The Perspective of the Turkish Thoracic Society Members on Institutional Preparedness During the COVID-19 Pandemic in Turkey

OBJECTIVE: We aimed to evaluate the perspective of the Turkish Thoracic Society (TTS) members regarding institutional preparedness, in terms of administrative measures and availability of personal protective equipment (PPE), in the first and third months of the coronavirus disease 2019 (COVID-19) pandemic in Turkey.MATERIAL AND METHODS: A 22-item online survey was e-mailed between the first and third months to TTS members, and participants’ responses were evaluated.RESULTS: The number of participants was 295 in the first survey and 141 in the second. In the second survey, the percentage of answers implying availability increased in all 18 control measures, 16 of which were statistically significant. However, there were still less than half of the respondents who reported the availability of psychological and behavioral support and some PPE, including respirators, facial protectors, goggles, and gowns. Statistical significance was observed for provision of a waiting area (P = .008), rooms for aerosol-generating procedures (P = .042), and special wards for patients with suspected or definite COVID-19 (P < .001); testing healthcare workers (HCWs) with a history of contact with a COVID-19 case (P < .001); and surveillance of symptomatic HCWs (P = .048), between tertiary vs. primary and secondary healthcare facilities in the first survey, but provision of special wards (P = .002) and supply for aprons (P = .027) in the second survey.CONCLUSION: Our results showed an improvement in control measures in the third month of the pandemic. However, the persistent low availability of psychological and behavioral support and several items of PPE pointed out the need for action. Considering the health and safety of HCWs, the control measures should be actively monitored and deficiencies eliminatedWOS:0006726408000082-s2.0-8510933071

Follow-up hemoglobin concentrations in ICU: Relationship between diagnostic blood loss and daily fluid balance

Bu çalışmanın amacı, belirgin kanaması olmayan solunumsal yoğun bakım hastalarının günlük hemoglobin değişikliklerini (ΔHb) saptamak; tanısal kan kaybı (TKK) ve günlük sıvı dengesi (SD)’nin bu değişiklikler üzerindeki olası etkilerini araştırmaktır. Solunumsal yoğun bakım ünitesinde, yatış süresi en az 72 saat olan, aktif kanama, akut/kronik böbrek yetmezliği, kanama diyatezi ve sepsis bulgusu olmayan 34 olgunun dosyası retrospektif olarak değerlendirildi. Demografik özellikler, etyolojik tanı, ek hastalık varlığı, uygulanan tedavi, ilk 24 saatte hesaplanan “Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II” skorlaması, günlük hemoglobin sonuçları, günlük TKK ve SD kaydedildi. Günlük ΔHb ile TKK ve SD arasındaki korelasyon araştırıldı. İlk üç gün içinde ΔHb ≥ 0.5 g/dL/gün olan hastalar (grup A) ile ΔHb < 0.5 g/dL/gün olan hastalar (grup B) karşılaştırıldı. Olguların ortalama yaşı 55 ± 14, ortalama Hb değerleri girişte 13.2 ± 1.7 g/dL, çıkışta 12.6 ± 2.3 g/dL; giriş APACHE II skoru 19 ± 5 idi. Birinci gün TKK ortalama 25.2 ± 7.4 (10.5-49) mL idi. İzleyen günlerde, günlük TKK miktarının azaldığı ancak farkın istatistiksel olarak anlamlı olmadığı saptandı. Birinci gün SD ortalama 251 ± 1783 mL/gün idi. İlk üç günde ΔHb= -0.54 ± 1.5 g/dL iken, izleyen dört günde ΔHb= -0.23 ± 1.5 g/dL idi; aradaki fark istatistiksel olarak anlamlı değildi (p= 0.9). İlk üç gündeki ΔHb ile üç günlük SD ve TKK arasında korelasyon saptanmadı. Grup A ve grup B, yaş, cinsiyet, APACHE II skoru, SD ve TKK’ya göre karşılaştırıldığında anlamlı fark saptanmadı. Çalışmamızda günlük ΔHb ile TKK ve SD arasında anlamlı bir ilişki gösterilememiştir. Ancak bu ve benzeri çalışmalar, yoğun bakım hastalarında hemoglobin konsantrasyonunun, kanama olmaksızın düşebileceğini göstermesi açısından önemlidir.BULGULAR: Olguların ortalama yaşı 55±14, ortalama Hb değerleri girişte 13.2±1.7 g/dl, çıkışta 12,6±2,3; giriş APACHE II skoru 19±5 idi. Birinci gün TKK ortalama 25,2±7,4 (10,5-49) ml idi. İzleyen günlerde, günlük TKK miktarının azaldığı ancak farkın istatistiksel olarak anlamlı olmadığı saptandı. Birinci gün SD ortalama 251±1783 ml/gün idi. İlk 3 günde ∆Hb= -0,54±1,5 gr/dl iken, izleyen 4 günde ∆Hb= -0,23±1,5 gr/dl idi; aradaki fark istatistiksel olarak anlamlı değildi (p=0,9). İlk 3 gündeki ∆Hb ile 3 günlük SD ve TKK arasında korelasyon saptanmadı. Grup A ve Grup B, yaş, cinsiyet, APACHE II skoru, SD ve TKK’ya göre karşılaştırıldığında anlamlı fark saptanmadı. SONUÇ: Çalışmamızda günlük ∆Hb ile TKK ve SD arasında anlamlı bir ilişki gösterilememiştir. Ancak bu ve benzeri çalışmalar, yoğun bakım hastalarında HB konsantrasyonunun, kanama olmaksızın düşebileceğini göstermesi açısından önemlidir.To evaluate &amp;#916;Hb (daily changes of hemoglobin concentrations) in nonbleeding critically ill patients, and to investigate its&amp;#8217; relation with diagnostic blood loss (DBL) and fluid balance (FB). Hospital records of 34 nonseptic patients who stayed in respiratory intensive care unit (RICU) at least 72 hours with no evidence of acute bleeding, renal failure and bleeding diathesis, were evaluated retrospectively. Demographics, clinical features, acute physiology assessment and chronic health evaluation (APACHE) II scores, daily Hb levels, DBL and FB were recorded. Correlation statistics was performed between &amp;#916;Hb and DBL and FB. We compared the patients with &amp;#916;Hb &amp;#8805; 0.5 g/dL/day (group A) and the patients with &amp;#916;Hb &lt; 0.5 g/dL/day (group B) in the first three days. The mean age was 55 &plusmn; 14, Hb level was 13.2 &plusmn; 1.7 g/dL at admission and 12.6 &plusmn; 2.3 g/dL at discharge from RICU. DBL was 25.2 &plusmn; 7.4 mL/d, and FB was 251 &plusmn; 1783 mL/d for the first day in intensive care unit. DBL was lesser in subsequent days than in the first day but it wasn&amp;#8217;t significant. &amp;#916;Hb was -0.54 &plusmn; 1.5 g/dL for the first three days, while it was -0.23 &plusmn; 1.5 g/dL for subsequent four days (p= 0.9). &amp;#916;Hb in the first three days has no correlation with DBL and FB. Age, sex, APACHE II score, clinical features, DBL and FB were not differed between Group A and Group B. CONCLUSION: No relation was found between &amp;#916;Hb and DBL, and also FB; but studies like this are important to indicate that Hb concentrations may decrease in critically ill patients without any reason such as bleeding

Management of kyphoscoliosis patients with respiratory failure in the intensive care unit and during long term follow up

<p>Abstract</p> <p>Background</p> <p>We aimed to evaluate the ICU management and long-term outcomes of kyphoscoliosis patients with respiratory failure.</p> <p>Methods</p> <p>A retrospective observational cohort study was performed in a respiratory ICU and outpatient clinic from 2002–2011. We enrolled all kyphoscoliosis patients admitted to the ICU and followed-up at regular intervals after discharge. Reasons for acute respiratory failure (ARF), ICU data, mortality, length of ICU stay and outpatient clinic data, non-invasive ventilation (NIV) device settings, and compliance were recorded. NIV failure in the ICU and the long term effect of NIV on pulmonary performance were analyzed.</p> <p>Results</p> <p>Sixty-two consecutive ICU kyphoscoliosis patients with ARF were enrolled in the study. NIV was initially applied to 55 patients, 11 (20%) patients were intubated, and the majority had sepsis and septic shock (p < 0.001). Mortality in the ICU was 14.5% (n = 9), reduced pH, IMV, and sepsis/septic shock were significantly higher in the non-survivors (p values 0.02, 0.02, 0.028, 0.012 respectively). Among 46 patients attending the outpatient clinic, 17 were lost to follow up and six were died. The six minute walk distance was significantly increased in the final follow up (306 m versus 419 m, p < 0.001).</p> <p>Conclusions</p> <p>We strongly discourage the use of NIV in the case of septic shock in ICU kyphoscoliosis patients with ARF. Pulmonary performance improved with NIV during long term follow up.</p

COVID-19 pandemic and the global perspective of Turkish Thoracic Society

It has been more than 3 months now since the first case of COVID-19 was reported in Turkey. Globally, the number of confirmed cases and deaths reached 9,653,048 and 491,128 respectively, as reported by 216 countries by June 27, 2020. Turkey had 1,396 new cases, 194,511 total cases, and 5,065 deaths by the same date. From the first case until today, the Turkish Thoracic Society (TTS) has been very proactive in educating doctors, increasing public awareness, undertaking academic studies, and assisting with public health policies. In the present report, social, academic, and management perspectives of the pandemic are presented under appropriate subtitles. During this critical public health crisis, TTS has once again demonstrated its readiness and constructive stance by supporting public health, healthcare workers, and the environment. This review summarizes the perspective of TTS on each aspect of the COVID-19 pandemic and casts light on its contributions

TÜRKIYE’DE YOĞUN BAKIM ÜNITELERINDE VENTILATÖR ILIŞKILI PNÖMONIYI ÖNLEMEK IÇIN ALINAN GÜNCEL ÖNLEMLER: TÜRK TORAKS DERNEĞI SOLUNUM YETMEZLIĞI VE YOĞUN BAKIM ÇALIŞMA GRUBU NOKTA PREVALANS ÇALIŞMASI

Objectives: The inadequate quality and nature of sleep is a commonly reported problem among hospitalized patients. The purpose of this study is to examine the effects of progressive muscle relaxation training program on sleep quality, sleep state, pain and life quality of patients who underwent pulmonary resection