The relationship between bi-spectral index and VOTE score in evaluation of drug-induced sleep endoscopy: A systematic meta-analysis.

OBJECTIVE: The aim of this study was to investigate both the presence and severity of collapse in anatomical regions defined by the VOTE score (velum, orofarinx, tongue, and epiglottis), during drug induced sleep endoscopy (DISE) in patients diagnosed with obstructive sleep apnea, based on the bi-spectral index (BIS) sedation level. METHODS: In order to conduct a meta-analysis of articles examining the relationship between the VOTE score and BIS sedation level in determining the presence and severity of upper airway collapse during DISE, a literature review was performed. RESULTS: As a result of the search made in the specified databases, a total of 1864 articles were reached. Five articles included in this review that had sufficient statistical data to be included in the meta-analysis were found. A statistically significant correlation was found between the BIS sedation level and the areas of obstruction in the VOTE score. The strongest association is at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively (CC: 0.639, CC: 0.53, CC: 0.49, and CC: 0.346, P < .001). In the subgroup analysis of publications with BIS sedation levels in the range of 60 to 65, the distribution in the epiglottis region was heterogeneous, and it was found to be statistically significant according to the random effect model (P < .001). The distribution in the tongue was homogeneous, and it was found to be statistically significant according to the fixed effect model (P < .001). When the publications in which the BIS sedation level is in the range of 65 to 75 are examined according to the areas of obstruction; the distribution in 4 anatomical regions was homogeneous and statistically significant according to the fixed effect model (P < .001). CONCLUSION: It was found that BIS sedation levels during DISE application in obstructive sleep apnea patients were associated with obstruction of the anatomical regions of the upper airway. The strongest association was found at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively. It is helpful to monitor the sedation level with BIS in order to better define the collapsed areas during DISE application. However, more studies are needed to better understand the relationship between BIS sedation values and sleep stages.

Clinical Significance of Pleural Lactate Measurement in Critically Ill Patients with Parapneumonic Pleural Effusion.

OBJECTIVE: Pleural fluid pH measurement is recommended for tube thoracostomy decisions in complicated parapneumonic pleural effusions. However, pleural fluid pH may be affected by blood pH in critically ill patients with common systemic acid-base disorders. We aimed to investigate the use of pleural fluid lactate to distinguish culture-positive parapneumonic effusions from other pleural effusions. MATERIAL AND METHODS: This prospective observational study included 121 eligible patients (51 female and 70 male). All patients with pleural effusion who underwent thoracentesis were assessed. Pleural fluid lactate was measured by a blood gas analyzer. RESULTS: Of the 121 patients, 30 (24.8%) were transudate and 91 (75.2%) were exudate. Of the 91 patients with exudative pleural effusion, 61 were diagnosed as culture-negative parapneumonic, 13 as culture-positive parapneumonic, 9 as malignant, and 8 as other exudative effusion. There was a strong positive linear association between serum pH and pleural fluid pH (R = 0.77, P < .001). The post hoc tests for pleural fluid lactate revealed there was a significant difference between culture-positive parapneumonic versus culture-negative parapneumonic groups (P = .004), culture-positive parapneumonic versus transudative effusion groups (P < .001), culture-negative parapneumonic versus transudative effusion groups (P = .008) and lastly; malignant effusion versus transudative effusion groups (P = .001). Receiver operating characteristics curve analysis for culture-positive parapneumonic indicated a cutoff of 4.55 mmol/L for pleural fluid lactate to have a sensitivity of 76.9% and a specificity of 84.3% (positive predictive value: 37%, negative predictive value: 96.8%). CONCLUSION: A cutoff of 4.55 mmol/L of pleural fluid lactate can be used as a useful tool to distinguish culture-positive parapneumonic effusions from other effusions in critically ill patients.

Combined Effects of Prone Positioning and Airway Pressure Release Ventilation on Oxygenation in Patients with COVID-19 ARDS.

Objective: Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS). Invasive mechanical ventilation (IMV) support and prone positioning are essential treatments for severe COVID-19 ARDS. We aimed to determine the combined effect of prone position and airway pressure release ventilation (APRV) modes on oxygen improvement in mechanically-ventilated patients with COVID-19. Methods: This prospective observational study included 40 eligible patients (13 female, 27 male). Of 40 patients, 23 (57.5%) were ventilated with APRV and 17 (42.5%) were ventilated with controlled modes. A prone position was applied when the PaO2/FiO2 ratio <150 mmHg despite IMV in COVID-19 ARDS. The numbers of patients who completed the first, second, and third prone were 40, 25, and 15, respectively. Incident barotrauma events were diagnosed by both clinical findings and radiological images. Results: After the second prone, the PaO2/FiO2 ratio of the APRV group was higher compared to the PaO2/FiO2 ratio of the control group [189 (150-237)] vs. 127 (100-146) mmHg, respectively, (P=0.025). Similarly, after the third prone, the PaO2/FiO2 ratio of the APRV group was higher compared to the PaO2/FiO2 ratio of the control group [194 (132-263)] vs. 83 (71-136) mmHg, respectively, (P=0.021). Barotrauma events were detected in 13.0% of the patients in the APRV group and 11.8% of the patients in the control group (P=1000). The 28-day mortality was not different in the APRV group than in the control group (73.9% vs. 70.6%, respectively, P=1000). Conclusion: Using the APRV mode during prone positioning improves oxygenation, especially in the second and third prone positions, without increasing the risk of barotrauma. However, no benefit on mortality was detected.

Can Some Viral Respiratory Infections Observed Before the Pandemic Announcement Be Related to SARS-CoV-2?

OBJECTIVE: There have been doubts that SARS-CoV-2 has been circulating before the first case was announced. The aim of this study was to evaluate the possibility of COVID-19 in some cases diagnosed to be viral respiratory tract infection in the pre-pandemic period in our center. MATERIAL AND METHODS: Patients who were admitted to our hospital's pulmonary diseases, infectious diseases, and intensive care clinics with the diagnosis of viral respiratory system infection within a 6-month period between October 2019 and March 12, 2020, were screened. Around 248 archived respiratory samples from these patients were analyzed for SARS-CoV-2 ribonucleic acid by real-timequantitative polymerase chain reaction. The clinical, laboratory, and radiological data of the patients were evaluated. RESULTS: The mean age of the study group was 47.5 (18-89 years); 103 (41.5%) were female and 145 (58.4%) were male. The most common presenting symptoms were cough in 51.6% (n = 128), fever in 42.7% (n = 106), and sputum in 27.0% (n = 67). Sixty-nine percent (n = 172) of the patients were pre-diagnosed to have upper respiratory tract infection and 22.0% (n = 55) had pneumonia, one-third of the patients (n = 84, 33.8%) were followed in the service. Respiratory viruses other than SARS-CoV-2 were detected in 123 (49.6%) patients. Influenza virus (31.9%), rhinovirus (10.5%), and human metapneumovirus (6.5%) were the most common pathogens, while none of the samples were positive for SARS-CoV-2 RNA. Findings that could be significant for COVID-19 pneumonia were detected in the thorax computed tomography of 7 cases. CONCLUSION: The negative SARS-CoV-2 real-time-quantitative polymerase chain reaction results in the respiratory samples of the cases followed up in our hospital for viral pneumonia during the pre-pandemic period support that there was no COVID-19 among our cases during the period in question. However, if clinical suspicion arises, both SARS and non-SARS respiratory viral pathogens should be considered for differential diagnosis.

A bibliometric analysis of obstructive sleep apnea and anesthesia.

To conduct a bibliographic analysis of obstructive sleep apnea (OSA) which has reached epidemic proportions and is a frequent, unknown, and important cause of perioperative morbidity and mortality, by examining the internationally most cited articles. For OSA, the most cited articles in the field of anesthesiology and reanimation, appropriate access terms were compiled and combined, and related publications were searched using the Thompson Reuters Web of Science Citation Indexing search engine. A total of 79 journal publications were found on OSA and anesthesia, with an average of 14.86 citations per article. The most cited publication was the "Society for Ambulatory Anesthesia Consensus Statement on Preoperative Selection of Adult Patients with Obstructive Sleep Apnea Scheduled for Ambulatory Surgery" published in the journal Anesthesia and Analgesia and was conducted by Joshi et al. It was found that 38 of the 79 studies reached as a result of the search were articles, and the average number of citations was 21.13. The Hirsch index of these articles, which were cited 803 times in total, was 15. A total of 31 articles (81.57%) were cited at least once, while the remaining 7 articles (18.43%) were not cited at all. The majority of the articles obtained are from the research fields of anesthesiology (n = 20; 52.63%), followed by otorhinolaryngology (n = 5; 13.15%), pediatrics (n = 5; 13.15%), respiratory system (n = 5; 13.15%), internal medicine (n = 4; 10.52%), and the rest were in various fields. Publications on "Obstructive Sleep Apnea" and "Anesthesia" have increased rapidly in the last decade. Anesthesia management and airway safety, patient management, including pain control in the postoperative period, and noninvasive mechanical ventilation treatment methods, such as continuous positive airway pressure, are hot topics.

Dexmedetomidine may reduce the risk of acute kidney injury development in critically ill patients during colistin therapy.

INTRODUCTION: Colistin is considered as a last resort therapy for multidrug-resistant gram-negative organisms. It is widely used despite the significant risk of nephrotoxicity. Experimental studies showed the nephroprotective effect of dexmedetomidine, a sedative agent, against colistin toxicity. This study was performed to show the possible nephroprotective effect of dexmedetomidine among critically ill patients who received colistin. METHODS: Adult (>17 years) patients who were admitted to our surgical and medical intensive care unit (ICU) from March 2018 through March 2021, and who received colistin were included. Patients who receive Colistin therapy or intensive care unit follow-up of <72 h (discharge or death) and Acute kidney injury (AKI) or need hemodialysis prior to colistin therapy at the same hospitalization were excluded. AKI risk factors were examined by grouping patients with and without AKI. Patients, receiving colistin concomitantly with dexmedetomidine were also evaluated. RESULTS: Of the 139 patients included, 27 (17.8%) patients received dexmedetomidine. Sixty-five patients (47%) had AKI, at a median 5 (4-7) days after the initiation of colistin. Older age, lower baseline estimated glomerular filtration rate, and vasopressor use were associated with a higher risk of AKI, while dexmedetomidine use was associated with a lower risk. In the multivariate regression model, dexmedetomidine use was independently associated with a lower risk of AKI development (OR 0.20 95% CI 0.07-0.59, p = 0.003). CONCLUSION: In respect to these findings, dexmedetomidine may provide protection against AKI during colistin therapy in critically ill patients.

Amikacin-induced acute kidney injury in mechanically ventilated critically ill patients with sepsis.

In this retrospective cohort study, we aimed to evaluate the incidence, risk factors and outcomes of amikacin-induced acute kidney injury (AKI) in critically ill patients with sepsis. A total of 311 patients were included in the study. Of them, 83 (26.7%) had amikacin-induced AKI. In model 1, the multivariable analysis demonstrated concurrent use of colistin (OR 25.51, 95%CI 6.99-93.05, p< 0.001), presence of septic shock during amikacin treatment (OR 4.22, 95%CI 1.76-10.11, p=0.001), and Charlson Comorbidity Index (OR 1.14, 95%CI 1.02-1.28, p=0.025) as factors independently associated with an increased risk of amikacin-induced AKI. In model 2, the multivariable analysis demonstrated concurrent use of at least one nephrotoxic agent (OR 1.95, 95%CI 1.10-3.45; p=0.022), presence of septic shock during amikacin treatment (OR 3.48, 95%CI 1.61-7.53; p=0.002), and Charlson Comorbidity Index (OR 1.12, 95%CI 1.01-1.26; p=0.037) as factors independently associated with an increased risk of amikacin-induced AKI. In conclusion, before amikacin administration, the risk of AKI should be considered, especially in patients with multiple complicated comorbid diseases, septic shock, and those receiving colistin therapy.

The effect of frailty on the development of acute kidney injury in critically-ill geriatric patients with COVID-19.

BACKGROUND: Acute kidney injury is strongly associated with mortality in critically ill patients with coronavirus disease 2019 (COVID-19); however, age-related risk factors for acute kidney injury are not clear yet. In this study, it was aimed to evaluate the effects of clinical factors on acute kidney injury development in an elderly COVID-19 patients. METHODS: Critically ill patients (≥65years) with COVID-19 admitted to the intensive care unit were included in the study. Primary outcome of the study was the rate of acute kidney injury, and secondary outcome was to define the effect of frailty and other risk factors on acute kidney injury development and mortality. RESULTS: A total of 132 patients (median age 76 years, 68.2% male) were assessed. Patients were divided into two groups as follows: acute kidney injury (n = 84) and nonacute kidney injury (n = 48). Frailty incidence (48.8% vs. 8.3%, p < 0.01) was higher in the acute kidney injury group. In multivariate analysis, frailty (OR, 3.32, 95% CI, 1.67-6.56), the use of vasopressors (OR, 3.06 95% CI, 1.16-8.08), and the increase in respiratory support therapy (OR, 2.60, 95% CI, 1.01-6.6) were determined to be independent risk factors for acute kidney injury development. The mortality rate was found to be 97.6% in patients with acute kidney injury. DISCUSSION: Frailty is a risk factor for acute kidney injury in geriatric patients with severe COVID-19. The evaluation of geriatric patients based on a frailty scale before intensive care unit admission may improve outcomes.

The Safety of Fiberoptic Bronchoscopy in Airway Pressure Release Ventilation Mode in Critically Ill Patients with Severe Acute Respiratory Distress Syndrome: A Preliminary Study.

OBJECTIVE: The most appropriate ventilatory mode during fiberoptic bronchoscopy is still not yet known clearly for patients with acute respiratory distress syndrome. Airway pressure release ventilation is used as a recovery treatment for patients with severe acute respiratory distress syndrome. In this study, the aim was to evaluate the safety of the fiberoptic bronchoscopy process in patients with severe acute respiratory distress syndrome ventilated with airway pressure release ventilation mode and its effect on gas exchange and respiratory mechanics. MATERIAL AND METHODS: Single-center retrospective observational study was performed in the intensive care unit of a tertiary referral center from September 2018 to November 2019. Patients with severe ARDS ventilated with APRV mode and undergoing FB were included. Fiberoptic bronchoscopy was performed by an expert intensivist-pulmonologist. All ventilator parameters set by the clinician were kept stable, and no change was made other than O2 concentration. The mechanical ventilation parameters and arterial blood gas values before and after the procedure and fiberoptic bronchoscopy-related complications were recorded for the first 24 hours. RESULTS: A total of 14 acute respiratory distress syndrome patients who were ventilated with airway pressure release ventilation were enrolled. No significant deteriorations were detected in gas exchange, pulmonary compliance, and airway resistance values in our case series. It was observed that a small reduction in PaO2 and an increase in PaCO2 were present after the 1st hour; however, both were returned to baseline values in the 24th hour. Only 1 patient developed fiberoptic bronchoscopy-induced hypoxemia (7.1%). Complications, such as fiberoptic bronchoscopy-induced barotrauma, pneumothorax, hemodynamic deterioration, and bleeding, were not detected. CONCLUSION: According to our preliminary findings, performing fiberoptic bronchoscopy under airway pressure release ventilation mode by an experienced bronchoscopist does not bring additional complication risks in patients with severe acute respiratory distress syndrome.

Incidence of and risk factors for postintubation hypotension in critically ill patients with COVID-19. / Incidência e fatores de risco para hipotensão pós-intubação em pacientes críticos com COVID-19.

OBJECTIVE: To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19. METHODS: We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study. RESULTS: Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29). CONCLUSION: The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.

OBJETIVO: Avaliar a incidência de fatores de risco para hipotensão pósintubação em pacientes críticos com COVID-19. METÓDOS: Foi realizado um estudo retrospectivo com 141 pacientes com COVID-19 que foram intubados na unidade de terapia intensiva. Hipotensão pós-intubação foi definida como a necessidade de qualquer dose de vasopressor a qualquer momento em até 60 minutos após a intubação. Pacientes com parada cardiorrespiratória relacionada à intubação e hipotensão antes da intubação foram excluídos do estudo. RESULTADOS: Dos 141 pacientes incluídos, 53 pacientes (37,5%) e 43,6% dos pacientes (n = 17) eram do sexo feminino. A idade mediana do grupo com hipotensão pós-intubação foi de 75 anos (amplitude interquartil: 67,0 - 84,0). Na análise multivariada, índice de choque ≥ 0,90 (RC = 7,76; IC95% 3,14 - 19,21; p < 0,001), níveis de albumina < 2,92g/dL (RC = 3,65; IC95% 1,49 - 8,96; p = 0,005) e níveis de procalcitonina (RC = 1,07, IC95% 1,01 - 1,15; p = 0,045) foram fatores de risco independentes para hipotensão pós-intubação. A mortalidade hospitalar foi semelhante em pacientes com hipotensão pós-intubação e pacientes sem hipotensão pós-intubação (92,5% versus 85,2%; p = 0,29). CONCLUSÃO: A incidência de hipotensão pós-intubação foi de 37,5% em pacientes críticos com COVID-19. Um índice de choque ≥ 0,90 e níveis de albumina < 2,92g/ dL foram independentemente associados à hipotensão pós-intubação. Além disso, índice de choque ≥ 0,90 pode ser uma ferramenta do leito antes da intubação endotraqueal. Neste estudo, a hipotensão pós-intubação não esteve associada ao aumento da mortalidade hospitalar em pacientes com COVID-19.

The Impact of Mechanical Ventilation Modes on Complications of Fiberoptic Bronchoscopy in Critically Ill Patients.

OBJECTIVE: The effects of fiberoptic bronchoscopy are not elucidated in different mechanical ventilation modes. The present study aimed to evaluate the effects of fiberoptic bronchoscopy on lung mechanics, ventilation parameters, and gas exchange in 2 often-used modes, volume control and pressure control, in invasively ventilated patients followed up in the intensive care unit. MATERIAL AND METHODS: Eligible patients were screened and included in the study after intensive care unit-fiberoptic bronchoscopy database search. Patients who underwent fiberoptic bronchoscopy under volume control and pressure control mechanical ventilation modes were compared. The primary outcome was the occurrence of any complication within the first 24 hours after the procedure, and secondary outcomes were changes in lung mechanics (dynamic lung compliance and airway resistance) and gas exchange (arterial partial pressures of oxygen and carbon dioxide). RESULTS: A total of 61 patients (median age: 69 years, 60.7% male) were included. Twenty-nine (47.5%) patients were ventilated in volume control mode and 32 (52.5%) in pressure control mode during the fiberoptic bronchoscopy procedure, and the median (interquartile range) duration of the procedure was 9 [8-11] minutes. Baseline dynamic lung compliance, airway resistance, arterial partial pressures of oxygen and carbon dioxide, and the fraction of inspired O2 were similar in both groups. After fiberoptic bronchoscopy, dynamic lung compliance decreased in both groups, and airway resistance and peak airway pressures increased but reached pre-fiberoptic bronchoscopy values at the 1st hour after the procedure. No significant differences were detected in both groups in terms of blood gas values and lung mechanics in the 1st and 24th hours after the procedure. In both groups, the 24th hour fraction of inspired O2 was the same as the pre-fiberoptic bronchoscopy values, but the ratio of arterial partial pressure of oxygen and the fraction of inspired O2 improved. No complications developed in patients within 24 hours after the procedure. CONCLUSION: No differences were detected in terms of gas exchange and pulmonary mechanics, and complications in volume control and pressure control modes in critically ill intubated patients.

Incidência e fatores de risco para hipotensão pós-intubação em pacientes críticos com COVID-19 / Incidence of and risk factors for postintubation hypotension in critically ill patients with COVID-19

RESUMO Objetivo: Avaliar a incidência de fatores de risco para hipotensão pósintubação em pacientes críticos com COVID-19. Metódos: Foi realizado um estudo retrospectivo com 141 pacientes com COVID-19 que foram intubados na unidade de terapia intensiva. Hipotensão pós-intubação foi definida como a necessidade de qualquer dose de vasopressor a qualquer momento em até 60 minutos após a intubação. Pacientes com parada cardiorrespiratória relacionada à intubação e hipotensão antes da intubação foram excluídos do estudo. Resultados: Dos 141 pacientes incluídos, 53 pacientes (37,5%) e 43,6% dos pacientes (n = 17) eram do sexo feminino. A idade mediana do grupo com hipotensão pós-intubação foi de 75 anos (amplitude interquartil: 67,0 - 84,0). Na análise multivariada, índice de choque ≥ 0,90 (RC = 7,76; IC95% 3,14 - 19,21; p < 0,001), níveis de albumina < 2,92g/dL (RC = 3,65; IC95% 1,49 - 8,96; p = 0,005) e níveis de procalcitonina (RC = 1,07, IC95% 1,01 - 1,15; p = 0,045) foram fatores de risco independentes para hipotensão pós-intubação. A mortalidade hospitalar foi semelhante em pacientes com hipotensão pós-intubação e pacientes sem hipotensão pós-intubação (92,5% versus 85,2%; p = 0,29). Conclusão: A incidência de hipotensão pós-intubação foi de 37,5% em pacientes críticos com COVID-19. Um índice de choque ≥ 0,90 e níveis de albumina < 2,92g/ dL foram independentemente associados à hipotensão pós-intubação. Além disso, índice de choque ≥ 0,90 pode ser uma ferramenta do leito antes da intubação endotraqueal. Neste estudo, a hipotensão pós-intubação não esteve associada ao aumento da mortalidade hospitalar em pacientes com COVID-19.

ABSTRACT Objective: To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19. Methods: We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study. Results: Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29). Conclusion: The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.

Is serum magnesium level associated with atrial fibrillation in the mixed medical/surgical intensive care unit setting?

Background: Although low serum magnesium level is a a relatively common problem in mixed medical/surgical intensive care units (ICUs), its association with new-onset atrial fibrillation (NOAF) has been studied to a lesser extent. We aimed to investigate the effect of magnesium levels on the development of NOAF in critically ill patients admitted to the mixed medical/surgical ICU. Methods: A total of 110 eligible patients (45 female, 65 male) were included in this case-control study. The age and sex-matched control group (n = 110) included patients with no atrial fibrillation from admission to discharge or death. Results: The incidence of NOAF was 2.4% (n = 110) between January 2013 and June 2020. At NOAF onset or the matched time point, median serum magnesium levels were lower in the NOAF group than in the control group (0.84 [0.73-0.93] vs. 0.86 [0.79-0.97] mmol/L; p = 0.025). At NOAF onset or the matched time point, 24.5% (n = 27) in the NOAF group and 12.7% (n = 14) in the control group had hypomagnesemia (p = 0.037). Based on Model 1, multivariable analysis demonstrated magnesium level at NOAF onset or the matched time point (OR: 0.07; 95%CI: 0.01-0.44; p = 0.004), acute kidney injury (OR: 1.88; 95%CI: 1.03-3.40; p = 0.039), and APACHE II (OR: 1.04; 95% CI: 1.01-1.09; p = 0.046) as factors independently associated with an increased risk of NOAF. Based on Model 2, multivariable analysis demonstrated hypomagnesemia at NOAF onset or the matched time point (OR: 2.52; 95% CI: 1.19-5.36; p = 0.016) and APACHE II (OR: 1.04; 95%CI: 1.01-1.09; p = 0.043) as factors independently associated with an increased risk of NOAF. In multivariate analysis for hospital mortality, NOAF was an independent risk factor for hospital mortality (OR: 3.22; 95% CI: 1.69-6.13, p<0.001). Conclusion: The development of NOAF in critically ill patients increases mortality. Critically ill patients with hypermagnesemia should be carefully evaluated for risk of NOAF.

New-onset atrial fibrillation in critically ill patients with coronavirus disease 2019 (COVID-19).

Background: Mortality in critically ill patients with coronavirus disease 2019 (COVID-19) is high, therefore, it is essential to evaluate the independent effect of new-onset atrial fibrillation (NOAF) on mortality in patients with COVID-19. We aimed to determine the incidence, risk factors, and outcomes of NOAF in a cohort of critically ill patients with COVID-19. Methods: We conducted a retrospective study on patients admitted to the intensive care unit (ICU) with a diagnosis of COVID-19. NOAF was defined as atrial fibrillation that was detected after diagnosis of COVID-19 without a prior history. The primary outcome of the study was the effect of NOAF on mortality in critically ill COVID-19 patients. Results: NOAF incidence was 14.9% (n = 37), and 78% of patients (n = 29) were men in NOAF positive group. Median age of the NOAF group was 79.0 (interquartile range, 71.5-84.0). Hospital mortality was higher in the NOAF group (87% vs 67%, respectively, P = .019). However, in multivariate analysis, NOAF was not an independent risk factor for hospital mortality (OR 1.42, 95% CI 0.40-5.09, P = .582). Conclusions: The incidence of NOAF was 14.9% in critically ill COVID-19 patients. Hospital mortality was higher in the NOAF group. However, NOAF was not an independent risk factor for hospital mortality in patients with COVID-19.

Clinical characteristics and risk factors for 28-day mortality in critically ill patients with COVID-19: a retrospective cohort study

Background: To date, the coronavirus disease 2019 (COVID-19) caused more than 2.6 million deaths all around the world. Risk factors for mortality remain unclear. The primary aim was to determine the independent risk factors for 28-day mortality. Materials and methods: In this retrospective cohort study, critically ill patients (≥ 18 years) who were admitted to the intensive care unit due to COVID-19 were included. Patient characteristics, laboratory data, radiologic findings, treatments, and complications were analyzed in the study. Results: A total of 249 patients (median age 71, 69.1% male) were included in the study. 28-day mortality was 67.9% (n = 169). The median age of deceased patients was 75 (66­81). Of them, 68.6% were male. Cerebrovascular disease, dementia, chronic kidney disease, and malignancy were significantly higher in the deceased group. In the multivariate analysis, sepsis/septic shock (OR, 15.16, 95% CI, 3.96­58.11, p < 0.001), acute kidney injury (OR, 4.73, 95% CI, 1.55­14.46, p = 0.006), acute cardiac injury (OR, 9.76, 95% CI, 1.84­51.83, p = 0.007), and chest CT score higher than 15 (OR, 4.49, 95% CI, 1.51-13.38, p = 0.007) were independent risk factors for 28-day mortality. Conclusion: Early detection of the risk factors and the use of chest CT score might improve the outcomes in patients with COVID-19.

Effects of bevacizumab administration on the hypoxia - induced pulmonary hypertension rat model.

BACKGROUND: Bevacizumab is a chemotherapeutic drug, which selectively binds to vascular endothelial growth factor (VEGF) and mainly inhibits angiogenesis and neovascularization. We aimed to study the possible effects of bevacizumab on right ventricular pressure (RVP), right ventricular hypertrophy, and VEGF, in hypoxia - induced pulmonary hypertension (PH) rat model. METHODS: 24 adult Wistar Albino rats were randomly divided into four groups: control group - saline; Bevacizumab Group; PH Group; PH + Bevacizumab Group. In hypoxia - induced model, 10% oxygen and 90% nitrogen were applied in a plexiglas box for eight days to PH Group and PH + Bevacizumab Group. On day eight, RVPs were measured directly from the heart, and then animals were sacrificed. Heart and lung tissues were examined, and Fulton index was measured. RESULTS: RVP, Fulton index, and tissue VEGF scores were significantly lower in PH + Bevacizumab group than PH group: median (ranges), RVP, mmHg, 37.8 (33.0-39.0) and 32.3 (28.0-35.0), p: 0.01; Fulton index: 0.30 (0.29-0.33) and 0.25 (0.24-0.26), p: 0.003; tissue VEGF scores: 5.1 (4.8-5.3) and 4.0 (3.8 4.1), p: 0.004, respectively. DISCUSSION: Bevacizumab, which is indeed an antineoplastic agent, might have a favorable effect on hypoxia - induced pulmonary hypertension.

Therapeutic Approaches and Mortality in Acute Respiratory Failure due to Drowning.

OBJECTIVE: Drowning is a process of submersion and can lead to respiratory failure. Annually, there are an estimated 320 000 deaths worldwide due to drowning, in addition to nonfatal drowning events. There are limited data for respiratory failure due to drowning and its prognosis in Turkey. The aim of this study was to identify the therapeutic modalities used for acute respiratory failure (ARF) due to drowning, and its prognosis in hospitalized patients. MATERIAL AND METHODS: All adult drowning cases (according to the International Classification of Disease (ICD) diagnosis code) who were admitted to either the emergency department (ED) or the intensive care units (ICU), or the pulmonology inpatient clinics between 2008 and 2018 were included in the study. Data for demographic characteristics, radiologic evaluations, respiratory support and mechanical ventilation, hospital stay duration, and hospital mortality were retrospectively collected from hospital records. RESULTS: A total of 117 patients (47 females, 70 males, mean age: 57.3 years) were included in the study. The drowning accidents most commonly occurred in summer (86.3%). Of them, 31 victims (26.4%) were admitted to ICU due to severe respiratory failure. The mean pH was 7.32, and PaO2 was 69.13 mmHg in the arterial blood gas at admission. Invasive and noninvasive mechanical ventilation were performed in 24.7% and 25.6% of the patients respectively. The PaO2/FiO2 of 106 patients (who had accessible FiO2 values) were >300 in 12 (11%), 201-300 in 32 (30%), 101-200 in 49 (46%), and <100 in 13 (12%) patients. Bilateral opacities were observed in 85.4% of the patients. Cardiopulmonary resuscitation was performed in 8 (6.8%) patients. The hospital mortality rate was 6%. CONCLUSION: The present study results show that with appropriate therapeutic and support strategies, respiratory failure due to drowning can be treated successfully.

Management of an Organ Donation Process in COVID-19 Pandemic: First Case of Turkey.

The first case of coronavirus disease 2019 (COVID-19) was defined as unexplained pneumonia on December 8, 2019, and then it rapidly caused a pandemic and affected transplantation rates negatively. Organ donation processes got more complex because the exclusion of the disease in a short period became more difficult than normal. The exclusion of the disease is vital not only for recipients but also for the medical staff, transplantation teams, and intensive care professionals to reduce the transmission risk. The main steps for diagnosis of COVID-19 are investigation of symptoms, recollection of travel and physical contact history, and testing using the real time polymerase chain reaction (RT-PCR) test. Although it has limitations such as false negative results, RT-PCR is the most accurate method to detect COVID-19, and it is mandatory before donation processes in many countries. In this case report, we aim to share our experience about the first organ donation during the COVID-19 pandemic in Turkey.