The conflicting results of studies on intensive care unit (ICU) mortality of obese patients and obese patients with acute kidney injury (AKI) reveal a paradox within a paradox. The aim of this stud...

Amaç: Çin’in Wuhan kentinde ortaya çıkan ve tüm dünyayı etkisi altına alan koronavirüs hastalığı-2019 (COVID-19) pandemisinde mortaliteyi etkileyen risk faktörleri henüz açıkça belirlenmemiştir. Mortalite riski yüksek olan hastaların belirlenmesinde Charlson komorbidite indeksi (CCI) ve pnömoni şiddet indeksi (PSI) değerlendirmesi klinisyenlere yardımcı olabilir. Bu çalışmanın amacı, COVID-19 enfeksiyonunda komorbidite yükünü gösteren CCI ile hastalık şiddetini gösteren PSI arasındaki ilişkinin ve mortalite ile ilişkisinin belirlenmesidir. Gereç ve Yöntem: Bu araştırma, 10 Mart 2020-1 Haziran 2020 tarihleri arasında Sağlık Bilimleri Üniversitesi, İstanbul Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi’nin Yoğun Bakım Ünitesi’nde takip edilen COVID-19 tanısı almış 214 hastanın elektronik medikal kayıtlardan demografik, klinik ve laboratuvar verilerine ulaşılarak değerlendirilmesi ile retrospektif kohort olarak gerçekleştirilmiştir. Bulgular: Hastalar; hayatta kalan (n=109; %50,9) ve mortalite gelişenler (n=105; %49,1) olmak üzere iki gruba ayrıldı. CCI’da bir puanlık artışın mortalite olasılığını %32 artırdığı belirlendi [olasılık oranı (OR): 1.324 %95 güven aralığı (GA): 1.178-1.488]. PSI’da bir puanlık artışın mortalite olasılığını %2 artırdığı belirlendi. (OR: 1.020; %95 GA: 1.012-1.0.27). CCI ve PSI arasındaki ilişkiyi belirlemek için yapılan korelasyon analizinde CCI ile PSI arasında çift yönlü ve kuvvetli bir korelasyon olduğu belirlendi (p

Background: Increasing in emergency department need to critical care, the number of intensive care unit bed worldwide is inadequate to meet these applies. Objectives: The aim of this study was to investigate the effect of waiting for admission to the Intensive Care Unit (ICU) in the Emergency Department (ED) on the length of stay in the ICU and the mortality of critically ill patients. Methods: This retrospective cohort study carried out between January 2012 - 2019 patients admitted to the ICU of a training and research hospital. The data of 1297 adult patients were obtained by searching the Clinical Decision Support System. Results: The data of the patients were evaluated in two groups as those considered to be delayed and non-delayed. It was determined that the delay of two hours increased the risk of mortality 1.5 times. Hazard Ratios (HR) was 1.548 (1.077 - 2.224). Patients whose ICU admission was delayed by 5 - 6 hours were found to have the highest risk in terms of mortality (HR = 2.291 [1.503 - 3.493]). A statistically significant difference was found in the ICU mortality, 28-day and, 90-day mortality between the two groups. ICU mortality for all patients’ general was 25.2% (327/1297). This rate was 11.4% (55/481) in the non-delayed group and 33.3% (272/816) in the delayed group (P < 0.001). The 28-day mortality rate for all patients’ general was 26.9% (349/1297). This rate was found to be 13.5% (65/481) in the non-delayed group and 34.8% (284/816) in the delayed group (P < 0.001). The 90-day mortality for all patients’ general was 28.4% (368/1297). This rate was 14.1% (68/481) in the non-delayed group and 36.8% (300/816) in the delayed group (P < 0.001). Conclusions: Prolonged stay in the ED before admission to the ICU is associated with worse consequences, and increased mortality. Keywords Intensive Care Unit Emergency Department Mortality Rate Delayed Admission Critically Patients

COVID-19 can cause a clinical spectrum from asymptomatic disease to life-threatening respiratory failure and acute respiratory distress syndrome (ARDS). There is an ongoing discussion whether the clinical presentation and ventilatory parameters are the same as typical ARDS or not. There is no clear understanding of how the hemodynamic parameters have been affected in COVID-19 ARDS patients. We aimed to compare hemodynamic and respiratory parameters of moderate and severe COVID-19 and non-COVID-19 ARDS patients. These patients were monitored with an advanced hemodynamic measurement system by the transpulmonary thermodilution method in prone and supine positions. Data of 17 patients diagnosed with COVID-19 and 16 patients diagnosed with other types of diseases with moderate and severe ARDS, mechanically ventilated, placed in a prone position, had advanced hemodynamic measurements with PiCCO, and stayed in the intensive care unit for more than a week were analyzed retrospectively. Patient characteristics and arterial blood gases analysis recorded at admission and respiratory and advanced hemodynamic parameters during the first week were compared in prone and supine positions. No difference was observed in the respiratory parameters including respiratory system compliance between COVID-19 and non-COVD-19 patients in prone and supine positions. In comparison of advanced hemodynamic parameters in the first week of intensive care, the extravascular lung water and pulmonary vascular permeability indexes measured in supine position of COVID-19 ARDS patients were found to be significantly higher than non-COVID-19 patients. Duration of prone position was significantly longer in patients diagnosed with COVID-19 ARDS. The results of this study suggested that COVID-19 ARDS is a variant of typical ARDS with a different pathophysiology. Asar S, Acicbe Ö, Sabaz MS, Tontu F, Canan E, Cukurova Z, et al. Comparison of Respiratory and Hemodynamic Parameters of COVID-19 and Non-COVID-19 ARDS Patients. Indian J Crit Care Med 2021;25(6):704–708.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear.Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19.Study Design: Multicenter prospective observational clinical study.Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged >= 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated.Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 +/- 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004).Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.