The usual course of thorax CT findings of COVID-19 infection and when to perform control thorax CT scan

COVID-19 infection, a highly contagious disease caused by the SARS-CoV virus, and the World Health Organization declared this increasingly spreading disease as a global public health emergency (pandemic). In the diagnosis of COVID-19, the polymerase chain reaction (RT-PCR) is considered as the reference standard test. In the early stages, thorax CT findings could be present even before the onset of symptoms, thorax CT has quite high sensitivity in COVID-19 patients with false negative RT-PCR results, and it has a great importance not only in diagnosis but also in follow up. We think that it might be beneficial for our radiologist colleagues in the early diagnosis of the imaging features of this disease, by sharing the experiences we have gained by evaluating the typical and relatively atypical CT findings regarding the natural course of the tomographic findings of COVID-19 and when to control CT

The Prevalence of Cardiac and Ocular Findings in Patients with Invasive Candida Infection in Intensive Care Unit

Conclusion: In our study, we did not detect cardiac and ocular involvement in patients with IC. We believe that larger-scale prospective studies are needed to determine the prevalence of these complications in the ICU

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

In vitro evaluation of antimicrobial features of vasopressors

Background: Drugs administered as intravenous infusion may be contaminated during several stages of production or preparation. However studies focusing on antibacterial effects of vasopressor drugs are very rare. This study investigates the in vitro antimicrobial activity of the clinically used forms of vasopressors. Materials and Methods: In vitro antimicrobial activities of vasopressor drugs of different concentrations were investigated by using the micro dilution technique. Microorganisms used in the test were Escherichia coli ATCC 25922, Yersinia pseudotuberculosis ATCC 911, Pseudomonas aeruginosa ATCC 10145, Listeria monocytogenes ATCC 43251, Enterococcus faecalis ATCC 29212, Staphylococcus aureus ATCC 25923, Bacillus cereus 702 Roma, Mycobacterium smegmatis ATCC607, Candida albicans ATCC 60193, and Saccharomyces cerevisiae RSKK 251. Antibacterial assays were performed in Mueller-Hinton broth at pH 7.3 and antifungal assays were performed in buffered Yeast Nitrogen Base at pH 7.0. Results: Two different dopamine preparations showed antimicrobial activity. No other study drug showed any antimicrobial activity. Conclusions : In our opinion, dopamine's antibacterial effects may be advantageous for inhibiting the spread of bacterial contamination during the preparation of the infusion solutions. However, it is important that strict guidelines regarding the need for sterile equipment and deliverables be adhered to during all procedures performed in the intensive care units. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study

Background: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. Methods: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. Results: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. Conclusion: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series

Steroidal nondepolarizing neuromuscular blocker induced allergic reactions and role of sugammadex in treatment

Genel anestezi sırasında gelişen anafilaktik ve anafilaktoid reaksiyonların yarıdan fazlası kas gevşetici ajanlar nedeniyle oluşur. Teşhis ve uygun tedavide gecikme nedeniyle yüksek mortalite ve morbiditeyle sonuçlanan bu tür reaksiyonların önlenmesinde geleneksel destek tedavisi esastır. Fakat dolaşımdaki allerjenin hızla vücuttan uzaklaştırılması resüs itasyona büyük katkı sağlayabilir. Sugammadeks, ? -siklodekstrin yapısında bir ilaçtır. Steroid yapılı nondepolarizan nöromüsküler blokerleri selektif olarak bağlayarak, böbrek yoluyla vücuttan uzaklaştırmak üzere tasarlanmıştır. Literatürde, roküronyuma bağlı geliştiği saptanan, fakat rutin anafilaksi tedavisine yanıt vermeyen durumlarda, sugamm adeks ile etkin düzelme sağlandığını bildiren vaka sunumları vardır. Nondepolarizan nöromusküler blokerlere bağlı gel işen anafilaksinin geleneksel tedavisinde, dolaşımdaki alle rjeni elimine etmeye yönelik sugammadeksten faydalanılab ileceği kanaatindeyiz.More than half of the anaphylactic and anaphylactoid rea ctions during general anesthesia occur due to neuromuscular blocking agents. Traditional resuscitation is the mainstay therapy in these reactions, which have a high morbidity and mortality due to delay in diagnosis and specific treatment. However, prompt removal of the offending agent from circulation may greatly improve the outcome. Sugammadeks is a drug that is the structure of ? -cyclodextrin. It's designed specifically to encapsuate steroidal nondepolarizing neuromuscular blockers and facilitate their excretion through kidneys. There are case reports in the literature suggesting that anaphylactic reactions due to rocuronium, unrespo nsive to rutin anaphylactic therapy, respond promptly to sugammadex. In our opinion traditonal anaphylaxis trea tment may benefit from sugammadex in removal of the offending agent from circulation

The use of sugammadex in a patient with myasthenia gravis

Miyastenia gravis, postsinaptik asetilkolin reseptörlerine karşı antikor gelişimiyle karakterize otoimmün bir hastalıktır. Hastalarda nondepolarizan kas gevşeticilere karşı duyarlılık artmıştır. Sugammadeks, roküronyum ve veküronyum gibi steroid yapılı nondepolarizan kas gevşeticileri seçici şekilde bağlayarak, etkilerini kaldırmak üzere tasarlanmış yeni bir ilaçtır. Bu makalede kas gevşetici olarak 0.6 mg kg-1 roküronyum kullanılan miyastenia gravisli bir olguda, kas gücünün geri dönüşünü sağlamada 4 mg kg-1 sugammadeks kullanımı sunulmuştur.Myasthenia gravis is an autoimmune disease characterized by antibody formation against postsynaptic acetylcholine receptors. Patients demonstrate increased sensitivity to nondepolarizing muscle relaxants. Sugammadex is a new selective nondepolarizing muscle relaxant-binding agent designed to reverse the effect of steroidal muscle relaxants like rocuronium and vecuronium. This article reports the use of 4 mg kg-1 Sugammadex to reverse neuromuscular blockade in a myasthenia gravis case, where 0.6 mg kg-1 rocuronium was used as a neuromuscular blocking agent

Ankilozan spondilite bağlı ağır solunum yetmezliği ve zor entübasyon vakasında sugammadex kullanımı

Bu yazıda, torasik spinal rekonstrüksiyon operasyonu planlanan, ankilozan spondilite bağlı ağır restriktif akciğer hastalığı ve zor entübasyon bulguları gösteren 50 yaşında erkek hastanın anestezi yönetimi tartışıldı. Torakal deformite nedeniyle hastanın baş ekstansiyonu kısıtlı, supin pozisyonda uyuma ve nefes almada zorluk çekiyor. Ağız açıklığında ve baş ekstansiyonundaki kısıtlılık nedeniyle hasta larengeal maske kullanılarak entübe edildi. Bronşiyal sekresyonlarda artış ve bronkospazmı önlemek, solunum kaslarının fonksiyonunu optimum düzeyde geri döndürmek için sugammadex uygulamasını takiben ekstübe edildi.We describe anesthesia management of a 50-year-old man scheduled for thoracic spinal reconstruction, presenting with severe restrictive respiratory disease and difficult airway due to ankylosing spondilitis. The patient was unable to extend his head, had difficulty in breathing and sleeping in supine position due to thoracal deformities. The patient was intubated using intubating laryngeal mask airway to overcome the difficulties of limited mouth opening and head extension. He was extubated following administration of sugammadex to obtain optimal conditions in terms of respiratory muscle function and to prevent hypersecretion and bronchospasm