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 ünitelerinde tedavi gören hastaların büyük bir kısmı, yeterli tedaviye rağmen orta ve şiddetli ağrı deneyimlemektedir. Ağrının etkili bir şekilde değerlendirilememesi, hastaların mortalite ve morbiditesini artıran uzun vadeli komplikasyonlara yol açabilir. İletişim kurulamayan veya sedatize hastalarda standart yöntemlerin yetersiz kalması nedeniyle, davranışsal ve fizyolojik göstergelere dayalı tek ve çok boyutlu ağrı değerlendirme ölçekleri geliştirilmiştir. Tek boyutlu ölçekler arasında görsel kıyaslama ölçeği (VAS), sayısal derecelendirme ölçeği (NRS) ve yüz ağrı ölçeği (FPS) öne çıkarken, çok boyutlu ölçekler arasında davranışsal ağrı ölçeği (BPS), yoğun bakım ağrı gözlem ölçeği (CPOT) ve FLACC ölçeği sıkça kullanılmaktadır. Bu ölçekler, ağrının erken tanımlanması ve etkili yönetimi için sağlık profesyonellerine standart bir yaklaşım sunar. Özellikle hasta uyumunu kolaylaştıran teknolojik ve davranışsal yöntemlerin entegrasyonu, ağrı yönetiminde gelecekteki uygulamalara ışık tutmaktadır. A significant proportion of patients treated in intensive care units (ICUs) experience moderate to severe pain despite adequate treatment efforts. Ineffective pain assessment can lead to long-term complications that increase patient mortality and morbidity. In patients who are non-communicative or under sedation, the inadequacy of standard methods necessitated the development of standardized uni- and multidimensional pain assessment scales based on behavioral and physiological indicators. Among unidimensional scales, the visual analog scale (VAS), numeric rating scale (NRS), and faces pain scale (FPS) are frequently utilized, while multidimensional scales such as the behavioral pain scale (BPS), critical care pain observation tool (CPOT), and FLACC scale are commonly applied. These scales provide healthcare professionals with a standardized approach to facilitate early pain detection and effective management. Particularly, the integration of technological and behavioral methods that enhance patient compliance sheds light on future practices in pain management.

Background/Objectives: Invasive mechanical ventilation (IMV) in older intensive care unit (ICU) patients represents a critical turning point in disease trajectory. While acute illness severity is a key determinant of IMV, the independent contributions of frailty and comorbidity remain uncertain. This study evaluated whether integrating geriatric domains with acute physiological parameters provides additional information about the risk of IMV requirement, beyond acute severity alone. Methods: In this single-center retrospective cohort study, patients aged ≥65 years admitted to a tertiary ICU between January 2024 and December 2025 were included. Variables obtained within the first 24 h included Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and laboratory parameters. The primary outcome was IMV requirement. Multivariable logistic regression models were constructed, and performance was assessed using discrimination (AUC) and calibration. Results: Among 285 patients (median age 77 years [IQR 71–86]), 161 (56.5%) required IMV. These patients had higher frailty, comorbidity burden, and illness severity on univariable comparison. In multivariable analysis, SOFA score showed the strongest independent association with IMV requirement (adjusted OR 1.91; 95% CI 1.63–2.23; p < 0.001), followed by serum lactate (adjusted OR 1.30; 95% CI 1.08–1.58; p = 0.006). Older age was independently associated with lower odds of IMV (adjusted OR 0.96 per year; 95% CI 0.92–1.00; p = 0.034). Neither frailty (CFS) nor comorbidity burden (CCI) remained independently associated after adjustment. The final SOFA- and APACHE II-based models demonstrated AUCs of 0.899 (95% CI 0.864–0.933) and 0.911 (95% CI 0.879–0.944), respectively. Conclusions: Acute organ dysfunction and early lactate remain the dominant determinants of IMV requirement in older ICU patients. Neither comorbidity burden nor frailty retained an independent association once acute severity was accounted for; instead, advancing age was independently associated with a lower likelihood of IMV, a finding that may reflect unmeasured treatment-limitation decisions and warrants further investigation. These findings suggest that frailty and comorbidity indices should not be used in isolation as triggers for ventilatory decision-making and instead support a framework centered on acute severity and perfusion markers, with age considered mainly as a marker of care-goal context.