Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study

OBJECTIVE

A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic.

MATERIAL AND METHODS

All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded.

RESULTS

A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%).

CONCLUSION

The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

The Effect of Health Literacy on Preoperative Anxiety Levels in Patients Undergoing Elective Surgery

Objective

This study aimed to determine preoperative anxiety levels, their associated factors, and the relationship between health literacy and preoperative anxiety in adult patients undergoing elective surgery.

Materials and Methods

This descriptive cross-sectional study was conducted in a tertiary hospital between December 21, 2021, and June 20, 2022, and included 466 adult patients. Participants were administered the demographic data and basic health status form, Health Literacy Scale (HLS), and Beck Anxiety Inventory (BAI). Statistical significance was set at p < 0.05.

Results

The participants' mean BAI score was low to moderate (9.28±10.85). The total HLS score was 105.89±24.42. For the BAI, a negative correlation was found between the access to information sub-dimensions of the HLS and BAI (p=0.043, r=-0.094). In addition, a negative correlation was detected between patients' age and HLS and its sub-dimensions (p<0.001, respectively [r=-0.188, r=-0.193, r=-0.205, r=-0.161]), and a positive correlation was observed among the HLS sub-dimensions (p<0.001, respectively [r=0.873, r=0.057, r=0.966, r=0.915]). Higher HLS and sub-dimension averages were observed in single, high school, university graduates, and civil servant participants. In addition, higher BAI averages were detected in females, homemakers, urban residents, participants living only with their children, and those with additional diseases (respectively, p<0.001, p<0.001, p=0.007, p=0.0034, p<0.01).

Conclusion

As the level of health literacy increased, preoperative anxiety levels decreased. Preoperative assessment and education are fundamental to perioperative patient care, particularly in the surgical setting.

Factors affecting extubating time of postoperative patients who underwent congenital cardiac surgery: a randomized prospective study

OBJECTIVE

Anesthesia management in pediatric cardiac surgery using health resources sparingly focuses on reducing morbidity and mortality and increasing patients' quality of life. The duration of postoperative mechanical ventilation (MV) heavily influences pediatric cardiac surgery recovery. Thus, in this study we aimed to determine factors influencing extubation times after pediatric cardiac surgery.

PATIENTS AND METHODS

A total of 72 pediatric patients with an ASA score of III or above undergoing cardiac surgery were included in the study. As a result of their extubation time, the patients were divided into three groups as follows: those who were extubated immediately after surgery or in the operating room (OR) were recorded as Immediate Extubators (IE); those who were extubated within 6 to 48 hours of entering the intensive care unit were recorded as Early Extubators (EE), and those who were extubated after 48 hours or not extubated were recorded as Delayed Extubators (DE).

RESULTS

A logistic regression analysis showed that anomalies and need of MV before surgery, airway difficulty, and prolonged cross-clamp (CC) time were observed as factors affecting DE. The risk of DE was significantly correlated with the presence of abnormality [Odds ratio (OR): 20.3, 95% Confident interval (CI): 2.8-142.7], with the need of MV before surgery (OR: 1,844, 95% CI: 1.8-1,790,461.9), and with the presence of airway difficulty (OR: 44.7, 95% CI: 4.4-445.0). In addition, it was determined that CC time increased the probability of DE 1.038 times per minute (95% CI: 1.004-1.072).

CONCLUSIONS

Early and immediate extubation in children who underwent congenital heart surgery was successfully performed in our clinic. Early and immediate extubation in pediatric cardiac surgery can be completed safely and successfully when suitable conditions are provided.

Intraoperative hyperoxygenation may negatively affect postoperative cognitive functions in coronary artery bypass graft operations: A randomized controlled study

OBJECTIVE

In this study, it was aimed to compare various parameters during surgery and postoperative cognitive functions in patients undergoing coronary artery bypass graft (CABG) surgery using different levels of perioperative oxygen.

METHODS

One hundred patients scheduled for elective CABG surgery were included in the study. The patients were divided into two groups according to arterial oxygen levels during surgery. In the normoxia group (NG) (n = 50), partial arterial oxygen pressure (PaO₂ ) was between ≥100 and <180 mmHg with at least 40% fraction of inspired oxygen (FiO₂ ) mechanical ventilation (MV), and in the hyperoxia group (HG) (n = 50), PaO₂ was ≥180 mmHg with 100% FiO₂ MV. Hemodynamic parameters, peripheral oxygen saturation (SpO₂ ), regional cerebral oxygen saturation (rSO₂ ) measured from bilateral sensors, and blood gas values were recorded at the planned measurement times. Postoperative features (mortality and infection rates, length of stay in the hospital, and intensive care unit) and complications of the patients have been recorded (low cardiac output syndrome, renal failure, delirium). Mini-Mental State Examination (MMSE) test was applied to the patients before and at the 12th, 24th hours; on the first, third, sixth months after surgery.

RESULTS

Extubation time was found to be shorter in NG (p < .05). Between the groups, rSO₂ and mean arterial pressure were found to be significantly lower in HG at the time of T4 measurement (p = .042, p = .038, respectively). MMSE values of the groups at the first, third, and sixth months were found to be significantly higher in NG (p = .017, p = .014, p = .002, respectively).

CONCLUSION

Hyperoxemia application during CABG may be associated with worse postoperative late-term cognitive functions.

Postoperative infection-related mortality and lymphocyte-to-C-reactive protein ratio in patients undergoing on-pump cardiac surgery: a novel predictor of mortality?

OBJECTIVE

This study aims to investigate the relationship between postoperative infection-related mortality and lymphocyte-to-C-reactive protein ratio (LCR), a newly defined parameter with the combination of inflammatory and immune parameters, in patients undergoing cardiac surgery.

PATIENTS AND METHODS

Between January 2016 and November 2021, 236 patients who underwent on-pomp cardiac surgery with median sternotomy and developed postoperative infection were analyzed retrospectively. Patients were divided into six groups according to the types of postoperative infection. Preoperative, perioperative, and postoperative variables of the patient groups were compared, and factors affecting postoperative mortality were evaluated.

RESULTS

The mortality rate in the patient group we included in the study was 22.9%. Mortality rates did not differ significantly between the infection groups. However, when the LCR value was evaluated between the groups, there was a statistically significant difference (p<0.001). The preoperative LCR cut-off value, which predicts postoperative infection-related mortality, was determined as 133.46 (area under the curve (AUC): 0.607, p=0.017, 48.1% sensitivity, and 47.8% specificity). In the multivariate analysis, postoperative cerebrovascular event (OR: 78.365, 95% CI: 12.367-496.547, p<0.001) and Intensive Care Unit (ICU) stay (odds ratio (OR): 1.136, 95% confidence interval (CI): 1.004-1.284, p=0.042) variables were found to be independent predictive factors of postoperative infection-related mortality in the model. There was no positive differentiation of the type of infection in predicting mortality.

CONCLUSIONS

The calculated LCR value is a novel and remarkable parameter in estimating postoperative infection-related mortality in patients undergoing cardiac surgery.

Microvascular dysfunction as a link between obesity, insulin resistance and hypertension

Impaired microvascular dilatation from any cause and impaired insulin-mediated capillary recruitment in particular result in suboptimal delivery of glucose and insulin to skeletal muscle, and subsequently impairment of glucose disposal (insulin resistance). In addition, microvascular dysfunction, through functional and/or structural arteriolar and capillary drop-out, and arteriolar constriction, increases peripheral resistance and thus blood pressure. Microvascular dysfunction may thus constitute a pathway that links insulin resistance and hypertension. Overweight and obesity may be an important cause of microvascular dysfunction. Mechanisms linking overweight and obesity to microvascular dysfunction include changes in the secretion of adipokines leading to increased levels of free fatty acids and inflammatory mediators, and decreased levels of adiponectin all of which may impair endothelial insulin signaling. Microvascular dysfunction may thus constitute a new treatment target in the prevention of type 2 diabetes mellitus and hypertension.