Ultrasound-guided percutaneous dilatational tracheostomy is a safe procedure for critically ill patients and has the advantages of a low complication rate, short duration of procedure, being informative with regard to neck anatomy, and facilitating prevention of vascular puncture. Thus, US-PDT can be used as an alternative to FOB-PDT.

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IntroductionBiomarkers are useful for diagnosing infection and sepsis in adults, but data are limited in elderly patients. Furthermore, clinical symptoms of infection in elderly patients are usually atypical or unclear. We aimed to assess the usefulness of PCT, CRP, and WBC in distinguishing elderly patients infected with sepsis from infected without sepsis and those with no infection.We also aimed to find a cut-off value for diagnosing sepsis and infection without sepsis in elderly critically ill patients. MethodsIn this single-center and prospective observational study, patients older than 65 years were enrolled. Serum levels of PCT, CRP, and WBC were measured within 24 hours. Patients were allocated into sepsis(S), infected without sepsis (IWS), and no-infection (NI) groups. Data were analyzed with Mann-Whitney's U test and Kruskal-Wallis test. The Receiver Operating Characteristic (ROC) curves were used to assess the accuracies of the biomarkers in diagnosing IWS and S. ResultsWe analyzed 188 patients with a mean age of 77,05 ±7.4 in the study; 95 (50.5%) of them were women. 64 (34%) of whom were classified as IWS, 29 (15%) as S, and 95 (50.5%) as NI group.There were significant differences in the PCT, CRP levels between the IWS and NI, S and NI (p<0. 001, p<0.001, p< 0.001, p<0.01, respectively). The PCT levels were significantly different when the NI group was compared to IWS (p<0.001) and S (p<0.001) groups. The CRP levels were also different when the NI group was compared to both IWS (p<0.001) and S (p<0.001). PCT was significantly higher in S compared to IWS (p<0.001), while CRP and WBC were not (p< 0.80, p<0.07, respectively). The value of PCT for discrimination of patients with IWS was highest with an AUC of 0.886, followed by CRP (AUC = 0.787; p<0.001), and WBC (AUC = 0.695; p<0.001).PCT also yielded the highest value for discrimination of patients with S with an AUC of 0.994, followed by CRP (AUC = 0.795:p<0.001) and WBC (AUC=0.768,p<0.01).The PCT cut-off values were 0.485μ/L and 1.245 μg / L for the discrimination of patients with IWS and S, respectively. The cut-off values of CRP level were 59.45 mg / L and 57.50 mg/L for infected without sepsis and sepsis, respectively. ConclusionsPCT was found to be a more valuable marker than CRP and WBC for the discrimination of elderly patients with infected without sepsis and sepsis.

Background/aim: To compare the inferior vena cava (IVC) indices, identify their variation rates at positive pressure values and accurate predictive values for the volume status in patients with spontaneous respiration receiving different positive pressure support. Material and methods: The study included 100 patients who were divided into 4 pressure support groups, according to the different pressure supports received, and 3 volume groups according to their CVP values. Ultrasonography was applied to all of the patients to define their IVC diameters at different pressure supports. Dynamic parameters were derived from the ultrasonographic assessment of the IVC diameter [collapsibility (CI-IVC), distensibility (dIVC), and delta (ΔIVC) indices]. Results: There were significant differences between the 3 indices (CI-IVC, dIVC, and ΔIVC) according to the pressure groups [(10/5), (10/0), (0/5), (t tube 0/0)]. The median value for the dIVC percentages was ≤18% for all of the positive pressure support hypervolemic groups, apart from the hypervolemic t tube group (19%). For the hypervolemic groups, the best estimation according to the cutoff value appeared to be for the dIVC. Values with the highest sensitivity for differentiation of the hypovolemic individuals were calculated with the dIVC. Conclusion: The dIVC had a more accurate predictive role in predicting the volume status when compared with the CI-IVC and ΔIVC, and may be used reliably with positive pressure supports.

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Background and Aims: Post-dural puncture headache is seen more frequently in pregnant women due to stress, dehydration, intra-abdominal pressure, and insufficient fluid replacement after delivery. Obesity protects against post-dural puncture headache in pregnant women; increased intra-abdominal fat tissue reduced cerebrospinal fluid leakage by increasing the pressure in the epidural space. Therefore, this study investigated the influence of body mass index on post-dural puncture headache in elective cesarean section patients in whom 27G spinal needles were used. Material and Methods: The study included 464 women who underwent elective cesarean section under spinal anesthesia. Dural puncture performed with a 27G Quincke spinal needle at the L3-4 or L4-5 intervertebral space and given 12.5 mg hyperbaric bupivacaine intrathecally. The patients were questioned regarding headache and low back pain 6, 12, 24, and 48 h after the procedure, and by phone calls on days 3 and 7. Results: Post-dural puncture headache developed in 38 (8.2%) patients. Of the patients who developed post-dural puncture headache, 23 (60.5%) had a body mass index <30 and 15 (39.5%) had a body mass index ≥30. Of the patients who did not develop post-dural puncture headache, 258 (60, 6%) had a body mass index <30 and 168 (39, 4%) had a body mass index ≥30. Conclusion: This prospective study found the body mass index values did not affect post-dural puncture headache in the elective cesarean section performed under spinal anesthesia.

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In intensive care units, differences in definitions and care of patients with brain death continue to be a complication. There has been a lack of progress in criterion standards of brain death diagnosis and donor care, as verified by our survey.