Investigating the incidence and causes of difficult mask ventilation in geriatric patients

Amaç: Dünyanın birçok gelişmiş bölgesinde toplam nüfusun en hızlı artan bölümünü geriatrik popülasyon oluşturmaktadır. Ortalama yaşam ömrünün uzaması geriatrik popülasyonun artmasına ve cerrahi girişimlere maruz kalacak olan geriatrik hastaların anestezi uygulamalarının daha özellikli hale gelmesine neden olmuştur. Havayolu yönetiminin temelini maske ventilasyonu oluşturur. Ayrıca başarılı maske ventilasyonu endotrakeal entübasyonla veya diğer yöntemlerle (trakeostomi, krikotirotomi gibi) güvenli havayolu sağlanamamış olgularda oksijenizasyona ve ventilasyona olanak sağlayan hayat kurtarıcı bir temel havayolu yönetimi tekniğidir. Bu çalışmanın amacı geriatrik hastalarda zor maske ventilasyonu insidansının ve nedenlerinin saptanması, ayrıca günlük ameliyathane pratiğinde karşılaşılan geriatrik hasta popülasyonunun belirlenmesidir. Gereç ve yöntemler: Bu çalışma genel anestezi altında elektif olarak opere edilecek 65 yaş ve üzeri ASA 1-4 sınıfından toplam 254 hasta üzerinde yapıldı. Çalışmaya alınan hastalar operasyondan bir gün önce tarafımızca değerlendirildi ve Langeron ve ark. nın zor maske ventilasyonu formundan modifiye edilen ZMV 1 (zor maske ventilasyonu) formu dolduruldu. Operasyon günü hastalar yüz maskesi ile solutulduktan sonra, Han ve ark. nın zor maske ventilasyonu skalasını içeren ZMV 2 formu dolduruldu. Günlük ameliyathane pratiğinde opere olan geriatrik hasta popülasyonunun ne kadar olduğunu belirlemek, geriatrik hastalarda zor maske ventilasyonu nedenlerini ve sıklığını saptamak için mevcut formlar değerlendirmeye alındı. Bulgular SPSS 15 programında oluşturulan veri tabanına girildi. Kruskal Wallis, Man Whitney U ve Chi-square testi kullanılarak mevcut değişkenler karşılaştırıldı. Tüm testlerde 1. tip hata payı, ? : 0.05 olarak seçildi ve çift yönlü olarak test edildi, 'p' değerinin 0.05?ten küçük olması durumunda gruplar arası fark, istatistiksel olarak anlamlı kabul edildi. Bulgular: Çalışmanın yapıldığı Kasım 2012 - Mayıs 2013 tarihleri arasındaki sekiz aylık sürede Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi merkezi ameliyathane, günübirlik cerrahi hastanesi ve ameliyathane dışı anestezi merkezlerinde toplam 2500 geriatrik hasta opere edildi. Bunlardan merkezi ameliyathanede genel anestezi ile opere edilen 254 tanesi çalışmaya alındı. Çalışmaya alınan hastaların %32.7?si grade 1 maske ventilasyonu, %54.7?si grade 2 maske ventilasyonu, %12.6?sı grade 3 maske ventilasyonu olarak saptandı. Grade 4 maske ventilasyonuna hiç rastlanmadı. Hastaların mallampati skoru, ağız açıklığı mesafesi, tiromental mesafesi, sternomental mesafesi, mandibular protruzyon testi, horlama öyküsü, dişsizlik, vücut kitle indeksi, boyun hareketleri, anestezi indüksiyonunda opiyat ajan ve kas gevşetici ajan kullanımı zor maske ventilasyonu ile ilişkili bulunmadı. Hastanenin sistem analiz biriminden elde edilen verilere göre Ocak 2012 ile Ocak 2013 tarihleri arasındaki bir yıllık sürede hastanede her hasta için yapılan operasyonun içeriğine göre bir veya birden fazla cerrahi işlem kodu girilmiş olup toplam 27.381 adet cerrahi işlem kodlanmıştır. Bu cerrahi işlem kodlarının 7948 tanesi 65 yaş ve üzeri hastaları içermektedir. Bu verilere göre cerrahi operasyon geçiren geriatrik hasta popülasyonu toplam cerrahi operasyon geçiren hasta popülasyonunun %29?u kadar bulundu. Sonuç: Çalışmada geriatrik hasta popülasyonunda zor maske ventilasyonu insidansı %12.6 olarak bulundu. Erkek cinsiyet, boyun çevresinin kalın olması, erkek hastalarda sakal varlığı ve anestezi hekiminin tecrübesi zor maske ventilasyonu için bağımsız risk faktörü olarak saptandı Objective: The geriatric population constitutes the fastest growing part of the population in many developed regions worldwide. Increase in the average life span has led to a growth of geriatric population as well as the anesthesia applications to become more specific for the geriatric patients who are potantially subject to surgical procedures. Mask ventilation is the basic element of the airway management. Furthermore, successful mask ventilation is a life-saving basic airway management technique that enables oxygenation and ventilation in airways that endotracheal intubation or other techniques (tracheostomy, cricothyrotomy) have already failed. The aim ofthis study was to determine the incidence and the causes of difficult mask ventilation in geriatric patients, as well as to identify the geriatric patient population that may be encountered in daily practice in the operating room. Materials and methods: This study was conducted with a total of 254 ASA1-4 patients aged 65 and over, who will be electively operated under general anesthesia. We evaluated the participating patients the day before surgery and completed the DMV 1 (difficult mask ventilation) form, that we modified from Langeronet al.?s original form of difficult mask ventilation. At the day of surgery, following mask ventilation, the DMV 2 form, which included the scale of difficult mask ventilation of Han et al, was completed for the same patients. In order to detemine the size of the geriatric patient population operated in daily operating practice, as well as the causes and incidence of difficult mask ventilation in geriatric patients, current forms were evaluated. Findings were entered into the database created in the SPSS 15 program. The current variables were compared with Kruskal-Wallis, ManWhitney U and Chi-square test. For all tests, type 1 error was determined as ?: 0.05 and tested in a two-way analysis of variance, and ' p' value <0.05 was considered statistically significant for the differences between the groups. Results: We conducted our study between November 2012 and May 2013 and 2500 geriatric patients have been operated in the central operating room, ambulatory surgery hospital and non-operating room anesthesia centers of Dokuz Eylul University, Faculty of Medicine, University Hospital in this 8-month period. Out of these, 254 patients who were operated under general anesthesia in the central operating room center were included in the study. Of the enrolled patients, 32.7% were grade 1 mask ventilation, 54.7% grade 2 mask ventilation, 12.6% grade 3 mask ventilation. There was no grade 4 mask ventilation. Mallampati score, mouth opening, thyromental distance, sternomental distance, mandibular protrusion test, snoring history, edentation, body mass index, neck movements, opiate agent and muscle relaxant agent use during anesthetic induction were not correlated with difficult mask ventilation. According to the data obtained from the hospital system analysis unit, one or more surgical procedure codes have been entered according to the coverage of the operation performed for each patient and a total of 27.381 surgical procedures have been coded within one-year period between January 2012 and January 2013. Of these surgical procedure codes, 7948 implicated patients aged 65 years and over. According to these data, the percentage of geriatric patient population undergoing surgery was found to be 29% of the total population having undergone surgical operations. Conclusion: In this study, the incidence of difficult mask ventilation was found to be 12.6% in geriatric patient population. Male gender, thick neck circumference, having beard in male patients and experience level of the anesthesiologist were determined as independent risk factors for difficult mask ventilation

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