Cardiopulmonary bypass (CPB) has been established as the gold-standard technique for performing certain heart, aorta, or lung surgeries. First, the purpose of using extracorporeal circulation is to maintain blood circulation and to provide tissue perfusion throughout the body intraoperatively. Cardiac and/or pulmonary functions should be shut down during lifesaving surgical interventions to obtain a bloodless surgical area and movement less target organs. Second, body temperature must be sustained normally, hypo- or deep hypothermic during surgical procedures, mainly to protect the cerebrum and collectively the whole body from any temporary, permanent, or fatal ischemic and reperfusion damage. Finally, adequate and aggressive immunoregulation must be maintained to prevent severe cytokine storm due to the foreign structure of the CPB circuit and infectious invasion through all invasive cannulations and intravenous treatments, as well as surgical wounds. Understanding the immunological changes associated with CPB and recognizing the factors that increase the risk of postoperative infection can help physicians develop strategies to prevent infections and sepsis. Although the benefits versus risks have not been established, it is also common practice to extend “prophylaxis” for 48 hours after open-heart surgery. Antimicrobial prophylaxis is particularly beneficial in cardiac surgery to prevent serious superficial or potentially life-threatening deep wound infections, such as mediastinitis, and it must also account for altered pharmacokinetics with CPB. This chapter focuses on infection propensity, strategies to reduce perioperative risks and preventive approaches, while elimination of microbial colonization should be the main strategy to avoid postoperative nosocomial infections.

Background Osteoporosis is a well-recognized and curable complication of lung transplantation. This study aimed to determine the degree of bone mineral density before transplantation and to evaluate the risk factors associated with osteoporosis in lung transplant patients. Material and Methods The bone mineral density of 72 patients who underwent lung transplantation with the diagnosis of end-stage lung diseases between December 2016 and April 2021 was evaluated in the pre-transplant period. Results 58 of 72 patients who underwent lung transplantation were included in the study. The age range of the cases was 14-64 (mean 48) years, and 14 (23.7%) were female. The presence of osteoporosis in the study population was 49.2% (n: 29), and osteopenia was 40.7% (n: 24). Osteoporosis was significantly more common in patients with younger age and lower body mass index (p = 0.024 and p = 0.009, respectively). And most down forced expiratory volüme 1 values were in patients with osteoporosis (p < 0.001 and p = 0.008, respectively). Steroid usage (OR: 0.06, 95% CI: 0.01-0.36, p = 0.002) in T score (femur neck) and 1.25 dihydroxy vitamin D (OR: 1.15, 95% CI: 1.03-1.28, p = 0.012) in T score (lumbal spine) were found to be independent predictors of osteoporosis according to multivariate analyzes. Conclusions A significant proportion of patients with end-stage lung disease undergoing lung transplantation have osteoporosis and osteopenia. Interestingly, the candidates were similarly affected despite the variety of underlying conditions. Since osteoporosis is treatable, strict follow-up and treatment management are recommended before referral for transplant candidates.

OBJECTIVESIn this study, our aim was to investigate whether bacterial culture growth from donors and recipients is related to early posttransplant complications and to analyze its role in primary graft dysfunction and posttransplant pneumonia in lung transplant recipients.MATERIALS AND METHODSThis retrospective cohort study included patients diagnosed with end-stage lung disease who received a lung transplant for treatment. We examined relationships between donor bronchial lavage, pretransplant recipient sputum, and recipient posttransplant serial bronchial lavage culture results, as well as the development of both primary graft dysfunction and pneumonia after lung transplant during the early posttransplant period.RESULTSOur study included 77 patients with median age of 48 years (25%-75% IQR, 34-56 years) and who were mostly men (79.2%; n = 61). Donor culture positivity was 62.3% (n = 48), and the positivity of sputum culture from patients before transplant was 20.8% (n = 16). Compared with that shown in those without versus those with primary graft dysfunction, there were significantly more positive sputum cultures from patients before transplant (P = .003). Recipients with donor culture growth had a longer duration of invasive mechanical ventilation (median of 4 days [IQR, 2-13 days] vs 1 day [IQR, 1-2 days]; P = .001, respectively) than those without. Multivariate logistic analysis identified both donor culture positivity (odds ratio: 3.391; 95% CI, 1.12-20.46; P = .0028) and sputum culture positivity in pretransplant recipient candidates (odds ratio: 6.494; 95% CI, 1.80-36.27; P = .004) as independent predictors of primary graft dysfunction.CONCLUSIONSBacterial growth shown in donor bronchial lavage and sputum culture positivity in patients before transplant were found to be independent predictors of primary graft dysfunction in the early posttransplant period. Organism growth in both the donor and the recipient during the pretransplant period are important determinants for the development of primary graft dysfunction.

Objectives: The 6-minute-walk test is a practical and widely used test, which indicates the exercise capacity in patients with a severe pulmonary disease. The study aims to investigate the related factors with the 6-minute-walk test in lung transplantation candidates. Materials and Method: The data were collected retrospectively from 349 patients, between January 2012 and September 2020. The patients were grouped according to their underlying lung disease as obstructive lung diseases, interstitial lung diseases, and infective lung diseases. The data collected included patient demographics, gender, body mass index, artery blood gas, the results of the respiratory function test, six-minute walk test, long-term oxygen therapy, and the need for non-invasive mechanical ventilation [such as group 1 (6MWD<200) and group 2(6MWD≥200)]. All of the collected data were analyzed and compared between the groups. Results: Overall, 349 patients were included in the study, and there were 123 females and 226 males (35.2% and 64.8% respectively) with a mean age of 46.92 ± 14.1 years. Their mean body mass index was 23.58 ± 12.52 kg/m2, the median FEV1(%) was 35.3 (33.4-37.2), the median six-minute walk distance was 222 m (125-335 m), and the mean PaO2/FiO2 (P/F) was 250.32% ± 74.81, the mean PCO2 was 45.71 mmHg ± 11.97. Furthermore, the patients using long-term oxygen therapy were (n=274, 78.5%) and non-invasive mechanical ventilation were (n=125, 35.8%). The mortality status, P/F, long-term oxygen therapy usage, and non-invasive mechanical ventilation usage were different between Group 1 and Group 2 (p=0.001, p=0.001, p<0.001, and p<0.001, respectively). There was no difference between the groups in patients with and without IPF between underlying diseases. The 6-minute walk test was found to have moderate correlation with FEV1 and P/F; and a negative correlation with age and PCO2 (p<0.01, r=0.33.8, p<0.001, r= 38.1 and p=0.17, r=12,7, p<0.001, r=-0.30.6, respectively). There was no correlation between P/F, FEV1, and body mass index; and also, between PCO2, age, and body mass index. Age had a weak correlation with FEV1(p<0.001, r=19.3). There was no correlation between the age and 6MWD, as well as P/F, PCO2, and the body mass index. The factors affecting survival in multivariate analysis were investigated by using the Cox regression model. It was observed that gender (OR, 0.001; 95% CI, 0.246-0.716; p=0.42), FEV1(OR, 1.02; 95% CI, 1.00-1.04; p<0.001), P/F (OR, 1.00; 95% CI, 1.00-1.01; p<0.001), and LTOT (OR, 9.83; 95% CI, 3.70-26.14; p<0.001) were independent factors associated with 6MWD<200 m. Conclusion: The 6-minute walk test is associated with mortality, gender, poor oxygenation, and with the utilization of domiciliary non-invasive mechanical ventilation or long-term oxygen therapy. Furthermore, it is an independent risk factor for mortality in lung transplant candidates and in providing a valuable method for the management of patients.

Aim: Lung transplant recipients are the highest risk group in terms of infective complications among solid organ transplants. It has improved the management of the most common infectious complications with the aid of advances in diagnostic methods, prophylaxis, and therapeutic strategies. In the present study, we evaluated the results of microbiological culture samples by the bronchoscopic method.Methods: This retrospective cohort study included patients who were admitted between November 2016 and May 2019 in a Lung Transplantation Department. We evaluated the results of bacteria detected in the lavage fluid obtained by serial bronchoscopy in the first year after lung transplantation in lung transplant patients. We divided the patients into two groups: those with acute rejection and those without. The two groups were compared according to their culture of growth and analyzed.Results: Of the 77 patients included in the study, 77.2% were male. In the first year after transplantation, 79 bronchoscopic lavage cultures were positive in the follow-up. While bacterial culture positivity by post-transplant bronchial lavage was found to be 62% in the first 3 months, it decreased to 43.6% between the third month and the first year. There was no significant difference between the groups with and without acute rejection of lavage culture growth.Conclusion: This study revealed the importance of the bronchoscopic method in terms of the detection of microbiological findings and the prempitic antibiotic therapy approach in the evaluation of lung infections in lung transplant patients.

Background In this study, we aimed to evaluate the value of transthoracic echocardiography in the estimation of pulmonary artery pressure and to identify the presence of pulmonary hypertension in lung transplant candidates with end-stage lung disease. Methods Between January 2012 and September 2020, a total of 244 patients (166 males, 78 females; mean age: 48.6±13.8 years; range, 18 to 77 years) who were diagnosed with end-stage lung disease due to various underlying conditions and underwent right heart catheterization and transthoracic echocardiography within 72 h were retrospectively analyzed. Hemodynamic parameters of the patients were compared. Correlation analysis was performed among the values estimated by transthoracic echocardiography and measured by right heart catheterization for pulmonary artery pressure measurements. Results The median pulmonary artery systolic pressure with right heart catheterization was 43 mmHg and 40 mmHg using transthoracic echocardiography. A positive correlation was seen between the pulmonary artery systolic pressure estimated by transthoracic echocardiography and right heart catheterization (r=0.718; p<0.001). The sensitivity, specificity, and positive and negative predictive values of pulmonary artery systolic pressure measurement were 76.30%, 64.22%, 72.54%, and 68.63%, respectively. Conclusion This study revealed a strong positive correlation between the pulmonary artery systolic pressure evaluated with transthoracic echocardiography and measured with right heart catheterization. Pulmonary hypertension detection by these two methods showed acceptable sensitivity and specificity. Transthoracic echocardiography may be a useful and practical method to monitor pulmonary artery pressure trends both initially and in the subsequent follow-up of cardiac hemodynamics in lung transplant candidates.

This study aimed to evaluate the cardiopulmonary function and impairment of exercise endurance in patients with COVID-19 after 3 months of the second wave of the pandemic in Turkey. A total of 51 consecutive COVID-19 survivors, mostly healthcare providers, still working in the emergency room and intensive care units of the hospital after the second wave of Covid 19 pandemia were included in this study. Cardiopulmonary exercise stress test was performed. The median of the exercise time of the COVID-19 survivors, was 10 (4.5-13) minutes and the mean 6.8 ± 1.3 Mets was achieved. The VO2max of the COVID-19 survivors was 24 ± 4.6 ml kg-1min-1which corresponds the 85 ± 10% of the predicted VO2max value. The VO2WRs value which was reported about 8.5-11 ml min-1per watt in healthy individuals as normal was found lower in Covid 19 survivors (5.6 ± 1.4). The percentage of the maximum peak VO2calculated according to the predictable peak VO2of the COVID-19 survivors, was found significantly lower in male patients (92 ± 9.5% vs 80 ± 8.5%,p: 0.000). Also, there was a positive correlation between the percentage of the maximum predicted VO2measurements and age (r: 0.320,p: 0000). The peak VO2values of COVID-19 survivors decreased, and simultaneously, their exercise performance decreased due to peripheral muscle involvement. We believe that COVID-19 significantly affects men and young patients.

Objective: The aim of this study was to investigate the effects of home-based pulmonary rehabilitation on control of asthma, spirometric parameters, functional capacity and lower limb muscle strength in patients with asthma. Methods: Thirty patients were randomized to training (TG) or control (CG) groups. All patients were evaluated with the asthma control test, spirometry, six-minute walk test (6MWT) and 30 seconds chair stand test (30CST). TG received home-based pulmonary rehabilitation consisting of stretching exercises, strengthening exercises for upper and lower extremities, breathing exercises and regular physical activity as walking for 8 weeks, with a minimum of 3 days per week. One of these sessions was supervised every week by the same physiotherapist. All these exercises were practiced with equipment that patients can easily provide at home and the intensity of the exercises gradually increased. CG only received a booklet about breathing exercises and physical activity in addition to one educational session. Also, a pedometer and exercise diary were given to all patients. Results: There were significant improvements in asthma control test, PEF, 6MWT and 30CST (p Conclusion: Home-based pulmonary rehabilitation programs can be given to increase functional capacity and respiratory parameters in asthmatic adults who cannot be supervised for various reasons.

Objective: Through the years, tobacco has been used in many ways.While the most common way of consumption is through smoking cigarettes, smokeless use by chewing or nasal snuffing are also quite common.Smokeless tobacco, also named "Maras powder", is generally used as a substitute to reduce or quit smoking.The effects of smokeless tobacco use on the immune system, respiratory system and cardiovascular system have been extensively researched.In our study, we aimed to investigate the effects of Maras powder on the respiratory, electrocardiogram (ECG) findings and biochemical methods.Methods: One hundred and forty-nine cases were included and the cases were classified into the following four groups: only using Maras powder; using Maras powder and smoking; only smoking and control group neither smoking nor using Maras powder.Physical examination findings, ECG findings, results of pulmonary function tests, results of biochemical analysis including complete blood count and lipid profile of all participants were recorded on admission. Results:The risk of mouth sores was 7.9 times higher in the Maras powder group due to direct contact to the oral mucosa.There is a relationship between the daily use frequency of smokeless tobacco and the development of oral wounds, but the total period of use or the duration in mouth was not related to this situation.The ECG findings of both the smoking and Maras powder consuming group was found to be significantly higher than the control group. Conclusion:The smokeless tobacco use, which is considered as an alternative way of quitting smoking, does not have adverse effects on respiratory functions.However, it is an important risk factor for many life-threatening health conditions such as ECG abnormalities and occurrence of oral lesions.Social awareness must be created for smokeless tobacco use in order to fight this habitual threat to public health.

Background: Patients admitted to the intensive care unit (ICU) with acute respiratory failure (ARF) due to COPD have high mortality and morbidity. Acidosis has several harmful effects on hemodynamics and metabolism, and the current knowledge regarding the relationship between respiratory acidosis severity on the short-and long-term survival of COPD patients is limited. We hypothesized that COPD patients with severe acidosis would have a poorer short-and long-term prognosis compared with COPD patients with mild-to-moderate acidosis. Patients and methods: This retrospective observational cohort study was conducted in a level III respiratory ICU of a tertiary teaching hospital for chest diseases between December 1, 2013, and December 30, 2014. Subject characteristics, comorbidities, ICU parameters, duration of mechanical ventilation, length of ICU stay, ICU mortality, use of domiciliary noninvasive mechanical ventilation (NIMV) and long-term oxygen therapy (LTOT), and short-and longterm mortality were recorded. Patients were grouped according to their arterial blood gas (ABG) values during ICU admission: severe acidotic (pH <= 7.20) and mild-to-moderate acidotic (pH 7.21-7.35). These groups were compared with the recorded data. The mortality predictors were analyzed by logistic regression test in the ICU and the Cox regression test for long-term mortality predictors. Results: During the study period, a total of 312 COPD patients admitted to the ICU with ARF, 69 (72.5% male) in the severe acidosis group and 243 (79% male) in the mild-to-moderate acidosis group, were enrolled. Group demographics, comorbidities, duration of mechanical ventilation, and length of ICU stay were similar in the two groups. The severe acidosis group had a significantly higher rate of NIMV failure (60.7% vs 40%) in the ICU. Mild-to-moderate acidotic COPD patients using LTOT had longer survival after ICU discharge than those without LTOT. On the other hand, severely acidotic COPD patients without LTOT showed shorter survival than those with LTOT. Kaplan-Meier cumulative survival analysis showed that the 28-day and 1-, 2-, and 3-year mortality rates were 12.2%, 36.2%, 52.6%, 63.3%, respectively (p=0.09). The Cox regression analyses showed that older age, PaO2/FiO(2) <300 mmHg, and body mass index <20 kg/m(2) was associated with mortality of all patients after 3 years. Conclusion: Severely acidotic COPD patients had a poorer short-and long-term prognosis compared with mild-to-moderate acidotic COPD patients if acute and chronic hypoxemia was predominant.

Inflammatory myofibroblastic tumor of the lung is a rare condition, with a reported incidence between 0.04 - 1.2% of all tumors of the lung. We present a case of inflammatory myofibroblastic tumor of the lung. A61-year man presented to the outpatient department complaining of cough and blood-streaked sputum for 5 days. The computed tomography scan of the chest demonstrated a 4.5 x 4 cm, calcified pulmonary mass in the anterior segment of the right upper lobe. Bronchoscophy and computed tomography-guided transthoracic fine needle aspiration was inconclusive. The tumor was removed via wedge resection. Histological and immunohistochemical findings were consistent with inflammatory myofibroblastic tumor of the lung.

Objective: Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare eosinophilic lung disorder with an unknown etiology and is characterized by subacute or chronic respiratory and general symptoms, alveolar and/or peripheral eosinophilia, and the accumulation of eosinophils in the lungs. We aimed to present diagnostic test results and follow-up outcomes of 17 patients who were diagnosed with ICEP in our hospital in light of literature. Methods: Between 2008 and 2013, we examined 17 cases of ICEP. We evaluated clinical and laboratory findings together with the long-term follow-up data. Results: The patients had a mean age of 40.8 years at presentation, and the female/male ratio was 0.8. The most common symptoms were cough (94%), shortness of breath (76%), and high fever (35%). Bronchoalveolar lavage eosinophil percentages of the patients ranged from 3% to 80%. Nine (53%) patients experienced recurrence. Six patients were maintained on low dose steroid due to repeating relapses. Among these patients, 7 (77.7%) had a total IgE level of above 500/IU/mL. Conclusion: Relapses are common in ICEP after the withdrawal of corticosteroid treatment or during dose reduction. We point out the importance of the close monitoring of patients for identifying relapse. A higher total IgE level during diagnosis may serve as a predictor of recurrence.

Aim: Effect of the severity of respiratory acidosis on short and long term survival in chronic obstructive pulmonary disease (COPD) patients is investigated in this study. Methods: Retrospective, observational cohort study in a intensive care unit (ICU) of a chest diseases hospital from January-December 2014. Acute respiratory failure(ARF) and COPD patients were included to study. Patients were divided into two groups according to ICU admission arterial blood gas values; ph≤7.20 (group1) and pH:7.21-7.34(group 2).Patients characteristics, ICU parameters, ICU mortality, short (28 days ) and long term (12 months) mortality were recorded. Results: 312 COPD patients were enrolled. Study groups were group 1 (n=69 ) and group 2 (n=243). Groups demographics were similar. Length of ICU stay and ICU mortality were similar in two groups.28 day mortality was %13.1 and %10.6 (p=0.35),1 year mortality 29.5% ve 36 % (p=0.35 ) in group 1 and 2 respectively. In cox regression analysis, hazard ratio of 1 year mortality was associated with presence of septic shock (HR:2.1,CI:1-4.5, p=0.039), presence of domiciliary noninvasive mechanical ventilation(DNIMV) before ICU(HR:2.5, CI:1-5.9, p=0.03), severe acidosis (HR:0.42,CI:0.5-3.03, P=0.51) and DNIMV prescription after ICU discharge(HR:0.4,CI:0.17-0.9, p=0.035). Conclusions: Severity of acidosis (pH< 7.20) does not affect short and long term mortality. Septic shock during ICU and pre ICU presence of DNIMV found to be a risk factor for 1 year mortality therefore should be followed closely. Also prescription of DNIMVafter ICU discharge decreases long term mortality significantly.

Background: Pulmonary carcinosarcoma (PC) is a rare malignant tumour of the lung. Due to its rarity, few studies have been reported and its clinicopathological characteristics and treatment outcomes remain unclear. The aim of the present study was to evaluate clinical, radiological and pathological findings and treatment outcomes of patients with PC.Methods: We retrospectively reviewed the records of the Pathology Department from the beginning of 2005 to the end of 2013.Results: The present study included eight cases with PC. All patients were male and their ages ranged from 56 to 77 years, with a mean age of 63.1 years. The most common radiological finding was a solitary mass, followed by atelectasis and mass. All patients underwent surgical resection, in the form of lobectomy (n = 6), bilobectomy inferior (n = 1) and pneumonectomy (n = 1). Pathological diagnosis of PC was made by surgical resection, in all patients. Pathologically, the epithelial component of the tumour was squamous cell carcinoma in four patients and adenocarcinoma in four patients. The most common sarcomatous component was spindle cell, followed by chondrosarcoma. Four patients received adjuvant chemotherapy. Survival time for four of the patients was shorter than one year. The median survival time was 21.5 months (range: 1-75 months).Conclusions: Pulmonary carcinosarcoma of the lung is a rare biphasic tumour. Complete surgical resection is the treatment of choice. The prognosis of patients with PC is poor despite complete surgical resection and adjuvant chemotherapy.

BACKGROUND AND AIMS:Lung cancer is the most common cause of malignant pleural effusions (MPEs). For patients with lung cancer and MPE, median survival is only 3-4 months. The aim of this study was to evaluate lung cancer patients with MPE by clinical and laboratory findings on admission, and determine 2-year survival rate and prognostic factors.METHODS:Between 2008 and 2011, we examined 199 cases of non-small cell lung carcinoma with MPE. Demographic factors of patients, tumor characteristics, treatment delivered and laboratory parameters affecting prognosis were evaluated. Survival rates were estimated by Kaplan-Meier method. Significance of each prognostic factors selected by univariate analysis were confirmed using Cox regression model.RESULTS:The study included 139 (69.8%) male and 60 (30.2%) female patients with a median age of 64 (30-85) years. Median overall survival was 4.4 months. Adenocarcinoma was the leading cause of MPE with 80.4%. A univariate analysis showed that factors affecting mortality included gender (P < 0.001), MPE with distant metastasis (P = 0.025), lower serum albumin (P < 0.0001), lower pleural protein (P < 0.0001), increased serum lactate dehydrogenase (P = 0.003), increased serum C-reactive protein (CRP) (P < 0.0001), increased white blood cells (P < 0.0001), histopathological type (P = 0.004) and treatment decision (P < 0.0001). A multivariate analysis revealed that patients who had high level of serum CRP (P = 0.017), lower serum albumin (P = 0.009) and lower pleural protein (P = 0.003), MPE with distant metastasis (P = 0.003) and those who were chemotherapy naive (P < 0.0001) had shorter survival.CONCLUSION:High level of serum CRP, lower serum albumin and lower pleural protein, MPE with distant metastasis were most important prognostic factors for non-small cell lung carcinoma in patients with MPEs.