Tracheostomy Timing in Unselected Critically Ill Patients with Prolonged Intubation: A Prospective Cohort Study.

Background: Tracheostomy procedures are performed in the intensive care unit (ICU) for prolonged intubation, unsuccessful weaning and infection prevention through either percutaneous or surgical techniques. This study aimed to outline the impact of tracheostomy timing in the ICU on mortality, need for mechanical ventilation, and complications. Methods: Patients were included in the study on the day of tracheostomy. Demographic information, tracheostomy timing, technique, complications, sedation requirement and need for mechanical ventilation at discharge were recorded by an anesthesiologist, including the pre-tracheostomy period. Results: Tracheostomy was performed on 33 patients during the first 14 days of intubation and on 54 patients on the 15th day and beyond. There was no significant difference between the tracheostomy timing and mortality, sedation requirement, or weaning from the ventilator. We observed that patients who underwent tracheostomy with the surgical technique experienced more complications, but there was no significant difference. Tracheostomy performed after the 14th day was shown to be associated with prolonged hospital stay. Conclusions: Early tracheostomy does not have any influence on the need for mechanical ventilation, sedation and mortality. The optimal timing for tracheostomy is still controversial. We are of the opinion that randomized controlled trials involving patient groups with similar survival expectations are needed.

Intraoperative Patient Warming Instead of Gas on the Management of Postoperative Pain in Laparoscopic Colectomy and Cholecystectomy: A Randomized Controlled Trial.

INTRODUCTION: Blurred lines remain in details of the association between patient warming with postoperative pain and a proper analgesic requirement. Therefore, the present study proposes to observe the effects of intraoperative patient warming and carbon dioxide insufflation duration in laparoscopic colectomy (LCol) and laparoscopic cholecystectomy (LChol) procedures on postoperative pain, analgesic requirements, and hemodynamics. METHODS: The present study involved 80 cases aged 18-80 years with the American Society of Anesthesiologists I-III classification, possessing two initial groups primarily, one for LCol and one for LChol. Subsequently, each was divided into two through randomization for intraoperative warming. Postoperatively, pain perception, per se, was evaluated using the visual analog scale (VAS) score at the 30 minutes, 1st, 6th, 12th, and 24th hours, along with the impact of pain on hemodynamic parameters and side effects such as nausea/vomiting and the dosage of analgesics used. RESULTS: Groups actively heated with warm air-blowing devices detected significantly higher intraoperative core and skin temperature measurements, and postoperative early pain perception was significantly lower in the warmed ones. Furthermore, a significant decrease in the VAS scores and the analgesic at the 12th and 24th hours compared to the first six hours was recognized between them. CONCLUSION: Consequently, herewith, we postulate that so-called patient warming positively affects the VAS scores.

Role of Lactate Dehydrogenase and Lymphocyte Count as Predictors of Poor Perinatal Outcomes in COVID-19-Infected Pregnancies Requiring Hospitalization and Delivery: A Retrospective Cohort Study.

INTRODUCTION: Physiological, hormonal, or biochemical changes may be related to the increased morbidity of COVID-19 during pregnancy. Our knowledge remains limited about which pregnant women will worsen and develop complications. The aim was to evaluate the maternal, fetal, and neonatal outcomes in hospitalized pregnant women who delivered while infected with acute COVID-19 and to investigate the possible predictors of poor prognosis in a tertiary pandemic center. METHODS: A retrospective cohort study was conducted on pregnant women who required termination or delivery during a COVID-19 infection in a tertiary hospital. Serum markers were analyzed to determine any possible association and the predictive value of these markers to show poor maternal, fetal, and/or neonatal outcomes. RESULTS: Out of 45 patients, 12 had maternal complications (Group 1) and 33 had no maternal complications (Group 2). The mean lymphocyte at hospital admission was measured as 1,175.83 ± 362.0 and 1,735.30 ± 746.1 in Groups 1 and 2, respectively (p=0.02). The lymphocyte count measured at hospital admission showed significance in predicting poor maternal outcome, with an area under the curve (AUC) of 0.737 (95% CI:0.578 to 0.897) and a cut-off value of 1,110 mcL with 82% sensitivity and 67% specificity. Nineteen of the 45 women had fetal complications. Receiver operating characteristic analysis showed maternal lactate dehydrogenase as a significant predictor for poor fetal outcome with a cut-off value of 213 U/L (AUC:0.719; 95% CI:0.566 to 0.872) with 85% sensitivity and 60% specificity. CONCLUSION: The lymphocyte count can be used as a predictor of poor maternal outcome and lactate dehydrogenase demonstrates poor fetal outcome during hospitalization.

Impact of music therapy and hand massage in the pediatric intensive care unit on pain, fear and stress: Randomized controlled trial.

PURPOSE: This study was performed with the aim of assessing the effect of music therapy and hand massage on pain, fear and stress among 12-18 year-old adolescents treated in the pediatric intensive care unit (PICU). DESIGN: This study was a randomized controlled trial, with single-blind design. METHODS: The adolescents were divided into groups with 33 receiving hand massage, 33 receiving music therapy and 33 in the control group. Collection of data used the Wong-Baker FACES (WB-FACES) Pain Rating Scale, Children's Fear Scale (CFS) and blood cortisol levels. FINDINGS: In the study, adolescents in the music therapy group had lower mean points for WB-FACES before, during and after the procedure by a significant level compared to the control group (p < 0.05). Additionally, the CFS mean points before and during the procedure were lowest in the music therapy group, while the music therapy and massage groups were determined to have lower points by a significant level after the procedure compared to the control group (p < 0.05). However, when the mean cortisol levels of adolescents before the procedure and on the 1st and 2nd day after the procedure were compared, there was no significant difference between the groups (p > 0.05). CONCLUSIONS: It was determined that hand massage and music therapy were more effective than standard care at reducing pain and fear levels during blood drawing among 12-18-year-old adolescents in the PICU. PRACTICE IMPLICATIONS: Nurses may use music therapy and hand massage to manage fear and pain related to blood drawing in the PICU.

Evaluation of accidental and intentional pediatric poisoning: Retrospective analysis in an emergency Department of Turkey.

INTRODUCTION: Childhood poisoning is one of the leading causes of applications to ED and is a preventable cause of morbidity and mortality. The characteristics of poisoning may differ by geographic region, season, and the sociocultural aspects of the community and age groups. METHOD: Poisoned patients age ≤ 18 years admitted to the ED January 2018-December 2019, were evaluated retrospectively. RESULTS: Of 170 cases, mean age was 7.48 ± 5.54 years. Of the cases, 0-5 years (44.1%), 6-12 years (24.7%), and 13-18 years (31.2%); most were female (58.2%). Causes were accidental (72.9%), intentional (24.1%), and substance use (2.9%). Accidental cases were all patients age 0-5 years, 31.8% of age 6-12 years, and 24.5% of age 13-18 years. Drugs caused 72.9% of cases, primarily analgesics (22.4%), among which nonsteroidal anti-inflammatory drugs were most common (12.4%). Intentional poisoning by repeated drug intake caused 5.9% of cases. Rat poison caused 7.1% of non-drug cases. Treatment was gastric lavage (52.4%) and oral activated charcoal (45.9%). CONCLUSION: As a result of the study, it was determined that accidental drug intake was the most common reason for children to apply to the ED due to acute poisoning in our region. Childhood poisoning can be prevented by measures to be taken by the environment, family, and healthcare professionals. PRACTICE IMPLICATIONS: The fact that children's acute poisoning cases are mostly accidental in our region shows that it is important to raise the awareness of parents to reduce acute poisoning and alleviate its negative consequences.

The Effect of Music Therapy, Hand Massage, and Kaleidoscope Usage on Postoperative Nausea and Vomiting, Pain, Fear, and Stress in Children: A Randomized Controlled Trial.

PURPOSE: The objective of this study was to investigate the effects of music therapy, hand massage, and kaleidoscope usage on nausea and vomiting, pain, fear, and stress in 7-year-old to 11-year-old children after circumcision. DESIGN: This study was a prospective and randomized controlled trial. METHODS: The study was conducted at the pediatric surgery unit in a hospital in Turkey. The children were assigned to four groups through randomization performed using a computer program: group 1 was the control group with children who received no intervention; group 2 received hand massage; group 3 were distracted using kaleidoscope; and group 4 received music therapy. FINDINGS: There was a significant difference between the postoperative pain scores of the children in the intervention and control groups after the intervention (P < .05). This difference was found to be caused by the music therapy and kaleidoscope methods. There was a significant difference between the intervention and control groups' postoperative fear and anxiety levels in favor of the kaleidoscope group after the intervention (P < .05). But, no significant difference was found between the groups for the children's postoperative vomiting and nausea levels after the intervention (P > .05). CONCLUSIONS: Distraction with music therapy and kaleidoscope is recommended for use in the postoperative period in children with circumcision to reduce the severity of their pain, fear, and anxiety.