Background: High-chloride solutions such as 0.9% saline are widely used for medication dilution in intensive care units (ICUs) and are an underrecognized source of hyperchloremia and acid–base disturbances. Excess chloride reduces the strong ion difference (SID), contributing to hyperchloremic metabolic acidosis and worse clinical outcomes. This study evaluated the impact of replacing isotonic saline with 5% dextrose as a diluent on ICU outcomes in mechanically ventilated patients. Methods: In this retrospective cohort study, 4347 adult ICU patients requiring ≥12 h of mechanical ventilation were analyzed across two periods with different diluent strategies (2015–2018: saline-based; 2019–2025: chloride-sparing, dextrose-based). Demographics, comorbidities, illness severity (APACHE II, SOFA), fluid exposure, SID, and laboratory values over the first 48 h were compared. Predictors of mortality were identified using multivariate logistic regression. Results: Mortality decreased from 44.6% to 39.2% after adoption of chloride-sparing diluents (absolute reduction 5.4%, p = 0.003), despite similar renal function across periods. The later cohort demonstrated significantly higher SID (median 39 vs. 38 mmol/L; p < 0.001), lower chloride levels, and more favorable acid–base profiles. In 2015–2018, chloride showed a strong association with mortality (~12–13% increased odds per mmol/L), while in 2019–2025 the association persisted but was attenuated (~2% per mmol/L). SID emerged as a significant marker of improved acid–base balance after the diluent transition. pH remained the most powerful predictor of mortality in both periods. Mean glucose levels increased by ~30–40 mg/dL after switching to dextrose diluents, although insulin requirements did not change. Conclusions: Transitioning from chloride-rich to chloride-sparing diluents was associated with reduced ICU mortality and improved acid–base balance, without changes in renal function. However, modestly increased glucose levels highlight the need for strict glycemic monitoring. These findings support chloride-sparing strategies with robust glycemic monitoring in critical care.

Background and Objectives: Mechanical ventilation, while essential, can precipitate ventilator-induced lung injury (VILI) due to excessive mechanical stress. Among respiratory mechanics, driving pressure (ΔP) has emerged as the most robust predictor of mortality, with mechanical power (MP) and tidal volume (TV), respiratory rate (RR), positive end-expiratory pressure (PEEP), and peak inspiratory pressure (P_peak) also potentially influencing clinical outcomes. This study primarily evaluated whether the implementation of a standardized Lung and Diaphragm Protective Ventilation (LDPV) protocol, designed to minimize ΔP, reduced intensive care unit (ICU) mortality. Secondary objectives included assessing the prognostic impact of MP, P_peak, TV, RR, and PEEP on mortality in the pre- and post-LDPV implementation periods. Materials and Methods: In this retrospective cohort study, a total of 3468 adult ICU patients receiving invasive mechanical ventilation between 2012 and 2024 were analyzed. Patients were categorized into two groups: pre-LDPV (2012–2018) and post-LDPV (2019–2024). Ventilatory data were automatically collected using the Metavision system and evaluated through receiver operating characteristic (ROC) derived cutoffs, survival modeling, and Cox proportional hazards regression. Results: Implementation of the LDPV protocol was associated with a significant reduction in ICU mortality (47.7% vs. 41.1%, p < 0.0001) and a shorter ICU length of stay. Patients in the post-LDPV cohort (2019–2024) exhibited lower ΔP (median 12.9 vs. 14.3 cmH₂O), lower MP (median 15.0 vs. 17.0 J/min), improved respiratory system compliance, and reduced peak inspiratory pressure (P_peak) and tidal volume (TV_e) compared to the pre-LDPV cohort (2012–2018). Analysis revealed that the reduction in ΔP was the most significant determinant of improved survival; median ΔP decreased by approximately 2 cmH₂O (from 14.3 to 12.9 cmH₂O). Elevated MP and P_peak were also predictive of mortality, while compliance below 34 mL/cmH₂O consistently indicated a poor prognosis across both study periods. Conclusions: Implementation of an LDPV protocol significantly reduced ICU mortality, primarily through the systematic reduction in ΔP, while MP and its components provided complementary prognostic information. These findings underscore ΔP as the primary modifiable determinant of survival, with MP, P_peak, TV, and PEEP serving as secondary indicators of VILI.

Background and Objectives: Mechanical ventilation, though life saving for patients with Acute Respiratory Distress Syndrome (ARDS), carries the risk of Ventilator-Induced Lung Injury (VILI) through mechanisms such as alveolar volutrauma and barotrauma. These injuries can exacerbate systemic inflammation and hinder recovery, particularly in compromised lungs. Lung and Diaphragm Protective Ventilation (LDPV) has demonstrated significant survival benefits, with driving pressure (ΔP) emerging as a key predictor of outcomes. This study evaluated whether a standardized Lung and Diaphragm Protective Ventilation (LDPV) protocol, optimizing ΔP and MP, reduced ICU mortality in mechanically ventilated patients over 12 years (2012–2024). Materials and Methods: This retrospective cohort study included all adult ICU patients requiring invasive mechanical ventilation between January 2012 and December 2024. A standardized LDPV protocol was introduced in November–December 2018 for all intubated patients, incorporating low Tidal Volumes (TV) (6–8 mL/kg), individualized Positive End Expiratory Pressure (PEEP), ΔP <15 cmH₂O, and reduced MP. Patients were categorized into pre-LDPV (2012–2018) and post-LDPV (2019–2024) groups. Primary outcome was ICU mortality. Secondary outcomes included temporal trends in ΔP, MP, and other ventilatory parameters (TV, PEEP, compliance, peak inspirator pressure). Results: Implementation of the LDPV strategy was associated with a significant reduction in ICU mortality, despite increasing number of admitted patienst, age and illness severity over time. Both ΔP and MP declined progressively in 2019-2024 group, particularly after protocol adoption. Improvements were also observed in compliance, tidal volumes, and SOFA scores in the 2019-2024 period. Conclusions: Systematic optimization of ΔP and MP through an LDPV protocol is associated with markedly improved survival in mechanically ventilated patients. These findings support the incorporation of real-time ΔP/MP monitoring into routine ICU practice to guide personalized, physiology-based ventilation strategies.

Aims: To measure the effects of the Coronavirus Disease-19 (COVID-19) pandemic on the socioeconomy and their depression, anxiety and stress scores of anesthesiology and reanimation specialists, using the DASS-21 (Depression, Anxiety and Stress Scale – 21). Methods: The study was conducted with an online questionnaire directed to the participants online, following the approval of Uludağ University Ethics Committee labeled 2020-16/1. The questionnaire was prepared on SurveyMonkey and distributed via a specially acquired link. Participants were prevented from completing the questionnaire more than once. 38 questions were asked to the participants. At the end of the questionnaire, the participants were asked to fill the DASS-21 scale. Questionnaire link has been distributed through social media and mobile communication applications. Results: 198 volunteers participated in the study. 122 of the participants were female (61.62%) and 76 (38.38%) were males. 75 of the participants (37.88%) were trainees, 113 (57.07%) were anesthesiology and reanimation specialists, 2 (1.01%) were specialist physicians undergoing intensive care training, 4 (%) 2,02) were intensive care specialists, 1 was a specialist physician receiving algology training, and 3 (1.52%) were algologists. 42 participants were (21.21%) in a training-research hospital, 87 participants (43.94%) in a university hospital, 35 participants (17.68%) in a state hospital, 13 participants (6.57%) in city hospitals, and 21 participants (10.61%) were working in private hospitals. %81.6 of all physicians participating in the survey show depression symptoms, %62 of participants were showing symptoms of anxiety and 71.1% of participants described stress symptoms. All scores were higher in female physicians (p <0,05). Depression scores of residents were higher than specialists (p<0,05). All scores of physicians working in training-research hospitals are higher than physicians working in other institutions (p <0,05). Conclusion: Almost all physicians have experienced changes in workload, income and workplaces during the pandemic. High DASS-21 scores in all physicians were thought-provoking and highlighted the psychological pressure that anesthesiology and reanimation physicians had been under.

Bilgi ve teknoloji yoğun bakım bilim alanında hızlı bir şekilde gelişirken uygulanan tedavi yöntemleri ve yaklaşımlarda bu duruma paralel olarak yeniden şekillenmektedir. Yoğun bakım ünitelerine yatan hasta gruplarına uygulanan bu yeni tedavi modaliteleri hastaların son dönemlerine kadar fizyolojik parametrelerle yaşamlarına olanak sağlamaktadır. Bu durum somatik/biyolojik ölüm gerçekleşmeden önce çoğunlukla beyin ölümünün gerçekleşmesinin ön koşullarını oluşturur. Bu durumda beyin ölümü tanısının organ donasyonuna izin verecek optimal zamanda yapılması ve hasta yakınları hastanın donör olmasını kabul etmedikleri taktirde boşa çabayı engellemek ve yoğun bakım yataklarının efektif kullanımı açısından önemlidir. Bu esnada hekimlerin etik sorumluluklarını yerine getirmesi ve etik olmayan davranışların engellenmesi de öenemli bir konudur. Etiğin işlerlik kazanması için gereken nesnel koşullar ülkemizde de normlar, töreler ve kanunlardan oluşmuş ve belli bir tarihi geçmişe sahiptir. Ancak halen kanunlar nezdinde beyin ölümü açısından boşluklar bulunmaktadır. Beyin Ölümü ve Etik Abdulkadir YEKTAŞ Erişkinlerde Beyin Ölümü Tanısı Mustafa Kemal ŞAHİN Organ Donör Bakımı Payam RAHİMİ Pediatrik Hastalarda Beyin Ölümü Tanısı Ahmet GÜNDÜZALP Mehmet GÜNDÜZALP Pediatrik Hastada Donör Bakımı ve Potansiyel Donör Bakımı Sevgi TOPAL Olgularla Beyin Ölümü Nuri Burkay SOYLU

Brief Report: A cardiac surgery protocol for suspected malignant hyperthermia - Turkish Journal of Thoracic and Cardiovascular Surgery