Search

Copyright of Turkiye Klinikleri Journal of Sports Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) phenotypes in lung compliance have been described in patients with COVID19-related ARDS. Our study examined mechanical ventilation support and its results in patients with COVID-19-related ARDS. Materials and Methods: The retrospectively planned study was performed in patients with COVID19-associated ARDS who were determined to have three phenotype subgroups based on the calculated static compliance (Cstat) value [type high (H) = Cstat <40 mL/cmH2 O, type light (L) = Cstat ≥50 mL/cmH2 O and type intermediate (Int) =40≤ Cstat <50 mL/cm H2 O]. The effects of mechanical ventilation strategy on the duration of mechanical ventilation, length of stay in the intensive care unit, and mortality in COVID-19 ARDS phenotypes were investigated. Results: It was determined that the study patients were 72.3% type H, 23.4% type L, and 4.3% type Int in terms of COVID-19 ARDS phenotype. It was observed that the mechanical ventilation strategy did not affect the duration of mechanical ventilation (p=0.357), the length of stay in the intensive care unit (p=0.127), and the mortality rate (p=0.583) in all three phenotypes. Conclusion: We believe that a phenotype-independent protective ventilation strategy defined according to compliance is appropriate in patients with COVID-19-associated ARDS. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Research in Health Sciences (JARHS) / Sağlık Bilimlerinde İleri Araştırmalar Dergisi (SABİAD) is the property of Journal of Advanced Research in Health Sciences (JARHS) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Iatrogenic anemia is an overlooked entity in daily practice. It is known that iatrogenic anemia is associated with increased morbidity and mortality, especially in intensive care unit patients. COVID-19 caused excessive intensive care hospitalizations due to acute respiratory failure. We sought to investigate iatrogenic anemia and its results in COVID-19 patients followed in intensive care unit. Materials and Methods: We retrospectively reviewed the adult patients who were hospitalized in ICU for COVID-19 longer than 14 days. Individuals younger than 18 or who had major bleeding, or postoperative patients were excluded. The remaining 112 patients took part in study. We collected the demographic data, comorbidities, laboratory results, and total amount of blood samples taken in intensive care follow-up in mililiters (mL). Results: The mean age of participants was 71.3 (min: 23, max: 100). Male/ female ratio was 1.8. The most common comorbidity was hypertension (60), coronary heart disease (29), and diabetes mellitus (26), The median length of ICU stay is 19 days (min: 14, max: 58). 66 (58.6%) patients have died. Mean Hb was decreased from 13.9 (±SD: 1.67) to 9.74 (±SD: 1.98) g/dL. In the end, 65 (90.2%) of males and 38 (95.0%) of females were anemic. On a total of 2545 hospitalization days, an average of 27.6 mL of blood was drawn in 7.4 sampling tubes per patient day. Biochemistry tests were the most common reason. We observed that more blood was drawn from intubated patients than non-intubated patients, resulting in a greater reduction in hemoglobin levels (463 mL, 2 g/dL, 677 mL, 3.9 g/ dL, respectively) (p<0.001). Conclusion: Excessive blood sampling is still a significant problem in ICUs associated with poor outcomes. Considering that most COVID-19 patients are admitted to ICU due to acute respiratory failure, it is vital to keep hemoglobin levels as high as possible to maintain oxygenation. [ABSTRACT FROM AUTHOR]

Acute Respiratory Distress Syndrome (ARDS) is characterized with diffuse bilaterat radiologic infiltration, and a hypoxemic respiratory failure. A 48-year-old housewife hospitalized in a chest diseases hospital with the diagnosis of pneumonia was intubated for increased respiratory distress. The patient, who developed cardiac arrest three times underwent CRP for nearly 15 minutes. When she was admitted to intensive care unit of a tertiary healthcare institute, severe acidosis was detected in her first arterial blood gas sample (ph 6.9). Bilateral rales were heard in respiratory system auscultation and “cotton wool spots” were observed on her PA chest X-ray and initial diagnosis of ARDS was made. The patient was consulted with the department of infectious diseases, and zyvoxid 2x1 (avelox 1x1 meronem 2x1) were added to her antibiotherapy. The patient’s admission parameters were as follows: WBC 45000/mm3 CRP: 11 mg/dL sedimentation: 84 mg/dL. Although the patient was followed up on a mechanical ventilator with a protective ventilation strategy for 2 days, ECMO treatment was decided because PaO2 / FiO2 <100 and blood gas values did not improve. ECMO treatment was applied for 5 days. Then, the patient was extubated and transferred to the service without complications. [ABSTRACT FROM AUTHOR]

Sepsis is a serious condition characterized by an inflammatory condition throughout the body and the presence of a known or suspected infection. The body can improve this inflammatory response by its immune system to microbes in blood, urine, lungs, skin or other tissues. The results of this complex pathophysiology can be monitored in different ways, such as severe hypotension, metabolic acidosis, tissue damage and multiple organ failure, acute respiratory distress syndrome (ARDS) / acute lung injury (ALI), and even death. Despite supportive treatments, antibiotics, immunotherapy agents and new treatment options, sepsis appears to be the most common health problem in intensive care units with a high mortality rate of up to 90%. For this reason, sepsis is known as both one of the most researched diseases in humans and one of the most studied models in experimental animals. At the same time, sepsis and complications related to sepsis are frequently investigated in veterinary medicine, especially in animals such as sheep. In this article, the information will be given about the models used in animals to create sepsis (Sepsis model created by injection of an exogenous toxin such as lipopolysaccharide (LPS), Fecal sepsis models, sepsis model created by infusion or inoculation of exogenous bacteria), both because of the necessity to try and examine the drugs before the clinical trial in animal experiments and as a disease that threatens animal welfare. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic have enormous impact on healthcare systems around the world. The majority of cases are asymptomatic or mild, with a severe course in 15-20% of patients. In severe cases, treatment in the intensive care unit (ICU) is required for severe pneumonia and acute respiratory distress syndrome. A number of physical, cognitive and mental disorders defined as "Post-Intensive Care Syndrome" are seen in ICU survivors and determine the long-term prognosis of patients. COVID-19 affects other organ systems besides its well-known pulmonary involvement. ICU associated complications, pulmonary and extrapulmonary involvement of the disease will cause a growing proportion of patients with COVID-19 infection related sequelae and disability. Therefore, the implementation of effective rehabilitation programs for COVID-19 survivors has come to the fore. Considering the pulmonary, neurological, musculoskeletal and ICU related complications, rehabilitation professionals can play an important role in the recovery process of individuals with COVID-19 disease. In this review, intensive care associated complications of COVID-19 infection, pulmonary and extrapulmonary involvements will be discussed and treatment with available early evidence and general rehabilitation approaches will be mentioned. [ABSTRACT FROM AUTHOR]

Towards the end of 2019, new coronavirus causing acute respiratory distress syndrome in patients was detected in Wuhan Province, China . This virus was called serious acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Virus Taxonomy Committee. The disease caused by this new coronavirus was called coronavirus disease-2019 (COVID-19) by the World Health Organization. This virus was found to be in the subclass of Betakoronavirus caused by bats. The role of viral proteins such as envelopes, membranes, nucleocapsids and spike proteins responsible for viral infectivity in immunopathogenesis is being investigated in studies. It has been emphasized in studies in which multiple organ failure develops due to the development of cytokine storm, especially in the advanced stages of the disease. An effective host immune response, including natural and adaptive immunity to SARS-Cov-2, is essential for controlling and treating viral infection. Although there is no effective treatment for the disease today, the benefits of various immunosuppressive and immunomodulatory drugs have been shown in studies. In this article, the immunopathogenesis of SARS-CoV-2 and the treatment models that can be effective on immunopathogenesis are reviewed in the light of curr ent literature. [ABSTRACT FROM AUTHOR]

Legionella pneumophila, an etiologic agent of both community- and hospital-acquired pneumonia that can show serious course, and can be transmitted via aerosols from shower heads and air conditioners, and does not respond to β-lactam antibiotics. It can cause sporadic infections or epidemics. It can colonize in city waters, natural water sources such as thermal pools and humidifier water systems of air conditioners. In this report, a 54-year old male with L. pneumophila pneumonia presented with complaints of fever, cough and diarrhea for five days, and diagnosed by a positive urinary antigen test is presented. Upon deterioration of his condition on the first day, he was transferred to the intensive care unit. and died on 36th day in the picture of acute respiratory distress syndrome. The patient's history revealed smoking and a shower at a hotel as risk factors for Legionella. [ABSTRACT FROM AUTHOR]

Coronavirus diesase (COVID-19) infection is a fatal infection, caused by the acute respiratory failure syndrome-coronavirus-2 virus, which has spread worldwide all around the world. There are researches showing benefits of anti-cytokine treatments when macrophage activation syndrome (MAS) developed during COVID-19 infection. During the COVID-19 pandemic, tocilizumab treatment was applied to 10 patients, due to the development of MAS syndrome in their follow-up after a diagnosis of high probable or definitive COVID-19 infection in our hospital. When these cases were admitted, the SOFA score (mean ± standard deviation value) was 7.4±3.47, and the acute physiological and chronic health evaluation 2 score was 28±10.17. All patients had symptoms specific to COVID-19 pneumonia on lung tomography, and polymerase chain reaction positivity was accompanied in 8 cases. The cultures of 9 cases were pozitif in a way that supports the literature, and 1 case discharged from the intensive care unit having no culture positivity. COVID-19 infection was mortal in 7 cases, 2 cases were discharged and 1 patient continued to be treated in intensive care unit. In two of our discharged cases, after tosilizumab was given, a rapid improvement was observed when clinical and laboratory data were examined. Candida albicans/parapsylosis were detected both in peripheral blood and deep tracheal aspirate culture in one of the 4 cases diagnosed with fungal infection; one case in deep tracheal aspirate and in other case it were detected in urine culture.It is difficult to make a recommendation about COVID-19 infection yet, treatment algorithms are updated according to the results of the studies, and there are many ongoing studies. Due to the lack of sufficient data on long-term results and side effects in COVID-19 patients, we think that attention should be paid especially in terms of secondary infection development after tocilizumab use. [ABSTRACT FROM AUTHOR]

While the last pandemic in the world has been in memory as Spanish Flu in 1918, the World Health Organization announced a pandemic caused by the corona virus family, Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which started in China in December 2019 and spread all over the world. It was determined that the symptoms of the infection caused by the SARS-CoV-2 virus is a clinic with fever, shortness of breath and especially acute respiratory symptoms called Coronavirus disease-2019 (COVID-19). It was understood in a short time that COVID-19 pneumonia may be asymptomatic in patients as well as cause pulmonary edema, Acute Respiratory Distress Syndrome (ARDS) and/or multiple organ failure. Studies have shown that the prevalence of ARDS is 17% in COVID-19 patients and sustaining oxygenation is the biggest problem. In the presence of respiratory failure and severe hypoxemia in COVID-19 pneumonia during follow-up and treatments, It was revealed that the prone position used in ARDS treatment can be used as an adjuvant treatment method to increase oxygenation. Prone position can be used worsening oxygenation (20% reduction in PaO2/FiO2 compared to supine position), if complications do not develop (such as pressure ulcers, brachial plexus injury, corneal/ conjunctival damage, facial/periorbital venous catheter related problems), It can be performed alternately with the supine position for at least 4 hours until PaO2/FiO2 ≥150 mmHg, positive endexpiratory pressure ≤10 cmH2O, FiO2 ≤0.60. In this article, we aimed to present the results of the prone position we used for the treatment of hypoxia in 2 cases that we admitted in our intensive care unit with the pre-diagnosis of COVID-19 at the age of 68 and 81. [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]

Objective: It is known that infections caused by influenza viruses are important public health problems all over the world. In this study, the general features of influenza A (H1N1) virus infections were reviewed and the data of severe cases treated in intensive care unit were summarized. Materials and Methods: Demographic characteristics, clinical, laboratory and radiological findings of 12 patients with H1N1 who were followed up in the intensive care unit between 2009 and 2013 were evaluated retrospectively. Results: The mean age was 33.9 years and 66% of the cases (n=8) were female. In 75% of the cases (n=9), an underlying cause such as respiratory, metabolic disease or pregnancy was detected. Eleven patients (92%) had acute respiratory distress syndrome, and ten patients (83%) had multi-organ failure and septic shock. Encephalitis was detected in two patients and peripheral circulatory defect was observed in two patients. The most common finding in the radiological examinations was infiltration of the lower and central zones of the lung. The length of intensive care stay was 1 to 18 days, and the mortality rate was 83% (n=10). Conclusion: The severity of pulmonary symptoms was the most important determinant of prognosis in patients with H1N1 and mortality increased in the presence of an underlying risk factor. [ABSTRACT FROM AUTHOR]

Gynecologic tumors originating from great vessels are observed quite rarely. Migrating along with the bloodstream; they can extend into cardiac chambers in chronic process. As they reach to larger sizes, and become symptomatic urgent surgery may be needed. These patients whose surgical and anesthesiologic management create difficulties are open to hemodynamic and respiratory complications. In this case report; we tried to describe anesthesiologic management of a patient who had intracardiac gynecologic tumor, and presented with acute respiratory failure, in the light of literature. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to investigate the efficacy of pre-hospital use of aspirin and anti-inflammatory agents in patients with Acute Respiratory Distress Syndrome (ARDS) and mortality in critically ill patients, by retrospectively screening ARDS patients treated in intensive care unit (ICU). Material and Method: Demographic data, duration time of ICU, intensive care unit Apache-II score, presence of comorbidity and mortality, procalcitonin and C-Reactive Protein (CRP) levels, neutrophil/lymphocyte (NID rates, Berlin Criteria, the use of aspirin and anti-inflammatory drugs, and the presence of infection findings from the files of ARDS patients followed from January 2016 to January 2017. Results: Forty of the 43 ARDS patients were included in the study. Eighteen patients (90%) had worsening in the first week, 24 (70%) had chest X-ray pathology, 15 had (75%) pulmonary edema and 12 had (60%) needed oxygen. Statistically significant difference was found in these Berlin Criteria (p<0.05). There were significant differences between last procalcitonin values, the first and last CRP, N/L ratios values, hospitalization times and APACHE II scores (p<0.05). There were no statistically significant differences between first and last leukocyte levels (p≤0.05). Conclusion: Pre-hospital aspirin and anti-inflammatory drugs seemed to decrease morbidity in terms of Berlin Criteria but there were no significant differences between mortality in ARDS patients in intensive care unit. However, further research is needed to confinn the results. [ABSTRACT FROM AUTHOR]

Neuromuscular blocking agents can be used for purposes such as eliminating ventilator-patient dyssynchrony, facilitating gas exchange by reducing intra-abdominal pressure and improving chest wall compliance, reducing risk of lung barotrauma, decreasing contribution of muscles to oxygen consumption by preventing shivering and limiting elevations in intracranial pressure caused by airway stimulation in patients supported with mechanical ventilation in intensive care units. Adult Respiratory Distress Syndrome (ARDS), status asthmaticus, increased intracranial pressure and therapeutic hypothermia following ventricular fibrillation--associated cardiac arrest are some of clinical conditions that can be sustained by neuromuscular blockade. Appropriate indication and clinical practice have gained importance considering side effects such as ICU-acquired weakness, masking seizure activity and longer durations of hospital and ICU stays. We mainly aimed to review the current literature regarding neuromuscular blockade in up-to-date clinical conditions such as improving oxygenation in early ARDS and preventing shivering in the therapeutic hypothermia along with summarising the clinical practice in adult ICU in this report. [ABSTRACT FROM AUTHOR]

In patients with acute respiratory distress syndrome (ARDS), many factors, especially barotrauma may cause pneumothorax. Early detection of pneumothorax is critical in ARDS patients. When pneumothorax is suspected, chest radiography is usually preferred as the first line imaging modality. Recently, ultrasonography has been used by intensive care physicians in many fields, even in imaging of pneumothorax. We present a 75-year-old female patient with ARDS complicated by pneumothorax, in whom chest radiography was not diagnostic but ultrasound was used for diagnosis and follow-up. [ABSTRACT FROM AUTHOR]

Leptospirosis is a zoonotic infection caused by spirochetes and is usually seen in rural areas. The clinical status may range from self-limiting mild leptospirosis to icterohemorrhagic leptospirosis characterized by jaundice, renal failure and hemorrhage progressing to acute respiratory distress syndrome and multiple organ dysfunction syndrome. In this study, we aimed to present a fatal leptospirosis case followed in the intensive care unit. [ABSTRACT FROM AUTHOR]

The use of heated and humidified high-flow nasal cannula oxygen (HFNC) is increasingly popular in place of conventional oxygen therapy for patients with acute hypoxemic respiratory failure. HFNC oxygen rapidly alleviates symptoms of respiratory distress and the effort to breathe through several mechanisms, including dead space washout, reduction in inspiratory nasopharyngeal resistance, and a positive airway pressure effect that may generate alveolar recruitment. HFNC oxygen increases the comfort and tolerance of patients and reduces the requirement for respiratory support in patients with respiratory failure. Several studies have shown that HFNC oxygen may also reduce breathing effort and respiratory rate, and increase alveolar ventilation, tidal volume, and exercise tolerance in patients with hypercapnic respiratory failure. Presently described are 2 cases in which a HFNC system was used to successfully manage hypercapnic respiratory failure secondary to chronic obstructive pulmonary disease in 2 patients unable to tolerate conventional noninvasive mechanical ventilation. This report is presented in order to draw attention to the use of HFNC oxygen in patients with hypercapnic respiratory failure. [ABSTRACT FROM AUTHOR]

Hemophagocytic histiocytosis is a syndrome of similar inflammatory response that can occur with different underlying pathologies that can be seen at any age. It is a rare disease characterized by fever, splenomegaly, jaundice, hemophagocytosis of bone marrow and other tissues (phagocytosis of erythrocytes, leukocytes platelets and their precursors by macrophages). There are two forms as primary and secondary, primary form (familial hemophagocytic syndrome) is autosomal recessive inheritance. It is seen in newborn children approximately 1/50.000 ratios. The secondary form is especially associated with Epstein-Barr virus infection, but it can be seen together with viral, bacterial, fungal and parasitic infections, collagen tissue diseases and malignant diseases. In this article, a 44-year-old female patient with no chronic disease history and has respiratory complaints was admitted to the chest diseases service with pre-diagnosis of pneumonia and the patient was admitted to the intensive care unit after the development of acute respiratory distress syndrome (ARDS). In this case, the development of hemophagocytic syndrome due to ARDS which is rarely seen syndrome is presented while ARDS therapy continues. [ABSTRACT FROM AUTHOR]

Although fever, cough and dyspnea are the major symptoms of Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2), it may have different signs and symptoms. COVID-19 has different clinical forms. A broad spectrum can be seen from asymptomatic cases to acute respiratory distress syndrome and respiratory failure. In this review, clinical findings related to COVID-19 are explained in the light of current information. [ABSTRACT FROM AUTHOR]

Nearly 5% of patients with COVID-19 need intensive care unit (ICU) admission due to the severity of disease progress. These patients generally have pneumonia induced acute respiratory disease syndrome (ARDS) and mostly need invasive mechanic ventilation. ARDS is a specific disease state that needs a long and complex treatment period. Since critical patients with COVID-19 have high viral loads and require a long therapy period, the risk of disease transmission from patients to medical staffs is high. Therefore, healthcare personnel should wear personal protective equipment (gloves, respirators, full bodysuits, bonnet, safety glasses, and full shield in the case of contact with airway) during the invasive procedures and therapies. In this article, we wanted to share our own experience of caring for critically ill patients with COVID-19-pandemia. [ABSTRACT FROM AUTHOR]

Introduction: Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of illness, bilateral chest radiographic infiltrates consistent with pulmonary edema, and poor systemic oxygenation. ARDS has severe morbidity and mortality. The most common risk factor for the development of community-acquired ARDS is severe sepsis with a pulmonary source of infection. The first step in the therapy of ARDS is identification and treatment of the underlying disease. Here, we report two cases of ARDS associated with Legionnaires disease. Case 1: A 54-year-old male tourist with diabetes mellitus apply to our institution with diarrhea and high fever. At the time of admission, the patient had a temperature of 39.5°C, a blood pressure of 140/70 mmHg, a heart rate of 102 beats/min and a respiratory rate of 24 breaths/min. His oxygen saturation was 93% while breathing room air. Chest examination revealed rales and the chest x-ray showed right-lower zone infiltrates. Legionella urinary antigen was positive on admission day. Treatment with levofloxacin (1000 mg/day) was started in the first 4 hours of admission after taking cultures. The patient had progressive dyspnea and cyanosis was developed. Analysis of arterial blood gas revealed a pH of 7.29, CO2 pressure of 30 mmHg, O2 pressure of 37 mmHg and oxygen saturation of 62%. Roentgenogram of the chest worsened and showed bilateral infiltration, indicating ARDS. Thirty-two hours after admission, the patient was admitted to intensive care unit for ventilator support. The patient's clinical status continued to deteriorate. He was hypotensive and required dopamine infusions for blood pressure support. Legionella pneumophila serogroup 1 was isolated on sputum culture. Five days after hospitalization, chlarithromycin (1000 mg/day) and ciprofloxacin (1200 mg/day) were substituted for the initial antibiotics. The patient had nosocomial pneumonia caused by methicilline resistant Staphylococcus aureus during subsequent days. Vancomycine 2 gr/days was added to treatment. Clinical status improved and the body temperature fell below 37.5°C on the eleventh day. On the patient's relatives' request, he was flown back to his country by air ambulance. One year later, the patient came back again as a tourist and had fully recovered from the illness. Case 2: A 82-year-old female with diabetes mellitus applied to our institution with high fever, dyspnea and mental change. She had been treated for pulmonary edema without any response to this therapy in a private hospital. She had been hospitalized in another hospital due to gastrointestinal bleeding approximately two weeks prior to her application. Chest examination revealed diffuse rales and the chest x-ray showed bilateral infiltrates. Analysis of arterial blood gas revealed pH of 7.31, CO2 pressure of 41.7 mm Hg, O2 pressure of 21.9 mmHg and oxygen saturation of 33.6%. The patient was admitted to intensive care unit for ventilator support. Legionella urinary antigen was positive on admission day. Treatment with ciprofloxacin (1200 mg/day) and chlarithromycin (1000 mg/day) was started on admission after taking cultures. Legionella pneumophila serogroup 1 was isolated on endotracheal aspirate culture. The patient died on the 7th day. Conclusions: The clinicians should be aware of Legionnaires disease in etiology of ARDS. Early diagnosis and treatment are important factors in determining prognosis. [ABSTRACT FROM AUTHOR]

Objective: The incidence of barotrauma in patients who received mechanical ventilation (MV) has decreased due to protective MV strategies. This study aimed to assess the incidence, treatment, and prognosis of barotrauma in patients who received MV in our tertiary intensive care unit (ICU) and to discuss with the literature. Material and Methods: Patients hospitalized between January 2008 and December 2014 were assessed. Those who had barotrauma were retrospectively analyzed. Results: Invasive MV was performed in 861 of 1341 patients. Barotrauma was seen in 19 (2.2%) patients. These patients' (mean age, 63.2±18.2 years; 14 males) median APACHE II score was 18, and their median duration of MV was 168 h. Acute Respiratory Distress Syndrome(ARDS) was diagnosed in 57.9% of the patients at admission, and volume-controlled ventilation was mostly used (47.4%). Barotrauma occurred on day 8 (median; range, day 4--21). Pneumonia was diagnosed in 84.2% of the patients. Pressure support ventilation was mostly used (47.4%) at the time of barotrauma. All patients had pneumomediastinum. Pneumothorax was diagnosed in 16 (84.2%) patients (bilaterally in 3 patients). Subcutaneous emphysema was seen in 11 patients (57.9%). Pneumothorax was treated by tube thoracostomy in 15 patients (83.3%). While the mortality rate was 26.3% in first 24 h, the overall mortality rate was 100%. Conclusion: The incidence of barotrauma was lower among our ICU patients who received MV, but the prognosis of these patients was poor. [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome (ARDS) is characterized by pulmonary edema caused by sudden increase in alveolocapillary membrane permeability, hypoxemia, and bilateral lung infiltration. Despite improvement in ICU treatment modalities, the mortality rate among ARDS patients is still considerably high. In the treatment of ARDS, in addition to the treatment of underlying cause, low-tidal volume, lungprotective mechanical ventilation is recommended. However, in patients who cannot attain target oxygen level or develop high plateau pressure despite low-tidal volume ventilation and who cannot tolerate high carbon dioxide and low pH levels, extracorporeal membrane oxygenation (ECMO) may be considered as a good treatment option. In this article, cases of ARDS patients treated with ECMO in our clinic during 2013-14 have been retrospectively documented and discussed in line with the literature. [ABSTRACT FROM AUTHOR]

Amaç: Akut respiratuvar distres sendromu (ARDS) yüksek mortalite ve morbidite ile seyreden bir hastalık olup standart tedavide akciğer koruyucu ventilasyon stratejileri uygulanmaktadır. Bu uygulamalar sırasında düşük tidal volüm ventilasyonu ve yüksek pozitif ekspiryum sonu basınç nedeniyle hastalarda yüksek karbondioksit (PCO2) değerleri ile karşılaşılmaktadır. Derin sedasyon, nöromüsküler bloke edici ajanlar, solunum sayısını artırma, rekruitment manevraları ve pron pozisyon gibi kurtarıcı tedavilere rağmen hemodinamik instabiliteye neden olan ciddi respiratuvar asidoz ve hipoksemi durumlarında ekstrakorporeal destek tedavilerine başvurulmaktadır. Ekstrakorporeal membran oksijenizasyonu (ECMO) endikasyonu bulunmayan, ECMO merkezlerine transferi mümkün olmayan ve izole CO2 yüksekliği ile seyreden ağır ARDS hastalarında renal replasman tedavisine (RRT) entegre edilebilen ekstrakorporeal CO2 uzaklaştırma (ECCO2R) sistemi kulanılabilir. Bu çalışmada ECCO2R filtresi ile takip ettiğimiz tedaviye dirençli hiperkapnisi olan iki olgumuzu sunmayı hedefledik. Olgu: Hastanemiz yoğun bakım ünitelerinde takip ettiğimiz rutin ARDS protokolüne rağmen kan gazında şiddetli hiperkapnisi bulunan alev yanığı nedeniyle takip sırasında sepsis ve ARDS gelişen 23 yaş erkek ve ileus operasyonu sonrası pnömoni ve ağır ARDS tanılarıyla takip edilen 64 yaş erkek iki hastamızı RRT için kullandığımız cihazımıza ilk hastada ECCO2R (Prismaflex PrismaLung+-Baxter), sitokin (Prismaflex oXirisBaxter) ve karbon (Prismaflex Hp & Adsorba Charcoal Cartridges-Baxter) filtreleri; ikinci hastada ECCO2R ve sitokin filtreleri ekleyerek takip ettik. İki hastamızın da tedavi başlangıcında derin respiratuvar asidozu olup; kan gazında pH ve PCO2 değerleri sırasıyla 6,9/90,5 mmHg ve 7,05/88 mmHg idi. İlk hastada tedaviye rağmen asidoz gittikçe arttı (respiratuvar + metabolik), yaygın enfeksiyona bağlı septik şok nedeniyle ertesi gün eks oldu. İkinci hastanın 2 saat sonra alınan kan gazında PCO2 değerlerinde anlamlı düşüş (56 mmHg) ve pH değerinde anlamlı artış (7,21) izlendi. Ayrıca hastamızın oksijen ve inotrop destek ihtiyacında azalma ve PO2 ve SpO2 değerlerinde anlamlı artış izlendi. Yirmi dört saat sonra kan gazı değerleri pH 7,36, PCO2 43 mmHg, PO2 140 mmHg idi. ECCO2R ile takibi sırasında kan gazı değerleri normal seyreden hasta dirençli pnömosepsis ve septik şok nedeniyle eks oldu. Sonuç: Ağır ARDS olgularında akciğer koruyucu ventilasyon stratejileri ve kurtarma manevralarına rağmen hiperkapnik seyreden hastalarda erken aşamada kar-zarar hesabı yapılarak respiratuvar hemodiyaliz (ECCO2R) başlanması hastanın kliniğine katkı sağlayabilir. [ABSTRACT FROM AUTHOR]

Amaç: İntestinal lipomatozis, matür yağ dokusunun intestinal submukozal veya subserozal tabakalarına multifokal infiltrasyonu ile karakterize çok nadir görülen bir hastalıktır. Abdominal bölgede çok sayıda lipomla giden olgularda intraabdominal basınç (İAB) artışı izlenebilmektedir. Bu durum çeşitli mekanik komplikasyonlara yol açabilmekte ve özellikle solunumsal etkilenmeyle giden sistemik enflamasyon durumlarının (ARDS gibi) yönetimini güçleştirebileceği düşünülmektedir. Bu olgu sunumumuzda, ARDS nedenli şiddetli solunum yetmezliği ile seyreden hastada eş zamanlı intestinal lipomatozisin ARDS tedavi yönetimi ve prognozuna etkisini ortaya koymaya çalıştık. Olgu: Otuz yaşında, bilinen intestinal lipomatozis tanılı kadın hasta 3 gün önce başlayan solunum sıkıntısının şiddetlenmesi, desatürasyon gözlenmesi üzerine acil serviste entübe edilerek hastanemiz YBÜ’ye yatırıldı. Hastanın tetkiklerinde saptanan AFR değerlerinde artış ve PAAC’de bilateral yaygın infiltrasyon sebebiyle hastada sepsise sekonder ARDS ön tanısı düşünüldü. Hastanın mekanik ventilatördeki takiplerinde uygun PEEP titrasyonu ve akciğer koruyucu ventilasyon stratejilerine rağmen hava yolu basınçları yüksek seyretmeye devam etti. Bu durumu şiddetlendiren faktörler arasında en büyük etkinin intestinal lipomatozisin yarattığı abdominal distansiyon ve intraabdominal basınç artışı olduğu düşünüldü. İAB ölçümü yapıldı ve 32 cmH2O tespit edildi. Uygun PEEP titrasyonu amacı ile PV-tool yapıldı ve alt infleksiyon noktasının 30 cmH2O olduğu görüldü. Hastanın PEEP değeri 32 cmH2O olarak ayarlandı. İAB artışı nedeni ile genel cerrahiye konsülte edilen hastaya acil cerrahi girişim düşünülmedi ve lavman önerildi. Distansiyonu azaltmak için önerilen tedavinin uygulanmasına ve optimal PEEP titrasyonuna rağmen solunum parametrelerinde düzelme izlenmeyen ve inotrop ihtiyacı artan hasta YBÜ’ye yatışının 16. gününde solunum yetmezliği nedeniyle kaybedildi. Sonuç: Bazı yaygın intestinal lipomatozisli hastalarda intusepsiyon, kanama, perforasyonun yanı sıra lipomların oluşturduğu hacim etkisiyle abdominal distansiyon ve barsak obstrüksiyonu meydana gelebilmektedir. Dolayısıyla özellikle abdominal distansiyona yol açmış yaygın intestinal lipomatozisli hastalarda, ARDS gibi ciddi solunumsal yetmezlik oluşturan durumların, prognoz ve tedaviye yanıtı daha da kötüleştirebileceği varsayılabilir. Bu nedenle akciğer koruyucu ventilasyon uygulamalarının zorluğu ve gereğinde cerrahi girişim seçeneğinin de akılda tutulması gereklidir. [ABSTRACT FROM AUTHOR]

Amaç: C OVID-19 enfeksiyonu olan gebelerde, mortalite ve morbidite artmıştır. Gebelerde artmış enflamatuvar cevabın, bu kötü prognozla ilişkili olduğu gösterilmiştir. Olgu: Ek hastalığı olmayan, solunum sıkıntısı şikayetiyle hastanemize başvuran, COVID-19 aşısı yaptırmamış 39 yaşında, 32 haftalık gebe, PCR pozitifliğinin 6. gününde servis takibine alındı. İlk başvurusunda nazal oksijen desteğiyle SpO2 >%95 sağlanmaktaydı. Yatışının 3. gününde dispnesi artan hastaya high-flow nazal oksijen (HFNO) ve noninvaziv mekanik ventilasyon (NİMV) döngüsü ile solunum desteğine başlanarak, tedavisine metilprednisolon eklendi. Hastanın SpO2 <%92 olması durumunda, planlama olarak, acil sezeryan ve sonrasında yoğun bakım ünitesine transferi olarak belirlenip heparin infüzyonu ile antikoagülasyona geçildi. Yatışının 7. gününde interlökin 6 düzeyi 53 saptanan hastaya tocilizumab verildi. Yatışının 8. gününde hipoksik, hipotansif izlenen hasta NİMV ile ameliyathaneye transfer edilerek, genel anestezi altinda sezaryen kesi ile doğuma alındı. İntraoperatif paO2/fiO2 değeri 60 olan hastaya sezeryan bitiminde sağ vena jugularis interna - sağ vena femoralis yoluyla perkütan venovenöz (vv) ECMO’ya alınarak yoğun bakim ünitesine transfer edildi. PCV modda %60 fiO2 ile driving pressure 15 olacak şekilde mekanik ventilasyonu ayarlandı. İzleyen günlerde aralıklı recruitment manevraları yapıldı. Hastanın vv-ECMO desteğindeki fiO2 desteği kademeli olarak düşürüldü. Yoğun bakım yatışının 13. gününde vv-ECMO desteğinin fiO2 değeri 40’a indirilen hasta vv-ECMO’dan ayrıldı. Toraks tomografisi değerlendirilmesinde alt loblarda belirgin konsolidasyon ve atelektazi alanlari devam eden hastanın mekanik ventilasyon ile takibine devam edildi. Sedasyonları sonlandırılan, şuuru açık ve koopere takip edilen, spontan solunum çalışmaları yaptırılan hasta yoğun bakım yatışının 19. gününde ekstübe edilerek HFNO ile spontan solunuma alındı. Yoğun bakım yatışının 23. gününde yürüteç ve nazal oksijen desteğiyle mobilize olabilen hasta, servise transfer edildi. Sonuç: Literatürde kısıtlı sayıda olgu bildirimlerinde COVID-19 ilişkili ARDS tedavisinde vv-ECMO desteğiyle anne sağkalımının arttığı gösterilmiştir. Biz de bu hasta grubunun peri-postpartum dönemlerinde vv-ECMO ile desteklenmesini seçilmiş hastalarda önermekteyiz. [ABSTRACT FROM AUTHOR]

Amaç: COVID-19 pandemi döneminde önemli bir maternal morbidite ve mortalite nedeni olmuştur. Bununla birlikte, mevcut araştırmalar, COVID- 19 ile gebenin hastalık ciddiyetinin, %0-18 arasında şiddetli pnömoni oranıyla hamile olmayan kadınlarınkine benzer olduğunu göstermektedir. COVID-19 için doğum sonrası alevlenmenin doğumdan hemen sonra kısa süreli patofizyolojik değişiklikler nedeniyle ortaya çıktığını bildiren yayınlar olsa da bunun hastalığı seyriyle de ilişkili olabileceği bilinmektedir. Çalışmamızda pandemi döneminde COVID-19 varyantlarının gebelerde ve lohusalarda mortaliteyi artırıp artırmadığı ve aşılanmanın mortalite ve morbiditeye etkilerinin araştırılması hedeflenmiştir. Gereç ve Yöntem: Pandemi yoğun bakımlarda yatan 40 adet 18 yaş üstü gebe ve lohusa hasta bu prospektif gözlemsel çalışmaya dahil edilmiştir. Yaş, mevcut komorbiditeler, aşı durumu, gravida parite, gebelik haftası, semptom başlangıç tarihi, hastada COVID-19 PCR pozitif gelen tarih, eğer çalışıldıysa varyant durumu, yoğun bakıma giriş tarihi, gebenin doğum yaptığı tarih, doğum eylemi gerçekleşti ile bebeğin APGAR skoru, entübasyon tarihi, yoğun bakımdan taburculuk tarihi, mortalite durumu ile birlikte yoğun bakıma giriş laboratuvar verileri ile entübe olan hastalarda entübasyon günü laboratuvar verileri kaydedilmiştir. Bulgular: Eksitus olan 10 hastanın 9’u aşısız ve 1’i tek doz Sinovac yaptırmıştı. Mortalite açısından aşılı ve aşısız hastalar arasında istatistiksel anlamlı fark yoktu. Eksitus olan 10 hastanın 7’si alfa varyant 3’ü delta varyantdı. Otuz altı alfa varyant olan hastanın 7’si (%9,4) eks olurken, 4 tane delta varyantı olan hastanın 3’ü (75%) eks olmuştur ve bu istatistiksel olarak da anlamlıdır (p=0,042). Sonuç: Gebe kadınlar, değişen fizyolojileri, enfeksiyonlara duyarlılıkları ve bozulmuş mekanik ve immünolojik işlevleri nedeniyle herhangi bir bulaşıcı hastalık salgınında savunmasız bir grubu temsil eder. Fetüsün korunması ihtiyacı, sağlıklarını yönetme zorluğuna katkıda bulunur. DSÖ gebeliğin her döneminde ve lohusalarda aşılanmayı önermektedir. Çalışmamızda hastaların çoğunu aşısız gebeler oluşturmakta idi. Mortalite açısından aşılı ve aşısız gebeler arasında fark olmasa da bu durum aşılı hasta sayısının az olmasına bağlı olduğu düşünülmektedir. [ABSTRACT FROM AUTHOR]

Lung injury resulting from inhalation of chemical products continues to be associated with high morbidity and mortality. Concentrated nitric acids are also extremely corrosive fuming chemical liquids. Fumes of nitric acid (HNO3) and various oxides of nitrogen such as nitric oxide (NO) and nitrogen dioxide (NO2) may cause fatal illnesses such as severe pulmonary edema and acute respiratory distress syndrome (ARDS) when inhaled. Intensive respiratory management including mechanical ventilation with positive end expiratory pressure (PEEP), inverse ratio ventilation, replacement of surfactant and extracorporeal membrane oxygenation (ECMO), steroids and n-acetylcysteine (NAC) may improve survival. In this case report we present the diagnosis and successful treatment of a 57 years old male patient who developed ARDS following pulmonary edema due to nitric acid fumes inhalation. [ABSTRACT FROM AUTHOR]

ARDS is an inflammatory process that can be life-threatening respiratory failure. ARDS can be a directly derived lung injury from infection or aspiration of gastric contents or an indirect injury that can be derived from an extrapulmonary process. Although more than 60 reasons have been defined, the most common cause of ARDS is sepsis. The incidence is between 28-32 cases per 100,000. Although intensive care management has evolved, mortality is still between 34%-58%. Refractory hypoxia in ARDS necessitates hypoxemic rescue therapy strategies. Patients with ARDS have two important primary physiologic problems. The first and most important problem is severe hypoxia stemming from alveolar collapse due to loss of alveolar surfactant. The other problem is the accumulation of protein-rich edematous fluid in the alveoli and interstitium and a significant decrease in respiratory system compliance because of loss of surfactant. Lung-protective ventilation strategies have been successful in such cases. Rescue therapies, such as iNO, prone positioning, recruitment maneuvers, titration of PEEP, and HFOV, which can be chosen due to the etiology and progress of the pathology, are promising. [ABSTRACT FROM AUTHOR]

Thoracic trauma defines injuries of the ribcage and the intrathoracic organs. Patients with multitraumas are first approached by providing an airway (A: Airway), maintaining breathing (B: Breathing), and providing blood circulation and the control of bleeding (C: Circulation). In the management of patients with such traumas, well-equipped intensive care units (ICUs) with well-educated staff are necessary, as is a multidisciplinary approach. The major frequent complications seen in the ICU follow-up of patients with trauma involve infection, atelectasis, empyema, pulmonary embolism, air embolism, kidney failure, hyperglycemia, delirium and severe sedation, bronchopleural fistula, acute respiratory distress syndrome (ARDS), malnutrition, decubitus, nosocomial infections, and pneumomediastinum. [ABSTRACT FROM AUTHOR]

Amaç: Aralık 2019’da Çin’in Wuhan şehrinde ortaya çıkan, günümüzde çok yaygın olan koronavirüs hastalığı-2019’un (COVID-19) hala etkin ve spesifik bir tedavisi bulunmuş değildir. Bu hastalarda hızla ARDS, sepsis ve multiorgan yetmezlikleri gelişebilmektedir. Tedavide yeterli oksijenizasyonun sağlanması önemli rol oynamaktadır. Bu çalışmada yoğun bakım ünitesinde yatmakta olan hastaların uygun farmakolojik tedavi ve oksijenizasyonlarının sağlanmasıyla beraber prone pozisyonunun tedavi üzerine etkisini incelemeyi amaçladık. Hastanemiz anestezi yoğun bakım 1-2 ünitesinde COVID-19 tanısıyla Ocak 2021-Aralık 2021 tarihleri arasında takip edilen 548 hastayı retrospektif olarak inceledik. Olgu: COVID-19 nedeniyle yoğun bakımda takip edilen hastaların %46,54’ü kadın, %53,46’sı erkekten oluşmaktadır. Yaş ortalaması 71,31 olup, yoğun bakımda kalış süreleri ortalama 63,7’dir. Hastaların mortalite oranları %62,59’dur. Sonuç: Akciğer tutulumu yüksek olan hastalarda SpO2 düşmektedir. Bu hastalara HFNO ve NIMV uygulaması yaygın olarak kullanılmaktadır. Entübe edilen hastaların ekstübasyon oranının az olması ve mortalite oranının fazla olması sebebiyle entübasyon olabildiğince geciktirilmeye çalışılmaktadır. Bu nedenle non-invaziv yöntemlerle hastanın oksijen artışına yönelik girişimler yapılmaktadır. Bunlardan en önemlilerinden biri hastanın pozisyonudur. Prone pozisyonu ile sırt üstü yatan hastanın tam tersine oksijenizasyonun düzelmesi ve karbondioksit atılımının artması, foksiyonel solunum kapasitesinin yükselmesi, perfüzyon dağılımının homojenize edilmesi, postral drenajın yapılması, diyafragmanın hareketli bölgesinin değişmesi lenfatik akımın homojenize edilmesi ve çevresel uyaranlara daha az maruz kalması sağlanır. Bunların yanında bu pozisyonda takip edilen hastalarda bası ülseri oluşma riski, pozisyona uyumsuzluk, ajitasyon ve aspirasyon riski mevcuttur. Bu hastalarda bası yarası oluşumuna yönelik bariyer krem kullanılarak hastanın kemik çıkıntıları desteklenmelidir. Beslenmeye yönelik nutrisyon birimi ve hekimle beraber paranteral ve enteral beslenme ürünleri planlanarak yüksek kalori alması sağlanmalıdır. Hastaya emosyonel destek verilerek pozisyona uyumu sağlanmalıdır. Sonuç olarak; prone pozisyonu verilen hastalarda yapılan tetkiklerde SpO2 de %10-15 oranında anlamlı yükseliş olduğu görülmüştür. Pozisyona uyum sağlayan hastalarda entübasyona gerek kalmadığı ya da entübasyon süresinin uzadığı ve iyileşme oranlarının, mortalite, morbidite ve hastanede yatış süresinin azaldığı görülmüştür. [ABSTRACT FROM AUTHOR]

Aim: Acute respiratory distress syndrome (ARDS) is an acute hypoxemic respiratory failure refractory to oxygen therapy. The incidence of ARDS is not high, but its management is very difficult for the intensivist and the mortality rate is high. In this study, the general characteristics of patients with ARDS in a medical intensive care unit (ICU) in a university hospital were evaluated. The mortality rate in these patients was determined and factors related to mortality were assessed. Material and Methods: Patients who had ARDS upon admission or developed ARDS after admission between April 2007 to August 2010 in our medical ICU were included in the study. The prospective data of ARDS patients were studied retrospectively. Demographic characteristics, reasons for ARDS, treatment modalities, mortality rate and factors determining mortality were evaluated. Results: One thousand one hundred and twenty-five (1125) patients were admitted to our medical ICU during the study period. Ninety (8%) patients had ARDS upon admission or developed ARDS after admission in this period. These ARDS patients were accepted as the study group. The median age was 46 [30-60] and 61% of patients were male. Upon admission, the APACHE II and Glasgow coma scores were 23 [17-28] and 15 [11-15], respectively. The most common underlying disease was hematological malignancy (57%). Sixty-two percent (62%) of patients were immunocompromised. The most common etiologies of ARDS were pneumonia (58%) and sepsis (21%). The ratio of partial oxygen pressure to inspired oxygen fraction (PaO2/FiO2) was 113 [76-166] mmHg. Nineteen percent (19%) of ARDS patients received non-invasive mechanical ventilation (NIMV), 30% received invasive mechanical ventilation (IMV), and 48% received both NIMV and IMV. ICU and hospital stay were 8 [4-14] and 22 [12-38] days, respectively. ICU and hospital mortality were 66% (59) and 70% (63), respectively. Performing NIMV and admission from the emergency room (ER) were found to be independent risk factors associated with lower mortality, whereas the development of immunosuppression and sepsis in the ICU were independent risk factors associated with higher mortality. Conclusion: The ICU mortality rate was 66% in our ARDS patients. We also found that immunosuppression and sepsis that developed in the ICU increased the mortality rate, while performing NIMV and admission from the ER reduced the mortality rate in our ARDS patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated patients with acute respiratory failure who were followed under mechanical ventilation support. Material and Method: 21 acute respiratory failure patients under mechanical ventilation support were included in the study. All patients were sedated with propofol infusion to have a sedation level of 3 on the Ramsay scale. After adequate sedation and hemodynamic stability was achieved, baseline values of oxygen consumption, carbondioxide production and energy consumption of the patients were measured by indirect calorimetry device and recorded. Neuromuscular transmission was monitorized by TOF-Guard, and then 0,1 mg/kg bolus dose vecuronium was administered to the patients. When TOF 0, 25, 50, 90 values were obtained, oxygen, carbondioxide and energy consumption were measured by indirect calorimetry device and recorded. Results: No statistically significant difference were found between preand post-curarisation hemodynamic parameters, ventilation parameters, arterial blood gas values (p>0.05). A statistically significant decrease was observed between the oxygen consumption, carbondioxide production and energy consumption measured before curarisation and when TOF value was 0 (p<0.05). However, there was no significant difference between TOF 25, 50, 90 values and the baseline value (p>0.05). Conclusion: It was concluded that the effect of neuromuscular blockage on reducing energy and oxygen consumption should be taken into consideration while calculating the daily energy need in intensive care in patients curarized at TOF 0 level. [ABSTRACT FROM AUTHOR]

Intrauterine dead fetus can increase maternal morbidity and mortality inducing serious bleeding and infection. Coagulapathy as a result of hyperfibriolysis activated by the dead fetus is one of the reasons that trigger disseminated intravascular coagulapathy (DIC) cascade in the affected patient. DIC is a serious risk factor that causes the acute respiratory distress syndrome (ARDS). In this paper, we aim to present a patient with postpartum DIC following ARDS caused by intrauterine dead fetus. [ABSTRACT FROM AUTHOR]

Aim: To compare invasively mechanically ventilation (IMV) for acute respiratory failure patients with obstructive (OLD) and restrictive (RLD) lung disease. Material and Methods: In this retrospective cohort study, 79 patients (OLD: 52, RLD: 27) were chosen from 122 patients, mechanically ventilated over 24 hours in a respiratory critical care unit, between January 2004 and December 2005. The clinical and demographic charateristics at the beginning, arterial blood gases and APACE II results before intubation, on the weaning day, extubation time and day of discharge from the critical care unit, total IMV duration, critical care days are compared by means of mortality and complication rates. Results: The mean age was 62±14 while the gender variation was F/M: 23/56. In the OLD group, age and HCO3 ( initial) results were higher (p=0.01, p=0.054) while respiratory rate and oxygen saturation results were lower (p=0.04, p= 0.053) than in the RLD group. Gender, comorbidity and the other initial results were similar in both groups. In the RLD group, the PaO2 results and APACHE II scores before extubation were lower (p=0.046, p=0.02). The extubation failure rate was 63% in the RLD group, and 8.5% in the OLD group (p=0.03). Total IMV and critical care unit duration, complications and mortality rates were similar. Conclusion: Noninvasive mechanical ventilation is recommended immediately after extubation of acute respiratory failure patients with RLD, as extubation failure rates are higher in these patients than in the OLD patients. [ABSTRACT FROM AUTHOR]

Myasthenia gravis is an autoimmune disease of the nicotinic acetylcholin receptors at the postsynaptic membrane of the neuromuscular junction. Myasthenic crisis, defined as respiratory failure requiring mechanical ventilation is a common life-threatening complication that occur approximately 15% to 20% of patients with MG. Endotracheal intubation and invasive mechanical ventilation have a number of complications and a high mortality. On the other hand, noninvasive mechanical ventilation is being successfully used in many pulmonary and neuromuscular diseases . There are few reports about the use of noninvasive mechanical ventilation in myasthenic crisis. We present a case with myasthenic crisis who was treated with noninvasive mechanical ventilation. [ABSTRACT FROM AUTHOR]

Chilaiditi's syndrome is the interposition of the colon or small bowel between the right hemidiapragma and the liver. In general, patients are asymptomatic, but some patients have been associated with gastrointestinal or respiratory symptoms. Here is reported a six-year- old boy who was admitted to our hospital complaining of breathlessness and respiratory distress caused by Chialiditi's syndrome, and who was treated conservatively. [ABSTRACT FROM AUTHOR]

A seven-month pregnant woman who admitted to the hospital with high fever, cough and fatigue and developed respiratory failure within one day, was admitted to the intensive care unit with the diagnosis of acute respiratory distress syndrome (ARDS) and suspected H1N1 infection. The patient, who had bilateral infi ltration on her chest X-ray, did not respond to the ventilator adjustments appropriate to ARDS, empirical Oseltamivir treatment. In spite of this treatment, her oxygenation became worse and she was treated by caesarean section. When the patient's saturation fell to 35%, 18 cmH2O pressure PEEP was implemented, then it was observed that her oxygenation began to show improvement. The patient's initial H1N1 diagnosis was confi rmed. The patient's overall health returned to normal, while no serious health problem was observed in the baby. Since pregnant patients with H1N1 may develop serious respiratory failure within a very short time, we found this report signifi cant because lung expansion may increase with section and this condition assists the treatment of using high PEEP pressures. [ABSTRACT FROM AUTHOR]