A Study of Cerebral Performance Categories Based on Initial Rhythm and Resuscitation Time Following In-Hospital Cardiac Arrest in a State Hospital in Turkey

Background: The cerebral performance category (CPC) score is widely used in research and quality assurance to assess neurologic outcome following cardiac arrest. However, little is known about the results of the CPC in Turkey. Objective: This study aimed to determine whether the CPC is associated with the initial rhythm and resuscitation time following resuscitation from in-hospital cardiac arrest. Methods: This study compared the CPCs (CPC 1-2 and CPC 3-4-5) of patients discharged from the hospital after surviving cardiopulmonary arrest (CPA) during a 2-year period between June 2013 and June 2015 (at discharge, and at 6th, 12th, 18th, and 24th months) based on the initial rhythm (asystole/pulseless electrical activity and ventricular fibrillation/pulseless ventricular tachycardia) and resuscitation time (0–14 min and 15–30 min) at the time of arrest. Results: No difference was found between CPC 1-2 and CPC 3-4-5 scores at discharge or at 6th, 12th, 18th, and 24th months in terms of the first rhythm and resuscitation time (P > 0.05). Conclusion: Patients discharged from the hospital following in-hospital cardiopulmonary resuscitation (CPR) were found to have no difference in 2-year CPC scores with respect to cardiac rhythms and resuscitation durations at the onset of resuscitation

Yoğun Bakımdaki Kritik Hastalarda Akut Böbrek Hasarında Renal Replasman Tedavisi Kararı ve Zamanlaması

Yoğun bakım ünitelerinde YBÜ takip edilen kritik hastalarda gelişen akut böbrek hasarı ABH önemli bir morbidite ve mortalite nedenidir. Bu hastalarda yapılan renal replasman tedavilerinin RRT başlatılmasında hangi kriterlerin kullanılacağı ve tedavinin ne zaman başlatılacağı soruları net olarak cevaplanmış değildir. Bu derlemede YBÜ’de RRT başlangıcını belirleyen faktörler incelendi. Ayrıca hastaların üre-kreatinin seviyeleri, idrar çıkışı-sıvı yükü, YBÜ yatışı ile RRT başlangıcı arasında geçen süre, prognostik faktörler ve bazı belirteçlere göre başlatılan erken ve geç RRT çalışmaları incelendi. Sonuçta YBÜ’de kritik hastalarda RRT başlangıcını belirleyen kriterler ve bu kriterlerin eşik değerlerinin kişiselleştirilmesi gerektiği düşünüld

Pulmonary Involvement of Diffuse Large B-cell Lymphoma with Cavitary Lesions

Abstract Diffuse large B-cell lymphoma (DLBCL) is the most common type of extranodal lymphoma. Typically disease occurs fastly growing nodal or extranodal masses with systemic symptoms. Pulmonary involvement may also occur in DLBCL. Here we present a DLBCL with cavitary lesions in the lung. A 59-year-old male was diagnosed with DLBCL through an endoscopic gastric biopsy that was performed 1.5 years ago. After six course of R-CHOP chemotherapy, the relaps of disease was confirmed with mediastinoscopy. Despite two courses of RICE chemotherapy and one course of R-BAB therapies, the patient was admitted to the intensive care unit with shortness of breath and tachypnea. Thorax computed tomography showed a mass lesion that enclosed and narrowed the right major bronchus and multiple lesions with cavitation. The infections were excluded with bronchoscopy. The patient received pulse steroid therapy, radiotherapy and three courses of Hyper-CVAD chemotherapy. In the control thorax CT, cavitary lesions got smaller, respiratory insufficiency of patient improved. When pulmonary cavitary lesions are observed in patients under follow-up with the diagnosis of lymphoma, the pulmonary involvement of lymphoma should also be considered in addition to the infectious agents

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Airway Management of “At-Risk Extubation'” in Intensive Care

Extubation failure due to airway problems is rare in critically ill patients. Intensive care mortality and morbidity among patients having extubation failure due to airway problems are less than among those requiring re-intubation due to respiratory failure. This is due to the fact that the latter group of patients is mostly comprised of postoperative patients. Postoperative extubation failure may arise because of many possible mechanical problems due to the patient, surgery or anesthesia. Problems which cause the obstruction of upper airways may not give symptoms until tracheal extubation is performed. Obesity, obstructive sleep apnea syndrome, major head and neck surgery, upper airway surgery and cervical column operations are hazardous conditions affecting extubation success. Upper airway obstructing conditions like edema, soft tissue collapse and laryngospasm are frequently observed in this group of patients and because of these conditions, it may become hard to ensure airway integrity after extubation. For this reason, it is necessary to identify the postoperative patients who are expected to have difficult extubation processes and to transfer them to intensive care unit for a careful and planned extubation process. In this review, an efficient strategy for a successful extubation will be explained for patients having high risks for extubation failure and difficult airway problems

Natural Radioactivity Concentration of Peanuts in Osmaniye-Turkey.

The peanut is grown in Osmaniye where located in southern Turkey. Due to it is grown underground, the measurements of natural radioactivity of peanuts become important. For this reason some peanut samples have been collected from different places of Osmaniye and the measurements of natural activity concentrations for 40K, 226Ra and 232Th in some peanuts samples have been carried out using a NaI(Tl) gamma-ray spectrometer. Activity of 40K was measured from its intensive line at 1460 keV, for 226Ra activity peak from 214Bi at 1760 keV and 232Th activity, peak from 208Tl at energy of 2610 keV was used