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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]

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]

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.)

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]

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]