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Ultrasonography is an imaging tool that is increasingly used in the diagnosis and follow-up of many lung and heart diseases. Full lung ultrasonography is the examination of both hemithorax and protocols and image definitions have been created to make the examination more systematic and accurate. Cardiac ultrasonography is used to evaluate a moving organ. It requires users to be able to detect and interpret dynamic and variable values. Another feature of ultrasonography is its ability to guide interventional procedures. Ultrasonography will develop in the future and will be used more as a modern diagnostic tool in lung and heart evaluation by specialists.

Background Our aim in this observational prospective study is to determine whether the prone position has an effect on intracranial pressure, by performing ultrasound-guided ONSD (Optic Nerve Sheath Diameter) measurements in patients with acute respiratory distress syndrome (ARDS) ventilated in the prone position. Methods Patients hospitalized in the intensive care unit with a diagnosis of ARDS who were placed in the prone position for 24 h during their treatment were included in the study. Standardized sedation and neuromuscular blockade were applied to all patients in the prone position. Mechanical ventilation settings were standardized. Demographic data and patients’ pCO2, pO2, PaO2/FiO2, SpO2, right and left ONSD data, and complications were recorded at certain times over 24 h. Results The evaluation of 24-hour prone-position data of patients with ARDS showed no significant increase in ONSD. There was no significant difference in pCO2 values either. PaO2/FiO2 and pO2 values demonstrated significant cumulative increases at all times. Post-prone SPO2 values at the 8th hour and later were significantly higher when compared to baseline (p < 0.001). Conclusion As a result of this study, it appears that the prone position does not increase intracranial pressure during the first 24 h and can be safely utilized, given the administration of appropriate sedation, neuromuscular blockade, and mechanical ventilation strategy. ONSD measurements may increase the safety of monitoring in patients ventilated in the prone position.

Aim: The incidence of adverse postoperative outcomes in surgeries for femur fractures is high and is associated with malnutrition. In this study, it was aimed to determine the independent factors for 6-month survival in patients with femur fracture and to evaluate the predictive value of the prognostic nutrition index (PNI). Material and Method: One hundred and sixteen patients operated on only for femoral fracture were divided into survival and non-survival groups according to mortality.Demographic characteristics of the patients, operation data, fracture sites, need for intensive care unit and length of stay, postoperative hospital stay, and preoperative laboratory values, prognostic nutrition indices and mortality were evaluated. Results: Twenty-six (22.4%) of 116 patients who were operated for femoral fracture resulted in 6-month mortality. CRP, albumin, prealbumin, crp/albumin ratio and PNI values at admission were independent risk factors for postoperative mortality (p=0.014, p

Introduction: Although COVID-19 disease often includes respiratory system findings, that affects the gastrointestinal system, circulatory system, coagulation system and neurological system. In this study, we identified the neurological signs and symptoms observed in critical COVID-19 patients. Material and Method: This retrospective study reviewed 595 COVID-19 patients admitted to our intensive care unit (ICU) between January to June 2020. Patients with neurologic symptoms that were divided into two groups were diagnosed neurological disease (group ND) and non-neurological disease (group non-ND). Clinical signs and symptoms, radiological findings, demographic data (age, gender, presence of comorbidities), white blood cell (WBC), lymphocyte, platelet, lactic acid, glucose, and D-dimer levels, length of hospitalization, requirement of mechanical ventilation, and mortality were recorded for each patient. Results: Neurologic symptoms were observed in 148 (24.8%) patients. Of these, 44 patients were diagnosed neurological disease and 104 patients were non- neurological disease. The prevalence of neurologic symptoms was significantly higher in group ND. The rate of acute ischemic cerebrovascular disease in 595 critical COVID-19 patients was 6.2%. Conclusion: Presence of cerebrovascular diseases should be suspected in COVID-19patients with paresis, altered consciousness, numbness, taste/smell disorders, and plegia. The rate of ischemic cerebrovascular disease was approximately seven times higher than the rate of hemorrhagic cerebrovascular disease in critically COVID-19 patients.

IntroductionThe new coronavirus disease-19 , also known as the new coronavirus pneumonia, first appeared in Wuhan Province of China during early December and spread almost all over the world within two months which also caused a pandemic. COVID-19 disease is caused by the virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 80% of COVID-19 patients have mild illness whereas 20% require hospitalization. Some of these cases need to be followed under the intensive care units (ICU). The cases that need to be followed up in intensive care refer to the patients with severe pneumonia and acute respiratory distress syndrome (ARDS) requiring invasive or non-invasive respiratory support. This rate is between 5% and 10% for the patients requiring hospitalization (1-3).In general, pneumonia is ranked 6th among all causes of death in the United Kingdom and the USA. Pneumonia is also ranked 1st among the deaths caused by infections. The mortality rate ranges between 1-5% for the ambulatory patients diagnosed with pneumonia whereas it reaches up to 12% for the hospitalized patients and 40% for the patients in the ICUs. In our country, the mortality rate ranges between 30% and 87% for the hospital-acquired pneumonia (4). Several scoring systems are used to predict mortality in pneumonia. The most popular ones are the pneumonia severity index (PSI) and CURB-65. The patient's demographic data, concomitant diseases, physical examination findings and laboratory values are used in calculating PSI (5-7).The fatal disease incidents appear as severe pneumonia and ARDS in COVID-19 patients. The PaO2/FiO2 (arterial oxygen pressure/fraction of inspired oxygen) and the alveolar-arterial oxygen gradient (AaDO2) are the indicators of oxygenation status in critical ill patients and stand as the diagnostic criteria for ARDS in adults. Low PaO2/FiO2 value has been associated with the increased mortality and hospitalization period for the patients admitted to the ICUs. The PaO2/FiO2 rate provides quick and easy data on the oxygenation status of critical ill

Some of the patients with COVID-19 pneumonia are followed up in intensive care units (ICU). This study aimed to determine the success of intensive care scores used in patients followed up in the ICU with the diagnosis of COVID-19 pneumonia in predicting morbidity and mortality. This retrospective study included patients treated for COVID-19 pneumonia in the ICUs of Samsun Training and Research Hospital. We used the patients' demographic characteristics, vital signs, arterial blood gas values, radiological imaging, and laboratory data by using the hospital database and patient files. Group I was composed of alive patients, while Group II was of dead ones. A total of 75 patients were included in the study, of which 34 (45.3%) were female and 41 (54.7%) were male. The median length of intensive care stay was 8 (5-15) days in Group I patients and 5 (2-8) days in Group II patients, which was higher in alive patients (p=0.004). Radiological involvement was present in 93.3% (n=70) of the patients, and involvement was observed in both lungs in 77.3% (n=58). We observed complications in 54.7% (n=41) of the patients, whereas the incidence of complications was 20% in Group I and 72% in Group II, which was statistically significant (p<0.001). APACHE II, PSI, SOFA, qSOFA, SMART-COP, CURB65, A-DROP and NEWS2 scores were statistically significantly higher in patients who died, whereas APACHE II, SOFA, qSOFA, and SMART-COP scores were more successful in predicting morbidity. It is vital to predict the mortality risk early in patients with COVID-19 pneumonia followed up in intensive care units. Among the scoring systems, APACHE II, PSI, SOFA, qSOFA, SMART-COP, CURB65, A-DROP, and NEWS2 can be used safely to predict mortality.

Background and objectives: To investigate whether ultrasound (US)-guided femoral vein (FV) and inferior vena cava (IVC) measurements obtained before spinal anesthesia (SA) can be utilized to predict SA-induced hypotension (SAIH) and to identify risk factors associated with SAIH in patients undergoing non-obstetric surgery under SA. Methods: This was a prospective observational study conducted between November 2021 and April 2022. The study included 95 patients over the age of 18 with an American Society of Anesthesiologists (ASA) physical status score of 1 or 2. The maximum and minimum diameters of FV and IVC were measured under US guidance before SA initiation, and the collapsibility index values of FV and IVC were calculated. Patients with and without SAIH were compared. Results: SAIH was observed in 12 patients (12.6%). Patients with and without SAIH were similar in terms of age [58 (IQR: 19–70) vs. 48 (IQR: 21–71; p = 0.081) and sex (males comprised 63.9% of the SAIH and 75.0% of the non-SAIH groups) (p = 0.533). According to univariate analysis, no significant relationship was found between SAIH and any of the FV or IVC measurements. Multiple logistic regression analysis revealed that having an ASA class of 2 was the only independent risk factor for SAIH development (p = 0.014), after adjusting for age, sex, and all other relevant parameters. Conclusions: There is not enough evidence to accept the feasibility of utilizing US-guided FV or IVC measurements to screen for SAIH development in patients undergoing non-obstetric surgery under SA. For this, multicenter studies with more participants are needed.