Intensive Care Specialists Research Articles

Prevalence of Bleeding and Thrombosis in Critically Ill Patients with Chronic Liver Disease.

Hemorrhage and venous thromboembolism (VTE) are recognized complications of chronic liver disease (CLD), but their prevalence and risk factors in critically ill patients are uncertain. We studied a retrospective cohort of patients with CLD nonelectively admitted to a specialist intensive care unit (ICU) determining the prevalence and timing of major bleeding and VTE (early, present on admission/diagnosed within 48 hours; later, diagnosed >48 hours post-ICU admission). Associations with baseline clinical and laboratory characteristics, multiorgan failure (MOF), blood product administration, and mortality were explored. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression. Of 623 patients with median age 52, bleeding (>48 hours after admission) occurred in 87 (14%) patients. Bleeding was associated with greater illness severity and increased mortality. Gastrointestinal bleeding accounted for 72% of events, secondary to portal hypertension in >90%. Procedure-related bleeding was uncommon. VTE occurred in 125 (20%) patients: early VTE in 80 (13%) and involving the portal vein in 85%. Later VTE affected 45 (7.2%) patients. Hepatocellular carcinoma (HCC) and nonalcoholic liver disease were independently associated with early VTE (OR: 2.79, 95% CI: 1.5-5.2 and OR: 2.32, 95% CI: 1.4-3.9, respectively), and HCC, sepsis, and cryoprecipitate use with late VTE (OR: 2.45, 95% CI: 1.11-5.43; OR: 2.26, 95% CI: 1.2-4.3; and OR: 2.60, 95% CI: 1.3-5.1). VTE was prevalent on admission to critical care and less commonly developed later. Bleeding was associated with MOF and increased mortality. Severe MOF was not associated with an increased rate of VTE which was linked with HCC, and specific etiologies of CLD.

The intensivist's assessment of gastrointestinal function: A pilot study

Gastrointestinal dysfunction/failure (GDF) is a common cause of concern in critically ill patients. Although the gut plays an important role in the genesis of organ failure, its exclusion from organ severity scoring systems has made it challenging for intensivists to score it sufficiently at the bedside. We aimed to survey intensive care specialists about their perceptions, attitudes, and approaches towards the assessment of the gut in Australia and New Zealand intensive care units (ICUs). An electronic (online) questionnaire was used to survey intensive care specialists from the Australia and New Zealand Intensive Care Society (ANZICS). The survey comprised 10 questions focused on four key areas: (i) the extent of the problem with GDF in ICUs, (ii) the use and reliability of the current gut scoring tools, (iii) personal approaches and practices associated with GDF assessment, and (4) potential value of a novel GDF scoring system and its incorporation into an organ severity score. Our results showed that GDF was a significant concern amongst ICUs in Australia and New Zealand intensivists (84%; 66/79), with a small number of participants (14%; 3/79) using a gut scoring tool in their ICUs. Despite this, we have no established objective scoring tool for its assessment. The survey highlighted the need for developing a novel scoring tool to assess the gut was considered important amongst majority of the intensivists (92%; 72/78), which would prove useful in clinical practice and potentially lead to incorporation into an organ severity score in the future.

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES).

This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.

Critical care nurses’ experiences of working during the first phase of the COVID-19 pandemic – Applying the Person-centred Practice Framework

AimThe aim of the study was to deductively study person-centred care, based on critical care nurses’ experiences during the first phase of the CoViD-19 pandemic. DesignThe study used a qualitative design. MethodData collection was conducted as individual interviews and was analysed with qualitative content analysis with a deductive approach. ParticipantsSix critical care nurses working in a special CoViD-19 intensive care unit during the first phase of the pandemic participated. FindingsThe findings are presented within the four domains of person-centred practice: the prerequisites, the care environment, person-centred processes and person-centred outcomes. While the ambition and knowledge about how to work in accordance with person-centred practice were high, there were several obstacles to perform it. ConclusionWe need to prepare ahead of time so that nurses have optimal organisational prerequisites to be able to work in accordance with person-centred practice, also during pandemics and other crisis, which means to be able to give nursing care in accordance with the ill person’s needs and resources.

Current Aspects of Professional Training of Anesthesiologists and Intensive Care Specialists in Residency Programs

The aim is to study the current aspects of resident training in anesthesiology and intensive care. The article focuses on the theoretical training of residents, the importance of a thorough knowledge of pathophysiology, and the formation of clinical thinking. Opportunities for the use of innovative educational computer technologies in residency training are shown. A consistent interdisciplinary pedagogical interaction makes it possible to improve the outcomes of residency training by achieving the main goal of developing a physician who has acquired universal, general and specific professional competences and is capable of providing high-quality medical care.

How Differences in the Disease Process of the COVID-19 Pandemic Pose Challenges to the Delivery of Critical Care Nutrition.

Purpose of ReviewThe COVID-19 pandemic is a unique disease process that has caused unprecedented challenges for intensive care specialists. The hyperinflammatory hypermetabolic nature of the disease and the complexity of its management create barriers to the delivery of nutritional therapy. This review identifies the key differences which characterize this pandemic from other disease processes in critical illness and discusses alternative strategies to enhance success of nutritional support.Recent FindingsProlonged hyperinflammation, unlike any previously described pattern of response to injury, causes metabolic perturbations and deterioration of nutritional status. High ventilatory demands, hypercoagulation with the risk of bowel ischemia, and threat of aspiration in patients with little or no pulmonary reserve, thwart initial efforts to provide early enteral nutrition (EN). The obesity paradox is invalidated, tolerance of EN is limited, intensivists are reluctant to add supplemental parenteral nutrition (PN), and efforts to give sufficient nutritional therapy remain a low priority.SummaryThe nature of the disease and difficulties providing traditional critical care nutrition lead to dramatic deterioration of nutritional status. Institutions should not rely on insufficient gastric feeding alone but focus instead on redoubling efforts to provide postpyloric deep duodenal/jejunal EN or re-examine the role of supplemental PN in this population of patients with such severe critical illness.

Advances in the Treatment of Relapsed and Refractory Multiple Myeloma in Patients with Renal Insufficiency: Novel Agents, Immunotherapies and Beyond.

Simple SummaryThe treatment of patients with relapsed/refractory multiple myeloma has advanced considerably in recent years, irrespective of whether they are younger or older patients. Treating patients with relapsed/refractory multiple myeloma and renal impairment is far more complicated than treating patients with normal renal function due to the frequent dose adjustments that are necessary and the resulting loss in effectiveness.Background: Renal insufficiency is one of the most frequent complications in multiple myeloma. The incidence of renal insufficiency in patients with multiple myeloma ranges from 20% to 50%. Renal impairment in patients with multiple myeloma results primarily from the toxic effects of monoclonal light chains on the kidneys. Dehydration, hypercalcemia, hyperuricemia, the application of nephrotoxic NSARs, antibiotics, contrast agents, etc., all play a major role in the deterioration of renal function in patients with multiple myeloma. The diagnosis and treatment of these patients use an interdisciplinary approach in consultation with hematologist–oncologists, radiologists, nephrologists and intensive care specialists. Using new drugs in the treatment of patients with refractory/relapsed multiple myeloma and renal insufficiency markedly improves progression-free survival and overall survival in these patients. Conclusions: New drugs have helped to widen the treatment options available for patients with renal impairment and refractory/relapsed multiple myeloma, since dose adjustments are unnecessary with carfilzomib as well as with panobinostat, elotuzumab, pomalidomide or daratumumab in patients with renal impairment. Several new substances for the treatment of refractory/relapsed multiple myeloma have been approved in the meantime, including belantamab mafodotin, selinexor, melflufen, venetoclax, CAR T-cell therapy and checkpoint inhibitors. Ongoing studies are investigating their administration in patients with renal impairment.

Миокардиальный станнинг в медицине неотложных и критических состояний, ассоциированных с системной гипоксией

Актуальность. Миокардиальный станнинг — феномен, заключающийся в продолжительном снижении сократительной способности миокарда после краткого периода ишемии/реперфузии, при котором не происходит омертвения ткани сердечной мышцы. Если изначально феномен станнинга ассоциировали исключительно с проявлениями ишемической болезни сердца, то в настоящее время имеется все больше свидетельств о том, что миокардиальный станнинг может осложнять совсем другую патологию. Цель: изучение результатов работ оте-чественных и зарубежных ученых, посвященных наблюдению феномена станнинга в медицине неотложных состояний, и систематизация накопленного клинического материала. Материалы и методы. Детальное изучение результатов современных клинических исследований, посвященных диагностике снижения сократительной способности миокарда у пациентов, находящихся в критических состояниях, которые развились не вследствие манифестации острого коронарного синдрома, обсуждению механизмов патогенеза миокардиальной дисфункции при этих состояниях и принципам оказания таким больным экстренной и специализированной медицинской помощи. Результаты. Для феномена миокардиального станнинга характерны следующие отличительные признаки: 1. Коронарный кровоток после перенесенного эпизода ишемии практически полностью восстанавливается. После ишемии очень часто регистрируется кратковременный период гиперперфузии. 2. Несмотря на восстановление коронарного кровотока, имеет место продолжительное снижение сократимости миокарда. 3. Необратимого повреждения кардиомиоцитов в период ишемии не происходит. 4. Снижение сократительной способности сердца, наблюдающееся после ишемии и последующей реперфузии, является полностью обратимым. Основными механизмами развития миокардиального станнинга являются: усиленная генерация активных форм кислорода в период реперфузии; перегрузка кардиомиоцитов кальцием; снижение сопряженности между процессами электрического возбуждения миокарда и его сократимостью. Продукция простациклина, активность ангиотензина I, II и ангиотензинпревращающего фермента, продукция брадикинина моделируют тяжесть мио-кардиальной дисфункции при станнинге. Причиной станнинга может быть индуцированная катехоламинами кардиотоксичность. Миокардиальный станнинг можно наблюдать у пациентов с геморрагическим, септическим шоком, субарахноидальными кровоизлияниями, на фоне проведения гемодиализа, после криза при феохромоцитоме, после реанимационной акции. Выводы. Миокардиальный станнинг требует своевременной диагностики, поскольку проведение гемодинамической коррекции не с помощью инотропной поддержки, а по другим направлениям, а именно за счет увеличения скорости объемной нагрузки (агрессивная инфузионная терапия) или применения вазопрессоров, может резко ухудшить состояние пациента вследствие увеличения нагрузки на ослабленное сердце.

Risk factors associated with bacteremia in burn children admitted to a specialized pediatric intensive care unit: A case-control study.

Infections due to bacteremia in burn patients are a common cause of complications and an extended length of stay. Knowing causative microorganisms and identifying associated risk factors allow to reduce infectious complications, morbidity, mortality, and health care expenditure. This study assesses the extent of the association between risk factors and bacteremia in burn patients and identifies the most common microorganisms found in blood cultures. Case-control study conducted at the Burn Intensive Care Unit of Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan" between June 1st, 2014 and September 30th, 2019 in patients with bacteremia events and a positive blood culture (cases) and patients with a negative blood culture (controls). During the study period, 29 cases of bacteremia were identified. The median length of stay at the time of bacteremia was 23 days. The most commonly identified microorganism was Pseudomonas (7 cases). The only risk factor that showed a significant association was the presence of a central venous line for 7 days or more (OR: 3.18; 95 % confidence interval: 1.20- 8.38). The overall mortality rate was 9.1%; 13.8% for cases and 3.4% for controls. Central venous lines for more than 7 days are an independent risk factor for bacteremia in critically ill burn children. No statistically significant association was established with other studied risk factors. Pseudomonas, Acinetobacter, and coagulase-negative Staphylococcus were the most common microorganisms found in bacteremia.

Pediatric ECMO Candidates at Non-ECMO Centers: Transfer, Cannulate, or Treat Locally?

Pediatric inpatient and intensive care specialists working outside of tertiary medical centers confront difficult clinical scenarios related to how best to care for extremely ill children who may or may not benefit from advanced medical technology, and these clinicians are often faced with limited local availability. Extracorporeal membrane oxygenation (ECMO) is a technology that is only available at a subset of tertiary care centers, and the decision to risk the transfer of a child for the potential benefit of ECMO is challenging. This article is aimed at addressing the main factors and ethical principles related to this decision-making: (1) whether ECMO is the standard of care, (2) clinical decision analysis of the risks and benefits, (3) informed consent and education of the parents and/or guardians, and (4) institutional leadership decision-making. A decisional framework is proposed that incorporates a thoughtful shared decision-making algorithm.

Development of paediatric critical care in northwestern Nigeria: Initial implementation with a needs assessment model

IntroductionThere is high paediatric morbidity and mortality in northwestern Nigeria, attributable in part to vaccine-preventable illnesses and lack of comprehensive training of medical and nursing staff in the healthcare delivery of paediatric critical care. Pediatric Universal Life-Saving Effort Inc. (PULSE), a New York–based nonprofit organisation with a mission to develop paediatric critical care in resource-limited settings, collaborated with Aminu Kano University Teaching Hospital to decrease the gaps in knowledge and skills of medical and nursing personnel. The joint effort also aims to address and remove barriers to the delivery of paediatric critical care in northwestern Nigeria. The primary objective was to perform a needs assessment for paediatric intensive care resources in northwestern Nigeria, identify barriers to delivering these services, and designate a hub for the development of paediatric critical care educational programs for healthcare professionals. MethodsAn anonymous survey was designed and distributed using SurveyMonkey® online software to medical and nursing staff from nine healthcare institutions in northwestern Nigeria. ResultsAnalysis from 67 responses revealed that care delivered to critically ill paediatric patients was by anaesthesiologists (77%), pediatricians (26%), and adult intensive care specialists (10%). The acquisition of clinical skills was perceived to be an essential need (65%), followed by adequate staffing of critical care units (19%), continuing medical and nursing education (13%), and availability of medical equipment (3%). DiscussionThere is an identified need for paediatric critical care training and resources in northwestern Nigeria. ConclusionThe needs assessment conducted has provided important results that will form the basis for building staff capacity and training programs for paediatric critical care in northwestern Nigeria.

Лікарські засоби, основою яких є молекулярні структури антимікробних пептидів, та терапевтичні можливості в лікуванні інфекційних захворювань респіраторного тракту (частина 2)

На даний час у лікарській практиці вже продемонстрована ефективність застосування антимікробних пептидів у лікуванні місцевого інфекційного процесу, наприклад дериватів кателіцидину (оміганану), дефензиноміметика (брилацидину), α-спірального магаїніну (пексиганану), синтетичного протимікробного пептидоміметика (літиксару). Однак препарати цієї групи, які, можливо, будуть рекомендовані для лікування пневмоній, знаходяться на ранніх стадіях дослідження. Створення нових антимікробних пептидів із високим терапевтичним індексом (співвідношення бактерицидності і токсичності) та вирішення питання доставки їх в осередок ураження легені у хворих з інфекційними захворюваннями, у тому числі і респіраторного тракту, дозволить досягти ерадикації бактерій з мультимедикаментозною резистентністю. Даний напрямок дасть змогу відкрити постантибіотичну еру в широкій практичній діяльності терапевтів, педіатрів, хірургів та лікарів інтенсивної терапії.

The Risk Factors for Weaning Failure of Mechanically Ventilated Patients With COVID-19: A Retrospective Study in National Medical Team Work.

Purpose: This study aimed to describe the clinical and laboratory characteristics and the parameters of the respiratory mechanics of mechanically ventilated patients with confirmed COVID-19 pneumonia and to clarify the risk or protective factors for weaning failure.Methods: Patients diagnosed with COVID-19 pneumonia were selected from the special intensive care unit (ICU) of the Sino-French New City Branch of Tong Ji Hospital, Wuhan, and treated by the National Medical Team Work. They were divided into successful weaning (SW) group (N = 15) and unsuccessful weaning (USW) group (N = 18) according to the prognosis. Information of these patients was analyzed.Results: There were 33 patients included in this study. Patients in the USW group were associated with a poor outcome; the 28-day mortality rate was higher than in the SW group (86.7 vs. 16.7% p < 0.001). By comparison, we found that the initial plateau pressure (Pplat) and driving pressure (DP) of the USW group were higher and that compliance was lower than that of the SW group, but there was no difference between positive end-expiratory pressure (PEEP), partial pressure of carbon dioxide (PCO2), and the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (P/F ratio). Comparing the worst respiratory mechanics parameters of the two groups, the results of the Pplat, DP, compliance, and PEEP were the same as the initial data. The PCO2 of the USW group was higher, while the P/F ratio was lower. A logistic regression analysis suggested that higher Pplat might be an independent risk factor and that higher compliance and lower DP might be protective factors for weaning failure of invasive mechanically ventilated patients with COVID-19 pneumonia.Conclusions: Patients with USW were associated with a poor outcome, higher Pplat might be a risk factor, and a higher compliance and a lower DP might be protective factors for the weaning failure of ventilated COVID-19 patients. Mechanical ventilation settings will affect the patient's prognosis.

25691 An audit of the management and outcomes of toxic epidermal necrolysis in a specialist intensive care unit in the UK

Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous reaction, usually secondary to drugs, which should be managed in specialist intensive care units (ICU). The British Association of Dermatologists (BAD) published UK management guidelines in 2016. This audit aims to assess how compliant our service is with the BAD standards for audit, and to measure patient outcomes. All patients admitted to Guy’s and St Thomas’ ICU (London) with a diagnosis of TEN between 2016 and 2019 were included. Data were collected retrospectively from patient records and included: SCORETEN, drug causality assessment, multidisciplinary team (MDT) involvement, length of ICU stay and survival. 14 cases were identified and included 8 males and 6 females, with a mean age of 61 years (SD ± 18.9). 78.6% of cases had SCORETEN documented on admission, of those, 45.5% had a SCORETEN of 4 to 6. Drug causality assessment was performed on admission in 100% of cases; allopurinol and sulfasalazine were the commonest culprit drugs. 92.9% of patients were reviewed by an ophthalmologist within 24 hours of admission. Oral and urogenital assessments were made on admission in 92.9% and 78.6% of cases, respectively. The average length of ICU stay was 11.9 days (SD ± 9). The rate of survival in this center was 64.3%. Mortality correlated positively with age (r = 0.6, 2-sided P = .02). Recovery rate at this center exceeded expectations, given the severity of SCORETEN. Good outcomes are attributed to compliance with the BAD standards, particularly in prompt drug causality assessment and MDT involvement.

Risk factors for poor outcome in older patients admitted in a surgical intensive care unit.

The benefit of a stay in an intensive care unit (ICU) is not certain for older patients, particularly in the surgical context. The objective of this study was to identify the factors associated with an unfavourable outcome in this population. Prospective, descriptive, monocentric study conducted in the surgical ICU of a French university hospital. Patients aged ≥75 years admitted in the surgical ICU for a predicted length of stay ≥48 hours were included. Patients received an initial and a 6-months nutritional and functional assessment performed by physicians and nurses. The outcome was considered as favourable if the Katz Activities of Daily Living (ADL) variation (ADL delta=6-months ADL - ICU admission ADL) was between 0 and -0.5 point 6 months after ICU discharge and unfavourable if the ADL delta decreased by more than 0.5 points or if the patient had died 6 months after ICU discharge. Fifty-six patients-32 (57%) male-aged 79 [77; 83]y were included. ICU mortality was 19%; 6-month mortality was 22%. Median ADL delta was -0.5 [-0.5-0] points. A low ADL score (P=.0438) and a low albumin level (P=.0213) at admission were the two independent factors associated with an unfavourable outcome. Mortality and loss of independence were high in this elderly population during and after their surgical ICU stay. The benefit of a systematic collaboration between intensive care specialists, ICU nurses, and geriatricians, to assess and manage nutritional and functional problems and to prevent a pejorative outcome in patients over 75 years old admitted in surgical ICU needs to be studied. There should be systematic screening for objective markers of undernutrition and frailty on ICU admission of older patients as they are associated with a poor prognosis.

Peripartum cardiomyopathy: from genetics to management.

Peripartum cardiomyopathy (PPCM) is a disease that occurs globally in all ethnic groups and should be suspected in any peripartum women presenting with symptoms and signs of heart failure, towards the end of pregnancy or in the months following delivery, with confirmed left ventricular dysfunction. After good history taking, all women should be thoroughly assessed, and alternative causes should be excluded. Urgent cardiac investigations with electrocardiogram and natriuretic peptide measurement (if available) should be performed. Echocardiography follows as the next step in investigation. Patients with abnormal cardiac investigations should be urgently referred to a cardiology team for expert management. Referral for genetic work-up should be considered if there is a family history of cardiomyopathy or sudden death. PPCM is a disease with substantial maternal and neonatal morbidity and mortality. Maternal mortality rates range widely, from 0% to 30%, depending on the ethnic background and geographic region. Just under half of women experience myocardial recovery. Remarkable advances in the comprehension of the pathogenesis and in patient management and therapy have been achieved, largely due to team efforts and close collaboration between basic scientists, cardiologists, intensive care specialists, and obstetricians. This review summarizes current knowledge of PPCM genetics, pathophysiology, diagnostic approach, management, and outcome.

Evaluation of SpO2, PaO2, FiO2 levels in developing retinopathy of prematurity

Background: Retinopathy of prematurity (ROP) is a potentially blinding disease affecting the retinas in premature infants. In the treatment procedure of ROP, oxygen inhalation as well as the SpO2, PaO2, FiO2 levels analysis are some major concerns.Methods: This was a prospective COHORT study which was conducted at the special care baby unit (SCABU) and intensive care unit (ICU) of Dhaka shishu (children) hospital, Dhaka, Bangladesh from July 2012 to December 2014. Total one hundred (100) neonates of both sexes were finalized as the study population. Data were processed and analyzed using statistical software SPSS version 17, EPI info 7.Results: We found statistically significant risk for ROP, RR 3.48 (2.61-4.64) but there was no risk associated with FiO2 (24-32) % or 33-40 % in inhaled air. SpO2 (95-99) % was present in 25 (78.13%) of ROP (positive) neonates and 16 (23.53%) in ROP (negative) neonates. The difference was statistically significant (p&lt;0.05) between the groups and RR 4.8 (2.51-9.28) for saturation of 95-99%. Partial pressure of oxygen &gt;150 mm of Hg present in 12 (37.50%) cases of ROP (positive) neonates and 6 (8.82%) in ROP (negative) neonates. The difference was statistically significant (p&lt;0.05) between the groups and RR 2.90 (1.83-4.5) for partial pressure of oxygen (&gt;150) but there was no risk for partial pressure of 70-99 and 100-150 mm of Hg.Conclusions: During oxygen therapy FiO2 value, SpO2 value and more precisely the PaO2 value on neonate should be maintained within a target range.

A problem of multi-drug resistant infectious in pediatric lymphoma treatment

The basis of modern high-effective therapeutic programs for pediatric lymphomas is an intensive, risk-adopted therapy, which complicated with myelosuppression. In myelotoxic agranulocytosis condition infectious complications are often and its treatment results depend on duration and level of agranulocytosis, and sensitivity of microorganism to antimicrobial agents. Multi-drug resistant strains of Pseudomonas aeruginosa, Acinetobacter baumannii and etc. are a serious problem in supportive care of postchemotherapy complications, when even multidisciplinary approach with pediatric oncologists/hematologists, microbiologists, clinical pharmacists, surgeons, specialists in extracorporeal blood purification modalities and intensive care are ineffective.

Surgical Tracheostomies in Sars-CoV-2-Positive Patients

Abstract Aims: Operating under personal protective equipment (PPE) has become the new norm. This study aims at assessing how the ear, nose, and throat surgeons coped with the changes, with tracheostomy as the procedure of interest. Materials and Methods: Chart review of 30 patients who underwent tracheostomy from March 23, 2020, to December 31, 2020, was done. A questionnaire was given to the senior residents in charge of the procedures after each tracheostomy and their experience on the various aspects of the procedure. The responses were compiled and various factors affecting the surgical experience and outcome were analyzed. Results: Vast majority of patients underwent tracheostomy for prolonged intubation (90%), which made preoperative assessment of cases difficult. The average time was 12.33 ± 2.54 min. Delay in procedures and difficulties of operating under PPEs made COVID-positive tracheostomy challenging. Conclusions: It is possible to perform aerosol-generating procedures safely with adequate protective gears. Tracheostomy in COVID-19 patients needs to be after careful considerations by intensive care specialists and streamlining of various logistical factors is very essential for effective utilization of Operation theatre and surgeons' time.

The effect of intensive care specialist on mortality in a Teaching Hospital in Turkey

Aim: Specialization in critical care, which has a long history in various countries, is still developing in our country, and the practical outcomes of this relatively new discipline are yet to be not fully understood in our country. In the present study, we investigate the effect on mortality of the introduction of intensivists to a Level III closed intensive care unit. Material and methods: The study was launched after being granted approval by the ethics committee. In this retrospective study we included the patients who were treated in the same period in two consecutive years. We excluded who were under the age of 18 years, who stayed in the intensive care unit for less than 24 hours and postoperative patients. For the purpose of the study, the patients were divided into intensivist and pre-intensivist groups. Results: Aside from the shorter stay at the intensive care unit in intensivist group, mortality rate was lower in the pre-intensivist group, there was no statistically significant difference between the intensivist and pre-intensivist groups. Conclusion: Intensivists have positive effects on patients’ clinical outcomes, although a change in even a single factor during the treatment of ICU patients does not be sufficient for a statistical difference.