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Volume 73, Issue 2 (5-2015)
Background: Bispectral Index (BIS) may be used in traumatic brain injured patients with different anatomical sites of injury to evaluate the level of consciousness. The objective of this study is to evaluate the relation between type of brain injury and the presence or absence of frontal lobe damage based on brain CT-scan with BIS monitoring in intubated acute head trauma patients admitted to the intensive care unit (ICU). Methods: Participants of this cross-sectional study consisted of 30 intubated head trauma patients over the age of 15 years old, without any known history of visual or hearing impairments, neurologic disorders, mental retardation, or frontal skin laceration, who were admitted to the ICU in Rasool Akram University Hospital, Tehran. Patients who needed muscle relaxant administration, or those who showed instability of vital signs, hypoxemia, disorders of the blood biochemistry, or blood gases, liver or kidney failure, convulsion or hypoxic encephalopathy during the study were excluded. In the first three days of admission, each patient underwent monitoring of BIS every sixty minutes for just six hours a day. All the hypnotic drugs were discontinued six hours prior to the start of monitoring and fentanyl was the only opioid, which was administered if an analgesic was required. Statistical analysis were used to evaluate the data and p-value less than 0.05 was considered statistically significant. Results: Mean age of all patients was 43.6 years with a Standard Deviation (SD) of 18.96. Presence or absence of frontal lobe injury, had no statistically significant correlations with mean BIS in each three days of study and the mean BIS total. However, mean BIS in the second and third days had statistically significant differences in different types of cranial lesions (contusion, subdural hemorrhage, subarachnoid hemorrhage, etc) which usually have different prognoses. Conclusion: Different kinds of acute traumatic cranial lesions with different prognosis may have different values in BIS monitoring. Presence or absence of frontal lobe injury, had no statistically significant correlations with BIS values.
Volume 73, Issue 11 (2-2016)
Background: Over the last two decades invasive candidiasis has become an increasing problem in neonatal intensive care units (NICUs). Colonization of skin and mucous membranes with Candida spp. is important factor in the pathogenesis of neonatal infection and several colonized sites are major risk factors evoking higher frequencies of progression to invasive candidiasis. The aim of this study was to detect Candida colonization in NICU patients.
Methods: This cross-sectional study was conducted on 93 neonates in NICUs at Imam Khomeini and Children Medical Center Hospitals in Tehran. Cutaneous and mucous membrane samples obtained at first, third, and seventh days of patients’ stay in NICUs during nine months from August 2013 to May 2014. The samples were primarily cultured on CHROMagar Candida medium. The cultured media were incubated at 35°C for 48h and evaluated based on colony color produced on CHROMagar Candida. In addition, isolated colonies were cultured on Corn Meal Agar medium supplemented with tween 80 for identification of Candida spp. based on their morphology. Finally, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed for definite identification of isolated species.
Results: Colonization by Candida spp. was occurred in 20.43% of neonates. Fifteen and four patients colonized with one and two different Candida spp., respectively. Isolated Candida spp. identified as; C. parapsilosis (n: 10), C. albicans (n: 7), C. tropicalis (n: 3), C. guilliermondii (n: 2), and C. krusei (n: 1). In present study non-albicans Candia species were dominant (69.56%) and C. parapsilosis was the most frequent isolate (43.47%). Using Fisher's exact test, the correlation between fungal colonization with low birth weight, low gestational age, and duration of hospital stay was found to be statistically significant (P=0.003).
Conclusion: The results of this study imply to the candida species colonization of neonates. Neonates in NICU are at the highest risk for severe infection with Candida parapsilosis. Therefore, isolation of C. parapsilosis as the most common species (43.47%) in present study was noteworthy.
Volume 74, Issue 4 (7-2016)
Background: Fungal infections especially Candida species are frequent cause of mortality and morbidity in very low-birth-weight (VLBW) infants receiving intensive care; Candida infections are tissue invasive. This infection increases the risks of adverse neurodevelopmental sequelae. Prevention and treatment of fungal infection is so important in very VLBW infants. The aim of this study was to determine the prophylactic effect of fluconazole in decreasing the mortality and morbidity in VLBW infants (less than 1500gr) admitted in NICU.
Methods: This prospective case control study were conducted among 102 Infants (weighing less than 1500gr at birth at born) admitted in NICU department of Ali Asghar University Hospital from 2012 to 2013, Tehran, Iran. Weigh of birth in cases and groups were less than 1500 gr and both were culture negative. Cases received oral fluconazole 3 mg/kg in 3 days in 1st and 2nd weeks, alternate day in 3rd and 4th weeks, daily in 5th and 6th weeks. Control groups had not received fluconazole. Mortality and morbidity and hospital stay were compared between cases and controls groups.
Results: We studied 49 very low-birth-weight infants with negative culture as cases (received fluconazole prophylaxis), 46 VLBW infants without fluconazole profilaxy (controls). No significant difference in gestational age (P=0.2), and mean weights (P=0.4) were observed between cases and controls. The mortality rate 8.7% (n=4) in controls (without prophylactic fluconazole) observed vs 2% (n=1) mortality rate in VLBW cases (with prophylactic fluconazole). Although the mortality rate in controls was 4 times higher than cases, but without significant differences (P=0.1). Indeed, mean duration of hospital stay in controls was longer than cases (28.41±9.93 vs 19.85±6.19 days, P=0.00001).
Conclusion: Although prophylactic fluconazole in VLBW could decrease the mortality of cases (control the fungal infection) 4 fold in compare with controls (no treatment), it was not significant. The prophylactic effect of fluconazole might decrease the length of hospital stay of VLBW neonates in NICU. Due to limited number of cases and control. For further decision about prophylactic use of fluconazole, prospective RCT studies with larger cases and control would be helpful in future.
Volume 74, Issue 7 (10-2016)
Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively.
Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form.
Results: The study of 105 patients' records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(.
Conclusion: The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.
Volume 74, Issue 11 (2-2017)
Background: Bacterial sepsis is a main cause of mortality and morbidity especially in preterm newborns. The aim of this study was to search the bacterial etiologies of neonatal sepsis in NICU admitted preterm neonates.
Methods: A descriptive cross-sectional study had done in NICU of Ali Asghar Hospital, Tehran, Iran from March 2007 to March 2009. Seventy septicemic preterm newborns (<37 weeks) were studied. At admission day, for blood culture, 1-2 ml of venous blood was drawn after swabbing the venipuncture site with alcohol. After centrifugation of blood samples, deposits were cultured on sheep blood agar and incubated in a candle jar at 37 °C for 48 h and followed by subcultured. Isolates were identified using standard techniques (Nima pouyesh, Iran). Type of isolated bacterial organisms determined. Its correlation with gestational age, birth weight, premature rupture of membranes (PROM) and other variables determined we used the nonparametric two independent sample test, Mann-Whitney U test. Chi-square values (CI 95%, P< 0.05) were calculated for all categorical variables. P-value less than 0.05 considered statistically significant.
Results: Of 70 studied septicemic preterm cases, 17 (10.6%) cases had positive blood culture. Overall gram-negative organisms were more frequent than gram-positive organisms, Klebsiella (K.) pneumoniae, Escherichia (E.) coli and Staphylococcus (S.) aureus organisms were the 3 common causes of bacterial sepsis in studied cases. Early onset sepsis produced by K. pneumonia (40%), E. coli (20%) and S. aureus (20%). K. pneumonia, E. coli, S. aureus had equal incidence in late onset sepsis (26.8%). K. pneumonia was more frequent in early onset sepsis (P= 0.05), and in low birth weight (< 1500 g) neonates (P= 0.005, and PROM (P= 0.05).
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Conclusion: Three causes for sepsis in premature newborns were determined: K. pneumonia, E. coli and S. aureus, it is so important for initial antibiotic treatment in admission day. Low birth weight, prematurity, and, PROM were the common risk factors for sepsis in cases. By preventing of low birth weight, low gestational age, and PROM the risk of sepsis could be decreased. We recommend empiric antibiotic in septic preterm newborns which can cover: K. pneumonia, E. coli and S. aureus in our center. |
Volume 76, Issue 1 (4-2018)
Methods: This clinical trial study was performed on 61 patients admitted to the intensive care unit of Ayatollah Rohani Hospital of Babol University of Medical Sciences from April 14, 2013 to April 14, 2016. In the first group (44 cases), tracheostomy was performed in percutaneous (PDT) and in the second group (17 patients) surgically. The early complications and waiting time (intubation to tracheostomy) for tracheostomy were compared in two groups. All data were analyzed by SPSS software, ver. 22 (Armonk, NY, USA), Analysis of variance (ANOVA) and P values of less than 0.05 were considered significant.
Results: The mean age of the patients was 59.87±8.15 years. The mean age of the male patients was 59.66±6.35 years and the female patients were 60.35±6.41 years. In this study, the average waiting time (time from intubation to tracheostomy) was 14.19 days in the PDT group and 20.69 days in the tracheostomy group, with a significant difference between the two groups (P= 0.001). The incidence of preoperative bleeding after surgery was five cases (8.2%). In the PDT group, two cases (3/3%) and the surgical group was three cases (4.9%) and the two groups did not have a significant difference (P= 0.46). The incidence of wound infection (during the period of admission and up to ten days later) in two groups was two patients (3.3%), one case (1.6%) In the PDT group, and one case (1.6%) in a surgical group and the two groups did not have a significant difference (P= 0.43). Other complications such a subcutaneous emphysema and posterior tracheal wall trauma and rupture was not shown in both groups.
Conclusion: The findings of this study showed that the complications (bleeding and wound infections) did not differ between the two groups. Due to the lower waiting time and the lack of need for patient transfer outside of the intensive care unit, percutaneous tracheostomy can be a safe alternative to the surgical tracheostomy.
Volume 77, Issue 11 (2-2020)
Methods: In this descriptive-analytic study, three common device-associated infections included central line-associated bloodstream infection (CLA-BSI), ventilator associated pneumonia (VAP), and catheter-associated urinary tract infection (CA-UTI), were assessed in intensive care units of Besat Hospital in Hamedan from April 2017 to April 2018. In order to determine the incidence of device-associated infections, the number of device-associated infection cases was calculated during the study period and divided into the number of device-days used. The device-days included all days of exposure to that device (vascular catheter, endotracheal tube (ventilator), or urinary catheter) in all patients in the study population.
Results: Out of 1806 intensive care unit admitted cases, 168 patients (9.3%) were device-associated infection with distribution of 92 cases (55%) of ventilator-associated pneumonia (VAP), 56 cases (34%) of catheter-associated urinary tract infection (CA-UTI) and 20 cases (11%) of central line-associated bloodstream infection (CL-BSI). The incidence of VAP, CA-UTI and CL-BSI was 44.7, 17.5, and 21.61 days, respectively. The most organisms were Acinetobacter (27.4%), Klebsiella (18.3%), Escherichia coli (E. coli) (15.4%). Vancomycin-resistant enterococcus (VRE) was 75%. Acinetobacter resistance to colistin and carbapenem was 16.8%. About half of Pseudomonas isolates were resistant to meropenem.
Conclusion: According to the present findings of this study, a high incidence of device-associated infections and resistant organisms in our intensive care units were documented, which represents a need to reinforce the preventive and control programs. Various results in different studies can be due to differences in the level of health care in different centers and countries.
Volume 78, Issue 8 (11-2020)
Methods: This cross-sectional study was performed on all patients with opioid poisoning admitted to the ICU, Imam Reza Hospital, Mashhad, Iran, from the beginning of April 2016 to March 2017 (Persian Calendar). For all poisoned patients enrolled in the study, the four mortality predicting tools were filled daily in the first three days of hospitalization and then every other day until discharge from the ICU or patient's death.
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Results: Overall, 57 patients were evaluated of whom 72% (41 patients) were male. The mean age was 49.9±19.8 (median 53, range 18-94) years. The mean length of stay in the ICU was 13.5±17.5 (median 7, range: 75-75) days. The mortality rate was 17.5% (10 patients). The scores of SOFA, SAPS II, APACHE II, and APACHE IV were significantly higher in deceased patients than in discharged ones. The highest diagnostic accuracy (area under the curve) for all four predicting tools was observed in the second week of hospitalization. On the other hand, SAPS II (74%) on the first day, APACHE-II (76%) on the second day, APACHE-II (82%) on the third day, SOFA (77%) on day 4-5, and SAPS II (82%) on day 6-7 had the highest diagnostic accuracy.
Conclusion: In the present study scores of all four mortality predicting tools at admission were significantly associated with mortality. The accuracy of SAPS II, APACHE IV, and APACHE II are appropriate for estimating prognosis, especially after the second week of admission. |
Volume 79, Issue 7 (10-2021)
Methods: In this study, among the cases of patients who were admitted to ICUs of the Rasoul Akram and Firoozgar hospitals of Tehran City, Iran, from December 2017 to March 2018, the first 24 hours of the ICUs admission data of 874 cases were gathered. A new model based on the standard methodology CRISP was developed. In the modeling section, two well-known data mining techniques called artificial neural network (ANN), K nearest neighbor (KNN) and decision tree (DT) were used. WEKA 3.9.2 open-source software was implemented for data analysis. Finally, according to the accuracy, sensitivity, specificity criteria and AUC-ROC Curve, the superior model was introduced.
Results: Based on the WEKA results, 19 variables had the most impact on the mortality prediction of patients admitted to ICUs including Glasgow Coma Scale (GCS), mechanical ventilation, surgical service at ICUs admission, gender, temperature, serum creatinine, diabetes, Blood urea nitrogen (BUN), age, addiction, International Normalized Ratio (INR), PH, Partial Thromboplastin Time (PTT), albumin, hemoglobin, glucose, pulse rate, hematocrit (HCT), PO2. Based on the created models, some rules have been extracted which can be used as a pattern to predict the probability of mortality. Although the AUC of the three models was acceptable (KNN 81.5%, ANN 77.5% and DT 74.3%), but the accuracy of decision tree J48 (74.2%) was higher.
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Conclusion: The study indicated that in the KNN model, the rules derived from it can be effective in mortality prediction in patients admitted to ICUs.
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