The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO2/FiO2 levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.
Pretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.
Although there is no randomised controlled study yet, colistin monotherapy and colistin combined therapy are likely to achieve similar treatment responses rates. Heteroresistant strains can emerge in patients who receive colistin monotherapy.
Aim:The aim of this study is to determine the prevalence of medical device-related pressure injuries in COVID-19 patients. Material and Method:This study was conducted with a cross-sectional and retrospective design. The data of 436 patients who were followed up and treated in the Anesthesia and Reanimation Intensive Care Unit with the diagnosis of COVID-19 disease between 11.03.2020-31.02.2021 in a Training and Research Hospital in İstanbul were included in the study. The sample of the study consisted of 32 patients out of 436 patients who met the sampling criteria. The data obtained by retrospective reviewing of the patient records were analyzed through the "Patient Information Form" and "Pressure Injury Stage" forms.Results: Medical device-related pressure injury developed in 32 (7.3%) of 436 patients examined in the study on the specified dates. 90.6% of these patients were male, and the average age was 67.5. 43.7% had comorbid diseases. According to the Braden Risk Assessment Scale, 25% of these patients had medium and 71.8% high risk. Medical devices that cause pressure injury were continuous positive airway pressure mask (n=13), intubation tube (n=7), nasogastric tube (n=5), nasal cannula (n=3), gel pads (n=3), and oxygen mask (n=1). Conclusion:In this study, the potential factors in the study that may have led to the incidence of medical device-related pressure injury specific to COVID-19 disease include the rapid increase in the need for respiratory support, ischemia caused by this infection, and the use of prone position.
Objective: Despite vaccine and drug studies, convalescent plasma (CP) therapy remains an alternative treatment for coronavirus disease 2019 . In this study, we aimed to reveal the efficacy of CP therapy on mortality and the factors affecting it for the patients diagnosed with COVID-19 and acute respiratory distress syndrome (ARDS) which were followed in our intensive care unit (ICU). Material and Method:The data (demographic characteristics, the amount of CP used, PaO2/FiO2, leukocyte, neutrophil, lymphocyte, D-Dimer, C-reactive protein (CRP), procalcitonin, ferritin values, and the clinical findings) of the patients who were hospitalized in the ICU with the diagnosis of COVID-19 and received CP treatment between 20 March and 20 October 2020 were analyzed retrospectively. Data of deceased patients (n=29) and survivors (n=50) were compared with each other and logistic regression analysis was performed to investigate the relationship with mortality. Results: 79 patients who received 166 units of CP therapy after a mean of 13.45±3.6 days symptom onset, were identified. 96.2% of the patients had at least one concomitant disease. Mortality was observed in 29 (36.7%) of the patients. Mortality (5.1%) was less common in those receiving CP therapy within the first 14 days after the onset of symptoms. Patient age (p=0.041), neutrophil/lymphocyte ratio (p=0.004), CRP values (p=0.002), the number of comorbidities (p<0.001), PaO2/FiO2 ratio before CP (p=0.005), and the period when CP was first infused from symptom onset (p<0.001) had a statistically significant effect on mortality. Conclusion:CP can be safely used to treat COVID-19. However, its positive effect is less observed in patients with the advanced stage of the disease, progressive deterioration of oxygenation, and a high number of comorbidities. For this reason, starting CP treatment at an early stage may increase its effectiveness.
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