Clinical Characteristics of Patients with Methyl Alcohol Intoxication Followed up in the Intensive Care Unit and Factors Affecting Mortality

Objective:Methyl alcohol is a solvent obtained by the fermentation of wood and used in various fields industrially. Due to its cheap and easy accessibility, it is frequently used to manufacture moonshine and can lead to severe morbidity and mortality. This study aims to evaluate the clinical features of patients with methanol intoxication followed in the tertiary center intensive care unit (ICU) and determine the factors affecting mortality.Method:All patients aged 18 years and older who were followed up in the ICU for methanol intoxication between January 2016 and September 2022 were included in the study. Demographic characteristics, clinical data, and factors affecting mortality were evaluated retrospectively by classifying the patients as discharged and dead.Results:A total of 32 patients, 11 (34.3%) in the discharged group and 21 (65.7%) in the dead group, were included in the study. The mean age of the whole population was 41.5±8.8 years, and all were male. Of the population, 37.5% had central nervous system findings, 34.3% had visual disturbances, and 15.6% had gastrointestinal system complaints. Renal replacement therapy was administered to 93.7% of the patients, ethyl alcohol or fomepizole to 40.6%, and folate to 28.1%. High anion gap metabolic acidosis (pH23.2) and high lactate levels (lactate>5.27) were associated with poor outcomes.Conclusion:Although methanol intoxication is an important public health problem affecting especially young-middle-aged men, it is a significant cause of mortality. We think that developing effective policies can prevent methanol intoxication and related deaths

Classical Blind Percutaneous Dilatational Tracheostomy vs Fiberoptic Bronchoscopy Guided Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: Complications, Mortality, and Outcomes

Aim: This study aimed to compare percutaneous dilatational tracheostomy (PDT) procedures performed with fiberoptic bronchoscopy (FOB) guidance and classical blind technique regarding complications, mortality, and patient outcomes. Material and Methods: This study included 62 patients receiving mechanical ventilator support in the intensive care unit (ICU) between October 2022 and June 2023. Patients were randomized into two groups: those who underwent FOB-guided PDT (group FOB, n=31) and those who underwent PDT with the classical blind technique (group C, n=31). Demographic data, clinical characteristics, PDT procedure times, complications, and mortalities were analyzed. Results: The median age was 64 (range, 19-94) years, and 67.7% (n=42) of the patients were male. Demographic data were found similar between groups. The most common primary diagnosis in patients who underwent PDT was intracranial hemorrhages (32.3%, n=20). While the median tracheostomy opening time in the entire study group was 13 (range, 3-31) days, there was no significant difference between the groups (p=0.637). The mean PDT procedure time (9.6±3.8 vs 12.6±5.4 min, p=0.015), median ICU stay (26 vs 37 days, p=0.004), and complication rate (6.4% vs 25.8%, p=0.038) were found to be significantly lower in group FOB. While the 28-day mortality in the entire study group was 17.7% (n=11), there was no significant difference between the groups (p=0.740). Conclusion: In PDT procedures performed under FOB guidance, procedure time, length of stay in the ICU, and procedure-related complication rates were significantly lower, while no significant difference was observed in terms of mortality

Procedural sedation protocols with or without ketamine in pediatric gastrointestinal endoscopy: A retrospective cohort study

Objective: A considerable difference exists in pediatric endoscopy sedation practices with the optimal sedation protocol for gastrointestinal (GI) endoscopy a subject of controversy and to investigate the safety and efficacy of sedation protocols with or without ketamine in procedural sedation for pediatric GI endoscopy. Materials and Methods: A total of 78 pediatric patients who received sedation anesthesia for GI endoscopy were included in this retrospective study. Anesthesia parameters include duration time, doses of anesthetic agents, Ramsay sedation score, respiratory and hemodynamic parameters, recovery time, modified Aldrete recovery scores, and side effects. Study parameters were evaluated with respect to ketamine dose (no ketamine group (NKG), low-dose ketamine group (LDKG, ≤0.75 mg/kg), and high-dose ketamine group (HDKG, ≥1 mg/kg). Results: The upper GI endoscopy rate (58.12% vs. 90.0%, p=0.001) was significantly lower in LDKG versus HDKG. No significant changes were observed in blood pressure levels, oxygen saturation, or heart rate compared to baseline levels. No significant difference was noted between study groups in terms of recovery time, modified Aldrete recovery scores, and nausea/vomiting. Final Ramsay sedation scores were significantly higher in NKG (p<0.05) and LDKG (p<0.01) than in HDKG. Conclusion: Our findings indicate a favorable safety and efficacy profile for ketamine as a useful adjunct to procedural sedation for pediatric GI endoscopy, enabling better quality of sedation with a low risk of cardiorespiratory suppression, or serious complications

Effects of Ultrasonography-Guided Transversus Abdominis Plane Block on Postoperative Analgesia, Gastrointestinal Motility, and Mobilization in Patients Delivering Cesarean Delivery Under Spinal Anesthesia: A Retrospective Study

Aim: The aim of this study was to investigate the effect of ultrasonography (USG)-guided transversus abdominis plane (TAP) block on postoperative analgesia, gastrointestinal motility, and mobilization time in patients who had a cesarean section under spinal anesthesia. Material and Methods: The follow-up forms of the total 81 patients who had elective cesarean delivery under spinal anesthesia between March 2022 and June 2022 were reviewed retrospectively. The patients were divided into two groups, 41 patients as the TAP block applied group (group T) and 40 patients as the control group (group C). Demographic data of patients, visual analog scale (VAS) values at postoperative 2nd-, 4th-, 6th-, 12th-, and 24th-hour, tramadol requirements, non-steroidal anti-inflammatory drug (NSAID) and tramadol consumption, postoperative nausea-vomiting (PONV) status, initial gas release times and mobilization times were analyzed. Results: The VAS scores of the patients in group T at the postoperative period 2nd-, 4th-, and 6th-hour were significantly lower than those of group C (

Kısa Bir Soru: Amantadin Sülfat İnfüzyonu Yoğun Bakım Ünitesinde Hayat Kurtarıcı Olur mu?

Objective: Traumatic brain injury (TBI) is one of the leading causes that cognitive and behavioral problems. Many pharmacological therapies reveal early neurochemical changes. The CRS-R is a standardized neuro-behavioral evaluation tool comprising six organized subscales (auditory, visual, motor, oromotor–verbal, communication, and arousal). We hypothesized that, the effect of amantadine sulfate infusion treatment on conscious recovery and clinical improvement in patients with severe head injury in terms of CRS-R and clinical recovery. Material and Methods: Patients’ age, gender, days of hospitalization, pre-treatment and post-treatment GCS, education level, day of amantadine sulfate, intubated or non-intubated when he/she come to intensive care unit (ICU), recovery time of conscious, discharge time, CT or MR pathology will be retrospectively recorded. Patients were aged >18 years, had brain trauma, had amantadine sulfate therapy in ICU were included the study between June 2016-June 2017. Results: A total of 40 patients using amantadine sulfate infusion were included in the study. It was determined that 13 of patients had mortality. Improvement in CT and MRI findings were detected in 21 of the living patients (77.8%). There were no differences between the mean starting time according to the clinical recovery levels and recovery status on CT-MRI. There were statistically significant differences between starting time and time of extubation and starting time of consciousness recovery and discharge time. Conclusion: In conclusion, we believe that amantadine treatment accelerates neurological recovery in terms of CRS-R and clinical recovery in TBI patients.Amaç: Travmatik beyin hasarı (TBH), bilişsel ve davranışsal sorunların önde gelen nedenlerinden biridir. Birçok farmakolojik tedavi erken nörokimyasal değişiklikleri açıklamaktadır. CRS-R, altı organize alt ölçek (işitsel, görsel, motor, oromotor-sözel, iletişim ve uyarılma) içeren standartlaştırılmış bir nöro davranışsal değerlendirme aracıdır. Biz CRS-R ve klinik iyileşme açısından ağır kafa travmalı hastalarda amantadin sülfat infüzyon tedavisinin bilinç düzeyinde ve klinik iyileşme üzerindeki etkisini sunmayı amaçladık. Gereç ve Yöntemler: Hastaların yaşı, cinsiyeti, hastanede yatış günleri, tedavi öncesi ve tedavi sonrası GKS, eğitim düzeyi, amantadin sülfat günü, entübe gelip gelmediği, bilinçte düzelme zamanı, taburculuk süresi, BT veya MR patolojileri retrospektif olarak kaydedildi. Haziran-Haziran 2017 tarihleri arasında 18 yaş üstü, beyin travması geçiren, yoğun bakımda amantadin sülfat tedavisi alan hastalar çalışmaya dahil edildi. Bulgular: Çalışmaya amantadin sülfat infüzyonu kullanan toplam 40 hasta dahil edildi. Hastaların 13’ünde mortalite olduğu tespit edildi. Yaşayan hastaların 21’inde (%77,8) BT ve MR bulgularında iyileşme saptandı. Klinik iyileşme düzeylerine ve BT-MR'da iyileşme durumuna göre ortalama başlangıç zamanı arasında fark yoktu. Başlangıç zamanı ve ekstübasyon zamanı ile bilincin düzelme ve taburculuk süresinin zamanı arasında istatistik olarak anlamlı fark gözlendi. Tartışma: Sonuç olarak, amantadin sülfat tedavisinin, CRS-R açısından da değerlendirildiğinde TBH hastalarında klinik iyileşme ve nörolojik iyileşmeyi hızlandırdığını düşünüyoruz