Altered kidney function induced by SARS-CoV-2 infection and acute kidney damage markers predict survival outcomes of COVID-19 patients: a prospective pilot study.

BACKGROUND: Literature with regard to coronavirus disease 2019 (COVID-19) associated morbidities and the risk factors for death are still emerging. In this study, we investigated the presence of kidney damage markers and their predictive value for survival among hospitalized subjects with COVID-19. METHODS: Forty-seven participants was included and grouped as: 'COVID-19 patients before treatment', 'COVID-19 patients after treatment', 'COVID-19 patients under treatment in intensive care unit (ICU)', and 'controls'. Kidney function tests and several kidney injury biomarkers were compared between the groups. Cumulative rates of death from COVID-19 were determined using the Kaplan-Meier method. The associations between covariates including kidney injury markers and death from COVID-19 were examined, as well. RESULTS: Serum creatinine and cystatin C levels, urine Kidney Injury Molecule-1 (KIM-1)/creatinine ratio, and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI cystatin C, and CKD-EPI creatinine-cystatin C levels demonstrated significant difference among the groups. The most significant difference was noted between the groups 'COVID-19 patients before treatment' and 'COVID-19 patients under treatment in ICU'. Advancing age, proteinuria, elevated serum cystatin C, and urine KIM-1/creatinine ratio were all significant univariate correlates of death (p < 0.05, for all). However, only elevated urine KIM-1/creatinine ratio retained significance in an age, sex, and comorbidities adjusted multivariable Cox regression (OR 6.11; 95% CI: 1.22-30.53; p = 0.02), whereas serum cystatin C showing only a statistically non-significant trend (OR 1.42; 95% CI: 0.00-2.52; p = 0.09). CONCLUSIONS: Our findings clearly demonstrated the acute kidney injury related to COVID-19. Moreover, urine KIM-1/creatinine ratio was associated with COVID-19 specific death.

A randomized, double-blind study of the ultrasound assessment of the effect of pharyngeal packing on perioperative gastric volume in nasal surgery.

BACKGROUND: Pharyngeal packing (PP) is commonly performed to reduce the incidence of perioperative blood ingestion (PBI) in nasal surgery (NS), and thus the incidence and severity of postoperative nausea and vomiting (PONV). This study examined the effects of PP on the perioperative gastric volume (GV) and PONV in patients undergoing NS, by ultrasound assessment. METHODS: Patients undergoing elective NS [septoplasty, septo-rhinoplasty (SRP) and functional endoscopic sinus surgery (FESS)] were randomised to receive or not receive PP. In the PP group, pharyngeal packs were placed after the orotracheal intubation. Ultrasound assessments were performed for all patients preoperatively (before the anaesthesia induction) and postoperatively (before the extubation). The antero-posterior (AP) and cranio-caudal (CC) antral diameters, antral cross-sectional area (ACSA), and total GV were calculated. PONV incidence and severity were rated. These variables were compared between timepoints and groups, and in the subgroup analyses according to the surgery type. Pearson correlation analysis was performed to assess correlations between the variables. RESULTS: AP and CC diameters and ACSAs were greater postoperatively than preoperatively in the PP and non-PP groups (n = 44 each; all p < 0.05). Postoperative AP and CC diameters and the ACSA were greater in the non-PP than in the PP group (all p < 0.05). Postoperative AP diameters were greater than preoperatively in patients undergoing SRP and FESS, and the postoperative CC diameter and ACSA were greater than preoperatively in patients undergoing SRP (all p < 0.05). Surgery duration was correlated positively with postoperative AP diameter (r = 0.380, p < 0.05), CC diameter (r = 0.291, p < 0.05), and ACSA (r = 0.369, p < 0.05). Patients who underwent septoplasty surgery, PP was decreased PONV incidence and severity at the first four hours, postoperatively (p < 0.05). CONCLUSIONS: The study findings indicate that PP reduces the increase in the perioperative GV due to PBI in an elective NS. It is therefore a useful and safe means of reducing the risk of perioperative pulmonary aspiration in such surgeries. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCT), ACTRN12619000487112 , 25/03/2019, Trial registration retrospectively registered.

Effects of Cilostazol and Diltiazem Hydrochloride on Ischemia-Reperfusion Injury in a Rat Hindlimb Model.

OBJECTIVE: Free radicals and neutrophils are potent sources of ischemia-reperfusion injury (I/R) and they can be limited by the use of exogenous application of some therapeutic agents. The objective of this study was to compare the effects of cilostazol and diltiazem hydrochloride in a rat hind limb model of I/R injury. Methods: Skeletal muscles submitted to 2 hours of ischemia by placing an aneurysm clip to femoral artery and reperfused after 1, 2 and 4 hours. Seventy-two Wistar-Albino rats were randomly divided into mainly four groups according to treatment agents:  Group I (control group) was treated with saline; Group II was treated with diltiazem hydrochloride; Group III was treated with cilostazol in 30% dimethyl sulphoxide; and Group IV was treated with 30% dimethyl sulphoxide intraperitoneally. These four main groups also subdivided into three subgroups according to duration of the reperfusion times.  Blood samples were taken and all rats were sacrificed. Results: Cilostazol-treated groups demonstrated a significant decrease in tissue and serum malondialdehyde (MDA) levels, and tissue myeloperoxidase (MPO ) activity compared with other groups. Increase in serum nitric oxide (NOx) level was significantly higher in all subgroups of cilastazol, diltiazem hydrochloride, and dimethyl sulphoxide groups versus the control group. CONCLUSION: Although these results suggest the beneficial effects of cilostazol and diltiazem hydrochloride on I/R injury, the effect of cilostazol on I/R injury seems to be more efficient than diltiazem hydrochloride.

Changes in intraocular pressure during cardiopulmonary bypass.

PURPOSE: The aim of the present study was to investigate the changes in intraocular pressures (IOP) in patients who underwent pulsatile and non-pulsatile cardiopulmonary bypass (CPB). METHODS: A total of 42 patients operated for elective coronary bypass surgery (CABG) on CPB were randomly allocated to pulsatile (Group P) and non-pulsatile (Group N) groups. Pulsatile flow was applied to Group P patients during crops-clamp period. The IOP measurements were made before and after the induction of anesthesia, before the onset of CPB, on the 5th, 15th, 30th, 45th, and 60th min of CPB, after CPB and at the end of the operation. The results of repetitive measurements were analyzed at different intervals and in two groups. RESULTS: The second IOP measurements of right and left eyes displayed statistically significant decreases from the baseline level [11.9 ± 2.9 (p = 0.0001) and 12.5 ± 3.2 (p = 0.0001), respectively]. The significant decrease in the IOP values persisted in the repeated measurements except for the 5th min of CPB values [17.0 ± 3.5 (p = 0.346) and 16.7 ± 3.6 (p = 0.399)]. Comparison of two groups demonstrated significant differences at pre-CPB (right 12.8 ± 2.3 vs. 10.8 ± 2.4; p = 0.013 and left 13.3 ± 2.4 vs. 11.5 ± 2.5; p = 0.023), and 5th min of CPB measurements (right 18.5 ± 3.1 vs. 15.9 ± 3.4; p = 0.015; left 18.2 ± 3.0 vs. 15.7 ± 3.6; p = 0.019). CONCLUSION: We noted a steady decrease in repeated IOP measurements except for the transient increase in CPB values on 5th min. The IOP values were higher in pulsatile CPB group in pre-CPB and 5th min of CPB measurements; however, the difference was not significant in the repeated measurements.

Luteolin ameliorates colistin-induced nephrotoxicity in the rat models.

INTRODUCTION AND AIM: To study the protective, preventive effect of luteolin from colistin-induced nephrotoxicity. MATERIAL AND METHOD: Four different treatment options were tested on rats: colistin, luteolin, and a combination of colistin and luteolin, intraperitoneally as two doses a day, for seven days. Another group of rats were used as the control and treated with sterile saline. Serum creatinine levels were measured before and after treatment. Histological changes and colistin-induced apoptosis (Insitu BrdU-red DNA Fragmentation Assay Kit) of the renal tissues were examined after the scarification procedure. RESULTS: In the Colistin Group, post-treatment creatinine levels were statistically higher than the pretreatment levels (p = .001). In the remaining groups, no significant changes were observed. Cells that undergo apoptosis were counted and it was shown that all groups except the colistin-treated group had a similar number of apoptotic cells, whereas the colistin-treated group had statistically higher number of apoptotic cells compared to other groups (p = .0001). Renal histological damage was also measured and the score of the colistin treated group was higher as compared to other groups. CONCLUSION: The results obtained from this study demonstrated us that luteolin was capable of preventing colistin-induced nephrotoxicity and that this effect was significant at histopathological level.

Indirect laryngoscopic assessment for the diagnosis of difficult intubation in patients undergoing microlaryngeal surgery.

BACKGROUND: The aim of this study is to investigate the feasibility of using indirect laryngoscopy for the diagnosis of difficult intubations in patients who are undergoing microlaryngeal surgery. METHODS: In the pre-anesthetic examination the thyromental distance, sternomental distance, interincisor distance, neck circumference, modified Mallampati scores, and Wilson risk scores were measured. An otolaryngologist conducted an indirect laryngoscopic assessment. Direct laryngoscopic profiles were classified according to their Cormack-Lehane scores. RESULTS: Forty patients underwent microlaryngeal surgery. Their mean ages, neck circumferences, Cormack-Lehane scores of the patients who had intubation difficulties were statistically significantly higher than those who did not have intubation difficulties (p < 0.05). The significant differences between the indirect laryngoscopic assessment distributions of patients who either had or did not have intubation difficulty were assessed (p < 0.05). CONCLUSIONS: Indirect laryngoscopic assessment is a simple and valuable technique that can be used for the diagnosis of difficult intubation in patients who are undergoing microlaryngeal surgery.

EFFECTS OF DEXAMETHASONE AND PHENIRAMINE MALEATE ON HEMODYNAMIC AND RESPIRATORY PARAMETERS AFTER CEMENTATION IN CEMENTED PARTIAL HIP PROSTHESIS.

PURPOSE: To prevent hemodynamic and respiratory changes that are likely to occur during cementation in partial hip prosthesis by prophylactic use of pheniramine maleate and dexamethasone. METHODS AND MATERIALS: The study included 40 patients aged between 60 and 85 years with an American Society ofAnesthesiologists (ASA) grade of II-III who underwent partial hip prosthesis. Just after spinal anesthesia, 4 mL normal saline was pushed in patients in Group S, whereas 45.5 mg pheniramine maleate and 8 mg dexamethasone mixture was pushed intravenously in a total volume of 4 mL in patients in Group PD. RESULTS: Amounts of atropine and adrenaline administered after cementation were significantly higher in Group S than in Group PD (P < 0.05). There was a significant difference between SpO2 values before and after cementation in Group S; SpO2 value was lower after cementation (P < 0.05) except for 1. min after cementation. SpO2 value increased 1 min after cementation (P = 0.031) CONCLUSION: Prophylactic use of pheniramine maleate and dexamethasone in partial hip prosthesis led to an increase in SpO2 value and a decrease in the utilization of adrenaline and atropine after cementation.

Cardiac condition during cooling and rewarming periods of therapeutic hypothermia after cardiopulmonary resuscitation.

BACKGROUND: Hypothermia has been used in cardiac surgery for many years for neuroprotection. Mild hypothermia (MH) [body temperature (BT) kept at 32-35°C] has been shown to reduce both mortality and poor neurological outcome in patients after cardiopulmonary resuscitation (CPR). This study investigated whether patients who were expected to benefit neurologically from therapeutic hypothermia (TH) also had improved cardiac function. METHODS: The study included 30 patients who developed in-hospital cardiac arrest between September 17, 2012, and September 20, 2013, and had return of spontaneous circulation (ROSC) following successful CPR. Patient BTs were cooled to 33°C using intravascular heat change. Basal BT, systolic artery pressure (SAP), diastolic artery pressure (DAP), mean arterial pressure (MAP), heart rate, central venous pressure, cardiac output (CO), cardiac index (CI), global end-diastolic volume index (GEDI), extravascular lung water index (ELWI), and systemic vascular resistance index (SVRI) were measured at 36°C, 35°C, 34°C and 33°C during cooling. BT was held at 33°C for 24 hours prior to rewarming. Rewarming was conducted 0.25°C/h. During rewarming, measurements were repeated at 33°C, 34°C, 35°C and 36°C. A final measurement was performed once patients spontaneously returned to basal BT. We compared cooling and rewarming cardiac measurements at the same BTs. RESULTS: SAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). DAP values during rewarming (basal temperature, 34°C, 35°C and 36°C) were lower than during cooling. MAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). CO and CI values were higher during rewarming than during cooling. GEDI and ELWI did not differ during cooling and rewarming. SVRI values during rewarming (34°C, 35°C, 36°C and basal temperature) were lower than during cooling (P < 0.05). CONCLUSIONS: To our knowledge, this is the first study comparing cardiac function at the same BTs during cooling and rewarming. In patients experiencing ROSC following CPR, TH may improve cardiac function and promote favorable neurological outcomes.

Is ultrasonic investigation of transverse tracheal air shadow diameter reasonable for evaluation of difficult airway in pregnant women: A prospective comparative study.

OBJECTIVE: The aim of this study was to compare clinical screening tests (modified Mallampati score, Cormack-Lehane score, thyromental distance, and sternomental distance) with ultrasonic measurements of the upper airway in predicting difficult intubation in pregnant women whose Body Mass Index (BMI) is higher and lower than 30 kg m-2. METHODS: This study was designed as a prospective observational trial, and consisted of 40 pregnant women of American Society of Anesthesiologists (ASA) 1-2 groups. Patients with a BMI lower than 30 kg m-2 were included in Group 1 (n=20), and patients with a BMI higher than 30 kg m-2 were included in Group 2 (n=20). In the supine position with head in mild extension, the diameter of the transverse tracheal air shadow in the subglottic area of the front neck was measured using ultrasonography. Modified Mallampati score, Cormack-Lehane score, thyromental distance and sternomental distance measurements were recorded. RESULTS: No statistically significant difference was detected between groups regarding mean age, mean number of pregnancy, ASA scores and comorbid disease. Mean body weight (p=0.0001) and mean pre-pregnancy weight (p=0.0001) were significantly higher in Group 2. There was no statistically significant difference between groups regarding mean modified Mallampati score, thyromental distance, sternomental distance measurements, Cormack-Lehane score, and mean ultrasonic measurements. CONCLUSION: It was found that BMI higher or lower than 30 kg m-2 has no effect on ultrasonic measurements and clinical airway tests. We thought that ultrasonic measurement could not give us valuable information in obese or non-obese pregnant women.

Use of a lower cut-off value for HbA1c to predict postoperative renal complication risk in patients undergoing coronary artery bypass grafting.

OBJECTIVE: There is an increasing interest in reexamining the relationship between glucose levels and postoperative complications. Threshold levels of HbA1c below those currently recommended may be additional indicators of risk for renal and cardiovascular dysfunction. In this study, the authors analyzed the perioperative outcomes of coronary artery bypass graft (CABG) operations to evaluate the association of HbA1c levels and renal complications. DESIGN: Retrospective. SETTING: Research and training hospital, single institution. PARTICIPANTS: The prospectively collected data of 510 coronary bypass patients with documented HbA1c levels were analyzed. INTERVENTIONS: The relationship of HbA1c with postoperative renal morbidity was evaluated with logistic regression analysis with lower threshold value (5.9%) for elevated levels. MEASUREMENTS AND MAIN RESULTS: Two hundred ninety-three patients (57.5%) had elevated HbA1c values. Patients with high HbA1c levels (>5.9%) had higher incidences of atherosclerotic vascular diseases. The incidence of acute kidney injury was higher in the high HbA1c group (11.9% v 1.8%; p = 0.0001). The high HbA1c group had higher incidence of renal morbidity (odds ratio = 4.608), and every 1% increase over 5.9% increased risk of renal complications by 23.6%. The other factors associated with renal morbidity were known history of diabetes, chronic renal disease, and performance of any concomitant procedure. CONCLUSIONS: The elevated levels of HbA1c are associated with increased renal complications and the cut-off values of HbA1c could be lowered to the upper range of normal limits.

The effect of postoperative hepatic fibrosis factors on morbidity in mitral valve replacement surgery: A single center ten years' experience.

Background: Previous studies have shown that hepatic fibrosis indices and rates can be used to predict cardiovascular mortality and morbidity. Our aim with this study was to investigate the effect of aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and fibrosis-4 (FIB-4) index calculated with ALT, AST, and platelet biomarkers, which are simple, fast, and relatively inexpensive and were used in previous studies to predict cardiovascular disease prognosis, on the prediction of postoperative morbidity and early mortality after mitral valve replacement (MVR) surgery. Methods: By scanning the hospital electronic health record system, 116 patients who underwent isolated MVR or MVR + tricuspid valve intervention were identified from 178 patients who underwent MVR with the standard sternotomy procedure between 2011 and 2021. The study was completed with 81 of these patients. Patients were divided into AST/ALT <2 (Group 1) and >2 (Group 2). In addition, the same patients were divided into FIB-4 index <3.25 (Group 3) and >3.25 (Group 4), and a total of four groups were formed. Results: The mean age of Group 2 was significantly higher than Group 1 (P = 0.049). In addition, the mean age of Group 4 was significantly higher than Group 3 (P = 0.003). Postoperative complications did not differ between Groups 1 and 2 (P > 0.05). While noninvasive mechanincal ventilation (NIMV) requirements did not differ between Groups 3 and 4 (P > 0.05), MV duration and intensive care unit stay were significantly longer in Group 4 (P < 0.05). Conclusion: The AST/ALT ratio, which has been shown to be a predictor of cardiovascular mortality in various studies, was not useful in predicting mortality and morbidity in our study. However, a high FIB-4 index, another hepatic fibrosis index, was found to be associated with increased perioperative bleeding, duration of mechanical ventilation, and cardiac intensive care unit stay, which are important criteria in the prediction of morbidity in cardiovascular surgery.

Evaluation of Acute Renal Failure After Acinetobacter Baumannii-related Ventilator-associated Event: Routine Data Base Study.

INTRODUCTION: Ventilator-associated events (VAEs) are major complications of mechanical ventilation (MV). Herein, we aimed to evaluate whether acute kidney injury (AKI) developed in patients who had been followed up with the diagnosis of Acinetobacter baumannii (AcB)-related VAE, the need for renal replacement therapy (RRT), and its relationship with mortality in patients who developed AKI due to colistin treatment. METHODS: A retrospective evaluation of 2,622 patients was conducted. Patients who developed AcB-based VAE and received parental colistin treatment were evaluated in terms of age, sex, diagnosis on intensive care unit (ICU) admission, Acute Physiology and Chronic Health Evaluation (APACHE) II score, colistin dose and treatment duration, duration of ICU stay, AKI staging according to Kidney Disease Improving Global Outcomes criteria, RRT requirement, and mortality. RESULTS: Eighty-five patients (3.19%) had VAEs, of whom 28 (32.9%) had AcB-related VAE. Bacterial eradication was achieved in 14 patients (50%), clinical response was achieved in 14 patients (50%), the mean colistin dose was 298.2 ± 85.5 mg/d, and mean duration of colistin treatment was 14.3 ± 8.6 days. AKI was detected as stages I, II, and III in 28.6%, 14.3%, and 28.6% of the patients; respectively. There was no difference between patients requiring RRT and those who did not in terms of the APACHE II score, bacterial eradication, clinical response to therapy, a daily dose of colistin, treatment duration, and MV duration. CONCLUSION: Colistin treatment of AcB-related VAE caused AKI in 71.5% of the patients and led to serious conditions in 25% of the patients requiring RRT.  DOI: 10.52547/ijkd.6694.

Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass.

Background: In cardiac surgery, supraphysiological oxygen levels are frequently applied perioperatively. In this study, we examined the postoperative effect of perioperative hyperoxemia in cardiac surgery. Methods: All patients who underwent mitral valve replacement via the standard sternotomy method between 2010 and 2021 were analyzed by scanning the hospital data system. The patients were divided into 2 groups: the hyperoxemic group (partial pressure of oxygen/fraction of inspired oxygen [PaO2/FiO2] > 500 mmHg) (Group I) and the normoxemic group (300 mmHg < PaO2/FiO2 < 500 mmHg) (Group II) according to the mean of 3 PaO2/FiO2 values calculated by using 3 PaO2 and 3 FiO2 levels. Postoperative complications, the mechanical ventilation time, the need for noninvasive mechanical ventilator support, the length of intensive care unit (ICU) stay, the hospitalization period, and the mortality rate of the groups were compared. Results: A total of 78 patients were included in the study, and 53 of the patients (67.9%) were female. The mean age of the patients was 58.89±12.60 years. The total mechanical ventilation time was significantly higher in the hyperoxemic group than in Group II (P<0.001) (18.18±12.90 h and 11.45±7.85 h, respectively). The amount of postoperative bleeding was significantly higher in Group I (P=0.003) (539.47±201.74 mL and 417.50±186.93 mL, respectively). The total amount of blood products administered during surgery and ICU stay was higher in Group I (P=0.041) (3.55±1.59 units and 2.87±1.89 units, respectively). Conclusion: We observed that the group with hyperoxemia during cardiopulmonary bypass had a higher amount of postoperative bleeding and the need for transfusion, as well as a longer duration of mechanical ventilation and intensive care.

Mild Hypothermia via External Cooling Improves Lung Function and Alleviates Pulmonary Inflammatory Response and Damage in Two-Hit Rabbit Model of Acute Lung Injury.

OBJECTIVES: Targeted temperature management (TTM) with therapeutic hypothermia (TH) has an organ-protective effect by mainly reducing inflammatory response. Here, our objective was to determine, for the first time, whether mild TH with external cooling, a simple and inexpensive method, could be safe or even beneficial in two-hit rabbit model of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). METHODS: Twenty-two New Zealand rabbits (6-month-old) were randomly divided into healthy control (HC) with conventional ventilation, but without injury, model group (ALI), and hypothermia group with external cooling (ALI-HT). After induction of ALI/ARDS through mild lung-lavages followed by non-protective ventilation, mild hypothermia was started in ALI-HT group (body temperature of 33-34 °C). All rabbits were conventionally ventilated for an additional 6-h by recording respiratory parameters. Finally, lung histopathology and inflammatory response were evaluated. RESULTS: Hypothermia was associated with higher oxygen saturation, resulting in partial improvement in the P/F ratio (PaO2/FiO2), oxygenation index, mean airway pressure, and PaCO2, but did not affect lactate levels. The ALI-HT group had lower histopathological injury scores (hyperemia, edema, emphysema, atelectasis, and PMN infiltration). Further, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6 and -8 levels in lung tissue and serum samples markedly reduced due to hypothermia. CONCLUSION: Mild TH with external cooling reduced lung inflammation and damage, whereas it resulted in partial improvement in gas exchanges. Our findings highlight that body temperature control may be a potentially supportive therapeutic option for regulating cytokine production and respiratory parameters in ALI/ARDS.

Continuous Endotracheal Tube Cuff Pressure Control Decreases Incidence of Ventilator-Associated Pneumonia in Patients with Traumatic Brain Injury.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common cause of morbidity and mortality in intensive care unit (ICU), and among the several preventative strategies described to reduce the incidence of VAP, the most important is the endotracheal tube cuff (ETC) pressure. The present study was conducted on 60 patients who required mechanical ventilation (MV) in the ICU with traumatic brain injury (TBI). METHODS: The patients were randomized into two groups of 30, in which ETC pressure was regulated using a smart cuff manager (SCM) (Group II), or manual measurement approach (MMA) (Group I). Demographic data, MV duration, length of ICU stay and mortality rates were recorded. The clinical pulmonary infection scores (CPISs), C-reactive protein (CRP) values, and the fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) values of the groups were compared at baseline, and at hours 48, 72 and 96. RESULTS: In Group I, CPIS values significantly higher than Group II in 48th, 72nd and 96th hours (p < 0.05). In Group I, PEEP values and deep tracheal aspirate (DTA) culture growth rates significantly higher than Group II in 72nd and 96th hours (p < 0.05). CONCLUSION: The continuous maintenance of ETC pressure using SCM reduced the incidence of VAP.

Comparison of Intra-operative Pressure-Controlled Ventilation and Volume-Controlled Ventilation in Bariatric Surgery: A Prospective Randomized Study.

BACKGROUND: Mechanical ventilation may be particularly challenging in obese patients undergoing laparoscopic bariatric surgery. The present study aimed to compare the effects of pressure-controlled ventilation (PCV) with those of volume-controlled ventilation (VCV) on peripheral tissue oxygenation (PTO), respiratory function, hemodynamic status, and ventilation-related complications in patients undergoing laparoscopic bariatric surgery. METHODS: A total of 100 patients with obesity who underwent gastric plication or sleeve gastrectomy were recruited for the study, and 60 patients (n=32, in group PCV; n=28, in group VCV) were ultimately enrolled. Data on peri-operative PTO (arterial blood gas [ABG] analysis and tissue oxygen saturation [StO2]) and respiratory functions were recorded for each patient, along with post-operative hemodynamic status, fluid intake, urinary output, Numeric Pain Rating Scale (NPRS) score , and complications. RESULTS: The two groups were similar in pH, partial pressure of oxygen, partial pressure of carbon dioxide, oxygen saturation, and lactate values at baseline, intra-operative and post-operative periods. The peri-operative StO2 values were also similar between the two groups at all times. The two groups were identical in terms of preoperative values for respiratory function tests and post-operative hemodynamic status, fluid intake, urinary output, pain scores, and complication rates. CONCLUSIONS: In conclusion, the choice of the mechanical ventilation mode did not appear to influence oxygen delivery, respiratory function, hemodynamic status, post-operative pain, or ventilation-related complications in obese patients undergoing laparoscopic bariatric surgery.

Does coexistence of fragmented QRS and cardiovascular disease have the ability to predict the mortality in hospitalized, critically ill patients with COVID-19?

OBJECTIVE: In this study, we aimed to investigate the prognostic accuracy of the presence of fragmented QRS (fQRS) on baseline electrocardiogram on the adverse outcome in critical patients with coronavirus disease 2019 (COVID-19) with cardiovascular disease (CVD). METHODS: The current study was retrospective designed and included 169 patients who were critically ill with COVID-19 and CVD (mean age of 62±15 years). The patients were grouped into those who died (non-survivor group) and those who survived (survivor group). RESULTS: The non-survivors were older and more often had CVD (p=0.009), hypertension (p=0.046), diabetes (p=0.048), cancer (p=0.023), and chronic renal failure (p=0.001). Although the presence of fQRS on the basal electrocardiogram was more common in patients who died, this was not statistically significant (p=0.059). Furthermore, non-survivors had more frequent the coexistence of CVD and fQRS (p=0.029). In Model 1 multivariate regression analysis, CVD alone was not a predictor of mortality (p=0.078), whereas coexistence of CVD and fQRS was found to be an independent predictor of mortality in Model 2 analysis [hazard ratio (HR): 2.243; p=0.003]. Furthermore, older age (HR: 1.022; p=0.006 and HR: 1.023; p=0.005), cancer (HR: 1.912; p=0.021 and HR: 1.858; p=0.031), high SOFA score (HR: 1.177; p=0.003 and HR: 1.215; p<0.001), and increased CRP level (HR: 1.003; p=0.039 and HR: 1.003; p=0.027) independently predicted the mortality in both multivariate analysis models, respectively. CONCLUSION: fQRS may be a useful and handy risk-stratification tool for clinical outcomes by identifying high-risk individuals, especially among those with CVD.

Intranasal levosimendan prevents cognitive dysfunction and apoptotic response induced by repeated isoflurane exposure in newborn rats.

Anesthetic-induced toxicity in early life may lead to risk of cognitive decline at later ages. Notably, multiple exposures to isoflurane (ISO) cause acute apoptotic cell death in the developing brain and long-term cognitive dysfunction. This study is the first to investigate whether levosimendan (LVS), known for its protective myocardial properties, can prevent anesthesia-induced apoptotic response in brain cells and learning and memory impairment. Postnatal day (P)7 Wistar albino pups were randomly assigned to groups consisting of an equal number of males and females in this laboratory investigation. We treated rats with LVS (0.8 mg/kg/day) intranasally 30 min before each ISO exposure (1.5%, 3 h) at P7+9+11. We selected DMSO as the drug vehicle. Also, the control group at P7+9+11 received 50% O2 for 3 h instead of ISO. Neuroprotective activity of LVS against ISO-induced cognitive dysfunction was evaluated by Morris water maze. Expression of apoptotic-related proteins was detected in the whole brain using western blot. LVS pretreatment significantly prevented anesthesia-induced deficit in spatial learning (at P28-32) and memory (at P33, P60, and P90). No sex-dependent difference occurred on any day of the training and probe trial. Intranasal LVS was also found to significantly prevent the ISO-induced apoptosis by reducing Bax and cleaved caspase-3, and by increasing Bcl-2 and Bcl-xL. Our findings support pretreatment with intranasal LVS application as a simple strategy in daily clinical practice in pediatric anesthesia to protect infants and children from the risk of general anesthesia-induced cell death and cognitive declines.

Venous air embolism during laparoscopic cholecystectomy.

Vascular air embolism is a rare and potentially life-threatening event. In this study, a case of venous air embolism during laparoscopic cholecystectomy due to an injured inferior vena cava is presented. Anesthesiologists and surgeons must be aware of this dangerous complication. Emphasis is given to the prevention and prompt recognition of this event and to the use of all available tools in the management of cardiovascular complications.

Acute otalgia during sleep (live insect in the ear): a case report.

Foreign bodies in the external auditory canal may cause otalgia, and live insects have been reported among the causes. A number of methods have been used to immobilize the live insects. In our manuscript, we describe immobilization of an insect and provision of analgesia using EMLA cream.