The triple combination of parameters obtained as part of the hemogram, NLR-RDW-MPV, indicated a much more predictive power than two parameters coupled. This combination of three parameters, NLR-RDW-MPV, is to be considered as a sensitive, high-quality, low-cost outcome prediction marker for cardiac surgery patients that is less time consuming and easy to use.

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Introduction Maintenance of microcirculatory homeostasis is essential for the preservation of organ function [1]. Cardiac surgery is associated with an inflammatory reaction that may promote alterations in the microcirculatory level, in addition to the general impact on hemodynamic status [2]. The use of cardiopulmonary bypass (CPB) additionally causes a broad range of changes in microcirculatory perfusion and oxygenation [1]. Anemia and transfusion not only make patients more prone to the deleterious effects of CPB but also aggravate the inflammatory response, oxidative stress, and renal hypoxia [3,4]. An intraoperative transfusion of red blood cells (RBCs) increases the risk of mortality and several morbidities. These risks are substantial for even one unit in general surgery patients [5]. The aim of this study was to compare tissue oxygenation, which was evaluated by blood lactate concentration, central venous oxygen saturation (S cv O 2), and venoarterial carbon dioxide pressure difference (ΔpCO 2), between patients who had dilutional anemia resulting from CPB and could be treated with a minimal RBC transfusion (1-2 units) and the patients who did not. Our hypothesis was that a minimal transfusion would lead to normalized Background/aim: Cardiac surgery, especially in the presence of cardiopulmonary bypass (CPB), is associated with an inflammatory reaction that may promote microcirculatory alterations, in addition to the general impact on system hemodynamics. Anemia and transfusion make patients more susceptible to the deleterious effects of CPB. In this study, it was aimed to evaluate the effect of dilutional anemia, which is caused by CPB and can be treated with 1-2 units of red blood cell (RBC) transfusion, on global tissue oxygenation parameters in cardiac surgery patients. Materials and methods: This prospective observational study comprised 127 patients who had a relatively stable operation period without any major anesthetic or surgical complications (e.g., operation duration >5 h, bleeding or hemodilution requiring more than 1-2 units of RBCs, or unstable hemodynamics, requiring inotropic support of more than 5 µg/kg/min dopamine). Patients were observationally divided into two groups: minimally transfused (Group Tr) and nontransfused (Group NTr). Global tissue oxygenation parameters were evaluated after anesthesia induction (T 1) and at the end of the operation (T 3) and compared between the groups. Results: Group Tr consisted of patients who had significantly lower preoperative hemoglobin values than Group NTr patients. The dilutional anemia of all Group Tr patients could be corrected with 1 unit of RBCs. The lactate levels at T 3 , increment rates of lactate, and venoarterial carbon dioxide pressure difference (ΔpCO 2) levels [(T 3-T 1) : T 1 ] in Group Tr were significantly higher than those in Group NTr. Conclusion: Dilutional anemia as a result of CPB mostly occurs in patients with borderline preoperative hemoglobin concentrations and its correction with RBC transfusion does not normalize the de...

Sugammadex encapsulates and inactivates rocuronium and vecuronium. It is used to reverse neuromuscular blockade from these nondepolarizing agents. The safety of sugammadex in patients with neuromuscular disease has not been established. Guillain-Barre Syndrome (GBS) is a neuromuscular disease characterized by acute inflammatory polyneuropathy. Patients with GBS may exhibit autonomic dysfunction, chronic pain, abnormal reactions to neuromuscular blocking agents, and may require postoperative mechanical ventilation. We report the successful use of sugammadex to reverse rocuronium in a patient with chronic GBS, who presented for a hemicolectomy.

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ÖZ Amaç: Akut solunum yetmezliğinde noninvazif mekanik ventilasyon (NIMV), entübasyon ihtiyacını ve entübasyona bağlı komplikasyonları azaltabilir. Ancak NIMV'nin bu olgularda endotrakeal entübasyonu geciktirerek mortaliteyi arttırabileceği yönünde endişeler de mevcuttur. Bu çalışmada akut pulmoner ödem (APÖ) ve postoperatif solunum yetmezliği (POSY) olan olgularda NIMV uygulamasının etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntem: 01.01.2014-15.12.2015 tarihleri arasında APÖ ve POSY nedeni ile NIMV uygulanan 100 hasta retrospektif olarak değerlendirildi. Hastalar; APÖ (grup 1; n=59) ve POSY (grup 2; n=41) nedeniyle NIMV uygulananlar olmak üzere iki gruba ayrıldı. Hastaların demografik özellikleri, NIMV uygulaması sonrası entübasyon yapılıp yapılmadığı, NIMV uygulamasından ne kadar süre sonra yapıldığı, ejeksiyon fraksiyonu (EF), sistolik pulmoner arter basınçları, APACHE II skorları, yoğun bakımda/hastanede kalış süreleri ve mortalite oranları kaydedildi. Bulgular: İki grup arasında entübasyon sıklığı ve NIMV uygulamasının başlangıcından entübasyona kadar geçen süre arasında istatistiksel olarak anlamlı farklılık saptanmadı. Her iki gruptaki hastalardan endotrakeal entübasyon uygulananlarda uygulanmayanlara göre hastanede/yoğun bakımda kalış süreleri, başlangıç APACHE II skorları ve mortalite anlamlı olarak daha yüksekti. Grup 1'de kronik obstrüktif akciğer hastalığı olan hastalar daha çok entübe edilirken, grup 2'de ise EF'si düşük hastalar daha çok entübe edildi. Sonuç: Bu çalışmada; APÖ ve POSY gibi iki farklı akut solunum yetmezliğinde, NIMV ile entübasyon arasındaki sürenin uzamasından çok NIMV uygulanan hastaların başlangıç APACHE II skoruyla mortalite oranları arasında pozitif bir ilişki olduğu sonucuna varıldı. Anahtar Kelimeler: Noninvazif mekanik ventilasyon, postoperatif solunum yetmezliği, akut akciğer ödemi, atelektazi ABSTRACT Objective: Noninvasive mechanical ventilation (NIMV) decreases the incidence of endotracheal intubation and complications related to the endotracheal intubation in acute respiratory failure. However, there is some concern that it can increase mortality due to the delay of endotracheal intubation. We aimed to evaluate the efficacy of NIMV in acute pulmonary edema (APE) and postoperative respiratory failure (PORF) patients. Materials and Methods: Records of 100 NIMV assisted patients suffering from APE and PORF were evaluated, retrospectively, for a period from Jan 01, 2011 to Dec 15, 2012. The patients were divided into two groups as APE (group 1; n=59) and PORF (group 2; n=41) patients. The demographic data of the patients having a frequency of endotracheal intubation after NIMV, the time between initiation of NIMV and intubation, ejection fraction (EF), systolic pulmonary arterial pressure, APACHE II scores, intensive care unit/hospital length of stay and mortality rate were recorded. Results: There were no significant differences between the groups in terms of endotracheal intubation incidence and the time between initiation of NIMV and intubation. The intubated pat...

Background: To examine the laboratory findings with clinical characteristics and treatments of patients who were hospitalized in a tertiary intensive care unit with the diagnosis of COVID-19 and developed pneumothorax and to determine epidemiology and risks of pneumothorax.Methods: The study was conducted by retrospectively examining the electronic records of 681 COVID-19 patients who were followed up between 1 April 2020 and 1 January 2021 in 3 tertiary care units (each was 24 beds). Patients demographic and clinical characteristics, laboratory findings, mechanical ventilator parameters and chest imaging were collected retrospectively,.Results: Pneumothorax in 22 (3.2%) of 681 with COVID-19 patients were detected and ARDS in 481 (70.6). All the study patients met ARDS diagnostic criterias. Mortality rates were 43.4% (296/681) in all patients, 52.8% (254/481) in patients with ARDS, and 86.3% (19/22) in patients with pneumothorax. Pneumothorax occurred in the patients within a mean of 17.4 ± 4.8 days. The computed tomographies of patients were observed common ground-glass opacities, heterogenic distribution with patch infiltrates, alveolar exudates, interstitial thickening in the 1st week of their follow-up. Conclusion: We observed that pneumothorax significantly increased mortality in COVID-19 patients with ARDS. We believe that understanding and preventing the characteristics of pneumothorax will make an important contribution to mortality reduction.