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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]

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]

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]

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]