Prospective evaluation of the recalibrated PRE-DELIRIC model for early detection of intensive care delirium

Deliryum, yoğun bakımda (YB) önemli bir sorundur ve artan mekanik ventilasyon (MV) süresi, daha yüksek mortalite ve daha uzun süreli bilişsel işlev bozukluğu gibi olumsuz hasta sonuçları ile ilişkilidir. Bu nedenle deliryumun erken tespiti önem arz etmektedir. Bu çalışmanın amacı, bir deliryum erken tespit modelinin YB hastalarında öngörü yeteneğini prospektif olarak değerlendirmektir. Araştırma, tek merkezli prospektif olarak Mart 2022-Mayıs 2022 tarihleri arasında yürütüldü. Araştırmanın yürütüldüğü tarih aralığında YB’ne kabulü yapılan ve 24 saatten fazla izlenmesi beklenen, 18 yaş üstü hastalar çalışmaya dâhil edildi. Araştırmanın verileri; “Hasta Tanıtım Formu”, “Yoğun Bakım Ünitesinde Konfüzyon Değerlendirme Metodu”, “Richmond Ajitasyon Sedasyon Skalası” ve rekalibre edilmiş “PRE-DELIRIC model” ile toplandı. Araştırmanın örneklemini belirtilen tarih aralığında dâhil edilme kriterlerine uyan 188 hasta oluşturdu. Deliryumlu hastalarda ortalama PRE-DELIRIC skoruna göre (30.32±8.36) ROC eğrisi altındaki alan (AUROC), modelin deliryumu öngörmedeki ayırt edici gücünün 0.937 (%95 güven aralığı: 0.903-0.972) olarak anlamlı olduğunu gösterdi (p=0.001). Modelin %19 kesme değeri ile duyarlılığının %87.5, özgüllüğünün %87.1 olduğu saptandı. Sonuç olarak, rekalibre edilmiş PRE-DELIRIC modelin, YB hastalarında deliryum riskini belirlemede iyi ayırt edicilik özellikler gösterdiği belirlenmiştir. Hesaplaması kolay bu model, hemşirelerin ve hekimlerin YB hastalarında deliryum riskini tahmin etmesine ve erken dönemlerde gerekli önlemleri almalarına yardımcı olacaktır.Delirium is a common problem in intensive care units (ICU) and is associated with adverse patient outcomes such as increased mechanical ventilation (MV) duration, higher mortality, and greater longer-term cognitive dysfunction. Therefore, early detection of delirium is important. The aim of this study was to prospectively evaluate the predictive ability of a delirium early detection model in ICU patients. The study was conducted as a single-center prospective study between March 2022 and May 2022. The study included patients aged over 18 years who were admitted to the intensive care unit during the study period and expected to be followed up for longer than 24 hours. The data of the study were collected with the “Patient Identification Form”, “The Confusion Assessment Method for ICU”, “Richmond Agitation Sedation Scale” and the recalibrated “PRE-DELIRIC model”. The sample of the study consisted of 188 patients who met the inclusion criteria within the specified date range. The area under the ROC curve (AUROC) according to the mean PRE-DELIRIC score (30.32±8.36) in patients with delirium showed that the discriminative power of the model in predicting delirium was significant as 0.937 (95% confidence interval: 0.903-0.972) (p=0.001). In conclusion, it has been determined that the recalibrated PRE-DELIRIC model has good discriminative properties in determining the risk of delirium in ICU patients. This easy-to-calculate model will help nurses and physicians predict the risk of delirium in patients and take the necessary precautions in the early stages

Amitriptyline Cardiac Toxicity Treated with Hemoperfusion

Tricyclic antidepressant intoxication is frequently encountered among children and adults due to widespread use of the drugs. Amitriptyline is among the major tricyclic antidepressants. It affects the cardiovascular, respiratory and central nervous system. In the treatment of amitriptyline intoxication, various treatments such as gastric lavage, activated charcoal, bicarbonate infusion, antiarrhythmic, and anticonvulsant drug usage were applied. Here, we reported a patient with severe amitriptyline intoxication who did not respond to these treatments but dramatically improved with hemoperfusion. A 33 year-old woman applied to the emergency service half an hour later ingesting 2000 mg of amitriptyline as a suicide attempt. On admission, her Glasgow coma scale (GCS) was 10, blood pressure was 100/60 mmHg, heart rate was 160 beats/min. Wide QRS and ventricular tachycardia was seen in the Electrocardiography (ECG) results. Having her GCS regressed to 7, she was intubated and admitted to intensive care unit after the initial treatments. Hemoperfusion was commenced within half an hour. While hemoperfusion was continuing, her ECG was seen to turn to sinus tachycardia. Her cardiovascular and neurological status returned to normal on the 2nd day and she was discharged from the intensive care unit on the 4th day. Besides hemoperfusion is not recommended due to high protein binding and large volume of distribution in classical treatment of amitriptyline overdose, current reports representing efficacy of hemoperfusion are also accumulating. After ingestion, tricyclic antidepressants are absorbed rapidly and reach to their effective concentration in the tissues, especially by the lung, the brain and the heart. Hence, hemoperfusion performed in early stage of ingestion is an effective treatment and in cases that do not respond to conventional therapies, it should be considered that this method can be used in the early period

The impact of the COVID-19 pandemic on tracheostomy applications in the COVID and non-COVID intensive care units: A single-center experience

Objective: In the early stages of the pandemic, there were reservations about early tracheostomy due to the high risk of infection transmission. We reported the clinical characteristics and outcomes of patients who underwent an elective tracheostomy during the pandemic.Materials and Methods: The data from patients who underwent the elective tracheostomy between March 20, 2020, and January 01, 2021, were evaluated retrospectively. Medical records were analyzed for age, gender, comorbidities, complications, and outcomes. The duration from intubation to tracheostomy and the length of intensive care unit (ICU) and hospital stay were calculated. The data of coronavirus disease-2019 (COVID-19) patients (group I) and non-COVID-19 patients (group II) were compared. Additionally, early tracheostomy (14 days) groups were compared in terms of clinical outcomes.Results: A total of 144 patients, 70 of whom were diagnosed with COVID-19, were included. Tracheostomy was performed on the median 19th day in both groups (p=0.85). Percutaneous tracheostomy (68.6%) was performed more frequently in COVID-19 patients. The time of tracheostomy application had no positive effect on mortality in either groups. Bleeding occurred less frequently in group I.Conclusion: Percutaneous tracheostomy was performed more frequently in COVID-19 patients. Percutaneous tracheostomy is feasible to be conducted by the ICU team at the bedside with few complications

The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye

Background:Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear.Aims:To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19.Study Design:Multicenter prospective observational clinical study.Methods:This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated.Results:As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004).Conclusion:Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients

Franchismo

We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study