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Objective: Hypercoagulopathy related to hyperinflammation may be responsible for mortality and organ failure in coronavirus disease-2019 (COVID-19) patients. Abnormal coagulation profiles were associated with poor outcomes. In this study, we aimed to evaluate the prognostic value of antithrombin (AT) levels in critically ill COVID-19 patients on the intensive care unit (ICU) admission. Materials and Methods: Four hundred ten critically ill COVID-19 patients were retrospectively analyzed. Inflammatory and conventional coagulation parameters as well as AT activity levels were recorded on the ICU admission. The clinical outcomes of patients were analyzed. Results: AT levels on the ICU admission were significantly lower in non-survivors than survivors (77.9% vs. 82.5%; p=0.027). Besides AT, D-dimer values of non-survivors were significantly higher than survivors (2775 vs. 1495 µg/L; p<0.001). The cut-off levels for AT and D-dimer were 70.5% and 1585 µg/L, respectively. When AT and D-dimer were analyzed together, mortality estimation was better than only D-dimer or AT. Conclusion: Low AT levels may be indicative of severe disease and mortality together with high D-dimer levels in COVID-19 patients. Diagnosing and managing AT deficiency in COVID-19 patients could be beneficial for survival. So AT level measurements should be included in the routine panel of laboratory investigation. [ABSTRACT FROM AUTHOR]

Objective: Tocilizumab (TCZ) is a recombinant humanized anti-interleukin-6 receptor monoclonal antibody that is beneficial in critically ill coronavirus disease-2019 (COVID-19) patients. However, the clinical efficacy and safety of immunosuppressants (including TCZ, sarilumab and anakinra) in COVID-19 patients are not yet known. These treatments may predispose patients to infection. The aim of this study was to find any connection between the use of TCZ and increased secondary bacterial infections. Materials and Methods: In this study, we conducted retrospective analyses of secondary bacterial infections in COVID-19 patients in the intensive care unit (ICU). This study included patients with laboratory-confirmed COVID-19 infection or clinically and radiologically confirmed COVID-19 infections who were admitted to the university hospital adult ICUs between March 2020 and January 2022. Demographic data, recent exposure and travel history, clinical symptoms or signs, laboratory findings, and comorbidities were recorded. Microbial cultures from tracheal aspirates, blood, and urine were obtained at admission and throughout the hospital stay. The patients who received TCZ treatment noted and analyzed for seconder infections. Blood cultures were taken at least 48 hours after the first dose of TCZ. Results: We found that 80 patients (%37) had positive culture samples at admission, and most of these cases were admitted to the ICU from various hospital wards. The analyzed data showed that the TCZ group had a higher incidence of positive culture samples (75% vs. 35%, p=0.0001). The results showed that culture of TCZ taken patients had more incidence with methicillin resistance Staphylococcus aureus, Klebsiella spp. and Acinetobacter spp. (p=0.0001). Infection and mortality rates were much higher than those in the usual care group. Conclusion: Secondary infections and sepsis are major risk factors for mortality. The pathogens detected were drug resistant and had a lower chance of treatment. The benefit of TCZ treatment was lost in these patients because of secondary infections. Future studies are needed to help determine the risks of TCZ treatments. [ABSTRACT FROM AUTHOR]

Objective: This study aims to determine the risk factors affecting the development of pressure injuries for inpatients in the intensive care unit, to determine the nursing interventions conducted to prevent pressure injuries, and to detect healing of the pressure injuries. Materials and Methods: This follow up-longitudinal type study was conducted with 48 patients at an Intensive Care Unit in a public hospital between 01.09.2018 and 30.11.2018. Study data were collected using the Braden scale for predicting pressure injury risk, pressure injury assessment form, and pressure injury healing assessment form. Results: Patients who had a hospitalization duration of 15 or more days, were supported with mechanical ventilators, were unconscious, were fed enterally, were immobile in bed, had an albumin level of 2.5 g/dL or below, or had a hemoglobin level of 10 g/dL or below had significantly more pressure injuries (p<0.05). No significant difference was found with nursing interventions (positioning, massaging, using barrier cream, moisturizing the skin, keeping the bed linen dry and stretched) performed in the clinic and the development of a pressure injury or healing of pressure injuries present during admission to the clinic (p>0.05). Conclusion: The main risk factors for developing pressure injuries in inpatients in the intensive care units were enteral feeding, consciousness or unconsciousness, and level of hemoglobin. More pressure ulcers occurred on patients who were positioned and whose skin was moistened because nurses applied interventions to patients with a high risk of pressure ulcers. Additionally, there was no improvement in the healing of the compression injuries. [ABSTRACT FROM AUTHOR]