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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.

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.

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.

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.