Cardiac arrest patients admitted to intensive care unit after cardiopulmonary resuscitation: a retrospective cohort study to find predictors for mortality.

BACKGROUND: In-hospital cardiac arrest is a common situation in hospital settings. Therefore, healthcare providers should understand the reasons that could affect the results of cardiopulmonary resuscitation. We aimed to determine the independent predictors for poor outcomes after the return of spontaneous circulation in in-hospital cardiac arrest patients, and also look for a relationship between patient...s background parameters and the status at intensive care unit. METHODS: We did a retrospective cohort study using cardiac arrest patients admitted to the intensive care unit after successful cardiopulmonary resuscitation between 2011...2015. PATIENTS: .. data were gathered from hospital database. Estimated probabilities of survival were computed using the Kaplan-Meier method. Cox proportional hazard models were used to determine associated risk factors for mortality. RESULTS: In total, 197 cardiac arrest patients were admitted to anesthesia intensive care unit after successful cardiopulmonary resuscitation in a 4-years period. Of 197 patients, 170 (86.3%) died in intensive care unit. Median of survival days was 4 days. Comorbidity (p.ß=.ß0.01), higher duration of cardiopulmonary resuscitation (p.ß=.ß0.02), lower Glasgow Coma Score (p.ß=.ß0.00), abnormal lactate level (p.ß=.ß0.00), and abnormal mean blood pressure (p.ß=.ß0.01) were the main predictors for increased mortality in cardiac arrest patients after intensive care unit admission. CONCLUSION: The consequent clinical status of the patients is affected by the physiological state after return of spontaneous circulation. Comorbidity, higher duration of cardiopulmonary resuscitation, lower arrival Glasgow Coma Score, abnormal lactate level, and abnormal mean blood pressure were the main predictors for increased mortality in patients admitted to the intensive care unit after successful cardiopulmonary resuscitation.

Cardiac arrest patients admitted to intensive care unit after cardiopulmonary resuscitation: a retrospective cohort study to find predictors for mortality

Abstract Background In-hospital cardiac arrest is a common situation in hospital settings. Therefore, healthcare providers should understand the reasons that could affect the results of cardiopulmonary resuscitation. We aimed to determine the independent predictors for poor outcomes after the return of spontaneous circulation in in-hospital cardiac arrest patients, and also look for a relationship between patient's background parameters and the status at intensive care unit. Methods We did a retrospective cohort study using cardiac arrest patients admitted to the intensive care unit after successful cardiopulmonary resuscitation between 2011-2015. Patients' data were gathered from hospital database. Estimated probabilities of survival were computed using the Kaplan-Meier method. Cox proportional hazard models were used to determine associated risk factors for mortality. Results In total, 197 cardiac arrest patients were admitted to anesthesia intensive care unit after successful cardiopulmonary resuscitation in a 4-years period. Of 197 patients, 170 (86.3%) died in intensive care unit. Median of survival days was 4 days. Comorbidity (p= 0.01), higher duration of cardiopulmonary resuscitation (p= 0.02), lower Glasgow Coma Score (p= 0.00), abnormal lactate level (p= 0.00), and abnormal mean blood pressure (p= 0.01) were the main predictors for increased mortality in cardiac arrest patients after intensive care unit admission. Conclusion The consequent clinical status of the patients is affected by the physiological state after return of spontaneous circulation. Comorbidity, higher duration of cardiopulmonary resuscitation, lower arrival Glasgow Coma Score, abnormal lactate level, and abnormal mean blood pressure were the main predictors for increased mortality in patients admitted to the intensive care unit after successful cardiopulmonary resuscitation.

Effectiveness of pericapsular nerve group block with ultrasonography in patients diagnosed with hip fracture in the emergency department.

BACKGROUND: Hip fractures (HF) are among the most common fractures present in the emergency department and are very painful. Pericapsular nerve group block (PENG) is a new regional anesthesia technique developed for analgesia in total hip arthroplas-ties. We aimed to determine the effectiveness of PENG block used to reduce pain in patients with HF in the emergency department. METHODS: This single-center, randomized, and prospective study was carried out in the emergency department. The patients in-cluded in the study were selected according to the suitability of the personnel who will perform the procedure. The sealed envelope system was used for randomization. RESULTS: Statistical analysis was performed with 39 patients (18 patients in the PENG group, 21 patients in the control group). Thir-teen (33.3%) of the patients were female and 26 (66.7%) were male. The mean age was 75.3. At rest post-procedure, the mean Numeric Rating Scale (NRS) scores of the patients at the 30th min, 2nd, 6th, and 24th h were 1.78±1.83, 0.00±0.00, 0.00±0.00, and 1.28±1.41 in the PENG group. On the other hand, it was 3.38±1.86, 0.05±0.22, 2.86±2.37, and 4.95±1.47 in the control group, respectively. The mean NRS scores of the patients at 15° elevation of the leg at the 30th min, 2nd, 6th, and 24th h were 3.06±1.80, 0.06±0.24, 0.22±0.43, and 2.44±1.50 in the PENG group and it was 5.24±1.81, 1.05±0.92, 4.29±2.35, and 7.14±1.24 in the control group, respectively. CONCLUSION: PENG block can reduce pain and the need for systemic analgesics as a practical option in patients with HF.

Mortality estimation using APACHE and CT scores with stepwise linear regression method in COVID-19 intensive care unit: A retrospective study.

BACKGROUND: COVID-19 is a disease with high mortality worldwide, and which parameters that affect mortality in intensive care are still being investigated. This study aimed to show the factors affecting mortality in COVID-19 intensive care patients and write a model that can predict mortality. METHODS: The data of 229 patients in the COVID-19 intensive care unit were scanned. Laboratory tests, APACHE, SOFA, and GCS values were recorded. CT scores were calculated with chest CTs. The effects of these data on mortality were examined. The effects of the variables were modeled using the stepwise regression method. RESULTS: While the mean age of female (30.14%) patients was 69.1 ± 12.2, the mean age of male (69.86%) patients was 66.9 ± 11.5. The mortality rate was 69.86%. Age, CRP, D-dimer, creatinine, procalcitonin, APACHE, SOFA, GCS, and CT score were significantly different in the deceased patients than the survival group. When we attempted to create a model using stepwise linear regression analysis, the appropriate model was achieved at the fourth step. Age, CRP, APACHE, and CT score were included in the model, which has the power to predict mortality with 89.9% accuracy. CONCLUSION: Although, when viewed individually, there is a significant difference in parameters such as creatinine, procalcitonin, D-dimer, GCS, and SOFA score, the probability of mortality can be estimated by knowing only the age, CRP, APACHE, and CT scores. These four simple parameters will help clinicians effectively use resources in treatment.

Does Preoperative Anxiety Decrease with BATHE Method? A Prospective Randomized Study.

INTRODUCTION: Preoperative anxiety due to anesthesia is a common situation and decreases with preoperative evaluation. The aim of this study is to determine whether utilization of BATHE method further decreases the anxiety scores of patients who are evaluated at an anesthesia clinic for preoperative examination. METHODS: The patients were randomized into "BATHE" and "Control" groups by using the closed envelope technique. State-Trait Anxiety Inventory (STAI) scores were recorded as entrance STAI for all patients. During preoperative evaluation, BATHE method was applied to the BATHE Group whereas it was not applied to the Control Group. Post-examination, STAI scores were recorded as exit STAI and the patients were later asked questions about their contentment. RESULTS: Data of 463 patients were included in the analysis. Demographic data was similar in the groups. In both groups the exit STAI scores (BATHE: 34.27±10.30, Control: 34.90±9.54) were lower in comparison to the entrance STAI scores (BATHE: 38.21±9.86, Control: 37.09±9.93). The mean gap between the entrance STAI and exit STAI scores of the BATHE (3.94±6.05) and Control groups (2.19±6.14) were statistically significant (p<0.001). CONCLUSION: Utilization of BATHE method decreases the anxiety scores of preoperative patients to a greater extent, as measured by STAI index, in comparison to standard preoperative evaluation.

Dynamic alterations in cerebral, celiac and renal flows resulting from ascending aorta, subclavian artery and femoral artery cannulations of extracorporeal devices.

INTRODUCTION: The aim of this study was to assess the relationships among cardiac output, extracorporeal blood flow, cannulation site, right (RCa) and left carotid (LCa), celiac (Ca) and renal artery (Ra) flows during extracorporeal circulation. METHODS: A mock circulatory circuit was assembled, based on a compliant anatomical aortic model. The ascending aorta, right subclavian and femoral artery cannulations were created and flow was provided by a centrifugal pump (Cp); cardiac output was provided by a roller pump (Rp). Five volume flow rates were tested. The Rp was set at 4 L/min with no Cp flow (R4-C0) and the basic volume flow rates of the vessels were measured. The flow of the Cp was increased while the Rp flow was decreased for other measurements; R3-C1, R2-C2, R1-C3 and R0-C4. Measurements were repeated for all cannulation sites. RESULTS: The RCa flow rate at R4-C0 was higher compared to the R3-C1, R2-C2, R1-C3 and R0-C4 RCa flows with subclavian cannulation. The RCa flow decreased as the Cp flow increased (p<0.05). The RCa flow with ascending aortic and femoral cannulation was higher compared to subclavian cannulation. Higher flows were obtained with subclavian cannulation in the LCa compared to the others (p<0.05). R4-C0 Ca and Ra flows were higher compared to other Ca and Ra flows with femoral cannulation. Ca and Ra flows decreased as Cp flow increased. Flows of the Ca and Ra with ascending and subclavian cannulations were not lower compared to the R4-C0 flow (p<0.05). CONCLUSION: This study shows that prolonged extracorporeal circulation may develop flow decrease and ischemia in cerebral and abdominal organs with both subclavian and femoral cannulations.

Propofol-Based Sedation Versus General Anesthesia for Endoscopic Submucosal Dissection.

The main objective of this study is to evaluate general anesthesia or propofol-based sedation methods at gastric endoscopic submucosal dissection (ESD) procedures.The anesthetic method administered to cases undergoing upper gastrointestinal ESD between 2013 and 2015 was retrospectively investigated. Procedure time, lesion size, dissection speed, anesthesia time, adverse effects such as gag reflex, nausea, vomiting, cough, number of desaturation episodes (SpO2 < 90%), oropharyngeal suctioning requirements, hemorrhage, perforation, and amount of anesthetic medications were recorded.There were 54 and 37 patients who were administered sedation (group S) and general anesthesia (group G), respectively. The demographics of the groups were similar. The calculated dissection speed was significantly high in group G (36.02 ±â€Š20.96 mm/min) compared with group S (26.04 ±â€Š17.56 mm/min; P = 0.010). The incidence of nausea, cough, number of oropharyngeal suctioning, and desaturation episodes were significantly high in group S compared with that in group G (P < 0.5). While there was no difference between the groups in terms of hemodynamic parameters, in group S the use of propofol and in group G the use of midazolam and fentanyl were significantly higher (P < 0.05). Anesthesia time, postoperative anesthesia care unit, and hospital stay durations were not significantly different between the groups.General anesthesia increased dissection speed and enhanced endoscopist performance when compared with propofol-based sedation technique.

[Risk factors associated with lower back pain in the Polyclinic of Algology]. / Algoloji poliklinigine basvuran bel agrili hastalarin risk faktörleri.

OBJECTIVES: To study the risk factors associated with lower back pain such as age, gender, marital status, occupation, education level, smoking and alcohol consumption among patients who presented to the Algology Polyclinic. METHODS: The patients' age, gender, occupation, marital status, education, economic level, smoking and alcohol consumption were evaluated and recorded on a "Pain Assessment Form". The highest level of education level was asked and when economic level was questioned, the answers of patients were considered without restricrion between limits. RESULTS: Out of 772 patients, 200 had mechanical lower back pain. 23.5% had hernia nucleous pulposus, 20% had facet joint degeneration, 18.5% had a narrow spinal channel, 7.5% had sakroiliac joint degeneration, 20.1% had more than one pathology, and 10.5% had other pathologies. Lower back pain did not differ according to age and gender. Students had significantly lower pain, whereas workers had significantly higher lower back pain (p=0.005). Of the patients with lower back pain, 170 of them were married and 30 were widowed or single (p=0.059). With higher education, pain was significantly decreased (p=0.001). More pain was reported among individuals with low socioeconomic level (p=0.042). There was a correlation between lower back pain and smoking (p=0030), but there was no correlation between lower back pain and alcohol consumption (p=0.638). CONCLUSION: Lower education, lower economic level, labor intensive jobs and smoking were correlated with lower back pain. It was concluded that by taking precautions that lower risk factors, incidence of lower back pain can be decreased.

[Sociodemographic properties and pain prevalence of patients applying to the Algology Department polyclinic of Adnan Menderes University Medical Faculty]. / Adnan Menderes Üniversitesi Tip Fakültesi Algoloji Poliklinigi'ne basvuran hastalarin sosyodemografik özellikleri ve agri prevalansi

OBJECTIVES: To investigate the differences and similarities of sociodemographic properties and pain conditions of patients seen at our institution compared to other studies conducted throughout the world. METHODS: Our study included the results of 772 patients who applied to our polyclinic between 1 January 2006 and 31 December 2007. In our polyclinic, all patients are queried with respect to the items contained on the "Pain Assessment Form" before the diagnosis and their answers are recorded. Their demographic characteristics, such as age, gender, occupation, marital status, education, and economic status, are also recorded on the forms. For the detailed pain anamnesis, the following factors are questioned and recorded on the pain assessment form: the location, quantity and starting time of pain, its period, the factors that increase and decrease the pain, duration of pain, and prior medication. RESULTS: The most frequent complaints were in the low back, shoulder and head. The three most frequent diagnoses were low back pain, musculoskeletal pain and headache. Visual analogue scale (VAS) value was found to be 7.3. Seventy-three percent of patients suffered from chronic pain. Pain was mostly accompanied by weakness, muscle weakness, insomnia, nausea, and vomiting. The most frequent treatments were medical treatments along with invasive pain therapy. CONCLUSION: Knowledge of sociodemographic characteristics and close investigation of patients' responses to the treatments are important. When medical treatment is insufficient, invasive pain treatment should be administered by an experienced pain therapy practitioner. Informing patients and their relatives about the applied treatment may increase treatment success.