BackgroundFrailty is a multidimensional syndrome associated with adverse outcomes in older adults. This study aimed to compare the predictive value of the FRAIL scale and the Clinical Frailty Scale (CFS) for 28-day mortality among critically ill geriatric patients.MethodsIn this prospective cohort study conducted in a tertiary intensive care unit, all consecutive patients aged ≥65 years were assessed for frailty at intensive care unit admission using the FRAIL scale and the CFS. Logistic regression analysis was performed to identify independent associations with 28-day mortality. Receiver operating characteristic analyses with DeLong comparison and Kaplan–Meier survival analyses with log-rank testing were also performed.ResultsAmong 168 patients, 53% were male, and the median age was 77 years (IQR 70–82). The 28-day mortality rate was significantly higher in frail patients compared with non-frail patients according to both the FRAIL scale (36% vs. 16%, p = 0.005) and CFS (34% vs. 15%, p = 0.009). Agreement between the two tools was good (κ = 0.75; 95% CI, 0.65–0.85). In multivariable analysis, frailty defined by the FRAIL scale remained independently associated with 28-day mortality (OR 2.41; 95% CI, 1.01–5.76; p = 0.048), whereas CFS-based frailty was not (OR 2.26; 95% CI, 0.91–5.63; p = 0.080). The AUROC values for total scores were 0.664 for the FRAIL scale and 0.700 for the CFS (DeLong p = 0.149); for dichotomized frailty status, AUROC values were 0.620 and 0.606, respectively (DeLong p = 0.595).ConclusionFrailty at ICU admission is an important predictor of short-term mortality in older adults. The FRAIL scale demonstrated independent prognostic value in the primary adjusted model, while AUROC comparison did not show a statistically significant discrimination advantage over the CFS.

Delays in intensive care unit (ICU) admissions are prevalent in overcrowded hospitals and can adversely affect patient outcomes. However, the extent of this impact, particularly beyond short-term mortality, remains unclear. We hypothesized that ICU admission delays exceeding 6 hours after consultation would independently increase 90-day mortality and prolong ICU length of stay. We conducted a retrospective analysis of data from 273 adult patients admitted to the ICU of a tertiary university hospital between January and December 2019. Patients were stratified into two groups: early admission (≤6 hours) and delayed admission (>6 hours). Multivariate Cox regression was employed to identify independent predictors of mortality. Delayed ICU admission was observed in 72.8% of patients. Although delayed admission was not independently associated with increased mortality in the multivariate analysis (HR: 0.88; 95% CI: 0.61–1.27), it was significantly correlated with prolonged ICU length of stay and higher 90-day mortality in the univariate analysis (p = 0.039), with no significant difference in vasopressor-free days (p = 0.809). In our assessment of independent mortality predictors, we found that patients with higher APACHE-II and Charlson scores experienced longer delays in ICU transfer. Additionally, respiratory and circulatory failure at admission were independently associated with increased mortality (HR: 2.17; 95% CI: 1.51–3.12). While early ICU admission did not independently predict mortality, it was linked to extended ICU stays, an increased treatment burden, and adverse long-term outcomes. These findings underscore the necessity of refining triage processes and evaluating baseline patient severity when interpreting the impact of ICU admission timing on outcomes.

Introduction: Colistin is considered as a last resort therapy for multidrug-resistant gram-negative organisms. It is widely used despite the significant risk of nephrotoxicity. Experimental studies showed the nephroprotective effect of dexmedetomidine, a sedative agent, against colistin toxicity. This study was performed to show the possible nephroprotective effect of dexmedetomidine among critically ill patients who received colistin.Methods: Adult (>17 years) patients who were admitted to our surgical and medical intensive care unit (ICU) from March 2018 through March 2021, and who received colistin were included. Patients who receive Colistin therapy or intensive care unit follow-up of <72 h (discharge or death) and Acute kidney injury (AKI) or need hemodialysis prior to colistin therapy at the same hospitalization were excluded. AKI risk factors were examined by grouping patients with and without AKI. Patients, receiving colistin concomitantly with dexmedetomidine were also evaluated. Results: Of the 139 patients included, 27 (17.8%) patients received dexmedetomidine. Sixty-five patients (47%) had AKI, at a median 5 (4-7) days after the initiation of colistin. Older age, lower baseline estimated glomerular filtration rate, and vasopressor use were associated with a higher risk of AKI, while dexmedetomidine use was associated with a lower risk. In the multivariate regression model, dexmedetomidine use was independently associated with a lower risk of AKI development (OR 0.20 95% CI 0.07-0.59, p = 0.003). Conclusion: In respect to these findings, dexmedetomidine may provide protection against AKI during colistin therapy in critically ill patients.

Objective: Myocardial injury incidence is high in critically ill patients with coronavirus disease-2019 (COVID-19) and mortality increases in COVID-19 patients with myocardial injury. Our objective was to determine the association between chest computed tomography (CT)-based measurements and myocardial injury in critically ill patients with COVID-19.Materials and Methods: We conducted a single-center cohort study of patients admitted to the intensive care unit (ICU) with a diagnosis of COVID-19 who underwent chest CT. Myocardial injury was defined as high-sensitivity troponin I blood levels above the 99th percentile upper reference limit, independent of new abnormalities in electrocardiography and echocardiography. Demographic, clinical, laboratory results, and chest CT findings were collected at ICU admission.Results: A total of 213 patients were included. Of the 213 patients, 69 (32.4%) were female, and 144 (67.6%) were male. Myocardial injury incidence was 61.0% (n=130). Acute Physiology and Chronic Health Evaluation-II score [odds ratio (OR): 1.07, 95% confidence interval (CI): 1.021.12, p=0.005], having a chest CT severity score >= 18 (OR: 2.85, 95% CI: 1.29-6.32, p=0.010), having any coronary artery calcification (CAC) (OR: 2.45, 95% CI: 1.09-5.52, p=0.030), and age (OR: 1.04, 95% CI: 1.01-1.08, p=0.041), as factors independently associated with an increased risk of myocardial injury.Conclusion: The incidence of myocardial injury is high in critically ill COVID-19 patients. Chest CT severity score >_18 and presence of CAC are practical and valuable tools readily available from existing chest CT to predict myocardial injury in critically ill patients with COVID-19.

Objective:Bispectral index (BIS) is a parameter generated from a mathematical analysis of frontal cortex activity. BIS monitoring has been widely used in cerebral pathologies such as traumatic brain injury, brain death, metabolic coma and barbiturate coma and some studies have reported a good correlation between neurological status and BIS values. We evaluated the validity of BIS monitoring for the detection and diagnosis of brain death in our studyMaterials and Methods:Our study was a methodological prospective study. Twenty-eight patients with severe coma [Glasgow coma scale score (GCS)<8] at intensive care unit (ICU) admission are monitored by BIS. Eight patients were excluded from the study due to varies reasons. Data of twenty patients with brain death were evaluated.Results:The most common diagnoses were intracranial hemorrhage (8 patients-40%) and subarachnoid hemorrhage (8 patients-40%). The most common used ancillary method was computed tomography angiography. BIS and suppression ratio (SR) were determined as 0 and 100 respectively at the moment of brain death diagnosis in 12 of 20 patients, whereas BIS was determined >0 in the remainders. When the receiver operating characteristic curve analysis was performed for the 34041 BIS values of 20 patients, the area under curve was found as 0.582 (0.576-0.588), which was statistically significant (p<0.05). There was a strong negative correlation between BIS and SR and it was statistically significant (R:-0.959, p<0.05).Conclusion:BIS is a non-invasive method and it may be used in the ICU. BIS monitoring may be useful, especially in patients with head trauma and GCS =3. BIS monitoring provides information about the neurological prognosis. We consider that BIS monitoring can prevent the loss of time by providing to detect the moment of the brain death and thus facilitating the organ transplantation process and however it can not take the place of the other ancillary methods.

Objective:To define histopathologic and immunohistochemical features of the lungs,heart,liver,and kidneys in patients who died from coronavirus disease 2019(COVID-19),and to determine the presence of SARS-CoV-2 in all tissues,as well as the presence of fungi and parasites in lung tissues. Methods:This retrospective case study was conducted in the intensive care units of Dokuz Eylül University Hospital,and patients(≥18 years)who died due to COVID-19 between October 2020 and April 2021 were included.The biopsy samples of the patient's lung,heart,liver,and kidney tissues were studied. Results:In the study,we enrolled 12 patients(mean age:70 years;50％male).Alveolar epithelial cell damage and diffuse alveolar damage were predominant in lung tissues.Lobular lymphocyte infiltration,centrilobular sinusoidal dilatation,and microvesicular steatosis in the liver,together with pigmented cast,non-isometric vacuolar degeneration,and capillary plugging in the kidneys,were commonly found among the patients.SARS-CoV-2 nucleocapsid protein antibodies were detected in three lung and two kidney tissues,and so did angiotensin-converting enzyme 2 receptor positivity in one lung and more than half of the kidney tissues.The RT-PCR tests were positive in three lungs and one kidney tissue.After DNA isolation from lung tissues,Pneumocystis jirovecii was detected in nine patients,Aspergillus fumigatus in two,Microsporidia in three,and Cryptosporidium in two. Conclusions:SARS-CoV-2 is a multisystemic disease.Fungi and parasites should be investigated in critically ill COVID-19 patients prescribed corticosteroids.

Background/Aim. - Nutritional planning is an important aspect of Intensive Care Unit (ICU) care. The present study aimed to evaluate the nutritional practices adopted in medical ICUs in Turkiye and to investigate their compliance with current international guidelines. Methods. - This multicenter, cross-sectional study was performed on a predetermined study date. Centers were required to fill three groups of questionnaires: One on ICU characteristics and facilities, one on patients included, and one on outcomes of patients. Forms on patients had questions on demographics and their nutritional status. Results. - A total of 12 sites participated and 132 patients were recorded in the study and 109 patients were included in analyses. The median age was 72 [57-83] years and 55 (50%) of them was female. The median APACHE II score was 23 [18-29], median SOFA score was 6 [4-9] and median BMI was 25.32 [21.22-29.38]. More than 50% of patients were fed enterally; for most, it was started within the first 24 hours of admission. On the study day, the median energy intake of the patients during the last 24 hours was 21.62 [15.9-27.3] kcal/kg and the median amount of protein intake was 1.02 [0.7-1.3] g/kg, representing 83.1% and 78.9% of the targets, respectively. A total of 64 (58.7%) patients were alive on the 28th day of the study, of them 23 (21.1% of all patients) were still in the ICU.

OBJECTIVE:Pleural fluid pH measurement is recommended for tube thoracostomy decisions in complicated parapneumonic pleural effusions. However, pleural fluid pH may be affected by blood pH in critically ill patients with common systemic acid-base disorders. We aimed to investigate the use of pleural fluid lactate to distinguish culture-positive parapneumonic effusions from other pleural effusions.MATERIAL AND METHODS:This prospective observational study included 121 eligible patients (51 female and 70 male). All patients with pleural effusion who underwent thoracentesis were assessed. Pleural fluid lactate was measured by a blood gas analyzer.RESULTS:Of the 121 patients, 30 (24.8%) were transudate and 91 (75.2%) were exudate. Of the 91 patients with exudative pleural effusion, 61 were diagnosed as culture-negative parapneumonic, 13 as culture-positive parapneumonic, 9 as malignant, and 8 as other exudative effusion. There was a strong positive linear association between serum pH and pleural fluid pH (R = 0.77, P < .001). The post hoc tests for pleural fluid lactate revealed there was a significant difference between culture-positive parapneumonic versus culture-negative parapneumonic groups (P = .004), culture-positive parapneumonic versus transudative effusion groups (P < .001), culture-negative parapneumonic versus transudative effusion groups (P = .008) and lastly; malignant effusion versus transudative effusion groups (P = .001). Receiver operating characteristics curve analysis for culture-positive parapneumonic indicated a cutoff of 4.55 mmol/L for pleural fluid lactate to have a sensitivity of 76.9% and a specificity of 84.3% (positive predictive value: 37%, negative predictive value: 96.8%).CONCLUSION:A cutoff of 4.55 mmol/L of pleural fluid lactate can be used as a useful tool to distinguish culture-positive parapneumonic effusions from other effusions in critically ill patients.

Objective: With new treatment modalities, the overall survival of patients with hematological malignancies (HM) has increased over the years.However, intensive care unit (ICU) mortality is still high.This study aimed to evaluate the clinical characteristics, treatment methods, and results of HM patients admitted to the ICU at a center in Turkey.Materials and Methods: Patients with HM admitted to the ICU between January 2013 and 2020 were retrospectively evaluated.A total of 172 adult patients with HM were included in the study.Results: The median (interquartile range) age of patients was 60 (47-67) years, admission Acute Physiology Assessment and Chronic Health Evaluation-II score was 30 (26-32), Sequential Organ Failure Assessment score was 10 (7-12).Results of the 172 patients, 60 (34.9%) had newly diagnosed malignancies, 16 (9.3%)were in remission, and 96 (55.8%) had relapsed/refractory disease.The ICU admission was mostly required for acute respiratory failure (62.5%) and/or shock (42.3%).Forty-seven (27.3%) patients had stem cell transplantation, and 59 (34.3%) were neutropenic.Of them, 143 (83.2%) patients were admitted to intensive care after intubation and 159 (92.4%) patients needed vasopressors during intensive care stay.Thirteen (7.5%) patients were diagnosed with fiberoptic bronchoscopy-bronchoalveolar lavage sampling only, and treatment was changed in 85% according to the results.We observed that the patients were admitted to the ICU at the 28 th hour (11-55) after determining the need for ICU follow-up.Intensive care mortality was 94.3% (163).Conclusion: Early detection of critical illness and rapid admission to the ICU are important for the patients with HM.Collaborative studies determining early admission criteria to ICUs should be performed by the intensivists and hematologists to improve survival.This may be achieved by allocating special ICUs for these patients within the hematology clinics.

OBJECTIVE: The most appropriate ventilatory mode during fiberoptic bronchoscopy is still not yet known clearly for patients with acute respiratory distress syndrome. Airway pressure release ventilation is used as a recovery treatment for patients with severe acute respiratory distress syndrome. In this study, the aim was to evaluate the safety of the fiberoptic bronchoscopy process in patients with severe acute respiratory distress syndrome ventilated with airway pressure release ventilation mode and its effect on gas exchange and respiratory mechanics. MATERIAL AND METHODS: Single-center retrospective observational study was performed in the intensive care unit of a tertiary referral center from September 2018 to November 2019. Patients with severe ARDS ventilated with APRV mode and undergoing FB were included. Fiberoptic bronchoscopy was performed by an expert intensivist-pulmonologist. All ventilator parameters set by the clinician were kept stable, and no change was made other than O 2 concentration. The mechanical ventilation parameters and arterial blood gas values before and after the procedure and fiberoptic bronchoscopy-related complications were recorded for the first 24 hours. RESULTS: A total of 14 acute respiratory distress syndrome patients who were ventilated with airway pressure release ventilation were enrolled. No significant deteriorations were detected in gas exchange, pulmonary compliance, and airway resistance values in our case series. It was observed that a small reduction in PaO 2 and an increase in PaCO 2 were present after the 1st hour; however, both were returned to baseline values in the 24th hour. Only 1 patient developed fiberoptic bronchoscopy-induced hypoxemia (7.1%). Complications, such as fiberoptic bronchoscopy-induced barotrauma, pneumothorax, hemodynamic deterioration, and bleeding, were not detected. CONCLUSION: According to our preliminary findings, performing fiberoptic bronchoscopy under airway pressure release ventilation mode by an experienced bronchoscopist does not bring additional complication risks in patients with severe acute respiratory distress syndrome.

Background/aim: Acute kidney injury is strongly associated with mortality in critically ill patients with coronavirus disease 2019 (COVID-19); however, age-related risk factors for acute kidney injury are not clear yet. In this study, it was aimed to evaluate the effects of clinical factors on acute kidney injury development in an elderly COVID-19 patients. Materials and methods: Critically ill patients (>= 65years) with COVID-19 admitted to the intensive care unit were included in the study. Primary outcome of the study was the rate of acute kidney injury, and secondary outcome was to define the effect of frailty and other risk factors on acute kidney injury development and mortality. Results: A total of 132 patients (median age 76 years, 68.2% male) were assessed. Patients were divided into two groups as follows: acute kidney injury (n = 84) and nonacute kidney injury (n = 48). Frailty incidence (48.8% vs. 8.3%, p < 0.01) was higher in the acute kidney injury group. In multivariate analysis, frailty (OR, 3.32, 95% CI, 1.67-6.56), the use of vasopressors (OR, 3.06 95% CI, 1.16-8.08), and the increase in respiratory support therapy (OR, 2.60, 95% CI, 1.01-6.6) were determined to be independent risk factors for acute kidney injury development. The mortality rate was found to be 97.6% in patients with acute kidney injury. Conclusion: Frailty is a risk factor for acute kidney injury in geriatric patients with severe COVID-19. The evaluation of geriatric patients based on a frailty scale before intensive care unit admission may improve outcomes.

OBJECTIVE:The effects of fiberoptic bronchoscopy are not elucidated in different mechanical ventilation modes. The present study aimed to evaluate the effects of fiberoptic bronchoscopy on lung mechanics, ventilation parameters, and gas exchange in 2 often-used modes, volume control and pressure control, in invasively ventilated patients followed up in the intensive care unit.MATERIAL AND METHODS:Eligible patients were screened and included in the study after intensive care unit-fiberoptic bronchoscopy database search. Patients who underwent fiberoptic bronchoscopy under volume control and pressure control mechanical ventilation modes were compared. The primary outcome was the occurrence of any complication within the first 24 hours after the procedure, and secondary outcomes were changes in lung mechanics (dynamic lung compliance and airway resistance) and gas exchange (arterial partial pressures of oxygen and carbon dioxide).RESULTS:A total of 61 patients (median age: 69 years, 60.7% male) were included. Twenty-nine (47.5%) patients were ventilated in volume control mode and 32 (52.5%) in pressure control mode during the fiberoptic bronchoscopy procedure, and the median (interquartile range) duration of the procedure was 9 [8-11] minutes. Baseline dynamic lung compliance, airway resistance, arterial partial pressures of oxygen and carbon dioxide, and the fraction of inspired O2 were similar in both groups. After fiberoptic bronchoscopy, dynamic lung compliance decreased in both groups, and airway resistance and peak airway pressures increased but reached pre-fiberoptic bronchoscopy values at the 1st hour after the procedure. No significant differences were detected in both groups in terms of blood gas values and lung mechanics in the 1st and 24th hours after the procedure. In both groups, the 24th hour fraction of inspired O2 was the same as the pre-fiberoptic bronchoscopy values, but the ratio of arterial partial pressure of oxygen and the fraction of inspired O2 improved. No complications developed in patients within 24 hours after the procedure.CONCLUSION:No differences were detected in terms of gas exchange and pulmonary mechanics, and complications in volume control and pressure control modes in critically ill intubated patients.

Background: The prediction of high-flow nasal oxygen (HFNO) failure in patients with coronavirus disease-2019 (COVID-19) having acute respiratory failure (ARF) may prevent delayed intubation and decrease mortality. Aims: To define the related risk factors to HFNO failure and hospital mortality. Study Design: Retrospective cohort study. Methods: To this study, 85 critically ill patients (≥18 years) with COVID-19 related acute kidney injury who were treated with HFNO were enrolled. Treatment success was defined as the de-escalation of the oxygenation support to the conventional oxygen therapies. HFNO therapy failure was determined as the need for invasive mechanical ventilation or death. The patients were divided into HFNO-failure (HFNO-F) and HFNO-success (HFNO-S) groups. Electronic medical records and laboratory data were screened for all patients. Respiratory rate oxygenation (ROX) index on the first hour and chest computed tomography (CT) severity score were calculated. Factors related to HFNO therapy failure and mortality were defined. Results: This study assessed 85 patients (median age 67 years, 69.4% male) who were divided into two groups as HFNO success (n = 33) and HFNO failure (n = 52). The respiratory rate oxygenation (ROX) was measured at 1 hour and the computed tomography (CT) score indicated HFNO failure and intubation, with an area under the receiver operating characteristic of 0.695 for the ROX index and 0.628 for the CT score. A ROX index of <3.81 and a CT score of >15 in the first hour of therapy were the predictors of HFNO failure and intubation. Age, Acute Physiology and Chronic Health Evaluation II score, arterial blood gas findings “(i.e., partial pressure of oxygen [PaO2], PaO2 [fraction of inspired oxygen]/SO2 [oxygen saturation] ratio)”, and D-dimer levels were also associated with HFNO failure; however, based on logistic regression analysis, a calculated ROX on the first hour of therapy of <3.81 (odds ratio [OR] = 4.78, 95% confidence interval [CI] = 1.75–13.02, P = 0.001) and a chest CT score of >15 (OR = 2.83, 95% CI = 1.01–7.88, P = <0.001) were the only independent risk factors. In logistic regression analysis, a ROX calculated on the first hour of therapy of <3.81 (OR = 4.78, [95% CI = 1.75–13.02], P = 0.001) and a chest CT score of >15 (OR 2.83, 95% CI = 1.01–7.88, P = <0.001) were the independent risk factors for the HFNO failure. The intensive care unit and hospital mortality rates were 80.2% and 82.7%, respectively, in the HFNO failure group. Conclusion: The early prediction of HFNO therapy failure is essential considering the high mortality rate in patients with HFNO therapy failure. Using the ROX index and the chest CT severity score combined with the other clinical parameters may reduce mortality. Additionally, multi-centre observational studies are needed to define the predictive value of ROX and chest CT score not only for COVID-19 but also other causes of ARF.

Objective: Bronchoscopy is important for the diagnosis and treatment planning of patients in the intensive care unit, especially for infectious conditions. However, increasing evidence is reported in recent guidelines showing that bronchoscopic sampling is not superior compared with endotracheal aspirate (ETA). This study aimed to evaluate the contribution of bronchoscopic sampling to antibiotic treatment and its effect on intensive care mortality. Materials and Methods: This retrospective observational study evaluated the data of 75 patients who were followed up under invasive mechanical ventilation using the intensive care fiberoptic bronchoscopy (FB) database. Results: The mean age of patients was 66.0 +/- 15.4 years, and 28 (37.32%) were female and 47 (62.7%) were male. The mean acute physiology and chronic health evaluation-II score was 23.1 +/- 6.2. Median FB timing was 7.0 (2.0-15.0) days after the intensive care unit admission. Indications for FB were infection evaluation in 44 patients, airway evaluation in 26 patients, hemoptysis-alveolar hemorrhage in 3 patients, and interstitial lung disease suspicion in 2 patients. Active immune suppression was present in 24 (32%) patients. Evaluation of ETA results revealed bacterial and fungal growth in 31 patients (41.3%). After FB sampling, 41 patients (54.6%) were found to have bacterial and fungal growth, and treatment was changed in 16 (21.3%) patients with FB sampling. However, no significant relationship was found between the change of treatment after FB and mortality in the intensive care unit (p=0.250). Conclusion: Our study has two important results. First, ETA and FB sampling results were found to be similar. Second, no correlation was found between treatment change after FB in the late period and mortality in intensive care. The application of FB, which is an invasive procedure, could be the right approach in selected patients.

Aim: Mortality risk factors and effective treatment approaches are still uncertain for the SARS-CoV-2. In this study, we aimed to determine risk factors of 90-day mortality critically ill patients with COVID-19 infection. Materials and Methods: All patients hospitalized in the intensive care unit of the university hospital with the diagnosis of COVID-19 pneumonia between 15 March and 30 November 2020 were reviewed in this retrospective study. The primary endpoint was 90-day mortality, while the secondary endpoints were in-hospital mortality, therapy responses for tocilizumab and corticosteroid treatments, duration of mechanical ventilation (MV), and length of hospital stay. Results: A total of 145 patients, 105 (73%) men and 40 (27%) women were included in the study. Median age was 71.0 (58-79.50) years. In-hospital mortality was 62.8%, 28-day mortality was 60%, and 90-day mortality was 66.9% for the whole study population. In-hospital mortality was 58.4% (n=52) and 90-day mortality was 64.0% (n=57) in patients receiving corticosteroid treatment. Both in-hospital and 90-day mortality was found as 60% (n=12) in patients receiving tocilizumab. Age and duration of invasive mechanical ventilation were determined as independent risk factors on logistic regression analysis performed for 90-day mortality (OR 1.060 (1.018-1.103), p=0.005 and OR 1.057 (1.004-1.113, p=0.035), respectively). Conclusions: Early and late mortality is high in patients with severe COVID 19 infection. Our results showed advanced age and duration of mechanical ventilation are independent risk factors for 90-day mortality. However long-term effect of corticosteroid and tocilizumab treatments on survival could not be demonstrated in this study.

Objective: Intoxication may mimic brain death and cause brain death. In the literature, brain death due to methanol intoxication is limited to case reports. In this report, patients with methanol intoxication who had findings of imminent brain death were evaluated. Materials and Methods: The study population consisted of patients with methanol intoxication treated in the adult intensive care unit (ICU) between October 2014 and October 2020. The records in the hospital automation system of patients with methanol intoxication were evaluated retrospectively. According to the outcomes, the patients were divided into two groups: survivors and patients who had imminent brain death. Results: Eighteen patients with methanol intoxication were investigated. The brainstem reflexes disappeared in seven patients who were in a coma. The imminent brain death rate of patients with methanol intoxication was 39%. Patients who had imminent brain death had lower Glasgow Coma Scale scores during ICU admission and a higher ratio of pathologic neuroimaging findings due to methanol intoxication (P < 0.05). According to the clinical criteria and ancillary tests, four patients were declared brain dead. The brain death rate of patients with methanol intoxication was 22%. One of four patients with brain death was an organ donor. The liver was transplanted from our donor. Conclusion: Treatment should be initiated immediately in cases of methanol intoxication. Patients who do not respond well to treatment should be followed closely in terms of brain death. Based on published data and our personal experience, organ donations can be performed after appropriate investigations in brain death cases due to methanol intoxication.

BackgroundAlthough low serum magnesium level is a a relatively common problem in mixed medical/surgical intensive care units (ICUs), its association with new-onset atrial fibrillation (NOAF) has been studied to a lesser extent. We aimed to investigate the effect of magnesium levels on the development of NOAF in critically ill patients admitted to the mixed medical/surgical ICU.MethodsA total of 110 eligible patients (45 female, 65 male) were included in this case-control study. The age and sex-matched control group (n = 110) included patients with no atrial fibrillation from admission to discharge or death.ResultsThe incidence of NOAF was 2.4% (n = 110) between January 2013 and June 2020. At NOAF onset or the matched time point, median serum magnesium levels were lower in the NOAF group than in the control group (0.84 [0.73-0.93] vs. 0.86 [0.79-0.97] mmol/L; p = 0.025). At NOAF onset or the matched time point, 24.5% (n = 27) in the NOAF group and 12.7% (n = 14) in the control group had hypomagnesemia (p = 0.037). Based on Model 1, multivariable analysis demonstrated magnesium level at NOAF onset or the matched time point (OR: 0.07; 95%CI: 0.01-0.44; p = 0.004), acute kidney injury (OR: 1.88; 95%CI: 1.03-3.40; p = 0.039), and APACHE II (OR: 1.04; 95% CI: 1.01-1.09; p = 0.046) as factors independently associated with an increased risk of NOAF. Based on Model 2, multivariable analysis demonstrated hypomagnesemia at NOAF onset or the matched time point (OR: 2.52; 95% CI: 1.19-5.36; p = 0.016) and APACHE II (OR: 1.04; 95%CI: 1.01-1.09; p = 0.043) as factors independently associated with an increased risk of NOAF. In multivariate analysis for hospital mortality, NOAF was an independent risk factor for hospital mortality (OR: 3.22; 95% CI: 1.69-6.13, p<0.001).ConclusionThe development of NOAF in critically ill patients increases mortality. Critically ill patients with hypermagnesemia should be carefully evaluated for risk of NOAF.

In this retrospective cohort study, we aimed to evaluate the incidence, risk factors and outcomes of amikacin-induced acute kidney injury (AKI) in critically ill patients with sepsis. A total of 311 patients were included in the study. Of them, 83 (26.7%) had amikacin-induced AKI. In model 1, the multivariable analysis demonstrated concurrent use of colistin (OR 25.51, 95%CI 6.99-93.05, p< 0.001), presence of septic shock during amikacin treatment (OR 4.22, 95%CI 1.76-10.11, p=0.001), and Charlson Comorbidity Index (OR 1.14, 95%CI 1.02-1.28, p=0.025) as factors independently associated with an increased risk of amikacin-induced AKI. In model 2, the multivariable analysis demonstrated concurrent use of at least one nephrotoxic agent (OR 1.95, 95%CI 1.10-3.45; p=0.022), presence of septic shock during amikacin treatment (OR 3.48, 95%CI 1.61-7.53; p=0.002), and Charlson Comorbidity Index (OR 1.12, 95%CI 1.01-1.26; p=0.037) as factors independently associated with an increased risk of amikacin-induced AKI. In conclusion, before amikacin administration, the risk of AKI should be considered, especially in patients with multiple complicated comorbid diseases, septic shock, and those receiving colistin therapy.

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.