Effect of cortisol and glycosylated-hemoglobin levels on mortality in intensive care unit.

OBJECTIVES: To research the effects of blood cortisol and hemoglobinA1c (HBA1C) levels on mortality in patients admitted to the intensive care unit (ICU) and whether these factors could be used as reliable indicators for mortality risk assessment in these patients. METHODS: After receiving approval from the ethics committee, 79 patients admitted to ICU were included in the study. From patient files, we collected data on demographics (age, gender), presence of diabetes mellitus, and levels of cortisol, HbA1C, glucose, and lactate measured during hospitalization, along with acute physiology and chronic health evaluation (APACHE) II scores calculated within the first 24 hours. In our study, we planned to investigate the relationship between patients' cortisol and HbA1C levels and mortality. RESULTS: A total of 79 patients were included in the study. The mortality rate of the patients included in the study was 65.8%. In the model established with all variables, only cortisol level (p=0.017) and APACHE II score (p=0.005) were defined to affect mortality. CONCLUSION: Cortisol levels at the time of admission to the ICU were found to affect mortality and can be considered a predictive factor, while HBA1C levels showed no such effect. Our findings indicate that neither cortisol nor HBA1C levels had an impact on the duration of mechanical ventilation or length of stay in the ICU.

Impact of vaccination on ICU admissions of hospitalized COVID-19 patients in a country with a heterologous vaccine policy.

INTRODUCTION: Vaccination against coronavirus disease-19 (COVID-19) is highly effective in preventing severe disease and mortality. Adenoviral vector and mRNA vaccines were effective against intensive care unit (ICU) admission, but the effectiveness of inactivated vaccine on ICU admission was unclear. We aimed to evaluate the effect of vaccination status on ICU admission in hospitalized COVID-19 patients in a country with heterologous vaccination policy. METHODOLOGY: This is a retrospective multicenter study conducted in three hospitals in Izmir, Turkey between 1 January 2021 and 31 March 2022. Patients aged ≥ 18 years and hospitalized due to COVID-19 were included in the study. Patients who had never been vaccinated and patients who had been vaccinated with a single dose were considered unvaccinated. A logistic regression analysis was performed for evaluating risk factors for ICU admission. RESULTS: A total of 2,110 patients were included in the final analysis. The median age was 66 years (IQR, 53-76 years) and 54% of the patients were vaccinated. During the study period, 407 patients (19.3%) were transferred to the ICU due to disease severity. Patients who were admitted to the ICU were older (median age 68 vs. 65 years, p < 0.001); and the number of unvaccinated individuals was higher among ICU patients (57% vs. 45%, p < 0.001). In multivariate regression analysis, being unvaccinated was found to be the most important independent risk factor for ICU admission with an OR of 2.06 (95% CI, 1.64-2.59). CONCLUSIONS: Vaccination against COVID-19 is effective against ICU admission and hospital mortality.

Effectiveness of the oxygen reserve index in detecting and preventing hyperoxia in critically ill patients on mechanical ventilation: a randomized controlled trial.

AIM: To assess the effectiveness of fraction of inspired oxygen (FiO2) titration guided by oxygen reserve index (ORi) in preventing hyperoxia in intensive care unit (ICU) patients receiving mechanical ventilator support. METHODS: Patients aged 18 years and older who were admitted to a tertiary ICU and required mechanical ventilator support were randomly divided into two groups: the control group (n=30) and the oxygen saturation (SpO2) +ORi group (n=30). In the SpO2+ORi group, the goal was to maintain SpO2 between 95% and 98% and ORi at 0.00. In both groups, SpO2, ORi, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide, positive end-expiratory pressure, FiO2, and hemodynamic parameters were recorded every six hours for two consecutive days. RESULTS: A very strong positive linear correlation was found between PaO2 and ORi (r=0.937; P<0.001). In the ORi+SpO2 group, PaO2 values were significantly lower and decreased with FiO2 titration over time. Severe hyperoxia was observed in 24.8% of the control group and in only 3.3% of the ORi+SpO2 group. When PaO2>120 mm Hg, FiO2>0.40 was found in 83.5% of the control group, and in 40% of the ORi+SpO2 group. CONCLUSION: FiO2 titration guided by ORi+SpO2 effectively prevents hyperoxia and reduces the exposure time to hyperoxia in critically ill patients.

Safe Hugs in Palliative Care.

Mnemonics are word formulations that aid physicians in recalling instances hidden among typical applications and may be neglected due to workload. Mnemonic abbreviations that benefit not only physicians but the entire care team are widely used throughout the world. Given that palliative care is the work of a multidisciplinary team, these mnemonics become even more significant. The aim of this study is to introduce the acronym "SAFE HUGS IN PC" (Sleep patterns, Analgesia, Feeding, Environment, Hospital Discharge-Home Care, Ulcer, Gastrointestinal, Social Support-Spiritual, Infection, Need of Religion, Physiotherapy-Psychotherapy, Goals of Care), which we believe will meet the requirements in the palliative care. The following databases were searched: CINAHL, Cochrane, Embase, MEDLINE, and Pubmed for studies exploring experiences of palliative care. With this mnemonic, which we use in our own clinic, patients' and patients' relatives' satisfaction and end-of-life quality have increased. We believe this simple mnemonic will encourage teamwork and help improve the quality of life on palliative care.

Convalescent plasma for COVID-19 in the intensive care unit.

INTRODUCTION: We aimed to investigate the clinical features and mortality of critically ill patients treated with convalescent plasma for COVID-19 in the intensive care unit (ICU). MATERIAL AND METHODS: We retrospectively collected clinical and laboratory data of COVID-19 patients treated in the ICU. The patients were divided into two groups: those who received convalescent plasma and those who did not. We evaluated changes in the laboratory parameters and PaO2/FiO2 of the patients in the convalescent plasma group on days 0, 7, and 14. RESULTS: A total of 188 patients were included, 89 of whom received convalescent plasma. There were no significant differences in length of hospitalization [median: 17 vs. 16 days, P = 0.13] or 28-day mortality between the two groups (59% vs. 65%, P = 0.38). The ICU stay of patients who received convalescent plasma was longer (P = 0.001). The dynamics of the laboratory parameters of 44 patients in the convalescent plasma group, who were still in intensive care on the 14th day, were analysed. There was no differences in CRP or PaO2/FiO2 on day 0, 7 or 14 (P = 0.12; P = 0.10, respectively). CONCLUSIONS: Convalescent plasma treatment was not associated with shorter hospitalisation or lower mortality in patients diagnosed with COVID-19. However, the ICU stay was longer in patients who received convalescent plasma.

Is Procalcitonin a Marker of Neurologic Outcome or Early Infection in Patients Treated with Targeted Temperature Management?

OBJECTIVES: Although high procalcitonin (PCT) levels are associated with poor neurological outcomes and increased mortality rates in patients treated with targeted temperature management (TTM) in the postcardiac arrest (CA) period, there are limited data about the correlation between PCT levels and infection. The aim of our study was to assess the relationship of PCT levels in the first 48 hours with early period infections, late period neurological prognosis, and mortality in patients treated with TTM after CA. MATERIALS AND METHODS: Serum PCT was measured on admission days 1 and 2. The early onset infection diagnosis before the seventh day in the intensive care unit (ICU) was made according to the criteria of infection centers for disease control and prevention. Mortality and neurologic outcomes were assessed 90 days after CA according to cerebral performance category (CPC) score. RESULTS: There was no statistically significant correlation between early period infection diagnosis and PCT levels at the time of admission, 24th, and 48th hours. Patients with poor neurologic outcomes on the 90th day had significantly high PCT levels at 24 (p = 0.044) and 48 hours (p = 0.004). There was no statistically significant correlation between admission PCT levels and neurological prognosis. While the correlation between mortality and PCT levels at 24 (p = 0.049) and 48 (p = 0.004) hours was significantly high, no statistically significant correlation was found between admission PCT levels and mortality. CONCLUSION: In patients treated with TTM after CA, increased PCT levels were significantly correlated with poor neurologic outcomes and mortality. However, the elevated PCT levels were not significantly correlated with early period infections. HOW TO CITE THIS ARTICLE: Zincircioglu C, Yavuz T, Saritas A, Çakmak M, Güldogan IK, Uzun U, et al. Is Procalcitonin a Marker of Neurologic Outcome or Early Infection in Patients Treated with Targeted Temperature Management? Indian J Crit Care Med 2020;24(5):327-331.

Comparison of inferior vena cava collapsibility, distensibility, and delta indices at different positive pressure supports and prediction values of indices for intravascular volume status

Background/aim: To compare the inferior vena cava (IVC) indices, identify their variation rates at positive pressure values and accurate predictive values for the volume status in patients with spontaneous respiration receiving different positive pressure support. Materials and methods: The study included 100 patients who were divided into 4 pressure support groups, according to the different pressure supports received, and 3 volume groups according to their CVP values. Ultrasonography was applied to all of the patients to define their IVC diameters at different pressure supports. Dynamic parameters were derived from the ultrasonographic assessment of the IVC diameter [collapsibility (CI-IVC), distensibility (dIVC), and delta (ΔIVC) indices]. Results: There were significant differences between the 3 indices (CI-IVC, dIVC, and ΔIVC) according to the pressure groups [(10/5), (10/0), (0/5), (t tube 0/0)]. The median value for the dIVC percentages was ≤18% for all of the positive pressure support hypervolemic groups, apart from the hypervolemic t tube group (19%). For the hypervolemic groups, the best estimation according to the cut-off value appeared to be for the dIVC. Values with the highest sensitivity for differentiation of the hypovolemic individuals were calculated with the dIVC. Conclusion: The dIVC had a more accurate predictive role in predicting the volume status when compared with the CI-IVC and ΔIVC, and may be used reliably with positive pressure supports.

Effect of regional cerebral oximetry to estimate neurologic prognostic outcomes in patients administered targeted temperature management.

PURPOSE: The aim of our study is to research the role and efficacy of cerebral oximetry in predicting neurologic prognosis when applied during TTM to patients experiencing coma after CA. METHODS: This study was performed on surviving adult comatose patients after CA treated with TTM. The average scores of rSO2 was measured at 6h intervals for the first 2days and once a day for the following 3days with a NIRS device during TTM. The CPC scale was used to define the neurologic outcomes of patients. We compared the correlations of rSO2 values between good (CPC 1-2) and poor (CPC 3-5) neurologic outcomes in CA patients. RESULTS: There was no statistically significant difference identified between the prognosis groups in terms of rSO2, CPR durations, hemoglobin values and admission body temperature (p>0.05). When the variation in rSO2 values over time is investigated, though there was no significant difference between the good and poor prognosis groups, it appeared to fall in the first 6h in both prognosis groups. The median NT-proBNP and lactate values were observed to be higher in the poor prognosis group. CONCLUSION: There is no significant correlation between rSO2 values and neurologic outcomes. Multimodal monitoring methods may be useful and further studies with a larger patient population are necessary in this area.

Brain Death in Intensive Care Units: Problems, Differences in Methods of Diagnosis, and Donor Care.

OBJECTIVES: Our aim was to investigate the most common problems in diagnosing brain death, the care of the organ donor, and organ donation after death. MATERIALS AND METHODS: A survey was sent randomly to clinicians working in national intensive care units in Turkey. The survey, which consisted of 17 questions for clinicians, had 163 responders. RESULTS: The most common cause of brain death was traumatic brain injury. Although 22% of clinicians found the apnea test necessary for brain death diagnosis, 78% stated that it could be used as an optional confirmatory test. However, 65.6% of the clinicians were not familiar with the modified apnea test. The most frequently used vasoactive agent for hypotension in patients with brain death was noradrenaline (54.6%) and dopamine (41.6%). Regarding time of death, 50.3% of clinicians considered it as the time and date when the patient was diagnosed with brain death and 47.8% as the time and date of cardiac arrest. When asked whether they terminate the treatment of a patient with brain death when organ donation is rejected, only 16.1% discontinued all advanced life support. According to the survey, the most common reason for not accepting organ transplant was for religious reasons. CONCLUSIONS: In intensive care units, differences in definitions and care of patients with brain death continue to be a complication. There has been a lack of progress in criterion standards of brain death diagnosis and donor care, as verified by our survey.

The recovery time of sevoflurane and desflurane and the effects of anesthesia on mental and psychomotor functions and pain.

BACKGROUND: Inhalation anesthetics have many advantages for outpatient general anesthesia, such as minimal postoperative side-effects and rapid and full recovery. The aim of this randomized study was to compare the postoperative recovery time of sevoflurane and desflurane and to observe the effects of anesthesia on mental, psychomotor and cognitive functions and pain in outpatients undergoing arthroscopic surgery. PATIENTS AND METHODS: This study included 40 American Society of Anesthesiologists I-II patients who were divided into two groups via sealed envelopes. For maintenance of anesthesia, a mixture of 66% N2O and 33% O2 and 4-7% desflurane was used in Group D, and a mixture of 66% N2O and 33% O2 and 1-2.5% sevoflurane was used in Group S. The modified Aldrete score (MAS) was evaluated postoperatively at time points determined previously. An MAS of 8 or higher was considered to indicate alertness. Mental and psychomotor functions of the patients were evaluated using the short cognitive examination (SCE), and postoperative pain levels were evaluated using the visual analogue scale (VAS). RESULTS: There was no difference between the groups in terms of demographic data (P > 0.05). The mean time to reach MAS 8, eye-opening, and orientation were higher in Group S as compared to Group D (P < 0.01). The mean MAS initially and at 5 and 10 min was higher in Group D as compared to Group S (P < 0.001). The mean SCE at 5 and 15 min was higher in Group D as compared to Group S (P < 0.01). There was no significant difference between the groups in terms of VAS scores (P > 0.05). CONCLUSION: It has been determined that desflurane provided better quality and more rapid recovery than sevoflurane, and the return of cognitive functions in the early postoperative period was faster. In conclusion, both agents can apparently be used safely in outpatient anesthetic procedures.