High flow nasal cannula (HFNC) was mostly used in intensive care units with few studies in other departments. We hypothesized that HFNC applied at wards is beneficial for acute respiratory failure in hematological malignancy patients. The study is a single center, randomized controlled study. Inclusion criteria were hypoxemic respiratory failure and hematological malignancy. Patients were randomized to either venturi mask/nasal cannula oxygen treatment or HFNC. One hundred patients were included into the study. Median age was 58.5 (18-86) years and APACHE II score was 17 (5-29). HFNC group was 51 patients and oxygen treatment group 49 patients. P/F ratios were similar between the groups throughout the study period. Endotracheal intubation was required in 10 (20.0%) patients in oxygen group and 17 (33.0%) patients in HFNC group (p=0.14). A total of 17 (35.0%) patients in oxygen group and 17 (33.0%) patients in HFNC group received non-invasive mechanical ventilation (p=0.97). Median VAS comfort scores at 2nd and 24th hours were not different between groups. Twenty-eight-day mortality rate was 36.7% (18 deaths) in standard group and 45.0% (23 deaths) in HFNC group (p=0.39). HFNC applied in wards is not superior to standard oxygen treatment for acute respiratory failure in hematological malignancy patients.

There are limited data on the long-term outcomes of COVID-19 from different parts of the world. To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Retrospective, observational cohort. Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO₂/FiO₂ ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

There is a need for a scoring system for predicting the overall and ICU prognosis of patients with ANCA-associated vasculitis (AAV), but there are limited data on it in the literature. Therefore, we aimed to determine the scores that can estimate the prognosis of patients with AAV during intensive care follow-up . All adult patients admitted to the medical ICUs of four reference university hospitals in Turkey due to AAV activation and/or disease/treatment complications in the last ten years were included in this study. Demographic data, treatments before ICU, the Birmingham Vasculitis Activity Score (BVAS) score at the time of vasculitis diagnosis, and BVAS, APACHE II, SOFA and SAPS II scores at the ICU admission, treatments, procedures, and complications during ICU stay were recorded for all AAV patients. Thirty-four patients were included in the study. The median age of the patients was 60 (IQR 42-70) years, and 64.7% were male. Twenty-five (73.5%) patients were diagnosed with Granulomatosis with polyangiitis, and 9 (26.5%) were diagnosed with Microscopic polyangiitis. The most common ICU admission causes were hemorrhage (85.3%) and sepsis/septic shock (67.6%). Twenty patients (58.8%) died in the ICU follow-up. There were significant differences in APACHE II (p= 0.004) and SAPS II (p= 0.044) scores between survivors and non-survivors, while there were no significant differences in BVAS (during diagnosis p= 0.089 and ICU admission p= 0.539) and SOFA (p= 0.097) scores. APACHE II score was found to be an independent risk factor for ICU mortality (OR= 1.231, CI 95%= 1.011-1.498, p= 0.038) according to logistic regression analysis. An APACHE II score of greater than 20.5 predicted ICU mortality with 80% sensitivity and 70% specificity (AUC= 0.8, p= 0.004, Likelihood ratio= 2.6) according to the ROC curve analysis. APACHE II score can be used for the prediction of ICU mortality in AAV patients.

Eren E, et al. Infect Chemother. 2020 Dec;52(4):530-538. https://doi.org/10.3947/ic.2020.52.4.530

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an ongoing global health threat. However, currently, no standard therapy has been approved for the disease. OBJECTIVES: To evaluate the clinical effectiveness of convalescent plasma (CP) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN AND SETTING: Retrospective study conducted at Kayseri City Education and Research Hospital, Kayseri, Turkey. METHODS: The case group consisted of adult patients (> 18 years) with ARDS due to COVID-19 who received CP in combination with antiviral and supportive treatment. These patients were compared with others who only received antiviral and supportive treatment. RESULTS: During the study period, a total of 30 patients with ARDS due to COVID-19 were included. Eleven patients (36%) received CP in combination with antiviral and supportive treatment, whereas nineteen patients (64%) in the control group only received antiviral and supportive treatment. On admission, the median age, demographic and clinical data and initial laboratory test results were similar between the groups (P > 0.05). On the 14th day of treatment, the laboratory values remained similar between the groups (P > 0.05). The mortality rates were not significantly different between the groups. CONCLUSION: CP treatment did not affect mortality or lead to clinical improvement for COVID-19 patients with ARDS.