The effect of High-Dose Vitamin C Treatment for Acute Respiratory Failure Due to Coronavirus Disease Pneumonia on Mortality and Length of Intensive Care Stay: A Retrospective Cohort Study.

Objectives: In our study, we aimed to determine the effect of vitamin C on short-term mortality and length of intensive care unit (ICU) stay in patients with coronavirus disease (COVID-19) followed up in the ICU. Methods: The patients who received and those who did not receive the high-dose intravenous vitamin C protocol were assigned to the treatment and control groups, respectively. The primary study findings in both groups were length of ICU stay and short-term mortality, while the secondary findings were vasopressor and invasive mechanical ventilation requirements and change in sequential organ failure assessment score from the 0 to the 96th hour. Results: Thirty-eight patients were included in the treatment group and 40 were included in the control group. The mortality rates were 44% and 60% in the treatment and control groups, respectively; however, the difference between the groups was not statistically significant (p>0.05). The median length of ICU stay in both groups was 10 days (p>0.05). No significant differences in the invasive mechanical ventilation and vasopressor requirements were found between the groups (p>0.05). Conclusion: Consequently, the high-dose vitamin C therapy in the patients with acute respiratory failure due to COVID-19 pneumonia did not reduce the length of ICU stay, mortality, and invasive mechanical ventilation and vasopressor reqirements.

Favipiravir Experience in COVID-19 Patients at a Tertiary Center Intensive Care Unit.

Objectives: The aim of this study was to compare intensive care unit (ICU) and overall hospital mortality in patients treated with favipiravir and lopinavir-ritonavir for COVID-19. Methods: Data were collected retrospectively between March 10 and May 10, 2020, from patients' records admitted to ICU due to COVID-19. Laboratory data, clinical characteristics, ICU and hospital mortality, ICU and hospital length of stay were compared in patients treated with favipiravir and lopinavir-ritonavir. Results: A total of 100 patients' data were investigated. Favipiravir was used as the treatment for 85% of patients, with the rest treated with lopinavir-ritonavir. Clinical and laboratory data of both antiviral treatment groups were similar. Length of hospital stay was 16 (9-24) days with favipiravir and 8.5 (5-12.5) days with lopinavir-ritonavir (p=0.002). Length of ICU stay for favipiravir and lopinavir-ritonavir groups were 8 (5-15) days and 4 (3-9) days, respectively (p=0.011). ICU mortality was 65.9% for the favipiravir and 80% for lopinavir-ritonavir (p=0.002). Hospital mortality for favipiravir and lopinavir-ritonavir was 67.1% and 80%, respectively (p=0.001). Conclusion: The mortality in patients treated with favipiravir was less than patients treated with lopinavir-ritonavir. Favipiravir needs more attention and trials for its effect to be confirmed.

Effect of early awake prone positioning application on prognosis in patients with acute respiratory failure due to COVID-19 pneumonia: a retrospective observational study.

BACKGROUND: We evaluated the effect of early awake prone position administration on oxygenation and intubation requirements and short-term mortality in patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) pneumonia. METHODS: This is an observational-cohort study. Patients receiving mask oxygen therapy in our intensive care units because of acute respiratory failure due to COVID-19 pneumonia were included. The Awake Prone Position (APP) group consisted of patients who were applied awake prone position, whereas non-APP group consisted of patients who were not applied awake prone position. PaCO2, PaO2, pH, SpO2 values and PaO2/FiO2 ratios were recorded at the beginning and 24th hour. Demographic data, comorbidities, intubation requirements, ventilator-free days, length of intensive care unit stay and short-term mortality of the patients were recorded. RESULTS: The data of total 225 patients were examined, and 48 patients who met our study criteria were included. At the 24th hour, the median SpO2 value of the APP group was 95%, the median PaO2 value was 82 mmHg, whereas the SpO2 value of the non-APP group was 90% and the PaO2 value was 66 mmHg. (p = 0.001, p = 0.002). There was no statistically significant difference between the groups in length of intensive care unit stay and ventilator-free days, but short-term mortality and intubation requirements was lower in the APP group (p = 0.020, p = 0.001) CONCLUSION: Awake prone position application in patients receiving non-rebreather mask oxygen therapy for respiratory failure due to COVID-19 pneumonia improves oxygenation and decreases the intubation requirements and mortality.

Effects of Pneumoperitoneum on Splanchnic Oxygenation during Abdominal Laparoscopic Surgery in Paediatric Patients: A prospective, Observational Study.

OBJECTIVE: Pneumoperitoneum can cause disruption in splanchnic perfusion. This study aims to investigate effects of pneumoperitoneum on splanchnic oxygenation during abdominal laparoscopic surgery in paediatric patients with NIRS (Near-Infrared Spectroscopy). MATERIAL AND METHODS: A total of 45 patients between 1 and 4 years of age with ASA physical status I-II and scheduled to undergo abdominal laparoscopic surgery under general anaesthesia were enrolled in this prospective, observational surgery. No premedication was used. Standard monitoring and regional splanchnic saturation (rSPcO2), regional cerebral oxygen saturation (rScO2) with NIRS were established before anaesthesia. Anaesthesia was induced with an inhalational agent and maintained with an oxygen/air mixture and sevoflurane. Peripheral oxygen saturation (SPO2), rSPcO2, rScO2, heart rate (HR), mean arterial pressure (MAP), end tidal CO2 (Et-CO2), and insufflation pressure (IP) were continuously monitored during administration of anaesthesia and recorded. After intubation (baseline T0); before CO2 insufflation induced pneumoperitoneum (PP) (T1); CO2 PP insufflation (T2); 5 minutes after PP insufflation (T3); 10 minutes after PP insufflation (T4); 15 minutes after PP insufflation (T5); 20 minutes after PP insufflation (T6); 30 minutes after PP insufflation (T7), 60 minutes after PP insufflation (T8), and after desufflation (T9). Bradycardia and hypotension were recorded. Paracetamol IV 10 mg kg-1 was applied for post-operative analgesia. p<0.05 wasconsidered significant. RESULTS: HR, rScO2, and rSPcO2 decreased at all measured time intervals when compared to T0 (p<0.01) MAP decreased at T1 compared to T0 (p<0.001). Et-CO2 increased at T3-T4-T5-T6 compared to T0 (p<0.001). CONCLUSION: We found that pneumoperitoneum reduced splanchnic oxygenation during laparoscopic abdominal surgery in paediatric patients, which was measured using NIRS.

Comparing I-Gel to Proseal Laryngeal Mask Airways in Infants: A Prospective Randomised Clinical Study.

OBJECTIVE: Laryngeal mask airways and the I-gel have become increasingly popular for children undergoing minor surgery. The goal of our study is to compare I-gel and ProSeal laryngeal mask airways (LMA) in infants by analysing different parameters, such as insertion success, ventilation, haemodynamic changes and postoperative complications. METHODS: For this prospective, randomised study, we selected 123 infants with an American Society of Anaesthesiologists (ASA) status I, who were undergoing minor elective lower abdominal surgery. After obtaining verbal and written informed consent from the parents, the infants were divided into two groups: the I-gel group (n=60) and the ProSeal LMA group (n=63). The times and ease of insertion, percentages of tidal volume leakage, and means and leakage pressures of these two supraglottic airways were noted. The complications and side-effects of each method were also recorded. RESULTS: The insertion time of the ProSeal group was statistically shorter than that of the I-gel group. The peak and mean pressures and the leakage percentage of the ProSeal group were statistically lower than those of the I-gel group. The leakage pressure of the ProSeal group was statistically higher than the I-gel group. CONCLUSION: In comparison with I-gel, the use of ProSeal LMA in infants' anaesthesia presents many advantages, such as the ease of its insertion, better oropharyngeal leakage pressure and less mucosal hyperaemia.

Peritonsillar dexamethasone-bupivacaine vs. bupivacaine infiltration for post-tonsillectomy pain relief in children: a randomized, double-blind, controlled study.

OBJECTIVE: Post-tonsillectomy pain is one of the most frequent morbidities of tonsillectomy surgery. Currently, there is no standard protocol for post-tonsillectomy pain control. In our study, we aimed to compare the effects of perioperative peritonsillar dexamethasone-bupivacaine and bupivacaine-alone infiltration on pain control in pediatric patients. MATERIALS AND METHODS: This prospective, randomized, double-blind, controlled clinical trial was conducted between February 2018 and May 2018 in a single-center tertiary education and research hospital, otorhinolaryngology/head and neck surgery clinic, under general anesthesia, which included 120 pediatric patients between the ages of 2-12 (mean 5.7 ± 1.8), and who were with ASA (American Society of Anesthesiologists) I-II classification. Patients were randomly divided into three groups as 40 participants in each group. Group 1 consisted of patients who were injected with dexamethasone-bupivacaine into their peritonsillar region, group 2 consisted of patients who were injected with bupivacaine only, and group 3 consisted of patients who were injected with saline only as the control group. FLACC (face, legs, activity, cry, consolability) Scale and Wong-Baker FACES® Pain Rating Scale (WBS) were used for early and late period postoperative pain scoring. Patients with pain score ≥ 4 were treated with paracetamol rescue analgesia. Side effects such as nausea, vomiting and bleeding were recorded. Data of all groups were compared statistically and p ≤ 0.05 was considered statistically significant. RESULTS: There was no significant difference between the groups in terms of demographic data, duration of operation and duration of anesthesia. The pain scores of group 1 were significantly lower than those of the control group except for postoperative 45th min, 2nd day and 3rd day. The pain scores of the group 1 were significantly lower at all times except for the postoperative 12th and 24th hour, than those of group 2. The pain scores of the group 2 were lower than the control group only at postoperative 7th day, but no significant difference was found at other times. No statistically significant difference was found between the groups in terms of requirement rates for the first 60 min recovery analgesia (p = 0.686). No statistical difference was found between the groups in terms of side effects. CONCLUSION: In our study, preoperative local dexamethasone-bupivacaine infiltration in pediatric patients was shown to be more effective than bupivacaine-only and serum-only infiltration for early and late post-tonsillectomy pain control.