BACKGROUND: Code blue (CB) is an emergency call system developed to respond to cardiac and respiratory arrest in hospitals. However, in literature, no scoring system has been reported that can predict mortality in CB procedures. In this study, we aimed to investigate the effectiveness of estimated APACHE II and PRISM scores in the prediction of mortality in patients assessed using CB to retrospectively analyze CB calls.
Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56–3.14); prior exposure to N-acetylcysteine, 0.11 (0.03–0.34) and prior surgical intervention, 1.26 (0.76–2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.
Amaç: Prospektif ve randomize olarak yapılan bu çalışmada; birincil olarak yerleştirme kolaylığı ve yerleştirme zamanı, ikincil olarak repozisyon gereksinimi, denemelerdeki başarı oranı, sPO 2 , EtCO 2 ve hemodinamik parametreler üzerine etkileri, yeterli ve güvenli havayolu sağlayabilme ve orafaringeal ve sistemik komplikasyonları açısından, laringeal maske (LMA) Klasik, LMA Klasik, LMA Fastrach and LMA Supreme'in karşılaştırılması amaçlandı.Yöntemler: Yaşları 18-70 arasında değişen, American Society of Anesthesiologists (ASA) I-II, doksan hasta randomize olarak 3 gruba ayrılarak havayolu sağlamak için LMA Klasik, LMA Fastrach ve LMA Supreme kullanıldı. Nöromüsküler bloker kullanıl-madı. Belirlenen LMA aynı anestezist tarafından bispektral index %40-%60 arasındayken yerleştirildi.Bulgular: Gruplar arasında birincil sonuç olarak belirlenen yerleştirme kolaylığı ve yerleştirme zamanı açısından istatiksel olarak fark yoktu. İkincil sonuç olarak yerleştirme sırasında repozisyon gerektirme oranı LMA klasik grupta diğer gruplara göre belirgin olarak yüksek (p<0,05), alet üzerinde kan lekesi varlığı ve mukozal ödem varlığı LMA Fastrach grubunda diğer gruplara göre yüksekti (p<0,05).Sonuç: LMA Klasik, LMA Fastrach ve LMA Supreme araçlarının tümünün etkinlik ve güvenli havayolu sağlama açısından benzer olduğunu düşünmekteyiz. Fakat LMA Supreme; repozisyon gerekmemesi ve daha az orafaringeal komplikasyona yol açmasından dolayı daha avantajlı görülmektedir. Anahtar kelimeler: Laringeal maske, havayolu yönetimi, etkinlikObjective: This prospective randomised study was designed to compare the Laryngeal Mask Airway (LMA) Classic, LMA Fastrach and LMA Supreme regarding ease of insertion and insertion time as primary outcomes and reposition, success rate of trials, effects on haemodynamic parameters, provision of an adequate and safe airway, amount of leakage and oropharyngeal and systemic complications as secondary outcomes. Methods:In this clinical trial, 90 patients aged 18-70 years of American Society of Anesthesiologists (ASA) group I-II were randomised into three groups as providing airway via LMA Classic, LMA Fastrach or LMA Supreme instead of tracheal intubation. No muscle relaxant was used. The allocated LMA was inserted by the same anaesthetist; bispectral index (BIS) was between 40% and 60%.Results: There was no statistical difference among the groups regarding the ease of insertion and insertion time as primary outcomes; the incidence of repositioning during placement was significantly higher in the LMA Classic group than that in other groups (p<0.05) and the rates of bloodstain on the device as well as oropharyngeal mucosal oedema were higher in the LMA Fastrach group than those in other groups (p<0.05) as secondary outcomes. Conclusion:We suggest that LMA Classic, LMA Supreme and LMA Fastrach had similar effectiveness regarding efficiency and airway safety. However, LMA Supreme seems to be more advantageous as it is more appropriate for fewer oropharyngeal complications and there was no repositioning. Keywords: L...
Compartment syndrome is a serious condition characterized by raised intracompartmental pressure, which develops following trauma. Well leg compartment syndrome (WLCS) is a term reserved for compartment syndrome in a nontraumatic setting, usually resulting from prolonged lithotomy position during surgery. In literature, 8 cases have been reported regarding well leg compartment syndrome in a supine position and bilateral symmetrical involvement was observed in only 2 cases. In WLCS etiology, lengthy surgery, lengthy hypotension, and extremity malpositioning have been held responsible but one of the factors with a role in the etiology may have been the tissue oedema and impaired microcirculation formed from the effect of vasoactive mediators expressed into the circulation associated with the massive blood transfusion. The case is presented here regarding symmetrical lower extremity compartment syndrome after surgery in which massive transfusion was made for gross haemorrhage from an abdominal injury. In conclusion, blood transfusion applied at the required time is life-saving but potential risks must always be considered.
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