Treatment of severe hypercapnic respiratory failure (HRF) has some challenges in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS), especially when lung protective ventilation (LPV) strategies are required. Extracorporeal CO2 removal (ECCO2R) therapy is an emerging option to manage hypercapnia while allowing LPV in these cases. However, further data on ECCO2R use are still needed to clear recommendations. This study was conducted on patients admitted to intensive care unit (ICU) between Jan 1st, 2016 to Dec 31st, 2019. The medical records were retrospectively scanned in institutional software database. Patients who were received invasive mechanic ventilation (iMV) support due to severe HRF related to COPD or ARDS were included into analyses. Patients were grouped according to treatment approaches as that ECCO2R therapy in addition to conventional treatments and conventional treatments alone (controls). Groups were compared for 28-day survival, iMV duration and length of stay (LOS). ECCO2R therapy was noted in 75 of the cases among included 395 patients (COPD n= 256, ARDS n= 139) out of scanned 1715 medical records. The survival rate of ECCO2R patients was 68% and significantly higher than 58% survival rate of controls (p= 0.025), with relative risk reduction (RRR)= 0.16, absolute risk reduction (ARR)= 0.10, number need to treat (NNT)= 10, and odds ratio (OR)= 1.5. In addition, iMV duration (12.8 ± 2.6 vs. 17.1 ± 4.9 days, p= 0.007) and LOS (16.9 ± 4.1 vs. 18.9 ± 5.5 days, p= 0.032) were significantly shorter than controls. Repeated measure analyses showed that LPV settings were successfully provided by 72 hours of ECCO2R therapy. Subgroup analyses according to diagnoses of COPD and ARDS also favored ECCO2R. ECCO2R therapy significantly improved survival, iMV duration and LOS in patients with severe HRF due to COPD or ARDS, and successfully provided LPV approaches. Further studies are needed to assess promising benefits of ECCO2R therapy.

Background: Although more than a year past since COVID-19 was defined, there is no specific treatment yet. Since COVID-19 management differs over time, it is hard to determine which therapy is more efficacious. In this study, we aimed to evaluate the efficacy of the regimen with Favipiravir (FPV) and determine if the timing of FPV addition offers any improvement. Methods: A retrospective observational case-controlled cohort study was performed between March and September 2020, including adults with COVID-19 in a single-center in Turkey. We categorized patients into age-sex matched three groups, group 1 (n = 48) and group 2 (n = 48) included patients treated with the combination of FPV plus Hydroxychloroquine (HQ) early and late, respectively. Group 3 (n = 48) consisted of patients on HQ monotherapy. In Group 2, if the respiratory or clinic condition had not improved sufficiently, FPV was added on or after day 3. Results: We found that starting FPV early had an impact on PCR negativity and the progression of the disease. 'No progression' was defined as the absence of a new finding in the control radiological examination and the absence of accompanying clinical deterioration. Also, the decrease in C-reactive protein (CRP) was greater in Group 1 than Group 3 (p < 0.001). However, we found that early initiation of FPV treatment did not have a positive effect on the estimated survival time. Conclusions: According to this retrospective study results, we believe that for better clinical outcomes, FPV treatment should be started promptly to enhance antiviral effects and improve clinical outcomes.

Turkthoracj, Turkish Thoracic Journal

Amaç: Deliryum yoğun bakım hastalarında sıklıkla görülmekte, mekanik ventilatörde ve yoğun bakımda kalış süresinin uzamasına neden olmaktadır. Yoğun bakım hastalarında pre-deliryum skoru deliryum tespiti için kullanılan bir testtir. Çalışmamızda, yoğun bakımda 24 saatten fazla kalan hastalarda pre-deliryum skorunun prognostik değerini saptamayı amaçladık. Gereç ve Yöntem: 1 Ocak 2016-31 Aralık 2016 tarihleri arasında; cerrahi, reanimasyon ve dahiliye yoğun bakımlarında 24 saatten fazla yatan tüm hastaların pre-deliryum skorları hesaplandı. Pre-deliryum skoru ≥50 grup 1 ve

Extracorporeal blood purification (EBP) therapies have shown promise as potential rescue treatments for patientswith septic shock. However, precise evidence regarding their effectiveness is lacking. This case-control study aimed to evaluate the 28-day survival benefit of a resin cartridge-based EBP therapy compared to conventional therapies in patients with septic shock.Materials and methods: The study sample was collected retrospectively from the medical records of patients admitted to the intensivecare unit (ICU) between 2015 and 2020. The study included patients with septic shock aged ≥18 years who had ICU stays >96 h andexcluded those lost to follow-up by 28 days or readmitted. First, 28-day survival was compared between EBP patients and 1:1 matchedconventionally treated controls. Second, the EBP patients were evaluated for clinical and laboratory improvements within 72 h of EBPtherapy.Results: Of 3742 patients, 391 were included in this study, of whom 129 received EBP therapy and had a 28-day survival rate of 44%,compared to 262 matched controls who received conventional therapy alone and had a survival rate of 33% (p = 0.001, log-rank =0.05, number needed to treat = 8, and odds ratio = 1.7). After receiving EBP therapy for 72 h, improvements were observed in theSequential Organ Failure Assessment scores (p < 0.05), shock indices (p < 0.05), partial pressure of oxygen in the arterial blood to the fractionof inspiratory oxygen concentration ratios (p < 0.001), vasopressor requirements (p < 0.001), pH (p < 0.05), lactate levels (p < 0.001), andC-reactive protein levels (p < 0.05).Conclusion: The findings suggest that administering resin cartridge-based EBP therapy to patients with septic shock may improve theirsurvival compared to conventional therapies.

Pulmonary embolism is a clinical condition with high mortality rates in all age groups. The treatment includes anticoagulation and fibrinolytic therapy, and clinical management is challenging in cases of bleeding diathesis. Sepsis-induced coagulopathy (SIC), which has been recently defined to cause disruption of coagulation cascade accompanied by organ dysfunctions, is regarded as a major cause of mortality. It is noteworthy that there is no decrease in fibrinogen levels, unlike disseminated intravascular coagulopathy (DIC). This study aimed to present the management of a 70-year-old female patient who was admitted to emergency department with atypical complaints and diagnosed with pulmonary embolism due to deep vein thrombosis and septic shock. The clinical success of fibrinolytic therapy following the administration of fresh frozen plasma (FFP), although the patient had elevated international normalized ratio (INR), is presented in this case report. Since elevated INR and thrombocytopenia, which are observed in SIC, are caused by the inhibition of fibrinolysis, fibrinolytic therapy can be a rational treatment choice considering the profit/loss rate.