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.

Sepsis is a state of augmented oxidative stress and diminished antioxidant capacity. High density lipoprotein (HDL) particles were shown to possess antioxidant and anti-inflammatory properties, as well as Paraoxonase 1 (PON1), which is an enzyme that is also protective against HDL oxidation. Previous studies suggested a possible role of decreased PON1 activity or HDL levels in sepsis patients. The present study was designed to test a hypothesis that higher PON1 activity and HDL-cholesterol levels could predict a better survival in sepsis patients. Observational study. Venous blood samples were collected from sepsis patients for HDL-cholesterol levels, PON1 activity and cytokine assays (TNF-α and IL-6) and Acute Physiologic and Chronic Health Evaluation II (APACHE II) scores were calculated in order to weight patients' disease severity on the day of sepsis diagnosis. Patients were followed-up until the 28(th) day for any cause intra-hospital mortality. Data were statistically analyzed for effects of study parameters on patients' survival. In total, 85 patients with sepsis were included in the study. The mean age was 65.2±17.9 years and 48 were male; at the end of the 28-day follow-up period, 46 survived. TNF-α (86.9±10.5 vs 118.6±16.4) and IL-6 levels (906.7±82.7 vs 1323.1±54.3) were significantly higher in non-survivors, while PON1 activity (140.7±42.3 vs 66.7±46.6) and HDL-cholesterol levels (43.6±8.1 vs 34.5±8.9) were significantly higher in survivors (p<0.001 for all). TNF-α (r=-0.763) and IL-6 levels (r=-0.947) showed strong negative correlations, PON1 activity (r=0.644) and HDL-cholesterol levels (r=0.477) showed positive correlations with patient survival (p<0.001 for all). Survival estimates significantly favored TNF-α (Log Rank 59.5, p<0.001) and IL-6 levels (Log Rank 53.2, p<0.001) according to PON1 activity (Log Rank 5.4, p<0.03) and HDL-cholesterol levels (Log Rank 8.3, p<0.005). Regression analyses for relative contributions of parameters to survival showed that higher IL-6 levels (t: -16.489, p<0.001) were the most significant negative factor for survival, and TNF-α levels (t: -4.417, p<0.001), whereas PON1 activity had a positive effect (t:3.210, p<0.003). The present study showed that although low PON1 activity and HDL-cholesterol levels were related to mortality, higher levels were not found to be as predictive as cytokine levels for survival.

Objectives This study was designed to evaluate effects of hyperbaric oxygen (HBO) plus 3-aminobenzamide (3-AB) cotreatment on tissue oxidative stress parameters (TOSp), tissue histopathology scores (THSc), and bacterial translocations (Bact-Trans) in an experimental model of severe acute pancreatitis (AP). Methods Seventy-five Sprague-Dawley rats were randomized into 5 groups. Group 1 received sham. Severe AP was induced by intraductal taurocholate infusion and then group 2 received saline, group 3 received 3-AB, group 4 received 3-AB plus HBO, and group 5 received HBO. 3-Aminobenzamide (10 mg/kg per day, once daily, intraperitoneal) and saline (1 mL/kg) were started right after the induction, whereas HBO (2,8 atm pressure, BID, 90 minutes each) was started at the sixth hour. The rats were euthanized at the 54th hour, and TOSp, THSc, and Bact-Trans were studied. Results In treatment groups 3 and 5, Bact-Trans (P < 0.05, P < 0.05), TOSp (P < 0.05, P < 0.05), and THSc (P < 0.001, P < 0.001) were significantly lower than controls. In addition to these findings, group 4 (cotreatment) showed the most significant effect on Bact-Trans and THSc (P < 0.001, P < 0.001) and also better in TOSp (P < 0.02). Conclusions Poly(ADP-ribose) polymerase inhibition by 3-AB and HBO treatment alone was effective in the course of severe AP, and favorable with cotreatment because of the improved cascades of inflammatory process by different aspects.

BACKGROUND: Shock index (SI) is defined as the ratio of heart rate to systolic blood pressure and is a feasible and reliable tool to assess patients' circulatory status in emergency conditions. Its efficiency was shown in hemorrhagic shock, sepsis, trauma, and emergency triages. This study was planned to evaluate predictive ability of SI on 28-day survival of intensive care unit (ICU) admitted emergency surgery (eSurg) patients. METHODS: The study was conducted in a 20-bed capacity ICU of a University Hospital. Medical records of patients who were admitted to ICU after an eSurg between January 1, 2017, and December 31, 2019, were retrospectively scanned. Patients with age 90, elective surgeries, no written consents, missing data, and lost to follow-up were excluded from the study. Patients age, gender, surgery type, associated medical comorbidity, ICU mechanic ventilatory (MV) length, length of stay (LOS), and 28-day survival status were recorded. Selected pre-operative (pre-op) and post-operative (post-op) laboratory parameters (hemoglobin [Hb], platelet count, international normalized ratio [INR], and pH) were collected, sequential organ failure assessment and SI scores were calculated. Data were statistically processed with 95% confidence interval and p<0.05 significance in relation to survival. RESULTS: Patient survival rate was 95%. Abdominal and gastrointestinal surgeries constituted 47% of the cases. The most frequent comorbidities were cardiovascular and pulmonary diseases. In statistical analyses, neither surgery type nor associated medical con-dition was related to patient outcome. The mean LOS was 2.3 days. The mean MV length was about 23 h and significantly shorter in survived patients (p<0.001, t=-7.5). The higher post-op Hb levels were related to the higher survival (p=0.020, t=2.4). Post-op higher INR levels were found as a negative prognostic factor for survival (p=0.025, t=-2.3). Both pre-op and post-op pH levels were significantly related to patient survival (p=0.001, t=1.9 and p<0.001, t=7.1). The lower post-op SI scores were predictive to the shorter MV lengths (p=0.010, t=1.9). A significant relation was presented between lower pre-op and especially post-op SI scores and patients' survival (p=0.001, t=-1.6 and p=0.001, t=-2.9). CONCLUSION: This study presented that SI scores successfully predicted patients' survival in ICU admitted eSurg patients. We believe that the SI forgotten in the dusty shelves of the literature does not get the importance it deserves. SI is a simplistic, reliable, and highly cost-effective assessment tool. Larger prospective RCTs should be planned to assess feasibility and reliability of SI in different patient populations.

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