Anesthesia Intensive Care Unit Research Articles

Bronchoscopy guided percutaneous dilatational tracheostomy; performed by anaesthesiology residents

Aims: Percutaneous dilatational tracheostomy can be performed safely at the bedside in critical patients today. Clinical studies on tracheostomy were mostly carried out by experienced healthcare professionals. This study was designed to investigate the differences of percutaneous dilatational tracheostomy performed by anaesthesiology residents using two different methods. Methods: Patients hospitalized in anaesthesia intensive care unit who underwent percutaneous tracheostomy were examined. All tracheostomy procedures were performed by anaesthesiology residents using the “Griggs” or “Ciaglia” method. The procedure time, difficulty and complications of both methods were recorded. Results: 38 patients were included in the study. It was observed that 22 of the patients had tracheostomy with the Griggs technique, and 16 with the Ciaglia technique. Tracheostomy application time was measured as 6.05 minutes with the Griggs technique and 6.35 minutes with the Ciaglia technique (p=0.939). There was no difference in complications and technical difficulties between the two methods. Conclusion: In this study, where bedside bronchoscopy guided percutaneous dilatational tracheostomies were applied by two different methods by anaesthesiology residents, no difference was found between the two methods in terms of complications and technical difficulties. We believe that "Griggs" and "Ciaglia Blue Rhino", two of the percutaneous dilatational tracheostomy methods, are not superior to each other in terms of ease of use and complications in anaesthesiology education.

Use of a combination of diaphragmatic ultrasound and muscle relaxation monitoring in predicting post-extubation adverse respiratory events among elderly patients in an anesthesia intensive care unit

ObjectiveThe purpose of this study was to examine the feasibility of using a combination of diaphragmatic ultrasound and muscle relaxation monitoring in predicting adverse respiratory events after extubation among elderly patients in an anesthetic intensive care unit (AICU).MethodsThe study participants were 120 elderly patients who were in the AICU after laparoscopic radical resection for colorectal cancer. Based on whether there were critical respiratory events (CREs) after extubation, they were divided into the adverse event group and the non-adverse event group. We used logistic regression to identify factors influencing the occurrence of CREs post-extubation in elderly patients. Using the receiver operating characteristic (ROC) curve, we analyzed the value of each indicator in predicting CREs post-extubation.ResultsWe included 109 patients in the final analysis. In the adverse event group (n = 19), the age, proportion of females, and proportion of preoperative respiratory diseases were higher than in the non-adverse event group (n = 90). The muscle relaxation value, quiet breathing diaphragmatic excursion during extubation (DE-QB), deep breathing diaphragmatic excursion during extubation (DE-DB), and deep breathing diaphragmatic thickening fraction during extubation (DTF-DB) of patients in the adverse event group were significantly lower than those in the non-adverse event group (P < 0.05). Using binary logistic regression analysis, we identified muscle relaxation value, DE-DB, and DTF-DB during extubation as significant predictors of CREs post-extubation in elderly patients (P < 0.05). The area under the curve (AUC) of the combination of the muscle relaxation value, DE-DB, and DTF-DB during extubation for predicting CREs after extubation in elderly patients was 0.949, which was higher than that of any single indicator.ConclusionThe combination of diaphragmatic ultrasound and muscle relaxation monitoring was more accurate in predicting CREs post-extubation among elderly patients in the AICU.

Effects of the care given to intensive care patients using an evidence model on the prevention of central line-associated bloodstream infections.

It is important to put evidence-based guidelines into practice in the prevention of central line-associated bloodstream infections in intensive care patients. In contrast to expensive and complex interventions, a care bundle that includes easy-to-implement and low-cost interventions improves clinical outcomes. The compliance of intensive care nurses with guidelines is of great importance in achieving these results. The Translating Evidence into Practice Model provides guidance in how to implement the necessary guidelines. This quasi-experimental study used a post-test control group design in nonequivalent groups and was conducted in the anesthesia intensive care unit of a tertiary-level training and research hospital. All patients who were hospitalized in the intensive care unit, who had a central line during the study, and who met the inclusion criteria were included in the sample. The care bundle comprised education, and protocols for hand hygiene and the aseptic technique, maximum sterile barrier precautions, central line insertion trolley, and management of nursing care. To analyze the data, the independent samples t-test, the Mann-Whitney U test, chi-square test, dependent samples t-test, rate ratio, and relative risk were used with 95% confidence intervals. The rate of central line-associated bloodstream infections was significantly lower in the intervention group (2.85/1000 central line days) than in the control group (3.35/1000 central line days) (P = 0.042). The number of accesses to the central line by the nurses decreased significantly in the intervention group compared to the control group (P < 0.001). The mean score for the nurses' evidence-based guideline post-education knowledge (70.80 ± 12.26) was significantly higher than that pre-education (48.20 ± 14.66) (P < 0.001). Compliance with the guideline recommendations in central line-related nursing interventions and in the central line insertion process was significantly better in the intervention group than in the control group in many interventions (P < 0.05). The mean score for the nurses' attitude towards evidence-based nursing increased significantly over time (59.87 ± 7.23 at the 0th month; 63.79 ± 7.24 at the 6th month) (P < 0.001). Nursing care given by implementing the central line care bundle with the Translating Evidence into Practice Model affected the measures. Thanks to the implementation of the care bundle, the rate of infections and the number of accesses to the central line decreased, while the critical care nurses' knowledge of evidence-based guidelines, compliance with the guideline recommendations in central line-related nursing interventions, and attitudes towards evidence-based nursing improved.

An Outbreak of Vancomycin-Resistant Enterococci in a City Hospital Intensive Care Unit: Molecular Characterization of Resistance.

Background and Objectives: Vancomisin-resistant Enterococci (VRE), is a resistant microorganism that colonizes and causes infections in hospitalized patients. The aim of this study was to show the spread of vancomycin-resistant Enterococcus faecium (VREfm) step-by-step in all intensive care units, which started with the growth of VREfm on 2 December 2021 in the blood culture of a patient hospitalized in the anesthesia intensive care unit of our hospital and was found to have reached epidemic size in the surveys. Materials and Methods: Rectal swab samples were taken from all patients hospitalized in intensive care units, VRE colonization was determined, the VanA and VanB resistance genes associated with the vancomycin resistance of VREfm isolates were determined by PCR method, and clonal association analysis was performed by Arbitrarily Primed-PCR (AP-PCR) and PFGE (pulsed-field gel electrophoresis). Results: In our study, VRE were detected in 61 of 2601 rectal swab samples. In total, fifty-four (85.52%) of the VRE isolates were Enterococcus faecium, three (4.91%) was Enterococcus faecalis, three (4.91%) was Enterococcus gallinorum, and one (1.63%) was Enterococcus casseliflavus. It was determined that all of the 54 VREfm isolates, which were the most detected among all VRE isolates, carried the vanA gene. In the clonal association analysis of the isolates by AP-PCR and PFGE methods, it was found that they had 12 different genotypes, 48 of them were included in any cluster, the clustering rate was 88.8%, and the largest cluster was the genotype 1 cluster, with 36 isolates. Of the 54 patients with VREfm isolated recently, 18.51 percent of the clinical samples were isolated before the survey, and 9.25% were isolated after the survey. It was determined that 100% of VREfm isolates were resistant to ampicillin, levofloxacin, ciprofloxacin, high-level gentamicin, trimethoprimsulfamethoxazole, and teicoplanin, 7.4% to tigecycline, and 1.85% to linezolid. Conclusions: In our study, in the clonal association analysis performed by isolating VREfm in rectal swab samples, it was found that 88.8% of the samples were indistinguishably similar, and that the increase in the number of VREfm infections after the index case in our hospital was associated with the epidemic. VREfm infections cause long-term hospitalization, costs and also deaths, which shows the seriousness of the event, and the importance of the combination of epidemiological and molecular analysis in epidemic research.

Investigation of Changes in Infection Rates in the Reconstructed Anesthesia Intensive Care Unit

Enfeksiyon, yoğun bakım ünitelerinde önemli mortalite ve morbidite nedenidir. Yoğun bakım ünitesinde dirençli organizmaların üremesini ve bulaşmasını azaltmak için önerilen stratejilerden biri, organizmaların komşu yataklardan bulaşma olasılığını azaltmak ve enfeksiyon kontrol önlemlerine uyumu artırmak için hastaları tek yataklı odalara yerleştirmektir. Açık koğuş sistemi ile yönetilen yoğun bakım ünitesi yeniden yapılandırılarak kapalı koğuş sistemi ile yönetilmeye başlandı. Açık koğuş sisteminde takip edilen 6 aylık süreç ve izole oda sistemine geçtikten sonraki 6 aylık süreçte yatan hastalardaki enfeksiyon oranlarını retrospektif olarak incelemeyi amaçladık. Yeni yoğun bakım ünitesinde 6 aylık periyodda 274 hasta (grup A) takibi yapılmış ancak çalışma kriterlerine uygun 35 hasta, eski yoğun bakım ünitesinde 6 aylık periyodda yatan (grup B) 203 hastadan 23 hasta çalışmaya dahil edildi. Açık koğuş sisteminde takip edilen 6 aylık süreç ve izole oda sistemine geçtikten sonraki 6 aylık süreçte en az 1 hafta yatışı olan mekanik ventilatör desteği alan hastalar çalışmaya dahil edildi. Dış merkezlerden kabul edilen hastalar ile entübe halde kabul edilen hastane içi hastalar çalışma dışı bırakıldı. Bilgisayar data sistemi kullanılarak hastaların APACHE II, GKS, yaş, cinsiyet, yatış nedeni ve kültür sonuçları ile kaçıncı gün üreme olduğu kayıt edildi. Bu kayıtlara göre hastalardaki enfeksiyonların görülme yerleri, sıklıkları, etkenler ve dirençli mikroorganizmaların üreme oranları karşılaştırıldı. İstatistiksel analiz sonucunda kolistin dirençli üreme sonuçları yönünden anlamlı bir fark olduğu (p&amp;lt;0,05), Grup B hastalarında kolistin direnci gelişme oranının daha yüksek olduğu bulunmuştur. Trakeal aspirat kültür sonuçları incelendiğinde Grup B’de istatistiksel olarak anlamlı bir fark olduğu (p&amp;lt;0,05) üreme oranlarının daha yüksek olduğu bulunmuştur. Sonuç olarak; yoğun bakım ünitelerinde çoklu ilaca dirençli bakterilerin ortaya çıkmasını ve yayılmasını önlemeye yönelik stratejiler antimikrobiyal tedavinin etkinliğini ve kullanımını artırmaya çalışan stratejilerin yanısıra enfeksiyon kontrol önlemleri arasında hasta izolasyonu önem arzetmektedir. Çalışmamızın sonucunda izole oda yoğun bakım ünitesinde daha az dirençli mikroorganizma üreme oranı olduğu gösterilmiştir.

Analysis of consultations requested from the tertiary intensive care unit and response times: a retrospective study

Aims: It is aimed to evaluate the effectiveness of the consultations and response times requested from the Intensive Care Unit on the cost.&#x0D; Methods: This study was conducted retrospectively in a 16-bed anesthesia intensive care unit (ICU) between 02.01.2019 and 30.12.2019. Patient information from the hospital data system was analyzed. Accordingly, demographic data, hospitalization diagnoses, departments for which consultation was requested, times of request, response times, and the average cost per day of a patient were investigated.&#x0D; Results: It was determined that consultation was requested from a total of 522 patients, 223 (43%) of the patients were female, 299 (57%) were male, and the age range was 18-98 (mean age 57). It was found that the average consultation response time in all departments was 4.09 hours outside of working hours and 3.54 hours during working hours. There was no significant difference in the response time of consultations between internal and surgical departments. The daily cost of one patient in the ICU was found to be 2380.39 ₺.&#x0D; Conclusion: Failure to promptly respond to the requested consultations in the intensive care unit may cause delays in patients' treatment and their discharge to the service. This situation increases the patient's length of stay and causes the intensive care units not to be used effectively and correctly. However, it can also increase morbidity and cost.

Perspective from anesthesiologists on the therapy of critically ill patients with COVID-19

With the surge of critically ill COVID-19 patients in China, numerous anesthesiologists from anesthesia intensive care units (AICU) or reallocated to other ICUs were devoted to the treatment of COVID-19. Besides the standard protocols to treat COVID-19 cases, anesthesiologists also have their own experience to treat COVID-19 cases based on professional expertise and practice. Here, we propose some viewpoints to treat critically ill COIVD-19 patients from the perspective of anesthesiologists.

Rectus abdominis and rectus femoris muscle thickness in determining nutritional risk in critically ill patients: a prospective cohort study in Turkey

ObjectivesMalnutrition is a clinical condition that is frequently seen in critically ill patients in the intensive care unit (ICU). Although there are many scoring systems and tools used to determine...

Brain Death and Its Effect on Organ Donation: A 10-Year Analysis

Objective :Brain death can be defined as the irreversible loss of brain functions. It is evident that a delay occurred in the diagnosis of brain death will result in the loss of many cadaveric organs and thus, the number of patients waiting for organ transplantation will increase. Despite there being many studies in the literature about the diagnosis and difficulties of brain death, family interviews, and organ donation, the studies regarding the effects of the regulation change in Turkey on organ donation are limited. The present study includes 10-year retrospective data and it has been conducted to offer an insight to the scientists about the diagnosis of brain death and organ donation.&#x0D; Method: The study was conducted by using data obtained from the examination of the retrospective files of patients diagnosed with brain death between 2011 and 2021 at Pamukkale University, Faculty of Medicine after obtaining the approval of the ethics committee.&#x0D; Results: After the study was initiated, the files of 71 patients diagnosed with brain death between 2011 and 2021, were accessed. Due to the missing information in the files of 4 patients, these patients were excluded from the study. Of 67 patients with registered brain death, 36 were male (53.7%) and 31 were female (46.2%). The age average was 49.07. When the treatment units of these patients were evaluated, 50 patients (74.6%) diagnosed with brain death were treated at the neurosurgery intensive care unit, 7 (10.4%) at the neurology intensive care unit, 6 (9%) at the anesthesia intensive care unit, and 4 (6%) at the cardiovascular surgery intensive care unit.&#x0D; Conclusions:The study concluded that the importance of the diagnosis duration of brain death and the number of specialists who diagnosed brain death in the previous years may have affected this process. It is clear that the formal process, which changed after 2014, showed an acceleration in diagnosis. The importance of the interviews with family members besides the brain death diagnosis has emerged as a result of the study

Effect of Anesthesia Intensive Care Unit during the COVID-19 Pandemic

Effect of Anesthesia Intensive Care Unit during the COVID-19 Pandemic

Evaluation of the Application Effect of WeChat Platform-based Communication Mode in Family Members of Patients after Partial Pulmonary Resection in the Anesthesia Intensive Care Unit.

Objectives: In this study, we explored the application effect of the communication mode based on WeChat platform in the family members of patients after partial pulmonary resection in the anesthesia intensive care unit. Methods: We selected 80 patients with elective general anesthesia for partial pulmonary resection and divided them into an observation group and a control group with 40 cases in each group according to the random number table method. We compared anxiety self-evaluation scores, medical service satisfaction scores, and family members' desire to visit between the 2 groups. Results: The anxiety score of the observation group was significantly lower than that of the control group (p<.05). The medical service satisfaction score of the observation group was significantly higher than that of the control group (p<.05). The desire for face-to-face visits of family members in the observation group was significantly lower than that in the control group (p<.05). Conclusion: The communication mode based on the WeChat platform can reduce the anxiety of patients, improve the satisfaction of patients with medical services, and reduce the desire of family members to visit. The method is simple and easy to implement and is worthy of clinical outreach.

Maternal and neonatal outcomes of pregnant women with SARS-CoV-2 infection in our tertiary hospital

Objective: To evaluate clinical features, laboratory test results, and maternal and neonatal outcomes of pregnant patients with the Coronavirus disease (COVID-19). Methods: We reviewed clinical data from pregnant women with a laboratory-confirmed SARS-CoV-2, who were admitted to our university hospital in Türkiye. Demographic and clinical characteristics, laboratory test results, and maternal and neonatal outcomes were collected. Results: A total of 46 pregnant women were included in this study. The mean maternal age was 28 (min. 21 – max. 39) years and gestational age was 31 (min. 26 – max. 41) weeks. Two (4.37%) pregnant women were vaccinated with 1 dose of BioNTech® vaccine, and all other patients were unvaccinated. Shortness of breath was the most common symptom present in 15 cases (32.6%). Twenty-seven (58.69%) pregnant women gave birth in the preterm period, and 19 (41.30%) in the term period. Six (13.04%) pregnant women were followed up in the Anesthesia Intensive Care Unit. Two women with critical COVID-19 died in the postpartum period. Conclusion: COVID-19 infection has negative consequences in terms of maternal and neonatal outcomes. The most common causes of adverse neonatal outcomes are iatrogenic or spontaneous preterm births, while the most common causes of adverse maternal outcomes are prolonged hospitalization time, increased likelihood of intensive care hospitalization, and maternal deaths. The most effective way to prevent this situation is to get vaccinated regardless of trimester.

PERCUTANEOUS TRACHEOTOMY IN ICU: OUR EXPERIENCE IN 2020-2021 (COVID-19 PANDEMIC).

<h3>INTRODUCTION</h3> Percutaneous tracheostomy (PT) is a surgical procedure for the placement of a tracheal tube through the anterior wall of the trachea. It is performed using a modified Seldinger technique between the second and third tracheal rings and guided under direct vision by the fiberoptic bronchoscope. It is a minimally invasive procedure with a low number of complications by experienced physicians. It is considered a safe alternative to surgical tracheostomies (ST), a more aggressive procedure. According to the internal protocols of the Anesthesia Intensive Care Unit (ICU) of the Valencia University General Hospital (CHGUV), PT are performed by anaesthesiologists, while ST are performed by otorhinolaryngologists. This study aims to confirm that PT is just as safe as ST, as well as that it presents the same or fewer immediate complications, understanding these as bleeding, loss of the airway due to the exit of the endotracheal tube, creation of a false pathway, injury to the posterior wall, injury to one or more tracheal rings, the appearance of subcutaneous emphysema and damage to the fiberoptic bronchoscope with the puncture needle. Due to the Covid-19 pandemic, patients with Covid-19 have been included. The modified protocol for this type of patient has been followed, following the consensus document of the Spanish Societies of Intensive Medicine (SEMICYUV), Otorhinolaryngology (SEORL-CCC), and Anesthesia (SEDAR). <h3>OBJECTIVE</h3> Review the total number of tracheotomies performed by anesthesiologists and otolaryngologists in the CHGUV ICU in 2020-2021, including patients with SARS-COV2 infection, as well as the total of immediate complications that occurred concerning the procedure. Confirm that PT is the technique of choice in critically ill patients due to its lower number and less severity of complications. <h3>MATERIAL AND METHODS</h3> Descriptive, observational, and retrospective study, in which each one of the tracheotomies performed in the CHGUV anesthesia ICU in 2020-2021, as well as their immediate complications, were collected. Patients with Covid-19 were included too. <h3>RESULTS</h3> A total of 294 tracheostomies were performed (20 were patients with SARS-COV2 infection). 294 were TP (12 with SARS-COV2) and 11 TQ (8 with SARS-COV2). Among the complications recorded, the most frequent was mild bleeding appearing in a total of 35 patients. Of these patients, only 30% belonged to the PD group. No cases required a surgical revision. In addition, within the ST, there was one case of accidental decannulation with loss of the airway. <h3>CONCLUSIONS</h3> Our study shows in general a low rate of early complications in tracheostomies, however, ST caused a higher incidence of immediate complications. Furthermore, PT has shown not only a lower incidence of complications but a lower severity of these too. The data from this study support the PT performed by experimented anesthesiologists as the technique of choice in critical patients compared to CT.

Evaluation of Satisfaction Level in Family-Centered Intensive Care Concept; A Single-Center Survey Study

Aim: In our study,it was aimed to determine and improve the quality of the intensive care unit(ICU) of our hospital by evaluating the satisfaction perception of patient relatives through a questionnaire.&#x0D; Materials and Methods: The revised version of the questionnaire named FS-ICU-24 was applied to the patients relatives whose patients had been treated for at least 48 hours in Eskişehir Osmangazi University Anesthesia ICU.&#x0D; Results: According to evaluation results of 79 questionnaires that fit the criteria of the study, it was seen that the satisfaction with the decision-making process of the patients with high satisfaction with care was also significantly higher (p

Systemic immune-inflammation index within the first postoperative hour as a predictor of severe postoperative complications in upper abdominal surgery: a retrospective single-center study

BackgroundSystemic pro-inflammatory factors play a critical role in mediating severe postoperative complications (SPCs) in upper abdominal surgery (UAS). The systemic immune-inflammation index (SII) has been identified as a new inflammatory marker in many occasions. The present study aims to determine the association between SII and the occurrence of SPCs after UAS.MethodsIncluded in this study were 310 patients with upper abdominal tumors who received UAS and subsequently were transferred to the anesthesia intensive care unit between November 2020 and November 2021 in Nanjing Drum Hospital. SPCs, including postoperative pulmonary complications (PPCs), major adverse cardiac and cardiovascular events, postoperative infections and delirium, were recorded during the hospital stay. The clinical features of the patients with and without SPCs were compared by Student’s t-test or Fisher’s exact test as appropriate. Risk factors associated with SPC occurrence were evaluated by univariable and multivariable logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to establish a cut-off level of SII value to predict SPCs.ResultsOf the 310 patients receiving UAS, 103 patients (33.2%) presented at least one SPC, including PPCs (n = 62), adverse cardiovascular events (n = 22), postoperative infections (n = 51), and delirium (n = 5). Both preoperative SII and 1-h postoperative SII in patients with SPCs were significantly higher than those in patients without SPCs. Multivariate analysis showed that 1-h postoperative SII was an independent predictor for SPC occurrence (OR = 1.000, 95% CI 1.000–1.000, P = 0.007), together with postoperative C-reactive protein, postoperative arterial lactate, postoperative oxygenation-index and older age. The ROC curve showed that the optimal cutoff value of 1-h postoperative SII to predict SPCs was 754.6078 × 109/L, with an 88.3% sensitivity and a 29% specificity. Multivariate analysis also confirmed that 1-h postoperative SII > 754.6078 × 109/L was associated with increased SPC occurrence (OR = 2.656, 95% CI 1.311–5.381, P = 0.007).ConclusionOur findings demonstrated an association between the higher level of 1-h postoperative SII and SPCs, suggesting that 1-h postoperative SII, especially categorized 1-h postoperative SII using cutoff value, may be a useful tool for identifying patients at risk of developing SPCs.

Yoğun Bakım Ünitelerinde Çalışan Hemşireler Arasındaki İş Birliğinin İncelenmesi

Aim: This study was conducted to examine the levels of nurse-nurse collaboration among nurses working in intensive care units. &#x0D; Method: The population of the research consisted of 100 nurses working in intensive care units of Bursa Uludag University Health Application and Research Center between November 2021 and February 2022. The sample of the research consisted of 85 nurses who voluntarily agreed to participate in the study. Data were collected using a “Nurse Introduction Form” and the “Nurse-Nurse Collaboration Scale”. In the analysis of data, descriptive statistics, Mann-Whitney U test and Kruskal Wallis test were used.&#x0D; Results: 74.1% of the nurses participating in the study were female. The mean age was 32.14±5.83; the mean duration of employment in the profession was 8.94±6.08 years; the mean duration of employment in the intensive care unit was 7.54±5.83 years. Of the nurses, 40% worked in the Anesthesia Intensive Care Unit; 91.8% had a bachelor’s degree; 65.9% were married; 82.4% worked in shifts; 48.2% were satisfied with the intensive care unit they worked in; 62.4% stated that they did not want to change the unit they worked in; 80% thought that nurse-nurse collaboration was adopted in the unit they worked. The mean total score of the nurses on the “Nurse-Nurse Collaboration Scale” was 3.00±0.28. As a result of the statistical analysis, the mean total Nurse-Nurse Collaboration Scale score of nurses who were satisfied with the intensive care unit they worked in and who did not want to change it was found to be significantly higher compared to other nurses (p

Type-H, and Type-L COVID-19: are they different subtypes or the same?

SARS-CoV-2 infection, which causes severe pneumonia, caused an epidemic that started in Wuhan, China in December 2019 and spread to the whole world. COVID-19 mainly affects the respiratory system and causes the development of severe pneumonia and related acute respiratory distress syndrome (ARDS) in some patients. We aimed to investigate whether COVID-19 pneumonia cases can be evaluated in different categories in clinical and radiological terms. COVID-19 associated ARDS cases being treated with the diagnosis of severe pneumonia between March 21, 2020 and June 15, 2020 in Anesthesia Intensive Care Unit were examined and divided into 2 groups (type-L and type-H, total 29 cases) according to their clinical findings (according to whether they benefited from high PEEP and their lung compliance) and lung computed tomography findings (according to the severity of the ground glass appearance). The groups were compared with each other in terms of inflammatory markers [CRP (C reactive protein), ferritin, D Dimer, PCT (procalcitonin), white blood cell, lymphocyte count, arterial blood gas analysis] and imaging findings. It was observed that the prone position was beneficial in improving oxygenation in both H-type and L-type patients. 7 of 22 L-type patients were intubated and 5 of these patients died. There was no statistical difference between the two groups in terms of intubation times, hospital stays, cytokine levels, prone position application responses and mortality rates. Are there two separate forms of COVID-19 pneumonia, such as h-type and l-type, or are they intertwined and describe the early and late stages of the disease? This question needs to be discussed. In addition, we believe that subtyping COVID-19 pneumonia patients does not make a difference in the treatments to be applied.

Yoğun Bakım Ünitemizde Perkütan Dilatasyonel Trakeostomi Açılan Hastaların Retrospektif Analizi

INTRODUCTION: Tracheostomy is a method frequently applied in intensive care units with the indication of prolonged intubation. [1] Our aim in this study is to retrospectively analyze the percutaneous dilatational tracheostomy (PDT) cases performed in our clinic within 1 year.&#x0D; METHODS: It's analyzed the patients who underwent PDT in Sakarya Training and Research Hospital, Anesthesia Intensive Care Unit between January 2019 and December 2019. Each patient's age, gender, diagnosis of intensive care admission, use of anticoagulant drugs, and APACHE II score were recorded. Then, the day of tracheostomy procedure, complications, total intensive care unit stay, and the patient's discharge from the intensive care unit were evaluated.&#x0D; RESULTS: A total of 79 patients were found to have undergone PDT. It was observed that the mean age of the patients was 66.56±17.83 and 48 (60.8%) were male. It was observed that 25(31.6%) of the patients were admitted to the intensive care unit with the diagnosis of postresuscitation syndrome, 17 (21.5%) cerebrovascular accident, and 15(19%) pneumonia. The mean APACHE II scores of the patients were 24.1±6.2, and 16(20.3%) patients were discharged. The median PDT procedure day was 19.5[12-30]. It was determined that only 2 of the patients had minor and 1 major and 3 (3.9%) patients did not develop any other complications apart from the bleeding related complication.&#x0D; DISCUSSION AND CONCLUSION: In our study, although 66 (83.6%) of the patients who underwent PDT procedure received anticoagulant-antiaggregant treatment, postoperative bleeding rates were observed to be quite low in accordance with the literature.

YOĞUN BAKIMA YATAN TİP 2 DİYABETLİ HASTALARIN İNSÜLİNE KARŞI ALGILARI İLE DİYABET ÖZ YÖNETİMLERİ ARASINDAKİ İLİŞKİNİN İNCELENMESİ

Aim: This study aimed to determine the level of perception of insulin and diabetes symptom management of patients with Type 2 diabetes who received inpatient treatment in intensive care. &#x0D; Materials and Methods: This study was conducted in the Internal Medicine and Anesthesia Intensive Care units of a state hospital during the period of December 01, 2020 and March 31, 2021. The sample of the study was composed of 100 voluntary patients who used insulin. Research data were collected via the Patient Introduction Form, Diabetes Self-Management Questionnaire and the Insulin Treatment Appraisal Scale. Written permission was obtained from ethics committee and patients. &#x0D; Results: The average age of the patients was 44.57 ± 14.8, 52% were female, 72% were single, 47% were primary school graduates, and 52% had a chronic complication related to diabetes. The mean time duration for being diagnosed with diabetes was 20.59 ± 12.87 years (3-52) while the mean duration of insulin use was 2.8 ± 1.17 years. Patients’ ITAS positive and negative item subscale mean scores were 11.44 ± 3.43 and 48.18 ± 12.09, respectively. Patients’ mean Diabetes Self-Management Questionnaire total score was 4.07 ± 1.74 (range: 0.62-8.75).&#x0D; Conclusion: Patients have a high negative perception towards insulin use and their diabetes self-management is below the average. There was a high level of negative correlation between patients’ negative insulin perception and glucose management and diet control sub-dimensions of their diabetes self-management.

The diagnostic accuracy of inferior vena cava respiratory variation in predicting volume responsiveness in patients under different breathing status following abdominal surgery

BackgroundThe validation of inferior vena cava (IVC) respiratory variation for predicting volume responsiveness is still under debate, especially in spontaneously breathing patients. The present study aims to verify the effectiveness and accuracy of IVC variability for volume assessment in the patients after abdominal surgery under artificially or spontaneously breathing.MethodsA total of fifty-six patients after abdominal surgeries in the anesthesia intensive care unit ward were included. All patients received ultrasonographic examination before and after the fluid challenge of 5 ml/kg crystalloid within 15 min. The same measurements were performed when the patients were extubated. The IVC diameter, blood flow velocity–time integral of the left ventricular outflow tract, and cardiac output (CO) were recorded. Responders were defined as an increment in CO of 15% or more from baseline.ResultsThere were 33 (58.9%) mechanically ventilated patients and 22 (39.3%) spontaneously breathing patients responding to fluid resuscitation, respectively. The area under the curve was 0.80 (95% CI: 0.68–0.90) for the IVC dimeter variation (cIVC1) in mechanically ventilated patients, 0.87 (95% CI: 0.75–0.94) for the collapsibility of IVC (cIVC2), and 0.85 (95% CI: 0.73–0.93) for the minimum IVC diameter (IVCmin) in spontaneously breathing patients. The optimal cutoff value was 15.32% for cIVC1, 30.25% for cIVC2, and 1.14 cm for IVCmin. Furthermore, the gray zone for cIVC2 was 30.72 to 38.32% and included 23.2% of spontaneously breathing patients, while 17.01 to 25.93% for cIVC1 comprising 44.6% of mechanically ventilated patients. Multivariable logistic regression analysis indicated that cIVC was an independent predictor of volume assessment for patients after surgery irrespective of breathing modes.ConclusionIVC respiratory variation is validated in predicting patients' volume responsiveness after abdominal surgery irrespective of the respiratory modes. However, cIVC or IVCmin in spontaneously breathing patients was superior to cIVC in mechanically ventilated patients in terms of clinical utility, with few subjects in the gray zone for the volume responsiveness appraisal.Trial registrationChiCTR-INR-17013093. Initial registration date was 24/10/2017.