The clinical characteristics and the risk factors for mortality in Non-COVID-19 critical patients in a pandemic hospital in Turkey: a retrospective cross-sectional study.

Background: Coronavirus disease 2019 (COVID-19) disrupted standard health policies and routine medical care, and thus, the management and treatment pathways of many clinical conditions have changed as never before. The negative impact of the pandemic rendered the systemic disease more complicated and accelerated mortality. For the last two years, clinicians have primarily focused on COVID-19 patients; however, the non-COVID-19 critically ill patients needed to be addressed from multiple perspectives. This study investigated the demographic and clinical characteristics of non-COVID-19 critical care patients admitted concurrently with a COVID-19 wave. The objective of this study was to identify the risk factors for mortality in critically ill non-COVID-19 patients. Methods: All consecutive cases admitted to the intensive care unit (ICU) were included in the study between January 1, 2021 and July 14, 2021. All data, including age, gender, admission characteristics, patient dependency, pre-existing systemic diseases, the severity of illness (Acute Physiology and Chronic Health Evaluation -APACHE-II), predicted death rate in ICU, life-sustaining medical procedures on admission or during ICU stay, length of stay, and admission time to the ICU, were obtained from the hospital's electronic database. The Charlson Comorbidity Index (CCI) was assessed for all patients. Results: A total of 192 patients were screened during the study period. Mortality was significantly increased in non-surgical patients, previously dependent patients, patients requiring mechanical ventilation, continuous renal replacement therapy, and patients requiring the infusion of vasoactive medications. The number of pre-existing diseases and the admission time had no impact on mortality. The mean CCI was significantly higher in non-survivors but was not a strong predictor of mortality as APACHE II. Conclusions: In this retrospective study, the severity of illness and the need for vasoactive agent infusion were significantly higher in non-survivors confirmed by multivariate analysis as predictive factors for mortality in critical non-COVID-19 patients.

Characteristics and outcomes of 974 COVID-19 patients in intensive care units in Turkey.

BACKGROUND: In our previous report on Turkish COVID-19 patients requiring intensive care, the 24 patients in a single ICU were elderly and mortality was high. We extended our analysis to include patients admitted to ten ICUs. OBJECTIVES: Report the demographics, clinical features, imaging findings, comorbidities, and outcomes in COVID-19 patients. DESIGN: Retrospective. SETTING: Intensive care unit. PATIENTS AND METHODS: The study includes patients with clinical and radiological confirmed or laboratory-confirmed COVID-19 infection who were admitted to ten ICUs between 15 March and 30 June 2020. MAIN OUTCOME MEASURES: Clinical outcomes, therapies, and death during hospitalization SAMPLE SIZE: 974, including 571 males (58%). RESULTS: The median age (range) was 72 (21-101) years for patients who died (n=632, 64.9%) and 70 (16-99) years for patients who lived (n=432, 35.2%) (P<.001). APACHE scores, and SOFA scores were higher in patients who died than in those who survived (P<.001, both comparisons). Respiratory failure was the most common cause of hospitalization (82.5%), and respiratory failure on admission was associated with death (P=.013). Most (n=719, 73.8%) underwent invasive mechanical ventilation therapy. CONCLUSIONS: The majority of patients admitted to the ICU with a diagnosis of COVID-19 require respiratory support. LIMITATIONS: Although the Turkish Ministry of Health made recommendations for the treatment of COVID-19 patients, patient management may not have been identical in all ten units. CONFLICT OF INTEREST: None.

The Psychological Impact of COVID-19 Disease is more Severe on Intensive Care Unit Healthcare Providers: A Cross-sectional Study.

OBJECTIVE: : Fear, anxiety, depression and sleep deprivation are common mental health disorders in COVID-19 disease. We aimed to analyse the risk for healthcare providers during COVID-19 pandemic in a university hospital. METHODS: Anesthesiologists, nurses and nurse anesthetists were invited to fill out the survey. The survey was consist of questions from ''The Fear of COVID-19 Scale'', ''Patient Health Questionnaire'' and ''Pittsburgh Sleep Quality Index'' (PSQI). Each question was worth a point. RESULTS: The data of 208 participants were analyzed. Mean age was 29 ± 7.748 years, 72.1% were male, 67.3% were nurses, 62% were working in intensive care units, 38% were in hospital wards, 62% of all participants were living alone. Moderate depression was the most frequently detected outcome (n = 90, 43.3%). Mean The Fear of COVID-19 Scale for all participants was 18.56 ± 7.731. The mean PSQI of patients was 6.18 ± 4.356 with a 45.7% rate of poor sleep quality. PSQI was found significantly higher in nurses (7.1 ± 4.7, p = 0.000). Nurses were the group with the highest deterioration in sleep quality (53.6%, p = 0.003). The rate of moderate-to-severe depressive symptoms was significantly higher in intensive care unit nurses and physicians (p = 0.018). PSQI score was found significantly higher in intensive care unit nurses and physicians than hospital ward co-workers (7.02 ± 4.59 vs. 4.81 ± 3.57 respectively, p = 0.001). A significant positive correlation was observed between PSQI and The Fear of COVID-19 Scale total score in all patients (p < 0.005). CONCLUSION: Depression, anxiety, fear and sleep disorders may occur in healthcare workers during COVID-19 outbreak. Intensive care unit nurses were at highest risk.

Preoperative Anxiety before Spinal Anesthesia: Does Internet-based Visual Information/Multimedia Research Decrease Anxiety and Information Desire? A Prospective Multicentered Study.

BACKGROUND: Preoperative anxiety may lead to peroperative or postoperative problems when not overcome. AIMS: The aim of this study was to examine the effect of seeking information and other factors on the anxiety of patients preoperatively. SETTINGS AND DESIGN: This study was a prospective, multicentered survey. MATERIALS AND METHODS: Patients scheduled to undergo surgical procedures under spinal anesthesia, preoperatively evaluated as the American Society of Anesthesia 1-3 and where spinal anesthesia was agreed on beforehand, were included. Patients completed State-Trait Anxiety Inventory Scale-State (STAI-S) survey preoperatively. Patients who sought information were also asked to complete the Amsterdam Preoperative Anxiety and Information Scale survey. STATISTICAL ANALYSIS: Quantitative data were compared with one-way ANOVA with post hoc analysis or Kruskal-Wallis test. Comparison of two groups of parameters showing normal distribution was compared using Student's t-test. Comparison of groups versus anxiety was performed using Chi-square and Fisher's exact tests. RESULTS: A total of 330 patients were included. Average STAI-S scores were similar when evaluated for patients' demographic data, gender, marital status, place of residence, type of operation, preoperative fasting time, and comorbidities. University graduates were found to have lower anxiety when compared to other educational statuses. Seeking information from the internet caused a significant decrease in surgical anxiety (P < 0.05) although it had no effect on anesthesia-related anxiety. Interestingly, those seeking information had higher information desire levels compared to patients who had not sought other sources of information (P < 0.05). CONCLUSION: While patients seeking information regarding surgical procedure and/or spinal anesthesia have lower preoperative anxiety levels, their information desire remains high. Apart from detailed information given by the anesthesiologist or surgeon, having access to correct and validated information in multimedia form may decrease anxiety and information desire.

Efficiency of levobupivacaine and bupivacaine for supraclavicular block: a randomized double-blind comparative study.

BACKGROUND AND OBJECTIVES: Success rate of catheter applications is low in supraclavicular block. Thus, bupivacaine and levobupivacaine become important with their long effect time in single injection practices. In this study, we aimed to compare the effectiveness, side effects and complications of bupivacaine and levobupivacaine in supraclavicular block. METHODS: Sixty patients aged between 20 and 65, with body weight between 50 and 100 kg, in the ASA I-II-III group who were scheduled for hand, forearm and arm surgery using supraclavicular block were randomized into two groups of 30. The patients received 30 ml 0.5% bupivacaine (Group B) or 30 ml 0.5% levobupivacaine (Group L). Motor and sensory blocks were evaluated. Motor and sensory block onset times, total block durations, postoperative pain, amount of postoperative analgesic used and patient satisfaction were recorded. RESULTS: Demographic data, distribution of surgical area and hemodynamic data were similar between the two groups. Surgery, motor and sensory block durations of Group B and L patients did not vary statistically significantly. However, motor and sensory block onset times in Group B were significantly shorter than Group L (p<0.05). The mean time for first postoperative analgesic demand were 16.6 ± 8.0 h in Group B and 14.4 ± 7.3h in Group L (p>0.05). CONCLUSION: 30 ml 0.5% bupivacaine and levobupivacaine provide similar block characteristics for supraclavicular block. Bupivacaine leads to faster motor and sensory block onset compared to levobupivacaine however similar duration of postoperative analgesia.

Preoperative indicators affecting postoperative mortality in elderly patients with hip fractures.

OBJECTIVE: In this study, we aimed to evaluate the factors which affect postoperative mortality in elderly patients with hip fractures and the reliability of the American Society of Anesthesiologists (ASA) classification. METHODS: The study included 107 patients (70 females, 37 males) of 65 years of age or older who were operated due to hip fracture. Preoperative laboratory and clinical data were collected from hospital files. Follow-up was conducted over the phone. The number of the patients who died in the first postoperative 12 months was compared with the official Turkish Statistical Institute mortality data. Preoperative clinical and laboratory findings and ASA scores were compared between surviving and deceased patients. RESULTS: Twenty-eight patients died in the postoperative first year. The first year mortality rate was significantly higher than the normal population (p<0.05). Of these 28 patients, 16 died within the first 3 months; the majority due to respiratory insufficiency. The death ratio was significantly higher in patients with abnormal creatinine values (p=0.001) in the preoperative laboratory results and classified as ASA 4 (p<0.0001). Postoperative mobilization was slower and mortality was higher in patients with cognitive dysfunction, such as senile dementia. CONCLUSION: The mortality rate in patients operated for hip fractures is higher when compared to the mortality rate in patients of the same age group. Because most deaths caused by pulmonary insufficiency occurred in the first 3 months in which patients were not adequately mobilized, the main cause of death might be pulmonary embolism. Abnormal creatinine values might indicate insufficient kidney function as another reason of death. ASA classification is useful for determination of preoperative risk in the elderly patients with hip fractures.

Efficiency of levobupivacaine and bupivacaine for supraclavicular block: a randomized double-blind comparative study / Eficiência de levobupivacaína e bupivacaína para bloqueio supraclavicular: estudo comparativo, duplo-cego e randomizado / Eficiencia de la levobupivacaína y la bupivacaína para el bloqueo supraclavicular: estudio comparativo, doble ciego y aleatorizado

Background and objectives: Success rate of catheter applications is low in supraclavicular block. Thus, bupivacaine and levobupivacaine become important with their long effect time in single injection practices. In this study, we aimed to compare the effectiveness, side effects and complications of bupivacaine and levobupivacaine in supraclavicular block. Methods: Sixty patients aged between 20 and 65, with body weight between 50 and 100 kg, in the ASA I-II-III group who were scheduled for hand, forearm and arm surgery using supraclavicular block were randomized into two groups of 30. The patients received 30 ml 0.5% bupivacaine (Group B) or 30 ml 0.5% levobupivacaine (Group L). Motor and sensory blocks were evaluated. Motor and sensory block onset times, total block durations, postoperative pain, amount of postoperative analgesic used and patient satisfaction were recorded. Results: Demographic data, distribution of surgical area and hemodynamic data were similar between the two groups. Surgery, motor and sensory block durations of Group B and L patients did not vary statistically significantly. However, motor and sensory block onset times in Group B were significantly shorter than Group L (p < 0.05). The mean time for first postoperative analgesic demand were 16.6 ± 8.0 h in Group B and 14.4 ± 7.3 h in Group L (p > 0.05). Conclusion: 30 ml 0.5% bupivacaine and levobupivacaine provide similar block characteristics for supraclavicular block. Bupivacaine leads to faster motor and sensory block onset compared to levobupivacaine however similar duration of postoperative analgesia. .

Justificativa e objetivos: a taxa de sucesso de aplicações de cateter é baixa em bloqueio supraclavicular. Assim, bupivacaína e levobupivacaína tornaram-se importantes por causa do efeito de longa duração em práticas de injeção única. Neste estudo, o objetivo foi comparar a eficácia, os efeitos colaterais e as complicações de bupivacaína e levobupivacaína em bloqueio supraclavicular. Métodos: foram randomizados em grupos de 30 cada 60 pacientes, entre 20-65 anos, 50-100 kg, estado físico ASA I-II-III, programados para cirurgia de mão, antebraço e braço com bloqueio supraclavicular. Receberam 30 mL de bupivacaína a 0,5% (Grupo B) ou 30 mL de levobupivacaína a 0,5% (Grupo L). Os bloqueios sensorial e motor foram avaliados e o tempo de início dos bloqueios, a duração dos bloqueios, a dor pós-operatória, a quantidade de analgesia pós-operatória e a satisfação dos pacientes foram registrados. Resultados: os dados demográficos, a distribuição da área cirúrgica e os dados hemodinâmicos foram semelhantes entre os dois grupos. A duração da cirurgia e dos bloqueios sensorial e motor não foi estatisticamente diferente entre os grupos B e L. Contudo, os tempos de início dos bloqueios sensorial e motor do Grupo B foram significativamente menores do que os do Grupo L (p < 0,05). O tempo médio para a primeira solicitação de analgésico no pós-operatório foi de 16,6 ± 8 horas no grupo B e 14,4 ± 7,3 horas no Grupo L (p > 0,05). Conclusão: características semelhantes para o bloqueio supraclavicular são fornecidas por 30 mL de bupivacaína a 0,5% e levobupivacaína. Bupivacaína proporciona início mais rápido de bloqueio sensorial e motor em comparação ...

Justificación y objetivos: la tasa de éxito de las aplicaciones de catéter es baja en el bloqueo supraclavicular. Así, la bupivacaína y la levobupivacaína son importantes debido al efecto a largo plazo en las prácticas de inyección única. En este estudio, el objetivo fue comparar la eficacia, los efectos colaterales y las complicaciones de la bupivacaína y la levobupivacaína en el bloqueo supraclavicular. Métodos: sesenta pacientes, con edades entre 20-65 años, 50-100 kg, estado físico ASA I-II-III, programados para cirugía de mano, antebrazo y brazo con bloqueo supraclavicular, fueron aleatorizados en grupos de 30 pacientes cada uno. Los pacientes recibieron 30 mL de bupivacaína al 0,5% (grupo B) o 30 mL de levobupivacaína al 0,5% (grupo L). Se evaluaron los bloqueos sensorial y motor y se registraron los tiempos de inicio de los bloqueos, duración de los bloqueos, dolor postoperatorio, cantidad de analgesia postoperatoria y satisfacción de los pacientes. Resultados: los datos demográficos, la distribución del área quirúrgica y los datos hemodinámicos fueron similares en los 2 grupos. La duración de la cirugía y de los bloqueos sensorial y motor no fue estadísticamente diferente entre los grupos B y L. Sin embargo, los tiempos de inicio de los bloqueos sensorial y motor del grupo B fueron significativamente menores que los del grupo L (p < 0,05). El tiempo promedio para la primera solicitación de analgésico en el postoperatorio fue de 16,6 ± 8,0 h en el grupo B y 14,4 ± 7,3 h en el grupo L (p > 0,05). Conclusión: los 30 mL de bupivacaína al 0,5% y levobupivacaína suministran características de bloqueo similares para el bloqueo supraclavicular. La bupivacaína proporciona un inicio más rápido de bloqueo sensorial y motor en comparación ...