Predictive Value of Serial Rapid Shallow Breathing Index Measurements for Extubation Success in Intensive Care Unit Patients.

Background and Objectives: Extubation success in ICU patients is crucial for reducing ventilator-associated complications, morbidity, and mortality. The Rapid Shallow Breathing Index (RSBI) is a widely used predictor for weaning from mechanical ventilation. This study aims to determine the predictive value of serial RSBI measurements on extubation success in ICU patients on mechanical ventilation. Materials and Methods: This prospective observational study was conducted on 86 ICU patients at Hitit University between February 2024 and July 2024. Patients were divided into successful and unsuccessful extubation groups. RSBI values were compared between these groups. Results: This study included 86 patients (32 females, 54 males) with a mean age of 54.51 ± 12.1 years. Extubation was successful in 53 patients and unsuccessful in 33. There was no significant difference in age and intubation duration between the groups (p = 0.246, p = 0.210). Significant differences were found in RSBI-1a and RSBI-2 values (p = 0.013, p = 0.011). The median RSBI-2a was 80 in the successful group and 92 in the unsuccessful group (p = 0.001). The ΔRSBI was higher in the unsuccessful group (p = 0.022). ROC analysis identified optimal cut-off values: RSBI-2a ≤ 72 (AUC 0.715) and ΔRSBI ≤ -3 (AUC 0.648). RSBI-2a ≤ 72 increased the likelihood of successful extubation by 10.8 times, while ΔRSBI ≤ -3 increased it by 3.4 times. Using both criteria together increased the likelihood by 28.48 times. Conclusions: Serial RSBI measurement can be an effective tool for predicting extubation success in patients on IMV. These findings suggest that serially measured RSBI may serve as a potential indicator for extubation readiness.

The evolution of sepsis publications and global productivity: A bibliometric analysis between 1980 and 2020.

The literature study was conducted by using the Web of Science (WoS) database, employing bibliometric analysis to examine all papers released from 1980 to 2020. The search was performed using the terms "sepsis, septicemia, septic shock" specifically within the titles of the publications. The findings of the literature research revealed a total of 51,725 articles. Out of the total number of publications, 26,896 articles were identified, accounting for 51.9% of the total. The bibliometric study revealed that the United States had the largest number of papers (8693), followed by China (2807), Germany (2299), France (1606), and the United Kingdom (1932). The writers that exhibited the most prolific output in terms of article production on the topic of sepsis were Vincent, with a total of 217 articles, followed by Wang P with 154 articles, and Chaudry IH with 126 articles. The University of Pittsburgh, Brown University, and the University of Michigan were identified as the most productive universities, in that order. The findings from the prediction model revealed that the projected number of articles to be published in 2021 is estimated to be 2086, while the projected number for 2030 is estimated to be 2637. The literature has predominantly focused on disease markers and diagnostic methods, severity and effects of the disease, immunity and inflammation, effects of the disease in neonates and the neonatal period, and treatment and care. According to trend analysis results, recent focus in sepsis research includes a broad spectrum of investigations such as mortality rates, prognostic determinants, diagnostic methods, biomarkers, epidemiological insights, critical care strategies, infections, treatment outcomes, emergency department scenarios, pediatric assessments, and antibiotic interventions.

Exploring the Feasibility of Calculating Expected pCO2 From Venous Blood Gas Samples Alone in Intensive Care Patients.

Introduction This study highlights the significance of assessing acid-base balance and gas exchange in intensive care patients. The research investigates the applicability of using the "expected (pCO2 = HCO3 + 15)" formula, derived from venous blood gas samples, as an alternative to Winter's formula and practical formula. The study emphasizes the importance of identifying the primary acid-base abnormality accurately and efficiently for appropriate clinical intervention in critically ill patients. Methods  This study included 400 adult patients admitted to the Anesthesia Clinic in the Third Stage Anesthesia and Reanimation Intensive Care Unit at Hitit University Erol Olçok Training and Research Hospital between April 2020 and July 2023. Blood gas samples were collected simultaneously from both arterial lines and venous catheters. Patients under 18 years, pregnant women, hemodialysis patients, and those with missing data were excluded. The study aimed to calculate the expected partial pressure of carbon dioxide (pCO2) values using Winter's formula and simple formula for both arterial and venous blood gas samples and assess potential correlations between them. Results The results showed a narrow range for arterial pH values (7.12-7.72), a wider distribution for pCO2 values (17.90-81.30 mmHg), and a moderate dispersion for HCO3 values (12.80-44.33 mmol/L). Both Winter's and simple formulas were applied to estimate the expected pCO2 values, showing strong positive correlations between arterial and venous pH, pCO2, and HCO3 values. The scatterplot illustrated a very high level of association (Pearson's correlation coefficient, r = 1) between the expected pCO2 values derived from both formulas using arterial and venous blood gas samples. Conclusion The clinical study demonstrates that estimating expected pCO2 values in mixed acid-base disorders can be achieved using a simple and convenient formulation, eliminating the need for arterial blood gas sampling and its associated complications.

Analgesic efficacy of ultrasound-guided bilateral transversus abdominis plane block in children: retrospective analysis of 97 cases.

BACKGROUND: Transversus abdominis plane (TAP) block is a method for postoperative pain management. Studies on children are gradually increasing. The aim of this retrospective study was to evaluate effectiveness of TAP block on pain control, its side effects, and parental satisfaction levels in children. METHODS: Study included patients operated between January 2019 and December 2020 in Gazi University Faculty of Medicine. Total of 97 patients (35 girls, 62 boys) between 5 and 18 years who had an ultrasound guided TAP block for lower abdominal or inguinal surgery were examined retrospectively. TAP block application time, hemodynamic variables, postoperative pain scores, postoperative analgesic requirement, sex, surgical history and satisfaction levels were evaluated. RESULTS: : The average application time of TAP block was 9.48 ± 3.4 and the time between TAP block and surgical incision was 12.06 ± 6.1 min. Pain scores in postanesthesia care unit (PACU) and at the postoperative first hour decreased as the time between TAP block and surgical incision increased (p < 0.05). Girls have higher pain scores at PACU than boys (p < 0.05). Previous surgical history increased postoperative 1st hour pain scores (OR: 13.8; 95% CI 1.7-113.3; p = 0.01). There was a significant negative correlation between pain scores at PACU, postoperative 1st, 2nd, 4th, 6th, 12th and satisfaction levels (r = -0.45, r = -0.56, r = -0.60, r = -0.54, r = -0.52, r = -0,43, respectively, p < 0.05). DISCUSSION: Ultrasound-guided TAP blocks can be performed safely in children in lower abdominal surgeries. However, the efficacy of TAP block on late term postoperative pain scores is limited. Time interval between the TAP block and the incision, sex, and pain memory, as well as other factors that may improve the quality of TAP block should be considered.

The Effect of Circadian Rhytm in Patients Undergoing Spinal Anesthesia.

OBJECTIVE: The circadian rhythm is the most important of the main rhythms that affect our daily lives and has a significant role in the efficiency of a lot of drugs used in anesthesia. The aim of this study is to prove whether circadian rythm has an effect on spinal anesthesia and, if any, its effect on postoperative analgesic request by retrospectively studying the patients operated under spinal anesthesia. METHODS: We conducted the study on patients operated on inguinal hernia and anorectal surgery under spinal anesthesia in general surgery room. The patients were divided into two groups according to the time when they were taken into surgery: between 06.00-12.00 (Group 1) and 12.00- 18.00 (Group 2). Time to first analgesic request, time to start walking, time to first urination, intraoperative and postoperative side effects, intraoperative hemodynamic data, and patient satisfaction were detected and recorded. RESULTS: The time to first analgesic request in Group 1 was longer than in Group 2, and this difference was statistically significant. The mean heart rate of the groups was found significantly lower in Group 2 than in Group 1 during measurements at the 25. and 30. minute when compared with their changes over time. There were no statistically significant differences between the groups in terms of side effects and the most common side effect was detected to be nausea - vomiting. CONCLUSIONS: We found out that the time to first analgesic request after spinal anesthesia was significantly longer in Group 1 than in Group 2.