Predicting mortality and morbidity of geriatric femoral fractures using a modified frailty index and perioperative features: a prospective, multicentre and observational study

Introduction: Femoral fracture is associated with high geriatric mortality. Frailty is the increased vulnerability to stressors resulting from aging-associated decreases in physiological reserve. We aimed to predict 30-365-day postoperative mortality and morbidity rates using modified frailty index and perioperative characteristics in geriatric femoral fractures. Materials and Method: Using a prospective observational design, data were collected from patients >65 years undergoing femoral fracture surgery from 13 different hospitals in 2016 and 2017. Post-discharge follow-up periods were 30, 90, 180, and 365 days. Age, sex, modified frailty index and anaesthesia types used during surgery were recorded. Renal markers, troponin I and haemoglobin levels were examined preoperatively and postoperatively at 24 and 72 hours. Results: We included 392 patients in this study. The age of the patients were between 65 and 101 (mean, 79 +/- 11.9). Median modified frailty index was 5 (interquartile range, 2-7). Increase in modified frailty index increased mortality rate. Mortality rate at postoperative 30 days was 9.8%, while overall study mortality rate was 23%. Spinal anaesthesia was administered in 205 patients (52.3%, most frequent), followed by general in 110 (28.1%), peripheral nerve blocks in 21 (5.4) and spinal-epidural in 43 (11%). Anaesthesia type affected both intensive care unit (p<0.001) and total hospitalization (p<0.012) duration. A logistic regression model revealed that frailty index, preoperative creatinine and centre type were independent mortality predictors. Conclusion: Increased modified frailty index was associated with higher postoperative mortality risk, thus providing an additional way for improving risk stratification. Preoperative creatinine increase and centre types are determining factors in mortality

Airway management in mucopolysaccharidosis: a retrospective case series review

Airway management can be difficult in surgeries of patients with mucopolysaccharidosis. We performed a retrospective review of 31 surgeries performed between 2015 and 2019. The mean age of the patients was 127.6 months. MPS-IV and MPS-VI were the most frequent subtypes. Orthopedic surgeries were the most common surgery type. Difficult intubation was seen in 10 procedures. All patients with difficult intubation were aged over 36 months. Video laryngoscopy was the most common intubation method. Seventeen patients were followed up in the intensive care unit. Although video laryngoscopy seems to be a safe method in these patients, one should always be prepared for alternative methods

Sevoflurane Elimination and Hystopathological Changes in Lung, Liver, Kidney and Brain Tissues

Objective: The aim of this study was to investigate the fluoride levels in lung, liver, kidney and brain tissues, and the histopathological changes of lung, liver and kidney tissues due to sevoflurane metabolism and fluoride uptake. Material and Methods: Study was performed on 24 New Zealand white rabbits weighing 2500-3000g. After the animals were anesthetized with intramuscular 35 mg/kg ketamine ve 5 mg/kg xylasine, all rabbits were monitored with ECG, oxygen saturation, oro-pharyngeal temperature, and the ear vein was cannulated. Rabbits were randomly allocated into four groups as Group I: Control group (n= 6), (anesthesia was maintained with IV 10 mg/kg ketamine, 3 mg/kg xylasine and 100% O(2)),Group II: Sevoflurane 1 (n=6), Group III: Sevoflurane 24 (n=6) and Group IV: Sevoflurane 48 (n=6).Anesthesia was maintained with sevoflurane in oxygen at a concentration of 2% in sevoflurane groups. All rabbits were extubated after three hours of anaesthesia. Rabbits were sacrificed with high dose ketamine/xylasine at 1,24 and 48 hours postexposure in Group II, III and IV, respectively. Biopsies were obtained from kidney, liver, brain, and lung for the determination of inorganic fluoride deposition and histopathological examination was performed in kidney, liver and lung tissues. Results: While maximum fluoride deposition was observed in kidney, minimum deposition was observed in the liver at one hour after anesthesia. After 24 and 48 hours, the fluoride levels decreased in the kidneys and increased mostly in the lungs. However, this deposition did not produce histopathological damage. In the liver, the fluoride levels increased at 24 hours (p<0.05). The histopathological damages were observed in the liver and kidney at 24 hours, and continued at 48 hours. Conclusion: It is concluded that the fluoride which occurs after sevoflurane metabolism deposits in the kidney at early phase and is eliminated after 24 hours however it deposits mostly in the lung and secondly in the liver. The histopathological changes seen in the liver and kidney 24 hours after sevoflurane anesthesia were not related to fluoride deposition in these tissues.WoSScopu

Effects of L-Carnitine Theraphy On Methabolic and Biochemical Changes Caused By Propofol Infusion in Rabbits Undergoing Mechanical Ventilation

Objective: Increased lipid mass in the body secondary to long term and high doses of propofol infusion may cause carnitine deficiency. In this study; we aimed to investigate the effects of carnitine, given for treatment purposes and have not been analyzed before, during high doses of propofol infusion in rabbits. Materials and Methods: Following ethical committee approval; 2500-3500 grams weight, 3-4 months-old, healthy, male, white 20 New Zealand rabbits were included in the study. The rabbits were premedicated with xsilazine and atropine. After the preparation period including tracheostomy, monitorization, catheterization of the ear arteries and veins and urinary vesical; basal blood samples for biochemical and metabolic parameters included in the study were taken and rabbits were divided into 4 groups, 5 rabbits in each,randomly (Group P, Group PC, Group S, Group SC). For sedation 20 mg/kg/h propofol infusion was given to Group P, 20 mg/kg/h propofol and 100 mg/kg L-carnitine infusions were given simultaneously to Group PC, sevoflurane for sedation was given to Group S, sevoflurane and L-carnitine infusion were given simultaneously to Group SC. Their sedation levels were evaluated every 30 minutes and their vital signs were reported every 15 minutes. Every 2 hours arterial blood gases analysis and every 12 hours electrolytes and metabolic parameters were repeated. Euthanasia with high doses (60 mg/kg) of ketamin is performed for rabbits that were alive at the end of 24 hours. Results: All groups were similar in weight, vital parameters, all parameters searched in arterial blood gases, life time, liver enzymes, lactate dehydrogenase, serum electrolytes, creatine kinase and renal function tests (p>0.05). However; amylase levels before death or euthanasia were lower in Group PC compared to other groups;myoglobin and CK-MB levels in Group P were higher compared to other groups; cholesterol levels at 12th hour, before death or euthanasia were higher in Group P and Group PC compared to other groups; low density lipoprotein levels at 12th hour were higher in Group S and Group SC compared to other groups (p<0.05). Conclusion: In the light of the results of our study; we think that further research investigating carnitine and its metabolites during increased lipid mass in the body secondary to long term and high doses of propofol infusion or its suspicion in humans and carnitine replacement in the case of carnitine deficiency. (Journal of the Turkish Society Intensive Care 2011; 9:38-47

The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study

Abstract This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528–404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592–88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469–707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164–75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360–548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229–112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509–20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity