The relationship between mortality and inflammatory markers and the systemic immune inflammatory index in patients in the intensive care unit with a pneumothorax as a complication of COVID-19 disease.

BACKGROUND: A pneumothorax is common in patients admitted to the intensive care unit (ICU) with coronavirus disease (COVID-19) when non-invasive or invasive mechanical ventilation is performed to maintain adequate oxygenation. The aim of the present study was to investigate the effects of elevated inflammatory markers and an elevated systemic immune inflammatory index (SII) on mortality in this patient population. MATERIALS AND METHODS: Between March 2020 and May 2021, 124 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reacion positviity who were admitted to the ICU in our hospital and diagnosed with and treated for a pneumothorax were evaluated retrospectively. Interleukin-6 (IL-6), C-reactive protein, neutrophil, lymphocyte, platelet and white blood cell levels were measured. These parameters were used to calculate the neutrophil-lymphocyte ratio (NLR) and SII, and the association of these parameters with pneumothorax-related mortality was examined. RESULTS: This study included 39 female (31.5%) and 85 male (68.5%) patients. The mean age was 65.3 ± 12.6 years. Non-invasive mechanical ventilation was performed in 13 (10.5%) patients, and 111 (89.5%) patients received invasive mechanical ventilation. Tube thoracostomy was performed in 113 patients (91.1%), and 11 patients (8.9%) were treated with oxygen therapy. The factors affecting mortality in the pneumothorax patients were the Charlson Comorbidity Index (four or higher), IL-6 level and NLR. The IL-6 level was 53.4 in those who died versus 24.6 in those who survived (p = 0.017). The NLR in the patients who died was 16.9 as compared to 12.5 in those who survived (p = 0.011). CONCLUSION: Elevated markers of infection were associated with an increased risk of mortality in pneumothorax patients with COVID-19 who received invasive or non-invasive mechanical ventilation in the ICU. In this patient population, high levels of positive end-expiratory pressure should be avoided, and inflammatory marker levels and the SII should be closely monitored.

Thoracic surgery experience from the largest pandemic hospital in Europe.

BACKGROUND: SARS-CoV-2 coronavirus disease 19 (COVID-19), which was detected in December 2019, whose first cases were observed in Turkey on 11th March 2020, and which was declared a pandemic by the World Health Organization on the same day, has become a public health problem worldwide and has required the adaptation of medical practices to the current situation. In the current paper, we present our experience and practices regarding thoracic surgery from the largest pandemic hospital in Europe over the 1-year period of the pandemic. METHODS: Patients who were operated by our thoracic surgery clinic in the largest pandemic hospital in Europe between March 2020 and March 2021 in the COVID-19 pandemic in our country and in the world were evaluated retrospectively. RESULTS: Eighty-five patients were operated on during the 1-year pandemic, of which 54 (63.5%) were men and 31 (36.5%) were women. The mean patient age was 47.7. Morbidity rate was 12%. The average number of PCR tests performed in the preoperative period for COVID-19 disease was 1.6. Sixteen patients had a history of COVID-19 before surgery. COVID-19 was not seen in any patient in our clinic during the postoperative period. Only one patient died out of those who underwent surgery. That patient died due to multiorgan failure. CONCLUSION: Thoracic surgery has one of the highest risks due to direct contact with the lungs, especially in terms of surgery and the postoperative period. We consider that this risk will be minimized by taking measures during all processes. Moreover, we think that surgical treatments should be delayed as little as possible due to the special status of oncology patients. In addition, considering that if all these rules are followed in the COVID-19 pandemic and in other types of pandemics that may occur in the future, there will be no delay or insufficiency in the treatment of patients and healthcare professionals will be able to work safely.

THE EFFECT OF COVID-19 VACCINES ON PNEUMOTHORAX IN GERIATRIC PATIENTS HOSPITALIZED IN INTENSIVE CARE UNIT DUE TO COVID-19.

In our study, we examined the effect of COVID-19 vaccination on the incidence of pneumothorax in intensive care patients over age 65. COVID-19 intensive care patients that presented to our department between April 2020 and May 2021 during the COVID-19 pandemic were evaluated retrospectively. Patients were divided into two main groups, i.e., before and after the vaccination period. Patients were evaluated retrospectively for the following parameters: gender, age, side of pneumothorax, mortality, discharge, comorbidity, and additional pleural complications. The total number of patients was 87, i.e., 66 patients before vaccination and 21 patients after vaccination. When patients in the pre- and post-vaccination period were compared, there was a significant difference in the incidence of pneumothorax between the two groups (p<0.05). Pneumothorax was less common after vaccination. When patients with pneumothorax and tube thoracostomy were evaluated according to pre- and post-vaccination mortality, mortality was significantly higher (89%) in the pre-vaccination period (p<0.05). We consider that COVID-19 vaccines used in patients aged over 65 reduced the incidence of pleural complications, especially pneumothorax. We think that mortality due to pneumothorax in patients over 65 years of age was lower during the vaccination period. In addition, we think that bilateral pneumothorax was more common in the non-vaccinated period. As a result, we think that life-threatening pneumothorax and similar complications could be reduced by increasing the number of vaccines made in the COVID-19 pandemic and spreading it around the world.

The effect of transcutaneous electric nerve stimulation on chronic postoperative pain and long-term quality of life.

BACKGROUND: This study aims to investigate the effects of transcutaneous electrical nerve stimulation on early-stage postoperative pain and long-term quality of life in patients undergoing thoracotomy. METHODS: Between January 2019 and September 2019, a total of 100 patients (76 males, 24 females; mean age: 57.9±11.9 years; range, 51 to 79 years) who underwent thoracotomy due to benign or malignant lesions were included. The patients were divided into two groups: 50 patients who received transcutaneous electrical nerve stimulation (Group 1) and a control group of 50 patients who did not receive transcutaneous electrical nerve stimulation (Group 2). The Short Form-36 life quality scale was used to evaluate patients' quality of life at one month before and after surgery. RESULTS: The mean length of hospital stay was 4.9±3.1 days in Group 1 and 6.2±4.6 days in Group 2 (p=0.008). There were no statistically significant differences in early-stage postoperative pain scores between the groups (p>0.05). Compared to Group 2, Group 1 had significantly lower pain scores and higher life quality scores pre- and postoperatively (p<0.05). CONCLUSION: Transcutaneous electrical nerve stimulation is an effective method to manage chronic pain in the postoperative period. On the other hand, it does not effectively reduce early-stage postoperative pain or affect complication rates. The prevention of chronic postoperative pain by transcutaneous electrical nerve stimulation improves long-term quality of life of patients.