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GirişTrombositopeni için farklı tanımlamalar olmakla beraber tam kan sayımındaki trombosit sayısının 150.000/μL altında olması trombositopeni olarak kabul edilir (1). Ancak bazı yazarlar tarafından trombositopeni sınırı 100.000/μL olarak kabul edilmektedir (2, 3). Trombositopenisi olan hastalarda beklenen en önemli problem kanamadır. Kanama riski trombosit değerleri ile ters orantılıdır (1).Objective: Thrombocytopenia is common in intensive care units (ICUs) and is associated with high mortality. The aim of this study was to determine the incidence of thrombocytopenia and to evaluate the factors affecting the development of thrombocytopenia in patients who stayed at a medical intensive care unit (MICU). Material and Methods:This study was conducted retrospectively in a MICU. The data were obtained from patients' folders and the hospital's electronic records system. Patients who stayed for more than 24 h in the ICU were included in the study. The demographic data, the worst laboratory values in the first 24 h, the lowest platelet counts, and medications that can cause thrombocytopenia were recorded.Results: A total of 237 patients were included in this study; 106 of them (45%) were female and 131 (55%) were male. Their average age was 62±18 years. The most common reasons for hospitalization in the ICU were respiratory failure (33%) and neurological diseases (13%). During follow-up, 45% of the patients developed thrombocytopenia. The mean APACHE-II score was 24±10 and SOFA score was 9±4. The mean MODS score was 6±3, and it was higher in the patients who developed thrombocytopenia than those who did not (p<0.0001). Upon analyzing the factors affecting the development of thrombocytopenia, prophylactic or therapeutic heparin use was determined in 61% of the patients. It was determined that 106 patients (45%) were using one or more drugs that can trigger thrombocytopenia. The patients who developed thrombocytopenia stayed longer in the ICU (p=0.042), and their overall mortality rate was higher than those who did not develop thrombocytopenia (91% vs. 55%; p<0.0001). Bulgular: Çalışmaya 237 hasta dâhil edildi. Hastaların 106'sı kadın (%45), 131'i ise erkekti (%55). Yaş ortalaması 62±18 yıl idi. En sık yoğun bakıma yatış nedenleri; solunum yetmezliği (%33) ve nörolojik hastalıklar (%13) idi. Takiplerinde hastaların %45'inde trombositopeni gelişti. Hastaların ortalama APACHE II skoru 24±10, SOFA skoru 9±4 ve MODS skoru 6±3 idi ve trombositopeni gelişen hastalarda gelişmeyenlere göre daha yüksek bulundu (p<0,0001). Trombositopeni gelişimini etkileyen faktörler incelendiğinde hastaların %61'inin profilaktik veya tedavi dozunda heparin aldığı tespit edildi. Hastaların 106'sında (%45) ise bir veya daha fazla trombositopeni yapan ilaç kullanıldığı görüldü. Trombositopeni gelişen hastalarda yoğun bakımda kalma süresi daha uzun idi (p=0,042). Hastaların genel mortalitesi trombositopeni gelişenlerde gelişmeyenlere göre daha yüksek idi (%91 ve %55; p<0,0001).

Sepsis bundle compliance is not clear. We evaluated rates of compliance with sepsis bundle protocols among health care providers in Turkey. MethodsOur study was carried out retrospectively. Forty-five intensive care units (ICU) participated in this study between March 2, 2018 and October 1, 2018. ResultsOne hundred thirty-eight ICUs were contacted and 45 ICUs agreed to participate. The time taken for the diagnosis of sepsis was less than six hours in 384 (59.8%) patients, while it was more than six hours in 258 (40.2%) patients. The median [interquartile range (IQR)] times for initial antibiotic administration, culturing, vasopressor initiation, and second lactate measurement were 120.0 (60-300) minutes, 24 (12-240) minutes, 40 (20-60) minutes, and 24 (18-24) hours, respectively. The rate of compliance with tissue and organ perfusion follow-up in the first six hours was 0%. The rates of three-and six-hour sepsis bundle protocol compliance were both 0%. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. ConclusionsThe rate of compliance with sepsis bundle protocols was evaluated in Turkey for the first time and determined to be 0%.

Background Organ transplantation reduces mortality and morbidity in patients with end-stage organ failure. The number of living organ donations is not enough to meet the current organ transplantation need; therefore, there is an urgent need for organ donation from cadavers. We aimed to determine the organ donation rates and reveal the obstacles against donation. Methods This study is designed as a retrospective multicenter study consisting of eight university hospitals, three training and research hospitals, 26 state hospitals, and 74 private hospitals in nine provinces in Turkey. A total of 1,998 patients diagnosed with brain death between January 2011 to April 2019 were examined through the electronic medical records data system. Results Median patient age was 38 (IQR: 19–57), and 1,275 (63.8%) patients were male. The median time between the intensive care unit admission and brain death diagnosis was 56 (IQR:2–131) hours. The most commonly used confirmatory diagnostic test was computed tomography in 216 (30.8%) patients, and the most common cause of brain death was intraparenchymal hemorrhage with 617 (30.9%) patients. A total of 1,646 (82.4%) families refused to permit organ donation. The most common reasons for refusal were family disagreement (68%), social/relative pressure (24%), and religious beliefs (8%). Conclusions Many families refuse permission for organ donation; some of the provinces included in this study experienced years of exceptionally high refusal rates.