Sequential Application of Oxygen Therapy via High-flow Nasal Cannula and Non-invasive Ventilation in COVID-19 Patients with Acute Respiratory Failure in the Intensive Care Unit: A Prospective, Observational Study

Objective:Non-invasive mechanical ventilation (NIV) and high-flow nasal oxygen therapy (HFNO) are the most frequently used methods for treating hypoxemia in those diagnosed with coronavirus disease-2019 (COVID-19) in the intensive care unit (ICU). In this prospective study, we compared the effects of these two treatment modalities applied alternately in the same patient.Materials and Methods:Standard oxygen therapy (SOT) was administered for 1 hour to patients hospitalized in the ICU with a diagnosis of acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) due to COVID-19. HFNO and NIV were applied alternately to patients who met the inclusion criteria, and we evaluated the effects of HFNO and NIV applied to the same patient.Results:Thirty of forty-five patients admitted to the ICU for COVID-19 ARDS met the inclusion criteria for the study. According to the first and second arterial blood gas (ABG) values, the PaO2/FiO2 (P/F) ratio was significantly higher during NIV compared to both baseline and HFNO. In addition, the ROX index was significantly higher during NIV than HFNO, and SpO2 in NIV increased significantly compared with the baseline value. In both methods, patient satisfaction according to the visual analog scale was better than that of SOT. Eighty percent (24/30) of the patients were orotracheally intubated; 13 patients were transferred to the ward (43.3%), 2 patients were discharged home (6.7%), and 15 patients died (50%).Conclusion:Starting respiratory support with HFNO and/or NIV rather than SOT is more effective in improving oxygenation in patients with AHRF and ARDS due to COVID-19 and other causes. NIV is more effective than HFNO in increasing the SpO2 and P/F ratio

Comparison of routine laboratory tests and thromboelastogram results in sepsis related coagulation defects

Sepsis tüm dünyada morbidite ve mortalite açısından önemli bir sorun teşkil etmektedir. Tanı ve tedavi anlamında gelişmeler halen devam etmektedir. Erken tanı ve erken tedavinin mortalite üzerine olumlu etkileri gösterilmiştir. Son yıllarda sepsis fizyopatolojisinin aydınlatılmasında önemli gelişmelerden biri koagülasyon kaskadının sepsis sürecindeki öneminin anlaşılmasıdır. Sepsiste sitokinler koagülasyonu tetikleyici bir etki gösterir. Koagülasyon kaskadında her iki yönde bozukluklar saptanırken hastalarda kanamaya eğilim ve tromboz gözlenebilir. Biz bu çalışmada yoğun bakım ünitesinde sepsis nedeniyle takip edilen hastalarda rutin izlenen konvansiyonel pıhtılaşma parametreleriyle, tromboelastogram (TEG) sonuçlarının korelasyonunu görmeyi, sepsis takibinde TEG sonuçlarını izlemleyerek sepsis markerlarıyla olan ilişkisini değerlendirmeyi amaçladık. Hastaların 0,3,5,7.ve 14.günlerde çalışılan TEG sonuçları ve eş zamalı biyokimya sonuçları incelendi. Hastaların R zamanı, maximum amplitüde, alfa açısı değerleri incelendiğinde 7. ve 14. Günlerde mortalite ile sonuçlanan hasta grubunda istatiksel olarak anlamlı fark saptandı. (p0.05). Takip edilen 40 hastada TEG parametreleri ileri derecede bozulmuş olanlarda mortalite yüksek olarak bulundu. Sonuç olarak yatak başı viskoelastik ölçüm yöntemlerinden olan tromboelastografinin, sepsis takibinde kullanılmasının faydalı olacağını düşünmekteyiz.Sepsis is an important issue in whole world in terms of mortality and morbidity. Diagnosis and treatment developments have still continued. Early diagnosis and treatment have positive effects on mortality. One of the important new development about illumination of sepsis physiopathology has been that appearance of the importance of coagulation cascade in sepsis process. Cytokines in sepsis have a triggering effect on coagulation. While coagulation cascade has disturbances in both directions, patients may have a tendecy to bleed and thrombosis. In this study, we aimed to see correlation of conventional parametres and thromboelastogram (TEG) results in patients hospitalized for sepsis in the intensive care unit, to observe TEG results in sepsis follow up and to evaluate its relationship with sepsis markers. TEG results of the patients were studied on 0, 3,5, 7. and 14th days of admission. When the R time, maximum amplitude and alpha angle values of the patients were examined, statistically significant differences were found in the patient group which resulted in mortality on 7th and 14th days (p0.05). Among the 40 sepsis patients, the ones who had severe TEG parameters were found to have higher mortality rates. As a result, we think that thromboelastography, which is one of the bedside viscoelastic measurement methods, may be useful in the follow-up of sepsis coagulation defects

Effect of perioperative terlipressin infusion on recipient's hepatic and renal functions in living donor liver transplantations

WOS: 000411688504243