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In recent years, perioperative transesophageal echocardiography has become well estab-lished and widely used in several heart surgical operations. Heart transplantation, which is the treatment of choice for patients with end-stage heart failure, may benefit from transe-sophageal echocardiography. It can be adopted for assessing donor organs in addition to the perioperative monitoring of heart transplant patients. In this review, the perioperative use of transesophageal echocardiography is discussed in heart transplantation. [ABSTRACT FROM AUTHOR]

A 61-year-old male patient diagnosed with Coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) was managed with tracheostomy and intermittent prone positioning in the intensive care unit. After a sudden deterioration, examination of tracheostomy tube (TT) and X-ray of the chest revealed that he had aspirated the fractured TT. The fractured tube was removed through the tracheostomy stoma using a rigid ventilating bronchoscope and forceps. Prone positioning is a beneficial postural therapy capable of improving patient oxygenation. However, it has some complications, like unplanned extubation and facial tissue injury. Percutaneous tracheostomy is also a valuable and safe procedure and has been increasingly performed in critical care patients, including those who suffer from COVID-19 ARDS. Fractures and aspiration of a tracheostomy tube can occur anytime after tracheostomy. We think prone positioning may contribute to the rupture and aspiration of the tracheostomy tube in this study. [ABSTRACT FROM AUTHOR]

Objective: Rapid response systems (RRSs), which aim to prevent cardiac arrests and unexpected deaths, have been implemented across hospitals worldwide. Most studies on RRS shave evaluated the effects of its implementation on in-hospital mortality. In this study, we evaluated the predictive factors of in-hospital mortality for patients who were subjects of RRS activation in a newly established major hospital in Turkey. Materials and Methods: Data on RRS activations were reviewed from paper charts and electronic medical records between March 2019 and February 2020. The demographic characteristics of patients, time of and reasons for RRS activation, initial cardiac rhythm, heart rate, mean arterial pressure, pulse oximetry-measured blood oxygen saturation (SpO2), time of arrival of the rapid response team, red cell distribution width, platelet distribution width obtained from the first blood gas analysis and haemogram test results as well as glucose, sodium, potassium, pH, lactate, neutrophils and lymphocyte levels were recorded. Univariate and multivariate logistic regression analyses were conducted to determine the independent predictors of in-hospital mortality. Results: A total of 531 patients were included in the analysis. Of these, 189 (35.6%) died during hospital admission. Compared with survivors, non-survivors were older (median age, 64 vs. 52 years) and more likely to be male (65.6% vs. 34.4%); be admitted for cardiovascular, pulmonary and oncologic diseases and trigger RRS at night and weekends than during the day. Activation of RRS by respiratory and haemodynamic triggers as well as during nighttime and weekend hours oncologic reasons for hospital admission, low SpO2 levels, high neutrophil-to-lymphocyte ratio (NLR), potassium levels and lactate levels were predictive of in-hospital mortality. Conclusion: This study found some weaknesses in the current RRS of the hospital. Hospital staffs working overnight and on weekends should be trained and empowered. SpO2, potassium and lactate levels as well as NLR are predictors of in-hospital mortality and can guide triage decision making, which is usually a challenging and stressful task. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery bypass grafting (CABG) plays an important role in the revascularization of ischemic heart disease. However, stroke is a rare but extremely serious complication after CABG. Aim: We investigated the relationship between platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio, red blood cell distribution width (RDW) values, and postoperative ischemic stroke by examining the preoperative complete blood count (CBC) parameters in patients who underwent CABG. Material and methods: A total of 1240 patients who underwent CABG between September 2016 and June 2019 were included in this retrospective observational study. The diagnosis of ischemic stroke was made in the postoperative period by neurology consultation and radiological imaging. The CBC data used as preoperative values for each case were obtained the day before surgery. Results: Ischemic stroke was observed in 40 patients. In patients with stroke, the mean age was higher, the hemoglobin (HB) value and lymphocyte count were lower (p < 0.001), and there were also higher neutrophil to lymphocyte ratio (NLR), PLR, and RDW values (p < 0.001), number of mechanical ventilator days, length of stay in the hospital, and length of stay in the ICU (p < 0.001). Statin and acetylsalicylic acid use were statistically significantly higher in patients without ischemic stroke after CABG (p < 0.001); the use of other antiaggregants was found to be higher in stroke patients (p < 0.05). However, age, operation time, PLR, NLR, and RDW values were determined as independent risk factors for ischemic stroke. Conclusions: In patients undergoing CABG, high preoperative PLR, NLR, and RDW values can be used as useful and independent risk factors for the prediction of postoperative ischemic stroke. [ABSTRACT FROM AUTHOR]

Introduction: Hospital-acquired anemia (HAA) is common, especially in the most intensive care patients (ICP). Several literature series suggest that patients who develop HAA have increased mortality and morbidity compared with those who do not. The cause of HAA is likely multifactorial; iatrogenic blood loss,impaired erythropoiesis, bleeding episodes all can lead to HAA in ICP. Little research has focused on HAA, which develops during ICU admission of ARDS patients. The objective of this study was to investigate the incidence HAA, as well as its relationship with mortality, in COVID-19 associated ARDS patients admitted to ICU. Materials and Methods: We retrospectively analyzed all adult COVID-19 ARDS patients admitted to our ICU between January 2020 and December 2021 (n=1,007). Patients with missing data (n=7) or who have a length of ICU stay of less than 24 hours (n=10) were excluded. In addition, patients with chronic anemia at admission (n=445) were also excluded, because main focus of the study was development of HAA. Anemia is defined as a hemoglobin (Hgb) value <12 g/dL in women and <13 g/dL in men by WHO. HAA was defined as a nadir Hgb value during the course of ICU stay meeting WHO criteria. We further grouped Hgb by degree into mild anemia (Hgb >11 and <12 g/dL in women, >11 and<13 g/dL in men), moderate anemia (Hgb >9 and ≤11 g/dL) and severe anemia (Hgb ≤9 g/dL). COVID-19 ARDS is diagnosed when the patient with confirmed COVID-19 infection meets the Berlin 2012 ARDS diagnostic criteria. Baseline patient characteristics, admission Hgb and lactate levels, lengths of ICU stay and in-hospital mortality of patients who developed HAA were compared with those who did not develop HAA. We further stratified the patients based on the severity of HAA. Results: HAA developed in 373 (68.4%) patients. Characteristics and mortality rates of patients with and without HAA are presents in Table 1. Table 2 shows the data of the patients by presence and severity of HAA. Conclusion: Development of HAA is common and associated with higher in-hospital mortality. Patients who developed severe HAA has the highest mortality rates (73.1%). Hospitals must raise awareness of HAA. [ABSTRACT FROM AUTHOR]

Introduction: Low hemoglobin levels are associated with an increased risk of mortality in intensive care (ICU) patients. The underlying reason is due to the limitation in oxygen delivery to the tissues caused by a reduction in the number of oxygen carrying erythrocytes. This study aimed to examine the relationship between hemoglobin drop (DHgb= admission hemoglobin-nadir hemoglobin), nadir hemoglobin levels (NdrHgb; the lowest hemoglobin value during ICU stay) and mortality in COVID ARDS patients admitted to intensive care. Materials and Methods: This was a prospective non-randomized study of consecutive COVID ARDS patients who had at least two determinations of hemoglobin level (the first on admission) separated by 24 hours and an ICU stay <14 days. Admission hemoglobin (AdmHgb), NdrHgb and DHgb levels were analyzed. Data on blood transfusions were also collected. Results: Although high DHgb and low NdrHgb levels were significantly associated with mortality in univariate analysis of patients, this was not sustained in multivariate analysis. The area under the ROC curve (AUC) of DHgb was 0.577, with a cut-off value of 1.9 g/dL, sensitivity and specificity were 50.7%, and 65.2%, respectively. NdrHgb had a cut-off value of 10.7 g/ dL, with an AUC of 0.423, sensitivity and specificity of 50%. Conclusion: Our results showed that DHgb and low NdrHgb levels are both predictive markers for mortality with moderate sensitivity and specifity. We recommend further studies evaluating a simple scoring model based on DHgb and NdrHgb for predicting mortality. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is the second most common cause of death (85%) worldwide. In addition, stroke patients with good nutritional parameters have a lower risk of death and earlier discharge from the hospital. In our study, we evaluated nutritional and other factors affecting intensive care mortality in stroke patients followed in the general intensive care unit. Materials and Methods: The data of 239 hemorrhagic and ischemic stroke patients followed in general intensive care units following ethics committee approval were evaluated retrospectively. Nutritional, sociodemographic and clinical characteristics of patients with hemorrhagic and ischemic stroke were compared and the effects of these characteristics on mortality were evaluated. Results: Comparisons of patients with hemorrhagic - ischemic stroke and stroke patients who lived and died was given in Table 1. Results of univariate and multivariate cox regression analysis performed to determine risk factors affecting intensive care mortality was given in Table 2. In the univariate model, stoke type, CPR (cardio-pulmonary resuscitation) requirement during intensive care stay, feeding time rate, nasogastric requirement, oral nutritional status, chronic kidney disease and APACHE II were statistically significant. In the multivariate model, the need for CPR, oral nutritional status, and APACHE II were statistically significant during ICU admission (respectively, p=0.032, p<0.001, p<0.001). Mortality risk was 14.8 times higher in patients who could not be fed orally than in patients who were fed orally. It was determined that a one-unit increase in the APACHE II score increased the mortality risk 1.07 times. Conclusion: We can say that mortality will decrease in stroke patients who can be fed orally, have a low APACHE II score, and do not need CPR during intensive care follow-up [ABSTRACT FROM AUTHOR]

Objectives: In this study, it was aimed to determine demographic and clinical characteristics, supportive treatments in intensive care unit (ICU), mortality rates and factors affecting mortality by grouping COVID-19 intensive care patients as octogenarian and nonagenarian groups, and patients younger than 80-years-old. Methods: The patients aged ≥18 years diagnosed with COVID-19 with PCR positivity in ICUs between March 19, 2020 and March 31, 2021 were included in this retrospective observational study. Results: Of the 1004 PCR positive patients, 58.7% were male. The youngest patient was 20, the oldest patient was 100-years-old. There were 738 patients in Group 1 (20-79 years) and 266 patients in Group 2 (≥80 years). Between the two groups, gender, APACHE II score, need for intubation, need for vasopressor/inotrope, and patients in need of care were higher in Group 2 (p<0.001 for all). Only the patients in Group 1 were established ECMO. Hypertension (HT), cardiovascular, respiratory and neurological diseases, number of comorbidity, and mortality rate were higher significantly in Group 2 (p<0.001, p=0.001, p=0.006, p<0.001, p<0.001, and p<0.001; respectively). Age, male gender, HT, intubation, and vasopressor/inotrope requirement were found to be predictors of mortality. Conclusion: COVID-19 may have a more severe and fatal course in the octogenerian and nonagenerian age group with high comorbidity in the ICU. [ABSTRACT FROM AUTHOR]

Objective: Coronavirus disease(COVID-19) rapidly spread worldwide after its first report in December 2019, in China. This spread drastically reduced the number of blood donations, thereby creating a shortage at blood banks in the whole world. Turkish Red Crescent (TRC) is the only legal authority that organizes collection, production, storage and distribution of blood and blood products in Turkey. Only in case of emergency TRC gives permanent permission to hospitals; for collecting blood and producing its components through their own transfusion centers. This report describes how the COVID-19 impacted blood supplies of TRC and hospital demands in Turkey with an aim to improve the management of blood supply and demand during the COVID-19 and future pandemics. Method: A cross-sectional study was conducted within a period of nine months from November 1, 2019 to July 31, 2020. Data were retrospectively obtained from donor attendance and blood inventory records of TRC and included; 1) the number of donated units of apheresis platelet concentrates (APC) and blood to TRC, 2) the number of units of APC and erythrocyte suspensions (ES) supplied by the hospitals themselves, 3) the number of units of APC and ES supplied to hospitals by TRC (APCH and ESH). The periods before (first period) and after (third period) emergence of COVID-19 outbreak in Turkey were compared. Results: An increase of 52% in the number of APC donations, but a decrease of 22% in the number of blood donations (NBDs) were detected in the third period compared to the first one. Mean APCH values were 7081±550 and 5121±55 units in the first and third periods,respectively. The mean ESH values in the first, and third periods were 873±326, and 3694±3143 units. Conclusion: It is obvious that we have learnt many lessons from the COVID-19 pandemic, like how to face challenges in maintaining the balance between blood demand and blood supply. Utilizing media to encourage donors and implementation of Patient Blood Management on national and institutional levels may be some of the key components of a comprehensive strategy. The collaboration of Ministry of Health, TRC and hospitals was successful in securing a balance between blood supply and demand in Turkey, on which COVID-19 pandemic impacted significantly. [ABSTRACT FROM AUTHOR]

Introduction: Cystoscopy is one of the most common procedures in outpatient urology. Although flexible cystoscopes are more tolerable, rigid cystoscopes have still been used in many clinics because of their lower costs, better visual performance, and easier handling. It can be difficult to achieve optimal relief of pain and anxiety during rigid cystoscopy. The aim of the present prospective randomized study was to evaluate the efficacy of hypnosis as an adjunct to routine local anesthesia in reducing pain and anxiety in rigid cystoscopy patients. Materials and Methods: Ninety male patients undergoing rigid cystoscopy for the first time were randomized into two groups: (1) Hypnosis Group (Group H) patients underwent cystoscopy with hypnotic communication as an adjuvant approach for periprocedural analgesia and anxiety, (2) Standard Care Group (Group SC) patients underwent cystoscopy with routine local anesthesia and lubrication as control group. The data were collected using visual analog scale (VAS) for pain, State-Trait Anxiety Inventory (STAI) for anxiety and hemodynamic parameters. Furthermore, a VAS was also completed by the urologist to assess his satisfaction. Results: Baseline characteristics, STAI, hemodynamic parameters, and recovery duration were statistically similar between the two groups. The procedure duration was shorter in Group H (p = 0.018). The postprocedural STAI and VAS scores of patients in Group H were significantly lower than those of Group SC (p = 0.006; p = 0.02, respectively). Heart rate and mean arterial pressure after positioning of the patient (p = 0.000; p = 0.004, respectively) and insertion of the cystoscope (p = 0.000; p = 0.000) were statistically lower in Group H, whereas baseline, postprocedural, and predischarge hemodynamic measurements were similar. Urologists were also more satisfied in Group H (p = 0.000). Conclusion: Hypnosis as an adjunct therapy to local anesthesia during rigid cystoscopy significantly reduces pain and anxiety, provides more stable hemodynamic conditions, shortens procedure duration, and thus appears attractive for pain and anxiety management. [ABSTRACT FROM AUTHOR]

perfusion, are usually measured by blood gas analyzers simultaneously with blood gases. Although arterial blood is the “gold standard” for measurement of lactate, the interchangeable use of arterial and venous lactate measurements can avoid increased costs and iatrogenic anemia resulting from frequent blood sampling when evaluation of venous blood gas samples are preferred. In this study; we aimed to examine the correlation and agreement between the arterial lactate (AL) and central venous lactate (CVL) values in patients undergoing on-pump cardiac surgery. Method: Adult patients who had both arterial and central venous blood gas sampling simultaneously in three stages (T1: after anesthesia induction, T2: during cross- clamping, T3: during skin closure) of operation as part of anesthetic management were eligible for inclusion in this retrospective study. CVL and AL concentrations were estimated during blood gas analysis at stages T1, T2 and T3. Spearman Rho and Bland-Altman Tests were used to assess correlation and agreement between AL and CVL measurements, respectively. Results: Totally 366 pairs of blood samples were obtained from 122 eligible patients. The 95% limits of agreement were -0.07 to -0.00 at T1; 0.30 to -0.10 at T2 and -0.16 to -0.03 at T3. The 95% Cls were detected 0.86 to 0.93 (r=0.90 and p<0.0001) at T1;0.95 to 0.97 at T2 (r=0.96 and p<0.0001) and 0.92 to 0.96 (r=0.94 and p<0.0001) at T3. Conclusion: Although sampling from arterial lactate can be considered as the “gold standard” for lactate measurement, sampling from central venous blood is an acceptable alternative for lactate measurement in on-pump cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of the Society of Thoracic Carido-Vascular Anaesthesia & Intensive Care is the property of Gogus Kalp Damar Anestezi ve Yogun Bakim Dernegi 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.)

Fahr Syndrome, which is a rare neurologic syndrome, is characterized by sporadic or genetically inherited basal ganglion calcification. There are some hypotheses about the pathophysiology of Fahr Syndrome related to a defect in calcium metabolism, metastatic calcium deposits and increased free radical production. Although patients are usually diagnosed with extrapyramidal symptoms, they may also present with cerebellar dysfunction, speech disorders, dementia and neuropsychiatric symptoms. We aimed to discuss sedation failure with dexmedetomidine and midazolam in a 49-year-old female patient with Fahr Syndrome who was admitted to our intensive care unit after suicidal carbamazepine overdose in this case report. Adequate sedation levels could not be reached although infusion of 1.5 μg kg-1 h-1 dexmedetomidine and bolus injections of 1.5 mg midazolam were administered. This may be due to the tolerance to sedatives developed by long-term use of antidepressant and antiepileptic agents. On the other hand; the unique sedative agent dexmedetomidine is a specific and selective α2 agonist and the widespread intracerebral calcification in our patient may have impaired α2 receptor activity. Besides, calcium metabolism disorder, one of the probable causes of Fahr Syndrome, may affect calcium-mediated inhibition of neurotransmitter release through α2 adrenoreceptors and reduced the effectiveness of dexmedetomidine. [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]

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]

Background/aim: Cardiac surgery, especially in the presence of cardiopulmonary bypass (CPB), is associated with an inflammatory reaction that may promote microcirculatory alterations, in addition to the general impact on system hemodynamics. Anemia and transfusion make patients more susceptible to the deleterious effects of CPB. In this study, it was aimed to evaluate the effect of dilutional anemia, which is caused by CPB and can be treated with 1-2 units of red blood cell (RBC) transfusion, on global tissue oxygenation parameters in cardiac surgery patients. Materials and methods: This prospective observational study comprised 127 patients who had a relatively stable operation period without any major anesthetic or surgical complications (e.g., operation duration >5 h, bleeding or hemodilution requiring more than 1-2 units of RBCs, or unstable hemodynamics, requiring inotropic support of more than 5 µg/kg/min dopamine). Patients were observationally divided into two groups: minimally transfused (Group Tr) and nontransfused (Group NTr). Global tissue oxygenation parameters were evaluated after anesthesia induction (T1) and at the end of the operation (T3) and compared between the groups. Results: Group Tr consisted of patients who had significantly lower preoperative hemoglobin values than Group NTr patients. The dilutional anemia of all Group Tr patients could be corrected with 1 unit of RBCs. The lactate levels at T3, increment rates of lactate, and venoarterial carbon dioxide pressure difference (ΔpCO2) levels [(T3 - T1) : T1] in Group Tr were significantly higher than those in Group NTr. Conclusion: Dilutional anemia as a result of CPB mostly occurs in patients with borderline preoperative hemoglobin concentrations and its correction with RBC transfusion does not normalize the degree of microcirculatory and oxygenation problems, which the patients are already prone to because of the nature of CPB. Preventing dilutional anemia and transfusion, especially in patients with preoperative borderline hemoglobin levels, may therefore reduce the burden of impaired microcirculation-associated organ failure in on-pump cardiac surgery. [ABSTRACT FROM AUTHOR]

Awareness about complications of transfusions of blood and blood products, their effects on mortality and morbidity and cost burden has increased in recent years which created the need for a new approach to transfusion practice. This new approach, defined as "Patient Blood Management (PBM)" aims to transfuse the right blood product to the right patient at the right time. Alteration of transfusion habits according to this new approach is quite difficult as seen in changing many established, traditional medical practices. Although there have been an increasing number of publications about the aim, context and results of PBM, there is limited studies and experience about the efficient implementation of this practice. In this article, the reports and clinical experiences of countries like USA and Australia that widely and successfully use this PBM project are reviewed. [ABSTRACT FROM AUTHOR]

Endovascular approach in aortic aneurysm repair is usually chosen for appropriate thoracal and abdominal lesions but simultaneous thoracal and abdominal endovascular stent graft reconstruction in the endovascular treatment of thoracoabdominal aneurysms (TEVAR+EVAR) is rarely performed long-lasting procedure. This is a high risk complex procedure for anesthetic management. In this report, the dexmedetomidine use in the anesthetic management of a patient during successful endovascular treatment of simultaneous thoracal and abdominal aortic aneurysms is described. [ABSTRACT FROM AUTHOR]

Copyright of Respiratory Case Reports is the property of LookUs Scientific 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: Thoracoabdominal aortic aneurysm (TAAA) surgery is accepted as a life-saving surgical repair, but its postoperative morbidity and mortality rates are high. Postoperative paraplegia and paraparesis, hospital-acquired infections, and renal insufficiency are serious complications that prolong hospital stay. Cerebrospinal fluid drainage (CSFD) has been shown to significantly reduce paraplegia and paraparesis risk, especially when used in combination with other methods. Despite its potential benefits, CSFD is not an innocent process because of possible infectious complications, such as localized infections, meningitis, intracranial hemorrhage, and neurological damage. In the present study, we aimed to appraise the postoperative outcomes and intensive care unit period of patients with TAAA surgery who underwent CSFD. Material and Methods: The records of all patients treated at the Türkiye Yüksek İhtisas Training and Research Hospital Cardiovascular Surgery Clinic between January 2014 and January 2018 for TAAA were reviewed retrospectively. Results: Although the early mortality rate was reported as 10% in the literature, in non-emergent cases, our mortality rate was higher in the present study. The probable reason for this is that we only assessed CSFD cases and total in-hospital mortality, suggesting that urgent cases constitute half of the patients. Excluding postoperative complications, the morbidity rate was 37.9% when the total number of morbidities following intensive care was included. The rate of CSFD-related complications was 10.33%. Conclusion: Previous studies have supported the use of CSFD in TAAA repair, and practical guidelines minimize the connatural risk of CSFD. Therefore, it is crucial to be aware of both the efficacy and the possible risks of CSFD. Although deficiency of the control group and being in retrospective nature prevents precise inferences in the present study, our results are consistent with the literature. We believe that this short-lived study needs to be repeated on a wider basis. [ABSTRACT FROM AUTHOR]

Copyright of Journal of the Society of Thoracic Carido-Vascular Anaesthesia & Intensive Care is the property of Gogus Kalp Damar Anestezi ve Yogun Bakim Dernegi 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: Noninvasive mechanical ventilation (NIMV) decreases the incidence of endotracheal intubation and complications related to the endotracheal intubation in acute respiratory failure. However, there is some concern that it can increase mortality due to the delay of endotracheal intubation. We aimed to evaluate the efficacy of NIMV in acute pulmonary edema (APE) and postoperative respiratory failure (PORF) patients. Materials and Methods: Records of 100 NIMV assisted patients suffering from APE and PORF were evaluated, retrospectively, for a period from Jan 01, 2011 to Dec 15, 2012. The patients were divided into two groups as APE (group 1; n=59) and PORF (group 2; n=41) patients. The demographic data of the patients having a frequency of endotracheal intubation after NIMV, the time between initiation of NIMV and intubation, ejection fraction (EF), systolic pulmonary arterial pressure, APACHE II scores, intensive care unit/hospital length of stay and mortality rate were recorded. Results: There were no significant differences between the groups in terms of endotracheal intubation incidence and the time between initiation of NIMV and intubation. The intubated patients had a longer length of hospitalization and stay in intensive care unit, higher baseline APACHE II scores, and mortality rates compared to nonintubated patients in both groups. The patients with chronic obstructive pulmonary disease in group 1 and with lower EF in group 2 were more likely to be intubated. Conclusion: In this study, we observed that higher baseline APACHE II scores were associated more with a high mortality rate than the extension of time between NIMV and endotracheal intubation in patients with two different acute respiratory failures, like APE and PORF. [ABSTRACT FROM AUTHOR]

Introduction: Massive PTE is a life-threatening clinical condition with high mortality.In this case report, we aimed to draw attention to a case who underwent VA-ECMO after systemic tPA with the diagnosis of massive PTE. Case: A 19-year-old male patient without comorbidity was admitted to ER with the complaint of dyspnea. PTE was diagnosed since thrombus was seen in main PA in pulmonary CT angiography. Half-dose tPA was administered to the desaturated patient during the follow-up in ER and patient develops cardiac arrest in ER. CPR is performed. Response to CPR is obtained, second arrest develops while being transferred to ICU (5 min CPR). RV dilatation, paradoxical movement in the septal wall and deviation to LV (D septum), severe hypokinesia indicating RV dysfunction were observed in bedside ECHO in ICU. The decision to apply VA-ECMO was made to the patient who developed massive PTE and shock with ECHO and CT findings. Bedside femoro-femoral VA-ECMO was performed. D septum and RV dilatation disappeared in the control ECHO. The patient’s hemodynamics returned to normal limits. However, bleeding from the cannula entry sites developed in a tPA patient before. Despite blood product replacements and pressure dressing, patient’s bleeding continued. Three hours after he was taken to VA-ECMO, patient arrested and died. Discussion: In the treatment of massive PTE, tPA and VA-ECMO can be applied. In a research consisting of cases similar to case presented in literature, it was reported that in the patient group with PTE who underwent systemic tPA and VA-ECMO, more CPR was applied before ECMO, major bleeding was more common, and there was no difference in mortality between the two groups. Massive PTE mortality is quite high. Although the response to tPA is good, adequate results may not always be obtained and more aggressive treatment modality such as VA-ECMO may be required. Hemorrhage, which is the biggest risk of VA-ECMO application after tPA, also poses a serious risk for mortality [ABSTRACT FROM AUTHOR]

Copyright of Mediterranean Journal of Infection, Microbes & Antimicrobials 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 Respiratory Case Reports is the property of LookUs Scientific 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.)

Central venous catheterization is performed frequently in especially intensive care, major surgery and cancer patients and arterial cannulation is one of the most serious complications of this procedure. Assessment of the colour, pulsatility and pressure of blood coming from the needle or injector, USG guidance, assessment of blood gases, fluoroscopy and echocardiography can be used for avoiding and recognizing this complication during the procedure. In this report; we interpreted the doubt of carotid artery cannulation because of very high oxygenation levels of the blood obtained from catheter after jugular venous catheterization in an intensive care patient with sepsis. [ABSTRACT FROM AUTHOR]

Amaç: Bira potomanyası, nadir görülen bir hiponatremi nedeni olup, ilk olarak 1972’de ağır bira içicilerde tanımlanmıştır. Biranın hipotonisitesi ve alkolün proteoliz üzerindeki süpresif etkisi sonucu oluşan dilüsyonel hiponatremi asemptomatik olabileceği gibi; bulantı, kusma, nöbet gibi semptomlara neden olabilir; koma ve ölümle sonuçlanabilir. Semptom ciddiyeti genellikle hiponatremi derecesiyle ilişkilidir. Bu bildiride amacımız ilk hastane başvurusunda 99 mmol/L sodyum değerine rağmen koopere, oriente olan olgumuzu sunmaktır. Olgu: Depresyon ve FMF dışında ek hastalığı bulunmayan 42 yaşındaki erkek hasta öksürük ve halsizlik şikayetiyle başvurduğu dış merkezde COVID-19 şüphesiyle tetkik edilmiş. PCR negatif gelen hastanın toraks tomografisindeki pnömonik infiltrasyonu nedeniyle COVID-19 öntanısıyla hastanemiz pandemi servisine sevk edilmesine karar verilmiş. Kan gazı tetkikinde sodyum değerinin 99 mmol/L olması üzerine hipertonik salin tedavisi eşliğinde hastanemize transfer edilen hastanın pandemi servisinde alınan kan gazında sodyum değeri tekrar 99 mmol/L gelince hiponatremi tedavisine devam edilmiş. Bu sırada koopere, oriente olan hastada yakın monitorizasyonla beraber kan biyokimya takibi yapılırken ani kardiyak arrest gelişmiş. Hasta, pandemi servisinde yapılan 15 dakikalık KPR sonrasında entübe şekilde yoğun bakımımıza alındı. Kan sodyum düzeyinin 24 saatte 10 mmol/L’den fazla yükseltilmemesi hedeflenerek hiponatremi tedavisine devam edildi. Yapılan tüm diğer kardiyopulmoner destek tedavilerine rağmen yoğun bakıma kabulünün 15. saatinde hasta kaybedildi. Sonuç: “Beer potomonia”, bira gibi hipotonik alkolleri fazla miktarda tüketen kişilerde protein malnütrisyonunun da eklenmesiyle görülebilen kronik bir hiponatremi sendromudur. Ciddi hiponatremisi olan hastalar, özellikle kronik hiponatreminin hızlı düzeltilmesiyle görülebilen “santral pontin myelinolizis” gibi ciddi sonuçlar nedeniyle oldukça korkulan bir hasta grubudur. Bunun yanında hiponatremi nadir de olsa ST segment değişikliklerine ve AV blok gibi kardiyak iletim defektlerine de neden olabilir. Olgumuzun GKS’nin 15, şikayetinin öksürük ve halsizlik olup pandemi döneminde klinisyenlerin COVID-19 öntanısına yoğunlaşmaları, sodyum düşüklüğünün hem dış merkez, hem hastanemiz pandemi servisine ilk kabulünde kan gazı örneklemesiyle gösterilebilmiş olması hastanın yoğun bakıma transferini geciktirmiştir. Anamnezinde özellikle hipotonik alkollerin fazla tüketimi olan hastalarda “bira potomanyası” akla getirilmelidir. [ABSTRACT FROM AUTHOR]

Amaç: Sarkopeni; iskelet kas kütlesinin, kuvvetinin ve performansının özellikle yaşlılarda ilerleyici, yaygın ve istenmeyen kaybı olarak tanımlanmıştır. Yoğun bakımda gelişen akut sarkopeni ya da eşlik eden hastalıklarla birlikte yavaş gelişen kronik sarkopeni entübe hastalarda weaning güçlüğüne, hastane ve yoğun bakım yatış gününün uzamasına ve mortalitede artışa neden olur. COVID-19 pnömonisi sırasında weaning zorluğu yaşadığımız ve eks olan olgumuzda saptadığımız sarkopeniyi tartışmayı amaçladık. Olgu: Alkol bağımlılığı nedeni ile dış merkezde tedavi olurken yüksek ateşi olan 52 yaşındaki erkek olgu (78 kg,174 cm) hastanemiz acil servisine getirildi. Toraks tomografisi COVID-19 uyumlu olduğundan servise yatırıldı. Oksijen ihtiyacı artınca 10. günde genel yoğun bakıma alındı. Bilinç açık, vital bulguları stabildi. Ateşi yoktu. Periferik oksijen satürasyonunun %81- 85 olması üzerine yüksek akımla nazal oksijen tedavisi (%100 oksijen/60 L/dk akım) başlandı. Alkol bağımlılığı açısından gastroenteroloji ve psikiyatri önerileri alındı. Yoğun bakım yatışının 24. saatinde entübe edilerek mekanik ventilatöre bağlandı. Sedasyon başlandı. Yatışının 20. gününde hasta ekstübe edildi. Beş gün ekstübe izlendi. Ancak sonra tekrar entübe edildi. Karaciğer fonksiyonlarında devam eden yükseklik nedeni ile abdominal tomografi (AT) çekildi. AT’de L3 vertebra hizasından iskelet kas kütle ölçümleri (psoas, paraspinal kaslar ve abdominal duvar kasları) yapıldı (Şekil 1). Bulunan değerin olgunun boyunun karesine olan oranının (iskelet kas kütle indeksi: 31,4 cm2/m2, erkeklerde eşik değer: 52,4 cm2/m2) düşük olması sarkopeni lehine değerlendirildi. Yatışının 31. gününde eks oldu. Sonuç: Acil servise gelişte AT olmadığı için var olan sarkopenin akut veya kronik olup olmadığı bilinmemektedir. Olgunun hastaneye gelişte kronik alkol kullanımına bağlı sarkopenik olacağı düşünülmüştür. COVID-19 enfeksiyonunun akut evresinin yaklaşık 2 hafta sürdüğü, oral alımın iştahsızlık veya anosmi nedeni ile azaldığı ve aynı zamanda hızlı bir katabolik süreç geliştiği, vücut ağırlığının yaklaşık %5-10’unun kaybına yol açtığı görülmüştür. Yoğun bakıma yatışının 25. gününde çekilen AT’de iskelet kas kütle indeksinin düşük bulunması sarkopeniyi gösterir. Ancak akut veya kronik ayrımını yaptırmaz. COVID-19 seyrinde sarkopeni gelişebileceği, eşlik eden hastalıkların varlığında sarkopeninin artabileceği, weaning güçlüğü ve mortalite artışına yol açabileceği akılda bulundurulmalıdır. [ABSTRACT FROM AUTHOR]

Amaç: Bu çalışmanın amacı, üçüncü basamak pandemi merkezi olan Ankara Şehir Hastanesi Yoğun Bakımları’nda COVID-19 gebe hastaların dönemsel özelliklerini paylaşmak. Gereç ve Yöntem: 21 Mart 2020-30 Kasım 2021 tarihleri arasında YBÜ’ye kabul edilen gebe hastaların verileri etik kurul onamı sonrası retrospektif olarak incelendi. Hastaların demografik ve klinik özellikleri üç döneme ayrılarak (Ağustos-Aralık 2020, Ocak-Haziran 2021, Temmuz-Kasım 2021) karşılaştırıldı. Bulgular: Toplam 109 gebe COVID-19 hastanın ortalama yaşı 30,5, APACHE II 9,68, gebelik haftası 28,5 idi. Hastaların %98’i tekil gebelik, %72,5’i 3. trimesterde, %92,6’sında PCR pozitif, %20,1’i delta varyantı, 5’i aşılı idi. %94,5’i dispne ile başvurdu, %45’inin IMV gereksinimi oldu, MV süresi 8,5 gün, YBÜ yatış süresi 11,6 gün idi. Yedi hastaya ECMO uygulandı, %21’inde gebelik devam etti, %49,5’ine 250 mg steroid, %34’üne anakinra, %57,8’ine antiviral verildi. Mortalite oranı %25,6’idi. Hastaların 18’i (%16,5), AğustosAralık 2020; 23’ü (%21) Ocak-Haziran 2021, 68’i (%62,4) Temmuz-Kasım 2021’de YBÜ’ye kabul edildi. Sonuç: Gebelerde de en sık başvuru semptomu COVID-19’un tipik semptomu olan dispne idi. YBÜ’ne kabul gebelik süresi ilerledikçe daha fazla idi. Uygulanan tedaviler ve pnömotoraks gibi gelişen komplikasyonlar arasında fark bulunmadı. Ancak delta varyantı son periyotta tespit edildi ve bu dönemde istatistiksel farklılık bulunmasa da YBÜ’ye kabul edilen gebelerin sayısında artış saptandı. Sonuç olarak, bu çalışmada, tüm toplumda olduğu gibi delta varyantının gebeleri de daha fazla enfekte ederek YBÜ’ye başvuru sıklığını artırdığı saptandı. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Anesthesia & Reanimation is the property of Turkish Society of Anaesthesiology & Reanimation 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.)

One lung ventilation to apply the use of bronchial blockers, often preferred as an alternative to double lumen tube shown, during coronary artery bypass graft surgery. Because she had bypass with median sternotomy, mitral valve replacement achieved by thoracotomy incission and in this case the provide of one lung ventilation with bronchial blocker has been used. A lot of co-existant disease, advanced age, previous operations, the patients with successful anesthesia and surgical management can be considered risky with a planned operation was completed with the healing. [ABSTRACT FROM AUTHOR]

Amaç: Cerrahi ve dâhili yoğun bakımlarda sepsis ve buna neden olan enfeksiyonlar daha fazla irdelenmeye başlamıştır. Ne yazık ki tanı ve tedavideki ilerlemelere rağmen, anastamoz kaçağı (AK), kolorektal kanser cerrahisinin en yıkıcı sonuçlarından biri olmaya devam etmektedir. Son zamanlarda, pek çok araştırma bu önemli komplikasyonu öngörmek ve önlemek için risk faktörlerini ve olası belirteçleri belirlemeye çalışmıştır. Bu sorunun teşhisi klinik, biyokimyasal ve radyolojik bulguların kombinasyonuna dayanırken NLR ve CRP gibi enflamatuar belirteçlerin AK'ını öngörmedeki etkisi araştırılmıştır. Bu çalışmanın amacı AK'ını öngörmede çeşitli enflamatuar belirteçlerin gücünü belirlemek ve karşılaştırmaktır. Gereç-Yöntem: Bu gözlemsel retrospektif çalışmaya, 2015-2018 yılları arasında elektif kolorektal cerrahi uygulanan 410 hasta dahil edildi. Kapsama kriterleri, yaş>18, patoloji ile kanıtlanmış kolorektal kanser ve neoadjuvan tedaviye bakılmaksızın potansiyel olarak küratif cerrahi idi. Çalışma dışı tutulan tanılar mezenter iskemi, FAP ve inflamatuar barsak hastalıklarıydı. Preoperatif ve postoperatif olarak değerlendirilmeye alınan enflamatuar belirteçler CRP, PDW, lökosit sayısı, nötrofil sayısı, lenfosit sayısı ve NLR oranı olarak belirlendi. Bu belirteçlerin aynı zamanda postoperatif- preoperatif farkları hesaplandı. Tüm parametreler için optimal cut-off değerlerini ve AUC değerlerini tanımlamak için ROC eğrisi analizi yapıldı. İstatistiksel hesaplamalar Medcalc. yazılımı kullanılarak yapıldı ve p değerinin 0.05'ten küçük olması istatistiksel olarak anlamlı kabul edildi. Bulgular: Çalışmaya dahil edilen 410 hastanın %68'i erkekti ve ortalama yaş 61,1 olarak belirlendi. Toplamda 26 hastada (%6,3) AK geliştiği belirlendi ve bu hastaların sadece 12'si reopere edilmişti. AK ile morbidite ve mortalite ilişkisi istatiski olarak belirgindi (p<0.05). Demografik veriler ve tümörün tipi, yeri ve derecesi ile AK arasında belirgin ilişki saptanmadı. AK ile enflamatuar belirteçlerden CRP, NLR nötrofil sayısı farkları ilişkili iken diğer belirteçlerle ilişki gözlenmedi. Bu belirteçlerden NLR farkının en yüksek AUC değerine sahip olduğu gözlendi (0,751) ve cut-off değeri 7,62 olarak belirlendi. Bu değerdeki sensitivite 66,67 ve spesifite 78,51 idi. Sonuç: Yoğun bakım takibinde morbidite ve mortaliteyi artıran AK'ın patogenezinde lokal iskemi ve inflamasyon önemli bir rol oynadığı düşünülmektedir. AK'nın klinik sunumu sıklıkla sinsi olduğu için ciddi bir tanı gecikmesi olabilmektedir. Kesin tanı için oral ve/veya rektal kontrast madde ile çekilen BT ve endoskopik incelemeler kullanılmaktadır ancak bu hem maliyeti artırmakta hem de anastamoz ayrışmasına yol açabilmektedir. Enflamatuar belirteçlerin değerlerinde olan değişikliğin ise hem saptanması kolay hem de ekstra bir işlem gerektirmediğinden maliyeti düşüktür. Çalışmamızda NLR en yararlı belirteç olarak belirlenmiş ve postoperatifpreoperatif farkın 7,62'den büyük olması morbidite ve mortalite ile ilişkili bulunmuştur. Bu çalışmamızda gösterilmiştir ki yoğun bakım takip edilen veya servisten kabul edilen hastalarda klinik tablonun yerleşmesinden önce NLR alarm zillerini çalmaktadır. [ABSTRACT FROM AUTHOR]

Amaç: Santral Nörojenik Hiperventilasyon (SNH); toksik veya metabolik bir etyoloji olmaksızın, serebral bir bozukluk nedeniyle oluşan ve düşük PaCO2, yüksek arteryel pH ile seyreden hiperventilasyonla karakterize nadir görülen bir durumdur. Tedavisinde altta yatan neden belirlenip, bu nedene yönelik tedaviden sonuç alınıncaya kadar benzodiyazepin, propofol ve opioidlerle solunumu baskılamaya yönelik sedasyon yer almaktadır.Bu bildiride; yüksek doz sedasyonla düzeltilemeyen ileri respiratuar alkalozu olan entübe bir hastada, mekanik ventilasyon devresindeki ölü boşluğun arttırılmasıyla kan pH'sının normalize edilmesinden bahsedilecektir. Olgu: Hipertansiyon dışında ek hastalığı bulunmayan, 75 yaşındaki bayan hasta iki gün önce başlayan bilinç değişikliği nedeniyle başvurduğu acil serviste konfüzyon, orientasyonunun bozulması ve solunumunun kötüleşmesi nedeniyle entübe edildikten sonra ileri tetkik ve tedavi amacıyla yoğun bakımımıza kabul edildi. Lomber ponksiyonda, abdominal, torakal ve kraniyal tomografisinde patolojik bulgu saptanmayan hastanın, kraniyal manyetik rezonans incelemesinde lineer ve nodüler kontrastlanma artışı izlendi.Yapılan diğer ileri tetkiklerle enfeksiyöz nedenler, otoimmün vaskülitler ve kollajen doku hastalıkları dışlandı.Santral Sinir Sistemi Lenfoma (SSSL) öntanısına yönelik beyin biyopsisi planlandı.Bu sırada devam eden takipne (45-50/dk) ve ileri respiratuar alkalozu (pH:7,60 üstü) mevcut olan hastaya deksmedetomidin, remifentanil, propofol ve midazolam gibi sedatiflerle derin sedasyon uygulandı.Buna rağmen düzelmeyen respiratuar alkalozu, solunum devresine ilave devre bağlanarak ve böylece ölü boşluk ventilasyonu arttırılarak 7,35-7,45 aralığına çekildi.Hastanın tetkik ve tedavisi halen kliniğimizde devam etmektedir. Sonuç: İlk olarak akut anoksik hastalarda tariflenen SNH'nın; diffüz infiltratif lenfoma, pontin glioma, medulloblastom, ensefalit, multipl skleroz, histiyositoz ve larinks karsinomu gibi diğer bazı kronik, diffüz infiltratif durumlarda da görülebildiği daha sonraki yayınlarda bildirilmiştir. Patofizyolojisi tam bilinmemekle birlikte, beyin sapındaki inspiratuar ve ekspiratuar merkezlerin önlenemeyen şekilde uyarılması sonucu oluşan derin solukların dakikada 25'in üstünde olmasıyla karakterizedir. Bu durumda oluşan hipokapni doku oksijenasyonunu bozarken, pH'nın 7,65 üstü olduğu alkaloz durumlarında, mortalite oranı %80'i bulmaktadır. Bu nedenle; SNH hastalarında asıl tedavi altta yatan nedenin çözülmesi olsa da, alkaloz mümkün olan en kısa sürede çözülmelidir. Sedatif ajanlar bu nedenle solunumun baskılanmasında kullanılabilir. Bu olguda; mevcut tüm sedatifler, hemodinaminin izin verdiği maksimum dozda kullanılmasına rağmen pCO2:15-25mmHg, pH:7.55-7.65 arasında seyretmiştir. Mekanik ölü boşluğu ve ekshale edilen CO2'in geri solunma oranını arttırmak için mekanik ventilatörün solunum devresine ilave uzatmalar eklenmiş ve bu yolla hastanın pCO2'si 40-45 mmHg, pH'sı ise 7.35-7.45 arasında tutulabilmiştir. Hasta halen yoğun bakımımızda entübe bir şekilde takip edilmekte olup, SSSL öntanısı doğrultusunda Beyin Cerrahi Kliniği'yle birlikte beyin biyopsisi planlanmıştır. [ABSTRACT FROM AUTHOR]

Amaç: Fahr Sendromu,bazal ganglia ve serebral kortekste kalsiyum depozitleriyle karakterize nadir görülen bir sendromdur(<1/1,000,000). Genellikle ekstrapiramidal semptomlarla tanı alan hastalar, serebellar disfonksiyon, konuşma bozuklukları, demans ve nöropsikiyatrik semptomlar da gösterebilir.Bu bildirideki amacımız yoğun bakımımızda takip ettiğimiz Fahr Sendrom'lu bir hastanın özellikle sedasyon süreci ve deksmedetomidin kullanımından bahsetmektir. Literatürde Fahr Sendromu'yla ilgili birçok yayın bulunmasına rağmen bu hastalardaki yoğun bakım takibi ve deksmedetomidin kullanımıyla ilgili yayına rastlanmamıştır. Olgu: Dört yıldır Fahr Sendromu tanısıyla takip edilen 49 yaşındaki bayan hasta, antiepileptik ilaç alımı yoluyla intihar girişimi nedeniyle acil servisten yoğun bakımımıza entübe şekilde kabul edildi.Hastanın anamnezinde depresif belirtiler nedeniyle 10 yıldır psikiyatri tarafından takip edildiği ve epilepsisinin olduğu öğrenildi.D vitamini ve kalsiyum desteği alan, antidepresan ve antiepileptik tedavi altındaki hastaya ajitasyonu nedeniyle deksmedetomidin başlandı, aktif kömür ve diyaliz uygulandı. Hipokalsemisi düzeltildi,asidozu ve genel durumunun düzeltilmesi amaçlandı.Deksmedetomidin dozu 1,5 mcg/kg/st'e kadar yükseltimesine rağmen yeterli sedasyon sağlanamayan hastaya aralıklı olarak 1 mg midazolam uygulansa da hasta kendini ekstübe etti.Tekrar entübe edilen hasta ekstremite kısıtlaması,1,5 mcg/kg/st dozunda deksmedetomidin ve aralıklı midazolam(1-2 mg) sedasyonuyla takip edildi.Devam eden süreçte ARDS ve sepsis gelişen hasta takibinin 29. gününde kaybedildi. Sonuç: Fahr Sendrom'lu hastaların yoğun bakım takibinde,özellikle idiyopatik hipoparatiroidi gibi eşlik edebilen endokrin hastalıkları nedeniyle kalsiyum düzeyleri yakından izlenmelidir. Ayrıca bu hastalar,nöropsikiyatrik semptomlarının tedavisi amacıyla yoğun ve çeşitli ilaç kullanıyor olabileceklerinden sedatif ilaçlara tolerans gösterebilirler. Diğer yandan deksmedetomidin bir α2 agonisttir. α2 reseptörler bazal ganglionlar dahil beyinde birçok alanda bulunur, en yoğun oldukları bölge ise locus coeruleus'tur.Bazal ganglionlar, locus coereleus'a yakın komşulukta olup, locus coereleus'la yoğun sinaptik ve fonksiyonel ilişki içindedir. Hastamızda serebral korteks ve bazal ganglionlarda yoğun intraserebral kalsifikasyon mevcuttu. Yani deksmedetomidinin etkisi hedef nöronlardaki kalsifikasyon nedeniyle de azalmış olabilir.Ayrıca Fahr Sendromu'nun patofizyolojisindeki muhtemel nedenlerden biri olan kalsiyum metabolizma bozukluğu da, α2 adrenoreseptörlerin kalsiyum aracılıklı nörotransmitter salınım inhibisyonunu etkilemiş ve bu reseptörler aracılığıyla gerçekleşen serebral inhibisyonu engellemiş olabilir. Sonuç olarak Fahr Sendromu olan hastalarda, deksmedetomidin etkinliği düşük olabilir.Bu hastalarda sedasyon gerekliliği olduğunda birden fazla sedatif ajana yüksek dozlarda ihtiyaç duyulabilir. [ABSTRACT FROM AUTHOR]

Amaç: Kalp cerrahisi sonrası nörolojik hasarlanma gözlenmesi ciddi komplikasyonlardandır. Bu durum hastaların mortalite ve yoğun bakım kalış sürelerini uzatmaktadır.Bu bildiride 15 aylık bir dönemde kalp cerrahisi yapılan hastalar incelendi ve tip 1 nörolojik hasar gelişmiş hastaları değerlendirildi. Gereç-Yöntem: Hastanemizde 15 aylık bir dönemde, 1452 hastanın kalp cerrahisi geçirdiği saptandı. KABG cerrahisi 783 (%54.7) hasta, kalp kapak cerrahisi 235 hasta (%16.4), anevrizma cerrahisi 159 (%11.1) hasta ile en fazla uygulanan cerrahilerdi. Bunların içinde postoperatif dönemde aşikar nörolojik hasar gelişen 56 hasta tespit edildi. İnme, geçici iskemik atak, koma ve ensefalopatiyi içeren Tip 1 nörolojik hasarlanma postoperatif dönemde ilk klinik şupe durumunda; nöroloji ve radyoloji konsültasyonu ile değerlendirilmiş ve kayıt altına alınmıştır. Bulgular: SVO geçiren 56 hastanın yaş ortalaması 60,2 yıl olarak bulundu. Hastaların özgeçmişinde; %46.4'ünde hiperlipidemi, %39,3'ünde hipertansiyon, %17,9'unda diyabet %14.4'ünde AF mevcuttu. Hastalara uygulanan cerrahi prosedürler ise; %50'sine koroner baypas cerrahisi, %8 'sine kapak cerrahisi,%7.1'ne anevrizma,%5'ne diseksiyon, %12.5'ine ise LVAD yerleştirme cerrahisi idi. İskemik inmelerin %67.9'una ilk 24 saatte izlenirken, %16'sı 1-3 gün içinde, %5.4'ü 3-7 günde, %10.8' ise >7 günden sonra görülmüştür. Mortalite ise 26 hastada (%46.4) mevcuttu. Araştırma sonucunda hastanemizde kalp cerrahisi sonrasında aşikar nörolojik hasarlanma oranı %3.8 olarak bulundu. Literatürde bununla ilgili olarak %0,5-5,4 gibi geniş bir aralık verilmiş olup hastanemizin bu oranları literatürle uyumludur. Perioperatif nörolojik hasarlanmaya katkıda bulunan durumlar hasta ile ilişkili faktörler, intraoperatif ve postoperatif faktörler olarak sınıflanır. Hasta ile ilişki faktörlerde 60 yaş üzerinde olmak, kadın cinsiyet, preoperatif kötü sol ventrikül fonksiyonu, kritik preoperatif durum, diyabet, hipertansiyon varlığı, önceden geçirilmiş inme olarak karşımıza çıkmaktadır. İntraoperatif risk faktörlerine bakıldığında cerrahi tipine göre, aort cerrahisi ve çoklu prosedür olgularında risk daha yüksektir. Hipoperfüzyon özellikle kardiyopulmoner baypas sırasında ortaya çıkan bir diğer inme risk faktörüdür. Bu nedenle pompa sırasında yüksek perfüzyon basınçları sağlanması da nörolojik hasarı önleme teknikleri arasındadır. Acık kalp cerrahisi sonrası yaklaşık olarak olguların %19-45'inde uzamış yoğun bakım suresinin gozlenebildiği bildirilmiştir.Cok sayıdaki makalede uzamış yoğun bakım hastaların %3,5-45'inde gorulduğu belirtilmekte olup; uzamış yoğun bakım suresi ise 48 saat ile 10 gun arasında geniş bir aralıkta kabul edilmiştir. Bizim hastalarımız çoğunda uzamış yoğun bakım kalış süresi mevcuttu. SVO geçiren hastalarda, Mv süreleri ortalama 14,8 gün,yoğun bakım yatış süreleri 19,66 gün olup; geçirmeyen hastalarla karşılaştırıldığında uzun ve istatiksel olarak anlamlı idi. Sonuç: Açık kalp cerrahisi sonrası nörolojik komplikasyonlar morbidite ve mortaliteyi arttıran, yoğun bakım kalış süresini uzatan önemli bir sorundur. [ABSTRACT FROM AUTHOR]

Amaç: İdiyopatik Pulmoner Fibrozis (IPF); idiyopatik interstisyel pnömonilerin en sık görülen formu olup, kronik, progresif, irreversibl, nedeni bilinmeyen ve çoğunlukla ölümcül bir akciğer hastalığıdır. Genellikle 55--75 yaşlar arasında tanı alan hastalar, ortalama 3,8 yıllık bir yaşam süresi sonrası kaybedilirler. Akciğer nakli bu hastalarda beklenen yaşam süresini uzatabilen tek tedavi seçeneğidir. Ekstrakorporeal Membran Oksijenasyon (ECMO) ise terminal dönemdeki, yoğun bakımda takip edilen IPF hastalarında uygun donör adayı bekleme sürecinde köprü tedavisi olarak uygulanabilir. Bu sunumdaki amacımız yoğun bakımımızda ECMO ile takip ettiğimiz ve akciğer nakli yapılan IPF hastamızı sunmaktır. Olgu: 15 yaşında tanı alan ve progresif seyirle solunum sıkıntısı gelişen 23 yaşındaki bayan hasta, respiratuar asidoz ve hiperkarbisinin düzeltilmesi amacıyla yoğun bakımıza kabul edildi. Akciğer nakli bekleme listesindeki hasta yoğun bakımda yüksek akım oksijen tedavisine rağmen düzelmeyen respiratuar asidozu nedeniyle entübe edildi. Entübasyon sonrasında hipotansif seyreden hastaya noradrenalin desteği ve remifentanille sedasyon başlandı. Takibinde 10 dakika süren kardiyak arrest sonrası başarılı bir şekilde ressusite edilen hastaya, respiratuar asidozunun düzelmemesi (pH: 6,9) nedeniyle ECMO takıldı. Jeneralize konvülzyonu oldu, levotirasetam başlandı. ECMO takibinde hemodinamisi ve respiratuar asidozu düzelen hasta koopere ve oriente bir şekilde uyandı. Uygun organ donasyonu sonrası akciğer nakli yapılan hasta, intraoperatif dönemde başarılı bir şekilde ECMO'dan ayrıldı, postoperatif dönemde herhangi bir sorun çıkmadan operasyondan sonraki 25. günde taburcu edildi. Sonuç: IPF, diffüz, progresif, histolojik olarak olağan interstisyel pnömoni bulguları gösteren parankimal bir akciğer hastalığıdır. Tanı yaşı ortalama 66, yaşam süresi ortalama 3,8'dir. Bizim olgumuz 15 yaşında tanı almış olması ve 8 yıllık bir süre sonunda terminal döneme gelmesi yönüyle klasik IPF olgularından farklıdır. Son yıllarda akciğer nakli endikasyonları arasında IPF sıklığı oldukça artmıştır. Hızla kötüleşen olgularda ECMO gibi yeni teknolojiler akciğer nakli öncesi başarılı bir köprü tedavisi olabilmektedir. Olgumuz, preoperatif dönemdeki hızlı ve kötü seyrine rağmen; kalp cerrahisinin, göğüs cerrahisinin ve yoğun bakım ekibimizin dahil olduğu akciğer nakil grubunun multidisipliner yaklaşımıyla başarılı bir şekilde taburcu edilebilmiştir. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Medical & Surgical Intensive Care Medicine / Dahili ve Cerrahi Yoğun Bakım Dergisi is the property of KARE Publishing 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 Turkish Journal of Medical & Surgical Intensive Care Medicine / Dahili ve Cerrahi Yoğun Bakım Dergisi is the property of KARE Publishing 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 Turkish Journal of Medical & Surgical Intensive Care Medicine / Dahili ve Cerrahi Yoğun Bakım Dergisi is the property of KARE Publishing 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.)

Sugammadex encapsulates and inactivates rocuronium and vecuronium. It is used to reverse neuromuscular blockade from these nondepolarizing agents. The safety of sugammadex in patients with neuromuscular disease has not been established. Guillain-Barre Syndrome (GBS) is a neuromuscular disease characterized by acute inflammatory polyneuropathy. Patients with GBS may exhibit autonomic dysfunction, chronic pain, abnormal reactions to neuromuscular blocking agents, and may require postoperative mechanical ventilation. We report the successful use of sugammadex to reverse rocuronium in a patient with chronic GBS, who presented for a hemicolectomy.