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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: The World Health Organization has emphasized that as there is no specific anti-coronavirus disease-2019 (COVID-19) treatment, supportive care according to disease severity is important. Previous studies have shown that acute kidney injury (AKI) develops in 30% of severe COVID-19 patients followed up in intensive care units and most these require renal replacement therapy. This study aimed to evaluate the COVID-19 prognosis, renal function, and organ systems of adult, severe COVID-19 patients treated with continuous renal replacement therapy (CRRT) and the effects on secondary hemophagocytic lymphohistiocytosis with the additional application of absorption filters. Materials and Methods: A retrospective examination was made of the data of COVID-19 patients who applied for CRRT between 11.03.2020 and 15.06.2021. The demographic data of the patients were recorded together with the renal function test results before and after CRRT, and the biochemical parameters were included in the COVID-19 prognosis. Results: Positive changes were determined in the kidney functions with CRRT applied to patients who developed AKI. No statistically significant difference was observed in the biochemical parameters included in the COVID-19 prognosis. In the 14 patients who applied with hemoabsorption, the need for short-term inotropic support was reduced. In our study, the mortality of the patients who were treated with CRRT was 95% (2 patients transferred to the ward), while the average intensive care unit stay was 18.2±11 days. While improvement was detected in renal function tests with CRRT applied to patients with AKI, no statistically significant difference was found in biochemical parameters in the prognosis of COVID-19. While mortality was 92.8% in 14 patients who underwent hemoabsorption, a short-term improvement was observed in the need for inotropes in these patients. Conclusion: Although vaccinations are expected to definitively eliminate COVID-19, for critical COVID-19 patients for whom the treatment options are limited, it would seem rational to adopt immunomodulator strategies including extracorporeal blood purification and supportive treatment such as CRRT. The results of this study have shown that CRRT applied to severe COVID-19 patients who develop AKI is an effective treatment for kidney failure. However, the effect on the progression of COVID-19 could not be clearly shown. [ABSTRACT FROM AUTHOR]

Objective: Since the coronavirus disease-2019 (COVID-19) pandemic caused respiratory failure in many patients, oxygen delivery methods had to be diversified, and their numbers increased. High flow nasal cannula (HFNC), which has been shown beneficial in acute respiratory failure previously, also came to the fore. We investigated the efficacy of HFNC on patients hospitalized in intensive care units due to COVID-19. Materials and Methods: We retrospectively screened the patients followed up in the intensive care unit due to COVID-19. Patients treated with HFNC performed the study group. We analyzed the relationships among demographics, laboratory results, treatment modalities, complications, and outcomes. Results: Among the 330 patients including mean ventilation duration with HFNC was 7.84 days. One hundred seventy (51.5%) patients were intubated during HFNC treatment. Only 5 of them were extubated. Intubated patients had higher mean HFNC duration [9.74 days - minimum (min): 2, maximum (max): 49] compared to non-intubated patients (6.05 days - min: 1, max: 30). There was a significant relationship between mortality and age [Odds ratio (OR): 1.04], Acute Physiology and Chronic Health Evaluation-II score (OR: 1.35), having cancer (OR: 3.89), receiving non-invasive ventilation (OR: 5.94), and presence of secondary bacterial infection (OR: 44.6). Conclusion: HFNC, whose benefit in acute respiratory failure has been proven, is also widely and successfully used in COVID-19 patients. Comprehensive randomized studies are required to demonstrate the effect of HFNC use on intubation requirement and mortality. [ABSTRACT FROM AUTHOR]

Objective: The patients admitted to coronavirus disease-2019 (COVID-19) intensive care units (ICUs) with the suspicion of COVID-19 in the first four months of the pandemic were evaluated both in diagnostics and according to periods of the pandemic. Materials and Methods: The data of 1,430 patients admitted to the COVID-19 ICUs were recorded with the same algorithm in a single-center retrospectively. Patients were classified as COVID-19 and non-COVID-19 patients according to polymerase chain reaction results, radiological and clinical findings. Also, COVID-19 patients were compared as dying and surviving. Additionally, the data of patients admitted to COVID-19 ICUs during the onset of the pandemic and during the normalization period were also compared. Results: Of 1,430 patients, 630 were included in the COVID-19 group and 800 in the non-COVID-19 group. While there was a significant difference in the mean age of the groups, there was no difference between the genders (p=0.001, p=0.262 respectively). The age in the COVID-19 and deceased group was higher than that in the survivors (p<0.001). The most common presenting symptom was dyspnea (51.2%), while hypertension’s most common comorbidity (51.2%). During the normalization period, the rate of patients admitted to the ICU with the diagnosis of COVID-19 and the mortality rates in the ICU was higher. Conclusion: The initial period of the pandemic was spent understanding COVID-19, which entered our lives as a mystery at the same time. It was a guiding period for us to treat patients more effectively while protecting the community and healthcare professionals. [ABSTRACT FROM AUTHOR]

Introduction: Severe acute respiratory syndrome-coronavirus 2 is the last member of β-coronaviruses to cause coronavirus disease-2019 (COVID-19), which has left deep traces in human history with pandemic effect over the last three decades. Nevertheless, an established approach associated with high intensive care unit (ICU) mortality and predicting disease’s poor prognosis has yet to be implemented. We sought to investigate parameters determining worse outcomes among patients hospitalized in ICU for COVID-19. Materials and Methods: Two hundred and seventy consecutive COVID-19 patients were retrospectively included in this single-center study. Baseline characteristics, risk factors, laboratory values, and therapies received by each individual were gathered from hospital’s registry. ICU mortality was the primary endpoint, while the secondary endpoint was a composition of acute renal failure, pulmonary thromboembolism, cerebrovascular events, and acute coronary syndromes. Regression analyses were run to determine which factors had an independent association with endpoints. Results: Mean age of the entire population was 68.4±13.2 years, with 174 males. Those who died had a significantly older age, lower systolic blood pressure, and a higher heart rate than survivors. Also, former had a higher likelihood of stroke, chronic renal disease, and atrial fibrillation. When laboratory findings were analyzed, it was discovered that numerous parameters in deceased individuals were impaired. Except for unfractionated heparin and LMWH, medications used to treat COVID-19 were comparable between two groups (Table 1). Multivariable logistic regression analysis showed that age, oxygen saturation, stroke history, LDH, and LMWH treatment had an independent relationship with primary endpoint; age, systolic blood pressure, stroke history, and troponin, on the other hand, were the determinants of secondary endpoint (Table 2). Additionally, ROC analysis demonstrated that LDH (AUC: 0.743, 95% CI: 0.684-802) was the best predictor of primary endpoint, whereas troponin (AUC: 0.793, 95% CI: 0.741-846) was the best determinant of secondary endpoint (Figure 1). Conclusion: We found that a variety of clinical and laboratory indicators are linked to poor ICU outcomes in COVID-19 [ABSTRACT FROM AUTHOR]

Introduction: Hospital-acquired anemia (HAA) is common, especially in the most intensive care patients (ICP). Several literature series suggest that patients who develop HAA have increased mortality and morbidity compared with those who do not. The cause of HAA is likely multifactorial; iatrogenic blood loss,impaired erythropoiesis, bleeding episodes all can lead to HAA in ICP. Little research has focused on HAA, which develops during ICU admission of ARDS patients. The objective of this study was to investigate the incidence HAA, as well as its relationship with mortality, in COVID-19 associated ARDS patients admitted to ICU. Materials and Methods: We retrospectively analyzed all adult COVID-19 ARDS patients admitted to our ICU between January 2020 and December 2021 (n=1,007). Patients with missing data (n=7) or who have a length of ICU stay of less than 24 hours (n=10) were excluded. In addition, patients with chronic anemia at admission (n=445) were also excluded, because main focus of the study was development of HAA. Anemia is defined as a hemoglobin (Hgb) value <12 g/dL in women and <13 g/dL in men by WHO. HAA was defined as a nadir Hgb value during the course of ICU stay meeting WHO criteria. We further grouped Hgb by degree into mild anemia (Hgb >11 and <12 g/dL in women, >11 and<13 g/dL in men), moderate anemia (Hgb >9 and ≤11 g/dL) and severe anemia (Hgb ≤9 g/dL). COVID-19 ARDS is diagnosed when the patient with confirmed COVID-19 infection meets the Berlin 2012 ARDS diagnostic criteria. Baseline patient characteristics, admission Hgb and lactate levels, lengths of ICU stay and in-hospital mortality of patients who developed HAA were compared with those who did not develop HAA. We further stratified the patients based on the severity of HAA. Results: HAA developed in 373 (68.4%) patients. Characteristics and mortality rates of patients with and without HAA are presents in Table 1. Table 2 shows the data of the patients by presence and severity of HAA. Conclusion: Development of HAA is common and associated with higher in-hospital mortality. Patients who developed severe HAA has the highest mortality rates (73.1%). Hospitals must raise awareness of HAA. [ABSTRACT FROM AUTHOR]

Objective: Pneumothorax (PNX) and subcutaneous emphysema (SCE) have increased in importance as a frequently occurring complication. This study aimed to reveal the frequency, timing, and possible risk factors in patients with PNX and SCE who are followed up with coronavirus disease-2019 (COVID-19) diagnosis in our tertiary intensive care unit (ICU). Materials and Methods: All patients with confirmed COVID-19 who were followed up and treated in our unit between August 8, 2020, and February 20, 2021, in a 16-bed tertiary ICU and who developed PNX and SCE during their hospitalization were included. Results: PNX and SCE developed in 16 (9.6%) of 165 patients who were followed up in our ICU due to COVID-19. Of these 16 patients, 3 (18.8%) survived. The median age of patients was 66.5 years (interquartile range: 58.5-75.5). Diabetes mellitus was the most common comorbidity in patients with PNX and SCE. Additionally, 12 (75%) patients had a smoking history. Of 15 (93.8%) patients who developed PNX, 4 (25%) were bilateral, and SCE developed in 9 (56.3%) patients. Twelve (75%) patients with PNX and SCE were under invasive mechanical ventilation, 3 (18.8%) under spontaneous breathing, and 1 (6.2%) under non-invasive mechanical ventilation treatment. The number of oxygen support days until the time PNX and SCE developed was 9 (6.25-17) days in the whole group, the median time was 6 days in the survival group and 9 days in the non-survival group. Conclusion: In the COVID-19 pandemic, complications, such as PNX and SCE, are more frequently observed (9.5%) than in the general intensive care population and the later period of intensive care admission (median 9 days). Smoking is defined as a risk factor in most of these patients; however, increased PNX rates are thought to be related to both COVID-19 pneumonia and parenchymal damage due to cytokine storms. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease-2019 (COVID-19) pandemic has turned into a global health issue in a short time because of its increasing mortality and high infection rate. Since thoracic computed tomography (CT) cannot be performed and it is not possible to transfer COVID-19 patients followed-up in the intensive care unit (ICU), follow-up, and diagnosis using lung ultrasound (LUS) has been highly advantageous nowadays. The aim of this study was to assess the correlation between the thoracic CT score and LUS score and to determine their association with mortality. Materials and Methods: Patients admitted to the ICU, diagnosed to have COVID-19 pneumonia, underwent an initial thoracic CT examination and who underwent LUS during admission to the ICU were included in the study. The clinical parameters, demographic characteristics, prognosis, LUS, and thoracic CT scores of the patients were recorded prospectively. The survivors and deceased patients’ demographic characteristics were compared. Results: The mean age of the 29 patients included in this study was 61.93±14.21 years, and the male-to-female ratio was 18/11 (62.1%/37.9%). A strong positive correlation was between the thoracic CT score and LUS score (r=0.964; p<0.001). The thoracic CT and LUS scores of the survivors were 15.5±2.7 and 27.3±4.9, respectively, while those of the deceased patients were 14.1±3.4 and 25.6±5.8, respectively, and the two groups found no significant difference. Conclusion: A strong positive correlation was found between the thoracic CT score and LUS score of COVID-19 patients admitted to the ICU. This result shows that LUS is easily preferred for patients who require imaging for diagnosis and follow-up under intensive care conditions. The mortality rates of COVID-19 patients could not be predicted by either thoracic CT score or LUS score. [ABSTRACT FROM AUTHOR]

Objective: Iatrogenic anemia is an overlooked entity in daily practice. It is known that iatrogenic anemia is associated with increased morbidity and mortality, especially in intensive care unit patients. COVID-19 caused excessive intensive care hospitalizations due to acute respiratory failure. We sought to investigate iatrogenic anemia and its results in COVID-19 patients followed in intensive care unit. Materials and Methods: We retrospectively reviewed the adult patients who were hospitalized in ICU for COVID-19 longer than 14 days. Individuals younger than 18 or who had major bleeding, or postoperative patients were excluded. The remaining 112 patients took part in study. We collected the demographic data, comorbidities, laboratory results, and total amount of blood samples taken in intensive care follow-up in mililiters (mL). Results: The mean age of participants was 71.3 (min: 23, max: 100). Male/ female ratio was 1.8. The most common comorbidity was hypertension (60), coronary heart disease (29), and diabetes mellitus (26), The median length of ICU stay is 19 days (min: 14, max: 58). 66 (58.6%) patients have died. Mean Hb was decreased from 13.9 (±SD: 1.67) to 9.74 (±SD: 1.98) g/dL. In the end, 65 (90.2%) of males and 38 (95.0%) of females were anemic. On a total of 2545 hospitalization days, an average of 27.6 mL of blood was drawn in 7.4 sampling tubes per patient day. Biochemistry tests were the most common reason. We observed that more blood was drawn from intubated patients than non-intubated patients, resulting in a greater reduction in hemoglobin levels (463 mL, 2 g/dL, 677 mL, 3.9 g/ dL, respectively) (p<0.001). Conclusion: Excessive blood sampling is still a significant problem in ICUs associated with poor outcomes. Considering that most COVID-19 patients are admitted to ICU due to acute respiratory failure, it is vital to keep hemoglobin levels as high as possible to maintain oxygenation. [ABSTRACT FROM AUTHOR]

Objective: The number of patients with COVID-19 has rapidly increased, thereby exceeding the capacities of health systems and causing serious losses in affected countries because of the rapid spreading potential, high virulence, and lack of vaccine and proven antiviral therapy. This may indicate the importance of protocol-based treatments in maintaining the treatment process accurately, with minimal errors. This study aimed to present the results of a protocol-based treatment prepared in accordance with the “Surviving Sepsis Campaign COVID-19 treatment guideline.” Materials And Methods: This retrospective and prospective study used data of five hospitals. Intensive care and treatment approaches were carried out in accordance with the “COVID-19 approach protocol” prepared according to the “Surviving Sepsis Campaign COVID-19 treatment guideline.” Results: A total of 1143 patients admitted to five hospitals were hospitalized with a prediagnosis of COVID-19, and 115 patients needed intensive care. Among them, patients without COVID-19 were excluded and the remaining 77 patients were evaluated. In this study, 9 (11.7%) of the 77 patients were lost. While the mortality rate did not differ by sex (p=0.661), the mean age of deceased patients was significantly higher (p=0.006). Considering their comorbidities, the mortality rates of patients with hypertension, chronic renal failure, and cancer were significantly higher (p=0.034, p=0.014, and p=0.007, respectively). Conclusion: The mortality rate in this series may suggest that the treatments performed in line with the “Survival in Sepsis Campaign COVID-19 treatment guideline” are useful. However, when the causes of mortality and morbidity were evaluated, good observation of neurological, infective, respiratory, and immune complications may be considered the main factor in reducing mortality and should be included in the guideline. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 outbreak has been threatening the entire world for approximately 4 months. Healthcare management is one of the most important precautions to be taken for the successful management of this epidemic. Evidence-based estimates are of great importance in solving these problems. In this study, as of the first week of April, we provide a description of Turkey according to the indicators of the COVID-19 outbreak in each city and an evaluation of the relationship between the population density of each province and the number of cases. Additionally, we calculate the change in the new case rate and aim to estimate the number of intensive care beds and the number of intubations needed on a day-to-day basis. Materials and Methods: The outbreak indicators and number of tests announced by the Ministry of Health of the Turkish Republic day-by-day were used. A Poisson regression model was used for data analysis. In addition, a new algorithm was proposed to estimate healthcare needs. Results: The relationship between urban density and the total number of cases was found to be statistically significant (r=0.464, p<0.001). When the density increased by one person, the total number of cases was estimated to increase by one. Minor changes were observed in the rate of new cases within the daily tests between March 29 and April 5. The total numbers of intensive care patients, intubated patients, patients quarantined at home or hospitalized in the normal service, and recovered patients, as well as the total case numbers were used in the calculations. By using the total forecasted cases, the service infrastructure requirements to be provided in hospitals, such as the number of beds and the number of intubations, were estimated and given in tables. Conclusion: When priorities are questioned in the coming days, it should not be forgotten that these types of studies will be helpful to solve important health problems. [ABSTRACT FROM AUTHOR]

Introduction: Our aim is to determine the brain damage caused by COVID-19 by examining the brain tomographies and predictive feature by examining the laboratory data at 0. and 7. days. Materials and Methods: A total of 60 patients, 30 with COVID-19 and 30 with non-COVID-19, were analyzed and patient data were compared. Brain tomography reports taken within the first 72 hours were analyzed. Age, gender, comorbidities, ICU stay, mortality, hemogram, total biochemistry and coagulation parameters were analyzed. Statistical significance level was accepted as p<0.05. Results: Mortality rates and the hospitalization days were higher in the COVID-19 group. Intracranial hemorrhages (ICH) rates were higher in both groups compared to ischemia. ICH was detected in 21 (70%) and cerebral infarction in 9 (30%) patients of COVID-19 patients. Right hemisphere and frontal lobe was the most common in the intracranial hemorrhage region and intraparenchymal hemorrhage (90%) was the most common in the type of hemorrhage. Shifts were found in 42% of the patients. In patients non-COVID-19, 22 (73.3%) patients had hemorrhage and 8 (26.7%) patients had infarction. Left hemisphere and frontal lobe was the most common in the intracranial hemorrhage and intraparenchymal hemorrhage (90%) was the most common in the type of hemorrhage. 31.8% of the patients had shifts. 22% of the patients had cerebral infarct. In COVID-19 patients 77% had right and 33% left hemisphere infarcts. Infarcts were observed in the right hemisphere in 75% of non-COVID-19 patients and in the left hemisphere in 25%. D-dimer, PLT, neutrophils, AST, ALT, BUN, and urea were found to be statistically significantly higher in the COVID-19 patientS. PaO2 /FiO2 ratios were found to be statistically significantly lower in the COVID-19 patient group. Hospitalization and 28-day mortality rates of the groups (%). Conclusion: We concluded that while the pathogenicity of COVID-19 and preventive treatment approaches affect neurological complications, ischemic or hemorrhagic type proportionally changes and has a bad effect on prognosis. [ABSTRACT FROM AUTHOR]

Introduction: This article aims to measure the prevalance of venous thromboembolism, predict it with the data provided by clinical findings and test results of COVID-19 patients followed up in ICU, and determine the dose of anticoagulan agents. Materials and Methods: Patients divided into two groups; n=53 who developed VTE, n=54 who did not develop thromboembolic events between April 1, 2020 and July 31, 2021. Patients who developed thromboembolism were divided into groups by imaging methods used for diagnosis of thromboembolic events (pulmonary embolism, deep vein thrombosis, and acute infarction). Wells score was measured based on patient epicrisis. D-dimer, fibrinogen, Interleukin-6, ferritin, platelet count, activated partial thromboplastin time (aPTT), lactate dehydrogenase, C-reactive protein, Troponin-I measures. Results: Mean age of the individuals is 63.6±15.3. Of the patients, 20.6% had pulmonary embolism, 9.3% had DVT, and 19.6% had acute infarction. As a result of the statistical analysis, the mean age and mortality rate of patients who developed VTE are found to be higher. In addition, Of those who developed VTE; D-dimer levels at day 2, week 1, and troponin levels at week 1 and discharge are found to be considerably higher. And also fibrinogen levels at Admission, day 2, day 3, PLT levels at day 2, day 3, week 1, There was no difference between the groups in terms of length of stay in ICU and duration of mechanical ventilation. Conclusion: It should always be considered that there may develop VTE in critically-ill COVID-19 patients following up in the ICU. It is widely known that COVID-19 causes a tendency to clot and the mortality of patients who develop thromboembolism is high. Despite this, since the patients are not stable, it can be challenging to diagnose thromboembolism with various imaging methods in ICU patients. For this reason, it is important to predict thromboembolism with clinical findings and blood test results. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the risk of death of patients with a diagnosis of COVID-19 followed in the intensive care unit according to age, gender, vaccine type and vaccine dose status. Materials and Methods: The present study was planned by retrospectively evaluating the data of patients admitted to the intensive care unit between March 2021 and August 2022 with the diagnosis of COVID-19. The patients were evaluated in 6 groups according to their vaccination status. Groups were 0: not vaccinated, 1: One or two doses of Sinovac, 2: Three doses of Sinovac, 3: One dose of BioNTech, 4: Two doses of BioNTech. Results: Three hundred fifty-one patients were included in the study. The mean age of the patients was 67.1±15.6 and 191 (54.4%) patients were male. Two hundred fourteen (61.0%) of the patients were unvaccinated. The unvaccinated group had the highest mortality rate (86.4%). Two doses of BionTech vaccine had statistically lower mortality rates than the other groups (p<0.005). The relationship between age groups and mortality was statistically significant (p=0.014). The group over 75 years old had statistically significant higher mortality rates compared to the other groups. Age and vaccination status were found to be effective on mortality in multivariate analysis. The group over 75 years of age had a higher risk of mortality compared to the other groups (p=0.002). Patients with 2 doses of BioNTech vaccine showed a lower mortality rate in multivariate analysis compared to unvaccinated patients (p=0.001). The other vaccine groups did not have a protective effect against death. Conclusion: SARS-CoV-2 is a disease with high mortality rates and these rates are being reduced by vaccination studies. Patients over the age of 75 face higher mortality rates. The full-dose BionTech vaccine significantly reduces mortality rates. Single-dose BionTech or full-dose Sinovac vaccines appear to be insufficient to prevent mortality [ABSTRACT FROM AUTHOR]

Objective: Since the COVID-19 pandemic caused respiratory failure in many patients, oxygen delivery methods had to be diversified, and their numbers increased. High flow nasal cannula (HFNC), which has been shown beneficial in acute respiratory failure previously, also came to the fore. We aimed to investigate the efficacy of HFNC on patients hospitalized in intensive care units due to COVID-19. Materials and Methods: We retrospectively screened the patients followed in the intensive care unit due to COVID-19. Patients treated with HFNC performed the study group. We analyzed the relationship between demographics, laboratory results, treatment modalities, complications, and outcomes. Results: Among the 330 patients included mean ventilation duration with HFNC was 7.84 days. 170 (51.5%) patients intubated during HFNC treatment. Only 5 of them were extubated. Intubated patients had higher mean HFNC duration (9.74 days - min: 2, max: 49) compared to nonintubated patients (6.05 days - min: 1, max: 30). There was a significant relationship between mortality and age (OR: 1.04), APACHE II score (OR: 1.35), having cancer (OR: 3.89), receiving NIV (OR: 5.94), and presence of secondary bacterial infection (OR: 44.6). Conclusion: HFNC, whose benefit in acute respiratory failure has been proven, is also widely and successfully used in COVID-19 patients. Comprehensive randomized studies are needed to demonstrate the effect of HFNC use on intubation requirement and mortality. [ABSTRACT FROM AUTHOR]

Objective: Invasive pulmonary aspergillosis is a complication of respiratory bacterial and viral infections such as COVID-19. Materials and Methods: In our hospital, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) PCR positive and Aspergillus spp. We analyzed the clinical and demographic characteristics of 13 patients with. Results: Aspergillus species were identified in 13 patients aged between 54 and 85 (mean 73.46±9.11). Of 13 patients, 8 were male and 5 were female. All patients were intubated. The mean time between SARS-CoV-2 PCR positivity and intensive care admission. 5.69±5.8 days, hospitalization period before intensive care unit 3.62±3.7 days, intensive care unit stay of the patients 12.69±9.87 days, time between intubation and tracheal aspirate culture 4.46±4, it was 66 days. Five patients needed renal replacement therapy. The most common comorbidity observed in the patients was diabetes mellitus. The mean time between culture and death was 7.23±7.60 days. Aspergillus spp. growth was observed in control cultures of 5 patients. Aspergillus fumigatus grew in 9 patients, Aspergillus flavus in 2 patients, and Aspergillus niger in 2 patients. While 12 patients died, 1 patient survived. Conclusion: COVID-19-associated pulmonary aspergillosis (CAPA) is a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following SARS-CoV-2 infection, with incidence rates ranging from 8 to 33%. However, the definitive diagnosis of CAPA is difficult. Standard diagnostic algorithms and definitions are missing. The most complex problem in ARDS patients is to differentiate Aspergillus colonization from invasive disease. Bronchoalveolar lavage is generally avoided because of the aerosolization of the virus and the high risk of transmission to healthcare providers during the procedure.As radiological findings may overlap between COVID-19 ARDS and invasive pulmonary aspergillosis, it is extremely important to seek microbiological diagnosis to minimize mortality and morbidity due to coinfection. [ABSTRACT FROM AUTHOR]

Objective: COVID-19 disease is unfortunately not yet understood and a definitive treatment has not been found. The aim of this study is to investigate the changes in clinical and laboratory tests of critical COVID- 19 patients followed in the intensive care unit between March/2020 and December/2020 and to evaluate the factors that cause these changes with literature information. Materials and Methods: In the study, during the beginning of the pandemic and its progress; 50 COVID-19 patients treated in the intensive care unit (ICU) between March-April-May/2020 were defined as group 1, and 50 COVID-19 patients treated in the ICU between October-November- December/2020 were defined as group 2. Clinical, laboratory and intensive care processes of the patients in the groups were analyzed retrospectively and compared. Results: Age and gender distribution in terms of demographic data was similar between group 1 and group 2. APACHE-II score average of group 1 was 22, and APACHE-II score average of group 2 was 25. There was no statistically significant difference between the demographic data of the groups (Table 1). As a result of statistical analysis, while there was no significant difference between the groups in terms of CRP and ferritin values, there was a significant difference between the D-dimer values. The values of the patients in group 1 were found to be higher than in group 2 (Table 2). Group 2 patients had higher 28-day mortality, and this result was statistically significant (p=0.006). Transfer rates of group1 patients to the service after intensive care were found to be statistically higher (p=0.029) (Table 3). Conclusion: As a result of this study, 28-day mortality was found to be different between similar patient groups who were admitted to intensive care during different periods of the pandemic.The reasons for this may be: changes in pathogenicity as a result of viral mutations, different immune responses of hosts to viral infection. Another factor influencing this outcome may be the presence of less experienced healthcare professionals in critically ill care. [ABSTRACT FROM AUTHOR]