Background Restrictive and liberal transfusion approaches to hemoglobin targets have used when deciding on red blood cell transfusions in patients who do not have acute bleeding and have a hemodynamically stable course in the ICU. However, physiologic trigger points that evaluate tissue oxygenation when deciding on blood transfusion in patients have also been among the important topics of research in recent years. In this study, we will evaluate the O2ER, which is an important indicator of the balance between oxygen delivery and consumption in tissues. Whether oxygen extraction rate can be used as a trigger for blood transfusion will be determined by clinical outcomes in ICU patients. If physiologic transfusion targets are feasible, the risks of unnecessary transfusions can be avoided with individualized targets. Also, the decision to transfuse blood can be made without delay in patients requiring red blood cell transfusion. Methods/Design We will perform a prospective, single-center, observational cohort study of 65 patients receiving red blood cell transfusions in the intensive care unit. Markers such as CaO2, CcvO2, O2ER, AV-O2 difference and NIRS will be measured before and 15 minutes after transfusion. We will investigate whether blood transfusion is really necessary and the frequency of transfusion-related events occur in patients with an O2ER ratio less than 30% and equal to 30% or above. All patients will be followed up to 90 days after transfusion. Ethics committee approval was obtained from Izmir Katip Celebi University Non-Interventional Clinical Studies Institutional Review Board. All patients must provide written informed consent prior to enrollment in the study. Discussion The existence of a direct relationship between individualized, patient-based oxygen extraction rates and the decision to transfuse red blood cells and reduce transfusion-related complications may imply that physiologically based blood transfusion targets should be established and routinely incorporated into existing transfusion decision-making protocols. Trial registration number NCT05798130

Introduction: Urine analysis is an important part of patient follow-up in intensive care unit (ICU). In this case report we aimed to examine the green colored urine image we see in our ICU and the conditions that may cause this. Case: A 70-year-old male patient was admitted to our ICU due to multilobar pneumonia. During the follow-up, he was intubated due to respiratory distress and15 mcg-1kg-1min propofol infusion was started for sedation. It was observed that the urine was green after 16 hours. Factors that could cause color change in urine were evaluated. Infusion was stopped due to similar cases in the literature. The total amount of propofol administered to the patient was 1200 mg. It was observed that the urine color returned to normal 8 hours after the drug was discontinued. Conclusion: A rare side effect of propofol is urine discoloration. Urine color may change when the excretion of phenolic metabolites exceeds hepatic clearance. It is reported that it can be seen even in anesthesia induction or sedation doses. It is important to know that the application of propofol may change the color of the urine, that this will not be an important problem and that the color may return to normal with the discontinuation of the drug, in order to prevent unnecessary tests.

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Most of the local anesthetic toxicity cases develop within the first five minutes of peripheral block administration. Late local anesthetic toxicity has been rarely reported in the literature. However, it is an important life-threatening problem that can lead to seizures, hemodynamic collapse, and cardiac arrest if it is ignored and not considered. Here we present the case of an 18-year-old male patient who had ultrasonography-guided infraclavicular brachial plexus block administration with a 30 mL local anesthetic. The patient had convulsions 210 minutes after the block administration and was treated with intravenous diazepam. Intraoperative and postoperative courses were uneventful. He had no neurologic signs or symptoms afterward. All laboratory tests and radiologic investigation tests were normal. This report demonstrates that late local anesthetic toxicity is still possible after several hours of the uneventful peripheral neural blockade, although it is rarely reported.

The utilization of open cardiac surgery on patients infected with coronavirus disease 2019 (COVID-19) has resulted in a very challenging perioperative management method. High rates of morbidity and mortality have been documented in the literature for patients who have undergone open heart surgery while infected with COVID-19; however, data on complications that may occur during and after surgery in patients with COVID-19 infection are limited. In this article, we aimed to present the clinical course and perioperative consequences of three patients with preoperative COVID-19 infection.