BackgroundNoninvasive ventilation (NIV) is a cornerstone for the treatment of acute respiratory failure of various etiologies. Using NIV is discussed in mild-to-moderate acute respiratory distress syndrome (ARDS) patients (PaO2/FiO2 > 150). These patients often have comorbidities that increase the risk for bronchoscopy related complications. The primary outcome of this prospective observational study was to evaluate the feasibility, safety and contribution in diagnosis and/or modification of the ongoing treatment of fiberoptic bronchoscopy (FOB) in patients with ARDS treated with NIV.MethodsARDS patients treated with NIV and who require FOB as the diagnostic or therapeutic procedure were included the study. Intensive care ventilators or other dedicated NIV ventilators were used. NIV was applied via simple oro-nasal mask or full-face mask. Pressure support or inspiratory positive airway pressure (IPAP), external positive end expiratory pressure (PEEP) or expiratory positive airway pressure (EPAP) levels were titrated to achieve an expiratory tidal volume of 8 to 10 ml/kg according to ideal body weight, SpO2 > 90 % and respiratory rate below 25/min.ResultsTwenty eight subjects (mean age 63.3 ± 15.9 years, 15 men, 13 women, PaO2/FiO2 rate 145 ± 50.1 at admission) were included the study. Overall the procedure was well tolerated with only 5 (17.9 %) patients showing minor complications. There was no impairment in arterial blood gas and cardiopulmonary parameters after FOB. PaO2/FiO2 rate increased from 132.2 ± 49.8 to 172.9 ± 63.2 (p = 0.001). No patient was intubated within 2 h after the bronchoscopy. 10.7, 32.1 and 39.3 % of the patients required invasive mechanical ventilation after 8 h, 24 h and 48 h, respectively. Bronchoscopy provided diagnosis in 27 (96.4 %) patients. Appropriate treatment was decided according to the results of the bronchoscopic sampling in 20 (71.4 %) patients.ConclusionFOB under NIV could be considered as a feasible tool for diagnosis and guide for treatment of patients with ARDS treated via NIV in intensive care units. However, FOB-correlated life-treathening complications in severe hypoxemia should not be forgotten. Furthermore, further controlled studies involving a larger series of homogeneous ARDS patients undergoing FOB under NIV are needed to confirm these preliminary findings.

The frailty is associated with higher NIV application problems, failure and mortality risk in elderly ICU patients. The CFS and EFS frailty scores can be used to predict NIV success and outcomes in ICUs.

In our study, in geriatric patient group colistin nephrotoxicity was not different from the younger age group. In the ICU, the age for nephrotoxicity does not appear to be a point to be considered for the initiation of colistin.

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Objectives:psychometric properties of the Turkish version of the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the sensitivity to changes in clinical indicators. Patients and Methods:This study was conducted within the framework of a national multicentre project. Patients with either stage IIIB or IV primary lung cancer diagnosed after April 2010were included in thisstudy. A classical confirmatory approach was used for both the reliability and validity analyses. Internal consistency was tested using Cronbach's α value, and the validity analysis was performed using construct validity and clinical validity. Results:276 (92.3%) patients were male and the average age was 60.8 ± 9.4 years. The most frequently observed histological type was squamous cell carcinoma (36.8%), and 61.5% of these stage IV tumours. Cronbachs α values for the subscales ranged from 0.60 to 0.84. The majority of the FACT-L subscales revealed inter-scale correlation coefficients greater than 0.35. All sub-dimensions, except that of the social/family well-being scale, are able to significantly discriminate between stages IIIB and IV. Significantly lower scale scores were detected in patients with stage IV than stage IIIB. The comparative fit index was 0.917, and the root mean square error of approximation was 0.091. Dyspnoea, haemoptysis, chest pain, weight loss, anorexia, localised pain, and fever symptoms had a significant correlation with the FACT-L, trial outcome index, and lung cancer subscale. Conclusion:Turkish version of the psychometric properties of the original FACT-L scale is regarded as a valid and reliable tool and can be used safely in a clinical context when managing patients with lung cancer in Turkey.

INTRODUCTIONOxygen support therapy should be given to the patients with acute hypoxic respiratory insufficiency in order to provide oxygenation of the tissues until the underlying pathology improves. The inspiratory flow rate requirement of patients with respiratory insufficiency varies between 30 and 120 L/min. Low flow and high flow conventional oxygen support systems produce a maximum flow rate of 15 L/min, and FiO 2 changes depending on the patient's peak inspiratory flow rate, respiratory pattern, the mask that is used, or the characteristics of the cannula. The inability to provide adequate airflow leads to discomfort in tachypneic patients. With high-flow nasal oxygen (HFNO) cannulas, warmed and humidified air matching the body temperature can be regulated at flow rates of 5-60 L/min, and oxygen delivery varies between 21% and 100%. When HFNO, first used in infants, was reported to increase the risk of infection, its long-term use was stopped. This problem was later eliminated with the use of sterile water, and its use has become a current issue in critical adult patients as well. Studies show that HFNO treatment improves physiological parameters when compared to conventional oxygen systems. Although there are studies indicating successful applications in different patient groups, there are also studies indicating that it does not create any difference in clinical parameters, but patient comfort is better in HFNO when compared with standard oxygen therapy and noninvasive mechanical ventilation (NIMV) (1-6). In this compilation, the physiological effect mechanisms of HFNO treatment and its use in various clinical situations are discussed in the light of current studies. The Impact Mechanisms of High Flow Nasal Oxygen TherapyThe HFNO device consists of an air/oxygen mixer, an active heater, a humidifier, a unidirectional inspiratory circuit hose, and a soft nasal cannula that is slightly larger than the standard nasal cannula. AbstractHigh-flow nasal oxygen (HFNO) therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNO in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNO for critical patients. This review summarizes the positive physiological effects, mechanisms of action, and the clinical applications of HFNO with available published literatures.

Objectives : Comparative data on hydroxychloroquine and favipiravir, commonly used agents in the treatment of Coronavirus Disease-2019 (COVID-19), are still limited. In this study, it was aimed to compare treatment outcomes in healthcare workers with COVID-19 who were prospectively followed by the occupational health and safety unit. Methods : A total of 237 healthcare-workers, diagnosed as mild or moderate COVID-19 between March 11, 2020 and January 1, 2021, were given hydroxychloroquine (n=114) or favipiravir (n=123). Clinical and laboratory findings were evaluated. Results : The mean age of the patients was 33.4±11.5 years. The mean time to negative PCR was found to be significantly shorter in patients receiving favipiravir compared to the hydroxychloroquine group (10.9 vs. 13.9 days; p<0.001). The rate of hospitalization in the hydroxychloroquine group was significantly higher than favipiravir group (15.8% vs. 3.3%). In terms of side effects; the frequency of diarrhea in patients receiving hydroxychloroquine was significantly higher than that in the favipiravir group (31.6% vs. 6.5%; p<0.001). Conclusions : Favipiravir and hydroxychloroquine were similar in terms of improvement of clinical symptoms of healthcare workers with mild or moderate COVID-19 infection, but favipiravir was significantly more effective in reducing viral load and hospitalization rates. Furthermore, favipiravir caused significantly less side-effects than hydroxychloroquine.

Ventilator-associated pneumonia (VAP) is one of the most common causes of nosocomial infections in the intensive care unit. Mechanically ventilated patients are at risk for upper gastrointestinal (GI) bleeding. It has been shown in previous studies that acid suppression therapy used for GI prophylaxis may cause the development of bacterial pneumonia. The aim of this review is to evaluate the effect of stress ulcer prophylaxis on VAP incidence in the intensive care unit.