Optimal cutoff value of carotid stump pressure for determining the need for a carotid shunt in carotid artery endarterectomy.

OBJECTIVE: This study was conducted to identify the diagnostic value of carotid stump pressure for determining the need for a carotid artery shunt in patients undergoing carotid artery endarterectomy. MATERIALS AND METHODS: Carotid stump pressure was prospectively measured in all carotid artery endarterectomies performed under local anesthesia between January 2020 and April 2022. The shunt was selectively used when neurological symptoms appeared after carotid cross-clamping. Carotid stump pressure was compared between patients who needed shunting and those who did not. Demographic and clinical characteristics, hematological and biochemical parameters, and carotid stump pressure of the patients with and without shunts were statistically compared. To determine the optimal cutoff value and diagnostic performance of carotid stump pressure for identifying the patients who need a shunt, receiver operating characteristic analysis was performed. RESULTS: Overall, 102 patients (61 men and 41 women) who underwent carotid artery endarterectomy under local anesthesia were included, with an age range of 51-88 years. A carotid artery shunt was used in 16 (8 men and 8 women) patients. The carotid stump pressure values of the patients with a shunt were lower than those without a shunt (median (min-max): 42 (20-55) vs 51 (20-104), p < 0.0006). In the receiver operating characteristic curve analysis performed to determine the need for a shunt, the optimal cutoff value of carotid stump pressure was ≤48 mmHg, sensitivity was 93.8%, and specificity was 61.6% (area under the curve: 0.773, p < 0.0001). CONCLUSION: Carotid stump pressure has sufficient diagnostic power to determine the need for a shunt, but it cannot be used alone in the clinical setting. Instead, it can be used in combination with other neurological monitoring methods.

The Effect of Diabetes Mellitus on Mortality in Patients Hospitalized Intensive Care Unit in Covid-19 Pandemic.

Backgorund and aim: There are many studies on the effects of Diabetes Mellitus on the clinical course in COVID-19 patients. Factors that increase the risk of contracting COVID-19 disease and increase disease progression have been caused, and diabetes mellitus is one of them. We aimed to evaluate the incidence of Diabetes Mellitus in patients treated in the intensive care unit in respiratory failure due to COVID-19 pneumonia, and the effect of Diabetes Mellitus on the length of stay in intensive care and mortality. METHODS: Our study is a single-center retrospective study. The study includes patients hospitalized in our COVID intensive care unit between March 16, 2019, and May 16, 2020 Patients over 18 years of age with and without a history of Diabetes Mellitus were compared in 2 groups. Demographic data of the patients, length of stay in the intensive care unit, respiratory support methods, presence of other comorbid diseases, effects of Diabetes Mellitus to mortality in ICU were recorded. RESULTS: The information of 150 patients was obtained in the COVID-19 intensive care units of our hospital. Diabetes Mellitus was detected in 49 of the patients hospitalized in intensive care. 34.7% of these patients were female and 65.3% were male. There was no significant difference in survival in both groups (p = 0.942). The BMI of the patients with Diabetes Mellitus was 27.07 ± 2.55, significantly higher (p = 0.005). Intensive care stay periods were similar in both groups. The presence of hypertension was significantly higher in those with Diabetes Mellitus (p = 0.000). There was no statistically significant difference between respiratory support methods. CONCLUSIONS: Diabetes Mellitus did not affect the duration of stay in the intensive care unit and mortality in patients who were followed up and treated in the intensive care unit due to COVID-19 pneumonia.

Anxiety and burnout in anesthetists and intensive care unit nurses during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: This study aimed to measure the levels of anxiety and burnout among healthcare workers, including attending physicians, residents, and nurses in intensive care units during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This is a cross-sectional survey analysis of healthcare workers in our institution. Data were collected on demographic variables, COVID-19 symptoms and test, disease status, anxiety level (assessed by the Beck Anxiety Inventory), and burnout level (measured by the Maslach Burnout Inventory). Subscales of the burnout inventory were evaluated separately. RESULTS: A total of 104 participants completed the survey. Attending physicians, residents, and nurses constituted 25%, 33.7%, and 41.3% of the cohort, respectively. In comparison to untested participants, those tested for COVID-19 had a lower mean age (p = 0.02), higher emotional exhaustion and depersonalization scores (p = 0.001, 0.004, respectively), and lower personal accomplishment scores (p = 0.004). Furthermore, moderate to severe anxiety was observed more frequently in tested participants than untested ones (p = 0.022). Moderate or severe anxiety was seen in 23.1% of the attending physicians, 54.3% of the residents, and 48.8% of the nurses (p = 0.038). Emotional exhaustion, personal accomplishment, and depersonalization scores differed depending on the position of the healthcare workers (p = 0.034, 0.001, 0.004, respectively). CONCLUSION: This study revealed higher levels of anxiety and burnout in younger healthcare workers and those tested for COVID-19, which mainly included residents and nurses. The reasons for these observations should be further investigated to protect their mental health.