Ali Sait; Arıcı, Ayşe Gülbin; Öztürk, Nihal
    Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements.
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    Factors affecting mortality in COVID-19
    (Galenos publishing house, 2025) Özer, Burcu; Yıldız, Ülkü Arslan; Kavaklı, Ali Sait; Cengiz, Melike; Temel, Hakan; Yılmaz, Murat
    Objective: Determining the factors affecting mortality may be pivotal in terms of improving survival in the coronavirus disease-2019 (COVID-19). The aim of this study was to determine the demographic, clinical and laboratory characteristics of COVID-19 patients and the factors affecting intensive care unit (ICU) mortality. Materials and Methods: It was designed as a retrospective cohort study in which patients with a diagnosis of COVID-19 hospitalized in the ICU. The clinical and laboratory parameters were compared between cohorts with mortality and those with survival cohorts. Univariate and multivariate logistic regression analyses were performed for the effect profiles of the parameters on mortality. Results: The mortality of 58.6% was similar for the three pandemic waves or selected time intervals (p=0.245). Presence of comorbid disease, age, COVID-19 related complications, admission, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were significantly higher in the mortality cohort (p<0.001). The factors influencing mortality according to the multivariate logistic regression model were hypertension, malignancy (solid and hematologic), neurological illness, age, APACHE-II and SOFA scores, and neutrophil to lymphocyte ratio. Conclusion: The patients with these risk factors should be monitored with greater caution in terms of the timing and duration of ICU care.