Showing 27 results for Intensive Care
Laya Amoozadeh, Mohammad Taghi Beigmohammadi,
Volume 80, Issue 2 (5-2022)
Abstract
Background: The decision to extubate the patient is crucial and challenging. The use of corticosteroids to reduce airway edema and extubation failure in intensive care patients is debatable.
Methods: In an observational prospective cohort study from April 2021 to July 2021, 110 patients undergoing head and neck surgery at Imam Khomeini Hospital's special wards were enrolled. Inclusion criteria: Patients undergoing head and neck surgery. Exclusion criteria: previous corticosteroid use, presence of tracheostomy tube, history of head and neck surgery. The intervention group (n=55) received intravenous dexamethasone 8 mg three times a day for the first 24 hours and 4 mg twice a day for the next 24 hours. The control group did not receive any corticosteroids (n=55). All the patients were weaned with the same protocol, including pressure support ventilation with pressure support 6-8 cm H20 and PEEP <5 cm H2o and FIO2 ≤0.4 for 1-2 hours without respiratory distress, hypoxia, tachycardia, and diaphoresis. Before extubation, the cuff leak test was done for all the patients with the cut-off point of 110 ml. The Chi-square or Fisher's exact test was performed for categorical variables, and a t-test was used to describe the quantitative variables. P-values less than 0.05 were considered statistically significant.
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Results: The mean age was 52.1±14.1, and there was no difference between the two groups. Demographic characteristics, including sex, body mass index, duration of surgery, kind of intubation, and Acute Physiology and Chronic Health Evaluation (APACHE) II score, were not significantly different. The length of stay in the intensive care unit in the dexamethasone group was significantly longer than the control group (104 vs. 79-hour, P=0.001, CI 95%: 10.995-40.878). The rate of failure in extubation and postoperative stridor was not significantly different between the two groups (P=0.237).
Conclusion: Dexamethasone usage seems not to be effective in reducing airway edema, and its routine use is not recommended in reducing stridor after endotracheal tube removal.
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Hamidreza Shetabi, Mehrdad Norouzi , Hossein Mahjubipour, Anahita Naviafar,
Volume 80, Issue 6 (9-2022)
Abstract
Background: Coronavirus in 2019 was recognized as one of the leading causes of death worldwide. According to reports, the mortality rate in people who need mechanical ventilation varies from 50 to 97 percent. The aim of this study was to evaluate the outcome of Covid-19 disease based on different characteristics in patients and mechanically ventilated variables.
Methods: This descriptive-analytical study was conducted on 160 patients with a definite diagnosis of Covid-19 who were under mechanical ventilation and admitted to the intensive care unit of Alzahra Hospital in Isfahan from March 2020 to March 2021. Data was collected by checklist. The checklist included demographic information, including age, gender, as well as information such as underlying diseases, disease outcome, length of hospitalization, etc. After collecting the data, they were analyzed in SPSS software version 22 and at a significance level of less than 0.05.
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Results: In this study, the overall mortality rate among mechanically ventilated patients was 62.5%. The mean age of patients was 69.99±17.87 years and the mean duration of hospitalization in surviving patients was 15.47±11.73 days and for deceased ones was 55.21±69.14 days. The mean age of the deceased group (65.71±16.59) was significantly higher than the surviving group 53±21.17 was (P=0.0001). The length of hospital stay in the deceased group was significantly longer than the surviving group (P=0.005). As a result, ventilator mode and inotropic agent intake during treatment increased the chance of mortality in patients under mechanical ventilation (P=0.001). There was a significant relationship between underlying diseases of hypertension, kidney disease and autoimmune disease with mortality in patients (P<0.05).
Conclusion: Various factors including the length of stay in the hospital, comorbidities such as hypertension, renal disease and autoimmunity may affect the outcome of critically ill ICU patients under mechanical ventilation. Patients who require long-term invasive ventilation and the use of inotropic drugs to maintain their cardiovascular status while hospitalized in the ICU are at higher risk for mortality.
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Mehran Kouchek, Niloufar Taherpour, Mirmohammad Miri, Roja Asadpour , Fatemeh Ilbeygi, Seyed Pouzhia Shojaei, Mohammad Sistanizad,
Volume 80, Issue 9 (12-2022)
Abstract
Background: Hypertension is an important and controllable risk factor for heart diseases, stroke, renal failure and peripheral vascular disease. The aim of this study was to determine the level of awareness of patients with hemorrhagic stroke to control blood pressure and to provide solutions to improve patients’ awareness.
Methods: This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire.
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Results: In this study, the median of patients age was 67 and 10 (58.82%) of them were women. The median systolic and diastolic blood pressures were 170 and 95 mmHg on admission. 4(23.53%) subjects were not aware of the disease. Out of 13 people who were aware of their hypertension, 11(64.71%) were under the supervision of a physician. However, 7(63.64%) of the subjects, despite being under the supervision of a physician and acceptable drug adherence, did not have controlled blood pressure and expired.
Conclusion: This study is a warning for patients and health care providers to pay more attention to blood pressure control. Furthermore, educating the community as well as medical staff about the importance of timely diagnosis and accurate treatment of hypertension is highly recommended.
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Jamalodin Begjani , Bahareh Yaghmaei, Azam Mahmoudi , Mohammad Mehdi Rajabi ,
Volume 82, Issue 1 (4-2024)
Abstract
Background: Prolonged stay in intensive care unit (ICU) can worsen the patient's prognosis and represents a significant economic burden. Previous studies have reported the effectiveness of early mobilization in reducing length of stay in ICUs for adult patients; However, conflicting results have been reported regarding its effects on pediatric patients. Therefore, this research aimed to investigate the impact of early mobilization on the length of stay in the pediatric intensive care unit (PICU) in ventilated children.
Methods: This pilot quasi-experimental study was conducted on 60 children admitted to the Children's Medical Center hospital from March 2020 to June 2021. For the control group, routine care (standard physiotherapy) was started on the second day of intubation and continued until discharge from the intensive care unit. In this study, we used an early mobilization protocol including active and passive exercises. The intervention was implemented by Pediatric intensive care unit nurses under supervision of a pediatric critical care fellowship physician. In the intervention group, passive exercises were started on the second day of intubation. At each shift, the nurses check the level of sedation and presence of delirium in the patients using the Richmond Agitation-Sedation Scale and the Cornell Assessment of Pediatric Delirium questionnaire. If the results showed that the sedation was not deep and delirium was not present, then active exercises were initiated. If the child did not achieve an adequate score indicating the absence of deep sedation and delirium, the patient remained in the passive exercise phase. The length of stay was recorded based on the patients' records. Descriptive and inferential statistics were used for data analysis using SPSS version 23.
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Results: The results showed that there was no significant difference in the length of stay in the pediatric intensive care unit (PICU) between the control (23.20±6.34 days) and intervention (22.60±6.18 days) groups (P=0.77).
Conclusion: The implementation of early mobilization did not significantly reduce the length of PICU stay for pediatric. The researchers are advised to identify and evaluate evidence-based guidelines for implementing early mobilization in children with different diagnoses.
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Neda Faraji, Mahbobeh Alizadeh, Asghar Ghorbani, Hadiseh Hosami Roodsari , Samane Akbarpour , Mohammad Arefi,
Volume 82, Issue 11 (2-2025)
Abstract
Background: This study aimed to evaluate serum amylase levels in hospitalized COVID-19 patients and investigate its association with disease prognosis. Elevated serum amylase levels have been reported in some COVID-19 patients, particularly in severe cases. This increase may indicate pancreatic involvement (pancreatitis) due to viral infection. This cross-sectional study aimed to evaluate the role of serum amylase levels as a prognostic marker in COVID-19 patients.
Methods: This descriptive cross-sectional study was conducted on 150 hospitalized patients with confirmed COVID-19 at Baharloo Hospital, Tehran, over a one-year period (July 2021–July 2022). The results showed that 20% of patients (30 out of 150) had elevated serum amylase levels. Patients with high amylase levels had significantly longer hospital stays (mean 14 days vs. 8 days) and higher mortality rates (15% vs. 5%). Additionally, these patients were more likely to require intensive care (25% vs. 10%). Statistical analysis revealed that elevated serum amylase levels were independently associated with poorer clinical outcomes.
Results: These results have important clinical implications for patient management. Routine measurement of serum amylase at admission could help identify high-risk patients who may benefit from closer monitoring and early intervention. Further research is needed to determine whether specific treatments for pancreatic involvement could improve outcomes in these patients.
Conclusion: These findings suggest that measuring serum amylase levels at admission can serve as a simple and accessible marker for identifying high-risk patients. Elevated amylase in COVID-19 patients is an important biological indicator of multi-organ involvement (pancreas and kidney) and severe inflammation, which is associated with worse prognosis and higher mortality. Monitoring this marker may aid clinical decision-making and improve patient outcomes
Majid Vatankhah, Saeed Kashani, Mohsen Sarafikhah, Bibi Mona Razavi, Mehrdad Sayadinia, Mehrdad Malekshoar,
Volume 83, Issue 2 (5-2025)
Abstract
Background: Aspiration pneumonia is a significant and potentially preventable cause of morbidity and mortality in critically ill ICU patients. Prophylactic pharmacological interventions, particularly antiemetics like metoclopramide (a prokinetic agent) and ondansetron (a 5-HT3 receptor antagonist), are commonly employed to reduce gastric aspiration and subsequent pneumonia. Despite their widespread use, comparative efficacy data remains limited. This randomized controlled trial was specifically designed to rigorously compare the effectiveness of these two distinct antiemetic strategies in preventing aspiration pneumonia among high-risk, mechanically ventilated patients, aiming to provide evidence-based guidance for clinical practice.
Methods: This double-blind randomized clinical trial involved 116 individuals admitted to the ICU at Shahid Mohammadi Hospital, Bandar Abbas from March 2024 to March 2025. Subjects were randomly assigned to metoclopramide or ondansetron groups. Enrollment criteria consisted of patients between 17 and 70 years old in the ICU requiring intubation and mechanical ventilation. Monitoring continued for 72 hours, with evaluation utilizing the Clinical Pulmonary Infection Score (CPIS), chest X-ray (CXR) results, and physical assessments. Data were analyzed with SPSS version 21 employing descriptive statistics (mean, standard deviation, percentage, frequency) and inferential tests with significance set at P<0.05.
Results: Chi-square analysis indicated no statistically significant gender difference between groups (P=0.947). Mean age was 30.6±10.5 years for metoclopramide recipients and 32.9±6.12 years for ondansetron recipients. Further analysis revealed no significant differences in age or BMI between cohorts. No significant difference emerged between metoclopramide and ondansetron groups regarding aspiration pneumonia occurrence, with similar incidence rates in both arms. Multiple logistic regression demonstrated that statistically, no variables influenced aspiration pneumonia development.
Conclusion: The results of this randomized trial clearly demonstrate no statistically significant difference in efficacy between metoclopramide and ondansetron for preventing aspiration pneumonia in intubated ICU patients. Both agents showed comparable effectiveness in our study population, suggesting that either drug represents a clinically acceptable prophylactic option. This finding provides clinicians with valuable therapeutic flexibility based on individual patient characteristics, drug availability, and cost considerations. However, further multicenter studies with larger sample sizes are recommended to confirm these findings across diverse patient populations and settings.
Majid Karimifard, Ashkan Sabouri, Khaled Rahmani , Mohammad Azad Majedi, Behzad Ahsan ,
Volume 83, Issue 4 (7-2025)
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.
