High Flow Nasal Oxygen Therapy: From Physiology to Clinic

High-flow nasal oxygen (HFNO) therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNO in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNO for critical patients. This review summarizes the positive physiological effects, mechanisms of action, and the clinical applications of HFNO with available published literatures

Eroin Inhalasyonuna Bağlı Akut Eozinofilik Pnömoni

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HIV Positive Patient with Respiratory Insufficiency

HIV epidemic, itself, was first diagnosed after lung related mortality and morbidity among young men. Pneumocystis pneumonia, tuberculosis, atypical mycobacterial infections, cytomegalovirus (CMV) pneumonia and opportunistic fungal infections must be remembered in the differential diagnosis of human immunodeficiency virus (HIV) positive patients presenting with respiratory distress. A fifty-three year-old male patient with HIV associated nephropathy applied to our clinic due to fever and respiratory distress, which did not respond to broad-spectrum antibacterial treatment. HIV viral replication was suppressed for a year. His vaccination status was up-to-date against seasonal influenza and pneumococci. Massive pulmonary thromboembolism was diagnosed. The patient was put on a fibrinolytic treatment

The Interrater Reliability of Inferior Vena Cava Ultrasonography Performed by Intensive Care Fellows

Background and aim: Inferior vena cava (IVC) measurements by ultrasonography (USG) is a repeatable and noninvasive tool but it is sonographer dependent and requires experience. The aim of this study is to investigate the interrater reliability of IVC-USG measurements performed by intensive care fellows. Methods: After training, four first-year intensive care fellows and an experienced ultrasonography trainer performed IVC USG within 5 minutes of each other without the fellows knowing the clinical history, the fluid balance and the previous IVC USG measurements of the patients. The minimum IVC diameter (IVC-min) and the maximum diameter (IVC-max) were measured using both M-mode and B mode. IVC collapsibility index (IVC CI) and the IVC distensibility index (IVC-DI) were calculated. The interrater reliability of the measurements was analyzed using intraclass correlation coefficients (ICC) with 95% confidence intervals (CI). Results: One hundred and seven IVC-USG measurements were conducted on 29 ICU patients. The trainer measured the median (minimum-maximum) IVC-min as 1.20(0.63-2.60) cm, IVC max as 1.76(0.95- 3.09) cm, and calculated IVC-CI as 0.23(0.05-0.68), and IVC-DI 0.30 (0.05-2.10) with B mode. The same measurements with M mode were as 1.34 (0.46-2.53) cm, 1.75 (1.07-3.08) cm, 0.19 (0.09-0.66), and 0.23 (0.10-1.95) respectively. All measurements of all of the fellows showed significant moderate-good correlations with the trainer’s measurements and each other (ICC > 0.6-0.8, p504- 777, p<0.001). Conclusion: The interrater reliability of IVC diameters, IVC collapsibility and IVC distensibility measurements performed by intensive care fellows is moderate

Comparison of Cumulative Corticosteroid Doses for Critically Ill Patients with COVID-19

Introduction: Dexamethasone is the first medication that improved survival in patients with Coronavirus disease-2019 (COVID-19); however, the effects of corticosteroids with different cumulative doses on disease outcome must be elucidated. Our study aimed to compare clinical features, hospital mortality, and secondary infections in patients with COVID-19 receiving different cumulative doses of systemic corticosteroids. Materials and Methods: A retrospective, observational study was conducted on patients with COVID-19 admitted to intensive care unit between 21st March 2020 and 20th September 2020 to determine who did not receive systemic corticosteroids, who received low-to-moderate cumulative doses of corticosteroids as recommended by the RECOVERY trial [proposed 6 mg of dexamethasone (equivalent to 32 mg methylprednisolone)] for 10 days (total dose of ≤320 mg of methylprednisolone or equivalent doses of corticosteroids), and who received high cumulative doses of corticosteroids (total dose of >320 mg methylprednisolone equivalent). Results: Among 134 patients, 35 (26%) did not receive systemic corticosteroids, 34 (25%) received low-to-moderate cumulative doses of corticosteroids, and 65 (49%) received high cumulative doses of corticosteroids. Secondary bacterial (31.4% vs. 41.2% and 63.1%, p=0.006) and opportunistic infections (2.9% vs. 5.9% and 21.5%, p=0.011) were more frequently observed in the low-to-moderate- and high-dose corticosteroid groups compared with those in the no corticosteroid group. Hospital mortality was 20% in patients who did not receive steroids and 29.4% and 46.2% in patients who received low-to-moderate and high doses of corticosteroids, respectively (p=0.012). High cumulative doses of systemic corticosteroids were found to be the independent determinant for hospital mortality [Odds ratio (OR): 6.302 (1.856-21.394); p=0.003] and secondary infection [OR: 3.334 (1.313-8.496); p=0.011]. Conclusion: Comparison among patients administered with and without systemic corticosteroids revealed that high cumulative doses may be associated with adverse events in critically ill patients with COVID-19

Evaluation of Risk Factors for Decubitus Ulcers in Intensive Care Unit Patients

Objective: Pressure ulcers are common problems in intensive care units (ICU) that increase mortality, prolong length of hospital stays and increase treatment costs. The pressure ulcer risk should be evaluated when the patient is first admitted and a care plan should be established. The aim of this study was to determine the prevalence of the pressure ulcers in our ICU and the risk factors that might predispose patients to them

High Flow Nasal Oxygen Therapy Usage in the Adult Intensive Care Units in Turkey: Multi-center, Prospective Study

European-Respiratory-Society (ERS) International Congress -- SEP 28-OCT 02, 2019 -- Madrid, SPAINWOS: 000507372405066…European Respiratory So