Prognostic factors for 30-days mortality in eighty years aged and older critically ill patients: a single center retrospective cohort study

Background/aim: Nowadays, with the rise in average life expectancy, the rate of hospitalization of the older population in intensive care unit (ICU) is gradually increasing. Unfortunately, there are no ideal combination of prognostic factors predicting the mortality in older patients admitted to the ICU. In the present study, we aim to determine the prognostic factors and their impacts on short-time mortality in older critically ill patients. Materials and methods: This retrospective cohort study was performed between January 2019 and February 2020. We included 133 patients aged ≥80 years and hospitalized ≥24 h in the ICU. Results: A total of 133 critically ill patients enrolled in the present study. And, the median age of the patients was 85 (80­106) years. 30-days and overall ICU mortality rates were found 30.1% and 34.6%, respectively. The patients were grouped as survivors (n = 94) and nonsurvivors (n = 39). Hospital length of stay before the ICU admission was found significantly longer in nonsurvivors (p = 0.001). Sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation-II (APACHE-II) score were significantly higher in nonsurvivors (p < 0.001, p < 0.001). Also, blood lactate level and glucose level were respectively significantly higher in nonsurvivors (p < 0.001, p = 0.006). We found that modified nutrition risk in critically ill (mNUTRIC) score and prehospital clinical frailty scale (CFS) were independent prognostic factors for the older critically ill patients (HR = 9.19, 95% CI=1.47­57.32, p = 0.018, HR = 20.16, 95% CI = 2.63­54.07, p =0.004). Conclusion: mNUTRIC score and prehospital CFS score were the most important prognostic factors in the admission of older patients to intensive care units.

Differential diagnosis of COVID-19 pneumonia from acute heart failure in pandemic: Importance of radiological and laboratory findings.

INTRODUCTION: COVID-19 pneumonia typically presents with high fever, cough, and shortness of breath and on thorax computed tomography (CT) peripheral ground glass opacities help the diagnosis. Although typical imaging findings for COVID-19 pneumonia are specified in thorax CT, these findings can be confused with other diseases. The aim of this study is to investigate the roles of radiological imaging and laboratory findings in the differential diagnosis of COVID-19 pneumonia and acute heart failure (AHF). MATERIALS AND METHODS: In the present study, 74 patients who admitted to the emergency department with respiratory distress during the pandemic period and received a diagnosis of COVID-19 pneumonia and AHF were included. Laboratory data and radiological findings of the patients, at the time of admission, were evaluated. RESULT: On admission, there was no difference in age, gender between two groups. However, COVID-19 exposure history was found significantly higher in COVID-19 pneumonia patients group (p<0.001). Fever, cough, and fatigue were found significantly higher in the COVID-19 pneumonia patients group (p<0.001). There was difference of lesions distribution between the two groups, centrally distributed lesions were found significantly higher in acute heart failure patients (p<0.001). Pleural effusion and cardiomegaly were found significantly higher in AHF patients (p<0.001, p<0.001). Counts of the white blood cells and lymphocytes were found significantly lower in COVID-19 pneumonia patients (p= 0.003, p= 0.009). COVID-19 pneumonia patients had significantly higher levels of CRP, ferritin, LDH and CK compared with AHF patients (p<0.001, p<0.001, p= 0.002, p= 0.013). However the level of NT-proBNP was found significantly higher in the AHF patients group (p<0.001). CONCLUSIONS: We believe that laboratory data and thorax CT findings can provide beneficial clinical information in differentiating COVID-19 pneumonia from AHF during the pandemic.

Decreased brain-derived neurotrophic factor levels may predict early perioperative neurocognitive disorder in patients undergoing coronary artery bypass surgery: A prospective observational pilot study.

STUDY OBJECTIVE: To determine the prognostic value of the change in intraoperative BDNF (Brain-derived neurotrophic factor) levels during cardiac surgery with cardiopulmonary bypass (CPB) on early perioperative neurocognitive disorder (PND). DESIGN: Prospective observational pilot study. SETTING: The study was performed in the Medical Faculty Hospital, from January 2020 to August 2020. PATIENTS: 45 adult patients undergoing elective coronary artery bypass surgery (CABG) with CPB. INTERVENTIONS: None. MEASUREMENTS: Cognitive function was evaluated 1 day before and 4 days after the surgery. Serum BDNF levels were measured at four time points (T1: after induction; T2: with aortic cross-clamp; T3: without aortic cross-clamp; T4: 4 days after surgery) by enzyme-linked immunosorbent assay. MAIN RESULTS: The incidence of PND was 37.8% four days after surgery. Serum BDNF (T2 and T4) levels were significantly lower in PND group compared to non- PND group (p = 0.003 and p = 0.016, respectively). Moreover, lactate, rSO2 (regional cerebral oxygen saturation), aortic cross-clamp time, CPB duration, and the amount of blood transfusion differed between the groups. Logistic regression analysis identified serum BDNF-T2, age, cross-clamp time, and rSO2-T2 as independent risk factors for PND. Based on the ROC analysis, the area under curve (AUC) of BDNF-T2 concentration for prediction of PND was 0.759 with sensitivity of 71.4% and specificity of 64.7% (p < 0.01). CONCLUSION: Intraoperative BDNF serum levels may be a useful biomarker in predicting PND in patients undergoing CABG surgery. More comprehensive studies is needed in order to confirm the effect of decreasing intraoperative BDNF serum levels on the development of PND. TRIAL REGISTRATION NUMBER: NCT04250935 www.clinicaltrials.gov.

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

Background/aim: The aim of this study was to compare the effects of different epidural initiation volumes on postoperative pain scores, analgesic requirements, and side effects in pregnant women administered patient-controlled epidural analgesia (PCEA) for postoperative pain after cesarean sections. Materials and methods: Eighty-one pregnant women, aged 18­45 years, were included in this randomized, double-blind study. Combined spinal epidural anesthesia was administered for each cesarean section. The patients were divided into 3 groups and different volumes (20 mL, 10 mL, and 5 mL) of the study drug (0.0625% bupivacaine plus 2 µg/mL of fentanyl) were administered 90 min after the spinal block via epidural catheter. The visual analogue scale (VAS) scores at rest and during movement, first PCEA dose time, number of PCEA doses required per hour, total analgesic consumed, and side effects were recorded postoperatively. Results: There were no statistically significant differences among the groups in terms of the VAS rest and VAS movement scores. The times to the first analgesic dose requirement were longer in Group 10 and Group 20 than in Group 5. The analgesic requirement during the first 2 h was lower in Group 20 than in the other groups. Conclusions: The PCEA initiations with different volumes provided similar pain scores. However, the 20 mL volume resulted in a lower analgesic dose requirement during the early postoperative period, and it also delayed the requirement for analgesia.

Emergency Difficult Airway Management in a Patient with Severe Epidermolysis Bullosa.

Epidermolysis bullosa (EB) is a rare disease characterised by vesiculobullous lesions with minimal trauma to the skin and mucous membranes. Bleeding, scar tissue, contractures, oedema and lesions that can spread throughout the body can cause a difficult airway and vascular access in patients with EB. Therefore, anaesthetic management in patients with EB is a major problem even for experienced anaesthesiologists. Herein, we report a case of difficult airway management in a patient diagnosed with severe EB who presented for emergency tracheostomy because of respiratory failure under general anaesthesia.

Retrospective Evaluation of Dental Treatment under General Anaesthesia.

OBJECTIVE: Most dental procedures can be performed with local anaesthesia, however noncompliant paediatric patients, patients with mental retardation or psychiatric disorders, severe anxiety, severe craniofacial anomalies and orofacial trauma may need general anaesthesia. In these patients accompanying central nervous system diseases and airway problems increase the risk of complications. Anaesthesia records of 467 cases of dental surgery performed under general anaesthesia between 2011-2014 is reported with information from the recent literature. METHODS: In the study, 467 cases of dental procedures performed under general anaesthesia were taken from the Inönü University of Medicine, Dentistry Disabled Treatment Centre, after approval of the Inönü University Faculty of Medicine Ethics Committee. Demographic data, ASA classification, Mallampati (MP) score, duration of surgery, type of intubation and difficulties, comorbid diseases, premedication application, endocarditis prophylaxis, recovery time, analgesia and reasons for general anaesthesia were recorded as mean±standard deviation (SD) or as a number. RESULTS: The mean age of the patients was 16.78±12 years and the female/male ratio was 277/190 (59.3%/40.7%). Of the 467 patients, 219 (46.9%) were classified as ASA I, 234 (50.1%) as ASA II and 14 (3%) as ASA III. Furthermore, 182 (38.9%) patients with mental retardation, 33 (7.1%) with cerebral palsy and 28 (6%) with autism were identified. The mean operative time was 114.53±35.4 min, and the average recovery time 40.4±6 was min. Of the endotracheal intubations 277 (59.3%) were oral, 82 (17.6%) were nasal, and 108 (23.1%) were nasal with the help of fibreoptics. Difficult intubation was observed in 20 (4.3%) patients. The MP score was 1 in 397 (85%) patients, 2 in 50 (10.7%) patients, 3 in 18 (3.9%) patients and 4 in 2 (0.4%) patients. General anaesthesia was applied because of cooperation difficulties in 213 (45.6%), mental retardation in 182 (38.9%), autism in 28 (5.9%), schizophrenia in 7 (1.7%) and jaw surgery in 37 (7.9%) patients. Local infiltration was used for analgesia in 141 (30.2%), morphine in 12 (2.6%), tramadol in 3 (0.6%) and paracetamol in 311 (66.6%) patients. Endocarditis prophylaxis was employed in 36 (7.7%) cases. CONCLUSION: General anaesthesia in dental procedures is becoming increasingly common. Anaesthetic management is important due to the frequency of genetic syndromes and mental retardation. In the anaesthetic management of these patients, strategies for the patient should be identified, the process should be implemented in the operating room and preparations should be made with risk analyses.