The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO₂/FiO₂ levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.

During laparoscopic cholecystectomy operations, increases in intra-abdominal, intra-thoracic and intracranial pressures(ICP) can be seen after pneumoperitoneum created for surgical imaging. Orbital ultrasonography(USG), which has been developed in recent years, is a method that can evaluate the ICP by measuring the optic nerve sheath diameter (ONSD) from the eyeball. In our study, we aimed to evaluate whether different intraabdominal pressure values created during laparoscopic cholecystectomy operations correlate with ICP by measuring ONSD. The study included a total of 90 patients with American Society of Anesthesiologists (ASA) physical status classification I (ASA I) and II (ASA II) and ages from 18-65 years with laparoscopic cholecystectomy planned. After patients were intubated, in the 5th minute bilateral ONSD measurements were performed. The same measurements were performed in the 15th and 30th minutes after CO2 insufflation and additionally 10 minutes after CO2 was released at the end of the operation. During intrabdominal CO2 insufflation patients with 10 mmHg pressure applied comprised Group 1, patients with 12 mmHg pressure applied were Group 2 and patients with 14 mmHg pressure applied comprised Group 3. The study was completed with 89 patients, 51 female and 38 males. One patient was excluded from the study due to erroneous values. The variations in ONSD measured in the right-left eye before pneumoperitoneum and in the 15th and 30th minutes after abdominal CO2 insufflation were observed to be statistically significant (p0.01). A significant increase was observed in ONSD values in direct proportion to the increase in intraabdominal pressure in patients undergoing laparoscopic cholecystectomy surgery. USG guided ONSD measurements appear be a guide to ensure optimization of intraabdominal pressures and safe anesthesia administration for patients, especially those at risk of ICP increase, during laparoscopic surgery.

Introduction: There are few randomized controlled trials examining the effectiveness of bilateral Erector Spinae Plane Block (ESP) with patients undergoing cardiac surgery. The effect of bilateral ESP block on postoperative pain levels and analgesic consumption for patients undergoing open-heart surgery was examined in this single-blind, randomized, controlled trial. Material and Method: 54 patients who underwent cardiac surgery with open median sternotomy under general anesthesia between May 2020 and June 2021 were included in the study. Patients were randomized into two groups, each consisting of 27 patients, one with 40 ml of 0.25% bupivacaine and bilateral ESP block, the other with no block implementation (control group). Demographic data, operation type, length of stay in the Intensive Care Unit (ICU), numerical rating scale (NRS) values in the first 24 hours after extubation, and morphine consumption values of the patients were recorded for the study. Results: In the study, 4 patients were excluded from follow-up due to prolonged intubation in the postoperative period. The data of a total of 50 patients (ESP group n=25; Control group n=25) were analyzed. The duration before first analgesic (mean±SD: 459.2±92.8 min.) of the ESP group was statistically longer than those in the control group (mean±SD: 142.0±56.6 min.) (p

Background: Reporting the death of relatives to a family member is a very stressful task for physicians. Grief reactions differ from person to person. Methods: Demographic data of 100 patients who died after staying in ICU for more than three days were recorded. For each patient, one of the family members filled a form which contained their own age, gender, education level, marital status, number of children, degree of relationship, psychiatric treatment status, living in the same house as the patient, and whether they had ever visited the ICU before. Grief reactions were evaluated in five different categories: normal grief response, initial shock reaction, denial, feeling guilty and anger. Results: When the death was reported, 55.0% of the relatives accepted this situation as normal, 19.0% felt guilty and 14.0% showed an initial shock reaction. The results showed that for a one-unit increase in the patient's age, the probability of the denial reaction among relatives was reduced by 746 times and the probability of feeling guilty was reduced by 698 times. Conclusion: The rate of denial and guilt in the grief reactions among patient relatives when given news of death in the intensive care unit increases with the decrease in patient age.

Aims The relationship between the innate immune system that creates the polysaccharide antibody response and COVID-19 is not fully understood. In this study, it was aimed to determine the predictive values of isohaemagglutinins in COVID-19 severity/mortality. Methods Approximately 15 440 patients diagnosed with COVID-19 were examined, and a total of 286 patients with anti-B and anti-A1 IgM isohaemagglutinins test results were randomly enrolled in the study. These patients were stratified into two groups according to anti-A1 (n: 138 blood type B or O) and anti-B (n: 148 blood type A) IgM isohaemagglutinins. Anti-A1 or/and anti-B IgM, biochemical parameters, symptoms, chronic diseases, hospitalisation status, intubation status, admission to intensive care unit (ICU) and exitus status were recorded and evaluated for all patients. Results Anti-A1 IgM and anti-B IgM were significantly lower in ICU patients (7.5 ± 9.9 vs 18.0 ± 20.4 and 5.5 ± 6.3 vs 19.3 ± 33.6 titres, respectively; P < .01) and in exitus patients (3.8 ± 3.6 vs 16.7 ± 18.7 and 3.5 ± 4.7 vs 16.9 ± 29.6 titres respectively; P < .01). In the ROC analysis performed to differentiate between exitus and discharge within groups, the sensitivity of anti-B IgM and anti-A1 IgM at cut-off ≤4 was 88.9% and 79.6%, specificity 66.0% and 73.4%, and AUC 0.831 and 0.861, respectively (P < .01). Anti-A1 IgM decreased the mortality risk 0.811 times per unit while anti-B IgM decreased 0.717 times (P < .01). Conclusion Anti-B and anti-A1 isohaemagglutinins, which are an expression of the innate immune system, can be used to predict the severity and mortality of COVID-19 disease.

Objective: Despite vaccine and drug studies, convalescent plasma (CP) therapy remains an alternative treatment for coronavirus disease 2019 (COVID-19). In this study, we aimed to reveal the efficacy of CP therapy on mortality and the factors affecting it for the patients diagnosed with COVID-19 and acute respiratory distress syndrome (ARDS) which were followed in our intensive care unit (ICU). Material and Method: The data (demographic characteristics, the amount of CP used, PaO2/FiO2, leukocyte, neutrophil, lymphocyte, D-Dimer, C-reactive protein (CRP), procalcitonin, ferritin values, and the clinical findings) of the patients who were hospitalized in the ICU with the diagnosis of COVID-19 and received CP treatment between 20 March and 20 October 2020 were analyzed retrospectively. Data of deceased patients (n=29) and survivors (n=50) were compared with each other and logistic regression analysis was performed to investigate the relationship with mortality. Results: 79 patients who received 166 units of CP therapy after a mean of 13.45±3.6 days symptom onset, were identified. 96.2% of the patients had at least one concomitant disease. Mortality was observed in 29 (36.7%) of the patients. Mortality (5.1%) was less common in those receiving CP therapy within the first 14 days after the onset of symptoms. Patient age (p=0.041), neutrophil/lymphocyte ratio (p=0.004), CRP values (p=0.002), the number of comorbidities (p