Acute Kidney Injury in Intensive Care Unit Patients with Coronavirus Disease 2019.

OBJECTIVE: The incidence of acute kidney injury during the hospital stay in patients with coronavirus disease 2019 varies between 8% and 17% in studies. This rate is at the highest levels among the critical patient group monitored in the intensive care unit (23% [14-35%]). In this study, we aimed to assess the incidence of acute kidney injury development, effective factors, and clinical outcomes of patients monitored in the intensive care unit due to coronavirus disease 2019. METHODS: A total of 801 patients were analyzed. Patients were divided into 2 groups as those developing acute kidney injury (n = 408) and those not developing acute kidney injury (n=393). Patients developing acute kidney injury were staged according to the Kidney Disease Improving Global Outcomes criteria. RESULTS: In all patients, the mortality rate was 65.2%. The mortality rate for those developing acute kidney injury was identified to be high by a statistically significant degree compared to those not developing acute kidney injury. The mortality rate in Kidney Disease Improving Global Outcomes criteria stage 1 was 81.3%, in stage 2 was 88.3%, and in stage 3 was 91.5%. The frequency of diabetes mellitus type 2, coronary artery disease, and chronic obstructive pulmonary disease in the group developing acute kidney injury was found to be statistically significantly higher. We have found positive correlations between acute kidney injury development and age, sex, history of diabetes mellitus, and ferritin levels in the multivariate analysis. CONCLUSIONS: The development of acute kidney injury in intensive care unit patients with coronavirus disease 2019 is associated with increased mortality. Therefore, predisposing factors should be determined and effective treatment strategies should be established in the early period.

Liver function as a predictor of mortality in COVID-19: A retrospective study.

INTRODUCTION AND OBJECTIVES: In many studies, varying degrees of liver damage have been reported in more than half of the COVID-19 patients. The aim of this study is to determine the effect of liver biochemical parameters abnormality on mortality in critical COVID-19 patients who have been followed in the ICU since the beginning of the pandemic process. MATERIALS AND METHODS: In this study 533 critical patients who admitted to the ICU due to COVID-19 were included. The patients were divided into three groups according to their ALT, AST, and total bilirubin levels at their admission to the ICU. Group 1 was formed of patients with normal liver biochemical parameters values; Group 2 was formed of patients with liver biochemical parameters abnormality; Group 3 was formed of patients with liver injury. RESULTS: 353 (66.2%) of all patients died. Neutrophil, aPTT, CRP, LDH, CK, ALT, AST, bilirubin, procalcitonin and ferritin values in Group 2 and Group 3 were found to be statistically significantly higher than Group 1. It was detected that the days of stay in ICU of the patients in Group 1 was statistically significantly longer than others group. It was found that the patients in Groups 2 and 3 had higher total, 7-day, and 28-day mortality rates than expected. CONCLUSIONS: The study showed that liver disfunction was associated with higher mortality and shorter ICU occupation time.

Pneumothorax in Coronavirus Disease-19 ID Patients: A Retrospective Case Series

Objective: Pneumothorax may develop secondary to alveolar damage and barotrauma in Covid- 19 patients. In this study, in the light of the literature. we aimed to present Covid-19 patients who developed pneumothorax among whom we followed up in the intensive care unit. Methods: Eleven patients among 2680 patients tested positive for Covid-19 in the PCR test and developed pneumothorax in the radiologic examination were included in the study. The data were obtsined from patient follow-up forms and electronic medical records. Demographic data, blood and biochemical parameters, blood culture results, time and location of development of pneumothorax, modality, and duration of pneumothorax treatment, and mortality data were recorded. Results: The frequency of development of pneumothorax was found to be 0.41%. The most common complaint was dyspnea. Comorbidiites were observed in 9 (81.8%) patients and the most common comorbidity was hypertension. It was determined that 3 (27.2%) patients did not smoke, 4 patients(36.3%) were active smokers, and 4 (36.3%) patients were ex-smokers. The mean age was 69±14.8 years, the APACHE II score were 18.8±8.7, the female/male ratio was 3/8, and the the time to pneumothorax development was 10.7±11.8 days. Pneumothorax developed in 3 (27.27%) patients on noninvasive mechanical ventilation and 8 (72.7%) patients on invasive mechanical ventilation. The mean length of stay in the intensive care unit was 21.6±26.5 days. It was found that 10 (90.9%) patients died and the mean time to mortality was 19.5±27.0 days. Conclusion: In Covid-19 infection, lung protective ventilation strategies should be adopted and it should be known that the development of pneumothorax is a late complication that increases mortality and morbidity. (English) [ABSTRACT FROM AUTHOR] Amaç: Covid-19 hastalarında alveolar hasar ve barotravmaya sekonder pnömotoraks gelişebilir. Bu çalışmada, yoğun bakım ünitesinde takip ettiğimiz Covid-19 hastalarından pnömotoraks gelişenlerini literatür eşliğinde sunmayı amaçladık. Yöntem: Çalışmaya PCR testi pozitif olduğu saptanan 2.680 hastadan radyolojik olarak pnömotoraks geliştiği belirlenen 11 hasta dahil edildi. Veriler hasta takip formları ve elektronik tıbbi kayıtlardan alındı. Demografik veriler, tam kan ve biyokimyasalparametreleri, kan kültür sonuçları, pnömotoraks gelişim zamanı ve lokasyonu, pnömotoraks tedavi şekli, mortalite ve süresi kaydedildi. Bulgular: Pnömotoraks gelişme sıklığı %0,41 bulundu. En sık başvuru yakınmasının dispne olduğu saptandı. Dokuz (%81.8)hastada comorbidite olduğu ve en sık gözlenen comorbiditenin hipertansiyon olduğu görüldü. Üç (%27,2) hastanın sigara kullanmadığı, 4(%36,3) hastanın aktif sigara içicisi olduğu ve 4 (%36.3) hastanın sigarayı bıraktığı saptandı. Hastaların yaş ortalamaları 69±14,8 yıl, APACHE II skor ortalamaları 18,8±8,7, kadın/erkek oranı 3/8 ve pnömotoraks gelişene 10,7±11,8 gün bulundu. Üç hastada (%27.27) noninvaziv mekanik ventilasyonda ve 8 hastada (%72,7) invaziv mekanik ventilasyondayken pnomotoraks geliştiği saptandı. Yoğun bakım ünitesinde ortalama kalma süresi 21,6±26,5 gündü. On (%90,9) hastanın eks olduğu ve eks olana kadar ortalama 19,5±27,0 gün geçtiği saptandı. Sonuç: Covid-19 infeksiyonu sırasında hipoksemi tedavi edilirken, akciğer koruyucu ventilasyon stratejileri benimsenmeli ve pnömotoraks gelişiminin mortalite ve morbiditeyi arttıran geç dönem komplikasyon olduğu bilinmelidir. (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Journal of the Society of Thoracic Carido-Vascular Anaesthesia & Intensive Care is the property of Gogus Kalp Damar Anestezi ve Yogun Bakim Dernegi 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.)

Is arterial switch operation possible with neonatology-focused intensive care unit modality.

BACKGROUND: In this study, we aimed to examine the feasibility of arterial switch operation and its perioperative management with neonatology-focused intensive care modality in a region of Turkey where the birth rate and the number of asylum seekers who had to leave their country due to regional conflicts are high. METHODS: Between December 2017 and June 2020, a total of 57 patients (48 males, 9 females; median age: 12.2 days; range, 2 to 50 days) who were diagnosed with transposition of the great arteries in our clinic and underwent arterial switch operation were retrospectively analyzed. All patients were followed by the neonatologist in the neonatal intensive care unit during the preoperative and postoperative period. RESULTS: Thirty-eight (66.7%) patients had intact ventricular septum, 16 (28.1%) had ventricular septal defect, two (3.5%) had coarctation of the aorta, and one (1.7%) had Taussig-Bing anomaly. Coronary artery anomaly was present in 14 (24.5%) patients. The most common complications in the intensive care unit were renal failure requiring peritoneal dialysis in seven (12.3%) patients, supraventricular tachyarrhythmia in six (10.5%) patients, and eight (14%) patients left their chests open. The median length of stay in intensive care unit was 13.8 (range, 9 to 25) days and the median length of hospital stay was 24.5 (range, 16 to 47) days. The overall mortality rate for all patients was 12.3% (n=7). The median follow-up was 8.2 months. A pulmonary valve peak Doppler gradient of ≥36 mmHg was detected in five patients (8.7%) who were followed, and these patients were monitored by providing medical treatment. None of the patients needed reoperation or reintervention. CONCLUSION: We believe that arterial switch operation, one of the complex neonatal cardiac surgery, can be performed with an acceptable mortality and morbidity rate with the use of neonatology-focused intensive care modality, which is supported by pediatric cardiology and pediatric cardiac surgery.