Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

FRESENIUS ENVIRONMENTAL BULLETIN

In the current study, the relation between boron nutrition of olive trees cv Domat and the boron content of thesoils in two olive groves, one grove with deformation in its fruits and the other without any deformation / healthy was examined. Leaf and fruit flesh were sampled and their boron concentrations were measured. The physical and chemical properties of the soil it is cultivated on was also examined and the relation between the soil characteristics and boron content of the studied plant parts was determined. Domat cv is considered as edible in the region and in this regard, fruit deformation is highly significant. However, in our present study, no statistically significant relationship was determined between deformation of Domat olives and their boron concentration

Leaf and Fruit Nutrient Status of Organically and Conventionally Grown 'Ayvalik' Oil Olive Orchards in Turkey and Their Oil Quality Parameters

6th International Symposium on Olive Growing -- SEP 09-13, 2008 -- Univ Evora, Colegio Espirito Santo, Evora, PORTUGALWOS: 000313111800080Olive's (Olea europaea L.) native land is claimed to be Hatay-Maras-Mardin located in Turkey, while it is produced broadly on Aegean and Mediterranean coasts thus having a significant economic importance for the Mediterranean countries. The cultivar 'Ayvalik' has a superior oil quality and also is used for table olive in the form of green pickled olive. It has been widely preferred on the western coast of Turkey. Especially at the orchard establishments, this cultivar is on the rise and also spreads to the other areas. The experimental area of this study is situated at the northern part of Ayvalik, Edremit Gulf of Turkey. The aim of the study is to determine leaf and fruit macro-nutrient element status, some quality parameters of olive oil and the relation between these parameters at organic and conventional plantations. This paper submits first experimental year data. Results show that, leaf nutrient elements have shown nearly the same distribution compared to the reference values of both the organic and conventional practices except K; since, N, Ca and partly Mg were inadequate, P was adequate. Leaf K was generally adequate in all of the experimental area; however, some of the conventional orchards were higher and some of the inorganic orchards were inadequate levels. Leaf N, P, K, Ca and fruit P, K contents were significantly affected by two of the growing methods. Furthermore, obtained data showed some significant relations between each other.ICAM, Int Soc Hort Sci (ISHS), Associacao Portuguesa Hort (APH), Bayer CropSci, Direccao Reg Agr Pescas Alentejo (Drap Alentejo), Masso, Div Agro, Gallo, Empresa Desenvolvimento Infraestruturas Alqueva (EDIA), Azeite Moura, Fundacao Eugenio Almeida, Lagar Cartuxa, Dow AgroSci, Sovena, Syngenta, Campo Casa, Olivais Sul, Casa Azeite, Centro Operativo Tecnologia Regadio, Delta Cafes, BET, Ministerio Agr, Desenvolvimento Rural Pescas, Instituto Nacl Recursos Biologicos (INRB), Makhteshim AGAN, MUI NOBRE & SEMPRE LEAL CIDADE EVORA, New Holland, Olint, Univ Evor

Intensive Care Unit

Objective: To determine the characteristics and outcomes of patients with prolonged stay in a tertiary-care ICU. Method: Electronic database records of patients 18 years or older and hospitalized in the ICU from March 2010 to March 2013 were enrolled. Age, gender, main reason for ICU admission, length of mechanical ventilation and ICU stay, in-hospital and one year mortality were noted. Results: The records of 1,908 patients from their initial ICU stays were analyzed. The mean Length Of Stay (LOS) for patients with a LOS >= 28 days (n: 215) was 85.6+/-81.9 days. The main disease category necessitating prolonged stays was neurologic disorders according to the diagnosis by the admission to ICU, while the main disease category necessitating a LOS< 28 days stays was elective surgery. Among the prolonged stay patients, 37 (17.2%) were alive one year post-discharge and only 13 (6%) were living independently. Conclusion: Patients with a prolonged ICU stay constituted a small percentage of all ICU admissions but they proportionally used many more ICU bed days than short-stay patients. The mortality of prolonged ICU stay patients was very high. Very few survivors were living independently at one year. Thus, development of intermediate care units, palliative care and home care services are emerging necessities, to decrease the LOS in ICUs

Intensive Care Unit Patients

Aim: To determine the incidences of anxiety and depression in relatives of patients admitted to an intensive care unit (ICU) and to investigate the relationships between psychological symptoms and demographic features of the patients and their relatives.Methodology: Relatives of 78 ICU patients were enrolled in the study. Sociodemographic features of patients and their relatives were recorded. The Turkish version of the Hospital Anxiety and Depression Scale was used to assess anxiety and depression.Results: Twenty-eight (35.9%) cases with anxiety and 56 (71.8%) cases with depression were identified. The mean anxiety and depression scores were 9.49 4.183 and 9.40 +/- 4.286, respectively. Anxiety (P = .028) and concomitant anxiety with depression (P = .035) were more frequent among family members of young patients. The relationship to the patient, especially being a spouse, was significantly associated with symptoms (anxiety, P = .009; depression, P = .019; and both, P = .005).Conclusion: Spouses and family members of relatively young patients had higher rates of anxiety and depression. In contrast to the literature, depression was more common than anxiety among the relatives of ICU patients. Further research is needed on the impact of cultural and regional differences on anxiety and depression rates in family members of ICU patients

Clinical and prognostic features of plasmacytomas: A multicenter study of Turkish Oncology Group-Sarcoma Working Party

PubMed ID: 18543343To identify the outcomes of prognostic factors of solitary plasmacytoma mainly treated with local radiotherapy (RT). The data were collected from 80 patients with solitary plasmacytoma (SP). Forty patients (50.0%) received radiotherapy (RT) alone while 38 of them (47.5%) were treated with surgery (S) and RT. The median radiation dose was 46 Gy (range 30-64). The median follow up was 2.41 years (range 0.33-12.33). Ten-year overall survival (OS) and local relapse-free survival (LRFS) were 73% and 94%, respectively. The median progression-free survival (PFS) and multiple myeloma-free survival (MMFS) were 3.5 years and 4.8 years, respectively. On multivariate analyses, the favorable factors were radiotherapy dose of >50 Gy and RT + S for PFS and younger age for MMFS. For the patients with medullary plasmacytoma, the favorable factor was younger age for MMFS. RT at ?50 Gy and RT + S may be favorable prognostic factors on PFS. Younger patients, especially with head-neck lesion and without pre-RT macroscopic tumor, seem to have the best outcome when treated with RT ± S. Progression to MM remains as the main problem especially for older patients. © 2008 Wiley-Liss, Inc

Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study

Background Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS. Methods PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide. All patients aged 18 years or older who were receiving mechanical ventilation in participating ICUs during a 1-week period between January, 2014, and January, 2015, were enrolled into the study. The Lung Injury Prediction Score (LIPS) was used to stratify risk of ARDS, with a score of 4 or higher defining those at risk of ARDS. The primary outcome was the proportion of patients at risk of ARDS. Secondary outcomes included ventilatory management (including tidal volume [VT] expressed as mL/kg predicted bodyweight [PBW], and positive end-expiratory pressure [PEEP] expressed as cm H2O), development of pulmonary complications, and clinical outcomes. The PRoVENT study is registered at ClinicalTrials.gov, NCT01868321. The study has been completed. Findings Of 3023 patients screened for the study, 935 individuals fulfilled the inclusion criteria. Of these critically ill patients, 282 were at risk of ARDS (30%, 95% CI 27â33), representing 0·14 cases per ICU bed over a 1-week period. VTwas similar for patients at risk and not at risk of ARDS (median 7·6 mL/kg PBW [IQR 6·7â9·1] vs 7·9 mL/kg PBW [6·8â9·1]; p=0·346). PEEP was higher in patients at risk of ARDS compared with those not at risk (median 6·0 cm H2O [IQR 5·0â8·0] vs 5·0 cm H2O [5·0â7·0]; p&lt;0·0001). The prevalence of ARDS in patients at risk of ARDS was higher than in individuals not at risk of ARDS (19/260 [7%] vs 17/556 [3%]; p=0·004). Compared with individuals not at risk of ARDS, patients at risk of ARDS had higher in-hospital mortality (86/543 [16%] vs 74/232 [32%]; p&lt;0·0001), ICU mortality (62/533 [12%] vs 66/227 [29%]; p&lt;0·0001), and 90-day mortality (109/653 [17%] vs 88/282 [31%]; p&lt;0·0001). VTdid not differ between patients who did and did not develop ARDS (p=0·471 for those at risk of ARDS; p=0·323 for those not at risk). Interpretation Around a third of patients receiving mechanical ventilation in the ICU were at risk of ARDS. Pulmonary complications occur frequently in patients at risk of ARDS and their clinical outcome is worse compared with those not at risk of ARDS. There is potential for improvement in the management of patients without ARDS. Further refinements are needed for prediction of ARDS. Funding None