Comparison of the effectiveness of delirium evaluation tools in intensive care patients: pre-deliric versions 1 and 2, E-pre-deliric and ICDSC.

OBJECTIVE: This study's objective was to compare the effectiveness of the delirium prediction model (pre-deliric) and the early prediction model (E-pre-deliric) in delirium prediction in an intensive care unit (ICU) according to the Intensive Care Delirium Screening Checklist (ICDSC). Our aim was to determine these models' usability and cut-off values for ICU patients. PATIENTS AND METHODS: We classified the studied patients based on their highest ICDSC scores (tested twice daily) during ICU hospitalization. ICDSC scores of 4 or higher indicated positive results for delirium, whereas a score of 0 represented a negative result. We recorded the patients' demographic and clinical details and characteristics and calculated their E-pre-deliric and pre-deliric version 1 and version 2 scores. To evaluate the effectiveness of the models, we used receiver operating characteristic (ROC) curve analysis. RESULTS: Two hundred fifty patients (55.6% males, mean age 60.6±18.7 years) participated in this study. Their mean Acute Physiology and Chronic Health Evaluation II (APACHE-II) score was 17.0±9.1. Delirium was more common in men, patients of older ages, those with high APACHE-II scores, those who had undergone urgent admissions, those with histories of trauma, those with high urea or creatinine values and those who had undergone sedation or mechanical ventilation. Compared to patients who did not develop delirium, those who did had longer ICU stays and hospital stays, as well as greater mortality risk. The cutoff values for the patients' pre-deliric version 1, pre-deliric version 2 and E-pre-deliric scores were 38% [area under ROC (AUROC)=1], 22% (AUROC=1) and 28% (AUROC=1), respectively. CONCLUSIONS: This study is the first to compare the pre-deliric and E-pre-deliric prediction models. These models' validity and reliability were acceptable. They were clinically useful, and we identified their cut-off values. These models provide options for early detection of delirium and are easily applicable in the ICU.

Investigation of the effectiveness of prone ventilation in patients followed up for acute respiratory distress syndrome in the intensive care unit.

OBJECTIVE: Prone positioning has been found to improve oxygenation in most patients with acute respiratory distress syndrome (ARDS). The study aimed to investigate the effectiveness of the prone position in patients with ARDS. PATIENTS AND METHODS: The prone position is one of the ventilator techniques included in recent guidelines for acute respiratory distress syndrome. This study was a retrospective evaluation of the records of 100 ARDS patients who were administered prone position mechanical ventilation in our intensive care unit. All patients were placed in the prone position for a total of 12 hours per day at 4-hour intervals (supine-prone) while admitted to the intensive care unit. RESULTS: This study included 100 participants. These patients were divided into two groups as survivors [(n=38, 16 females, 22 males, median age: 60 (24-86)] and non-survivors [(n=62, 19 females, 43 males, median age: 64 (21-93)], according to their intensive care follow-ups. Acute physiology and chronic health evaluation (APACHE) II score, the sequential organ failure assessment score (SOFA), and inflammation markers were statistically significantly higher in the non-survivor group. Between the two groups, there was no statistically significant difference in terms of fundamental characteristics. In the sub-group evaluation of the subjects in patients with ARDS with and without novel coronavirus disease 2019 (COVID-19) groups, the patients in the COVID-19 (+) group were older, had shorter hospital stays, had higher APACHE II and SOFA scores, and higher rates of cardiovascular disease and sepsis. CONCLUSIONS: Applying prone-position mechanical ventilation in the cohorts of our patients with ARDS resulted in a demonstrable significant improvement in the oxygenation levels of our patients.

Late-onset pulmonary edema due to propofol.

Pulmonary edema after the administration of propofol has rarely been reported. In this case report, we describe pulmonary edema due to the administration of propofol during a Cesarean section and while in the intensive care unit. The skin tests demonstrated strong positive weal and flare reactions to propofol. The patient was treated successfully with mechanical ventilatory support. This report emphasizes that this fatal complication may be seen with propofol and underlying mechanisms and therapeutic approach are discussed.