Introduction: Spinal anesthesia (SA) is one of the most frequently applied anesthesia procedures today. However, SA failure rate varies between 1 and 17%. The age of the patient, the position at which the procedure is performed, or the characteristics of the technical operation can affect success. In this study, we aimed to compare the most frequent SA failures according to the types of surgery and causes of failure. The results of SA procedures performed in a university hospital were compare to those published in the current literature. Materials and Methods: After obtaining ethics committee approval for our study, the hospital archives were examined retrospectively for 1 year with respect to SA procedures. SA application and failure rates were examined. Three or more SA attempts, failed dural puncture, or unsuccessful injection, and anesthesia applications that did not provide sufficient sensory block for surgery despite successful drug treatment were defined as failure. Results: Of all anesthesia procedures, SA was applied at a rate of 23.5%. Our SA failure rate was calculated as 16.6%. Considering a single surgical procedure, obstetric anesthesia was the most common surgery with failed SA (28.7%). The most common cause of failure was insufficient analgesia (32.9%). Discussion: SA failure rates were observed to be in a variable distribution range in the literature, and in some studies, SA failure was defined as a block that did not occur despite a full dose and successful injection, and this rate was found to be 3.9%. The high rate in our study group may be explained by differences in the definition of SA: blocks performed with several trials and any block that could not be applied were also recorded as SA failure. The reasons for failing to apply this procedure is an issue that is worth examining also in terms of patient satisfaction and safety, which is an important issue. Conclusion: Although the definition of unsuccessful SA is confusing, SA failure rates are worth examining and improving for each hospital.
A bstract Background In this study, we aim to describe clinical features and outcomes of very elderly (85 years old or older) patients and provide information about predictors of mortality and factors associated with the length of hospital stay (LOS). Materials and methods We reviewed retrospectively the files of patients over 85 years old and older who were admitted to the intensive care unit (ICU) of our training and research hospital between January 2017 and December 2018. Demographic and clinical findings, treatment modalities, and outcomes were recorded. The patients who died during the ICU stay were compared to the survivors, and factors associated with mortality and LOS in the intensive care were evaluated. Results We reviewed 2350 files, and 218 patients (58.3% females) were included. The rate of mortality was 81.7%. The factors independently associated with a higher rate of mortality were the acute physiology and chronic health evaluation (APACHE) II score; the need for mechanical ventilation (MV), or inotropic support; and the presence of coronary artery disease (CAD) or chronic kidney disease (CKD). A tracheostomy and a blood transfusion were inversely associated with mortality. We found an association between LOS and comorbidities (renal replacement, percutaneous gastrostomy, blood transfusion, and a tracheostomy). Conclusion The rate of survival in the intensive care was low among these very elderly intensive care patients. A higher APACHE II score; application of MV or inotropic support; and the presence of CAD or CKD were associated with a higher mortality rate. How to cite this article Miniksar OH, Özdemir M. Clinical Features and Outcomes of Very Elderly Patients Admitted to the Intensive Care Unit: A Retrospective and Observational Study. Indian J Crit Care Med 2021; 25(6):629–634.
Yoğun bakım ünitesinde takip edilen ergen ilaç intoksikasyonlarının retrospektif değerlendirilmesi Retrospective evaluation of adolescent drug intoxications followed in the intensive care unit
ÖZET Amaç: Yoğun bakım (YB) ve palyatif bakım (PB) üniteleri yaşam sonu bakımın uygulandığı kliniklerdir. PB hizmetlerinin optimal düzeyde verilebilmesi için bu ünitelerde çalışanların PB hakkında yeterli düzeyde bilgi sahibi olması gerekmektedir. Bu çalışmanın amacı, YB ve PB ünitelerinde çalışan doktor ve hemşirelerin PB'ye ilişkin bilgi ve görüşlerinin belirlenmesi ve karşılaştırılmasıdır. Gereç ve Yöntemler: Çalışma; Malatya Eğitim ve Araştırma Hastanesi Reanimasyon YB, Dahiliye YB ve PB ünitelerinde çalışan hekim ve hemşireler ile yüz yüze görüşme yöntemi ile yapılmıştır. Çalışmada veriler, sosyodemografik özellikler formu ve literatür bilgileri doğrultusunda hazırlanan, çalışanların PB'ye yönelik mevcut bilgi ve görüşlerini belirleyici anket formu kullanılarak elde edilmiştir. Bulgular: Çalışmaya katılanların (68 hemşire, 12 doktor) yaş ortalaması 34 olup, çoğunluğunu lisans mezunu kadınlar oluşturmaktaydı. Katılımcıların %80'i eğitimleri sırasında PB eğitimi almadıklarını ve %76,3'ü yapılacak eğitim programlarına ihtiyaç duyduklarını belirtti. YB çalışanlarının %37,5'i, PB çalışanlarının %20'si hospis tanımını bilmediklerini ifade etti. PB çalışanlarının çoğu (%85,1) tedavisi biten hastaların taburculuğunda zorlandıklarını ve %85,5'i PB'de tükenmişlik yaşadıklarını belirtti. YB hemşirelerinin %63,8'i "YB"de PB hizmeti verilmelidir, ifadesine katılmadıklarını ve bu konu hakkında bilgi sahibi olmadıklarını belirtti. Çalışanların tamamına yakını, PB temel eğitiminin üniversite eğitim programlarında zorunlu olması gerektiğini belirtti. Sonuç: YB ve PB ünitesinde çalışan sağlık personelinin "Palyatif bakım ve hospis" kavramları konusunda yeterli bilgiye sahip olmadıkları, bilgi düzeylerinde farklılıklar olduğu ve bu konuda yapılacak eğitim programlarına ihtiyaç duydukları belirlenmiştir. Bu durumun temel lisans eğitimindeki eksikliklerden kaynaklandığı, eğitim müfredatında zorunlu PB eğitim dersinin yer alması ve sertifikalı eğitim programlarının yaygınlaşması gerektiği düşünülmektedir.Anah tar Ke li me ler: Palyatif bakım; yoğun bakım; sağlık personeli; bilgi ABS TRACT Objective: Intensive care (ICU) and palliative care (PD) units are clinics where end-of-life care is applied. In order for PB services to be provided at an optimal level, employees working in these units should have sufficient knowledge about PB. The aim of this study is to determine and compare the knowledge and opinions of doctors and nurses working in the ICU and PD units about palliative care. Material and Methods: Study; Malatya Training and Research Hospital Reanimation YB, Internal Medicine YB and PB were conducted by face to face interviews with physicians and nurses working in the units. In the study, the data were obtained by using the questionnaire form, which was prepared in line with the socio-demographic characteristics form and the literature information, and which determines the current knowledge and opinions of the employees about PD. Results: The average age of the participants (68 nurses, 12 doctors) was 34, most of whom were ...
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