Bacterial and fungal secondary infections occurring in COVID-19 patients followed in intensive care: a retrospective study.

INTRODUCTION: We aimed to investigate the effects of secondary bacterial and fungal infections on patient outcomes in patients followed up in the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). METHODOLOGY: We retrospectively analyzed reverse transcriptase polymerase chain reaction (RT-PCR) positive COVID-19 patients followed in the ICU of our hospital between March 2020 and June 2021, using the hospital information system. Demographic data, pathogens causing a secondary infection, onset time of secondary infection, and patient outcomes were recorded. RESULTS: A total of 251 RT-PCR positive patients who met the inclusion criteria were evaluated. The mean length of stay (LOS) in the ICU was 13.3 ± 9.6 days. During this period, 165 (65.7%) patients died. When blood, urine, respiratory tract, and catheter cultures were examined, the number of patients with growth in at least one culture was 129 (51.4%). There was growth in a total of 227 cultures. The highest culture positivity rate was observed in respiratory tract samples (n = 94, 41.4%). Gram-negative bacterial pathogens (n = 130, 58.4%) predominated. Candida spp. was more frequent in urine cultures. The median day of the occurrence of secondary infection was 10 (range: 6-15). Patients who developed secondary infection had a longer LOS and higher mortality rate than patients who did not (p < 0.001). CONCLUSIONS: Gram-negative secondary infections, predominantly in respiratory tract cultures, occurred in COVID-19 patients followed in the ICU. As a result, the LOS was prolonged and mortality rates increased.

The Effect of Transoral Endoscopic Thyroidectomy Vestibular Approach on Regional Cerebral Oxygen Saturation: A Prospective Observational Study.

BACKGROUND: Decreased regional cerebral oxygen saturation (rSO2) is associated with neurological events. We aimed to investigate the effects of carbon dioxide (CO2) insufflation applied to the neck during transoral endoscopic thyroidectomy vestibular approach (TOETVA) surgery on the rSO2. MATERIALS AND METHODS: Patients scheduled for TOETVA and open thyroidectomy (OT) were enrolled between October 2019 and November 2020. Alongside hemodynamic parameters, the rSO2 values of the patients were recorded at 5 different times. These were; before anesthesia induction (T0), 10 minutes after anesthesia induction (T1), 5 minutes after the patient was placed in the operation position (T2), 10 minutes after the CO2 insufflation in the TOETVA group, 10 minutes after the platysma incision in the OT group (T3), 10 minutes after the CO2 desufflation in the TOETVA group, 10 minutes after platysma closure in the OT group (T4), at the end of the surgery (T5). RESULTS: A total of 40 patients, 20 in each group, were included in the study. The surgery duration was 113±26.9 minutes in the OT group, while it was 274.1±78.1 minutes in the TOETVA group (P=0.000). The EtCO2 values during the T3 time interval; group OT 31±2.2, group TOETVA 33.9±2.1 (P=0.000). The rSO2 values of the patients were similar, except for the T3 time interval. While the right rSO2 value we obtained during the T3 time interval in the TOETVA and OT groups were 66.9±9.1 and 73.9±7.8 (P=0.013), the left rSO2 value in the TOETVA and OT groups were 66.3±9.9 and 74.8±6.8 (P=0.003), respectively. CONCLUSIONS: As long as the patients stay within the limits of normocapnia, the CO2 insufflation applied during TOETVA surgery has no negative effects on rSO2.

Comparison of direct laryngoscope and McGrath videolaryngoscope in terms of glottic view and hemodynamics in bariatric surgery

Background/aim: In the recent years, videolaryngoscopes (VL) have emerged as alternative devices to direct laryngoscopes (DL) in difficult intubation situations. Therefore, we aimed to compare the Macintosh DL and McGrath VL in terms of the glottic image quality, intubation success, intubation time, hemodynamic response after intubation, and complications in bariatric surgery patients. Material and methods: After obtaining approval by the ethics committee and receiving informed consent, we recorded the demographic and physical data of patients undergoing bariatric surgery. Patients were divided into 2 groups: Group M was intubated with the Macintosh DL, and Group V was intubated with the McGrath VL. After intubation, we noted the Cormack­Lehane score, the duration of intubation, the number of intubation interventions, and the hemodynamic data of patients. Results: A total of 62 patients (ASA II, body mass index of >35 kg/m2) were included in the study. All patients except 1 patient were intubated on the first attempt. Although there was a decrease in heart rate and blood pressure with induction, similar hemodynamic data were obtained between groups during the operation. In group V, we obtained a better glottic image (P = 0.011), but intubation success was similar between the study groups. We also measured the intubation time in group M as 45.9 ± 19.1 s and group V as 57.1 ± 15.8 s (P = 0.015). Discussion: Although we measured longer intubation times with the McGrath VL compared with the Macintosh DL, we obtained a better glottic image without causing hemodynamic changes. However, these findings did not make any difference in terms of intubation success.

[Comparison of volume-controlled and pressure-controlled ventilation on respiratory mechanics in laparoscopic bariatric surgery: randomized clinical trial]. / Comparação das ventilações controlada por volume e controlada por pressão na mecânica respiratória em cirurgia bariátrica laparoscópica: estudo clínico randômico.

BACKGROUND: It is not clear which mechanical ventilation mode should be used in bariatric surgery, one of the treatment options for patients with obesity. OBJECTIVES: To compare volume-controlled ventilation and pressure-controlled ventilation in terms of respiratory mechanics and arterial blood gas values in patients undergoing laparoscopic bariatric surgery. METHODS: Sixty-two patients with morbid obesity scheduled for gastric bypass were included in this study. Their ideal body weights were calculated during preoperative visits, and patients were divided into two groups, volume-controlled ventilation and pressure-controlled ventilation. The patients were ventilated in accordance with a previously determined algorithm. Mechanical ventilation parameters and arterial blood gas analysis were recorded 5 minutes after induction, 30 minutes after pneumoperitoneum, and at the end of surgery. Also, the dynamic compliance, inspired O2 pressure/fractional O2 ratio, and alveolar-arterial oxygen gradient pressure were calculated. RESULTS: Peak airway pressures were lower in patients ventilated in pressure-controlled ventilation mode at the end of surgery (p = 0.011). Otherwise, there was no difference between groups in terms of intraoperative respiratory parameters and arterial blood gas analyses. CONCLUSIONS: Pressure-controlled ventilation mode is not superior to volume-controlled ventilation mode in patients with laparoscopic bariatric surgery.

Comparison of volume-controlled and pressure-controlled ventilation on respiratory mechanics in laparoscopic bariatric surgery: randomized clinical trial / Comparação das ventilações controlada por volume e controlada por pressão na mecânica respiratória em cirurgia bariátrica laparoscópica: estudo clínico randômico

Abstract Background: It is not clear which mechanical ventilation mode should be used in bariatric surgery, one of the treatment options for patients with obesity. Objectives: To compare volume-controlled ventilation and pressure-controlled ventilation in terms of respiratory mechanics and arterial blood gas values in patients undergoing laparoscopic bariatric surgery. Methods: Sixty-two patients with morbid obesity scheduled for gastric bypass were included in this study. Their ideal body weights were calculated during preoperative visits, and patients were divided into two groups, volume-controlled ventilation and pressure-controlled ventilation. The patients were ventilated in accordance with a previously determined algorithm. Mechanical ventilation parameters and arterial blood gas analysis were recorded 5minutes after induction, 30minutes after pneumoperitoneum, and at the end of surgery. Also, the dynamic compliance, inspired O2 pressure/fractional O2 ratio, and alveolar-arterial oxygen gradient pressure were calculated. Results: Peak airway pressures were lower in patients ventilated in pressure-controlled ventilation mode at the end of surgery (p = 0.011). Otherwise, there was no difference between groups in terms of intraoperative respiratory parameters and arterial blood gas analyses. Conclusions: Pressure-controlled ventilation mode is not superior to volume-controlled ventilation mode in patients with laparoscopic bariatric surgery.

Resumo Justificativa: O modo de ventilação mecânica que deve ser usado em cirurgia bariátrica, uma das opções de tratamento para pacientes com obesidade, ainda não foi definido. Objetivos: Comparar as ventilações controladas por volume e por pressão em termos de mecânica respiratória e dos valores da gasometria arterial em pacientes submetidos à cirurgia bariátrica laparoscópica. Métodos: Foram incluídos neste estudo 62 pacientes com obesidade mórbida programados para bypass gástrico. Seus pesos corporais ideais foram calculados durante as consultas pré-operatórias e os pacientes foram divididos em dois grupos: ventilação controlada por volume e ventilação controlada por pressão. Os pacientes foram ventilados de acordo com um algoritmo previamente determinado. Os parâmetros da ventilação mecânica e as análises da gasometria arterial foram registrados 5 minutos após a indução, 30 minutos após o pneumoperitônio e ao final da cirurgia. Além disso, a complacência dinâmica, a pressão e a fração de oxigênio inspirado e a pressão do gradiente alvéolo-arterial de oxigênio foram calculados. Resultados: As pressões de pico das vias aéreas foram menores nos pacientes ventilados no modo de ventilação controlada por pressão ao final da cirurgia (p = 0,011). Exceto por esse aspecto, não houve diferença entre os grupos quanto aos parâmetros respiratórios intraoperatórios e às gasometrias arteriais. Conclusões: O modo de ventilação controlada por pressão não é superior ao modo de ventilação controlada por volume em pacientes de cirurgia bariátrica laparoscópica.

Retrospective Analysis of Prognostic Factors of Severe Traumatic Brain Injury in a University Hospital in Turkey.

AIM: To examine the use of prognostic factors such as age, Glasgow Coma Scale (GCS) score, pupil reactivity and computerized tomography (CT) findings for predicting the prognosis of severe traumatic brain injury (TBI) patients in Turkey. MATERIAL AND METHODS: We retrospectively evaluated TBI patients who were accepted to Akdeniz University Intensive Care Unit between 1 January 2007 and 31 December 2009. Patient data were collected from the hospital information system. Marshall CT classification was performed and CT findings were noted. The Glasgow outcome scale (GOS) score of patients was calculated according to their 6-months follow up. RESULTS: A total of 101 patients with severe TBI were studied. The mean age of the patients was 34.7 ± 14.1 years. Of these, male patients (81.2%) were dominant and road accidents (83.2%) were the most common mechanism of TBI development. In addition, poor neurological outcome was detected in 58.4% of the patients and 29 patients (28.7%) died. The mechanism of injury (p = 0.34), gender (p = 0.64) or age (p = 0.34) did not lead to a difference in neurologic outcomes while the GCS score (p = 0.01), pupillary reactivity (p = 0.000), Marshall CT classification (p = 0.01) and the presence of traumatic subarachnoid haemorrhage (p = 0.04) affected the GOS scores. CONCLUSION: In our study, GCS score, CT findings and pupil reactivity were prominent as prognostic factors, but a relationship between age and prognosis was not observed.