Enteral Nutrition Target of Critical Patients in The Intensive Care Unit

Amaç: Beslenme desteği, yoğun bakım ünitesindeki (YBÜ) hastaların tedavisinin önemli bir parçası olup enteral beslenme ilk tercih edilen yoldur. Bu çalışmada, yoğun bakım ünitemize başvuran hastalar için beslenme desteği başlama zamanı, beslenme hedefine ulaşma düzeyi, bunun sürdürülebilirliği ve hedefe ulaşmada karşılaşılan nedenlerin araştırılması planlandı.Çalışma planı: Çalışmaya Acil Yoğun Bakım Ünitesinde 01.01.2017 ve 31.12.2018 tarihleri ​​arasında takip edilen 18-90 yaş arası yetişkin hastalar dahil edildi ve çalışma retrospektif olarak planlandı. Hastaların demografik özellikleri, beslenme desteği başlama zamanı, hedefe ulaşma zamanı, enteral beslenme sırasında karşılaşılan beslenmeyi durdurma nedenleri değerlendirildi.Bulgular: 152 hasta analiz edildi ve enteral beslenen 49 hasta araştırıldı. Hastalarda enteral beslenme desteği nazogastrik tüp (% 93) ve perkütan endoskopik gastrostomi (PEG) (% 7) ile sağlandı. Enteral beslenmeye başlama süresi ortalama 10.3 (± 8.6) saat olarak bulundu. Hedefe ulaşmak için ortalama süre, hastaların %96'sında 14,1 (± 5,9) saat olarak gözlendi. 2 hastada, kusma ve aşırı gastrik rezidü volüm nedeniyle hedef doza ulaşılamadı. Otuz (% 61) hastada beslenme sırasında problem yaşandı ve enteral beslenme kesintiye uğradı.Sonuç: 48 saatten fazla yoğun bakımda yatan kritik hastalar yetersiz beslenme için risk altında sayılmalıdır. Yoğun bakıma yatan hastalarda, ağızdan alım yoksa 48 saat içinde enteral beslenmeye başlanılması önerilir (erken enteral beslenme). Anahtar Sözcükler: erken enteral beslenme, beslenme hedefi, malnütrisyo

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