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Objective: By comparing viral sepsis caused by severe acute respiratory syndrome coronavirus-2 with pneumosepsis caused by other pathogens, we aimed to compare the pathogen-host relationship, organ damage affecting the clinic, and similar and different features of the two types of sepsis. Materials and Methods: A total of 414 patients diagnosed with critical coronavirus disease-2019 (COVID-19) between 2019 and 2021 and 303 pneumosepsis cases that met the diagnostic criteria for sepsis-3 between 2016 and 2019 admitted to the anesthesiology and reanimation intensive care unit (ICU) were retrospectively screened. The patient's demographic data, mortality rates, length of stay in the ICU, development of secondary organ dysfunction, presentation values of laboratory and mechanical ventilation, and changes within the 1-week follow-up were compared. Results: The sequential organ failure assessment scores were significantly higher in the COVID-19 sepsis group at presentation (8.2±2.9 vs. 7.2±3.7; p<0.0001) and during follow-up (8.9±4.9 vs. 7.8±3.7; p=0.002). The mean age of the patients was 65.4±17.2 years in the non-COVID-19 sepsis group and 57.9±17.1 years in the COVID-19 sepsis group (p<0.0001). The number of days on mechanical ventilation was significantly higher in the COVID-19 sepsis group (p=0.018). Mortality was detected in 299 patients (41.7%) in total, with no significant difference being observed between the two groups (p=0.592). Conclusion: Despite the patient population having a lower mean age and fewer comorbidities, organ dysfunction was higher in COVID-19 sepsis patients during admission to the ICU and follow-up. While the pathogen causing sepsis can be brought under control with rapid diagnosis and appropriate antimicrobial treatment, organ damage cannot be controlled with appropriate antiviral treatment in COVID-19 sepsis. In COVID-19 sepsis, secondary organ damage may be more evident as a result of damage and immunomicrothrombosis, which causes high mortality and morbidity, the mechanism of which has not yet been fully elucidated. [ABSTRACT FROM AUTHOR]

Objective: Intraoperative mechanical ventilation practices can lead to ventilator-induced lung injury (VILI) and postoperative pulmonary complications in healthy lungs. Mechanical power (MP) has been developed as a new concept in reducing the risk of postoperative pulmonary complications as it considers all respiratory mechanics that cause VILI. The most commonly used intraoperative modes are volume control ventilation (VCV) and pressure control ventilation (PCV). In this study, VCV and PCV modes were compared in terms of respiratory mechanics in patients operated in the supine and prone positions. Methods: The patients were divided into 4 groups (80 patients), volume control supine and prone, pressure control supine and prone with 20 patients each. MP, respiratory rate, positive end-expiratory pressure, tidal volume, peak pressure, plato pressure, driving pressure, inspiratory time, height, age, gender, body mass index, and predictive body weight data of the patients included in the groups have been obtained from "electronic data pool" with Structured Query Language queries. Results: The supine and prone MP values of the VCV group were statistically significantly lower than the PCV group (P values were 0.010 and 0.001, respectively). Conclusion: Supine and prone MP values of the VCV group were calculated significantly lower than the PCV group. Intraoperative PCV may be considered disadvantageous regarding the risk of VILI in the supine and prone positions. [ABSTRACT FROM AUTHOR]

Objective: The importance of prone positioning has increased with the density of coronavirus disease-2019-related acute respiratory distress syndrome (C-ARDS) during the pandemic process. It is aimed to investigate the effect of prolonged duration of prone positioning in C-ARDS patients on the blood gas parameters at the time after supine positioning (post-prone effect), the feasibility, the safety, and the mortality for 28 days. Materials and Methods: This study was a single-center prospective observational study with 1000 beds, 432 of which were intensive care units. Severe and moderate ARDS; the blood gas parameters (PaO2 /FiO2, PaO2, SpO2 etc.) of the patients who were applied the standard prone (16 hours) and the extended prone (36 hours) position were compared. Results: It was observed that PaO2 /FiO2 PaO2 and SpO2 values measured at the 8th hour (t4) (postprone) after the prone was placed in the supine position in the prolonged prone group were higher than before the prone (t1) (p<0.001). In the standard prone group, PaO2 /FiO2, PaO2, and SpO2 values were not maintained in the post-prone period and were even lower than before the prone. The mortality of patients in the standard prone group was 51.7% (n=31); in the prolonged prone group, the mortality was 45% (n=27). Conclusion: With the application of the prolonged prone position, it has been observed that C-ARDS patients have better blood gas exchange with less manpower without harming the patients (pressure ulcer, retinal damage, joint damage, etc.). [ABSTRACT FROM AUTHOR]

The early diagnosis of sepsis reduces the risk of the patient's death. Gradient-based algorithms are applied to the neural network models used in the estimation of sepsis in the literature. However, these algorithms become stuck at the local minimum in solution space. In recent years, swarm intelligence and an evolutionary approach have shown proper results. In this study, a novel hybrid metaheuristic algorithm was proposed for optimization with regard to the weights of the deep neural network and applied for the early diagnosis of sepsis. The proposed algorithm aims to reach the global minimum with a local search strategy capable of exploring and exploiting particles in Particle Swarm Optimization (PSO) and using the mental search operator of the Human Mental Search algorithm (HMS). The benchmark functions utilized to compare the performance of HMS, PSO, and HMS-PSO revealed that the proposed approach is more reliable, durable, and adjustable than other applied algorithms. HMS-PSO is integrated with a deep neural network (HMS-PSO-DNN). The study focused on predicting sepsis with HMS-PSO-DNN, utilizing a dataset of 640 patients aged 18 to 60. The HMS-PSO-DNN model gave a better mean squared error (MSE) result than other algorithms in terms of accuracy, robustness, and performance. We obtained the MSE value of 0.22 with 30 independent runs. [ABSTRACT FROM AUTHOR]

Objective: The diagnosis and treatment of electrolyte and acid-base imbalances in intensive care unit (ICU) patients have critical importance. The value of Stewart’s approach in revealing acid-base disorders is known. There are parameters defined according to this approach. This study investigates the impact of the chloride effect (ClEffect), sodium effect (NaEffect), sodium-chloride effect (Na-ClEffect), strong ion difference (SIDnl) and Cl/Na ratio values calculated according to Stewart’s approach on ICU mortality. Materials and Methods: Two thousand patients whose Na, Cl, K, standard base excess (SBE), pH values were recorded and SIDnl, ClEffect, NaEffect, Na-ClEffect, Acute Physiology Assessment and Chronic Health Evaluation-II (APACHE-II) and Sequential Organ Failure Assessment (SOFA) scores calculated are included in this study. ClEffect, NaEffect, Na-ClEffect, SIDnl, Cl/Na ratio values were evaluated with a multivariable logistic regression model in terms of ICU mortality. Results: Abnormal ranges of SIDnl (SIDnl <30 or SIDnl ≥43) were significantly increased in nonsurvivors than survivors (p=0.026). ClEffect, NaEffect, Na-ClEffect, Cl/Na ratio and their percentages of abnormal ranges were similar between survivor and non-survivor patients.In the multivariate logistic regression model, the likelihood of mortality was 3.5-fold (2.9-4.3), 1.7-fold (1.4-2.1) and 1.2-fold (1.0-1.5) increased by APACHE-II ≥26, SOFA >7, and SIDnl <30 or SIDnl ≥43 (p<0.001, p<0.001, p=0.041, respectively). Conclusion: SIDnl is associated with ICU mortality, but pH, SBE, ClEffect, NaEffect, Na-ClEffect and Cl/ Na ratio is not. SIDnl is one of the independent variables of Stewart’s approach and is a valuable parameter in blood gas evaluations [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: This research aimed to identify the factors associated with prolonged mechanical ventilation in the growing geriatric patient population in the intensive care unit and to investigate its effect on patient outcomes. Materials-Methods: In this retrospective study, the data of 1,501 patients aged 65 and over who were given mechanical ventilation support in the intensive care unit of a tertiary education and research hospital between January 2013 and January 2021 were obtained and evaluated electronically. Results: Among the 1,501 patients, 1,289 (85.9%) were non-prolonged mechanical ventilation and 212 (14.1%) were prolonged mechanical ventilation. The frequency of chronic obstructive pulmonary disease and trauma was found to be higher in the prolonged mechanical ventilation patients (p<0.05). The frequency of pressure wounds, acute kidney injury, and dialysis was higher in the prolonged mechanical ventilation group (p<0.001). The mechanical ventilation pressure and respiratory rate per minute were higher in the prolonged mechanical ventilation patients. Intensive care unit mortality was 45.3% (96) in the prolonged mechanical ventilation patients and 49.9% (643) in the non-prolonged mechanical ventilation patients (p>0.05). The mortality rates of the groups were similar in all admission diagnoses and age categories. A low glasgow coma scale, high partial pressure of carbon dioxide level, use of total parenteral nutrition, pressure sores, development of acute kidney injury, and dialysis were found to be associated with prolonged mechanical ventilation. Conclusion: Prolonged mechanical ventilation causes morbidity in geriatric patients but is not associated with mortality. [ABSTRACT FROM AUTHOR]

Objective: Risk factors affecting mortality in the coronavirus disease-2019 (COVID-19) pandemic, which emerged in Wuhan, China and affected the whole world, are yet to be clearly determined. Assessment of Charlson comorbidity index (CCI) and pneumonia severity index (PSI) can assist clinicians in identifying patients at high risk of mortality. This study aimed to determine the relation between CCI, indicating comorbidity burden in COVID-19 infection, and PSI, indicating disease severity, and their relationship with mortality. Materials and Methods: This was a retrospective cohort study conducted by accessing demographic, clinical and laboratory data from the electronic medical records of 214 patients diagnosed with COVID-19. The patients were followed up in the intensive care unit of University of Health Sciences Turkey, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital between March 10, 2020 and June 1, 2020. Results: Patients were divided into two groups i.e., survivors (n=109; 50.9%) and those with mortality (n=105; 49.1%). A one point increase in CCI was determined to increase the mortality probability by 32% [odds ratio (OR): 1,324, 95% confidence interval (CI): 1,178-1,488]. On the other hand, a one-point increase in PSI increased the mortality possibility by 2% (OR: 1,020, 95% CI: 1,012-1,0,27). In the correlation analysis performed to determine the relationship between CCI and PSI, a bidirectional and strong correlation was found between CCI and PSI (p<0.001, r=0.667). Conclusion: As a model for summarizing the sum of age and comorbidities, CCI can help identify patients at high mortality risk in the COVID-19 pandemic. Moreover, PSI may be useful in patients with low CCI scores for predicting mortality in COVID-19 patients; however, has not been found reliable in patients with high CCI scores. [ABSTRACT FROM AUTHOR]

Amaç: Mekanik ventilasyon, hayat kurtarıcı bir girişim olmakla birlikte ventilatörle ilişkili akciğer hasarına (VILI) yol açabilmektedir. Gattinoni ve ark., tidal volüm, sürücü basınç, gaz akımı, solunum sayısı ve PEEP gibi, çeşitli çalışmalarda VILI ile ilişkisi saptanan farklı değişkenleri tek bir parametrede birleştiren mekanik güç (mechanical power) kavramını geliştirmişlerdir. Bu çalışma, volum kontrol ve basınç kontrol modlarını mekanik güç kavramı üzerinden karşılaştırmaktadır. Gereç ve Yöntem: Bu çalışma Bakırköy Dr. Sadi Konuk Eğitim Araştırma Hastanesi Yoğun Bakım Kliniği’nde prospektif olarak 36 COVID-19 ARDS hastasında yapılmıştır (etik kurul no: 2019-02-23). Yatışlarının 2. gününde derin sedasyon altında ve kontrole modda (VCV veya PRVC) iken, hasta VCV modunda ise hiçbir ventilatör ayarı (RR, PEEP, TV, İE oranı) değiştirilmeden 60 dakikalığına PRVC moduna alınmıştır. Hasta PRVC modunda ise 60 dakikalığına VCV moduna alınmıştır. Dakikalık solunum parametrelerinden mekanik güç değerleri hesaplanmıştır. VCV modu için Gattinoni, PRVC modu için Becher mekanik güç formülleri kullanılmıştır. Her iki grubun 60 dakikalık solunum parametrelerinin hasta ortalamaları alındıktan sonra istatistiksel analizler yapılmıştır. Bulgular: Hasta özellikleri Tablo 1’de gösterilmiştir. Solunum mekanikleri ve mekanik güç değerleri her iki bağımlı grup değişkenleri homojen dağılım göstermiş olup paired T-testi karşılaştırılmıştır. Tüm parametrelere ait mean/SD ve p değerleri Tablo 2’de gösterilmiştir. Sonuç: Her iki ventilasyon modu arasında (VCV vs PCV), meanik güç (power) hesaplanmasında katkısı olan tüm solunum parametreleri eşit olmasına rağmen mekanik güç değerleri arasında hem istatistiksel hem de klinik açıdan anlamlı fark tespit edilmiştir. VCV grubunda Ppeak daha yüksek olmasına rağmen daha düşük mekanik güç hesaplanması her iki modun P-V looplarının geometrik farklılığına bağlanmıştır. Bu sonuçlar her iki ventilasyon modu için tek bir güç formülü kullanılmasını öneren güncel bir çalışma ile çelişkili bulunmuştur. Sonuç olarak VCV modunda PCV’ye göre daha düşük güç değerleri hesaplanmıştır. Bu çalışma güç kavramı bakış açısına göre VCV modunun daha avantajlı bir mod olarak ön plana çıktığı güncel eğilimi desteklemektedir. [ABSTRACT FROM AUTHOR]

Copyright of Medical Journal of Bakirkoy 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, we evaluated the efficacy of intercostal nerve block for postoperative pain management in pediatric patients undergoing atrial septal defect closure through a right lateral mini-thoracotomy., Methods: Between January 2016 and January 2019, a total of 63 pediatric patients (37 males, 26 females; mean age 34.8±26.8 months; range, 2 to 96 months) who underwent corrective congenital heart surgery for atrial septal defect closure through a right lateral mini-thoracotomy were retrospectively reviewed. The patients were divided into two groups as those (Group 1, n=33) receiving intercostal nerve block and general anesthesia and those (Group 2, n=30) receiving general anesthesia alone. Intravenous morphine at a dose of 0.03 mg/kg was applied as rescue analgesia to the patients with a Ramsay Sedation Scale score of >4 and Children"s Hospital of Eastern Ontario Pain Scale score of >7. The total analgesic requirement, adverse effects, duration of mechanical ventilation and length of stay in the intensive care unit were recorded., Results: The mean duration of mechanical ventilation and intensive care unit stay was shorter in Group 1 compared to Group 2 (3.6±1.3 vs. 9.4±2.1 h; 23±2.6 vs. 30±7.2 h, respectively) (p<0.0001). The need for postoperative rescue analgesia was statistically significantly lower in Group 1 compared to Group 2 (0.3±0.5 mg vs. 1.1±0.9 mg, respectively) (p=0.003). The mean total morphine consumption was also lower in Group 1 compared to Group 2 (4.0±2.2 mg vs. 9.0±3.4 mg, respectively) (p<0.0001)., Conclusion: Intercostal nerve block before thoracotomy closure in pediatric patients undergoing atrial septal defect repair under mini-thoracotomy provides early extubation, shorter mechanical ventilation duration and intensive care unit stay, and reduced analgesic requirements., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2020, Turkish Society of Cardiovascular Surgery.)