Although harmful effects of air pollution on airway diseases are well-established, its effect on allergy still remains unclear. The aim of this study was to examine changes on asthma clinic and oxi...

This study aimed to compare optic nerve sheath diameter (ONSD) measurements obtained during hypercapnic and normocapnic periods in mechanically ventilated patients and to describe changes in ONSD in relation to ventilation-associated carbon dioxide levels. The study included sixty intubated patients admitted to the intensive care unit with a diagnosis of pneumonia and who underwent mechanical ventilation. ONSD measurements were performed during periods of hypercapnia identified during routine monitoring. After adjustment of ventilator settings, arterial blood gas analysis (ABG) was obtained one hour later, and ONSD measurements were repeated when normocapnia was achieved. The mean age of the patients was 61.6 ± 17.9 years. During the hypercapnic period, the mean ONSD (average of both eyes) was 4.88 ± 0.31 mm. Following the achievement of normocapnia, the mean ONSD decreased significantly to 4.61 ± 0.24 mm (p < 0.001). Furthermore, a significant positive correlation was found between the change (∆) in PaCO₂ and the reduction in mean ONSD (r = 0.538, p < 0.001). ONSD measurements differed significantly between hypercapnic and normocapnic periods defined by PaCO₂ levels. These findings suggest that ONSD may reflect physiological responses across different ventilatory CO₂ states.

Background and Objectives: Thoracic trauma usually results in high morbidity and mortality. It is the leading cause of death in patients within the first four decades of life. In this study, we aimed to identify risk factors for intensive care mortality and to evaluate factors affecting clinical outcomes and complications in patients with thoracic trauma who were treated in the intensive care unit (ICU). Materials and Methods: This was a retrospective, single-center study. Patients diagnosed with thoracic trauma and followed up in the ICU between 1 May 2023 and 1 January 2025 were included. Critically ill patients aged 18 years and older whose admission blood values were available and who had undergone radiological imaging were included in the study. Patients were grouped as Survivors or Non-survivors. The primary outcome was to determine risk factors for mortality. The secondary outcome was to evaluate factors affecting clinical outcomes and complications. The tertiary outcome was to determine the predictive value of the Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Glasgow Coma Scale (GCS) for mortality. Results: A total of 104 patients (male/female ratio: 76/28) were included in the study. Twenty-four patients (23.1%) died, and eighty (76.9%) were discharged. Age in the Non-survivor group was found to be significantly higher (59.33 ± 22.21 vs. 40.50 ± 17.71; p < 0.001), and the proportion of women was also significantly higher in the Non-survivor group (p = 0.0082). Mortality was associated with advanced age, female sex, lower GCS score (p < 0.001), higher APACHE II scores (p < 0.001), and the presence of comorbid conditions (p = 0.003), including head trauma (p = 0.024) and cardiac arrest before ICU admission (p = 0.011). The Non-survivor group more frequently required mechanical ventilation (p < 0.001), vasopressor support (p < 0.001), and continuous renal replacement therapy (p < 0.001), and they developed ventilator-associated pneumonia (p < 0.001) and acute respiratory distress syndrome (p < 0.001) at higher rates. ICU length of stay was also significantly longer in the Non-survivor group (p = 0.045). The APACHE II score demonstrated the highest discriminatory performance, emerging as the strongest clinical predictor of mortality (AUC = 0.751, 95% CI: 0.630–0.872; p < 0.001). Age (OR: 1.06) and serum lactate levels (OR: 1.57) consistently emerged as strong independent predictors of mortality. The presence of head trauma significantly increased the risk of mortality, particularly in the APACHE II-adjusted model (OR: 9.08). The APACHE II–based model yielded high specificity (96.3%) and accuracy (88.5%), with good discrimination (AUC = 0.894) and the highest Nagelkerke R² (0.548). Conclusions: Factors that may shorten the length of ICU stay include infection control, early correction of acidosis, and maintenance of hemodynamic stability, which may reduce mortality. APACHE II was more closely related to overall clinical severity than the other scoring systems. Our data indicate that age-related frailty and acute physiological derangement, as best represented by the APACHE II score, are more significant determinants of survival than anatomic injury severity alone.

Achromobacter xylosoxidans is an emerging opportunistic pathogen increasingly encountered in intensive care units (ICUs). Data on clinical characteristics

Previous studies have reported that diaphragm atrophy and dysfunction might occur during mechanical ventilation (MV), but the frequency, effect on mortality, underlying causes and functional outcomes of diaphragm and lung parenchymal changes during routine MV have not yet been fully understood. The lung parenchyma and diaphragm of 50 patients were investigated using ultrasound (USG) on day 1, 5, and 10 of MV therapy. Mean age of the patients was 64.90 ± 15.96 years. Mean MV duration was 90.18 ± 21.09 days. Mean thickening fraction (TFdi) on day 1, 5, and 10 was 40.77 ± 15.42, 39.85 ± 16.85, and 43.57 ± 19.10, respectively. Mean diaphragm amplitude on day 1, 5, and 10 was 1.70 ± 0.74, 1.76 ± 0.74, and 1.70 ± 0.71, respectively. Mean diaphragmatic thickness at the end of expiration (Tde) on day 1, 5, and 10 was 0.18 ± 0.08, 0.17 ± 0.06, and 0.16 ± 0.05, respectively. There was no significant change between measurement days by TFdi, diaphragmatic amplitude (DA), and Tde values. On admission, TFdi was less than 20% in 8% of the patients, DA was less than 1 cm in 12%, and Tfde was less than 0.2 cm in 52%. There was no significant difference by the TFdi, DA and lung ultrasonography (LUS) scores of the non-surviving and surviving patients. An analysis of imaging results and LUS scores indicated that LUS values were measured higher in patients with infiltration on chest radiography. In addition, LUS scores significantly decreased from day 1 to day 5 and day 10, and from day 5 to day 10. Diaphragm dysfunction may occur as a result of MV therapy or associated with an inflammatory process, including sepsis. Assessment of diaphragmatic function by USG on admission to the intensive care unit may help to better recognize and manage diaphragmatic dysfunction. LUS provides information about the lung parenchyma as important as chest X-ray and facilitates bedside patient evaluation.

BRASH syndrome is a definition that encompasses complex causes of bradycardia. The use of atrioventricular node blockers, renal failure, hypercalcemia, bradycardia, renal hypoperfusion create a cascade that triggers each other. Additionally, hyperkalemic drugs such as angiotensin converting enzyme inhibitors may aggrevate the clinical condition. This is a clinical condition that can lead to shock and mortality if the diagnosis and mechanism are not considered or overlooked. We presented the BRASH clinic in 84-year-old female patient and discussed the approach. Finally, we created a graphical abstract summarizing this syndrome.