Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U.S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI). DA-HAI rates and DU ratios in our ICUs were higher than those reported in the INICC global report and in the US NHSN report.

Aim In this study, we aimed to investigate the effectiveness of ozone therapy, which is one of the integrative medicine applications that has been used safely for many years, on the prevalence of mortality in patients receiving COVID‐19 treatment. Methods This was a prospective, controlled study conducted on patients with COVID‐19 who were hospitalized. In this study, 55 patients were included. The patients were divided into two groups as the ozone and control group. Ozone therapy (major autohemotherapy) was applied to 37 patients who were being treated with the appropriate COVID‐19 treatment protocol determined by the infectious diseases committee of our hospital. The ozone treatment protocol consisted of seven sessions (1 session/day) of intravenous ozone administration, applied in a volume of 100 mL and a concentration of 30 μg/mL. Only the conventional COVID‐19 treatment protocol was applied to 18 patients in the control group. Clinical follow‐up was performed until the discharge of the patients from the hospital with successful treatment or until the mortality occurred. Factors affecting mortality were analyzed using univariate regression analysis. Results Intensive care unit (ICU) hospitalization was required in six of the 37 patients who were treated with ozone (16.2%), while four of 18 patients in the control group required ICU treatment (22.2%) (p = 0.713). When the mortality rates between the two groups were compared, mortality was lower in the ozone group (p = 0.032). As a result of univariate logistic regression analysis performed to investigate the factors affecting mortality, treatment with ozone therapy was determined as a risk factor for mortality. Patients receiving ozone therapy appear to have a lower mortality risk (OR:0.149, 95%CI 0.026‐0.863, p=0.034). Conclusion In this study, the findings suggested that the administration of ozone therapy along with the conventional medical treatment in patients hospitalized for COVID‐19 could reduce mortality.

This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV) was applied instead of the routine venturi face mask (VM) application after a successful weaning. Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30minutes were extubated. The patients were kept on VM for 1hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n=25), or NIV (n=25). Systolic arterial pressure (SAP), heart rate (HR), respiratory rate (RR), PaO2, PCO2, and pH values were recorded. The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV+5 reintubation in the VM group). The length of stay in the ICU was also significantly shorter in NIV group (5.2±4.9 vs. 16.7±7.7 days). The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as "successfully weaned". We recommend the use of NIMV in such patients to avoid unexpected ventilator failure.

OBJECTIVE: The purpose of our study was to compare the recovery characteristics and side effects of sugammadex (SM) and neostigmine (NT) in morbidly obese patients undergoing bariatric surgery. Residual neuromuscular block is a serious condition that increases pulmonary complications after anesthesia. Although acetylcholinesterase inhibitors help reverse this block, they may be insufficient, especially when administered with inhalational anesthetics. SM, a selective antagonist, may be more effective in reversing the block. METHODS: Patients were randomly divided into NT group (Group NT, n=34) and SM group (Group SM, n=34).For the induction, fentanil (1-1.5 mu/kg), propofol (2-3 mg/kg), and rocuronium (0.6 mg/kg) were used. For the maintenance, 50% O-2 + air, 1% sevoflurane, and remifentanil (0.5-0.3 mu g/kg/min) were used. Additional rocuronium was given to maintain the train of four (TOF) ratio <= 2. On completion of surgery and when the TOF ratio was 2, group NT received 50 mu g/kg of NT with 20 mu g/kg of atropine, whereas group SM received 2 mg/kg of SM. Hemodynamic parameters and peripheral oxygen saturation (SpO(2)) were recorded every 10 minfirst, and every 5 min after the reversal agents were given. When the TOF ratio was 0.9 or higher, time to reach a TOF ratio of 0.9, and time to extubation were recorded. Patients were observed in the recovery room for 30 min for adverse effects. RESULTS: Demographic characteristics of the patients and total rocuronium use in two groups were similar (p > 0.05).Time to extubation, time to TOF ratio of 0.9, time until patients responded to stimuli, time until cooperation, and time until orientation were significantly shorter in the SM group than in the NT group. Time to reach the Aldrete score of 9 was also significantly shorter in the SM group (p < 0.05).In the post-operative period, hemodynamic variables and side effects such asrespiratory difficulty, nausea, vomiting, hypo/hypertension, and presence of pain showed no statistically significant differences between the groups (p > 0.05). CONCLUSION: Considering the high risk of post-operative respiratory insufficiency inmorbidly obese patients, SM could be a safer choice in this patient group.

Objective: To compare preemptive and postoperative analgesic efficacy of tramadol and lornoxicam administered before anaesthesia induction in lumbar discectomy. Methods: This randomised, double-blind trial was conducted on 60 ASA I and II patients undergoing lumbar discectomy. Group L (n=30) received 3x8 mg day(-1) lornoxicam, and Group T (n=30) received 3x1.5 mg kg(-1) day(-1) tramadol. A verbal rating scale (VRS), the duration of effective analgesia, the number of additional analgesics used, adverse effects and patient satisfaction were evaluated at the postoperative 30th minute and 1st, 2nd, 4th, 6th, 8th, 12th and 24th hours. Results: There were no significant differences between Groups L and T regarding demographic and clinical characteristics, the number of additional analgesics and the duration of effective analgesia, adverse effects and patient satisfaction. VRS scores of the patients in Group T were significantly higher than those in Group L at the postoperative 30th minute (p=0.050) and the 1st hour (p=0.005). Conclusion: Lornoxicam, which was used for preemptive and postoperative analgesia in lumbar disc surgery, had provided adequate and effective analgesia such as tramadol. Moreover, preemptive analgesia was quite effective in prevention and treatment of postoperative pain.