Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study.

OBJECTIVE: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

Neuromuscular Electrical Stimulator as a Protective Treatment against Intensive Care Unit Muscle Wasting in Sepsis/Septic Shock Patients.

OBJECTIVE: To investigate the efficacy of neuromuscular electrical stimulation (NMES) application in preventing muscle wasting in intensive care unit (ICU) patients diagnosed with sepsis/septic shock. STUDY DESIGN: A single-centre, unblinded, parallel-group, prospective, randomised clinical study. PLACE AND DURATION OF STUDY: Ondokuz Mayis University, Faculty of Medicine Hospital, Level 3 ICU, between October 28th 2018, and October 1st, 2020. METHODOLOGY: Eighty patients from a single centre who were diagnosed with sepsis/septic shock, followed up at level 3 ICU, and met the criteria were included. The patients were evaluated in 2 groups: One who received physiotherapy alone (n=40) and the other who received physiotherapy + NMES (n=40). The development of intensive care unit-muscle wasting was evaluated in patients of both groups. Muscle wasting was identified by anthropometric and ultrasonographic measurements. The day the patients were diagnosed with sepsis was determined as the first day and the bilateral anthropometric and ultrasonographic measurements of the biceps brachii and rectus femoris muscles were obtained on days 3, 7, 14, 21, and 28. RESULTS: There was no significant difference between the groups in the ultrasonographic and anthropometric measurements on days 1, 3, and 7 (p>0.005). However, the ultrasonographic measurements of the group that received physiotherapy + NMES demonstrated a significantly lower loss in the upper extremities on days 14 and 21 compared to the group that received physiotherapy alone (p=0.003 and p=0.028, respectively). No significant difference was found in the anthropometric measurements. CONCLUSION: The NMES, which have been increasingly used as new treatment protocols in the prevention of ICU-AW, yield favourable results in patients with sepsis/septic shock. KEY WORDS: Intensive care unit, Acquired weakness, Neuromuscular electrical stimulation, Muscle wasting, Sepsis.

[From carbonmonoxide intoxication to organ donation; organ protective mechanic ventilation in severe pulmonary damage]. / Karbonmonoksit intoksikasyonundan organ donasyonuna; agir pulmoner hasarda organ koruyucu mekanik ventilasyon.

Organ donation is a matter of concern in critically ill patients who need intensive care after carbonmonoxide (CO) intoxication. A 26-year-old female patient was unconscious after having spent 20 minutes in the bathroom with a water heater (70% butane and 30% propane mixture). In the CT of the patient with Glasgow Coma Scale (GCS) 3, ventricular system was erased, white-gray matter separation was lost and fissures were observed as erased. Torax CT showed conspicuous areas showing air bronchograms in both lung bases and posterior areas and diffuse frosted glass densities in other areas. In a patient with no improvement in consciousness; apnea test, neurological examination and CT angiography showed that there was no blood flow in the brain and brain death was confirmed. On the second day of hospitalization, the relatives gave their approval for the donation. It may also be advantageous to use oxygen at high concentrations in carbonmonoxide poisoning as it may allow recruitment of closed alveoli. Successful kidney, heart, lung, liver and pancreas transplants from donors exposed to CO have been reported. Carbonmonoxide intoxication may be appropriate for transplantation for patients who are waiting for organs of brain death cases where the organ preservation is well done. Although carbonmonoxide intoxication has failed in the literature, it shows that there is no definite contraindication.

Anesthetic Challenges and Management in a case of Jarcho-Levin Syndrome with a Neural Tube Defect in a Newborn.

Jarcho-Levin syndrome (JLS) is a rare axial skeletal growth disorder characterized by the presence of multi-level costovertebral malformations, a short neck, a short trunk, and kyphoscoliosis at birth. Neural tube defects appear to be common findings in patients with JLS, and chest hypoplasia frequently leads to respiratory insufficiency and death in early childhood. There have been no previous studies in the literature on the anesthetic management of JLS with neural tube defects and hydrocephalus. Therefore, we have reported a case of JLS in a female full-term newborn, who underwent surgery for myelomeningocele repair and ventriculoperitoneal shunting, with the associated anesthetic challenges and their management.