Prognosis in Neurological Intensive Care Units

Objective: Neurocritical care, or neurological intensive care, provides critical care for patients with neurological or neurosurgical diseases. These patients need to receive medical care for their primary critical illnesses, comorbidities, and complications. This study aims to compare the clinical outcomes of patients with neurological or neurosurgical diseases treated in general ICUs and those of patients treated in neurological intensive care units (neuro-ICU). Materials and Methods: Patients with neurological and neurosurgical diseases who were treated in the ICUs by a neurointensivist were included in the study. The patients were categorized into two groups according to their ICU types and the study periods: patients in the mixed general ICU (period-1) and patients in the neuro-ICU (period-2). The records in the hospital automation system and this study's database of patients were evaluated retrospectively. Results: Sixty-one patients in period-1 and 58 patients in period-2 were evaluated. The ICU mortality rate and the ICU and hospital stay duration were lower in the neuro-ICU patients, but this difference was not statistically significant (P > 0.05). ICU readmission and in-hospital mortality rates were significantly lower in the neuro-ICU patients (P < 0.05). Conclusion: This study analyzed the effect of specialized neurocritical care and neuro-ICU organization on patient clinical outcomes. To achieve better patient management in the neuro-ICU, it is necessary to provide quality improvements in the process's structure, performance, and standardization. In Turkiye, there is a need for studies regarding this subject to establish and agree on standards for neurocritical care

NÖROLOJİK YOĞUN BAKIM ÜNİTESİNDE PROGNOZ

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Our Experience with Mesenchymal Stem Cells in Patients with COVID-19

Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2), which causes Coronavirus disease-2019 (COVID-19), has rapidly spread all over the world and has become a public health emergency. Coronavirus disease-2019 has a wide clinical spectrum, from asymptomatic infection to Acute respiratory distress syndrome, sepsis, metabolic acidosis, coagulation disorder, multi-organ failure and even death. The dysregulated and hyperimmune response to SARS-CoV-2 could possibly explain the highly variable disease manifestations and play an important role in the pathogenesis of COVID-19. Since there is no specific antiviral treatment in the treatment of COVID-19, treatments for inflammation against the virus and sharing experience are important. Mesenchymal stem cells (MSCs) have potent anti-inflammatory and immunomodulatory abilities that can migrate to damaged tissues, promote tissue regeneration, and inhibit tissue fibrosis. Today, MSCs are widely used in many clinical studies on immune-mediated inflammatory diseases such as Graft-versus-Host disease, systemic lupus erythematosus, and perianal Crohn's disease. MSC treatment in COVID-19 is a promising option. In this study, we would present four patients with COVID-19 who were treated with MSCs and who were found to be positive for real-time polymerase chain reaction tests on nasopharyngeal swab or tracheal aspirate. All patients were critically ill were followed up with mechanical ventilator due to severe hypoxemia. One patient was extubated and discharged. Other patients died. In this study, MSCs were used as salvage therapy in the late period, so benefit might not be seen. In previous studies, this treatment was used earlier and there were results showing the benefits of MSCs. Based on this study, MSCs can be a promising treatment option when used in the appropriate patient at the time

Comparison of the healthcare-associated infections in intensive care units in Turkey before and during COVID-19

Abstract Background Secondary bacterial infections are an important cause of mortality in patients with coronavirus disease 2019 (COVID-19). All healthcare providers acted with utmost care with the reflex of protecting themselves during the COVID-19 period. We aimed to compare the rates of ventilator-associated pneumonia (VAP) and bloodstream infections (BSIs) in our intensive care units (ICUs) before and during the COVID-19 outbreak surges. Methods This multicenter, retrospective, cross-sectional study was performed in six centers in Turkey. We collected the patient demographic characteristics, comorbidities, reasons for ICU admission, mortality and morbidity scores at ICU admission, and laboratory test data. Results A total of 558 patients who required intensive care from six centers were included in the study. Four hundred twenty-two of these patients (males (62%), whose mean age was 70 [IQR, 58–79] years) were followed up in the COVID period, and 136 (males (57%), whose mean age was 73 [IQR, 61–82] years) were followed up in the pre-COVID period. BSI and VAP rates were 20.7 (19 events in 916 patient days) and 17 (74 events in 4361 patient days) with a −3.8 difference (P = 0.463), and 33.7 (31 events in 919 patient days) and 34.6 (93 events in 2685 patient days) with a 0.9 difference (P = 0.897), respectively. The mortality rates were 71 (52%) in pre-COVID and 291 (69%) in COVID periods. Conclusion Protective measures that prioritize healthcare workers rather than patients and exceed standard measures made no difference in terms of reducing mortality