The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear. Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19. Study Design: Multicenter prospective observational clinical study. Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated. Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004). Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

Diagnostic and Therapeutic Approaches to Novel COVID-19 in Intensive Care Unit: A Narrative Review.

This study aimed to compile the up-to-date information about the methods and pharmacological agents used in the diagnosis and treatment of coronavirus disease 2019 (COVID-19) and examine the methods used in the treatment of COVID-19 in patients in the intensive care unit by reviewing the treatment guidelines published by national health authorities worldwide. We surveyed the literature published on the novel coronavirus (severe acute respiratory syndrome [SARS] coronavirus [SARS-CoV-2]) before April 25, 2020, in PubMed. The results of the study identified serological and molecular methods (e.g., real-time reverse transcriptase polymerase chain reaction) used by physicians for diagnosing COVID-19 and identified thorax computed tomography along with other imaging methods used for determining the severity of the disease. However, it was concluded that the desired developments for treatment and vaccination have not been achieved till today, and many of the agents used and studied for the treatment were drugs previously used for the treatment of Middle East respiratory syndrome and SARS. COVID-19 has higher levels of transmissibility and pandemic risk. The available information revealed that, given the size and scope of the pandemic, to date, there has been no scientifically proven effective medicine and vaccines against SARS-CoV-2. There is also an urgent need for further research for finding an effective medicine and vaccine for COVID-19 to prevent the occurrence of an outbreak in future and manage such public health emergency of this magnitude in both short and long terms.

Analysis of risk factors for sternal surgical site infection: emphasizing the appropriate ventilation of the operating theaters.

OBJECTIVE: To determine the incidence of and identify risk factors for sternal surgical site infection (SSI). DESIGN: Prospective cohort study. Data on potential risk factors, including the type of operating theater and infection data, were collected prospectively and analyzed by multivariate analysis. SETTING: Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, a 700-bed teaching hospital and the largest center for cardiac surgery in Turkey. The cardiothoracic unit performs approximately 3,000 cardiac operations per year. PATIENTS: All adult patients who underwent cardiac surgery with sternotomy between January 14, 2002, and July 1, 2002, and who survived at least 4 days after surgery were included in the study. RESULTS: Potential risk factor data were complete for 991 patients. There was sternal SSI in 41 patients (4.1%). Female sex, diabetes mellitus, operation performed in the older operating theaters, and duration of procedure exceeding 5 hours were identified as independent risk factors for sternal SSI. CONCLUSIONS: Female and diabetic patients are at higher risk for sternal SSI and should be followed up carefully after cardiac surgery to prevent the development of sternal SSI. Reducing the duration of surgery could reduce the rate of postoperative sternal SSI. The operating theater environment may have an important role in the pathogenesis of sternal SSI, and appropriate ventilation of the operating theaters would be critical in the prevention of sternal SSI.