Browsing by Author "Girgin, Nermin Kelebek"
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Item A rare complication of trigeminal nerve stimulation during radiofrequency thermocoagulation - Sudden ST segment elevation(Lippincott Williams & Wilkins, 2002-01) Bilgin, Hülya; Girgin, Nermin Kelebek; Korfalı, Gülşen; Bekar, Aynur; Kerimoğlu, Beklen; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabiim Dalı.; 0000-0001-6639-5533; A-7338-2016; 6701663354; 7801569062; 6701462594; 6603677218; 11641006500Coronary vasospasm resulting from a sudden autonomic response associated with an intracranial procedure was encountered during percutaneous radiofrequency trigeminal rhizotomy. Although it is very rare, careful monitoring and readiness for the occurrence of such a potentially lethal situation with necessary medications may prevent a fatal outcome.Item Acil cerrahi girişim uygulanan geriatrik hastalarda preoperatif kırılganlık ve malnütrisyonun postoperatif takip, tedavi ve hastane yatış süresine etkisi(Bursa Uludağ Üniversitesi, 2021) Kaya, Ercan; Girgin, Nermin Kelebek; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.Geriatrik hastalar arasındaki fiziksel farklılıklar hastane yatış süreçlerinde de farklılıklara yol açar. Çalışmamızda; 65 yaş ve üzeri, acil cerrahi girişim uygulanan hastalarda, preoperatif kırılganlık ve malnütrisyonun; postoperatif takip, tedavi ve hastane yatış sürecine etkisini saptamayı amaçladık. Çalışma, etik kurul onayı ve hastalardan alınan yazılı onam sonrası acil cerrahi girişim uygulanacak 65 yaş ve üzeri 150 hastada gerçekleştirildi. Hastalara preoperatif dönemde FRAİL Kırılganlık Ölçeği ve Mini Nutrisyonel Değerlendirme Testi- Kısa Formu (MNA-SF) uygulandı. Postoperatif 30 günlük sürede hastane yatış süreçleri incelendi. Bu süreçte hastaların toplam yatış süreleri, tekrar opere edilme sayıları, tekrar hastaneye başvuruları, postoperatif yoğun bakım (YB) takibi gerekliliği, postoperatif komplikasyon gelişimi ve mortaliteleri incelendi. Çalışmamızda kırılganlık ve malnütrisyon düzeyleri artan hastalarda uzamış hastane yatış süresi (p<0,001, p<0,001), postoperatif YB takibi gereksinimi (p<0,001 p=0,001), tekrar opere edilme sıklığı (p=0,001, p=0,003), postoperatif komplikasyonlarda (p<0,001, p<0,001) ve mortalitede artış (p<0,001, p<0,001) istatistiksel olarak anlamlı olarak fazla idi. Yeniden hastane başvuru kırılganlık düzeyiyle anlamlı artış gösterirken (p=0,002), malnütrisyon düzeyi yeniden başvuruyu etkilememişti (p=0,141). Sonuç olarak; preoperatif kırılganlık ve malnütrisyon durumlarının, acil cerrahi girişim uygulanan geriatrik hastaların hastane yatış sürecine olumsuz etkileri olabileceğini saptadık. Preoperatif dönemde kırılganlık ve malnütrisyonunun rutin olarak belirlenmesiyle alınacak önlemlerin, opere edilecek geriatrik hastaların tedavi sürecinde faydalı olabileceğini düşünmekteyiz.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 Are the tidal volumes used in intensive care units suitable for lung protective ventilation? Can training ensure compatibility?(Galenos Yayincilik, 2020-09-01) Kaya, Pınar Küçükdemirci; Sayan, Halil Erkan; Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; Kaya, Murad; KAYA, MURAD; Bursa Uludağ Üniversitesi/Tıp Fakültesi; 0000-0002-5882-1632Objective: Low tidal volume (VT) and lung protective ventilation (LPV) are recommended to prevent lung injury associated with invasive mechanical ventilation (IMV). Present study aimed to determine the patients with risk of high VT application, whether VT calculated according ideal body weight (IBW) values are suitable for the recommended (6-8 mL/kg) and whether a questionnaire on the issue contributes to IMV suitable for LPV.Materials and Methods: Present study is conducted as a multicenter point - prevalence study in the intensive care units of three hospitals in Bursa. Non-ARDS patients receiving IMV and patients who were older than 18 years were included in the study. IMV parameters and demographic data of the patients were collected. Then, the physicians responsible of ventilatory management completed a questionnaire about LPV strategies and VT values required according to the IVA were shown. After 24 hours, mechanical ventilation parameters were re-collected. Body mass index (BMI), average tidal volume applied [VTmean = minute volume (MV)/respiratory rate (RR)] and VTmean for IBW (VTmean/IBW) values were calculated.Results: Fifty-six patients were included in the study. There were 33 male patients (58.9%) and the mean age of the patients was 65.43 +/- 18.87 years. The mean BMI of the patients was 27.84 +/- 7.0. The most commonly used ventilation mode was synchronized intermittent mandatory ventilation (75%). The VTmean was 549.32 +/- 151.00 mL (VTmean/IBW =9.31 +/- 3.07 mL/kg). According to VTmean/IBW, for the use of large VTs, being female (10.77 +/- 2.74 mL/kg) and having BMI >= 30 (10.82 +/- 3.80 mL/kg) posed significantly higher risk than being male (8.31 +/- 2.91 mL/kg) and having BMI <30 (8.67 +/- 2.47 mL/kg) (p=0.002, p=0.015 respectively). The results showed a significant decrease (p=0.026) in VTmean/IBW (8.81 +/- 3.49 mL/kg) values after the physicians completed LPV questionnaire and were shown the VT values (predicted by IBW).Conclusion: VTmean/IBW values were found to be higher than 6-8 mL/kg, the recommended value for LPV. Ventilation with high VT was associated with female gender and having a BMI of >= 30. Completing the LPV questionnaire and seeing the VT values (predicted by IBW) contributed to the number of the patients ventilated with VT values suitable LPV.Item The combination of low-dose levobupivacaine and fentanyl for spinal anaesthesia in ambulatory inguinal herniorrhaphy(Sage Publications Ltd, 2008) Girgin, Nermin Kelebek; Gurbet, Alp; Bulut, Taner; Türker, Gürkan; Demir, Şerafettin; Kılıç, Nizamettin; Çınar, A.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0002-3019-581X; AAI-6642-2021; A-7994-2018; AAH-7250-2019; S-2847-2016; W-5792-2018; 55663009300; 35618853300; 57188733188; 7003400116; 57198228846; 7005266570; 26026902500This study investigated whether the addition of 25 mu g intrathecal fentanyl to levobupivacaine spinal anaesthesia for outpatient inguinal herniorrhaphy allows a sub-anaesthetic levobupivacaine dose to be used. Forty patients were assigned to receive 5 mg levobupivacaine 0.5% mixed with 25 mu g fentanyl (group LF) or 7.5 mg levobupivacaine 0.5% (group L). The highest sensory block levels achieved were T7 (range T5 - T9) and T6 (range T4 - T9) in groups LF and L, respectively. The times to two-segment regression, S2 regression, ambulation, urination and discharge were all significantly shorter in group LF than group L. These results indicate that, for outpatient inguinal herniorrhaphy, intrathecal fentanyl combined with low-dose levobupivacaine provides good quality spinal anaesthesia and minimizes the need for intra-operative analgesia. This protocol is well suited for the outpatient setting because it features rapid recovery of full motor power, sensory function and bladder function.Item Combination of ultra-low dose bupivacaine and fentanyl for spinal anaesthesia in out-patient anorectal surgery(Sage Publications, 2008) Gurbet, Alp; Türker, Gürkan; Girgin, Nermin Kelebek; Aksu, Hale Ayca; Bahtiyar, Nedret Haciferat; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0002-3019-581X; 0000-0002-6503-8232; A-7994-2018; AAH-7250-2019; AAI-6642-2021; 35618853300; 7003400116; 55663009300; 16432662600; 25622246800This study investigated whether the addition of 25 mu g fentanyl to an ultra-low (sub-an aesthetic) dose of intrathecal bupivacaine provides adequate anaesthesia for out-patient anorectal surgery, without increasing side-effects or delaying hospital discharge. Patients were randomly allocated to receive 2.5 mg 0.5% bupivacaine plus 25 mu g fentanyl (group BF, n = 18) or 5 mg 0.5% bupivacaine alone (group B, n = 17). There were no significant differences in intra-operative outcomes, but mean recovery and discharge times were significantly shorter in group BF. There were no between-group differences in hypotension, bradycardia or respiratory depression and post-operative complications were comparable, apart from pruritus which was significantly more frequent in group BF. Fewer patients requested analgesic medication in the early post-operative period in group BF than in group B. In conclusion, 25 mu g intrathecal fentanyl added to ultra-low dose (2.5 mg) bupivacaine provided good-quality spinal anaesthesia and reduced post-operative analgesic requirement in patients undergoing ambulatory anorectal surgery.Item Comparison of blood culture and multiplex real-time PCR for the diagnosis of nosocomial sepsis(Edizioni Minerva Medica, 2016-03) Dinç, Fatih; Akalın, Halis; Özakın, Cüneyt; Sınırtaş, Melda; Kebabçı, Nesrin; İşçimen, Remzi; Girgin, Nermin Kelebek; Kahveci, Ferda; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0001-8111-5958; 0000-0001-5428-3630; 0000-0003-4820-2288; AAI-8104-2021; AAG-8392-2021; AAU-8952-2020; AAG-9356-2021; 57193412784; 57207553671; 57200678942; 6505818048; 56060994000; 16645821200; 55663009300; 6602405968BACKGROUND: In many cases of suspected sepsis, causative microorganisms cannot be isolated. Multiplex real-time PCR generates results more rapidly than conventional blood culture systems. METHODS: In this study, we evaluated the diagnostic performance of multiplex real-time PCR (LightCycler (R) SeptiFast, Roche, Mannheim, Germany), and compared with blood cultures and cultures from focus of infection in nosocomial sepsis. RESULTS: Seventy-eight nosocomial sepsis episodes in 67 adult patients were included in this study. The rates of microorganism detection by blood culture and PCR were 34.2% and 47.9%, respectively. Sixty-five microorganisms were detected by both methods from 78 sepsis episodes. Nineteen of these microorganisms were detected by both blood culture and PCR analysis from the same sepsis episode. There was statistically moderate concordance between the two methods (kappa=0.445, P<0.001). There was no significant agreement between the blood culture and PCR analysis in terms of microorganism detected (kappa=0.160, P=0.07). Comparison of the results of PCR and cultures from focus of infection revealed no significant agreement (kappa=0.110, P=0.176). However, comparison of the results of PCR and blood cultures plus cultures from focus of infection ( positive blood culture and/or positive culture from focus of infection) showed poor agreement (kappa=0.17, P=0.026). When the blood culture was used as the gold standard, the sensitivity, specificity, positive and negative predictive value of PCR in patients with bacteremia was 80%, 69%, 57% and 87%, respectively. CONCLUSIONS: SeptiFast may be useful when added to blood culture in the diagnosis and management of sepsis.Item A comparison of the laryngeal mask airway and cuffed oropharyngeal airway during percutaneous dilatational tracheostomy(Saudi Med Jarmed Forces Hospital, 2007-07) Girgin, Nermin Kelebek; Kahveci, Şöhret Ferda; Yavaşçaoǧlu, Belgin; Kutlay, Oya; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0003-4820-2288; AAI-7914-2021; AAH-7250-2019; AAG-9356-2021; 55663009300; 6602405968; 6602742300; 6602199747Item Dakriyosistorinostomi cerrahisinde kontrollü sedoanaljezinin genel anestezi ile karşılaştırılması(Bursa Uludağ Üniversitesi, 2021) Sağlam, Utku; Girgin, Nermin Kelebek; Kıvanç, Sertaç Argun; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji Ve Reanimasyon Anabilim Dalı.Çalışmamızda, dakriyosistorinostomi (DSR) cerrahisinde genel anestezi ve kontrollü sedoanaljezi yöntemlerini; hemodinamik veriler, kanama miktarı, postoperatif komplikasyonlar (kanama, ağrı vs.) ve anestezi memnuniyeti açısından prospektif ve randomize kontrollü olarak karşılaştırmayı amaçladık. Çalışma, etik kurul onayı ve hastalardan alınan yazılı onam sonrası, primer eksternal DSR uygulanacak, 18 yaş üzeri, ASA sınıflaması I-II-III, 44 hastada gerçekleştirildi. Hastalar genel anestezi (GA, n=22) ve kontrollü sedoanaljezi (SA, n=22) uygulanmak üzere rastgele 2 gruba ayrıldı. GA grubuna standart genel anestezi, SA grubuna ise deksmedetomidin (10 dakika 1 μq/kg yükleme, 0,6 μq/kg infüzyon), midazolam (0,04 mg/kg) ve meperidin (intramusküler 50 mg) uygulandı. Anestezi derinliği her iki grupta da bispektral indeks (BİS) monitörü ile takip edildi. Peroperatif hemodinamik veriler ve BİS değerleri (preoperatif, cerrahi insizyon sonrası 5.dk, intraoperatif 10., 20., 30. ve 40.dk), kanama miktarı, cerrahi ve anestezi süresi kaydedildi. Her iki grupta kalp atım hızı ve periferik oksijen saturasyonlarının intraoperatif dönemdeki yüzde değişimleri, tüm ölçüm zamanlarında preoperatif değerlere göre benzerdi (hepsi için p>0.05). GA grubunda, SA grubuna göre, preoperatif değer ile karşılaştırıldığında tüm ölçüm zamanlarında ortalama kan basıncındaki düşme miktarının daha fazla olduğu saptandı (p=0.010, p=0.006, p=0.031, p=0.037, p=0.001). Her iki grupta intraoperatif kanama miktarı, cerrahi ve anestezi süresi, postoperatif ağrı skorları ve komplikasyonlar benzerdi (hepsi için p>0.05). Hasta memnuniyeti SA grubunda anlamlı olarak yüksek idi (p=0.033). Sonuç olarak; eksternal DSR cerrahisinde BİS monitörizasyonu eşliğinde uygulanan kontrollü sedoanaljezide hemodinamik parametrelerin, intraoperatif kanama ve komplikasyonların GA ile benzer, hasta iii memnuniyetinin ise GA’ya göre yüksek olması nedeniyle seçilmiş olgularda bu yöntemin genel anesteziye alternatif olabileceği kanısındayız.Item Delayed pneumothorax and contralateral hydrothorax induced by a left subclavian central venous catheter: A case report(Hospital Clinicas, Univ Sao Paulo, 2010-05) Girgin, Nermin Kelebek; Arıcı, Semih; Türker, Gürkan; Otlar, Banu; Hotaman, Leyla; Kutlay, Oya; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0002-3019-581X; AAH-7250-2019; AAI-6642-2021; 55663009300; 35800905700; 7003400116; 14627601000; 23481868500; 6602199747Item Deliryumun değerlendirilmesinde sık kullanılan ölçüm araçlarının incelenmesi(Bursa Uludağ Üniversitesi, 2020-03-04) Erbay, Öznur; Girgin, Nermin Kelebek; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.Deliryum; akut başlangıçlı, mental durumda dalgalanmalar gösteren ve geri dönüşü olan bir sendromdur. Hastaneye başvuran hastaların %10-30'unda deliryum geliştiği tahmin edilmektedir. Deliryum; yaşlı, operasyon sonrası ve yoğun bakım hasta popülasyonların da sıklıkla görülmektedir. Deliryum sonucunda gelişen, uzamış hastane yatış süresi, artmış morbidite, hastane maliyeti ve mortalitenin önüne geçilmesi için ve deliryum semptomlarının erken dönem kontrol altına alınabilmesi için deliryumun erken tanısı önem kazanmaktadır. Bu durum deliryuma özel tasarlanmış veya tanılanmasına yardımcı araçlardan yararlanmak, bu araçların amaç ve işlevini bilmek konusunu gündeme getirmektedir. Deliryumu önlemek, tespit etmek, etkili stratejiler belirlemek ve uygulamak adına ilk adım, uygun değerlendirme aracı ile hastaları izlemektir. Sağlık profesyonellerinin çoğu deliryumu göz ardı edebilmekte veya yönetmede zorlanabilmektedir. Bu derleme makalesinde deliryum değerlendirilmesinde sık kullanılan ölçme araçlarının amaç, işlevi ve uygunluğu özetlenerek sağlık profesyonellerine yol göstermesi ve literatürde konu ile ilgili eksikliğin giderilerek farkındalık oluşturması amaçlanmaktadır.Item Düşük-akım, düşük gradientli ciddi aort darlığı olan yaşlı hasta: transkateter aort kapak replasmanı (TAVİ) sonrası sol ventrikül sistolik disfonksiyonunun düzelmesi(Uludağ Üniversitesi, 2015-05-07) Güngören, Fatih; Sağ, Saim; Özdemir, Bülent; Yeşilbursa, Dilek; Biçer, Murat; Kan, İrem İris; Girgin, Nermin Kelebek; Serdar, Osman Akın; Uludağ Üniversitesi/Tıp Fakültesi/Kardiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Kalp Damar Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.Yaşlanan nüfus ile birlikte aort darlığı, hipertansiyon ve koroner arter hastalığından sonra en sık görülen kalp hastalığıdır. Düşük ejeksiyon fraksiyonlu (EF) ve düşük akım / düşük gradientli (DA/DG) aort darlığı, aort darlığı olan hastaların %5’inde görülmektedir. Bu hastaların konservatif tedavi ile prognozları kötüdür. Benzer şekilde bu hastalarda yapılacak cerrahi aort kapak replasmanın (AVR) mortalitesi yüksektir. Cerrahi AVR sonrasında sol ventrikül EF’sindeki düzelme değişkendir ve genellikle düşük olarak kalmaya devam etmektedir. Dahası düşük EF’li ciddi aort darlığı olan hastalarda AVR operasyonu belirgin derece artmış mortaliteyle ilişkili görülmüştür. Son zamanlarda transkateter aort kapak implantasyonu (TAVİ) ciddi komorbiditesi olan yüksek cerrahi riske sahip hastalarda AVR operasyonuna alternatif olarak ortaya çıkmıştır. Biz bu yazımızda oldukça ileri yaşta düşük EF ve DA/DG’li ciddi aort darlığı hastasına yapılan TAVİ sonrası, erken dönemde EF düzelmesini rapor ettik.Item The effect of nursing-implemented sedation on the duration of mechanical ventilation in the ICU(Ulusal Travma ve Acil Cerrahi Derneği, 2010-11-01) Yılmaz, Canan; Girgin, Nermin Kelebek; Özdemir, Nurdan; Kutlay, Oya; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0002-1510-0667; N-3608-2019; AAH-7250-2019; 56526391600; 55663009300; 57212543974; 6602199747BACKGROUND We aimed to compare the effects of nursing-implemented sedation protocol and daily interruption of sedative infusion on the duration of mechanical ventilation. METHODS Fifty patients receiving mechanical ventilation and requiring sedation in the intensive care unit (ICU) were randomly selected to receive either daily interruption of sedative infusion (Group P, n=25) or nursing-implemented sedation protocol (Group N, n=25). In Group P, daily interruption of sedative infusions without any sedation protocol was performed by physicians. In Group N, nursing-implemented sedation protocol prepared by physicians was applied. In this group, if the ideal level of sedation was not achieved, information was given by nurses to physicians. Patients in each group were compared according to demographic variables, duration of mechanical ventilation and sedation, length of stay in the ICU, and mortality. RESULTS Demographic variables, length of stay in the ICU and mortality were similar between the two groups. In Group P, duration of sedation and mechanical ventilation were significantly shorter than in Group N. Light sedation was seen more frequently in Group P and deep sedation in Group N. CONCLUSION Daily interruption of sedative infusions provided shorter duration of sedation and mechanical ventilation than nursing-implemented sedation with protocol. Although nurse-implemented sedation protocol has been found acceptable, if the number of nurses is lacking, we believe the nurse-implemented sedation protocol should not be applied.Publication Guillain-barre's intensive care(Galenos Yayıncılık, 2007-01-01) Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; Uludağ Üniversitesi/Tip Fakültesi/Anestezi & Reanimasyon Anabilim Dalı; AAH-7250-2019Intensive care in patient with Guillain-barre syndrome Guillain-Barrke syndrome is an acute demyelinating neuropathy, that evolves after infectious disorders.. Although a definitive cause of GBS has not been identified, about two-thirds of patients have an infectious history within a 6 week period prior to the diagnosis, generally a flu-like episode or gastroenteritis.Symptoms typically start from the legs and ascend symmetrically to the upper body, and lead to progressive motor weakness and sensory abnormalities, and in some patients it turns up to complete quadriplejia. Dysautonomic symptoms such as cardiac disrhythmia, hypertension, hypotension, ileus or urinary retention are common and potentially harmful. Patients with GBS require intensive care support for the reasons primarily related to GBS (respiratory muscle failure, hemodynamic instability due to dysautonamia) and coexisting diseases indirectly. All patients need support care, and 25-30% of them also require mechanical ventilation therapy. The other treatment options such as plasma exchange, immunotherapy are helpful for alleviating the duration and severity of the disease. About 2-4 weeks after onset of symptoms, the weakness id prominent. The improvement of the disease may be insufficient, and about 4-15% of patients die. This article focused on general review the treatment of patients with GBS in intensive care unit.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.Item Intrathecal morphine in anesthesia for cesarean delivery: Dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine(Elsevier, 2008-05) Girgin, Nermin Kelebek; Gurbet, Alp; Türker, Gürkan; Aksu, Hale; Gülhan, Nevra; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0002-3019-581X; 0000-0002-6503-8232; AAI-6642-2021; A-7994-2018; AAH-7250-2019; S-2847-2016; 55663009300; 7003400116; 16432662600; 7003400116; 6504394933Study objective: To evaluate the quality of analgesia and the severity of side effects of intrathecal morphine administered for a dose range of 0.0 to 0.4 mg for postcesarean analgesia with low-dose bupivacaine. Design: Double-blind, randomized study. Setting: University hospital. Patients: 100 ASA physical status I and II term parturients undergoing cesarean delivery with spinal anesthesia in the operating room. Interventions: Patients were randomized to one of 5 groups to receive 0.0, 0.1, 0.2, 0.3, or 0.4 mg intrathecal morphine in addition to low-dose (7.5 mg) heavy bupivacaine. Each patient received intravenous (IV) patient-controlled analgesia (PCA) with morphine after the operation. Measurements: 24-hour IV PCA morphine use and visual analog scores for pain were recorded. The severity score (4-point scale) of nausea, vomiting, and pruritus were assessed intraoperatively and at 4-hour intervals during the first 24 hours postoperatively. Main results: PCA morphine use was higher in the control group (0.0 mg) than in groups receiving 0.1, 0.2,03, or 0.4 mg intrathecal morphine. There was no difference in IV PCA morphine use between the 0.1 and 0.4-mg groups, despite a 4-fold increase in intrathecal morphine dose. There was no difference between groups in nausea and vomiting, but pruritus increased in direct proportion to the dose of intrathecal morphine (linear regression, P = 0.0001). Conclusions: The dose of 0.1 mg intrathecal morphine produces analgesia comparable with doses as high as 0.4 mg, with significantly less pruritus when combined with low-dose bupivacaine.Item Intravenous immunoglobulin in adult varicella pneumonia complicated by acute respiratory distress syndrome(Sage Publications, 2001) Özcan, Birgül; Tokat, O.; Girgin, Nermin Kelebek; Türker, Gürkan; Kahveci, Ferda; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji Anabilim Dalı.; 0000-0002-3019-581X; 0000-0003-4820-2288; AAI-6642-2021; AAG-9356-2021Pneumonia is a rare but serious complication of varicella in adults. We report a case of a previously healthy 32-year-old man with varicella pneumonia that was complicated by acute respiratory distress syndrome. He was treated successfully with acyclovir and intravenous immunoglobulin in to mechanical ventilation. We conclude that intravenous immunoglobulin, in combination with acyclovir, is a safe and probably effective therapy for adult varicella pneumonia that is complicated by acute respiratory distress syndrome.Publication Is bispectral index monitoring reliable for determining sedation level in a tetanus patient?(Int Scientific Information, Inc, 2008-01-01) Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; İşçimen, Remzi; İŞÇİMEN, REMZİ; Kutlay, Oya; Gurbet, Alp; GURBET, ALP; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0002-6503-8232; AAI-8104-2021; A-7994-2018; HKP-2533-2023; AAH-7250-2019Background: Tetanus is an infectious disease characterised by increased muscle rigidity, muscle spasms, and, in severe cases, cardiovascular instability secondary to autonomic dysfunction. Sedation is an important part of the treatment of tetanus. Clinical scoring systems, although simple and inexpensive, are often inadequate in evaluating the patient level of sedation in the intensive care unit (ICU). The bispectral index (BIS), a variable derived from the electroencephalography, could assess sedation in the ICU. In the present study, we aimed to present our experience on the application of BIS monitoring during treatment of a patient with tetanus.Case Report: A 69-year-old man was admitted to intensive care unit with a diagnosis of tetanus. The patient was intubated, and mechanical ventilation (MV) therapy with pressure support ventilation mode was administered. Dexmedetomidine, midazolam and morphine were administered for sedation and analgesia. Sedation was titrated to maintain a Ramsay Sedation Score (RSS) of 5 or greater. The RSS was assessed once a minute during the loading dose of dexmedetomidine and once an hour in the first day. On the following days, the RSS was recorded every 2 hours. When the RSS evaluation was applied, BIS values were also recorded simultaneously. On the 7th day, BIS monitoring could not be continued due to technical reasons. Sedation was monitored by RSS. A total number of 107 Ramsay score determinations and BIS values were obtained in the follow-up period. The patient underwent percutaneous tracheostomy on the 8th day. The patient was totally disconnected from MV on the 31st day and discharged from the hospital on the 33rd day.Conclusions: In this case, we thought that RSS is still a reliable method in monitoring the sedation level in tetanus. The BIS monitoring is inferior to and discordant with the standard monitoring of the RSS, largely to the painful muscle spasms and rigidity inherent in the pathophysiology of the disease. Moreover, if the sedative drug dosage is elevated according to BIS values, excessive sedation may occur in these patients.Publication Knowledge, perception and prevention performance of intensive care unit nurses about medical device-related pressure injuries(Wiley, 2021-08-22) Dallı, Öznur Erbay; Girgin, Nermin Kelebek; ERBAY DALLI, ÖZNUR; KELEBEK GİRGİN, NERMİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı/Yoğun Bakım Bilim Dalı; 0000-0003-2282-0846; 0000-0002-5882-1632; ABI-1236-2020; GBC-7197-2022Aim and Objective To examine intensive care unit (ICU) nurses' knowledge, perceptions and prevention performance about medical device-related pressure injuries (MDRPIs). Background Prevention of MDRPIs has been an important part of nursing care, and there is a limited number of studies on nurses' level of knowledge or perception about MDRPIs. Design This study was designed as a cross-sectional survey and conducted according to STROBE Guidelines. Method The data of the study were collected with the Nurse Information Form and the MDRPI Knowledge Assessment Questionnaire. In the first phase, the psychometric properties of the questionnaire were evaluated (content validity, internal consistency and test-retest). A pilot study was conducted with 20 nurses for the test-retest phase. These nurses were excluded from the general sample. Results The study was conducted with 142 ICU nurses. The average percent knowledge score of ICU nurses on MDRPIs was 68.4%. In the survey, the highest rate of correct response was found in the expressions about MDRPIs skin assessment (83.6%), and the lowest was in those about follow-up (50.8%). There was no significant relationship between the total score and age, work experience and specialties (p > .05 for each). However, scores were significantly higher in females than males (65.5 vs. 47.8, p = .020) and in those with a postgraduate degree than those with a bachelor's degree (81.8 vs. 57.9, p = .008). Conclusions Our study demonstrated that nurses do not have sufficient perception of MDRPIs. The findings of the study can be used to improve nursing policies and practices in acute care settings. Additional studies will be needed with nurses and healthcare professionals working in different clinical settings. Relevance to the clinical practice This study demonstrates the nurses' need for more knowledge about MDRPIs and will help inform healthcare institutions and their management teams in developing programs and improving protocols to reduce the incidence of MDRPIs.Item Kritik hastalarda nozokomiyal diyare insidansı ve risk faktörlerinin retrospektif incelenmesi(Uludağ Üniversitesi, 2011) Özgür, Mustafa; Girgin, Nermin Kelebek; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.Diyare, yoğun bakım ünitesi(YBÜ)'nde tedavi edilen kritik hastalarda yaygın olarak karşılaşılan bir komplikasyondur. Sıvı ve elektrolit kaybına, malnutrisyona neden olur. Aynı zamanda hemşire iş yükünü artırır, hastanın konforunu olumsuz etkiler ve hastanede kalış süresini uzatır. Çalışmamızda YBÜ'de tedavi edilen kritik hastalarda nozokomiyal diyare insidansını ve risk faktörlerini araştırmayı amaçladık.Anesteziyoloji ve Reanimasyon Anabilim Dalı Yoğun Bakım Ünitesi(YBÜ)'nde 1 Haziran 2004 ? 30 Mayıs 2009 tarihleri arasında tedavi edilen 786 erişkin hastanın dosyası retrospektif incelendi. Günde üç kez ve daha fazla, gevşek ve sulu dışkılama diyare olarak kabul edildi. Kontrol grubu olarak diyare gelişen hastalarla eş zamanlı YBÜ'de tedavi edilen, demografik verileri, Glasgow Koma Skalası (GKS) ve Akut Fizyolojik ve Kronik Sağlık Değerlendirme (APACHE) II skorları benzer hastalar alındı.Çalışma süresi içinde ünitemizde tedavi edilen 786 hastanın 78 (%9.92)'inde diyare geliştiği saptandı. Yoğun bakım ünitesine yatış ile diyare başlama arasında geçen süre 12.4 ± 21.7 gün, diyare süresi 4.38 ± 2.13 gün idi. Diyare gelişen olgularda, kontrol grubuna (n=80) göre enteral beslenme hızı yüksek olup, yoğunluğu yüksek enteral beslenme ürünleri, proton pompa inhibitörleri, sorbitol ve Mg+2 içeren ilaçlar, klindamisin ve sefalosporinler anlamlı olarak fazla kullanılmıştı (tümü için p<0.05). Ayrıca olguların albümin düzeyleri düşük, hastane yatış süreleri de uzundu (her ikisi için p<0.05).Diyare görülen 11 hastada (%14.1) Clostridium difficile (CD) toksini pozitif tespit edilmişti. Bu olgular daha yaşlı, yoğun bakım yatış süreleri ve diyare süreleri daha uzundu (p<0.05).Sonuç olarak YBÜ'de tedavi edilen kritik hastalarda gelişen nozokomiyal diyarenin hastane yatış süresini uzattığını saptadık. Bu nedenle diyare gelişen olgularda risk faktörleri incelenmeli ve gerekirse tedavi edilmelidir. Retrospektif olması çalışmamızı sınırlamasına rağmen, sonuçlarımızın ülkemizle ilgili eksik verilerin tamamlanmasına katkıda bulunacağını düşünmekteyiz.