Purpose We aimed to evaluate and compare the efficacy and complications of three consecutive prone positions (PP) in COVID-19 ICU. Materials and method Patients with ARDS and placed in PP for 3 times (PP1, PP2, PP3) consecutively were included. Arterial blood gases (ABG), partial pressure of arterial oxygen/fraction of inspired oxygen (PaO 2 /FiO 2 ) ratios, partial pressure of carbondioxide (PaCO 2 ), PEEP, and FiO 2 were recorded before (bPP), during (dPP), and after (aPP) every prone positioning. Eye, skin, nerve, and tube complications related to PP were collected. Results In all positions, PaO 2 value during PP was significantly higher than PaO 2 before and after prone position (p = 0.001). PaO 2 values were similar in all (PP1, PP2, PP3) bPP arterial blood gases. We found difference in PaO 2 values during prone position between the first (PP1) and second proning (PP2). When each prone was evaluated within itself, PaO 2 /FiO 2 increases after proning compared to before proning. PaO 2 /FiO 2 during PP were higher compared to before proning ones. PaO 2 /FiO 2 during PP1 was significantly higher compared to during PP3 (p = 0.005). In PP3, PEEP values bPP, dPP, and aPP were significantly higher than PEEP values after the second prone (p = 0.02, p = 0.001, p = 0.01). In the third prone, PaCO 2 levels were higher than in PP1 and PP2. There were eye complications in 13, tube-related complications in 10, skin complications in 30, and nerve damage in 1 patient. ConclusionWe believe that a more careful decision should be made after the second prone position in patients who have to be placed in sequential prone position.

Amaç: Bu çalışmada COVID-19 Yoğun Bakım Ünitesi’nde (YBÜ) takip edilen hastalarda kan transfüzyonu karakteristiklerini, ilişkili faktörleri ve sonuçlarını tespit etmeyi amaçladık. Gereç ve Yöntemler: COVID-19 tanısıyla 21 Mart 2020 ve 01 Haziran 2020 tarihleri arasında COVID-19 YBÜ’nde takip edilen, 48 saatten uzun süre YBÜ’de kalan hastaların dosyaları retrospektif olarak incelendi. Hastaların demografik verileri, laboratuvar verileri (hemogram, koagülasyon parametreleri, inflamatuvar markerlar, arteriyel kan gazı parametreleri), kalp hızı, arteriyel kan basıncı, kanama bulguları, yaygın intravasküler koagülasyon (DIC) gelişimi, vazopressor ihtiyacı ve kan transfüzyonu ihtiyacı kaydedildi. Bulgular: Kan transfüzyonu uygulanan hastaların yoğun bakımda kalış süreleri [27 (4-65) gün], uygulanmayanlara göre [5 (0-30) gün] anlamlı şekilde yüksekti (p0.05). Kronik obstrüktif akciğer hastalığı (KOAH) oranlarının kan transfüzyonu uygulananlarda anlamlı şekilde yüksek olduğu (%33,3 vs %0,0) tespit edildi (p=0.026). Kan transfüzyonu uygulanan grupta fatalite hızı %44,4, transfüzyon uygulanmayan grupta fatalite hızı %21,1 saptandı (p=0.371). Sonuç: Çalışmamız sonucunda COVID-19 YBÜ’de KOAH tanısı olan, ağır kliniğe sahip olup entübasyon, mekanik ventilasyon gereken, uzun süre yoğun bakımda yatan hastalarda daha çok anemi geliştiği ve kan transfüzyonu yapıldığı, transfüzyon yapılan hastalarda ise mortalitenin yüksek olduğu tespit edilmiştir

INTRODUCTION: In our study, we aimed to compare the analgesic efficacy, side effect profile and its effect on opioid consumption of the femoral nerve block applied with different concentrations of local anesthetic agents (%0.5 bupivacaine and %0.25 bupivacaine) in the same volume (20 mL) after total knee replacement (TKR) operation. METHODS: The files of patients who underwent unilateral TKR surgery under spinal anesthesia between August 2018 and June 2019 were retrospectively reviewed. A total of 163 patients were included in the study, 81 patients in group 1 who received %0.25 bupivacaine, and 82 patients in group 2 who received %0.50 bupivacaine for femoral block. The highest visual analogue pain scale (VAS) scores in the postoperative 24 hours, the amount of tramadol requested and consumed with intravenous patient-controlled analgesia (PCA) devices, and whether there was a significant difference in terms of side effects (nausea, vomiting, motor and sensory deficit) were analyzed. RESULTS: The highest VAS score in group 1 was 2.95 ± 1.31, in group 2 it was 2.84 ± 1.06, and there was no significant difference between them. The mean consumption of tramadol was 197.04 ± 92.03 mg in group 1 and 208.05 ± 85.06 mg in group 2. There was no difference between the demand and consumption of tramadol and side effects. DISCUSSION AND CONCLUSION: 20 mL %0.25 bupivacaine for the femoral block provided the equivalent analgesic efficacy to the same volume of %0.50 bupivacaine. We think that the use of % 0.25 bupivacaine is a more reliable option to reduce systemic side effects, motor block risk and complications.