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Comparison of the frequency of delirium in patients requiring anesthesia receiving a Presedex and fentanyl regimen with a midazolam and fentanyl regimen in the intensive care unit
Majid Karimifard, Ashkan Sabouri, Khaled Rahmani , Mohammad Azad Majedi, Behzad Ahsan ,
Volume 83, Issue 4 (July 2025)
Abstract
Background: Patients undergoing mechanical ventilation in the intensive care unit (ICU) are at higher risk for delirium. The present study aimed to compare the frequency of delirium in patients requiring anesthesia receiving the Presedex and fentanyl regimen with the midazolam and fentanyl regimen in the intensive care unit (ICU).
Methods: This historical cohort study was conducted on all patients hospitalized in the intensive care unit of Kowsar Hospital in sanandaj from May 2018 to December 2024 as a census with a sample size of 40 people in each group. Delirium and restlessness were assessed based on RASS criteria and the GCS scale was used to assess the level of consciousness of the patients. The data were entered into SPSS 24 software and a significance level of less than 5% was considered.
Results: The average age of the patients in Perdex, fentanyl, midazolam, and fentanyl regimens was 41.52 and 34.05 years, respectively. 53(66.3%) patients were male and the rest were female. The GCS score in the Presdex and Fentanyl group was 14(35%) and the Midazolam and Fentanyl group was 4(10%) with a level of consciousness above 7. The RASS score (5 patients in the Presdex and fentanyl group (12.5%) and the midazolam and fentanyl group (36 patients in the midazolam and fentanyl group (90%) had an anxiety score of zero or higher) was 0. The frequency of delirium based on CAM-ICU criteria in the Presdex and fentanyl group was 27(67.5%) mild delirium and 13(32.5%) moderate delirium, but in the midazolam and fentanyl group, 6(15%) mild delirium, 24(60%) moderate delirium, and 10(25%) severe delirium were present, and this difference was significant in the results of level of consciousness and restlessness and incidence of delirium (P=0.000).
Conclusion: The results showed that the use of Presedex and fentanyl would be more effective in reducing the incidence of delirium, and the use of this drug could be effective.
 
A comparative study on HOSPICE centers for patients with advanced non-curable advanced disease with a life expectancy of less than six months in the world
Ayoub Tavakolian, Shapour Badiee, Mahdi Mohammadi, Elahe Pourahmadi, Samaneh Sabouri, Navid Kalani , Mahdi Foroughian ,
Volume 83, Issue 7 (October 2025)
Abstract
Background: The present study is a systematic and comparative review of the studies conducted in the field of hospice centers for patients with acute incurable diseases with a life expectancy of less than six months in the world with the aim of examining the need in Iran and the experiences of other countries, identifying candidates to receive these services, type of services provided, costs and resources in these centers.
Methods: The present study was conducted as a systematic review by searching the databases: Scopus, PubMed, Elsevier, and Google Scholar search engine between 2010 and 2023. To search these databases, keywords such as hospice care centers, centers providing health services for patients with life expectancy less than six months, allocation of resources, allocation were used. After selecting the articles, the following topics were extracted from each article and compared: costs, sources of funding, candidates for receiving services, families' views, quality of near-death care, quality of life, quality of death, services provided, therapeutic interventions performed, place of death, length of stay.
Results: 6 articles referred to the discussion of cost, and in all articles except one case, the use of hospice was associated with reducing the cost of patients. In one study, the source of funding was philanthropic contributions and in another study, the national budget. In all the reviewed articles, the use of hospice was associated with an increase in the quality of care, quality of end of life and quality of death, and a decrease in therapeutic interventions. The care provided by hospice was also introduced in the form of symptom assessment and management, pain relief, psychosocial support and respite care.
Conclusion: Based on the findings of the present study, hospices can play an effective role in reducing treatment costs and, on the other hand, improve the quality of care, life and death in eligible people. In addition, hospices improved the end-of-life quality from the perspective of the deceased's family by reducing invasive interventions and providing physical and spiritual care.
 

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