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The first case of coronavirus disease 2019 (COVID-19) was defined as unexplained pneumonia on December 8, 2019, and then it rapidly caused a pandemic and affected transplantation rates negatively. Organ donation processes got more complex because the exclusion of the disease in a short period became more difficult than normal. The exclusion of the disease is vital not only for recipients but also for the medical staff, transplantation teams, and intensive care professionals to reduce the transmission risk. The main steps for diagnosis of COVID-19 are investigation of symptoms, recollection of travel and physical contact history, and testing using the real time polymerase chain reaction (RT-PCR) test. Although it has limitations such as false negative results, RT-PCR is the most accurate method to detect COVID-19, and it is mandatory before donation processes in many countries. In this case report, we aim to share our experience about the first organ donation during the COVID-19 pandemic in Turkey.

OBJECTIVE: Drowning is a process of submersion and can lead to respiratory failure. Annually, there are an estimated 320 000 deaths worldwide due to drowning, in addition to nonfatal drowning events. There are limited data for respiratory failure due to drowning and its prognosis in Turkey. The aim of this study was to identify the therapeutic modalities used for acute respiratory failure (ARF) due to drowning, and its prognosis in hospitalized patients. MATERIAL AND METHODS: All adult drowning cases (according to the International Classification of Disease (ICD) diagnosis code) who were admitted to either the emergency department (ED) or the intensive care units (ICU), or the pulmonology inpatient clinics between 2008 and 2018 were included in the study. Data for demographic characteristics, radiologic evaluations, respiratory support and mechanical ventilation, hospital stay duration, and hospital mortality were retrospectively collected from hospital records. RESULTS: A total of 117 patients (47 females, 70 males, mean age: 57.3 years) were included in the study. The drowning accidents most commonly occurred in summer (86.3%). Of them, 31 victims (26.4%) were admitted to ICU due to severe respiratory failure. The mean pH was 7.32, and PaO(2) was 69.13 mmHg in the arterial blood gas at admission. Invasive and noninvasive mechanical ventilation were performed in 24.7% and 25.6% of the patients respectively. The PaO(2)/FiO(2) of 106 patients (who had accessible FiO(2) values) were >300 in 12 (11%), 201-300 in 32 (30%), 101-200 in 49 (46%), and

Background: To date, the coronavirus disease 2019 (COVID-19) caused more than 2.6 million deaths all around the world. Risk factors for mortality remain unclear. The primary aim was to determine the independent risk factors for 28-day mortality. Materials and Methods: In this retrospective cohort study, critically ill patients (>= 18 years) who were admitted to the intensive care unit due to COVID-19 were included. Patient characteristics, laboratory data, radiologic findings, treatments, and complications were analyzed in the study. Results: A total of 249 patients (median age 71, 69.1% male) were included in the study. 28-day mortality was 67.9% (n = 169). The median age of deceased patients was 75 (66-81). Of them, 68.6% were male. Cerebrovascular disease, dementia, chronic kidney disease, and malignancy were significantly higher in the deceased group. In the multivariate analysis, sepsis/septic shock (OR, 15.16, 95% CI, 3.96-58.11, p < 0.001), acute kidney injury (OR, 4.73, 95% CI, 1.55-14.46, p = 0.006), acute cardiac injury (OR, 9.76, 95% CI, 1.84-51.83, p = 0.007), and chest CT score higher than 15 (OR, 4.49, 95% CI, 1.51-13.38, p = 0.007) were independent risk factors for 28-day mortality. Conclusion: Early detection of the risk factors and the use of chest CT score might improve the outcomes in patients with COVID-19.

Background Mortality in critically ill patients with coronavirus disease 2019 (COVID‐19) is high, therefore, it is essential to evaluate the independent effect of new‐onset atrial fibrillation (NOAF) on mortality in patients with COVID‐19. We aimed to determine the incidence, risk factors, and outcomes of NOAF in a cohort of critically ill patients with COVID‐19. Methods We conducted a retrospective study on patients admitted to the intensive care unit (ICU) with a diagnosis of COVID‐19. NOAF was defined as atrial fibrillation that was detected after diagnosis of COVID‐19 without a prior history. The primary outcome of the study was the effect of NOAF on mortality in critically ill COVID‐19 patients. Results NOAF incidence was 14.9% (n = 37), and 78% of patients (n = 29) were men in NOAF positive group. Median age of the NOAF group was 79.0 (interquartile range, 71.5‐84.0). Hospital mortality was higher in the NOAF group (87% vs 67%, respectively, P = .019). However, in multivariate analysis, NOAF was not an independent risk factor for hospital mortality (OR 1.42, 95% CI 0.40‐5.09, P = .582). Conclusions The incidence of NOAF was 14.9% in critically ill COVID‐19 patients. Hospital mortality was higher in the NOAF group. However, NOAF was not an independent risk factor for hospital mortality in patients with COVID‐19., The incidence of NOAF is high in critically ill COVID‐19 patients. Hospital mortality is high in severe COVID‐19 patients with NOAF. Patients with NOAF are older and have co‐existing comorbidities.

Background/aim: Bevacizumab is a chemotherapeutic drug, which selectively binds to vascular endothelial growth factor (VEGF) and mainly inhibits angiogenesis and neovascularization. We aimed to study the possible effects of bevacizumab on right ventricular pressure (RVP), right ventricular hypertrophy, and VEGF, in hypoxia -induced pulmonary hypertension (PH) rat model. Materials and methods: 24 adult Wistar Albino rats were randomly divided into four groups: control group -saline; Bevacizumab Group; PH Group; PH + Bevacizumab Group. In hypoxia -induced model, 10% oxygen and 90% nitrogen were applied in a plexiglas box for eight days to PH Group and PH + Bevacizumab Group. On day eight, RVPs were measured directly from the heart, and then animals were sacrificed. Heart and lung tissues were examined, and Fulton index was measured. Results: RVP, Fulton index, and tissue VEGF scores were significantly lower in PH + Bevacizumab group than PH group: median (ranges), RVP, mmHg, 37.8 (33.0-39.0) and 32.3 (28.0-35.0), p: 0.01; Fulton index: 0.30 (0.29-0.33) and 0.25 (0.24-0.26), p: 0.003; tissue VEGF scores: 5.1 (4.8-5.3) and 4.0 (3.8 4.1), p: 0.004, respectively. Conclusion: Bevacizumab, which is indeed an antineoplastic agent, might have a favorable effect on hypoxia -induced pulmonary hypertension.

Objective:This study aimed to determine and compare the effects of two different gastric residual volume (GRV) thresholds, 200 mL and 400 mL, on target calories and gastrointestinal intolerance in intensive care patients receiving enteral nutrition.Materials and Methods:Prospective data of 56 patients over 18 years of age who were expected to stay in the intensive care unit for more than three days were included in the study. Patients were randomized into two groups as GRV threshold 200 mL (group 1) and GRV 400 mL (group 2). Enteral Measurement of GRV was done every six hours. The feeding was initiated at a rate of 20 mL/h and was increased by 10 mL/h to reach the goal rate.Results:There was no significant difference between two groups regarding gender, age, APACHE II score, body mass index, length of stay in intensive care unit, admission reason, and co-morbidities. There was also no significant difference in the incidence of GRV, vomiting, diarrhea and intolerance. Time to target calories was 24 hours in group 1 and 26 hours in group 2, and no significant difference was found between the two groups.Conclusion:In this study, there was no significant difference between 200 mL and 400 mL GRV regarding time to target calories and incidence of gastrointestinal complications in critical intensive care unit patients.

Despite improvements in medical and surgical treatment, aneurysmatic subarachnoid hemorrhage (SAH) remains one of the main causes of early mortality. Cardiac and pulmonary complications are the main causes of mortality. One of the most severe cardiac complications is neurogenic stress cardiomyopathy. Left ventricular dysfunction which is seen in neurogenic stress cardiomyopathy, although it is usually reversible within a few days, can cause severe hypotension, pulmonary edema and cardiogenic shock. Traditional treatment of heart failure after SAH is based on the use of noradrenaline, dobutamine and high volume of fluids. However, it is difficult to treat reduced cardiac output in SAH. Because, myocardial cells are already under stress due to increased adrenergic stimulation. The use of exogenous catecholamines may cause additional neurocardiogenic damage in myocardial cells, excessive calcium burden, decreased cerebral blood flow, and delayed cerebral ischemia. By reducing the use of exogenous catecholamines with levosimendan, the vicious circle of cardiotoxicity induced by catecholamines can be broken. Levosimendan is a nonadrenergic inotropic calcium sensitizer that allows rapid recovery of cardiac output and optimizes cerebral perfusion without increasing myocardial oxygen consumption. If we consider that reduction in left ventricular systolic function plays a role in the pathogenesis of delayed cerebral ischemia, the risk of developing neurological complications may be reduced by administration of levosimendan in these patients. Moreover, new evidence from experimental studies also indicates that levosimendan may have neuroprotective effects in the SAH. In this review, the use of levosimendan in the treatment of hemodynamic disorders which develops in the course of SAH has been discussed in company with current literature.

Objective:Intensive care units (ICU) are multidisciplinary structures dealing with potentially life-threatening diseases. Trauma patients are among some of the patients treated in ICU. In this study, we aimed to investigate the causes of mortality and morbidity in trauma patients treated in our ICU.Materials and Methods:The data of trauma patients hospitalized in anesthesia ICU between January 2014-2016 were evaluated retrospectively. Patients’ age, gender, concomitant disease, trauma etiology, clinical diagnoses, APACHE-2 revised trauma score (RTS) and injury severity scores, duration of stay in ICU, duration of mechanical ventilation, duration of hospital stay, mortality rates, discharge status from ICU and discharge Glasgow Coma Scale score, hemodialysis requirement during follow-up, enteral nutrition status within 48 hours after admission to ICU and lactate levels at admission to ICU were evaluated.Results:A total of 954 patients were treated in the ICU and 106 patients (11.1%) were followed up for trauma. Regarding 28-day and 90-day mortality, the mean lactate levels, duration of mechanical ventilation and APACHE-2 scores were significantly higher in non-survivors (p

The nocturnal peak of melatonin can be altered after anesthesia and surgery. We aimed to examine the melatonin levels during the day and night after anesthesia with three commonly used inhalational anesthetics. Forty-eight male Wistar albino rats were randomized into eight groups. Rats were administered anesthesia between 7:00 AM and 1:00 PM (day groups) or 7:00 PM and 1:00 AM (night groups) for 6 hours. At the end of the anesthesia, blood samples were collected for assessing melatonin levels. Mean values of melatonin levels after 6 hours of anesthesia during daytime were 43.17 +/- 12.95 for control, 59.79 +/- 27.83 for isoflurane, 50.75 +/- 34.28 for sevoflurane and 212.20 +/- 49.56 pg/mL for desflurane groups. The night groups' mean melatonin levels were 136.12 +/- 33.20 for control, 139.85 +/- 56.29 for isoflurane, 117.48 +/- 82.39 for sevoflurane and 128.70 +/- 44.63 pg/mL for desflurane groups. Desflurane anesthesia between 7:00 AM and 1:00 PM significantly increased melatonin levels (p < 0.001). Sevoflurane and desflurane anesthesia between 7:00 PM and 1:00 AM decreased the melatonin levels but there were no significant differences (pZ0.904 and p > 0.99, respectively). Isoflurane anesthesia did not significantly change melatonin levels during day or night (p = 0.718 and p > 0.99, respectively). Our results demonstrate that during daytime desflurane anesthesia can alter melatonin levels. Altered melatonin rhythm following inhalational anesthesia can be related to sleep disorders observed after anesthesia. Copyright (C) 2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.

Objective: Emotional and physical burden is heavy in the intensive care unit (ICU) employees, and the risk of burnout has significantly increased. The purpose of this study is to determine the frequency of burnout and depression in nurses serving in tertiary ICUs in a university hospital by questionnaire.

Objective The aim of this study is to investigate the effect of day and night administration of desflurane anaesthesia on melatonin levels in rats. Methods Twenty-four 15-day-old rats were included in the study and were divided into four groups. The rats were anaesthetised between 19:00-01:00 (night group) and 07:00-13:00 (day group) with 5.7% desflurane concentration in 6 L min-1 100% oxygen. 6 L min-1 oxygen was administered to the control groups. At the end of 6 h of anaesthesia, blood samples were taken, and rats were sacrificed. Blood samples were centrifuged and melatonin levels from plasma samples were measured with radioimmunoassay. Results There was a statistically significant difference between the groups (p=0.007). Between group day control and group night control there was a statistically significant difference (p=0.042). Further, there was a significant difference between group day control and night desfluran as well (p=0.024). We could not find any difference between other groups. Conclusion This study showed that 6 hours of 5.7% desflurane anaesthesia during day and night hours did not significantly change melatonin levels.

Introduction: Sugammadex (Bridon ®) (SUG) is a recently developed neuromuscular block reversing agent. SUG can reverse also deep neuromuscular blockages in a short time period unlike other existing agents. SUG passes across blood brain barrier (BBB) in a very low ratio in normal patients. However SUG may pass the BBB in a higher ratio in patients whom BBB integrity is decreased. Since SUG passes BBB in a low ratio in normal patients there are only a small amount of studies investigating effects of this agent on central nervous system (CNS). In this study we aimed to assess the effects of SUG administered directly to intracerebroventricular space on CNS system of rats. Materials and Method: A total of 36 Wistar-Albino rats with normal motor activity weighting between 250-280 g were included in this study. Anesthesia was achieved with intraperitoneal 50 mg/kg sodium thiopental. The rats were divided into 6 equal groups randomly as one group being the control group. The experiment groups were received 2,4,8,16 and 32 mg/kg sugammadex via intracerebroventricular cannula. Effects of the SUG on CNS were assessed based on a 5 point scale. Results: Intracerebroventricular SUG administration did not result in any changes in behavioral status, locomotor activity or posture at any doses (2,4,8,16 and 32 mg/kg). There was no tonic clonic convulsion or seizure development following the sugammadex administration. Discussion: SUG barely passes the BBB in normal patients. However it was stated that this drug can pass BBB in higher ratios in certain patients. Therefore investigating the effects of SUG on CNS is an emerging subject of experiments. In our study we could not find any adverse effect of SUG on CNS even at high doses administered directly to intracerebroventricular space. However presence of a study indicating an increase in apoptotic cell death in cell cultures in presence of SUG makes it difficult to make a statement that SUG does not have any adverse effect on CNS. The authors of the aforementioned study stated a connection between decrease in cholesterol levels and apoptosis. It can be speculated that some mechanisms in live animals may restore this decrease in cholesterol levels occurring in presence of SUG therefore prevents the cells from apoptosis. Conclusion: In our study SUG did not cause any adverse effect on CNS in rats. Further studies assessing the relationship between SUG and cholesterol control mechanisms in neurons are necessary in order to make a certain statement.

The aim of our study was to examine the effects of the use of Transcutaneous Electrical Nerve Stimulation (TENS) in patients who had undergone spinal surgery on pain, functionality, depression and consumption of analgesic agents.Fifty-Four patients were randomized and placed into two groups, patient-controlled analgesia (PCA) plus TENS and only PCA. To assess the pain levels of the patients, the Visual Analog Scale (VAS) was used. In the assessment of their functional levels, the Timed Up and Go test (TUG) was utilized and in the assessment of their depression, the Beck Depression Inventory (BDI) was used. The measurements were performed before the operation and on the first and second postoperative days. The side effects were recorded from the analgesic agents.During the first and second days after the operation, a decrease in the pain levels was noticed in the TENS group (p0.05. In the TENS group, the consumption of analgesic agents also decreased and thus side effects were less frequent. From the viewpoint of functional and depression levels, no significant difference between the groups was noticed (p0.05).TENS was effective in reducing analgesic agent-related side effects and in reducing analgesic consumption. In addition, TENS also decreased activity related pain.