Vaccination status of COVID-19 patients followed up in the ICU in a country with heterologous vaccination policy: A multicenter national study in Turkey

OBJECTIVE

Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-2) prevents the development of serious diseases has been shown in many studies. However, the effect of vaccination on outcomes in COVID-19 patients requiring intensive care is not clear.

METHODS

This is a retrospective multicenter study conducted in 17 intensive care unit (ICU) in Turkey between January 1, 2021, and December 31, 2021. Patients aged 18 years and older who were diagnosed with COVID-19 and followed in ICU were included in the study. Patients who have never been vaccinated and patients who have been vaccinated with a single dose were considered unvaccinated. Logistic regression models were fit for the two outcomes (28-day mortality and in-hospital mortality).

RESULTS

A total of 2968 patients were included final analysis. The most of patients followed in the ICU during the study period were unvaccinated (58.5%). Vaccinated patients were older, had higher Charlson comorbidity index (CCI), and had higher APACHE-2 scores than unvaccinated patients. Risk for 28-day mortality and in-hospital mortality was similar in across the year both vaccinated and unvaccinated patients. However, risk for in-hospital mortality and 28-day mortality was higher in the unvaccinated patients in quarter 4 adjusted for gender and CCI (OR: 1.45, 95% CI: 1.06-1.99 and OR: 1.42, 95% CI: 1.03-1.96, respectively) compared to the vaccinated group.

CONCLUSION

Despite effective vaccination, fully vaccinated patients may be admitted to ICU because of disease severity. Unvaccinated patients were younger and had fewer comorbid conditions. Unvaccinated patients have an increased risk of 28-day mortality when adjusted for gender and CCI.

Is diaphragm ultrasound better than rapid shallow breathing index for predicting weaning in critically ill elderly patients?

Introduction

Prolonged weaning is associated with worse clinical outcomes in elderly patients. Beside traditional rapid shallow breathing index (RSBI), diaphragm ultrasound is a promising technique to evaluate the weaning process. We aimed to perform diaphragm ultrasonography for predicting the weaning process and its relation with frailty in the critically ill elderly population.

Materials and Methods

We enrolled thirthy-two patients over 65 years of age who were mechanically ventilated for at least 48 hours. Thickness of diaphragm and excursion were evaluated within 48 h of intubation and during spontaneous breathing trial (SBT). Clinical parameters, frailty, diaphragm ultrasound results were compared according to the weaning status.

Results

Mean age (standard deviation) was 79.3 ± 7.9 years, and 18 (56.3%) patients were classified as weaning failure. Diaphragmatic excursion during SBT was the only statistically significant parameter associated with weaning failure [2.37 cm (0.67) vs 1.43 cm (0.15), p= 0.0359]. There was no statistically significant difference regarding RSBI between the groups [70.5 (46) vs 127.5 (80), p= 0.09]. Baseline thickness of diaphragm and excursion at SBT were moderately correlated with frailty.

Conclusion

Ultrasound can be used to show diaphragm dysfunction in the elderly frail population, and a multifactorial approach to the extubation process may include ultrasound instead of using traditional RSBI alone.

Association of nutritional status, frailty, and rectus femoris muscle thickness measured by ultrasound and weaning in critically ill elderly patients

Introduction

Sarcopenia and frailty are critical factors linked with poor clinical outcomes among elderly individuals. This study aims to investigate the association between nutritional assessment tests and frailty with muscle thickness measured by ultrasound and their relationship with weaning among critically ill elderly patients.

Materials and Methods

Patients who were over 65 years old and required invasive ventilation were assessed for nutritional status and clinical frailty scale upon admission to the intensive care unit. Additionally, the thickness of their rectus femoris and vastus intermedius muscles were measured by ultrasound within 48 hours of intubation. Correlation analysis was conducted to examine the relationship between screening tests, frailty, and ultrasound results. The association between these parameters and weaning success was also evaluated.

Result

Between May and August 2022, 32 consecutive patients were enrolled in the study. The mean age was 79.3 ± 7.9, and 18 (56.3%) of them were female. Median APACHE-II- and first-day SOFA scores were 22.5 (16.2-29.7) and 7 (5-10.75), respectively. There was a moderate negative correlation between the thickness of the rectus femoris and frailty (r= -0.41, p= 0.036), and there was a moderate positive correlation between the rectus femoris and geriatric nutritional risk index (r= 0.45, p= 0.017). Of them, 18 (56.3%) patients were classified as weaning failure in which the mean frailty score was higher (7.6 ± 0.9 vs 6.5 ± 1.7, p= 0.035), sepsis (18 vs 7, p<0.001) and use of vasopressor (17 vs 6, p= 0.004) more common, and in-hospital mortality were higher (18 vs 5, p<0.001).

Conclusions

Bedside ultrasound could be beneficial for detecting nutritional high-risk patients. Frailty was associated with muscle thickness, and it was also associated with weaning failure.

Our experience of 200 patients: usage and maintenance of long-term oxygen therapy and non-invasive ventilation devices at home

OBJECTIVE

To evaluate the patients' attitudes about the devices, of which they use for long-term respiratory support at home.

METHOD

200 consecutive patients were questioned about the treatment and devices of respiratory support at home by face to face questionnaire. Their records were taken from the archives of Social Security Agency.

RESULTS

123 (61.5%) of the patients were men and 77 (38.5%) were women. The mean age was 65.8 ± 11.9 (15-92) years. The most frequently prescribed device was oxygen concentrator and BIPAP was the one that follows. The most common indications were hypoxic and hypercapnic respiratory failure due to COPD. The devices were prescribed by the state university hospitals, most commonly. The average daily oxygen usage duration was 16.3 ± 3.1 hours, the average duration was 7.4 ± 3.1 hours, for BIPAP. Twenty one (11.4%) of the patients, who were treated with LTOT, stated that they were taking oxygen less than 15 hours a day. Higher education levels of the patients was correlated with the higher rates of visiting the companies - that they bought the devices- both for information about and control of the devices (p=0.002). The rate of visiting companies/firms was significantly higher in patients, who use BIPAP and respiratory support combined with it (p=0.010). Twenty three (47.9%) of the 48 patients, who notified that their devices were impaired, waited for repairment by the firm, 20 (41.6%) investigated special repair facilities and the rest (10.5%) rented a new device.

CONCLUSION

Effective and continuous technical maintenance support must be provided to the patients, who are treated with long-term respiratory support at home.

Tautomeric behavior of some azoquinoline dyes in liquid and liquid crystalline media

The absorption spectra of three azoquinolin-8-ol derivatives (o-, m-, p-cyano hydroxy azoquinolin dyes) were investigated in liquid and liquid crystalline solutions as a function of the solvent polarity. The spectral data of the dyes were compared in both ordinary liquid solvents and liquid crystalline media. Analysis of the spectral data was used to determine the azo and hydrazone forms in both the environments. The spectral shifts were correlated by Kamlet-Taft and Katritzky multi-parameter polarity scales. For the azoquinoline dyes, the azo form is almost entirely dominated in polar anisotropic hosts. In contrast, the compounds remain dominantly in hydrazone form in some polar solvents such as DMF. The polarized absorption spectra of the compounds in the anisotropic media were measured and their degree of anisotropies was determined.