Background Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). Methods LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensivecare units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non-invasive ventilation. One of the trial's secondary aims was to characterise variations in the demographics, management, and outcome of patients with ARDS. We used the 2016 World Bank countries classification to define three major geo-economic groupings, namely European high-income countries (Europe-High), high-income countries in the rest of the world (rWORLD-High), and middle-income countries (Middle). We compared patient outcomes across these three groupings. LUNG SAFE is registered with ClinicalTrials.gov, number NCT02010073. Findings Of the 2813 patients enrolled in LUNG SAFE who fulfilled ARDS criteria on day 1 or 2, 1521 (54%) were recruited from Europe-High, 746 (27%) from rWORLD-High, and 546 (19%) from Middle countries. We noted significant geographical variations in demographics, risk factors for ARDS, and comorbid diseases. The proportion of patients with severe ARDS or with ratios of the partial pressure of arterial oxygen (PaO 2) to the fractional concentration of oxygen in inspired air (F I O 2) less than 150 was significantly lower in rWORLD-High countries than in the two other regions. Use of prone positioning and neuromuscular blockade was significantly more common in Europe-High countries than in the other two regions. Adjusted duration of invasive mechanical ventilation and length of stay in the intensive-care unit were significantly shorter in patients in rWORLD-High countries than in Europe-High or Middle countries. High gross national income per person was associated with increased survival in ARDS; hospital survival was significantly lower in Middle countries than in Europe-High or rWORLD-High countries. Interpretation Important geo-economic differences exist in the severity, clinician recognition, and management of ARDS, and in patients' outcomes. Income per person and outcomes in ARDS are independently associated.

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96eçmişte birçok farklı terim ile (yatak yarası, dekübit vb.) karşımıza çıkan basınç ülserleri, Florence Nightingale zamanından beri önemli bir bakım sorunu olarak bilinmektedir. Nisan 2016 Ö ÖZ ZE ET T Basınç yarası, uzun yıllardır sağlık alanında önemli bir bakım sorunu olarak karşımıza çıkmaktadır. Yoğun bakım ünitelerinde daha çok görülen basınç yaralarının önemli bir kısmı tıbbi cihaza bağlı gelişmektedir. Tanı veya tedavi amaçlı kullanılan tıbbi cihazlar erişkin/pediatrik yoğun bakım, travma üniteleri gibi hastane alanlarında daha fazla kullanılmaktadır. Tıbbi cihazlara bağlı basınç yaraları (TCBBY), hastane ortamında meydana gelen tüm basınç yaralarının %30'undan fazlasını oluşturmaktadır. Bu yaralar genellikle cihazın şeklini almakta ve cihazların çevresinde veya altında meydana gelmektedir. Tüm tıbbi cihazlar potansiyel olarak basınç yarasına neden olabilir. Tıbbi cihaza bağlı basınç yaraları enfeksiyon, doku nekrozu gibi birçok komplikasyona neden olabilmekte ve bu nedenle de bakım maliyetini artırabilmektedir. Tıbbi cihazın hastanın tedavisinin bir bileşeni olması nedeni ile bu tür yaraları; önlemek klasik bir basınç yarasını önlemekten daha karmaşık hâle gelmektedir. Bununla birlikte; Braden Ölçeği, Waterlow Ölçeği gibi mevcut basınç yarası risk değerlendirme araçları TCBBY riskinin öngörülmesinde yetersiz kalmaktadır; çünkü bu araçlar, cihazların hareketliliğinden ziyade hastanın hareketsizliğine odaklanmaktadır. Bu nedenle hekim veya hemşirenin basınç yarasını değerlendirirken TCBBY'yi ayrı olarak gözlemlemesi ve kaydetmesi önemlidir. Bu durumda sağlık profesyonellerinin TCBBY'ye ilişkin farkındalığını artırmak esastır. Bu çalışmada, TCBBY'ye ilişkin özellikler, kanıta dayalı önleme ve iyileştirme stratejileri tartışılarak sağlık profesyonellerinin farkındalığını artırmak ve konu ile ilgili literatürdeki eksikliği gidermek amaçlanmıştır.A An na ah ht ta ar r K Ke el li im me el le er r: : Basınç yarası; tıbbi cihaz; yoğun bakım A AB BS ST TR RA AC CT T Pressure injuries have been an important health problem for many years. Most of the pressure injuries encountered in intensive care units are due to medical devices. Medical tools used for diagnostic or therapeutic purposes are more widely used in hospital areas such as adult/pediatric intensive care and trauma units. Medical device related pressure injury (MDRPI) account for more than 30% of all pressure injuries occurring in the hospital environment. These injuries generally take the form of the device and occur around or under the device. All medical devices can potentially cause pressure sores. Medical device related pressure injuries can cause many complications such as infection, tissue necrosis and thus increase the cost of care. Because the medical device is a component of the patient's treatment, preventing such injuries becomes more complex than preventing a conventional pressure injury. However, existing pressure injury risk assessment tools such as the Braden Scale and the Waterlow Scale are insufficient to predict the risk of MDRPI becaus...

Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. MethodsIn this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middleincome countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42•4% vs 44•2%; absolute difference -1•69 [-9•58 to 6•11] p=0•67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H 2 O; p=0•0011). ICU mortality was higher in MICs than in HICs (30•5% vs 19•9%; p=0•0004; adjusted effect 16•41% [95% CI 9•52-23•52]; p<0•0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0•80 [95% CI 0•75-0•86]; p<0•0001).Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status.

Objectives: An exaggerated inflammatory immune response is observed in cases of COVİD 19. This study aims to evaluate the effects of vitamin C, as a significant modulator of inflammation, on the inflammatory parameters and mortality in patients followed up in the intensive care unit (ICU) during the pandemic. Methods: This single-center retrospective study included 160 adult patients with confirmed positive nasopharyngeal swab COVID-19 PCR test results, who were followed up in the ICU between 01 March and 01 August 2020. Hospital files were scanned and patients given and not given vitamin C were assigned, to Group 1 and Group 2, respectively. The Acute Physiology and Chronic Health Evaluation (APACHE II) scores, the data entries on demographics, ventilation, laboratory tests, duration of ICU stay, discharge, and mortality were compared. Interventions with antiviral and antibacterial agents. steroids, cytokine apheresis, and renal replacement therapy were evaluated. Results: Vitamin C treatment was started in patients with raised neutrophil/lymphocyte ratio (NLR) at admission to ICU, who made up 20% of the total 160 ICU patients. Mortality incidence was higher among patients with raised NLR. Vitamin C at the doses used did not affect the inflammatory parameters, length of stay or mortality, and 37.5% of the patients recovered and were discharged from the ICU. Conclusions: We think that vitamin C treatment will have positive effects on the initiation of COVID-19 and that the time of intiation of the therapy and the optimal doses used should be determined with prospective studies.

The aim of this study was to examine the relationship between the severity of fibrosis in lung tissue and epidermal growth factor receptor (EGFR) positivity in patients who died due to COVID-19 pneumonia, demographic characteristics, comorbidities, biochemical values, and treatments received. Fifty patients who died from COVID-19 pneumonia were included in the study. Demographic data for the patients, laboratory tests, thorax computerized tomography findings, comorbidities, length of stay in the intensive care unit (ICU), intubation times, and treatments given were noted. Postmortem Tru-cut lung biopsy was performed. EGFR positivity was examined and grouped as negative, mild, moderate, and severe. Data were analyzed statistically. EGFR involvement was negative in 11 (22%), mild in 20 (40%), moderate in 13 (26%), and severe in 6 (12%) patients. The mean C-reactive protein (CRP) values, D-dimer values, and mean length of stay in the ICU were found to be significantly different between the groups ( p = 0.024; p = 0.003; p = 0.016, respectively). Methylprednisolone dose and the presence of comorbidity did not differ significantly in EGFR involvement ( p = 0.79; p = 0.98, respectively). CRP and D-dimer values can be used as a guide to assess the severity of pulmonary fibrosis that develops in severe COVID-19 pneumonia patients. The dose of methylprednisolone used does not make a significant difference in the severity of fibrosis. Trail registration : Clinical Trials.gov identifier date and number 01/13/2022 NCT05290441.

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