ECMO support is a final treatment modality for patients in the refractory cardiogenic arrest and postcardiotomy cardiogenic shock with an utmost importance. Eventhough it is linked to high mortality, its usage gains popularity worldwide. We assessed the fluctuation of lactate levels and the clearance of lactate during the ECMO therapy and its prognostic role on mortality. Data were gathered on all patients receiving ECMO therapy longer than 48 h between January 2015 and December 2017 retrospectively. Blood lactate had been recorded before ECMO implantation and at specific time points during ECMO support as a routine procedure. In this study, the Lactate clearance at specific time points (Lactate clearance-1) and the duration that lactate cleared more than 10% of the initial lactate level (Lactate clearance-2) was measured. Statistical analysis included Mann Whitney U-test and ROC-curves to predict 30-day mortality. Fourty-eight patients underwent ECMO therapy for refractory cardiogenic shock resulting in 70.8% mortality. The lactate levels before and after ECMO therapy as well as the dynamic changes were significantly correlated with mortality variable. With AUC calculation, LC-2 has a strong discrimination (AUC = 0.97) on 30-day survivors and nonsurvivors. LAE-LBE (AUC = 0.785), L48-LBE (AUC = 0.706) showed moderate predictive power on 30-day mortality. Changes in lactate levels after ECMO implantation is an important tool to assess effective circulatory support and it is found superior to single lactate measurements as a prognostic sign of mortality in our study. Based on our results, an early insertion of ECMO before lactate gets high was suggested. Serial changes on lactate levels and calculation of its clearance may be superior to single lactate on both effective circulatory support and as prognostic prediction. LC-2 showed a strong discrimination on 30-day mortality.

Background: Gastric cancer is the 2nd most common cause of cancer-related deaths, and the morbidity rate after surgery is reported to be as high as 46%. The estimation of possible complications, morbidity, and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit. This study aimed to determine the prognostic value of the preoperative platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) and their relations with clinical outcomes and complications after gastrectomy for gastric cancer. Methods: This single-center, retrospective cohort study evaluated the data of 292 patients who underwent gastrectomy with curative intent between January 2015 and June 2018 in a tertiary state hospital in Ankara, Turkey. A receiver operating characteristic curve was generated to evaluate the ability of laboratory values to predict clinically relevant postoperative complications. The area under the curve was computed to compare the predictive power of the NLR and PLR. Then, the cutoff points were selected as the stratifying values for the PLR and NLR. Results: The area under the curve values of the PLR (0.60, 95% CI 0.542–0.657) and NLR (0.556, 95% CI 0.497–0.614) were larger than those of the other preoperative laboratory values. For the PLR, the diagnostic sensitivity and specificity were 50.00 and 72.22%, respectively, whereas for the NLR, the diagnostic sensitivity and specificity were 37.50 and 80.16%, respectively. The PLR was related to morbidity, whereas the relation of the NLR with mortality was more prominent. This study demonstrated that the PLR and NLR may predict mortality and morbidity via the Clavien-Dindo classification in gastric cancer patients. The variable was grade ≥ 3 in the Clavien-Dindo classification, including complications requiring surgical or endoscopic interventions, life-threatening complications, and death. Both the PLR and NLR differed significantly according to Clavien-Dindo grade ≥ 3. In this analysis, the PLR was related to morbidity, while the NLR relation with mortality was more intense. Conclusion: Based on the results of the study, the PLR and NLR could be used as independent predictive factors for mortality and morbidity in patients with gastric cancer.

Individual risk of surgical patients is more often underestimated and there is not an absolute criterion demonstrating which patient deserves intensive care. Since a nominative assessment of these patients to quantify the intensity of critical illness is not appropriate, prognostic scores are used to assess the mortality rate and prognosis for critical patients including surgical ones. This study aimed to test the calibration power of SAPS-3 score and SOFA score of surgical patients undergoing gastrointestinal surgery, and identify any relation with patient outcomes in the department of surgical ICU. This retrospective observational study was conducted during the period between August 2017 and December 2017. It was performed at a Gastroenterological Surgical ICU, a tertiary care hospital in Ankara, Türkiye. To calculate SAPS-3 and SOFA score, physiological data and laboratory analysis on the day of ICU admission were used. Records were reviewed from hospitalization to medical discharge or hospital mortality. Statistical analysis included Mann Whitney U-test and ROC-curves to predict 30-day mortality. A total of 233 patients admitted to the Gastroenterological Surgical ICU were included into the study and the main reason for ICU admission was surgical problems. Mortality rate was 2.6 % (6 patients). Average SAPS -3 score was 32.5 and SOFA score was 30.1. A significant correlation was observed with the SAPS-3 score, but not with the SOFA score statistically in mortality as a dependent factor. The discriminative power, assessed using the AUC and the probability of death estimation, was satisfactory with the SAPS-3 scores (AUC 0.754) while it was lower with the SOFA score (AUC 0.631). We found that SAPS-3 score was significantly correlated not only with mortality rate, but also with LOS in the ICU. Nonetheless, SOFA score was not related to mortality, but related to LOS in the ICU. Prognostic score systems are used to estimate mortality but they may be used to identify LOS in the ICU and postoperative complications. It can be concluded that SAPS-3 and SOFA scores may be used to prognosticate postoperative ICU requirement.

Objective: Clinic of Anaesthesiology and Reanimation, Turkiye Yuksek Ihtisas Training and Research Hospital, beginning in 2014, the patient blood management (PBM) protocol is individualised based on patients' comorbidities, and the threshold for transfusion is 7 g dL(-1) of haemoglobin for patients without comorbidities and 8-9 g dL(-1) for patients with comorbidities. In this study, our aim was to compare patient outcomes, requirement for transfusion and the cost of transfusion between two different periods with and without PBM protocol. Methods: 229 and 283 patients who underwent open-heart surgery using cardiopulmonary bypass during the first 4 months of 2012 and the first 4 months of 2017, respectively, were included in this retrospective, cross-sectional study. Results: There were no differences between the groups in preoperative data. Blood and blood product usage was observed to be significantly lower at the time of the PBM protocol. The use of packed red blood cells decreased from 2 units to 0 and that of fresh frozen plasma decreased from 2 units to 0. In terms of postoperative mortality, there were no differences between the groups. Conclusion: According to the results of this study, the transfusion of unnecessary blood and blood products was reduced and the cost decreased with PBM protocol. Blood product usage did not affect 30-day mortality. It will be possible to achieve more valuable results if more patients are assessed, PBM protocol is implemented and postoperative results are evaluated in detail.

COVID-19,intensive care,intensive care unit,pandemic,follow-up

Coronavirus disease 2019 increases transplant recipients' susceptibility to rare opportunistic infections as a consequence of the impairment that COVID-19 can cause in the immune system. Mucormycosis is a rare complication but has a high risk of fatal outcome. A 50-year-old woman who received a kidney transplant 10 years previously was admitted to the hospital with COVID-19. During follow-up by the inpatient service, the patient developed pain, edema, and proptosis in the right eye. She was diagnosed with rhino-orbital cerebral mucormycosis. This is the first reported case of rhino-orbital-cerebral mucormycosis in a renal transplant recipient with COVID-19 infection.