Objective: In late 2019, the Coronavirus disease 2019 (COVID-19) has been pandemic worldwide, starting in Wuhan, China. In this study, we aimed to evaluate the factors associated with 28-day outcomes ...in patients admitted to the intensive care unit with the diagnosis of COVID-19. Method: This study has a retrospective cohort design. COVID-19 patients identified according to World Health Organization guidelines are included. Patient data were recorded to a centralized system utilizing ImdSoft-Meta vision/OlinlCU Clinical Decision Support Software. Individual datasets about required parameters were obtained from Structured Ouery Language (SOL) queries. The main laboratory parameters were examined. SOFA, APACHE II, and Charlson Comorbidity Score (CCS) were calculated. In evaluating laboratory parameters and disease risk scores, which are thought to affect 28-day mortality, logistic analysis were performed using the Backward LR model. Results: The study was carried out with 101 patients, 40 (39.6%) of whom were women, and 61 (60.4%) of men, who met the inclusion criteria. The ages of the patients ranged from 21 to 88, and the mean age was 58.45 + or - 15.41 years. The mean intensive care hospitalization period was 12.5 + or - 10.2 days. The all-cause in-hospital mortality rate was 61.4%. Leukocyte count, CK, NT-proBNP, PCT, CRP, ferritin, neutrophil count and percentage, D-Dimer, LDH, AST values were found to be significantly higher in non-survivors. The lymphocyte count and percentage, and platelet count values were found to be significantly low in non-survivors. The lymphocyte percentage, LDH, and CCS were significant in the 28-day mortality in multivariate analysis (p values are 0.01, 0.003, 0.008, respectively). Conclusion: High lymphocyte values have been found to significantly reduce the risk of death in patients diagnosed with COVID-19. Lymphocyte percentage, LDH, and CCS were evaluated as the most successful parameters in predicting 28-day mortality in the intensive care unit. Keywords: COVID-19, Charlson Comorbidity Score, Mortality, Risk factors, SARS-CoV-2 Amac: 2019 sonlarinda, Cin'in Hubei eyaletinin Wuhan sehrinde baslayip 2020 yilinin ilk alti ayinda tum Dunyada Covid-19 pandemisi salgin olarak yasanmaktadir. Bu calismada, yogun bakim unitesine COVID-19 tanisiyla basvuran hastalarda 28 gunluk sonuclarla iliskili faktorlerin degerlendirilmesi amaclanmistir. Yontem: Bu calisma retrospektif kohort olarak tasarlandi. Dunya Saglik Orgutu kilavuzlarina gore tanimlanan COVID-19 hastalari hastalar calismaya dahil edildi. Hasta verileri, ImdSoft-Meta vision / QlinICU Clinical Decision Support Software kullanilarak merkezi bir sisteme kaydedildi. Structured Query Language (SQL) sorgularindan gerekli parametrelerle ilgili bireysel veri kumeleri elde edildi. Ana laboratuvar parametreleri incelendi. SOFA, APACHE II ve Charlson Komorbidite Skoru (CCS) hesaplandi. 28 gunluk mortaliteyi etkiledigi dusunulen laboratuvar parametreleri ve hastalik risk skorlarinin degerlendirilmesinde Backward LR modeli kullanilarak lojistik analiz yapildi. Bulgular: Calisma, dahil edilme kriterlerini karsilayan 40'i (% 39,6) kadin ve 61'i (% 60,4) erkek olmak uzere 101 hasta ile gerceklestirildi. Hastalarin yaslari 21 ile 88 arasinda degismekte olup, ortalama yas 58,45 + or - 15,41 yildi. Ortalama yogun bakima yatis suresi 12,5 + or - 10,2 gundu. Tum nedenlere bagli hastane ici olum orani% 61,4'tu. Hayatta kalmayanlarda lokosit sayisi, CK, NT- proBNP, PCT, CRP, ferritin, notrofil sayisi ve yuzdesi, D-Dimer, LDH, AST degerleri anlamli olarak yuksek bulundu. Hayatta kalmayanlarda lenfosit sayisi ve yuzdesi ile trombosit sayisi degerleri anlamli olarak dusuk bulundu. Lenfosit yuzdesi, LDH ve CCS, cok degiskenli analizde 28 gunluk mortalitede anlamliydi (p degerleri sirasiyla 0,01, 0,003, 0,008'dir). Sonuclar: Yuksek lenfosit degerlerinin COVID-19 teshisi konan hastalarda olum riskini onemli olcude azalttigi goruldu. Yogun bakim unitesinde 28 gunluk mortaliteyi ongormede en basarili parametreler lenfosit yuzdesi, LDH ve CCS olarak degerlendirildi. Anahtar kelimeler: Siddetli COVID-19, Mortalite, Risk faktorleri, YBU hastalari
INTERPRETATION : Dans cette etude, la mortalite chez les patients gravement malades de la COVID-19 hospitalises dans une USI a ete moins elevee que chez les patients d'etudes precedentes. Ces ...resultats donnent a penser que le pronostic des cas graves de COVID-19 pourrait ne pas etre aussi sombre que ce qui avait d'abord ete rapporte.
Background/Purpose: This study aimed to investigate the experiences of intensive care nurses who provided care for COVID-19 patients during the pandemic period.
Methods: This study is a descriptive ...phenomenological study with thematic analysis. Semi-structured interviews were conducted with 10 intensive care nurses in a pandemic hospital which has a total of seven intensive care units with a capacity of 88 beds in northwestern Turkey.
Results: Five main themes and 13 sub-themes emerged from the analysis. The main themes were Professional relations, working conditions, safety, nursing care and psychological aspect.
Conclusion: Intensive care nurses are experiencing intense emotional burden, fear of the unknown, perception of insufficiency and increased workload during the COVID-19 pandemic. Nursing care has been affected by the changes in the course of the disease and isolation.
Operating-room crises (e.g., cardiac arrest and massive hemorrhage) are common events in large hospitals but can be rare for individual clinicians. Successful management is difficult and complex. We ...sought to evaluate a tool to improve adherence to evidence-based best practices during such events.
Operating-room teams from three institutions (one academic medical center and two community hospitals) participated in a series of surgical-crisis scenarios in a simulated operating room. Each team was randomly assigned to manage half the scenarios with a set of crisis checklists and the remaining scenarios from memory alone. The primary outcome measure was failure to adhere to critical processes of care. Participants were also surveyed regarding their perceptions of the usefulness and clinical relevance of the checklists.
A total of 17 operating-room teams participated in 106 simulated surgical-crisis scenarios. Failure to adhere to lifesaving processes of care was less common during simulations when checklists were available (6% of steps missed when checklists were available vs. 23% when they were unavailable, P<0.001). The results were similar in a multivariate model that accounted for clustering within teams, with adjustment for institution, scenario, and learning and fatigue effects (adjusted relative risk, 0.28; 95% confidence interval, 0.18 to 0.42; P<0.001). Every team performed better when the crisis checklists were available than when they were not. A total of 97% of the participants reported that if one of these crises occurred while they were undergoing an operation, they would want the checklist used.
In a high-fidelity simulation study, checklist use was associated with significant improvement in the management of operating-room crises. These findings suggest that checklists for use during operating-room crises have the potential to improve surgical care. (Funded by the Agency for Healthcare Research and Quality.).
Background Dysphagia appears to be common in patients with severe COVID-19. Information about the characteristics of dysphagia and laryngeal findings in COVID-19 patients treated in the intensive ...care unit (ICU) is still limited. Objectives The aim of this study was to evaluate oropharyngeal swallowing function and laryngeal appearance and function in patients with severe COVID-19. Method A series of 25 ICU patients with COVID-19 and signs of dysphagia were examined with fiberendoscopic evaluation of swallowing (FEES) during the latter stage of ICU care or after discharge from the ICU. Swallowing function and laryngeal findings were assessed with standard rating scales from video recordings. Results Pooling of secretions was found in 92% of patients. Eleven patients (44%) showed signs of silent aspiration to the trachea on at least one occasion. All patients showed residue after swallowing to some degree both in the vallecula and hypopharynx. Seventy-six percent of patients had impaired vocal cord movement. Erythema of the vocal folds was found in 60% of patients and edema in the arytenoid region in 60%. Conclusion Impairment of oropharyngeal swallowing function and abnormal laryngeal findings were common in this series of patients with severe COVID-19 treated in the ICU. To avoid complications related to dysphagia in this patient group, it seems to be of great importance to evaluate the swallowing function as a standard procedure, preferably at an early stage, before initiation of oral intake. Fiberendoscopic evaluation of swallowing is preferred due to the high incidence of pooling of secretion in the hypopharynx, silent aspiration, and residuals. Further studies of the impact on swallowing function in short- and long-term in patients with COVID-19 are warranted.
Purpose To evaluate if reduced muscle mass, assessed with Computed Tomography (CT), is a predictor of intensive care unit (ICU) hospitalization in COVID-19 patients. Methods In this Institution ...Review Board approved study, we retrospectively evaluated COVID-19 patients treated in our tertiary center from March to November 2020 who underwent an unenhanced chest CT scan within three weeks from hospitalization.We recorded the mean Hounsfield Unit (Hu) value of the right paravertebral muscle at the level of the 12.sup.th thoracic vertebra, the hospitalization unit (ICU and COVID-19 wards), clinical symptoms, Barthel Index, and laboratory findings.Logistic regression analysis was applied to assess if muscle loss (Hu<30) is a predictor of ICU admission and outcome.Fisher's exact and Student's tests were applied to evaluate if differences between patients with and without muscle loss occurred (p<0.05). Results One-hundred-fifty patients matched the inclusion criteria (46 females; mean age±SD 61.3±15 years-old), 36 treated in ICU. Patients in ICU showed significantly lower Hu values (29±24 vs 39.4±12, p = 0.001). Muscle loss was a predictor of ICU admission (p = 0.004).Patients with muscle loss were significantly older (73.4±10 vs 56.4±14 years), had lower Barthel Index scores (54.4±33 vs 85.1±26), red blood-cell count (3.9±1 vs 4.6±1x10.sup.12 L.sup.-1 ), and Hb levels (11.5±2 vs 13.2±2g/l) as well as higher white blood-cell count (9.4±7 vs 7.2±4x10.sup.9 L.sup.-1 ), C-reactive protein (71.5±71 vs 44±48U/L), and lactate dehydrogenase levels (335±163 vs 265.8±116U/L) (p<0.05, each). Conclusions Muscle loss seems to be a predictor of ICU hospitalization in COVID-19 patients and radiologists reporting chest CT at admission should note this finding in their reports.
INTERPRETATION : Dans cette etude, la mortalite chez les patients gravement malades de la COVID-19 hospitalises dans une USI a ete moins elevee que chez les patients d'etudes precedentes. Ces ...resultats donnent a penser que le pronostic des cas graves de COVID-19 pourrait ne pas etre aussi sombre que ce qui avait d'abord ete rapporte.
Protocolized sedation and daily sedation interruption are 2 strategies to minimize sedation and reduce the duration of mechanical ventilation and intensive care unit (ICU) stay. We hypothesized that ...combining these strategies would augment the benefits.
To compare protocolized sedation with protocolized sedation plus daily sedation interruption in critically ill patients.
Randomized controlled trial of 430 critically ill, mechanically ventilated adults conducted in 16 tertiary care medical and surgical ICUs in Canada and the United States between January 2008 and July 2011.
Continuous opioid and/or benzodiazepine infusions and random allocation to protocolized sedation (n = 209) (control) or to protocolized sedation plus daily sedation interruption (n = 214). Using validated scales, nurses titrated infusions to achieve light sedation. For patients receiving daily interruption, nurses resumed infusions, if indicated, at half of previous doses. Patients were assessed for delirium and for readiness for unassisted breathing.
Time to successful extubation. Secondary outcomes included duration of stay, doses of sedatives and opioids, unintentional device removal, delirium, and nurse and respiratory therapist clinical workload (on a 10-point visual analog scale VAS).
Median time to successful extubation was 7 days in both the interruption and control groups (median IQR, 7 4-13 vs 7 3-12; interruption group hazard ratio, 1.08; 95% CI, 0.86-1.35; P = .52). Duration of ICU stay (median IQR, 10 5-17 days vs 10 6-20 days; P = .36) and hospital stay (median IQR, 20 10-36 days vs 20 10-48 days; P = .42) did not differ between the daily interruption and control groups, respectively. Daily interruption was associated with higher mean daily doses of midazolam (102 mg/d vs 82 mg/d; P = .04) and fentanyl (median IQR, 550 50-1850 vs 260 0-1400; P < .001) and more daily boluses of benzodiazepines (mean, 0.253 vs 0.177; P = .007) and opiates (mean, 2.18 vs 1.79; P < .001). Unintentional endotracheal tube removal occurred in 10 of 214 (4.7%) vs 12 of 207 patients (5.8%) in the interruption and control groups, respectively (relative risk, 0.82; 95% CI, 0.36-1.84; P = .64). Rates of delirium were not significantly different between groups (53.3% vs 54.1%; relative risk, 0.98; 95% CI, 0.82-1.17; P = .83). Nurse workload was greater in the interruption group (VAS score, 4.22 vs 3.80; mean difference, 0.41; 95% CI, 0.17-0.66; P = .001).
For mechanically ventilated adults managed with protocolized sedation, the addition of daily sedation interruption did not reduce the duration of mechanical ventilation or ICU stay.
clinicaltrials.gov Identifier: NCT00675363.
INTERPRETATION : Les corticosteroides pourraient reduire le risque de mortalite pour les patients atteints de la COVID-19 avec SDRA. Pour les patients atteints d'une forme grave de COVID-19 sans ...SDRA, les donnees sur les benefices provenant de differentes sources sont incoherentes et de tres faible qualite.
This study aimed to analyze the Turkish validity and reliability of a scale to be used for the assessment of post- intensive care syndrome in patients surviving in the intensive care unit. This is a ...methodological study in which the Turkish version of the "Post-Intensive Care Syndrome Scale" developed by Jeong and Kang (2019) was performed. The population of the study consists of 350 people. The sample consisted of 225 patients due to voluntary participation, unavailability, and death. The researchers collected data by applying the Post-Intensive Care Syndrome Scale. The data in the scale were measured as a number, percentage, standard deviation, minimum, maximum, and mean. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were applied for language and content validity and construct validity of the scale. There was a high level of agreement between the expert opinions regarding the items of the scale in terms of content validity of the "Post Intensive Care Syndrome Scale" (CSR=0.96). Exploratory factor analysis revealed that the scale has a three-factor structure, 17 items explained 69.64% of the total variance, and factor loadings ranged between 0.48-0.86. According to confirmatory factor analysis, Chi-square/sd=2.719 non-normed fit index=0.89 and comparative fit index=0.93. Cronbach's alpha reliability coefficient was 0.93. The study results showed the Turkish version of the Post-Intensive Care Syndrome. Scale meets the Turkish version criteria at an acceptable level and can be used in scientific research. Keywords: Intensive care, Post-intensive care syndrome, Scale, Validity, Reliability
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