Sleep in Mechanically Ventilated Patients in the Intensive Care Unit

Objective Sleep abnormalities are common in critically ill patients. Polysomnography (PSG) is the gold standard in assessing sleep quality. The aim of this prospective study was to monitor the sleep pattern in mechanically ventilated patients with PSG who were admitted to our medical intensive care unit. Materials and Methods This study was conducted in the Medical Intensive Care Unit of an University Hospital. Patients with endotracheal intubation and mechanical ventilation for at least 24 hours were included in the study. They were monitored for 18 hours per day by continuous PSG. Sleep parameters were recorded; [total sleep time (TST), sleep efficiency (SE) and sleep stages]. Results Records of 12 patients were evaluated. There were nine males and three females. Median age of patients were 72.5 years (min-max=31-92). Median APACHE II was 19 (min-max=10-27). Median sleep time was 489.5 minutes (180-1105), median SE was 77.1% (24.9-96.5) and median arousal number was 147.5/TST (14-450). While REM sleep and non REM stage 3 sleep time and proportion were found to be decreased, non REM stage 2 sleep time and proportion were increased. Conclusion We have shown that mechanically ventilated patients have changes in sleep architecture and that they have severe sleep fragmentation. Future research should address the cause of these problems by using methodology for comprehensive assessment of sleep-disrupting factors and by examining the dynamic effects of changes in illness severity on sleep quality

Visual and software-based quantitative chest CT assessment of COVID-19: correlation with clinical findings

PurposeThe aim of this study was to evaluate visual and software-based quantitative assessment of parenchymal changes and normal lung parenchyma in patients with coronavirus disease 2019 (COVID-19) pneumonia. The secondary aim of the study was to compare the radiologic findings with clinical and laboratory data.MethodsPatients with COVID-19 who underwent chest computed tomography (CT) between March 11, 2020 and April 15, 2020 were retrospectively evaluated. Clinical and laboratory findings of patients with abnormal findings on chest CT and PCR-evidence of COVID-19 infection were recorded. Visual quantitative assessment score (VQAS) was performed according to the extent of lung opacities. Software-based quantitative assessment of the normal lung parenchyma percentage (SQNLP) was automatically quantified by a deep learning software. The presence of consolidation and crazy paving pattern (CPP) was also recorded. Statistical analyses were performed to evaluate the correlation between quantitative radiologic assessments, and clinical and laboratory findings, as well as to determine the predictive utility of radiologic findings for estimating severe pneumonia and admission to intensive care unit (ICU).ResultsA total of 90 patients were enrolled. Both VQAS and SQNLP were significantly correlated with multiple clinical parameters. While VQAS >8.5 (sensitivity, 84.2%; specificity, 80.3%) and SQNLP 9.5 (sensitivity, 93.3%; specificity, 86.5%) and SQNLP <81.1% (sensitivity, 86.5%; specificity, 86.7%) were predictive of ICU admission. Both consolidation and CPP were more commonly seen in patients with severe pneumonia than patients with nonsevere pneumonia (P = 0.197 for consolidation; P < 0.001 for CPP). Moreover, the presence of CPP showed high specificity (97.2%) for severe pneumonia.ConclusionBoth SQNLP and VQAS were significantly related to the clinical findings, highlighting their clinical utility in predicting severe pneumonia, ICU admission, length of hospital stay, and management of the disease. On the other hand, presence of CPP has high specificity for severe COVID-19 pneumonia

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

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

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

Association of MG53 with presence of type 2 diabetes mellitus, glycemic control, and diabetic complications.

ObjectivesMitsugumin 53 (MG53) is a myokine that acts as a membrane repair protein in tissues. Data on the effect of MG53 on insulin signaling and type 2 diabetes mellitus (T2 DM) are still unknown; most are from preclinical studies. Nevertheless, some researchers have argued that it may be a new pathogenic factor, and therapies targeting MG53 may be a new avenue for T2 DM. Our study aims to evaluate the relationship of circulating MG53 levels with the presence of diabetes, diabetic complications, and glycemic control.MethodsWe conducted a case-control study with 107 patients with T2 DM and 105 subjects without insulin resistance-related disease. Concurrent blood samples were used for serum MG53 levels and other biochemical laboratory data. MG53 concentration was measured using Human-MG53, an enzyme-linked immunosorbent assay kit (Cat# CSB-EL024511HU).ResultsWe found no difference in MG53 levels between the diabetic and control groups (p = 0.914). Furthermore, when the subjects were divided into tertiles according to their MG53 levels, we did not find any difference between the groups in terms of the presence of diabetes (p = 0.981). Additionally, no correlation was observed between weight, BMI, waist circumference, systolic and diastolic blood pressure, fasting blood glucose, HbA1c, albumin excretion in the urine, e-GFR levels, and MG53. Finally, MG53 levels were similar between the groups with and without microvascular and macrovascular complications of diabetes.ConclusionOur research finding provides insightful clinical evidence of lack of association between the levels of MG53 and T2 DM or glycemic control, at least in the studied population of Turkeys ethnicity. However, further clinical studies are warranted to establish solid evidence of the link between MG53, insulin resistance and glycemic control in a wider population elsewhere in the world