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

Copyright of Turkish Journal of Intensive Care 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 Turkish Journal of Intensive Care 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.)

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

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

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

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

Copyright of Turkish Journal of Intensive Care 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.)

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

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

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

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

Copyright of Turkish Journal of Intensive Care 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.)

Background: In this study, the efficacy of an IL-6 antagonist, Tocilizumab, administered in the early period was studied in intensive care patients with COVID-19 pneumonia followed by hypoxic and systemic inflammation not receiving mechanical ventilation support., Methods: Patients with COVID-19 pneumonia who have signs of hypoxia and systemic inflammation and/or who have acute bilateral infiltrates on chest radiograph and who received tocilizumab treatment were compared with the patients who received standard medical therapy. Patients who were followed up with COVID-19 pneumonia and respiratory failure between March 2020 and March 2021 were retrospectively evaluated in the study. A 400 mg - 800 mg iv dose (depending on weight) of Tocilizumab was administered. The primary endpoint was determined as intensive care unit mortality., Results: A total of 213 patients who were admitted with respiratory failure associated with COVID-19 to our third-level intensive care unit were evaluated. Of these patients, the study was conducted with 50 patients in the tocilizumab treatment group and 92 patients in the standard treatment group. During the intensive care period, 26 patients (28.3%) in the standard treatment group and 12 patients (24%) in the group receiving tocilizumab died. The adjusted hazard ratio for mortality in the tocilizumab group was 0.39 (95% confidence interval [CI], 0.186 to 0.808; p = 0.001 by log-rank test). During the intensive care period, 22 patients (24.8%) in the standart treatment group and 16 patients (32%) in the tocilizumab group were intubated. The adjusted hazard ratio for a primary outcome intubation in the tocilizumab group was 0.71 (95% confidence interval [CI], 0.355 to 1.424; p = 0.184 by log-rank test).