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    Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: Risk factors for mortality
    (W B SAUNDERS CO-ELSEVIER INC, 2013) Cilli, Aykut; Erdem, Hakan; Karakurt, Zuhal; Turkan, Hulya; Yazicioglu-Mocin, Ozlem; Adiguzel, Nalan; Gungor, Gokay; Bilge, Ugur; Tasci, Canturk; Yilmaz, Gulden; Oncul, Oral; Dogan-Celik, Aygul; Erdemli, Ozcan; Oztoprak, Nefise; Samur, Anil Aktas; Tomak, Yakup; Inan, Asuman; Karaboga, Burcu; Tok, Demet; Temur, Sibel; Oksuz, Hafize; Senturk, Ozgur; Buyukkocak, Unase; Yilmaz-Karadag, Fatma; Ozcengiz, Dilek; Karakas, Ahmet; Savasci, Umit; Ozgen-Alpaydin, Aylin; Kilic, Erol; Elaldi, Nazif; Bilgic, Hayati
    Purpose: The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality. Materials and Methods: An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses. Results: Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P=.003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P=.042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P=.001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P=.045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P=.007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P=.032) were independent factors related to mortality. Conclusion: Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission. (C) 2013 Elsevier Inc. All rights reserved.
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    The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study
    (BIOMED CENTRAL LTD, 2014) Erdem, Hakan; Kocak-Tufan, Zeliha; Yilmaz, Omer; Karakurt, Zuhal; Cilli, Aykut; Turkan, Hulya; Yazicioglu-Mocin, Ozlem; Adiguzel, Nalan; Gungor, Gokay; Tasci, Canturk; Yilmaz, Gulden; Oncul, Oral; Dogan-Celik, Aygul; Erdemli, Ozcan; Oztoprak, Nefise; Tomak, Yakup; Inan, Asuman; Tok, Demet; Temur, Sibel; Oksuz, Hafize; Senturk, Ozgur; Buyukkocak, Unase; Yilmaz-Karadag, Fatma; Ozturk-Engin, Derya; Ozcengiz, Dilek; Karakas, Ahmet; Bilgic, Hayati; Leblebicioglu, Hakan
    Background: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. Methods: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. Results: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. Conclusion: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series.
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    Mortality indicators in community-acquired pneumonia requiring intensive care in Turkey
    (ELSEVIER SCI LTD, 2013) Erdem, Hakan; Turkan, Hulya; Cilli, Aykut; Karakas, Ahmet; Karakurt, Zuhal; Bilge, Ugur; Yazicioglu-Mocin, Ozlem; Elaldi, Nazif; Adiguzel, Nalan; Gungor, Gokay; Tasci, Canturk; Yilmaz, Gulden; Oncul, Oral; Dogan-Celik, Aygul; Erdemli, Ozcan; Oztoprak, Nefise; Tomak, Yakup; Inan, Asuman; Karaboga, Burcu; Tok, Demet; Temur, Sibel; Oksuz, Hafize; Senturk, Ozgur; Buyukkocak, Unase; Yilmaz-Karadag, Fatma; Ozcengiz, Dilek; Turker, Turker; Afyon, Murat; Samur, Anil Aktas; Ulcay, Asim; Savasci, Umit; Diktas, Husrev; Ozgen-Alpaydin, Aylin; Kilic, Erol; Bilgic, Hayati; Leblebicioglu, Hakan; Unal, Serhat; Sonmez, Guner; Gorenek, Levent
    Background: Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey. Methods: This study evaluated SCAP cases hospitalized in the ICUs of 19 different hospitals between October 2008 and January 2011. The cases of 413 patients admitted to the ICUs were retrospectively analyzed. Results: Overall 413 patients were included in the study and 129 (31.2%) died. It was found that bilateral pulmonary involvement (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.7) and CAP PIRO score (OR 2, 95% CI 1.3-2.9) were independent risk factors for a higher in-ICU mortality, while arterial hypertension (OR 0.3, 95% CI 0.1-0.9) and the application of non-invasive ventilation (OR 0.2, 95% CI 0.1-0.5) decreased mortality. No culture of any kind was obtained for 90 (22%) patients during the entire course of the hospitalization. Blood, bronchoalveolar lavage, and non-bronchoscopic lavage cultures yielded enteric Gram-negatives (n = 12), followed by Staphylococcus aureus (n = 10), pneumococci (n = 6), and Pseudomonas aeruginosa (n = 6). For 22% of the patients, none of the culture methods were applied. Conclusions: SCAP requiring ICU admission is associated with considerable mortality for ICU patients. Increased awareness appears essential for the microbiological diagnosis of this disease. (C) 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.