ABSTRACT
Objective: The risk for adverse outcomes in COVID-19 patients necessitates further scrutiny in Covid 19 patients in providing appropriate surgical indications and perioperative surgical safety precautions. In this study, we aimed to contribute to elective surgery resumption about infection with early and late postoperative complications and mortality in patients with RT-PCR (+) and clinically suspicious COVID-19 who underwent emergency surgery in our hospital. Methods: A total of 86 patients who have been operated on in our institution for emergency surgery over the age of 18 who were diagnosed with SARS-CoV-2 infection seven days before or 30 days after surgery were enrolled in the study. In this retrospective study, the primary outcome has been established as mortality factors and survival within postoperative 30 days. Results: Regarding the primary outcome as 30-day survival, every 1-year increase in age increased the risk of death by two folds. Patients with one or more comorbidities have an increased risk of death 13 times and those with two or more have an increased risk of death 23 times. Patients in intensive care units increase the risk of death by 8.5 times compared to those who are not hospitalized. On the contrary, an increase in hemoglobin level was shown to reduce the risk of death by 0.8 times. Conclusion: The need for intensive care and mortality is high, especially after emergency surgery, in patients with COVID19 symptoms and more than one comorbidity. Surgical indications of such patients should be well investigated.
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Purpose: This present study aimed to share experiences in the diagnosis and management of brain death (BD) and cadaveric donation cases, detected in a research hospital during the COVID-19 pandemic. Materials and Methods: BD cases diagnosed between 15/03/2020-15/05/2021 in our intensive care units (ICU) were retrospectively evaluated. Patients' demographic characteristics, primary diagnoses, ICU admission time, and length of hospital stay were analyzed. Clinical suspicion, diagnosis, declaration, and donation or cardiac arrest times and supplementary tests to support the clinical judgment performed were also evaluated. Results: 37 cases, were included in the study. Intracranial hemorrhage was the most common (54.1%) diagnosis in ICU admissions. Apnea tests could be performed only in 27 patients (73%). Cerebral CT-angiography was used as a supplementarytary test in 27 (73%) cases. Family consent for organ donation was obtained from 10 patients (27%), and 70% (n= 7) of them became donors. The time between ICU admission and BD diagnosis time was 114 +/- 92.8 (11-360) hours, the time between clinical suspicion and diagnosis was 32 +/- 15.1 (4-78) hours, the time between diagnosis and cardiac arrest of non-donors was 24 +/- 15.2 (5-72) hours, and the time between diagnosis and donation was 23 +/- 7.6 (15-35) hours. Conclusion: Occupancy in ICUs due to COVID-19 has reduced the admission of patients who may be donors to ICUs, and there has been a decrease in the number of BD detection, family approval, and organ donation in our hospital.
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Aim: This study aimed to evaluate the values of tracheobronchial angles on computed tomography (CT) and to investigate the relationship between angles and CT severity scores (CT-SS) of coronavirus disease 2019 (COVID-19) patients. There is no available literature measuring tracheobronchial angles of adult COVID-19 patients and investigating the relationship of angles with pneumonia severity. Material and Methods: This study was a single-center retrospective analysis of 92 RT-PCR positive patients, aged between 18-40 years, who underwent CT between May and October 2020. The right bronchial angles (RBA), left bronchial angles (LBA), subcarinal angles (SCA), and interbronchial angles (IBA) were measured by a radiologist on coronal CT images with the measurement model used in past. CT-SS was calculated by using a visual scoring system with a global score of 0-25. Results: Thirty-seven (40.2%) patients had normal CT imaging and 55 (59.8%) patients had pulmonary involvement. The CT-SS were ranged from 0 to 24, with a median value of 2.5. The mean IBA was calculated as 81.67±15.20°, mean SCA 77.65±15.78°, mean RBA 39.26±7.51°, and mean LBA 43.35±8.43°. No statistically significant difference was found in SCA, IBA, RBA, and LBA between the groups with and without COVID-19 pneumonia (p=0.277, p=0.389, p=0.218, and p=0.227, respectively). Also, no significant correlation was found between tracheobronchial angles and pneumonia CT-SS of the patients. Conclusion: We calculated the distribution range of tracheobronchial angle values in the adult Turkish COVID-19 patients. According to our study, tracheobronchial angles don’t affect the disease severity and clinical outcome of COVID-19 patients.
ABSTRACT
OBJECTIVE: There has been an increase in intensive care applications due to respiratory failure of COVID-19 infection. Management of respiratory failure includes a range of additional interventions, including high-flow nasal oxygen, noninvasive and invasive ventilation and prone position. These interventions contain risk factors for the development of ocular complications. This study aimed to elucidate the ocular pathologies that occurred in COVID-19 patients hospitalized in the intensive care unit. PATIENTS AND METHODS: Patients who completed 24 hours in the intensive care unit were included in the study. Age, gender, duration of hospitalization before intensive care unit, comorbid diseases and APACHE 2 scores of COVID-19 patients admitted to intensive care unit were recorded. SOFA scores, presence of sedation and muscle relaxant, oxygen therapy (conventional oxygen therapy, high flow nasal oxygen therapy, noninvasive ventilation, invasive ventilation) and presence of prone position were recorded. All patients were evaluated daily for ocular findings. Routine eye care protocol was applied to all patients. RESULTS: Seventy patients were followed for a total of 596 days in the intensive care unit. Pathological ocular findings were observed during hospitalization in 59 of the patients followed. The incidence of chemosis in patients who underwent IMV was significantly higher compared to other methods (p<0.001). CONCLUSIONS: In this study, we observed that despite our routine eye care protocols, invasive mechanical ventilation applications predispose corneal surface damage in patients followed up in the intensive care unit with COVID-19 infection.