Positive end-expiratory pressure (PEEP) can overcome respiratory changes that occur during pneumoperitoneum application in laparoscopic procedures, but it can also increase intracranial pressure. We investigated PEEP vs. no PEEP application on ultrasound measurement of optic nerve sheath diameter (indirect measure of increased intracranial pressure) in laparoscopic cholecystectomy. Eighty ASA I-II patients aged between 18 and 60 years scheduled for elective laparoscopic cholecystectomy were included. The study was registered in the Australian New Zealand Clinical Trials (ACTRN12618000771257). Patients were randomly divided into either Group C (control, PEEP not applied), or Group P (PEEP applied at 10 cmH₂0). Optic nerve sheath diameter, hemodynamic, and respiratory parameters were recorded at six different time points. Ocular ultrasonography was used to measure optic nerve sheath diameter. Peak pressure (PPeak) values were significantly higher in Group P after application of PEEP (p = 0.012). Mean respiratory rate was higher in Group C at all time points after application of pneumoperitoneum (p < 0.05). The mean values of optic nerve sheath diameters measured at all time points were similar between the groups (p > 0.05). The pulmonary dynamic compliance value was significantly higher in group P as long as PEEP was applied (p = 0.001). During laparoscopic cholecystectomy, application of 10 cmH₂O PEEP did not induce a significant change in optic nerve sheath diameter (indirect indicator of intracranial pressure) compared to no PEEP application. It would appear that PEEP can be used safely to correct respiratory mechanics in cases of laparoscopic cholecystectomy, with no significant effect on optic nerve sheath diameter.

Ağrının Tarihçesi Ahmet DÜZGÜN Ağrı ve Genetik Ali İhsan YÜREKLİ Yoğun Bakım Hastalarında Ağrı Biyokimyası Cemal NAS Yoğun Bakımda Ağrı Fizyolojisi Bedih BALKAN Ağrı Mekanizmaları ve Ağrıya Yaklaşım Mehmet ERTARGIN Yoğun Bakımda Ağrı Değerlendirmesi Ali Kendal OĞUZ Yoğun Bakım Ünitesinde Kullanılan Ağrı Değerlendirme Ölçekleri Maşallah ÇAKIRER Yoğun Bakım Hastalarında Ağrı ve Etik Abdulkadir YEKTAŞ Yoğun Bakımda Akut Ağrı Tedavisi ve Analjezikler Kaan KARA Kronik Ağrı Sendromlu Hastanın Yoğun Bakım Ünitesinde Takibi Burhan Sami KALIN Yoğun Bakım’da Ağrı Tedavi Yöntemleri Erhan GÖKÇEK Yoğun Bakımda Kullanılan Girişimsel Ağrı Yöntemleri Seher YANATMA Yoğun Bakımda Ağrılı Hastaya Psikiyatrik Yaklaşım Ahmet DEMİRDAĞ Kevser ERDOĞAN Yoğun Bakımda Yatan Kanser Hastaları ve Palyatif Bakım Hastalarında Ağrı Tedavisi Abid KARAGÖZ

Objective: To evaluate the prognostic value of arterial pH at ICU admission for short-term survival after cardiac arrest. Materials and Methods: This single-center observational study included 60 adults (≥18 years) admitted to the ICU between May 2024 and June 2025 after successful resuscitation with return of spontaneous circulation (ROSC). Clinical, demographic, and laboratory data were collected. Survivors and non-survivors at day 7 were compared using logistic regression and ROC analyses to determine independent predictors of mortality. Results: The mean age was 61 ± 17 years, and 43% of patients were women. Seven-day mortality was 51.7%. Non-survivors were older and had higher APACHE II scores, lactate and procalcitonin levels, longer CPR-to-ROSC intervals, lower arterial pH values, and shorter ICU stays (all p < 0.05). In multivariable logistic regression analysis, age, higher APACHE II score, elevated procalcitonin levels, and lower arterial pH were independently associated with 7-day mortality. Lower arterial pH remained significantly associated with mortality (OR: 1.53; 95% CI: 0.93–2.86; p = 0.044). ROC analysis yielded an AUC of 0.668, with an optimal pH cut-off value of 7.13 (sensitivity 61.3%, specificity 75.9%). Conclusion: Lower arterial pH at ICU admission independently predicts 7-day mortality after cardiac arrest, emphasizing the importance of early recognition and correction of acidosis in post-resuscitation care

Background/Objectives: Trauma remains a leading global cause of mortality and morbidity, particularly in low- and middle-income countries. Multitrauma patients often require intensive care and exhibit high mortality rates. Prognostic scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Revised Trauma Score (RTS) are widely used to predict outcomes; however, their performance in middle-income settings like Turkey has not been well established. This study aimed to evaluate the prognostic accuracy of APACHE II and RTS in predicting intensive care unit (ICU) mortality among multitrauma patients. Methods: This retrospective observational study was conducted in the General ICU of Diyarbakır Gazi Yaşargil Training and Research Hospital between January 2022 and December 2024. Adult patients (≥18 years) with multitrauma involving at least two anatomical regions were included. Demographic data, clinical scores (APACHE II, RTS, Sequential Organ Failure Assessment [SOFA], Injury Severity Score [ISS], Trauma and Injury Severity Score [TRISS]), laboratory parameters, complications, and outcomes were recorded. Univariate and multivariate logistic regression analyses identified independent predictors of ICU mortality. Receiver operating characteristic (ROC) analysis assessed the discriminatory ability of prognostic scores. Results: A total of 145 patients were analyzed, with an ICU mortality rate of 13.1%. Non-survivors had significantly higher APACHE II (27 ± 4 vs. 13 ± 6, p < 0.001) and SOFA scores (7 [4–13] vs. 2 [1–6], p < 0.001) and lower RTS (4.2 ± 1.7 vs. 7.2 ± 1.1, p < 0.001). Acute kidney injury, sepsis, septic shock, and mechanical ventilation were more frequent among non-survivors (p < 0.01 for all). In multivariate analysis, APACHE II (odds ratio [OR]= 1.54, 95% confidence interval [CI] 1.16–2.04, p = 0.003) and RTS (OR = 0.36, 95% CI 0.16–0.81, p = 0.013) were independent predictors of ICU mortality. ROC analysis showed excellent prognostic performance for APACHE II (area under the curve [AUC] = 0.959) and RTS (AUC = 0.888). Conclusions: In this retrospective single-center cohort, APACHE II and RTS were independently associated with ICU mortality and demonstrated good discriminatory performance for early risk stratification in critically ill multitrauma patients. The lower mortality observed in our cohort should be interpreted cautiously, as it may also reflect differences in case-mix, injury severity, ICU admission practices, and referral patterns. These findings require external validation in larger multicenter cohorts before broader generalization. Future studies should also validate the identified cut-off values and further investigate the prognostic role of biomarkers such as procalcitonin.

Yoğun bakım ünitelerindeki hastaların büyük bir kısmı, dinlenme halindeyken bile ağrı çekmektedir. Bu durum, hastaların tedavi süreçlerini zorlaştıran fizyolojik ve psikolojik komplikasyonlara yol açabilir. Ağrının etkili bir şekilde değerlendirilip yönetilmesi, yalnızca hastaların konforunu artırmakla kalmaz, aynı zamanda enfeksiyon, solunum yetmezliği ve kardiyovasküler stres gibi riskleri de azaltır. Geleneksel yöntemlerin yanı sıra, ultrason rehberliğinde gerçekleştirilen bölgesel anestezi teknikleri, daha güvenli ve etkili bir alternatif sunar. Bu teknikler, özellikle cerrahi sonrası dönemde ağrı kontrolü sağlamak için önemlidir. Ayrıca, multimodal analjezi yaklaşımları opioid bağımlılığını azaltarak hastaların daha hızlı mobilize olmasına ve uzun vadeli sonuçların iyileştirilmesine katkıda bulunur. Patients in intensive care units often experience significant pain even at rest, posing challenges to their recovery and care. Effective pain assessment and management are crucial not only for improving patient comfort but also for mitigating risks such as infection, respiratory failure, and cardiovascular stress. Beyond traditional methods, ultrasound-guided regional anesthesia techniques offer safer and more effective solutions for pain control, particularly in postoperative settings. Multimodal analgesic strategies also play a key role in reducing opioid dependency, promoting faster mobilization, and improving long-term outcomes.