Merve Yazici Kara

Background and Objectives: Elevated endotracheal tube (ETT) cuff pressure impairs tracheal mucosal perfusion and may contribute to upper airway soft-tissue changes. During cardiopulmonary bypass (CPB), the cuff usually remains inflated although ventilation is suspended, yet the relevance of cuff pressure management during CPB is unclear. We compared two ETT cuff pressure strategies during CPB (0 vs. 20–30 cmH₂O) on point-of-care ultrasound (POCUS) measurements of upper airway soft tissue in patients undergoing coronary artery bypass grafting (CABG). Materials and Methods: In this single-center, prospective, randomized, observer-blinded trial, 76 patients (ASA III–IV, aged 18–80 years) undergoing elective CABG were randomized 1:1 to a 0 cmH₂O or 20–30 cmH₂O ETT cuff pressure strategy throughout CPB (n = 38 per group). Transesophageal echocardiography (TEE) was not used in any patient. POCUS measurements of lateral pharyngeal wall (LPW) thickness, tongue thickness, parapharyngeal distance, midsagittal tongue area, and tongue width were obtained at four time points (T0–T3). The primary analysis was the omnibus group × time interaction for LPW thickness in a generalized estimating equations (GEE) model; the between-group difference in change from T0 to T2 was a planned supporting contrast. Results: All 76 randomized patients completed the study and were analyzed. The group × time interaction for LPW thickness was significant (p < 0.001); the between-group difference in the increase in LPW thickness from T0 to T2 was 1.50 mm (95% CI 1.27 to 1.73), and 1.00 mm (95% CI 0.82 to 1.18) at postoperative hour 2. Parapharyngeal distance and tongue thickness showed the same pattern. No multiplicity-adjusted between-group difference in LPW thickness was detected at T0 or T1, and a sensitivity analysis using the pre-intervention time point (T1) as baseline gave consistent results (T2 vs. T1: 1.43 mm, 95% CI 1.30 to 1.57). In an exploratory, unadjusted secondary analysis, difficult extubation occurred in 0/38 vs. 7/38 patients (absolute risk difference 18.4 percentage points, 95% CI 5.4 to 33.4; p = 0.012). Conclusions: Complete cuff deflation during CPB was associated with smaller ultrasonographic upper airway soft-tissue changes after CPB. The trial was not powered for clinical outcomes; the lower frequency of difficult extubation is hypothesis-generating, and these data do not support a change in routine practice before confirmation in trials with patient-centered endpoints.

Objectives: The primary aim of the study was to determine the publication rates of the theses produced in the department of Anesthesiology and Reanimation in Turkey between the years 2000 and 2018. Methods: This cross-sectional study evaluated 2580 theses identified in the National Thesis Center using the keywords “Anesthesiology and Reanimation”, to which online access was granted by the authors. Theses that had restricted access or were accepted as abstracts in congresses were excluded. The gender of the thesis writers, the date of completion of the thesis and the year of publication, the place where the thesis research was conducted (university or ministry of health), the field of thesis subject, the database where the publication is located, and whether the author began an academic career after the thesis, was investigated. Results: Thesis authors were female in 52.4% of the 2580 theses included in the study while 59.1% were in the field of general anesthesia and 14.4% in the intensive care field. The proportion of authors obtaining an academic career was 15.5%. The rate of publication was 39.1% (n=1010). The mean time to publication was 3.46±2.62 years. Authors who established an academic career were significantly more likely to publish (72.5%; p<0.001). Conclusion: Although higher than previously reported, thesis publication rate remains low at 39% although a higher proportion of authors were female. Furthermore, the time to publication was long.

Objective: The aim of the present study was to compare the average length of stay, mortality rates and service costs in intensive care unit provided to patients during October-November-December 2019 (pre-pandemic), with the average length of stay, mortality rates and service costs in intensive care unit during October-November-December 2020 (pandemic). Methods: This was a retrospective cross-sectional comparative, single-center study. The demographic data (age, gender), average length of stay, mortality and hospital costs of intensive care patients during October-November-December 2019 (pre-pandemic) were compared using the hospital records with the same data of patients in the same intensive care unit during October-November-December 2020 (pandemic), and the factors affecting the cost were investigated. Results: Of the 437 patients included in the study, 233 were hospiṫ aliż ed in pre-pandemic period and 204 in pandemic period. Pre-pandemic period mean age was 65.04 ± 17.0, and pandemic period mean age was 68.07 ± 15.1 years. The majority of the cases in both periods were male (57.9% and 63.2%). Length of stay, cost and mortality rates were significantly higher in the pandemic group (p: 0.000). There was a significant positive correlation between length of stay and cost (p: 0.000). Conclusion: It was found that intensive care costs increased considerably during the COVID 19 period, along with the increases in the length of stay and mortality rates. Advanced age and increase in length of stay were found to be correlated with mortality, but only length of stay was correlated with cost.