Does hospitalisation of a patient in the intensive care unit cause anxiety and does restriction of visiting cause depression for the relatives of these patients during COVID-19 pandemic?

OBJECTIVES: During the pandemic, anxiety and depression may occur increasingly in the whole society. The aim of this study was to evaluate the possible cause, incidence and levels of anxiety and depression in the relatives of the patients in the intensive care unit (ICU) in accordance with the patients' SARS-CoV-2 polymerase chain reaction (PCR) result. MATERIALS AND METHOD: The study was prospectively conducted on relatives of patients admitted to tertiary intensive care units during COVID-19 pandemic. Sociodemographic characteristics of the patients and their relatives were recorded. "The Turkish version of the Hospital Anxiety and Depression Scale" was applied twice to the relatives of 120 patients to determine the symptoms of anxiety and depression in accordance with the PCR results of the patients (PCR positive n = 60, PCR negative n = 60). RESULTS: The ratios above cut-off values for anxiety and depression among relatives of the patients were 45.8% and 67.5% for the first questionnaire and 46.7% and 62.5% for the second questionnaire, respectively. The anxiety and depression in the relatives of PCR-positive patients was more frequent than the PCR negative (P < .001 for HADS-A and P = .034 for HADS-D). The prevalence of anxiety and depression was significantly higher in female relatives (P = .046 for HADS-A and P = .009 for HADS-A). There was no significant correlation between HADS and age of the patient or education of the participants. The fact that the patients were hospitalised in the ICU during the pandemic was an independent risk factor for anxiety (AUC = 0.746) while restricted visitation in the ICU was an independent risk factor for depression (AUC = 0.703). CONCLUSION: Positive PCR and female gender were associated with both anxiety and depression while hospitalisation in the ICU due to COVID-19 was an independent risk factor for anxiety and restricted visitation in the ICU is an independent risk factor for depression.

Influence of sarcopenia focused on critically ill patients.

A systemic review was performed to evaluate the epidemiological, pathophysiological, and clinical features of sarcopenia, the relationship of sarcopenia with critical illness and its impact on mortality, and diagnostic methods and treatment modalities. Generally, in the presence of critical illness, sarcopenia is not included in the treatment approach strategies. An intensivist should be aware that sarcopenia may be present in critically ill patients. Although the main modalities against sarcopenia are early mobilization and nutritional support, they can only prevent its development and may have positive effects on prognosis rather than treating the existing sarcopenia.

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.

Effect of Nutritional Support Containing Arginine, Glutamine and ß-hydroxy-ß-methylbutyrate on the Protein Balance in Patients with Major Burns.

OBJECTIVE: To evaluate the effect of a supplementary nutritional product containing arginine, glutamine and ß-hydroxy-ß-methylbutyrate (HMB) on the nutritional parameters of patients with major burns. METHODS: In a total of 40 patients with major burns treated in the Burns Unit, standard nutritional support was administered to 20 patients, and the study product was added to the standard nutritional support of the remaining 20 patients. The biochemical laboratory test results and burn severity were recorded on the first day of treatment and on Days 14 and 28. The 40 patients were divided as the study and the control group, and their results were compared. RESULTS: An increase in the albumin, prealbumin and total protein values in the group administered with the study product was found to be statistically significant compared to the control group (p=0.021, p=0.02, p<0.001, respectively). The decreases in haemoglobin and C-reactive protein (CRP) were at the levels expected in burn trauma. CONCLUSION: The results obtained in this study demonstrated that the addition of arginine, glutamine and HMB to the nutrition of patients with burns had a positive effect on the protein balance.

Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers.

OBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.

Pressure support ventilation with the I-gel in intensive care unit: case report / Ventilação controlada por pressão com I-gel em unidade de terapia intensiva: relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: The I-gel supraglottic airway has a non-inflatable cuff made from a gel-like thermoplastic elastomer. The use of the I-gel during anesthesia for spontaneously breathing patients or intermittent positive pressure ventilation has been reported. But there are a few published reports about the use of the I-gel with pressure-controlled ventilation. CONTENTS AND CONCLUSIONS: In this case report we described the use of the I-gel supraglottic airway along 48 h in intensive care unit for the management of ventilation in a patient needed mechanic ventilation but in whom tracheal intubation could not be performed.

RESUMO JUSTIFICATIVA E OBJETIVOS: O dispositivo supraglótico I-gel para o manejo das vias aéreas tem um manguito não insuflável feito de um elastômero termoplástico semelhante ao gel. Há relato sobre o uso do I-gel em pacientes sob anestesia para a ventilação, espontânea ou com pressão positiva intermitente. Porém, há poucos relatos publicados sobre o uso do I-gel com ventilação controlada por pressão. CONTEÚDO E CONCLUSÕES: Descrevemos neste relato de caso o uso do dispositivo supraglótico I-gel durante 48 horas em unidade de terapia intensiva para o manejo das vias aéreas em paciente que precisou de ventilação mecânica, mas no qual a intubação traqueal não pôde ser feita.

Pressure support ventilation with the I-gel in intensive care unit: case report.

BACKGROUND AND OBJECTIVES: The I-gel supraglottic airway has a non-inflatable cuff made from a gel-like thermoplastic elastomer. The use of the I-gel during anesthesia for spontaneously breathing patients or intermittent positive pressure ventilation has been reported. But there are a few published reports about the use of the I-gel with pressure-controlled ventilation. CONTENTS AND CONCLUSIONS: In this case report we described the use of the I-gel supraglottic airway along 48h in intensive care unit for the management of ventilation in a patient needed mechanic ventilation but in whom tracheal intubation could not be performed.

The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation / Comparação entre os efeitos de dexmedetomidina, fentanil e esmolol na prevenção da resposta hemodinâmica à intubação / Comparación entre los efectos de la dexmedetomidina, el fentanilo y el esmolol en la prevención de la respuesta hemodinámica a la intubación

Background and objectives: Laryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response. Methods: Ninety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I–II group and ages between 21 and 65 years were included in that prospective, randomized, double-blind study. Systolic, diastolic, mean arterial pressures, heart rates at the time of admittance at operation room were recorded as basal measurements. The patients were randomized into three groups: Group I (n = 30) received 1 μg/kg dexmedetomidine with infusion in 10 min, Group II (n = 30) received 2 μg/kg fentanyl, Group III received 2 mg/kg esmolol 2 min before induction. The patients were intubated in 3 min. Systolic, diastolic, mean arterial pressures and heart rates were measured before induction, before intubation and 1, 3, 5, 10 min after intubation. Results: When basal levels were compared with the measurements of the groups, it was found that 5 and 10 min after intubation heart rate in Group I and systolic, diastolic, mean arterial pressures in Group III were lower than other measurements (p < 0.05). Conclusions: Dexmedetomidine was superior in the prevention of tachycardia. Esmolol prevented sytolic, diastolic, mean arterial pressure increases following intubation. We concluded that further studies are needed in order to find a strategy that prevents the increase in systemic blood pressure and heart rate both. .

Justificativa e objetivos: Laringoscopia e intubação podem causar resposta hemodinâmica. Vários medicamentos podem ser usados para controlar essa resposta. Neste estudo, nosso objetivo foi comparar os efeitos de dexmedetomidina, fentanil e esmolol sobre a resposta hemodinâmica. Métodos: Foram incluídos no estudo prospectivo, randômico e duplo-cego 90 pacientes programados para cirurgias eletivas, com intubação endotraqueal, estado físico ASA I-II, entre 21 e 65 anos. Pressões arteriais médias, sistólicas, diastólicas e frequências cardíacas foram medidas ao darem entrada na sala de operações e registradas como valores basais. Os pacientes foram randomizados em três grupos: Grupo I (n = 30) recebeu 1 μg/kg de dexmedetomidina com infusão em 10 min; Grupo II (n = 30) recebeu 2 μg/kg de fentanil; Grupo III (n = 30) recebeu 2 mg/kg de esmolol 2 min antes da indução. Os pacientes foram intubados em 3 min. As pressões médias, sistólicas e diastólicas e as frequências cardíacas foram medidas antes da indução, antes da intubação e nos minutos 1, 3, 5 e 10 após a intubação. Resultados: Quando os níveis basais foram comparados entre os grupos, verificou-se que nos minutos 5 e 10 pós-intubação as frequências cardíacas no Grupo I e as pressões arteriais médias, sistólicas e diastólicas no Grupo III estavam mais baixas do que em outros tempos mensurados (p <0,05 ). Conclusões: Dexmedetomidina foi superior na prevenção de taquicardia. Esmolol preveniu o aumento das pressões arteriais médias, sistólicas e diastólicas após a intubação. Concluímos que estudos adicionais são necessários para descobrir uma estratégia que previna tanto o aumento ...

Justificación y objetivos: La laringoscopia y la intubación pueden causar una respuesta hemodinámica. Varios medicamentos pueden ser usados para controlar esa respuesta. En este estudio, nuestro objetivo fue comparar los efectos de la dexmedetomidina, el fentanilo y el esmolol sobre la respuesta hemodinámica. Métodos: Noventa pacientes programados para cirugías electivas con intubación endotraqueal, estado físico ASA I-II, y edades entre 21 y 65 años, se incluyeron en el estudio prospectivo, aleatorizado y doble ciego. Las presiones arteriales medias, sistólicas, diastólicas y las frecuencias cardíacas se midieron cuando los pacientes llegaron al quirófano y se registraron como valores basales. Los pacientes fueron aleatorizados en 3 grupos: el grupo i (n = 30) recibió 1 μg/kg de dexmedetomidina con infusión en 10 min; el grupo ii (n = 30) recibió 2 μg/kg de fentanilo; el grupo iii recibió 2 mg/kg de esmolol 2 min antes de la inducción. Los pacientes fueron intubados en 3 min. Las presiones medias, sistólicas y diastólicas y las frecuencias cardíacas fueron medidas antes de la inducción, antes de la intubación y durante los minutos 1, 3, 5 y 10 después de la intubación. Resultados: Cuando los niveles basales fueron comparados entre los grupos, verificamos que en los minutos 5 y 10 la postintubación, las frecuencias cardíacas en el grupo i y las presiones arteriales medias, sistólicas y diastólicas en el grupo iii eran más bajas que en otros tiempos medidos (p < 0,05). Conclusiones: La dexmedetomidina fue superior en la prevención de la taquicardia. El esmolol previno el aumento de las presiones arteriales medias, sistólicas y diastólicas después de la intubación. Concluimos que son necesarios algunos estudios adicionales para descubrir una estrategia ...

[The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation]. / Comparação entre os efeitos de dexmedetomidina, fentanil e esmolol na prevenção da resposta hemodinâmica à intubação.

BACKGROUND AND OBJECTIVES: Laryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response. METHOD: Ninety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I-II group and ages between 21 and 65 years were included in that prospective, randomized, double-blind study. Systolic, diastolic, mean arterial pressures, heart rates at the time of admittance at operation room were recorded as basal measurements. The patients were randomized into three groups: Group I (n=30) received 1µg/kg dexmedetomidine with infusion in 10 min, Group II (n=30) received 2µg/kg fentanyl, Group III received 2mg/kg esmolol 2min before induction. The patients were intubated in 3min. Systolic, diastolic, mean arterial pressures and heart rates were measured before induction, before intubation and 1, 3, 5, 10min after intubation. RESULTS: When basal levels were compared with the measurements of the groups, it was found that 5 and 10min after intubation heart rate in Group I and systolic, diastolic, mean arterial pressures in Group III were lower than other measurements (p<0.05). CONCLUSIONS: Dexmedetomidine was superior in the prevention of tachycardia. Esmolol prevented sytolic, diastolic, mean arterial pressure increases following intubation. We concluded that further studies are needed in order to find a strategy that prevents the increase in systemic blood pressure and heart rate both.

The effects of a small-dose ketamine-propofol combination on tourniquet-induced ischemia-reperfusion injury during arthroscopic knee surgery.

STUDY OBJECTIVE: To determine the effects of a small-dose ketamine-propofol combination used for sedation during spinal anesthesia on tourniquet-induced ischemia-reperfusion injury. STUDY DESIGN: Prospective randomized study. SETTING: Training and research hospital. PATIENTS: 60 adult, ASA physical status 1 and 2 patients, ages 20-60 years, scheduled for elective arthroscopic knee surgery for meniscal and chondral lesions. INTERVENTIONS: The initial hemodynamic parameters were recorded and blood samples were collected at baseline (T1); then spinal anesthesia was performed. In Group I (n=30), a combination of 0.5 mg/kg/hr of ketamine and 2 mg/kg/hr of propofol was administered; Group II (n=30) received an equivalent volume of saline as an infusion. A pneumatic tourniquet was applied. MEASUREMENTS: Malondialdehyde (MDA), superoxide dismutase (SOD), and catalase levels were measured one minute before tournique deflation in the ischemic period (T2), then 5 (T3) and 30 (T4) minutes following tourniquet deflation in the reperfusion period. MAIN RESULTS: No differences were noted between groups in hemodynamic data (P > 0.05) or SOD levels (P > 0.05). In Group I, MDA levels at T2 were lower than in Group II (P < 0.05). In Group I, catalase levels were lower at T2 and T4 than they were in Group II (P < 0.05). CONCLUSION: Small-dose ketamine-propofol combination may be useful in reducing tourniquet-induced ischemia-reperfusion injury in arthroscopic knee surgery.

Comparison of levobupivacaine alone and in combination with fentanyl and sufentanil in patients undergoing transurethral resection of the prostate.

BACKGROUND: It was aimed to compare the efficacy and adverse effects of levobupivacaine alone and in combination with fentanyl and sufentanil during transurethral resection of the prostate (TURP) under spinal anesthesia. MATERIALS AND METHODS: In this prospective, randomized, double-blind trial, 60 patients undergoing elective TURP under spinal anesthesia were randomized into three groups. Ten milligrams of 0.5% levobupivacaine in Group-I, 7.5 mg 0.5% levobupivacaine combined with 25 µg fentanyl in Group-II and 7.5 mg 0.5% levobupivacaine with 2.5 µg sufentanil in Group-III were administered intrathecally. RESULTS: The time for sensorial block to reach level T10 was 10.2 ± 2.0, 6.9 ± 1.7 and 7.0 ± 1.4 min in Group-I, II and III, respectively (P < 0.001). The maximum sensorial block level was T8 in all groups. The frequency of a complete motor block was higher in Group-I. The mean duration of motor block was shorter in Group-II and III than in Group-I (P < 0.001). There were no differences between groups regarding side effects (P > 0.05). The time for first analgesic request was shorter in Group-I than in the other two groups (P < 0.05). During the first postoperative 24-h period, 11 (58%) patients in Group-I, 9 (48%) patients in Group II and 9 (45%) patients in Group-III required an analgesic drug (P > 0.05). CONCLUSION: This study showed that combining lower dose levobupivacaine with fentanyl and sufentanil provides faster onset of sensorial block, lower frequency and shorter duration of motor block, and longer analgesia time in TURP under spinal anesthesia.

Comparison of bupivacaine alone and in combination with sufentanil in patients undergoing arthroscopic knee surgery.

PURPOSE: One disadvantage of spinal anesthesia using bupivacaine is the relatively short duration of action. Combining it with opioids can increase its analgesic effects. It was aimed to analyze the effectiveness and the side effects of bupivacaine alone and in combination with sufentanil in arthroscopic knee surgery during unilateral spinal anesthesia. METHODS: This is a prospective, randomized, double-blind trial. Fifty patients undergoing unilateral arthroscopic knee surgery were enrolled in this study. The patients were assigned into two groups to receive either 10 mg of 0.5% hyperbaric bupivacaine (Group I) or 5 mg of 0.5% hyperbaric bupivacaine combined with 2.5 µg sufentanil (Group II) to obtain unilateral spinal anesthesia. RESULTS: The time for sensorial block to reach level T10 was 6.3 ± 1.7 min in Group I and 4.8 ± 1.6 min in Group II (P < 0.05). Complete motor block was obtained at the 10th min in 16 patients in Group I (P < 0.005), and the duration of the motor block was lower in Group II (4.9 ± 2.2 h and 2.0 ± 1.1 h, P < 0.001). Bradycardia was encountered in 8 patients in Group I and in 1 patient in Group II (P < 0.05). No differences were encountered regarding other side effects. During the postoperative 24 h, 5 patients in Group I and 3 patients in Group II required analgesic drugs (n.s.). There was not any significant difference between groups with regard to first analgesic request time (8.3 ± 2.4 and 9.0 ± 2.3 h, n.s.). CONCLUSIONS: This study showed that combining lower dose bupivacaine with sufentanil provided faster onset of sensorial block and lower risk of motor block in unilateral spinal anesthesia for arthroscopic knee surgery.

NeoGemOx: Gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer.

BACKGROUND: Neoadjuvant chemotherapy can facilitate pancreatic resection in patients with initially unresectable pancreatic cancer (PC). We report the results of a phase II trial of gemcitabine-oxaliplatin neoadjuvant chemotherapy for patients with locally advanced, nonmetastatic PC. METHODS: A prospective, phase II clinical trial using neoadjuvant chemotherapy, consisting of gemcitabine (900 mg/m(2)) and oxaliplatin (60 mg/m(2)) given as intravenous infusion once a week at day 1 of each treatment cycle (NeoGemOx protocol). Patients received 6-9 cycles of chemotherapy. Those patients with sufficient tumor regression subsequently underwent pancreatic resection and were followed postoperatively to assess long-term survival. RESULTS: A total of 33 patients were eligible and were included in the intent-to-treat and evaluable population. On centralized review of the imaging studies, 18 patients had unresectable disease at inclusion, and 15 patients had borderline resectable PC. Eventually, 13 patients (39%) had a curative resection after neoadjuvant therapy. The R0 resection rate was 69%. Median overall survival of patients who underwent tumor resection was 22 months (95% confidence interval [CI], 14-30) compared with 12 months (95% CI, 9-15) for those without resection (P = .046). The median recurrence-free survival rate after resection was 10 months (95% CI, 4-17). CONCLUSION: Neoadjuvant gemcitabine plus oxaliplatin is well tolerated and safe. Substantive tumor regression occurs in some patients with locally advanced PC treated with this neoadjuvant protocol, offering the potential for curative resection and improvement in overall survival. Additional studies involving the NeoGemOx protocol should be considered to further evaluate the safety and efficacy of this combination.

CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: a randomized controlled trial.

INTRODUCTION: Air insufflation during colonoscopy is considered the standard method in most endoscopic centers. Notably, several studies have reported reduced abdominal pain after colonoscopy with CO2 insufflation in unsedated and in lightly sedated patients. The present study was designed to assess the efficacy of CO2 insufflation after colonoscopy in moderately and deeply sedated patients. We also evaluated whether CO2 insufflation increases patients' compliance for colorectal cancer screening. PATIENTS AND METHODS: A total of 300 consecutive patients allocated to colonoscopy were randomly assigned to either CO2 or air insufflation. Propofol was titrated to a level of deep sedation and propofol combined with midazolam was used for moderate sedation. Post-interventional pain levels and satisfaction with the procedure were registered on a 10-point visual analog scale. Compliance for colorectal cancer screening was ascertained separately. RESULTS: CO2 insufflation was used during colonoscopy in 157 patients; conventional air was used in 143 patients. The two groups were comparable with regard to age, sex and body mass index. Neither major nor minor complications were observed. Pain sensation was significantly lower in the CO2 group at 15 min, 30 min and 6 h after colonoscopy (P<0.01); at 12 h no difference was observed. In contrast, levels of patient satisfaction did not show any significant difference. Voluntary colorectal cancer screening appeared not to be influenced by the type of insufflation gas used. CONCLUSIONS: CO2 insufflation in deeply and moderately sedated patients during colonoscopy has no impact on patients' satisfaction with the procedure or on their attitude to voluntary colorectal cancer screening. However, the use of CO2 insufflation significantly diminishes abdominal pain after colonoscopy.