Does prolonged prone position affect intracranial pressure? prospective observational study employing Optic nerve sheath diameter measurements.

BACKGROUND: Our aim in this observational prospective study is to determine whether the prone position has an effect on intracranial pressure, by performing ultrasound-guided ONSD (Optic Nerve Sheath Diameter) measurements in patients with acute respiratory distress syndrome (ARDS) ventilated in the prone position. METHODS: Patients hospitalized in the intensive care unit with a diagnosis of ARDS who were placed in the prone position for 24 h during their treatment were included in the study. Standardized sedation and neuromuscular blockade were applied to all patients in the prone position. Mechanical ventilation settings were standardized. Demographic data and patients' pCO2, pO2, PaO2/FiO2, SpO2, right and left ONSD data, and complications were recorded at certain times over 24 h. RESULTS: The evaluation of 24-hour prone-position data of patients with ARDS showed no significant increase in ONSD. There was no significant difference in pCO2 values either. PaO2/FiO2 and pO2 values demonstrated significant cumulative increases at all times. Post-prone SPO2 values at the 8th hour and later were significantly higher when compared to baseline (p < 0.001). CONCLUSION: As a result of this study, it appears that the prone position does not increase intracranial pressure during the first 24 h and can be safely utilized, given the administration of appropriate sedation, neuromuscular blockade, and mechanical ventilation strategy. ONSD measurements may increase the safety of monitoring in patients ventilated in the prone position.

Extracorporeal Circulation and Optic Nerve Ultrasound: A Pilot Study.

Background and Objectives: Cardiopulmonary bypass (CPB) is an extracorporeal circuit that provides surgical access to an immobile and bloodless area, allowing for technical and procedural advances in cardiothoracic surgery. CBP can alter the integrity of the blood-brain barrier and cause changes in intracranial pressure (ICP) postoperatively. Optical nerve sheath diameter (ONSD) measurement is among the alternative non-invasive methods for ICP monitoring. In this study, we aimed to evaluate the optic nerve sheath diameter measurements under the guidance of ultrasonography for ICP changes during the extracorporeal circulation process. Materials and Methods: The study population included 21 patients over 18 years of age who required extracorporeal circulation. Demographic data of the patients, such as age, gender, comorbidity, American Society of Anesthesiologists (ASA) classification and reason for operation (coronary artery disease or mitral or aortic valve disease) were recorded. The ONSD was measured and evaluated before the extracorporeal circulation (first time) and at the 30th minute (second time), 60th minute (third time) and 90th minute (fourth time) of the extracorporeal circulation. Non-invasive ICP (ICP ONSD) values were calculated based on the ONSD values found. Results: The mean ONSD values measured before the extracorporeal circulation of the patients were found to be 4.13 mm (3.8-4.6) for the right eye and 4.36 mm (4.1-4.7) for the left eye. Calculated nICPONSD values of 11.0 mm Hg (1.0-21.0) for the right eye and 10.89 mm Hg (1.0-21.0) for the left eye were found. It was observed that there was a significant increase in the ONSD and nlCPONSD values recorded during the extracorporeal circulation of all patients compared to the baseline values (p < 0.005). Conclusions: During extracorporeal circulation, ultrasound-guided ONSD measurement is an easy, inexpensive and low-complication method that can be performed at the bedside during the operation to monitor ICP changes.

Retrospective Comparison of Anesthetic Methods for Percutaneous Balloon Kyphoplasty Surgery: General Anesthesia and Erector Spinae Plane Block.

Background and Objectives: This study aims to investigate whether erector spinae plane (ESP) block can be an alternative to general anesthesia as a primary anesthesia method in percutaneous balloon kyphoplasty surgery. In addition, postoperative intensive care needs were compared in terms of length of intensive care unit stay and length of hospital stay. Materials and Methods: Medical records of patients who underwent percutaneous balloon kyphoplasty operation at Kastamonu Training and Research Hospital between January 2020 and November 2022 were reviewed retrospectively. Among 70 patients who underwent percutaneous balloon kyphoplasty, 58 patients with ASA (American Association of Anesthesiologists) classification III or IV, who underwent general anesthesia as the anesthesia method or ESP block, were included in the study. The patients were divided into two groups according to the anesthesia method applied. Group GA: general anesthesia group (n = 19) and Group ESP: ESP block group (n = 39). Group data for age, gender, ASA classification, number of surgical levels, surgical urgency, duration of surgery, postoperative complications, need for intensive care, length of stay in the intensive care unit, and hospital stay were compared. Results: There was no statistically significant difference between Group GA and Group ESP in terms of age, gender, ASA classification, surgical urgency, number of surgical levels, duration of surgery, and postoperative complication data of the patients included in the study. Seven (36.6%) patients in Group GA and six (15.4%) patients in Group ESP needed intensive care, and there was no statistically significant difference between the groups (p = 0.06). However, the need for intensive care was higher in Group GA. A statistically significant difference was found in Group GA and Group ESP, which was higher in Group GA for the length of stay in the intensive care unit (p = 0.02) and length of hospitalization (p = 0.04). Conclusions: ESP block may be an alternative method to general anesthesia as the primary anesthetic option for single or multilevel percutaneous balloon kyphoplasty surgery. With the ESP block, the length of stay in the intensive care unit and the length of stay in the hospital can be reduced, especially in high-risk patients.

Predictive Role of Biomarkers in COVID-19 Mortality.

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in high mortality among patients in critical intensive care units. Hence, identifying mortality markers in the follow-up and treatment of these patients is essential. This study aimed to evaluate the relationships between mortality rates in patients with COVID-19 and the neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic inflammation response index (SII), and systemic inflammatory response index (SIRI). Methodology In this study, we assessed 466 critically ill patients diagnosed with COVID-19 in the adult intensive care unit of Kastamonu Training and Research Hospital. Age, gender, and comorbidities were recorded at the time of admission along with NLR, dNLR, MLR, PLR, SII, and SIRI values from hemogram data. Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and mortality rates over 28 days were recorded. Patients were divided into survival (n = 128) and non-survival (n = 338) groups according to 28-day mortality. Results A statistically significant difference was found between leukocyte, neutrophil, dNLR, APACHE II, and SIRI parameters between the surviving and non-surviving groups. A logistic regression analysis of independent variables of 28-day mortality identified significant associations between dNLR (p = 0.002) and APACHE II score (p < 0.001) and 28-day mortality. Conclusions Inflammatory biomarkers and APACHE II score appear to be good predictive values for mortality in COVID-19 infection. The dNLR value was more effective than other biomarkers in estimating mortality due to COVID-19. In our study, the cut-off value for dNLR was 3.64.

Ferritin / albumin ratio could be a new indicator of COVID-19 disease mortality.

INTRODUCTION: Despite significant advances in the management of patients with COVID-19, there is a need for markers to guide treatment and predict disease severity. In this study, we aimed to evaluate the relationship of the ferritin/albumin (FAR) ratio with disease mortality. METHODOLOGY: Acute Physiology and Chronic Health Assessment II scores and laboratory results of patients diagnosed with severe COVID-19 pneumonia were retrospectively analyzed. The patients were divided into two groups: survivors and non-survivors. Data for ferritin, albumin, and ferritin/albumin ratio among COVID-19 patients were analyzed and compared. RESULTS: The mean age was higher in non-survivors (p = 0.778, p < 0.001, respectively). The ferritin/albumin ratio was significantly higher in the non-survival group (p < 0.05). Taking the cut-off value of the ferritin/albumin ratio of 128.71 in the ROC analysis, it predicted the critical clinical status of COVID-19 with 88.4% sensitivity and 88.4% specificity. CONCLUSIONS: ferritin/albumin ratio is a practical, inexpensive, and easily accessible test that can be used routinely. In our study, the ferritin/albumin ratio has been identified as a potential parameter in determining the mortality of critically ill COVID-19 patients treated in intensive care.

Can Ultrasound-Guided Femoral Vein Measurements Predict Spinal Anesthesia-Induced Hypotension in Non-Obstetric Surgery? A Prospective Observational Study.

Background and objectives: To investigate whether ultrasound (US)-guided femoral vein (FV) and inferior vena cava (IVC) measurements obtained before spinal anesthesia (SA) can be utilized to predict SA-induced hypotension (SAIH) and to identify risk factors associated with SAIH in patients undergoing non-obstetric surgery under SA. Methods: This was a prospective observational study conducted between November 2021 and April 2022. The study included 95 patients over the age of 18 with an American Society of Anesthesiologists (ASA) physical status score of 1 or 2. The maximum and minimum diameters of FV and IVC were measured under US guidance before SA initiation, and the collapsibility index values of FV and IVC were calculated. Patients with and without SAIH were compared. Results: SAIH was observed in 12 patients (12.6%). Patients with and without SAIH were similar in terms of age [58 (IQR: 19-70) vs. 48 (IQR: 21-71; p = 0.081) and sex (males comprised 63.9% of the SAIH and 75.0% of the non-SAIH groups) (p = 0.533). According to univariate analysis, no significant relationship was found between SAIH and any of the FV or IVC measurements. Multiple logistic regression analysis revealed that having an ASA class of 2 was the only independent risk factor for SAIH development (p = 0.014), after adjusting for age, sex, and all other relevant parameters. Conclusions: There is not enough evidence to accept the feasibility of utilizing US-guided FV or IVC measurements to screen for SAIH development in patients undergoing non-obstetric surgery under SA. For this, multicenter studies with more participants are needed.