Point of care guided coagulation management in adult patients on ECMO: A systematic review and meta-analysis.

BACKGROUND: Despite the advancements in extracorporeal membrane oxygenation (ECMO) technology, balancing the prevention of thrombosis and the risk of bleeding in patients on ECMO is still a significant challenge for physicians. This systematic review and meta-analysis aimed to assess the efficacy and safety of viscoelastic point-of-care (POC)-guided coagulation management in adult patients on ECMO. METHODS: PubMed Medline, Embase, Scopus, Web of Science, and Cochrane Library databases were searched. After quality assessment, meta-analysis was carried out using random effects model, heterogeneity using I2 and publication bias using Doi and Funnel plots. RESULTS: A total of 1718 records were retrieved from the searches. Fifteen studies that enrolled a total of 583 participants met the inclusion criteria. Of those, 3 studies enrolling 181 subjects were eligible for meta-analysis. In patients managed with POC-guided algorithms, the odds were coherently lower for bleeding (OR 0.71, 95%CI 0.36-1.42), thrombosis (OR 0.91, 95%CI 0.32-2.60), and in-hospital mortality (OR 0.54, 95%CI 0.29-1.03), but not for circuit change or failure (OR 1.50, 95%CI 0.59-3.83). However, the differences were not statistically significant due to wide 95%CIs. CONCLUSION: Viscoelastic POC monitoring demonstrates potential benefits for coagulation management in ECMO patients. Future research should focus on standardizing evidence to improve clinical decision-making. REGISTRATION: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023486294.

Comparison of the Effects of Sevoflurane and Desflurane on Endothelial Glycocalyx in Patients Undergoing Laparoscopic Hysterectomy: A Randomized, Double-Blind Trial.

Objective: Various enzymes, reactive oxygen species, inflammatory conditions, and major surgeries cause endothelial glycocalyx breakdown. Inhalation of anaesthetic agents may have protective effects on the endothelium. This study compared syndecan-1 and heparan sulfate levels to evaluate the effects of sevoflurane and desflurane on the endothelial glycocalyx. Methods: This prospective randomized, double-blind study included 46 patients undergoing laparoscopic hysterectomy. The participants were allocated into sevoflurane and desflurane groups. Subsequently, blood samples were drawn at three time points: before anaesthesia induction for a baseline value (T0), after pneumoperitoneum (T1), and after extubation (T2). Heparan sulfate and syndecan-1 levels were measured. Results: There was no statistical difference between the sevoflurane and desflurane groups in terms of heparan sulfate and syndecan-1 levels at any time point. A significant difference was found only in the desflurane group in the intragroup comparisons of the measurements of heparan sulfate levels (χ2=29.826, P < 0.001). Matched pairs of the time points in the desflurane group showed that P=0.036 (Z=-2.099) for T1-T0, P < 0.001 (Z=-3.924) for T2-T0, and P < 0.001 (Z=-4.197) for T2-T1. The change in percentage between T2 and T1 of heparan sulfate in the desflurane group was found to be statistically significant (P=0.034). Conclusion: The damage caused by surgical stress on the endothelial glycocalyx can be reduced by both desflurane and sevoflurane. The protective effect of desflurane is more prominent than that of sevoflurane.

Evaluation of Long-Coronavirus Disease 2019 Cases Readmitted to Intensive Care Units Due to Acute Respiratory Failure: Point Prevalence Study.

OBJECTIVE:  Coronavirus disease 2019 (COVID-19) caused morbidity and mortality worldwide. Besides the acute effects, subacute and long-term effects are defined as long-COVID causing morbidity. The intensive care unit (ICU) data of long-COVID-19 cases were evaluated with the participation of 11 centers. MATERIAL AND METHODS:  Study was designed by Turkish Thoracic Society Respiratory Failure and Intensive Care Working Group to evaluate long COVID-19 patients. All patients followed up in the ICU with long-COVID diagnosis were included in point prevelance study. RESULTS:  A total of 41 long COVID-19 patients from 11 centers were included in the study. Half of the patients were male, mean age was 66 ± 14, body mass index was 27 ± 5. Hypertension, diabetes mellitus, lung cancer, malignancy, and heart failure rates were 27%, 51%, 34%, 34%, and 27%, respectively. Eighty percent had received COVID vaccine. Patients had moderate hypoxemic respiratory failure. APACHE II, SOFA score was 18 (14-26), 6 (3-8), respectively. Forty-six percent received invasive mechanical ventilator support, 42% were sepsis, 17% were septic shock. Bilateral (67%), interstitial involvement (37%) were most common in chest x-ray. Fibrosis (27%) was detected in thorax tomography. Seventy-one percent of patients received antibiotherapy (42% carbapenem, 22% linezolid). Sixty-one percent of the patients received corticosteroid treatment. CONCLUSION:  More than half of the patients had pneumonia and the majority of them used broad-spectrum antibiotics. Presence of comorbidities and malignancies, intensive care severity scores, intubation, and sepsis rates were high. Receiving corticosteroid treatment and extensive bilateral radiologic involvement due to COVID-19 might be the reasons for the high re-admission rate for the ICUs.

The clinical characteristics and the risk factors for mortality in Non-COVID-19 critical patients in a pandemic hospital in Turkey: a retrospective cross-sectional study.

Background: Coronavirus disease 2019 (COVID-19) disrupted standard health policies and routine medical care, and thus, the management and treatment pathways of many clinical conditions have changed as never before. The negative impact of the pandemic rendered the systemic disease more complicated and accelerated mortality. For the last two years, clinicians have primarily focused on COVID-19 patients; however, the non-COVID-19 critically ill patients needed to be addressed from multiple perspectives. This study investigated the demographic and clinical characteristics of non-COVID-19 critical care patients admitted concurrently with a COVID-19 wave. The objective of this study was to identify the risk factors for mortality in critically ill non-COVID-19 patients. Methods: All consecutive cases admitted to the intensive care unit (ICU) were included in the study between January 1, 2021 and July 14, 2021. All data, including age, gender, admission characteristics, patient dependency, pre-existing systemic diseases, the severity of illness (Acute Physiology and Chronic Health Evaluation -APACHE-II), predicted death rate in ICU, life-sustaining medical procedures on admission or during ICU stay, length of stay, and admission time to the ICU, were obtained from the hospital's electronic database. The Charlson Comorbidity Index (CCI) was assessed for all patients. Results: A total of 192 patients were screened during the study period. Mortality was significantly increased in non-surgical patients, previously dependent patients, patients requiring mechanical ventilation, continuous renal replacement therapy, and patients requiring the infusion of vasoactive medications. The number of pre-existing diseases and the admission time had no impact on mortality. The mean CCI was significantly higher in non-survivors but was not a strong predictor of mortality as APACHE II. Conclusions: In this retrospective study, the severity of illness and the need for vasoactive agent infusion were significantly higher in non-survivors confirmed by multivariate analysis as predictive factors for mortality in critical non-COVID-19 patients.

Opioid-free general anesthesia and induced recovery from anesthesia in a patient with myotonic dystrophy type-1: a case report / Anestesia geral sem opioide e recuperação induzida da anestesia em paciente com distrofia miotônica tipo-1: relato de caso

Abstract Myotonic dystrophy type-1 (Steinert disease) is an autosomal dominant, progressive multisystem disease in which myotonic crisis can be triggered by several factors including pain, emotional stress, hypothermia, shivering, and mechanical or electrical stimulation. In this report, dexmedetomidine-based general anesthesia, in combination with a thoracic epidural for laparoscopic cholecystectomy in a patient with Steinert disease, is presented. An Aintree intubation catheter with the guidance of a fiberoptic bronchoscope was used for intubation to avoid laryngoscopy. Prolonged anesthetic effects of propofol were reversed, and recovery from anesthesia was accelerated using an intravenous infusion of theophylline.

Resumo A Distrofia Miotônica (DM) tipo-1 (Doença de Steinert) é uma doença multissistêmica progressiva autossômica dominante em que a crise miotônica pode ser desencadeada por vários fatores, incluindo dor, estresse emocional, hipotermia, tremores e estímulo mecânico ou elétrico. O presente relato descreve anestesia geral realizada com dexmedetomidina em combinação com peridural torácica para colecistectomia laparoscópica em paciente com Doença de Steinert. Para evitar laringoscopia, a intubação traqueal foi realizada utilizando cateter de intubação Aintree guiado por broncofibroscopia óptica. Os efeitos anestésicos prolongados do propofol foram revertidos e a recuperação anestésica foi acelerada pelo uso de infusão intravenosa de teofilina.

Positive heparin/pf4 antibodies and high mortality rate: a retrospective case-series analysis

Abstract Introduction: Heparin-induced thrombocytopenia (HIT) is a potentially lethal complication of unfractionated or low-molecular weight heparin therapy. We aimed to determine the incidence and mortality rate of patients with positive heparin/platelet factor 4 (PF4) antibodies, which is a rapid detection test of HIT. Methods: Coronary artery bypass grafting and mitral and aortic valve surgeries were evaluated. Cardiopulmonary bypass was employed in all patients. The diagnosis of HIT was based on immunological assays. Postoperative complications, mortality rates, and the causes of death were specified in patients with positive heparin/PF4 antibodies. Results: Postoperative thrombocytopenia was detected in 257 patients. Twenty of these patients undergoing open heart surgery were included in the final analysis. Antibodies against heparin/PF4 complex were positive in 20 patients. The mean body mass index was 28.8±2.3 kg/m2, mean value of left ventricular ejection fraction was 48.3±6.7%, cardiopulmonary bypass time was 113.0±35.0 min, aortic cross-clamping time was 88.0±32.7 min, mean intensive care unit length of stay was 10.9±4.9 days, mean preoperative platelet count was 307.250±88528 platelets/microliter, and mean postoperative platelet count was 243.050±89.354 platelets/microliter. The mean duration of heparin exposure was 6.9±2.9 days. The mortality rate was 45% (nine patients) and 1.2% (three patients) in heparin/PF4 complex positive and negative patients, respectively. Conclusion: Although the incidence of HIT was low in patients undergoing open heart surgery, an increased rate of early mortality was observed in patients with positive heparin/PF4 antibodies.