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Objective: This study examined the clinical consequences of pregnancy coexisting with severe acute respiratory syndrome coronavirus 2 in the intensive care unit (ICU). Materials and Methods: The study was designed as a retrospective observational study. After the ethical approval of the local ethics committee, the study was conducted for a period when the number of young coronavirus disease-2019 (COVID-19) cases increased in our country. The patients enrolled in the study were pregnant/puerperal patients followed up in our third-level ICU. Results: The mean age of 35 pregnant women included in the study was 29.57±4.36 years. Twenty-one of the births (80.8%) were preterm births. Twelve (34.3%) patients received invasive mechanical ventilation (IMV), and 5 (41.7%) of these patients were deceased. Twenty-six (74.3%) underwent a cesarean section (C/S). There were 5 (14.3%) patients who needed extracorporeal membrane oxygenation and 3 (8.5%) patients who needed continuous renal replacement therapy. The 28-day neonatal mortality rate for 26 births was 3.8%. The maternal mortality rate in the ICU was 14.3%. Conclusion: The preterm birth rate was high in our pregnant patients followed up in the ICU with a diagnosis of COVID-19. Because of clinical and radiological progression in pregnant women, it is difficult to indicate any gestational week in which maternal outcomes are better to undergo C/S. IMV mortality is not higher than in non-pregnant patients, so endotracheal intubation should not be avoided in appropriate patients, whether pregnancy continues or not. The absence of fully vaccinated patients in the study group revealed the protective effect of vaccination during pregnancy. [ABSTRACT FROM AUTHOR]

OBJECTIVES: In this article, the results of severe coronavirus disease 2019 (COVID‑19) cases followed with extracorporeal membrane oxygenation (ECMO) support in a 3‑month period in the third wave when there were an increased number of cases of young patients in our intensive care unit (ICU) were presented. METHODS: The study was carried out with all COVID‑19 patients who were given ECMO support in our tertiary referral hospital ICU after obtaining the consent of the Ministry of Health Scientific Research Platform and after the approval of the local ethics committee. Patient data were obtained retrospectively from intensive care bedside follow‑up charts and computer records. The demographic and clinical characteristics of the patients were presented in average, median, and percentages. The data of the patients were evaluated and compared with the current literature. RESULTS: ECMO treatment was applied in seven patients who were followed up with severe COVID‑19 pneumonia in the last 3 months. Venovenous extracorporeal membrane oxygenation (VV‑ECMO) was applied to all patients. Five (71.5%) of seven patients were weaned from ECMO. Four (57.2%) of seven patients were discharged from the ICU and hospital in good health. While two of the patients had a cesarean section (C/S) before ECMO, one patient underwent C/S under ECMO. All three newborns were delivered via C/S and all were premature (C/S dates were 35 weeks, 32 weeks, and 27 weeks), and all were discharged from the hospital in good health. CONCLUSION: Our experience shows that ECMO in COVID‑19 patients is a lifesaving treatment option that can be successfully applied in severe acute respiratory distress syndrome cases who do not respond to conventional treatments. [ABSTRACT FROM AUTHOR]

Objective: Pneumothorax (PNX) and subcutaneous emphysema (SCE) have increased in importance as a frequently occurring complication. This study aimed to reveal the frequency, timing, and possible risk factors in patients with PNX and SCE who are followed up with coronavirus disease-2019 (COVID-19) diagnosis in our tertiary intensive care unit (ICU). Materials and Methods: All patients with confirmed COVID-19 who were followed up and treated in our unit between August 8, 2020, and February 20, 2021, in a 16-bed tertiary ICU and who developed PNX and SCE during their hospitalization were included. Results: PNX and SCE developed in 16 (9.6%) of 165 patients who were followed up in our ICU due to COVID-19. Of these 16 patients, 3 (18.8%) survived. The median age of patients was 66.5 years (interquartile range: 58.5-75.5). Diabetes mellitus was the most common comorbidity in patients with PNX and SCE. Additionally, 12 (75%) patients had a smoking history. Of 15 (93.8%) patients who developed PNX, 4 (25%) were bilateral, and SCE developed in 9 (56.3%) patients. Twelve (75%) patients with PNX and SCE were under invasive mechanical ventilation, 3 (18.8%) under spontaneous breathing, and 1 (6.2%) under non-invasive mechanical ventilation treatment. The number of oxygen support days until the time PNX and SCE developed was 9 (6.25-17) days in the whole group, the median time was 6 days in the survival group and 9 days in the non-survival group. Conclusion: In the COVID-19 pandemic, complications, such as PNX and SCE, are more frequently observed (9.5%) than in the general intensive care population and the later period of intensive care admission (median 9 days). Smoking is defined as a risk factor in most of these patients; however, increased PNX rates are thought to be related to both COVID-19 pneumonia and parenchymal damage due to cytokine storms. [ABSTRACT FROM AUTHOR]

Objective: Few studies have evaluated patients with spontaneous subarachnoid haemorrhage (sSAH) from an intensivist perspective. This study aimed to report the results of patients with sSAH in a high-volume centre monitored by a team experienced in the fields of brain surgery, interventional radiology and intensive care. Materials and Methods: Data of patients with sSAH followed up between January 2014 and July 2018 in the intensive care unit (ICU) were retrieved from ICU patient observation charts, file records and hospital automated information system. Results: This study enrolled 150 patients, of which 61 (40.7%) patients died despite receiving intensive care. Mortality rates between patients with (42.8%) and without (40%) vasospasm were comparable (p=0.917). Vasospasm developed in 37.8% of the 45 patients who underwent endovascular coiling and in 19.2% of those who underwent neurosurgical clipping (p=0.044). The median times that elapsed before endovascular or surgical procedures were 2.5 [interquartile range (IQR): 2-5] days in the surviving group and 2 (IQR: 1-5) days in the deceased group (p=0.164). Blood sodium and blood chloride levels were significantly higher in the deceased group from the third day onward. The median blood sodium level exceeded 142 mEq/L in the deceased group, but was lower than 142 mEq/L on the same day in the surviving group. Conclusion: The results of this study suggest that Glasgow coma scale (GCS) at admission to the ICU is one of the important factors that affect treatment success. GCS is an important independent factor in selecting the timing or type of treatment (surgical clipping/endovascular coiling) and medical treatments such as nimodipine in patients with sSAH requiring intensive care. In addition, the incidence of vasospasm was higher in patients who underwent endovascular coiling. Increased sodium and chloride values during follow-up are the only parameters significantly associated with mortality. [ABSTRACT FROM AUTHOR]

Objective: Current data in intensive care unit (ICU) suggest that at least 70-100% of patients’ energy have to met, while the effects of hypocaloric nutrition (HN) on patient outcomes are questioned. This study aimed to determine the relationship between renal replacement requirement and other organ failure and patient outcomes in normocaloric and hypocaloric fed patients. Materials and Methods: The data of patients followed up in the intensive care unit between 2003- 2012 were retrospectively evaluated. Normocaloric nutrition (NN) group is determined as patients with 70%-110% of the daily energy requirement was reached, HN group is determined as patients with less than 70% of their daily energy requirement. Patient data were recorded for 14 days. Results: Data of 1,955 patients were evaluated and 92 patients were included to NN group, 199 patients were included to HN group. There was a significant decrease in Sequential Organ Failure Assessment score in the HN group compared to the hospitalization day (p<0.005). Renal replacement therapy was needed in 19 (20.7%) patients in the NN group, whereas renal replacement was performed in 35 (17.6%) patients in the HN group (p=0.643). In the HN group, the number of RIFLE stage-3 days was 460 (25%), and in the NN group it was 157 (15.1%) days (p<0.001). The length of stay in ICU was 16.88±10.88 days in NN group and 11.42±9.11 days in the HN group (p<0.001). There was no significant difference in ICU mortality and 28th day mortality in both groups (p>0.05). Conclusion: There was no difference between NN and HN in critically ill patients in ICU. Although the duration of ICU stay was less in the hypocaloric group, no significant difference was found between low-calorie intake and 28th day and hospital mortality. There is still a need for a prospective, randomized controlled trial on this subject. [ABSTRACT FROM AUTHOR]

Amaç: Solid organ nakli alıcılarında immünosüpresyonun ağır COVID-19 enfeksiyonu için bir risk faktörü olduğu düşünülmekte ve bu hastalarda greft disfonksiyonu, çoklu organ yetmezliği ve mortalite riski normal popülasyona göre artmaktadır. British Transplantation Society (BTS) bu hastalarda immünsüpresif tedavilerde doz azaltımı ve destekleyici tedaviler önermektedir. Bu çalışma ile; daha önce homojen verisi olmayan COVID-19’lu yoğun bakım hasta grubunda renal transplant alıcılarının klinik sonuçları sunulmuştur. Gereç ve Yöntem: Etik kurul onamı sonrası 3. düzey üniversite hastanesi COVID-19 yoğun bakımında Mart 2020-Ocak 2022 arası takip edilmiş 550 hasta retrospektif olarak tarandı ve böbrek nakil alıcısı olan hastalar çalışma grubu olarak belirlendi. Bulgular: Çalışmaya alınan 550 hastanın 15’i renal nakil alıcısı bunlardan 5’i kadındı.Ortalama yaş 52 yıl idi. Yoğun bakım öncesi hastane yatış süresi medyan 4 (IQR: 2-5) gün idi. Renal nakil zamanı COVID-19 tanısından medyan 30 ay (IQR: 11-58) önce idi. Hastaların 13’ü (%86,7) COVID-19 ilişkili ARDS (CARDS) tanısı mevcuttu. Hastaların bazal kreatinin medyan değeri 1,18 (IQR: 1,02-1,46) mg/dL idi. Eksitus olan hastalarda KDIGO evresi daha ileriydi. Hastaların %93,3’ünde pulse steroid tedavisine rağmen progresyon devam etti. Hastaların 12'sinde (%80) periferik kan dolaşımı enfeksiyonu tanısı konuldu. Hastaların demografik özellikleri ve yoğun bakım kabul klinik değerleri Tablo 1’de, uygulanan tedavilerin dağılımı Tablo 2’de, birincil ve ikincil sonlanımlar Tablo 3’te, mortaliteye göre kreatinin trendi Şekil 1’de ve KDIGO trendleri Şekil 2’de verildi. Hastalar medyan 2. günde (0-10) entube edildiler. Entübe edilen hastalarda mortalite %100 idi. Beş (%33,3) hasta yoğun bakımdan taburcu edildi. Yoğun bakım mortalitesi %66,7 idi. Sonuç: COVID-19 tanısı konulan renal transplant alıcılarında CARDS nedeni ile yoğun bakım ihtiyacı geliştiğinde sağkalım oldukça düşüktür. Çalışmamızda hastaların transplantasyon zamanı ile tanı zamanı arasında uzun süre mevcuttu ve çoğunun birden fazla komorbiditesi vardı. CARDS ile takip edilen ve mortal seyreden olguların tamamı IMV ile takip edilen ve KDIGO evresi ileri olan AKI hastalarıydı. Sekonder enfeksiyonların sık görüldüğü bu hasta grubunda immünosüpresif ilaçların yönetimi oldukça önemlidir. Çalışmanın karşılaştırmalı analizleri yapılmaya devam edilmektedir. Ön analiz sonuçları sunulmuştur. [ABSTRACT FROM AUTHOR]

Objective: Drowning is a common and important cause of accidental deaths. Complications and mortality rates are high in patients requiring intensive care unit (ICU) support. The aim of our study was to determine the clinical course and treatment efficacy of a limited number of patients with acute respiratory failure and multiorgan failure due to drowning. Materials and Methods: Patients who were hospitalized >24 hours in the ICU between January 2010 and August 2018 and who met the inclusion criteria were retrospectively analyzed. Results: Of 103 patients admitted to the emergency department over an 8-year period, 13 required intensive care support. Five patients (38.4%) died and eight patients (61.5%) were discharged. Steroids were used in six patients (46.2%), but no statistically significant difference was found in terms of mortality (p=0.592). The presence of diffuse cerebral edema in five patients (38.5%) was associated with a statistically higher mortality rate compared to six patients (46.2%) with normal findings (p=0.003). Mechanical ventilation was performed with synchronized intermittent mandatory ventilation mode in nine patients (69.2%) and with airway pressure-release ventilation (APRV) mode in four patients (31.8%). According to our clinical observations, apparent radiological improvement was detected in patients who received mechanical ventilation with APRV mode. Conclusion: Neither steroids nor prophylactic antibiotherapy are found effective on mortality rates. In addition to these ineffective interventions, mechanical ventilation strategies, the degree of metabolic acidosis at admission and the neurological status of the patient may be considered as variable clinical parameters that may affect patient outcome. [ABSTRACT FROM AUTHOR]

It is estimated that there are a total of 1014 microorganisms colonized in many organs and tissues in the human body. It is also estimated that there are trillions of bacteria in the human body, almost 10 times that of host cells. This new life association, which we define as microbiomes, has been shown to be essential for protection against enteric and systemic pathogens through many direct and indirect (immunologically mediated) mechanisms in preclinical studies. Dysbiosis or imbalance in the homeostasis of the intestinal microbiota has been associated with many different diseases such as diabetes, obesity, inflammatory bowel disease and rheumatoid arthritis. In general, intestinal microbiota in patients with sepsis following intensive care unit (ICU) follow-up is characterized by lower diversity and commensal species (such as Faecalibacterium, Blautia, Ruminococcus) and an increase in strains such as Escherichia, Shigella, Salmonella, Enterococcus, C. difficile or Staphylococcus. Current treatment methods are based on two principles, either to reduce the excess proliferation of potentially pathogenic microorganisms (decolonization strategies) or to re-supply the pool of beneficial organisms. As in all areas, research on microbiota-targeted treatment strategies in ICU continues. [ABSTRACT FROM AUTHOR]

Meningococcemia is a highly mortal disease that can cause septic shock and multiple organ failure, which can be accompanied by sudden onset, rapid course, purpura fulminans and diffuse intravenous coagulation tables. Mortality increases when meningococcal causes to meningitis. The fact that it is the cause of neurological sequelae and extremity losses even in the recovering cases makes the support provided by the intensive care unit quite important in the management of cases. A case with meningococcal meningitis with high mortality, who was successfully treated through the use of supportive methods, such as monitorization, mechanical ventilation practices with new modalities, plasmapheresis and sympathetic ganglion blockage, has been presented in company with the literature. [ABSTRACT FROM AUTHOR]

Introduction: Electrical impedance tomography (EIT) is a real-time, non-invasive imaging method that evaluates regional lung ventilation. Although it allows the patient to be monitored at the bedside, it can be a good imaging method especially in pregnant women as it does not contain radiation. Twenty-seven weeks pregnant patient intubated with severe ARDS. The case in which our EIT follow-up played an active role in the decision of radiological progression and delivery. Case: A 28-year-old and 24+4/7 week pregnant woman admitted to our intensive care unit with influenza-A PCR positive ARDS. The patient with bilateral infiltration was started oseltamivir, clarithromycin and methylprednisolone and followed up with high flow oxygen (flow 60 Lt/ min, FiO2 80%).The patient was monitored with EIT because of the concern about computed tomography, which is due to both transport difficulties and pregnancy. An increase in oxygen demand was observed at the 8th hour of hospitalization, and bilateral lung loss was observed in EIT at the same time. The patient, who had confusion and persistent fever, was intubated and emergency cesarean was performed. Linezolid was added after S. aureus was isolated in tracheal aspirate culture. The patient was followed up both daily chest radiograph and EIT. The patient was extubated on the 3rd day of hospitalization and transferred to the service on the 7th day of her hospitalization. Discussion: In the management of pregnant ARDS cases; physicians have to make critical decisions such as birth, termination and intubation. Our patient had severe ARDS and was also 27 weeks pregnant. EIT follow-up was important in the pregnant patient group with limited imaging, since there was no radiation exposure and it gave instant information. This instant information can be used in the pregnant patient population, especially in the follow-up of ARDS patients. These experiences should be supported by multi center studies. [ABSTRACT FROM AUTHOR]

Introduction: Electrical impedance tomography (EIT) is a real-time, noninvasive, bedside evaluation method of regional lung ventilation. EIT screening experience is presented in a patient with VV-ECMO and used bronchoscopy due to atelectasis. Case: A 46-year-old female patient diagnosed with microscopic polyangitis with diffuse bilateral lung infitrations.While being followed with pulse steroid therapy and high flow oxygen, she was intubated after rapid progression and then taken to VV-ECMO. The cause of progression was found to be diffuse pneumonia in the left hemithorax, and meropenem was started rapidly. Steroid therapy of the patient was gradually reduced. Bronchoscopy was performed. EIT monitorization was applied to the patient to evaluate the lung vantilation before and after bronchoscopy. Consistent with the chest radiograph before bronchoscopy, severe vantilation impairment was observed in the left lung, especially in the lower zones. It was observed that left lung ventilation and tidal volumes increased within hours after bronchoscopy. The patient was successfully extubated 3 days after weaning from VV-ECMO and transferred to the service. Discussion: EIT is as a new functional imaging modality that provides instant visualization of the dynamic state of the lung during ventilation. It’s use without using ionizing radiation and in-hospital transport is an important advantage in ECMO as in our patient or in ventilator-dependent patients. In our patient, secretion clearance and removal of atelectasis with bronchoscopy were visualized instantly at the bedside with EIT. Increase in ventilation at the left lung was observed after bronchoscopy. As a result; Bedside EIT monitoring is a method that allows rapid evaluation of ventilation in critically ill patients during bronchoscopy, and it can provide significant benefits in the clinical decisions of patients with VVECMO. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the clinical outcomes of pregnancy and SARS-CoV-2 association in the intensive care unit. Materials and Methods: Pregnant/puerperal patients followed in our tertiary intensive care unit during the 6-month period (March-September 2021). After approved by local ethic committee, the data of all critically ill patients’ data were obtained from retrospective patient records. Results: The mean age of 35 pregnant women was 29.57±4.36 years. None of the 35 patients were fully vaccinated. The median week of birth was 34 (IQR: 26-38) weeks. Twenty-one (80.8%) of these were preterm births. Twelve (34.3%) patients received invasive mechanical ventilator respiratory support. Five (41.7) of these patients died. C/S was applied in 26 (74.3%) of them. There were 5 (14.3%) patients who needed ECMO and 3 (8.5%) patients who needed CRRT. While CPFA was applied to 1 patient, cytokine adsorption was applied to 2 patients. Nine (25.7%) were discharged from the intensive care unit with ongoing pregnancy. The 28- day neonatal mortality rate for 26 births was 3.8%. Thirty (85.7%) of the 35 patients were discharged from the intensive care unit in good health. ICU mortality was 14.3%. Conclusion: The rate of preterm birth increased in our pregnant patients. It is difficult to indicate ideal gestational week for maternal outcomes are better for C/S performed due to clinical and radiological progression in the mother. However, termination of pregnancy generally improves the respiratory parameters of the mother by eliminating the problems caused by the pregnant uterus and increasing respiratory functions. IMV mortality in patients is not higher than normal patient IMV mortality, so intubation should not be avoided in appropriate patients to avoid maternal hypoxemia. The absence of fully vaccinated patients with comorbidities among our patients reveals the protective effect of the vaccine in this patient group. [ABSTRACT FROM AUTHOR]

A rare phenomenon that can occur in intensive care patients with hyperleukocytosis has been identified that is known as “spurious hypoxemia” in arterial blood gas analyses. Hyperleukocytosis is a common cause of spurious hypoxemia. A 53-year-old male patient who was newly diagnosed with acute myeloid leukemia, and who had no known chronic disease or drug use, presented with complaints of weakness, swelling of the hands and blood spitting, and is reported on here in the light of the literature due to the inconsistency between the peripheral oxygen saturation and arterial blood gas values. The aim in presenting this case report is to emphasize the importance of spurious hypoxemia in patients in which hypoxemia may be expected, but who are not actually hypoxemic, for the determination of a treatment procedure. [ABSTRACT FROM AUTHOR]

Crimean-Congo hemorrhagic fever (CCHF) is a viral hemorrhagic fever syndrome that can cause multi-organ failure with hyperactivation of the immune system. There is no proven treatment for CCHF, supportive care is essential for management. Extracorporeal depurative techniques have been used to remove inflammatory mediators from the bloodstream. This report aims to present the use of coupled plasma filtration and adsorption (CPFA) in CCHF patients. We performed CPFA on three patients with CCHF, all of which were confirmed with polymerase chain reaction. A 35-year-old female was admitted one week after tick-exposure. Despite supportive treatment, patient developed mucosal and gastrointestinal bleeding due to disseminated intravascular coagulation (DIC). After CFPA, her clinic situation and laboratory results improved. A 54-year-old female was admitted to the intensive care unit due to severe bleeding and had a history of tick bite nine-days-ago. She had multiple organ failure with DIC, we started CPFA. Patient didn’t respond to the treatment and died. A 69-year-old male was admitted to the hospital on the seventh-day of exposure to tick. He had diabetes, hypertension and coronary artery disease. Next day, patient developed alveolar hemorrhage and his liver enzymes, coagulation parameters deteriorated. We performed CFPA, however, the patient didn’t respond to treatment and died. We suggested that CPFA may have positive effects on the outcome and prognosis of critically ill CCHF patients. Only one patient responded well which can be a result of being young, early admission to the hospital and lack of comorbidity. CPFA may be an option to treat severe CCHF infection with cytokine storm. However,there is a need for further studies on when we should apply this treatment and whether early application prevents mortality. [ABSTRACT FROM AUTHOR]

Many cardiac, pulmonary, and psychiatric complications occur due to long-term bed rest, infection, and critical illness neuropathy/myopathy in extra-corporeal membrane oxygenation (ECMO) applied coronavirus disease-2019 (COVID-19) inpatients in intensive care units. Physiotherapy plays an important role in restoring physical functions in the subacute phase following ECMO decannulation. After being discharged, and with combined rehabilitation, these patients experience a faster recovery and their quality of life increases. In this article, the effects of the combined physiotherapy program, which was applied to two patients with COVID-19 who received ECMO treatment and were discharged from the intensive care unit, is discussed. Early application of the combined rehabilitation program after discharge resulted in a positive outcome. [ABSTRACT FROM AUTHOR]

Amaç: Hangi kritik Koronavirüs hastalığı-2019 (COVID-19) hastalarının fungal enfeksiyon geliştirme olasılığının daha yüksek olduğu konusu ve olası risk faktörleri belirsizliğini korumaktadır. Özellikle COVID-19 hastalarında invaziv fungal enfeksiyon gelişiminde kortikosteroidlerin ve diğer immün modülatörlerin rolü henüz aydınlatılamamıştır. Bu çalışmanın amacı, kritik COVID-19 hastalarında fungemi ilişkili klinik özellikleri, sonuçları ve risk faktörlerini tanımlamaktır. Gereç ve Yöntem: Etik kurul onamı sonrası üniversite hastanesi düzey 3 yoğun bakım ünitesi COVID-19 tanısı ile kabul edilen 550 hasta tarandı. Hastaların verileri kaydedilerek analizleri sağlandı. Bulgular: Taranan 550 hastadan fungal enfeksiyon tanısı alan 14 hasta çalışmaya dahil. Bu hastaların 5’i kadındı ve yaş ortalaması 55 yıl idi. Hastaların kabul anı karakteristik özellikleri Tablo 1’de gösterildi. Hastalar yüksek Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II ve Ardışık Organ Yetmezliği Değerlendirme Skoruna sahiptiler. Yoğun bakım yatış süresinde hastalara uygulanan tedaviler ve primer, sekonder sonlanımlar Tablo 2’de gösterilmekle beraber fungemi hastalarının %85,7’si kaybedildi. Hastalarda uzun süre hastane ve yoğun bakım yatışı gözlendi. Fungal enfeksiyon anındaki karakteristik özellikler ve fungal enfeksiyona ait bilgiler Tablo 3’te gösterildi. Bu hastalarda enfeksiyon öncesi uzun süre steroid kullanım zamanıyla göze çarparken beraber en sık odak periferik kan en sık üreyen mikroorganizma Candida türleri idi. Sonuç: Çalışmamız sonucunda en sık fungemi etkeni Candida türleri olarak belirlenmiştir. COVID-19 hastalarında normal popülasyonla karşılaştırdığımızda fungemi insidansı 1.000 yoğun bakım günü başına normal popülasyon daha yüksekti. Fungemi saptanan hastalarda %85,7 gibi yüksek mortalite oranları saptandı. Fungemi saptanan hastalarda mortalite için risk faktörleri uzun süre steroid kullanımı, uzun süre yoğun bakım yatışı olarak bulundu. Çalışmanın karşılaştırmalı analizleri yapılmaya devam edilmektedir. Ön analiz sonuçları sunulmuştur. [ABSTRACT FROM AUTHOR]

Introduction: Electrolyte imbalance may occur in long-term antibiotic use; especially with meropenem and colistin. Our case, which was followed up with complicated intra-abdominal infection and applied various treatments, is presented to guide our colleagues in clinical practice. Case: An 18-year-old male patient with epilepsy, hypoxic brain admitted to our intensive care unit with status epilepticus. Although antiepileptic treatments were arranged, he was intubated due to his resistant seizures. After PEG was performed due to lack of secretion control and food aspiration history, persistant fever and hypotension occured,and free air in the abdomen was observed in the imaging. In diagnostic laparotomy transfers colon perforation detected and was repaired. Empirical antibiotic therapy was started in the case of intra-abdominal septic shock. Shock resuscitation and cytokine adsorption with oxiris colon were applied to the patient who received high-dose multiple inotropes. In tissue biopsy culture, E. coli and P. aeruginosa were grown. Meropenem 3x1 gr and colistin 2x150 mg were added to the vancomycin-fluconazole treatment. Respiratory support was switched to home mechanical ventilation. On the 45th day of meropenem-colistin, resistant hypokalemia, hypomagnesemia, metabolic alkalosis and hypernatremia developed despite appropriate fluid and electrolyte replacement. Corrected calcium was 14.5 mg/dL, immobility-related hypercalcemia was considered for primery diagnosis. Zometa was administered, and patient was taken to hemodialysis once. After dialysis, corrected calcium decreased from 14.2 mg/dL to 11.1 mg/ dL, sodium decreased from 157 mEq/L to 143 mEq/L. However, it increased again in the follow-up. Considering it might be antibiotic related, meropenem-colistin was discontinued on the 56th day and polymyxin b was started. It was observed that all electrolytes quickly returned to normal values (Graphic 1-3). He was referred to the palliative service on the 110th day of his follow-up. Discussion: Cases of hypokalemia, hypomagnesemia and metabolic alkalosis have been reported in prolonged use of colistin for more than 4 weeks, and also cases of meropenem-associated hypernatremia, hypokalemia and metabolic alkalosis have been reported in different publications like our case report. It should be kept in mind that such side effects may occur depending on the use of meropenem and colistin. [ABSTRACT FROM AUTHOR]

Amaç: SARS-CoV-2 ile enfekte hastaların %1-2’sinde sekonder spontan pnömotoraks geliştiği bildirilmiştir. Bu yazıda pnömotoraks için risk faktörü olmayan ve yoğun bakım takibinde spontan pnömotoraks gelişen COVID-19 tanılı 4 olgu literatür eşliğinde sunulmuştur. Olgu 1: Kronik hastalık öyküsü olmayan 40 yaşında erkek hasta COVID servis takipli iken akciğerlerinde progresyon olması üzerine yoğun bakım ünitemize alındı. Yoğun bakımda high flow nazal kanül (HFNC) ile (FiO2 %100, akım 60 lt/dk) pron pozisyonda takip edilen hastada (tanısının 27. günü) sol akciğerde pnömotoraks saptandı. Göğüs tüpü takıldı. Takiplerinde servise devredildi. Olgu 2: Diabetes mellitus öyküsü olan 35 yaş erkek hasta COVID tanısının 10. gününde reverzuarlı maske ile SpO2 %75 olması üzerine yoğun bakım ünitemize kabul edildi. Tanısının 32. günü ani desatürasyon sonucu entübe edilerek yoğun bakıma devralındı. Sol akciğerde pnömotoraks saptanan hastaya tüp torakostomi uygulandı. Takiplerinde sağ pnömotoraks gelişen hastaya tüp torakostomi uygulandı. Takiplerinde hasta kaybedildi. Olgu 3: Seksen altı yaş erkek hasta COVID tanısının 24. gününde rezervuarlı maske ile 14 lt/dk oksijen desteğine rağmen desatüre olması üzerine yoğun bakımımıza alındı. Akciğer parankiminde traksiyon bronşektazileri ve hava kistleri mevcuttu. Hasta HFNC ile pron pozisyonda iken sol hemitoraksta pnömotoraks saptanması üzerine tüp torakostomi uygulandı. Entübe edilerek mekanik ventilasyona alınan hasta hemodinamide bozulma sonrası aynı gün kaybedildi. Olgu 4: Yetmiş dört yaş kadın hasta COVID servis takibinin 4. gününde akciğer grafisinde progresyon ile yoğun bakıma alındı. HFNC ile pron pozisyonda takip edilirken pnömotoraks gelişen hastaya göğüs tüpü takıldı, takiplerinde servise devredildi. Sonuç: Spontan pnömotoraks SARS-CoV-2 pnömonisinin geç dönem komplikasyonu olarak (olgularımızda yaklaşık 20 gün) ortaya çıkabilir. COVID-19 hastalarında şiddetli enflamasyon ve uzun süreli hastalık kombinasyonunun akciğer parankimindeki dejeneratif değişikliklere bağlı olarak pnömotoraksa yol açtığı düşünülmektedir. COVID-19 ile enfekte yoğun bakım hastalarında en kısa sürede oksijen desteğinin azaltılmaya çalışılması, hastaların klinik değişikliklerinin yakından gözlenerek akciğer grafilerinin dikkatle değerlendirilmesi, özellikle hastalığın geç döneminde hastalarda pnömotoraksın da karşılaşılabilecek bir komplikasyon olduğunun akılda tutulması gerekmektedir. [ABSTRACT FROM AUTHOR]