Rox Index Dynamics According to High Flow Nasal Cannula Success in Intensive Care Unit Patients with COVID-19-Related Acute Respiratory Failure

Background: High-flow nasal cannula therapy has been shown to be useful in the treatment of patients with acute respiratory failure caused by severe acute respiratory syndrome-coronavirus disease-2. The ROX index can help predict the success of high-flow nasal cannula in coronavirus disease-19-related acute respiratory failure. However, the timing of ROX- index assessment is still unclear to protect the patients from complications due to early or delayed intubation. Aims: To evaluate the relation between ROX index patterns within the first 48 hours of the therapy and high-flow nasal cannula success rates. The secondary aim was to determine other possible predictors of high-flow nasal cannula failure. Study design: A cross-sectional study. Methods: Patients admitted to the intensive care unit between April 2020 and January 2022 with coronavirus disease-19-related acute respiratory failure and treated with high-flow nasal cannula were included in the study. Patients' demographics, clinical characteristics and laboratory findings at intensive care unit admission; ROX indices at initiation, 2nd, 8th, 12th, 24th and 48th hours of high-flow nasal cannula; and outcomes were recorded. Results: In the study period, 69th patients were managed with high-flow nasal cannula for at least 2 hours. While 24 patients (34.7%) were successfully weaned from high-flow nasal cannula, 45 (65.3%) patients failed. Overall mortality at day 28 was 44.9%. ROX indices were lower in the high-flow nasal cannula failure group through the 12th, 24th, and 48th hours of the therapy, no significant change was observed (P = 0.33). While an overall increase in ROX index patterns were detected in patients weaned from high-flow nasal cannula (P = 0.002). Pairwise analyses revealed that ROX indexes remain stable during the first 8th hours in both groups, then improved to 12th hours of the therapy in successfully high-flow nasal cannula-weaned patients. Conclusion: Dynamic assessments of the ROX indexes could be more suggestive rather than a point assessment to identify patients who would benefit from the high-flow nasal cannula or deteriorate in coronavirus disease-19 related acute respiratory failure.

Mucormycosis in a Patient with Uncontrolled Diabetes Mellitus

Mucormycosis;is a rapidly progressive fungal infection due to filamentous fungi of the mucoraceae family. In this case report, we aimed to present the diagnosis and treatment modalities of a patient who developed rhinoorbital mucormycosis. A 54-year-old patient with a history of hypertension applied to the emergency department with a complaint of wound in the mouth that started four days ago. In the examinations performed here, the patient was diagnosed with diabetic ketoacidosis. In the examination of the patient, it was found that there was a necrotic wound on the left hard palate, a necrotic wound extending from the left inferior turbinate to the nasopharynx, and hyphae in the nasal passage. The patient underwent an aggressive debridement operation on the third day, due to the growth in the fungal culture. In the following clinical examination of the patient, ketone in the urine became negative, and his acidosis status improved. On the same day, the patient was treated with a positive coronavirus disease-2019 (COVID-19) polymerase chain reaction. After 15 days of treatment, the patient died due to COVID-19 pneumonia. Mucormycosis should be doubtful in patients presenting with uncontrolled diabetes mellitus and severe sinoorbital infection. All physicians following diabetic ketoacidosis should be vigilant against this rapidly progressing disease with high mortality. (English) [ FROM AUTHOR] Mukormikoz mucoraceae familyasının filamentli mantarlarına bağlı hızla ilerleyen bir mantar enfeksiyonudur. Bu olgu sunumunda rinoorbital mukormikoz gelişen bir hastanın tanı ve tedavi yöntemlerini sunmayı amaçladık. Elli dört yaşında hipertansiyon öyküsü olan hasta, dört gün önce başlayan ağızda yara şikayeti ile acil servise başvurdu. Burada yapılan tetkiklerde hastaya diyabetik ketoasidoz tanısı konuldu. Hastanın muayenesinde sol sert damakta nekrotik yara, sol alt konkadan nazofarenkse kadar uzanan nekrotik yara ve burun pasajında hifa tespit edildi. Üçüncü gün mantar kültüründe üreme olması üzerine hastaya agresif debridman operasyonu uygulandı. Hastanın sonraki klinik muayenesinde idrarda keton negatif çıktı ve asidoz durumu düzeldi. Aynı gün hasta pozitif koronavirüs hastalığı-2019 (COVID-19) polimeraz zincir reaksiyonu ile tedavi edildi. On beş günlük tedaviden sonra hasta COVID-19 pnömonisi nedeniyle eksitus kabul edildi. Kontrolsüz diabetes mellitus ve şiddetli sino-orbital enfeksiyon ile başvuran hastalarda mukormikozdan şüphelenilmelidir. Diyabetik ketoasidoz sonrası tüm hekimler hızla ilerleyen ve mortalitesi yüksek olan bu hastalığa karşı dikkatli olmalıdırlar. (Turkish) [ 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 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 . (Copyright applies to all s.)

Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units.

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.

Influenza or other respiratory viruses: does it matter as the cause of acute respiratory failure in the critically-ill patients?

INTRODUCTION: Respiratory virus infections may cause serious respiratory failure requiring intensive care unit (ICU) admission. The objective of this study was to evaluate the clinical features and the outcome in patients with acute respiratory failure (ARF) due to viral infections comparing etiological agents. MATERIALS AND METHODS: ARF patients with positive viral serology were retrospectively recruited. Cohort was evaluated with regard to subgroups as influenza and other respiratory viruses (ORV), as well as survivors and nonsurvivors. RESULT: Out of 938 admitted patients, 319 were followed as ARF and only 149 patients had viral respiratory panel results. In 49 patients with ARF, 52 positive viral results were detected and 47 patients with single positive viral isolates of either influenza or ORV were included. Among them, 62% had ORV with quite similar characteristics with influenza group apart from diabetes mellitus which was encountered more in influenza group (p= 0.02). Overall ICU mortality was 32% and there was no difference between the two groups (p= 0.42). Acute Physiology and Chronic Health Evaluation (APACHE) II score was independently associated with ICU mortality (OR: 1.25; 95% CI: 1.04-1.51; p= 0.02). CONCLUSIONS: This study emphasizes to consider the possibility of other respiratory viruses for the cause of ARF with similar characteristics and mortality as influenza species.

Management of COVID-19 in intensive care units

Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 had already affected the whole world before the pandemic could be prevented and resulted in challenges to the development of an efficacious drug treatment. Intensive care admission is lower than the SARS and Middle East respiratory syndrome-CoV pandemics, although the rapid development and simultaneous contagion in society resulted in feasibility problems associated with intensive care units. The disease results in severe pneumonia, acute respiratory distress syndrome, cardiogenic shock, or multiorgan failure, causing mainly lung and myocardial damage. Decreasing the viral load and providing supportive treatment for organ failures are the main principles of treatment in such patients. One should take care to decrease the risk of transmission of the disease to the stuff providing care and treating patients in the intensive care unit. Precautions should be applied to the greatest extent possible, especially during aerosol-producing interventions.