The association between Acinetobacter baumannii infections and the COVID-19 pandemic in an intensive care unit.

We aimed to describe the increased rate of Acinetobacter baumannii infections during the COVID-19 pandemic and define its significance within the last five years. This study was performed in a tertiary hospital with 280 beds and included all patients infected with A. baumannii in the intensive care unit between January 1, 2018, and June 30, 2022. A. baumannii-infected patients in the intensive care unit 27 months before the pandemic and 27 months during the pandemic were included. Pulsed-field gel electrophoresis was performed to assess clonal relatedness. The infection control measures were specified based on the findings and targeted elimination. In total, 5718 patients were admitted to the intensive care unit from January 1st, 2018, to June 30th, 2022. A. baumannii infection was detected in 81 patients. Compared to the pre-pandemic era, the rate of A. baumannii infection during the pandemic was 1.90 times higher (OR: 1.90, 95% CI: [1.197, 3.033]). Clonality assessment of multidrug-resistant A. baumannii samples revealed eight clusters with one main cluster comprising 14/27 isolates between 2021 and 2022. The case fatality rate of the pre-pandemic and pandemic era was not different statistically (83.33% vs. 81.48%, p = 0.835). Univariate analysis revealed the association of mechanical ventilation (p = 0.002) and bacterial growth in tracheal aspirate (p = 0.001) with fatality. During the COVID-19 pandemic, potential deficits in infection control measures may lead to persistent nosocomial outbreaks. In this study, the introduction of enhanced and customized infection control measures has resulted in the containment of an A. baumannii outbreak.

Poliomiyelit Sekeli, COVID-19 ARDS Sonrası Íyileşme için Bir Dezavantaj mı: Olgu Sunumu

Keywords: COVID-19, poliomyelitis, muscular weakness, intensive care unit, acute respiratory distress syndrome GÍRÍŞ Şiddetli akut solunum sıkıntısı sendromu koronavirüs 2'nin (SARS-CoV-2) neden olduǧu COVID-19, yoǧun bakım ünitesine (YBÜ) kabul gerektiren hayatı tehdit edici bir akut solunum sıkıntısına neden olabilir (1). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and metaanalysis. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a singlecentered, retrospective, observational study.

Is Poliomyelitis Sequelae A Disadvantage for Recovery from Covid-19 ARDS: A Case Report.

We present a case with acute respiratory distress syndrome due to COVID-19 who had poliomyelitis sequelae. He was hospitalized in the intensive care unit and supported by non-invasive mechanical ventilation for 7 days. IL-6 inhibitor was administered due to cytokine storm. No steroid or sedative agents were administered. Early mobilization was performed in the intensive care unit. One month after discharge, physical examination revealed COVID-19 infection did not cause significant changes in muscle strength and physical performance in this patient with poliomyelitis sequelae. It is important to promote early mobilization in the intensive care unit to prevent post-intensive care syndrome in COVID-19 acute respiratory distress syndrome.

COVID-19 Olgularında Görülen Trakeal Hasar: Pozisyon mu, Entübasyon Komplikasyonu mu?

Amaç: Trakeal hasar (TH) entübe hastalarda karşılaşılabilen nadir bir komplikasyondur. Sunuda COVID-19 pnömonisiyle yoğun bakım ünitesinde (YBÜ) takip edilen iki hastamızda görülen TH incelenmiştir. Olgu: Olgu 1: Yirmi yedi yaşında bilinen ek hastalığı bulunmayan erkek hasta, SARS-CoV-2 PCR pozitifliğinin 7. gününde ateş ve hemoptizi nedeniyle hastaneye yatışı yapılmıştır. Artan oksijen gereksinimi sebebiyle steroid ve tocilizumab başlanmıştır. Solunum yetersizliği ilerleyince YBÜ’ye alınmıştır. NIMV ve prone pozisyona rağmen hipoksisi nedeniyle entübe edilmiştir. Günde 16 saat prone 8 saat supine pozisyon verilmiştir. Hipoksemisi devam eden hastaya VV-ECMO başlanmıştır. Entübasyonun 7. gününde pnömotoraks, deri altı amfizemi ve bozulan enteral tolerasyon saptanmıştır. On dokuzuncu gününde toraks bilgisayarlı tomografi görüntülemesinde bilateral hidropnömotoraks, trakeaösefageal fistül (TÖF) izlenmiştir (Şekil 1). Yapılan eksploratif torakoskopide trakeada tam kat rüptür görülmesi sebebiyle inoperable kabül edilen hasta entübasyon sonrası 20. günde eksitus olmuştur. Olgu 2: Koroner arter hastalığı bulunan hasta SARS-CoV2 PCR pozitifliğinin 11. gününde NIMV ve HFNC desteğine rağmen hipoksisi nedeniyle dış merkezde entübe edilmiştir. YBÜ’müze sevk edilen hasta 16 saat prone 8 saat supin olacak şekilde takip edilmiştir. Takibinin 6. gününde çekilen toraks tomografisinde yaygın pnömomediastinum saptanmıştır, endotrakeal tüpünün (ETT) kafının distalinde trakeanın sağ posterolateralinde trakeal fistül görülmüştür (Şekil 2). Hastanın pnömomediastinumunun artmaması için ETT bölgenin distaline, tek akciğer ventilasyonuna da neden olmayacak şekilde 26 cm’de bırakılarak hasta takip edilmiştir. Hasta pnömomediastinumu takiben 11. günde prone pozisyona yanıt vermemesi üzerine hipoksi ve şok tablosunda eksitus olmuştur. Sonuç: TH’de risk faktörleri travmatik entübasyon, kaf basıncı, uzun süreli mekanik ventilasyon, hava yolu enfeksiyonları, steroid kullanımı, trakeal arka duvar yapısal sorunları ve entübasyon/nazogastrik tüpün basısı olarak sıralanabilir. Yüksek hacim düşük basınç kaflı ETT kullanımıyla TH/TÖF sıklığı azalmıştır. Prone pozisyon arka duvara basıyı artırarak yaralanma oluşturabilir. COVID-19 pnömonili hastaların prone pozisyonlanmasından ve virüsün direkt mukoza hasarından dolayı trakeal hasarla karşılaşılabilir. Bu açıdan ETT kaf basınçlarının takip edilmesi ve prone pozisyonda sedasyon uygulanması entübe hastalarda önem taşıyor olabilir. (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.)

COVID ve Non-COVID ARDS Hastalarında Statik Kompliyans ve Yoğun Bakım Mortalite Ílişkisinin Karşılaştırılması

Amaç: Koronavirüs hastalığı-2019 ile ilişkili akut solunum yetersizliği sendromu (COVID-19 ARDS) bazı patofizyolojik yönleri ile non-COVID-19 ARDS’den farklılıklar göstermektedir. COVID-19 ARDS’de belirgin hipoksemiye rağmen korunmuş kompliyans bunlar arasında en çok üzerinde durulan konulardan biridir. Biz bu retrospektif veri tabanı çalışmasında, kontrollü mekanik ventilasyonda ilk 24 saatte ideal kiloya göre hesaplanan kompliyans (Crs) ve tidal volüm (VT) değerlerinin COVID19 ARDS ve non-COVID-19 ARDS hasta gruplarında mortaliteli ile ilişkisini karşılaştırmayı amaçladık. Gereç ve Yöntem: Koç Üniversitesi etik kurul onamıyla, 2015-2021 yılları arasında VKV Amerikan Hastanesi Yoğun Bakım Ünitesi’ne kabul edilen;18 yaş üstü 24 saatten fazla mekanik ventilasyon uygulanan hastalar incelenmiştir. Berlin sınıflamasına göre ARDS kriterlerini karşılayan, Crs, DP, TV verileri eksiksiz hastalar çalışmaya dahil edilmiştir. Demografik bilgileri, APACHE II ve SOFA skorları, kan gazları, mekanik ventilatör ayarları IMDSoft (MetaVision, QlinICU) sisteminden kaydedilmiştir. Elli bir tane COVID-19 ARDS hastasına demografik olarak eşdeğer 52 tane nonCOVID-19 ARDS hastası belirlenmiştir. Íki grubun kompliyans ve mortalite ilişkisi Mann-Whitney U, Student t-test ve ki-kare testi ile incelendi. Bulgular: Demografik bulgular Tablo 1, solunum parametreleri ve mortaliteyle ilgili bulgular Tablo 2 ve 3’te yer almaktadır. Sonuç: COVID-19 ve non-COVID-19 ARDS hasatlarında kompliyans değerlerinde Peep uygulaması, MV süresi ve YBÜ kalış süresinde anlamlı farklılıklar görülmesine rağmen mortalitede anlamlı farklılık bulunmamıştır. Beklenenin tersine COVID ARDS olgularında daha düşük kompliyans izlenmiştir. (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.)

Physical rehabilitation in Intensive Care Unit in acute respiratory distress syndrome patients with COVID-19.

BACKGROUND: The risk of muscle weakness is high in the survivors of acute respiratory distress syndrome with COVID-19 following discharge from intensive care unit. AIM: To evaluate the effects of early rehabilitation program in intensive care unit in patients with acute respiratory distress syndrome secondary to COVID-19. DESIGN: The design of the study is observational. SETTING: The setting of the study is inpatient. POPULATION: Thirty-five patients with acute respiratory distress syndrome secondary to COVID-19 were enrolled. METHODS: This study was performed in an intensive care unit of a university hospital. Early rehabilitation program consisting of passive or active range of motion exercises and neuromuscular electrical stimulation in addition to standard intensive care (N.=18) compared to standard intensive care (N.=17). Primary outcome was hand grip strength following discharge. RESULTS: Rehab group had higher prevalence of chronic pulmonary diseases and neurologic diseases. There was no difference in hand grip or manual muscle strength following discharge between rehab and non-rehab groups. No adverse event was noted. CONCLUSIONS: The results did not support the beneficial effects of early rehabilitation in intensive care unit on improving muscle strength. More patients with pulmonary and neurologic diseases in rehab group might impede the impact of rehabilitation on outcomes. On the other hand, these comorbidities underline the role and need of rehabilitation. It is safe both for the patients and the health care workers when necessary precautions are taken. CLINICAL REHABILITATION IMPACT: This study guide how to rehabilitate patients with acute respiratory distress syndrome with COVID-19 during intensive care unit in a safe way.

Appropriate use of tocilizumab in COVID-19 infection.

OBJECTIVE: This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. METHODS: All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. RESULTS: Forty-three patients were included: 70% were male; the median age was 64 years (minimum-maximum: 27-94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. CONCLUSION: Earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes.