Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO 2 /FiO 2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.
BackgroundPatients in intensive care units (ICUs) are often physically unable to communicate with their physicians. Thus, the sharing of information about the on-going treatment of the patients in ICUs is directly related to the communication attitudes governing a patient’s relatives and the physician.This study aims to analyze the attitudes displayed by the relatives of patients and the physician with the purpose of determining the communication between the two parties.MethodsFor data collection, two similar survey forms were created in context of the study; one for the relatives of the patients and one for the ICU physicians. The questionnaire included three sub-dimensions: informing, empathy and trust. The study included 181 patient relatives and 103 ICU physicians from three different cities and six hospitals.ResultsBased on the results of the questionnaire, identification of the mutual expectations and substance of the messages involved in the communication process between the ICU patients’ relatives and physicians was made. The gender and various disciplines of the physicians and the time of the conversation with the patients’ relatives were found to affect the communication attitude towards the patient. Moreover, the age of the patient’s relatives, the level of education, the physician’s perception, and the contact frequency with the patient when he/she was healthy were also proven to have an impact on the communication attitude of the physician.ConclusionThis study demonstrates the mutual expectations and substance of messages in the informing, empathy and trust sub-dimensions of the communication process between patient relatives and physicians in the ICU. The communication between patient relatives and physicians can be strengthened through a variety of training programs to improve communication skills.
ÖZET Amaç: Bu çalışmada bir genel yoğun bakım ünitesinde (YBÜ) izlenen travma hastalarının genel özellikleri incelenmiş, bu hastalardaki mortalite oranı ve mortaliteye etki eden faktörler saptanmaya çalışılmıştır. Gereç ve Yöntem: Konya Numune Hastanesi'nde Ocak 2012-Mart 2013 tarihleri arasında genel YBÜ'de takip edilen 108 travma hastasının verileri retrospektif olarak incelendi. Hastaların demografik özellikleri ve klinik verileri kaydedildi. Hastalar YBÜ sonuçlarına göre sağ kalanlar ve ölen hastalar olarak iki gruba ayrıldı. Mortalite oranı ve bu orana etki eden faktörler incelendi. Bulgular: Çalışmaya 108 travma hastası dahil edildi. Mortalite oranı %19,4 tespit edildi. Hastaların median yaşları 44,5 ve %75,9'u erkek olarak tespit edildi. Medyan Glasgow Koma Skorları ölüm grubunda sağkalım grubuna göre daha düşük (5 (3-8) vs. 15 (13-15), p<0,0001), medyan APACHE II skorları daha yüksek (20 (15-26) vs. 10 (8-13), p<0,0001) ve median yatış süreleri daha uzun (27 (5-62,5) vs. 2 (1-5), p<0,0001) tespit edildi. En sık görülen travma etiyolojisi %47,2 oranda trafik kazası olup, hastaların %52,7'sinde kafa travması mevcut idi. Herhangi bir nedenle vücudunda fraktür bulunan hastaların oranı sağ kalan hasta grubunda daha yüksek bulundu (%66,7 vs. %33,3, p=0,007). Hastaların %38,9 eritrosit süspansiyonu, %27,8'i taze donmuş plazma, %0,9'u trombosit süspansiyonu ve %8,3'ü albümin almıştır. İnvaziv mekanik ventilasyon, %27,8 oranda yapılmış olup, median İMV süresi 5 (1,75-33,5) gün tespit edildi. Hastaların %42,6'sı opere edilmiştir. Trakeostomi, renal replasman tedavisi, bronkoskopi ve perkütan endoskopik gastrostomi uygulanan hastaların oranı ölen hasta grubunda daha yüksek tespit edildi. Logistic regresyon analizinde ileri yaş (p=0,016, OR: 1,054; %95 CI: 1,010-1100) ve düşük Glasgow Koma Skoru (p<0,0001, OR: 0,583; %95 CI: 0,456-0,745) yoğun bakımdaki travma hastalarının mortalitesini etkileyen bağımsız risk faktörleri olarak bulundu. Sonuç: YBÜ'de travma hastalarının mortalitesini etkileyen bu faktörlerin belirlenmesi ile ülkemizdeki diğer yoğun bakımlarda travma hastalarının yönetimine olumlu katkıda bulunabileceğimizi düşünmekteyiz. Anahtar Kelimeler: Yoğun bakım ünitesi, mortalite, travma SUMMARY Objective: The aim of this study was to determine the mortality rate and factors affecting the mortality of trauma patients in general intensive care unit (ICU) of a state hospital. Material and Method: Data of trauma patients hospitalized between January 2012 and March 2013 in ICU of Konya Numune Hospital were retrospectively analyzed. Demographic characteristics and clinical data of patients were recorded. Patients were divided into two groups as survivors and dead. Mortality rate and factors affectin mortality were examined. Results: A total of 108 trauma patients were included in the study. The mortality rate of overall group was 19.4%. Median age of the patients was 44.5 years and 75.9% of them were males. Median Glasgow Coma Scale of death group was lower (5 (3-8) vs. 15 (13-15), p<0.0001), median APACHE II score...
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