Does the pleth variability index have any predictive value for intraoperative respiratory problems in bariatric surgery?

Background/aim: We aimed to search the relationship between the preoperative PVI (pleth variability index) and intraoperative respiratory parameters to reveal whether PVI can be used as a prediction tool in bariatric surgery. Materials and methods: Forty patients undergoing bariatric surgery were included. Noninvasive pleth variability index measured via finger probe before induction of general anesthesia. Following intubation each patient was ventilated in controlled mode. Intraoperative blood pressure, peak airway pressure, end-tidal CO2, SpO2, PEEP, and FiO2 were recorded every 5 min for the first 10 min and then every 10 min until extubation. Steroid and bronchodilator requirements were recorded. Results: The systolic pressure-PVI, oxygen saturation-PVI relationship was statistically significant (p = 0.03, p = 0.013). A relationship was found between pleth variability index and peak airway pressure (p = 0.002). No correlation was detected between end-tidal CO2 and pleth variability index. The relationship between steroid, bronchodilator use, and PVI was significant (p = 0.05, p = 0.01). A positive correlation between PEEP and PVI was detected at varying time points. A positive correlation was found between FiO2-PVI. Conclusion: A relationship was found between PVI and intraoperative peak airway pressures, oxygen saturation, PEEP, bronchodilatator, and steroid usage. This result may be inspiring to conduct larger studies addressing the issue of predicting intraoperative respiratory problems in bariatric surgeries.

Can chin-nape circumference and the ratio of neck circumference to chin-nape circumference predict difficult mask ventilation or difficult intubation in obese patients?

We aimed to evaluate the success of the ratio of chin-nape circumference (CNC) and neck circumference (NC) to CNC in predicting difficult mask ventilation (DMV) or difficult intubation (DI). Eighty-seven obese patients (body mass index ≥ 30) were evaluated between September 15, 2019 and September 15, 2020. Mallampati score, mouth opening, upper lip bite test, distance between incisors, thyromental distance (TMD), sternomental distance (SMD), and thyromental height were recorded. NC and CNC were measured in a neutral position. The ratio of NC to TMD and the ratio of NC to CNC were calculated. Mask ventilation was graded according to the method described by Han et al (Grade 3 or 4 equals DMV). DI assessment was performed using the intubation difficulty scale (IDS, IDS < 5 equals easy intubation, IDS ≥ 5 equals DI). Logistic regression analysis was performed to identify the variables thought to be effective in DMV and DI. Receiver operating characteristic curves were generated for each parameter considered effective. DMV was found in 17.2% (n = 15) of the patients included in the study, and DI was found in 16.1% (n = 14). The relationship between DMV and age, male gender, obstructive sleep apnea syndrome, NC, ratio of NC to TMD, ratio of NC to SMD, ratio of NC to CNC, and CNC was significant. Male gender and NC >45.5 cm were independent risk factors for DMV. The relationship between DI and distance between incisors, NC, ratio of NC to TMD, ratio of NC to SMD, and CNC was significant. A distance between the incisors < 4.85 cm and a NC > 41.5 cm were found to be independent risk factors for DI. CNC may predict DMV and DI in obese patients. The ratio of NC to CNC may predict DMV in obese patients.

Evaluation of the efficiency and complications of the consecutive proning in COVID-19 ICU: a retrospective study.

PURPOSE: We aimed to evaluate and compare the efficacy and complications of three consecutive prone positions (PP) in COVID-19 ICU. MATERIALS AND METHOD: Patients with ARDS and placed in PP for 3 times (PP1, PP2, PP3) consecutively were included. Arterial blood gases (ABG), partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratios, partial pressure of carbondioxide (PaCO2), PEEP, and FiO2 were recorded before (bPP), during (dPP), and after (aPP) every prone positioning. Eye, skin, nerve, and tube complications related to PP were collected. RESULTS: In all positions, PaO2 value during PP was significantly higher than PaO2 before and after prone position (p = 0.001). PaO2 values were similar in all (PP1, PP2, PP3) bPP arterial blood gases. We found difference in PaO2 values during prone position between the first (PP1) and second proning (PP2). When each prone was evaluated within itself, PaO2/FiO2 increases after proning compared to before proning. PaO2/FiO2 during PP were higher compared to before proning ones. PaO2/FiO2 during PP1 was significantly higher compared to during PP3 (p = 0.005). In PP3, PEEP values bPP, dPP, and aPP were significantly higher than PEEP values after the second prone (p = 0.02, p = 0.001, p = 0.01). In the third prone, PaCO2 levels were higher than in PP1 and PP2. There were eye complications in 13, tube-related complications in 10, skin complications in 30, and nerve damage in 1 patient. CONCLUSION: We believe that a more careful decision should be made after the second prone position in patients who have to be placed in sequential prone position.

Is Airway Management More Risky in Bariatric Surgery?

PURPOSE: Airway problems may be experienced more often during anesthesia management in bariatric surgery. In this prospective study, we aimed to compare the incidence of difficult ventilation and intubation between bariatric surgery and other surgeries. DESIGN: This was a case-control study. METHODS: Medical records of 156 patients over the age of 18 who were scheduled for bariatric (n = 68) and nonbariatric surgery (n = 88) under general anesthesia were evaluated. FINDINGS: The percentage of ASA III, diabetes mellitus, and obstructive sleep apnea syndrome (75%, 33.8%, and 16.2%, respectively) was significantly higher in bariatric surgery patients compared to nonbariatric patients (14.8%, 10.2%, and 3.4%, respectively). No significant difference was found in mean thyromental distance and history of difficult intubation, restriction of cervical extension, beard presence, tooth loss, mallampati, Cormack-Lehane score, intubation score, difficult ventilation, difficult intubation and intubation device used. An increase in neck circumference (>50 cm) rather than body mass index was a more significant indicator in predicting difficult intubation and difficult ventilation. CONCLUSIONS: The incidences of difficult ventilation and difficult intubation were similar in bariatric and nonbariatric surgeries in circumstances where the necessary equipment and experienced anesthesiologists are available.

Bismuth intoxication resulting in acute kidney injury in a pregnant adolescent girl.

Çelebi-Tayfur A, Yaradilmis RM, Ulus F, Çaltik-Yilmaz A, Özayar E, Kosar B, Büyükkaragöz B, Horasanli E. Bismuth intoxication resulting in acute kidney injury in a pregnant adolescent girl. Turk J Pediatr 2019; 61: 292-296. Bismuth intoxication is a rare cause of acute kidney injury (AKI) and is usually reversible by appropriate therapeutic measures. We present here a case of an adolescent pregnant girl who developed AKI due to an overdose of colloidal bismuth subcitrate (CBS, total amount of 6 g). She received parenteral chelating agent dimercaprol for 14 days. Continuous venovenous hemodiafiltration (CVVHD) with high-flux membrane was carried out in the first 3 days of chelating therapy and intermittent hemodialysis for 11 days, thereafter. The patient recovered clinically and was discharged after 21 days. She gave birth to a healthy term boy. At the last visit, the baby was 6 months old with normal growth and development as well as normal kidney functions. Neither deterioration in renal functions nor emergence of proteinuria was recorded in the patient during follow-up care after hospital discharge. In cases of AKI due to an overdose of CBS, treatment with dimercaprol combined with high flux hemodiafiltration and subsequently hemodialysis appears to be both useful and safe for bismuth elimination.

Effects of Increasing Airway Pressures on the Pressure of the Endotracheal Tube Cuff During Pelvic Laparoscopic Surgery.

BACKGROUND: Tracheal tube cuff pressures exceeding the perfusion pressures of the tracheal mucosa have been associated with complications such as sore throat, tracheal mucosa ulcers, tracheal rupture, and subglottic stenosis. Despite appropriate inflation, many factors can increase the tracheal cuff pressure during mechanical ventilation. This prospective observational cohort study was designed to test the hypothesis that during a clinical model of decreasing respiratory compliance, the pressure within the endotracheal tube cuff will rise in direct relationship to increases in the airway pressures. METHODS: Twenty-eight adult obese patients (BMI ≥30 kg/m) scheduled for elective laparoscopic gynecologic procedures were enrolled. All patients received general anesthesia utilizing endotracheal tubes with low-pressure high-volume cuffs. After baseline adjustment of the cuff pressure to 25 cm H2O, the airway pressures and endotracheal cuff pressures were continuously measured using pressure transducers connected to the anesthesia circuit and cuff pilot, respectively. Data on cuff and airway pressures, mechanical ventilation parameters, intraabdominal pressures, and degree of surgical table inclination were collected throughout the anesthetic procedure. General linear regression models with fixed and random effects were fit to assess the effect of increases in airway pressures on cuff pressure, after adjusting for covariates and the clustered structure of the data. RESULTS: The mean (standard deviation) age and body mass index were 42.2 (8.8) years and 37.7 (5.1) kg/m, respectively. After tracheal intubation, the cuffs were overinflated (ie, intracuff pressures >30 cm H2O) in 89% of patients. The cuff pressures significantly changed after concomitant variations in the airway pressures from a mean (standard error) value of 29.6 (1.30) cm H2O before peritoneal insufflations, to 35.6 (0.68) cm H2O after peritoneal insufflation, and to 27.8 (0.79) cm H2O after peritoneal deflation (P < .0001). The multilevel mixed regression models revealed that after controlling for clustering of the data (at the patient and study phase levels) and covariates, increased peak airway pressures were significantly associated with increased pressures within the endotracheal cuff (coefficient [95% confidence interval], 0.25 [0.14-0.36]; P < .0001). Other variables associated with increasing endotracheal cuff pressure included degree of surgical table inclination (0.08 [0.04-0.12]; P = .0003) and I:E ratio of 1:1 (4.47 [2.10-6.83]; P = .0002). CONCLUSIONS: This clinical model of decreased respiratory compliance in mechanically ventilated patients reveals that the pressure within the endotracheal cuff significantly changes in direct relation to changes in the airway pressures. This finding may have clinical relevance in patients requiring prolonged use of high airway pressures.

Reducing sedation time for thyroplasty with arytenoid adduction with sequential anesthetic technique.

OBJECTIVE: To determine the extent to which a sequential anesthetic technique 1) shortens time under sedation for thyroplasty with arytenoid adduction (TP-AA), 2) affects the total operative time, and 3) changes the voice outcome compared to TP-AA performed entirely under sedation/analgesia. STUDY DESIGN: Case-control study. METHODS: A new sequential anesthetic technique of performing most of the TP-AA surgery under general anesthesia (GA), followed by transition to sedation/analgesia (SA) for voice assessment, was developed to achieve smooth emergence from GA. Twenty-five TP-AA cases performed with the sequential GA-SA technique were compared with 25 TP-AA controls performed completely under sedation/analgesia. The primary outcome measure was the time under sedation. Voice improvement, as assessed by Consensus Auditory-Perceptual Evaluation of Voice, and total operative time were secondary outcome measures. RESULTS: With the conventional all-SA anesthetic, the duration of SA was 209 ± 26.3 minutes. With the sequential GA-SA technique, the duration of SA was 79.0 ± 18.9 minutes, a 62.3% reduction (P < 0.0001). There was no significant difference in the total operative time (209.5 vs. 200.9 minutes; P = 0.42) or in voice outcome. This sequential anesthetic technique has been easily adopted by multiple anesthesiologists and nurse anesthetists at our institution. CONCLUSION: TP-AA is effectively performed under sequential GA-SA technique with a significant reduction in the duration of time under sedation. This allows the surgeon to perform the technically more challenging part of the surgery under GA, without having to contend with variability in patient tolerance for laryngeal manipulation under sedation. LEVEL OF EVIDENCE: 3b. Laryngoscope, 127:2813-2817, 2017.

Effect of Uterine Fundal Pressure on Maternal Intraocular Pressure in Cesarean Delivery: Comparison of Regional and General Anesthesia.

PURPOSE: To evaluate the intraocular pressure (IOP) changes accompanying fundal pressure during a cesarean-section procedure under both regional and general anesthesia. METHODS: In total, 60 women scheduled for elective cesarean section, none of them diagnosed with ocular problems, were enrolled in the study. Patients underwent cesarean section under either general (group G, n=30) or regional anesthesia (group S, n=30) according to their choice. IOP was measured with a Tono-Pen before (T1) and after (T2) application of anesthesia, during fundal pressure (T3), and after the birth of the baby (T4). Heart rate as well as systolic, diastolic, and mean arterial pressure were recorded during the procedure. RESULTS: There was no significant difference in IOP between the groups (P>0.05). In group S, IOP at T3 was significantly higher than at all other timepoints (P<0.001). In group G, IOP at T3 was significantly higher than at T2 and T4. Mean arterial pressure was significantly lower in group S at all timepoints except T1. CONCLUSIONS: In conclusion, fundal pressure may significantly increase the IOP, but the choice of anesthetic technique may not have any effect on IOP.

A sequential anesthesia technique for surgical repair of unilateral vocal fold paralysis.

Thyroplasty with arytenoid adduction, a combined procedure for treatment of unilateral vocal fold paralysis, is typically performed under local anesthesia with sedation to allow for intraoperative voice assessment. However, the need for patient immobility and suppression of laryngeal responses to surgical manipulation can make sedation-analgesia challenging. We describe our first 26 consecutive cases undergoing thyroplasty and arytenoid adduction with a standardized technique consisting of a combination of general anesthesia with tracheal intubation followed by sedation-analgesia. Most patients (69 %) were women, with age of 53 ± 15 years (mean ± SD). Neck surgery was the cause of vocal fold paralysis in 50 % of patients. Initially, general anesthesia was maintained with desflurane and remifentanil with dexmedetomidine added just before tracheal extubation. During the sedation-analgesia phase, patients received infusions of remifentanil and dexmedetomidine. Duration of general anesthesia and sedation-analgesia phases was 162 ± 68.2 and 79 ± 18.3 min, respectively. Mean (SD) wake-up time was 8.0 ± 4.0 min after desflurane discontinuation. Extubation occurred without coughing, bucking, or agitation in 96 % of patients. All the patients were able to phonate appropriately and remained comfortable after emergence. This technique allowed improved surgical conditions with reduced patient discomfort and may be advantageous for other laryngeal and neck surgeries in which intraoperative patient feedback is required.

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy: From the View of an Anesthesiologist.

PURPOSE: To determine the differences among the hemodynamics, neuroendocrine stress response (NESR), and postoperative visual analogue scale (VAS) scores of pain between the procedures of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for lower pole kidney stones. PATIENTS AND METHODS: Fifty-six patients undergoing RIRS and PNL with lower puncture approach, under general anesthesia, were prospectively enrolled in our study. Perioperative blood pressure (systolic, diastolic, and mean), heart rate, and peripheral oxygen saturation (SpO2) values were recorded at intervals. Arterial blood gas (ABG) and blood glucose, serum insulin, and cortisol levels as stress response markers were analyzed in the perioperative period. Postoperative VAS scores were recorded at 30 minutes and 2, 4, 6, and 12 hours after extubation. Duration of surgery, stone sizes, and stone-free rates (SFRs) were noted. RESULTS: SFRs were 93.3% in the PNL group (28/30 patients) and 88.5% in the RIRS group (23/26 patients) (p = 0.52). There was no statistical difference between the hemodynamics of both groups. Perioperative ABGs and NESRs were similar between groups (p > 0.05). Postoperative VAS scores and analgesic consumptions were also similar between groups (p > 0.05). Duration of surgery was significantly shorter in the RIRS group (p = 0.001). Stone size was significantly higher in the PNL group (p = 0.013). CONCLUSION: Although the PNL is assumed to be more invasive than the RIRS procedure among urologists and anesthesiologists, both techniques may have similar perioperative outcomes in terms of hemodynamics, ABG, NESR, and pain scores in the management of lower pole stones with lower pole approach.

Ketamine-propofol sedation in circumcision / Sedação com cetamina-propofol em circuncisão

ABSTRACTBACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation.METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II.RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p < 0.050).CONCLUSION: Propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

RESUMOJUSTIFICATIVA E OBJETIVO: Comparar os efeitos terapêuticos da cetamina isolada ou combinação de cetamina-propofol em analgesia, sedação, tempo de recuperação e efeitos colaterais em crianças pré-medicadas com midazolam-cetamina-atropina programadas para procedimentos de circuncisão.MÉTODOS: 60 crianças, estado físico ASA I-II (de acordo com a classificação da Sociedade Americana de Anestesiologistas), com idades entre três e nove anos, submetidas a procedimentos de circuncisão sob sedação, foram recrutadas de acordo com um protocolo de randomização duplo-cego aprovado pelo Conselho de Revisão Institucional. Os pacientes foram randomizados e alocados em dois grupos com o uso do método de envelopes lacrados. Ambos os grupos receberam uma mistura de midazolam 0,05 mg kg-1 + cetamina 3 mg kg-1 + atropina 0,02 mg kg-1 por via intramuscular, na presença dos pais na área de intervenções pré-operatórias. A indução foi realizada com propofol-cetamina no Grupo I ou cetamina isolada no Grupo II.RESULTADOS: Nas comparações entre os grupos foram observadas a idade, o peso, a pressão arterial sistólica inicial e a diferença em relação à taxa de pulso inicial (p > 0,050). A pressão arterial diastólica inicial e as mensurações seriadas subsequentes nos minutos 5, 10, 15 e 20 da pressão arterial sistólica, pressão arterial diastólica e taxa de pulso do grupo cetamina foram significativamente maiores (p < 0,050).CONCLUSÃO: Cetamina-propofol (cetofol) proporcionou melhor qualidade de sedação e estabilidade hemodinâmica que cetamina isolada em cirurgias pediátricas de circuncisão. Não foram observadas complicações significativas durante a sedação nos dois grupos. Portanto, cetofol parece ser um método de sedação eficaz e seguro para procedimentos de circuncisão.

[Ketamine-propofol sedation in circumcision]. / Sedação com cetamina-propofol em circuncisão.

BACKGROUND AND OBJECTIVE: to compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation. METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05mg/kg+ketamine 3mg/kg+atropine 0.02mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II. RESULTS: in the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p>0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20thmin, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p<0.050). CONCLUSION: propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

Ketamine-propofol sedation in circumcision.

BACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation. METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05mg/kg+ketamine 3mg/kg+atropine 0.02mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II. RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p>0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20thmin, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p<0.050). CONCLUSION: Propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

Three-year evaluation of nosocomial infection rates of the ICU.

BACKGROUND AND OBJECTIVES: Evaluating the incidence of nosocomial and invasive device-related infections enables the comparison of the health care associated infection (HAI) between the intensive care units of different hospitals and different units in the same hospital. MATERIAL AND METHODS: A retrospective surveillance study was performed to identify nosocomial infections, device-related infections rates, and causal agents from January 2007 through December 2010 in the Anesthesiology Intensive care unit (ICU). HAI were defined according to the CDC (Centers for Disease Control and Prevention) criteria, and invasive device-related infections were defined according to National Nosocomial Infection Surveillance System (NNIS) criteria. RESULTS: During a two-year period, 939 patients were analyzed throughout a total of 7,892 patient-days. The rates of HAI were 53% in 2007, 29.15% in 2008, 28.85% in 2009 while 16.62% in 2010. Most common HAI was blood stream infection. The rate of soft tissue and skin infection was the second most common. Overall, the most common agents were Gram(-) 56.68%, Gram(+) 31.02% and Candida spp 12.3% among patients with nosocomial infections. CONCLUSIONS: The incidence of HAI in the ICU of our hospital was high, compared to the Turkish overall rates obtained at the Refik Saydam Center in 2007. When the rates of device-related infections between 2007 and 2008 were compared, they were higher in 2007. The rates of device-related infections were diminished in 2008 to below-national mean rates by infection control measures. Since the rate of urinary catheter-related infections are still high, we should exert continuous efforts for infection control.

Três anos de avaliação das taxas de infecção nosocomial em UTI / Three-year evaluation of nosocomial infection rates of the ICU / Tres años de evaluación de las tasas de infección nosocomial en UCI

JUSTIFICATIVA E OBJETIVOS: Avaliar a incidência de infecções nosocomiais associadas aos dispositivos invasivos permite comparar as infecções associadas aos cuidados em saúde (IACS) entre as unidades de terapia intensiva (UTI) de diferentes hospitais e unidades do mesmo hospital. MATERIAL E MÉTODOS: De janeiro de 2007 a dezembro de 2010, um estudo de vigilância retrospectivo foi realizado para identificar infecções nosocomiais, taxas de infecções relacionadas a dispositivos e agentes causadores na UTI de anestesiologia. As IACS foram definidas de acordo com os critérios do Centro de Controle e Prevenção de Doenças (CDC) e as infecções relacionadas aos dispositivos invasivos definidas de acordo com os critérios do Sistema Nacional de Vigilância de Infecções Nosocomiais (NNIS). RESULTADOS: Durante dois anos, 939 pacientes em um universo de 7.892 pacientes/dia foram avaliados. As taxas de IACS foram de 53% em 2007, 29,15% em 2008, 28,85% em 2009 e 16,62% em 2010. A IACS mais comum foi infecção da corrente sanguínea. A taxa de infecção de tecido mole e pele foi a segunda. Entre os pacientes com infecções nosocomiais, os agentes causadores mais comuns foram Gram (-) 56,68%, Gram (+) 31,02% e candidíase 12,3%. CONCLUSÕES: A incidência de IACS na UTI de nosso hospital foi alta, em comparação com as taxas turcas globais obtidas no Refik Saydam Center em 2007. Quando as taxas de infecções relacionadas aos dispositivos foram comparadas entre 2007 e 2008, foram maiores em 2007. A taxas de infecções relacionadas aos dispositivos em 2008 foram reduzidas abaixo da média nacional por causa das medidas de controle de infecção. Como a taxa de infecções relacionada ao cateter urinário ainda permanece alta, devemos exercer esforços contínuos para o controle das infecções.

BACKGROUND AND OBJECTIVES: Evaluating the incidence of nosocomial and invasive device-related infections enables the comparison of the health care associated infection (HAI) between the intensive care units of different hospitals and different units in the same hospital. MATERIAL AND METHODS: A retrospective surveillance study was performed to identify nosocomial infections, device-related infections rates, and causal agents from January 2007 through December 2010 in the Anesthesiology Intensive care unit (ICU). HAI were defined according to the CDC (Centers for Disease Control and Prevention) criteria, and invasive device-related infections were defined according to National Nosocomial Infection Surveillance System (NNIS) criteria. RESULTS: During a two-year period, 939 patients were analyzed throughout a total of 7,892 patientdays. The rates of HAI were 53% in 2007, 29.15% in 2008, 28.85% in 2009 while 16.62% in 2010. Most common HAI was blood stream infection. The rate of soft tissue and skin infection was the second most common. Overall, the most common agents were Gram(-) 56.68 %, Gram(+) 31.02% and Candida spp 12.3% among patients with nosocomial infections. CONCLUSIONS: The incidence of HAI in the ICU of our hospital was high, compared to the Turkish overall rates obtained at the Refik Saydam Center in 2007. When the rates of device-related infections between 2007 and 2008 were compared, they were higher in 2007. The rates of devicerelated infections were diminished in 2008 to below-national mean rates by infection control measures. Since the rate of urinary catheter-related infections are still high, we should exert continuous efforts for infection control.

JUSTIfiCATIVA Y OBJETIVOS: La evaluación de la incidencia de las infecciones nosocomiales asociadas con los dispositivos invasivos, permite comparar las infecciones relacionadas con la asistencia a la sanidad (IRAS) entre las UCIs de diferentes hospitales y las unidades del mismo hospital. MATERIAL Y MÉTODOS: De enero de 2007 a diciembre de 2010, un estudio de vigilancia retrospectivo fue realizado para identificar infecciones nosocomiales, tasas de infecciones relacionadas con los dispositivos y agentes causantes en la unidad de cuidados intensivos (UCI) de anestesiología. Las IRAS se definieron de acuerdo con los criterios del Centro de Control y Prevención de Enfermedades (CDC) y las infecciones relacionadas con los dispositivos invasivos definidas de acuerdo con los criterios del Sistema Nacional de Vigilancia de Infecciones Nosocomiales (NNIS). RESULTADOS: Durante dos años, se evaluaron 939 pacientes dentro de un universo de 7.892 pacientes/día. Las tasas de IRAS alcanzaron el umbral del 53% en 2007, 29,15% en 2008, 28,85% en 2009 y 16,62% en 2010. La IRAS más frecuente fue la infección de la corriente sanguínea. La tasa de infección de tejido suave y de la piel fue la segunda. Entre los pacientes con infecciones nosocomiales, los agentes causantes más a menudo encontrados fueron Gr (-) 56,68%, Gr (+) 31,02% y la candidiasis 12,3%. CONCLUSIONES: La incidencia de IRAS en la UCI de nuestro hospital fue alta en comparación con las tasas turcas globales obtenidas en el Refik Saydam Center en 2007. Cuando las tasas de infecciones relacionadas con los dispositivos se compararon entre 2007 y 2008, fueron mayores en el 2007. Las tasas de infecciones relacionadas con los dispositivos en 2008 quedaron por debajo del promedio nacional a causa de las medidas de control de infección. Como la tasa de infecciones relacionada con el catéter urinario todavía permanece alta, debemos esforzarnos más en el sentido de controlar las infecciones.

Three-year evaluation of nosocomial infection rates of the ICU.

BACKGROUND AND OBJECTIVES: Evaluating the incidence of nosocomial and invasive device-related infections enables the comparison of the health care associated infection (HAI) between the intensive care units of different hospitals and different units in the same hospital. MATERIAL AND METHODS: A retrospective surveillance study was performed to identify nosocomial infections, device-related infections rates, and causal agents from January 2007 through December 2010 in the Anesthesiology Intensive care unit (ICU). HAI were defined according to the CDC (Centers for Disease Control and Prevention) criteria, and invasive device-related infections were defined according to National Nosocomial Infection Surveillance System (NNIS) criteria. RESULTS: During a two-year period, 939 patients were analyzed throughout a total of 7,892 patient- days. The rates of HAI were 53% in 2007, 29.15% in 2008, 28.85% in 2009 while 16.62% in 2010. Most common HAI was blood stream infection. The rate of soft tissue and skin infection was the second most common. Overall, the most common agents were Gram(-) 56.68%, Gram(+) 31.02% and Candida spp 12.3% among patients with nosocomial infections. CONCLUSIONS: The incidence of HAI in the ICU of our hospital was high, compared to the Turkish overall rates obtained at the Refik Saydam Center in 2007. When the rates of device-related infections between 2007 and 2008 were compared, they were higher in 2007. The rates of device- related infections were diminished in 2008 to below-national mean rates by infection control measures. Since the rate of urinary catheter-related infections are still high, we should exert continuous efforts for infection control.