Investigation of high flow nasal cannule efficiency with electric impedance tomography based parameters in COVID-19 adults patients: a retrospective study.

Background/Aim: This study aimed to investigate the effects of oxygen therapy using a high flow nasal cannula (HFNC) on patients diagnosed with COVID-19 Acute Respiratory Distress Syndrome (C-ARDS) by utilizing electrical impedance tomography (EIT)-based parameters. Materials and Methods: Oxygen therapy was administered to the patients at two different flow rates and two different positions: T0-baseline measurements were taken in the supine position before any therapy was initiated. T1-HFNC was administered in the supine position with a flow rate of 30 L/min. T2-HFNC was administered in the supine position with a flow rate of 50 L/min. T3-HFNC was administered in the prone position with a flow rate of 30 L/min. T4-HFNC was administered in the prone position with a flow rate of 50 L/min. EIT-based parameters (global inhomogeneity index (GI index), center of ventilation (CoV), regional ventilation delay index (RVD index), region of interest ratio (ROI ratio)), as well as respiratory and hemodynamic parameters of the patients, were recorded from the database. Results: A total of twenty patients were included in this retrospective observational study. The mean age of the included patients was 64.3 ± 10.6 years. Statistically significant differences were observed in the measurements of GI index, CoV, RVD index, ROI ratio, PaO2/FiO2 ratio, respiratory rate, and mean arterial pressure parameters across different time intervals (p < 0.005). Pairwise comparisons of EIT parameters and measurements of respiratory and hemodynamic parameters at five different time points revealed statistically significant differences. For the GI index, significant differences were observed between the mean measurements taken at T0-T1, T0-T2, T0-T3, T0-T4, T1-T3, T1-T4, T2-T3, T2-T4, and T3-T4 time intervals (p < 0.05). Regarding CoV, significant differences were found between the mean measurements taken at T0-T3, T1-T3, T2-T3, and T3-T4 time intervals (p < 0.05). Additionally, for the ROI ratio, significant differences were observed between the measurement averages taken at each time interval (p < 0.05). Conclusion: Our findings suggest that prone positioning during the management of C-ARDS patients leads to improved lung homogeneity, as indicated by EIT parameters. However, further research is required to enhance the visualization of ventilation using EIT.

Fungal colonization and infections in patients with COVID-19 in intensive care units: A real-life experience at a tertiary-care hospital.

PURPOSE: To evaluate the management of patients with COVID-19 in the intensive care units (ICUs) with fungal infection/colonization and to highlight diagnostic problems in these patients. METHODS: We included all patients with a COVID-19 diagnosis who were aged ≥18 years and followed in the ICU for the first 8 months. Patient data were obtained from medical records. We compared the risk factors, laboratory data, and outcomes of patients with fungal infection/colonization. RESULTS: A total of 118 patients (81 men and 37 women) were included. The mean age was 70.3 ± 14.8 (35-94) years. Of the patients, 79 (66.9%) patients were ≥65 years old. Fungal infection/colonization was detected in 39 (33.1%) patients. Fungi were isolated from 34 (28.8%) patients. Ten fungal species were isolated from 51 samples (the most common being Candida albicans). Three patients (2.5%) had proven candidemia. We observed two (1.7%) possible cases of COVID-19-associated pulmonary aspergillosis (CAPA). Eighteen patients (15.3%) underwent antifungal therapy. The risk of fungal infection/colonization increased as the duration of invasive mechanical ventilation increased. The fatality rate was 61.9% and increased with age and the use of mechanical ventilation. The fatality rate was 4.2-times-higher and the use of mechanical ventilation was 35.9-times-higher in the patients aged ≥65 years than in the patients aged <65 years. No relationship was found between fungal colonization/infection, antifungal treatment, and the fatality rate. CONCLUSION: During the pandemic, approximately one-third of the patients in ICUs exhibited fungal infection/colonization. Candida albicans was the most common species of fungal infection as in the pre-pandemic area. Because of the cross-contamination risk, we did not performed diagnostic bronchoscopy and control thorax computed tomography during the ICU stay, and our patients mainly received empirical antifungal therapy.

Medicolegal Evaluation of Long-Term Respiratory Functions in Patients Injured Due to Traffic Accidents.

Aim Blunt chest trauma is a frequent injury in developing countries, with motor vehicle accidents being the most common cause. Most studies about the effects of post-traumatic injuries on pulmonary functions are related to the acute phase. The aim of this study is to compare the effect of injury type on pulmonary function tests as a long-term disability in patients with severe chest trauma due to traffic accidents. Methods In our study, 53 patients were admitted to the Forensic Expert Council with the aim of determining the disability ratio at least six months after the traffic accident. All patients who had a respiratory function test because of respiratory symptoms and whose reporting period was completed were appreciated. A retrospective examination of the forensic committee reports, types of injuries, and current pulmonary function test results were analyzed and the data were evaluated by using the Statistical Package for the Social Sciences (SPSS) 22.0 program (IBM Corp, Armonk, NY). Results Thirty-two (32) of the patients were male while 21 were female. Their average age was 39.88 ± 15.29. Sixty-six percent (66%; n: 35) of the cases were injured due to in-vehicle traffic accidents, 18.9% (n: 10) due to motorcycle accidents, 15.1% (n: 8) due to non-vehicle traffic accidents. The number of cases with costa fractures was 47 and 74.4% of these cases had three or more rib fractures. The mean forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC-Tiffeneau-Pinelli index) was calculated as 85.3% ± 9.45, and the average FVC was 84.3 ± 14.98%. The average number of rib fractures in all patients was 3.41 ± 2.24. It was observed that tube thoracostomy was performed in seven of 12 cases with FEV1/FVC below 80%, and the average number of rib fractures was 3.75. In 20 cases where the FVC average was below 80%, the mean number of rib fractures was 3.8, and tube thoracostomy was performed in 10 of these cases. The highest FEV1 value was 116%, and the lowest FEV1 value was 35%. The FEV1 value of 23 cases was between 75% and 95%. The highest FEV1/FVC value was 113% and the lowest FEV1/FVC value was 50%. The FEV1/FVC values of 38 cases were between 80% and 100%.  Conclusions In our study, most patients achieve near-complete recovery in pulmonary function tests; the impact of pre-existing pulmonary compromise on recovery is less known. The number of rib fractures can reflect the severity of the blunt trauma but it would not necessarily predict the resulting pulmonary function. These results are consistent with the previous studies. Further larger prospective studies are required to investigate different factors affecting prognosis.

Differences in Polysomnography Parameters of Women in the Post and Transitional Phases of Menopause.

Objectives To investigate the relationship between the changes in the main components of sleep during the menopausal transition and the postmenopausal period. Methods A total of 162 patients were included in the study, including 62 patients in the menopausal transition period and 100 patients in the postmenopausal period. The Epworth sleepiness scale (ESS) was applied to the patients before polysomnography (PSG). In PSG recordings, the total sleep time, sleep efficiency, rapid eye movement (REM) sleep (%), non-REM (NREM) sleep (%), apnea-hypopnea index (AHI), REM-AHI, NREM-AHI, minimum and mean oxygen saturation, oxygen desaturation time, and oxygen desaturation index (ODI) were recorded. Results Total sleep time (256.4±89.9 vs. 302.8±73.8, p<.03) and sleep efficiency (63.8±16.3 vs 75.6±16.0, p<.005) were significantly decreased in the postmenopausal patient group compared to the menopausal transition group. ODI, desaturation time, and desaturation percentages were significantly higher and minimum oxygen saturation was significantly lower in the postmenopausal group than in the transitional group. While mild obstructive sleep apnea syndrome (OSAS) rates in the menopausal transition group were significantly higher than in the menopausal group, moderate and severe OSAS rates were significantly higher in the menopausal group. Conclusion Changes in PSG measurements during the menopausal transition and postmenopausal period showed a significant effect of hormonal changes on sleep in women.

Effects of smoking and physical exercise on respiratory function test results in students of university: A cross-sectional study.

We explored the effects of smoking and exercise on pulmonary function (PF) in young adults.This was a 2-year, prospective cross-sectional study on university students. We recorded age, gender, weight, height, pulmonary symptoms, smoking status, and sports habits. Spirometry was used to evaluate lung function; we recorded the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), and the FEV1/FVC ratio.A total of 1014 (552 female, 464 male) subjects were included. Smokers reported significantly more wheezing and sputum production than nonsmokers, but exhibited better FVC and FEV1 values. Those who smoked less than half a pack/d had significantly poorer FVC and FEV1 levels than nonsmokers. Smokers exhibited significantly lower FEV1/FVC ratios than nonsmokers. Overall, those who exercised exhibited better FEV1 and FVC levels, but this was attributable entirely to females.The spirometric percentile data were adjusted for gender, age, and height, and used as indicators of health status (good: >90: average: 25-90, poor <25). ln males, PF was associated with regular exercise (good: 7.8, average: 6.5, poor: 14.2, P = .02). The smoking rate was higher in the "good" group (males: good: 31.3, average: 30, poor: 17.9, P = .02/females: good: 22.4, average: 17.9, poor: 10.4, P = .02).On multivariate regression analysis, above-average PF test results were associated with age (1.32 [1.04-1.69]) and exercising at least once per week (4.06 [1.16-14.20]) in males. In females, above-average results were associated with irregular exercise (2.88 [1.36-6.09]), age (1.85 [1.44-2.37]), and exercising until palpitations developed (0.18 [0.04-0.88]).Smoking improves lung function in young adults; these are "healthy smokers." Physical activity did not improve lung function, but the absence of physical activity significantly worsened lung function.