Impact of neurological problems on mechanical ventilation and intensive care unit outcomes in pulmonary intensive care unit patients: a retrospective analysis of a single-center cohort.

Neurological problems (NPs) are frequently connected with different critical illnesses in intensive care unit (ICU) patients, and they may influence ICU outcomes. This study aims to examine the effects of NPs on ICU outcomes, especially in pulmonary ICU patients. This is a retrospective observational study comprising adult pulmonary critical care patients who were hospitalized between 2015 and 2019. The frequency of NPs at admission, their impact on mechanical ventilation (MV), ICU outcomes, the rate of NP development during the ICU stay, and risk factors for them were investigated. A total of 361 patients were included in the study, and 130 of them (36%) had NPs (group 1). The noninvasive ventilation requirement rate in patients with NPs was less than in those without NPs (group 2), and the requirement of MV was significantly more frequent in this group (37% and 19%, p<0.05). The duration of MV (19±27 and 8±6 days, p=0.003) and sepsis rate (31% and 18%, p=0.005) were also higher in group 1. NPs developing after ICU admission increased the MV requirement 3 times as an independent risk factor. Risk factors for ICU-acquired NPs were the existence of sepsis during admission [odds ratio (OR): 2.01, confidence interval (CI) 95%: 1.02-4, p=0.045] and longer MV durations before ICU admission (OR: 1.05, CI 95%: 1.004-41.103, p=0.033). NPs were not independent risk factors for mortality (OR: 0.67, CI 95%: 0.37-1.240, p=0.207). NPs did not increase mortality but more frequently caused MV requirement, more extubation failure, and a longer ICU stay in this study population. Additionally, our data suggest that having sepsis during admission and a longer length of MV prior to admission may increase the neurological complication rate.

Risk Factors for Prolonged Intensive Care Unit Stay in Patients with Hypercapnic Respiratory Failure.

INTRODUCTION: Hypercapnic respiratory failure (HRF) is one of the most frequent reasons for intensive care unit (ICU) admissions. In this study, we aimed to investigate the risk factors for prolonged ICU stay in HRF patients for longer than 7, 10, and 15 days. METHODS: Impact of demographics, vitals at the admission, comorbid disease severity, respiratory parameters, admission diagnosis, noninvasive mechanical ventilation (NIV) application time and settings, arterial blood gas, and blood biochemistry results were analyzed in patients with HRF to investigate risk factors for longer ICU stay. RESULTS: A total of 210 patients who were admitted to ICU with HRF (PaCO₂ values of 45 mmHg and higher) were included in this retrospective cohort study. The mean age of the patients was 69 ± 12 years, and the mean ICU duration was 9 ± 7 days. Forty-five percent of the patients stayed in the ICU for more than one week and 10% of them stayed for more than 15 days. Risk factors for a prolonged stay in ICU for more than 7 days were high SOFA score, acute renal failure (ARF) at admission, low PaO₂/FiO₂ on the 2^nd day of admission, and high TSH level. Low FEV1 and FEV1/FVC ratio, ARF at admission, and low PaO₂/FiO₂ ratio on the 2nd day of admission were found to be risk factors for prolonged stay in ICU for longer than 10 days. Significant risk factors prolonging the ICU duration for more than 15 days were high SOFA score, low FEV1, low FEV1/FVC ratio (p = 0.008), and hypothyroidism (p = 0.037). FEV1% predicted less than 25.5% and FEV1/FVC% less than 46.5% were significantly associated with ICU stay longer than 10 days. CONCLUSION: Earlier diagnosis and treatment of patients with hypothyroidism and severe airflow obstruction could shorten the length of ICU stay of hypercapnic patients.

Pulmonary artery leiomyosarcoma: A clinical dilemma.

Leiomyosarcomas are rare neoplasms of the smooth muscles. Primary pulmonary leiomyosarcomas, which constitute approximately 0.2%-0.5% of all primary lung malignancies, are extremely rare and highly lethal. They may originate from the smooth muscle cells of the bronchial wall, the blood vessels, or the pulmonary interstitium, and their rare occurrence, localization, and nonspecific clinical symptoms mean that correct diagnosis and proper management are often delayed. Here, we report a rapidly growing primary pulmonary leiomyosarcoma, which invaded the right atrium, vena cava superior, mediastinum, right hilar area, and left pulmonary artery within 4 months. On histopathology, a transthoracic needle biopsy of the mass confirmed leiomyosarcoma, and delayed presentation meant that there was a local spread to the neighboring structures at the time of diagnosis.