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Objective: By comparing viral sepsis caused by SARS CoV-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 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 intensive care unit, development of secondary organ dysfunction, presentation values of laboratory and mechanical ventilation, and changes within the 1-week follow-up were compared. Results: The SOFA scores were significantly higher in the COVID-19 sepsis group at presentation (8.2±2.9 vs.7.2±3.7; p

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.

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) (post-prone) after the prone was placed in the supine position in the prolonged prone group were higher than before the prone (t1) (p

Abstract Background Mechanical power may serve as a valuable parameter for predicting ventilation-induced injury in mechanically ventilated patients. Over time, several equations have been developed to calculate power in both volume control ventilation (VCV) and pressure control ventilation (PCV). Among these equations, the linear model mechanical power equation (MPLM) closely approximates the reference method when applied in PCV. The dynamic mechanical power equation (MPdyn) computes power by utilizing the ventilatory work of breathing parameter (WOBv), which is automatically measured by the mechanical ventilator. In our study, conducted in patients with Covid-19 Acute Respiratory Distress Syndrome (C-ARDS), we calculated mechanical power using both the MPLM and MPdyn equations, employing different inspiratory rise times (Tslope) at intervals of 5%, ranging from 5 to 20% and compared the obtained results. Results In our analysis, we used univariate linear regression at both I:E ratios of 1:2 and 1:1, considering all Tslope values. These analyses revealed that the MPdyn and MPLM equations exhibited strong correlations, with R 2 values exceeding 0.96. Furthermore, our Bland–Altman analysis, which compared the power values derived from the MPdyn and MPLM equations for patient averages and all measurements, revealed a mean difference of −0.42 ± 0.41 J/min (equivalent to 2.6% ± 2.3%, p

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 7, and SIDnl

Objective:Although there is no antiviral treatment specific to the virus, favipiravir has entered the treatment routine as an antiviral in our country in May 2020. In this study, in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) acute respiratory distress syndrome (ARDS) in the intensive care unit; The effects of favipiravir antiviral regimen on mortality and morbidity were evaluated.Materials and Methods:Patients admitted to the intensive care unit were divided into two groups as those who received favipiravir (group F; n=208) and those who did not (group N; n=101). The treatment of the cases is arranged according to current national guidelines. Metavision/QlinICU Clinical Decision Support Software, in intensive care unit; Acute Physiology and Chronic Health Evaluation-II, Sequential Organ Failure Assessment score, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, lactate dehydrogenase, ferritin, C-reactive protein (CRP), procalcitonin, Pro-BNP, D-dimer, fibrinogen, white blood cell, neutrophil count (NEU), lymphocyte count (LYM), NEU/LYM, CRP, t1 acceptance (0th hour), t2 follow-up (24th hour) and t3 (discharge or ex) values of acute phase parameters, and the comorbidity is obtained by Structured Query Language queries. The primary outcome is mortality; secondary outcomes are possible drugrelated organ toxicities, sudden change of the level of the acute phase reactants, requirement of continuous renal replacement therapy (CRRT), hospitalization time, ventilator dependent days.Results:One hundred eight women (35%), 201 men (65%), a total of 309 cases were evaluated in the study. In the demographic data of the groups, no statistically significant difference was found between the frequency of comorbidity, mortality rate, CRRT need, and secondary infection. The mean increase of 107.66±628.99 units between the t1 and t3 measurement was found to be statistically significant in F group cases. In the F group, the neutrophil/lymphocyte ratio (NLR) during the follow-up period and the last NLR were found to be lower than the initial value.Conclusion:It was determined that favipiravir used in the treatment of SARS-CoV-2 ARDS has no superiority in preventing mortality.

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.

Background The conflicting results of studies on intensive care unit (ICU) mortality of obese patients and obese patients with acute kidney injury (AKI) reveal a paradox within a paradox. The aim of this study was to determine the effects of body mass index and obesity on AKI development and ICU mortality. Methods The 4,459 patients treated between January 2015 and December 2019 in the ICU at a Tertiary Care Center in Turkey were analyzed retrospectively. Results AKI developed more in obese patients with 69.8% (620). AKI development rates were similar in normal-weight (65.1%; 1172) and overweight patients (64.9%; 1149). The development of AKI in patients who presented with cerebrovascular diseases was higher in obese patients (81; 76.4%) than in normal-weight (158; 62.7%) and overweight (174; 60.8%) patients (p

Objective: To compare the efficacy of pulsed-dose corticosteroids (≥250 mg methylprednisolone, 3 days) and tocilizumab in treating COVID-19-related hyperinflammation. Methods: This prospective observational study included RT-PCR positive COVID-19 patients with acute respiratory distress syndrome, who were admitted to the COVID-19 Adult Intensive Care Unit of Prof Dr. Murat Dilmener Emergency Hospital (Istanbul, Turkey) between December 1, 2020 and February 28, 2021. Clinical, laboratory and radiological examinations were used to diagnose COVID-19 associated hyperinflammation. Three cohort groups were formed: the pulsed-dose corticosteroids group (250 mg methylprednisolone for 3 days), the tocilizumab group (8 mg/day single dose or 400 mg/day for 2 days), and the combined group (pulsed-dose corticosteroid+tocilizumab). The difference in mortality rates among the groups was compared primarily. The most common cause(s) of death was determined. Furthermore, adverse events (secondary infection, acute kidney injury, arrhythmia, gastrointestinal system bleeding) for 28 days were recorded. Results: A total of 60 patients were included in this study, with 20 patients in each group. There was no statistically significant difference between the 3 groups in mortality rates (55% in the pulsed corticosteroid group, 60% in the tocilizumab group, 50% in the combined group, χ2=0.404, P=0.817). Infectious causes were found to be the most common cause of mortality in all the three groups, and no difference was found between them (χ2=0.404, P=0.817). There was also no difference in the development of adverse events such as secondary infection, acute kidney injury, arrhythmia, and gastrointestinal bleeding among the groups (P>0.05). Conclusions: Corticosteroids can be used instead of tocilizumab to treat hyperinflammation in COVID-19 patients with acute respiratory distress syndrome.

Objective: To investigate the code blue application at a training and research hospital in Turkey. Methods: The code blue declaration forms and the hospital database with 238 complete records between January 2016 and July 2017 were collected. The form involved individual characteristics, the reason for issuing the code blue call, the unit and block where the code was given, time and location related properties such as working time and arrival duration, properties regarding the intervention process such as its type, duration or result. The 24-hour and 30-day long survival data of the patients to whom cardiopulmonary resuscitation was implemented were obtained from the hospital database, or from their relatives. The influencing factors of arrival duration were analyzed. Results: The median duration of arrival was 2.14 (2.00-3.02) min. Code blue applications were performed more frequently in Departments of General Surgery, Internal Medicine, Orthopaedics, and Cardiology Clinics. Half of the code blue calls were due to cardiac arrest; the other half was due to shortness of breath or respiratory distress, syncope, and respiratory arrest. Three-out- of four code blue calls were treated with orotracheal intubation and cardiopulmonary resuscitation, or only orotracheal intubation or only medical treatment; one-fourth of the calls were not intervened. Altogether, 72.36% of the code blue calls patients were intervened; 69.35% of them were made both orotracheal intubation and cardiopulmonary resuscitation, and 20.5% of them were made only orotracheal intubation and 10.55% of them made only medical treatment. It was found that giving the code blue day or night had no effect on the time to reach the area where the code was given. Similarly, it was found that giving the code blue within daytime or night shift had no effect on the time to reach the area where the code was given. (P>0.05). The survival rates were 39.1% within the first 24 h and 18.1% within the first 30 d. Conclusions: Applications of code blue should be analyzed at regular intervals as clinical quality indicators. Reasons for wrong calls should be determined. The duration of reaching locations where calls are made should also be decreased.

Objectives: To assess the outcomes of the intensive care of Syrian refugees under temporary protection (SRUTP). Methods: The sample of the study was composed of 110 SRUTP patients who were treated at a tertiary intensive care unit (ICU) between 2013 and 2019 in Istanbul, Turkey. Baseline information and clinical data of the patients were collected by scanning the hospital’s electronic database and clinical decision support system. Results: The mean length of ICU stay was 97.6 (36.3-187.8) h. Among the patients, 71 (64.5%) had comorbid diseases, and ICU mortality was 40%. The median cost of health care for each patient was 2 144 (1 060-4 471) USD, and the total health care cost of all patients was 534 012USD. Conclusions: Use of vasoactive drug, hemodialysis application, and low Glasgow Coma Scale scores are independent risk factors of the mortality. More researches are needed to clearly reveal the health and cost consequences of war.

Objective: To investigate the effect of the variability of Nas, Cls, Ks, lactate values and sodium effect (NaEffect), chloride effect (ClEffect), non-lactate strong ion difference (SIDnl) values calculated according to Stewart’s approach on predicting intensive care unit (ICU) mortality. Methods: The study was conducted on 1539 patients, retrospectively. Serum Na (Nas), serum Cl (Cls), serum K (Ks), serum Ca (Cas), serum Mg (Mgs), lactate, pH values and SIDnl, NaEffect, ClEffect, APACHE II (first, last), and SOFA (first, last) scores were recorded. Radiometer ABL 800 (Denmark) was used for blood gas analysis. The variability of each parameter was calculated. The effect of variability of each parameter on 30-day ICU mortality was analyzed. Results: The variability of lactate (P