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Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age >60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥ 1 (1.42 [1.00-2.02], P = .050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality. [ABSTRACT FROM AUTHOR]

Objective: The ABCDEF (Assess, prevent, and manage Pain, Both spontaneous awakening trials and spontaneous breathing trials, Choice of analgesia and sedation, Delirium: assess, prevent, and manage, Early mobility and Exercise, and Family engagement and empowerment) bundle is a path for optimal resource utilization. This study aimed to investigate the knowledge level and views of physicians working at the intensive care units (ICUs) in Turkey, a developing country, on the use of ABCDEF bundle. Materials and Methods: A cross-sectional online survey was administered to ICU physicians in Turkey, using Supplemental Digital Content 1, on June 20, 2018. The survey was terminated and deactivated on September 30, 2018. Results: A multidisciplinary team oriented for compliance with the ABCDEF bundle was not found to be present in any of the responding ICUs in Turkey. Of 461 participants, 161 (35.1%) were knowledgeable about the bundle. The bundle could not be used due to lack of a team and shortage of trained personnel. Conclusion: The rates of using scales proposed by the ABCDEF bundle were remarkably low although most participants acknowledged that the use of protocols and scales leads to decreased morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to evaluate vitamin D (Vit D) level in critically ill patients and to assess its level about morbidity and mortality. Materials and Methods: This study was conducted in an intensive care unit (ICU). Vit D level was measured on admission, third and seventh day. Results: Of the 62 patients, the median Vit D level at baseline and on the third and seventh days was 12.8 mcg/L, 8.35 mcg/L, and 9.30 mcg/L, respectively. Vitamin D level was low (<30 mcg/L) in 92% of patients at baseline and 97% on the third day. 23% of the studied patients developed a new site infection. No statistically difference in the Vit D level at baseline, or on the third or seventh day based on the presence of infection (p=0.556, p=0.404, p=0.439, respectively). The most commonly seen infections were ventilator-associated pneumonia (VAP) and catheter-related bloodstream infection (CRBSI). The growth of Acinetobacter baumannii was the most frequent. Vit D level (p>0.05) might not have a causal role in mortality (ICU, 30-day, and 6-month), and no correlation was found between them. Conclusion: The level of Vit D was low. Our study did not show any relationship between mortality rates and Vit D level, but VAP and CRBSI were observed. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the demographic and clinical characteristics of patients fed with total parenteral nutrition who were hemodynamically unstable in the ICU. This study was performed retrospectively in the medical intensive care unit of a university hospital. Information was obtained from the patients' files, the hospital electronic registry system and nutrition unit registration forms. This study included 51 patients. The mean age of the patients was 57 ± 19 years, of the patients 47% were male and 53% were female. When the reasons for total parenteral nutrition were evaluated, it was found that the most common causes of total parenteral nutrition were because of septic shock (47%) and gastrointestinal bleeding (23%). The daily caloric intake of the patients was 1,389 ± 286 kcal, and the target caloric value was 1,824 ± 256. The number of days with mechanical ventilation was 5 (median 0-42), the number of days stayed in the intensive care unit was 9 (median 1-125) and the number of days stayed in the hospital was 13 (median 1-155). The mortality rate of the patients was 71%. Serum albumin levels were found to be lower in patients who died than in those who lived, and these low albumin levels were statistically significant (p=0.015). In this study, it was seen that total parenteral nutrition was most commonly applied to the patients in a state of septic shock who had vasopressor support and to the patients who had gastrointestinal bleeding. In addition, it was determined that the target energy value could not be reached. [ABSTRACT FROM AUTHOR]

To investigate the effect of empirical or culture based colistin therapy on the mortality of intensive care medicine (ICU) patients with severe sepsis and septic shock. Patients treated in three Intensive Care Units of medical faculty of Erciyes University were included in this retrospective, descriptive study. The groups did not differ regarding the mean duration of intensive care stay (15 days vs. 20 days, p = 0.20) or in terms of the intensive care mortality (58.3% vs. 72.7%, p = 0.31). There was also no difference between the groups in 30-day in hospital mortality (61.1% vs. 78.8%, p = 0.12). In patients with severe sepsis/septic shock, there were no differences between the groups in which the colistin therapy was initiated empirically or based on sensitivity test results. [ABSTRACT FROM AUTHOR]

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The aim of the present study is to evaluate the value of hyaluronan (HA) as a biomarker of sepsis in patients not showing sepsis-associated liver dysfunction and to investigate the relationship between HA level and disease severity. Sepsis patients that had been followed-up between 2015 and 2016 in intensive care units (ICU) of Erciyes University Hospital were included in this prospective study. Sepsis was defined according to the 2013 Sepsis Survival Campaign Guidelines. The patients were classified as sepsis, severe sepsis, and septic shock. Blood samples were collected from the patients on the first and the third days to measure the HA level. The demographic characteristics, the duration of intensive care unit stay, and mortality data of the patient and the control groups were analyzed. A total of 46 patients and 30 control subjects were evaluated. HA levels were found to be higher in the sepsis group than the others. HA was neither a predictor of the disease mortality, nor was it correlated with the inflammatory markers, C-reactive protein (CRP), and procalcitonin (PCT). HA is not a sepsis biomarker in the patients with sepsis who do not show sepsis-associated liver dysfunction. [ABSTRACT FROM AUTHOR]

Objective: Postoperative patients requiring intensive care are at risk of developing pneumonia and clearance of secretions may be difficult because of the type of surgery and pain. Enhanced mucociliary clearance with high-frequency chest wall oscillation (HFCWO) therapy devices were previously used in chronic obstructive pulmonary disease and thoracic surgery patients. We studied the short-term effects of HFCWO on postoperative abdominal surgery patients. Material and Methods: Non-intubated postoperative abdominal surgery patients requiring intensive care were included in the study. Patients were randomized either to the standard chest physiotherapy group (early mobilization, incentive spirometry, postural drainage) or standard chest physiotherapy plus HFCWO group. HFCWO was applied for 10 min at 12 hz frequency. Laboratory data were collected for 3 days, and patients were followed until discharge from the hospital. Results: We included 40 patients in each group. The mean age of the patients was 62.78±13 years; 32 of the patients in the study were women and 48 were men. There was no difference between the two groups according to acute physiology and chronic health evaluation II score, length of stay in the intensive care unit (ICU), length of hospital stay, invasive and non-invasive mechanical ventilation requirement, overall mortality rate, and ICU mortality rate. There were no complications related to HFCWO therapy. Conclusion: HCFWO therapy did not help in improving the physiological parameters and had no effect on the duration of ICU and hospital stay and mortality. The number of nosocomial pneumonia attacks was lower with HFCWO, but did not reach statistical difference. HFCWO is a safe technique, in which we did not observe any complications. [ABSTRACT FROM AUTHOR]

Objective: Endotracheal intubation is a frequently performed procedure in the intensive care unit (ICU). Extremely serious complications occur during this procedure. In this study, theoretical and practical training were given to residents who started to work in the medical intensive care unit, and it was aimed to evaluate the complications following training. Materials and Methods: This study was conducted prospectively. Results: A total of 36 patients were included in the study; 16 (45%) were male, and the average age of the patients was 64±16.0 years. The most common indications for admittance to the ICU were shock (50%) and acute respiratory failure (36%). The most common indication for intubation was determined as acute respiratory failure (44%). The intubation was performed as an emergency procedure in 27% of these patients, whereas it was performed semi-urgently in 8% and electively in 65%. Among intubated patients, at least one complication developed in 13 (36%) cases. The drugs most commonly used for sedation were midazolam (76%) and propofol (16.7%). Conclusion: Complications of endotracheal intubation are significant problems in ICUs. A successful procedure of intubation avoids complications. Regular training for endotracheal intubation in the ICU decreases the complications. [ABSTRACT FROM AUTHOR]

The most important reasons of mortality and morbidity in the intensive care unit are severe sepsis and septic shock. It is estimated that more than 200,000 patients in the USA and more than 150,000 patients in Europe die with a diagnosis of severe sepsis every year. In sepsis, an excessive and irregular response of hosts is available against infection. Multiorgan failure and hypovolemic shock may occur if the patient is not treated. Multiorgan failure is the most common cause of death in sepsis. It has been observed that application of the protocols in sepsis guides reduces mortality. The American College of Chest Physicians and Society of Critical Care Medicine organized a meeting in order to create a standard definition of sepsis syndromes in 1991, and sepsis syndromes were defined in the manual (guide), which was published in 1992. In order to improve the results of the treatment of severe sepsis and septic shock, international guidelines were published in 2004 and then in 2008 by a group of experts in the diagnosis and treatment of sepsis. In the last manual, which was published 2012, there has been some additions and changes. Compared to the 2008 guidelines, the severe sepsis and septic shock guidelines that were published by the Surviving Sepsis Campaign in 2012 are summarized below, along with the quality of evidence and recommendations. [ABSTRACT FROM AUTHOR]