محمد امین ولی زاده حسنلویی

Increased intra-abdominal pressure, which is often hidden in the evaluating of patients, causes critical and complete-rest patients with irreparable consequences. Numerous and consecutive position changes can be effective in creating conditions to increase intra-abdominal pressure. The present study aimed to investigate the effect of position changes on intra-abdominal pressure in mechanically ventilated patients.

The present study was a clinical trial in which 68 patients were randomly selected and enrolled. Intra-abdominal pressure was measured by intrablader method using water manometer. Other hemodynamic and respiratory parameters were measured by BENNETT 840 ventilator and SAADAT hemodynamic monitoring device. Data were entered into a checklist and analyzed using SPSS software version 22 and parametric and non-parametric statistical tests. In this study, a significance level of P < 0.05 was considered significant.

The mean intra-abdominal pressure of patients in different conditions had statistically significant differences. Patients in the 15° and 45° positions had the lowest and in the 30° position to the right side, the patients had the highest intra-abdominal pressure (P<0.001). Mean arterial pressure and abdominal perfusion pressure were the lowest in the position of 30° to the right side, and the highest values were in the position of 15° and 45°. The highest values of airway pressure were observed in the position of 30° to the right side.

Changing of position for mechanically ventilated patients in Intensive Care Units can be associated with significant respiratory and hemodynamic consequences.

Over the past decade, inpatient hyperglycemia has become a major focus, due to its association with increased mortality, hospitalization complications, and its negative economic impact. Patients with hyperglycemia have greater mortality, postoperative stroke, and longer length of stay. Therefore, the aim of this study was to determine the prevalence of hyperglycemia and its therapeutic approach in the Intensive Care Unit (ICU).

This descriptive study was perfumed in the ICU of Imam Khomeini Educational Hospital in Urmia in 2016-2017. According to sample size determination, about 120 patients who were admitted to ICU for more than 24 hours were enrolled. The AACE / ADA 2009 guideline was used as a standard for hyperglycemic stress control.

The records of 120 non-diabetic patients were studied for stress-induced hyperglycemia. The rate of stress-induced hyperglycemia was 19.2%. The mean age of the patients was 39 ± 24 years. The most common cause of hospitalization in ICU was traumatic problems (37.5%). About 57% of patients with hyperglycemia received intravenous feeding, 60.9% received corticosteroids, and 39.1% received vasopressor. Twenty-one (86.9%) patients used the SSI method and 3 (13.1%) used the infusion technique. The mortality rate was 35% for the patients admitted and 60.9% for patients with hyperglycemia.

In this study, the prevalence of hyperglycemia in the ICU was similar and relatively high in almost the same studies. Therefore, it seems that 6-hour blood glucose control has a better effect than once a day. In this study, most patients received SSI insulin for controlling hyperglycemia, while according to AACE / ADA 2009 guideline, the insulin infusion method is more appropriate. Therefore, in order to reduce hypoglycemia and mortality, it is recommended to use the insulin infusion technique to control hyperglycemia.

weaning of ventilator-dependent patients has always been associated with serious and risky challenges. There are some measurable categories that predict the consequences of weaning. Due to the multiplicity of these categories, the researchers decided to conduct a study to identify the most important category in the patientchr('39')s readiness for and consequences of weaning from the ventilator.

In this cross-sectional study, 96 ventilator-dependent patients were included randomly. Patient`s respiratory criteria and physiological parameters were measured in three time intervals. Patients were divided in two, successful and unsuccessful of weaning. By following each of the respiratory and physiological criteria and using regression test statistics and plotting the rock curve, we plotted the power of each of the above criteria in predicting the weaning consequences.

The odds ratio (OR) for failure in weaning increases with increasing RSBI at all three times. Also the results showed that the criteria of RSBI in the time of before the take out of the endotracheal tube with a sensitivity of 73% and a specificity of 88% and a surface below the curve of 0.82 in comparison with other criterions has the greatest effect on predicting failure in weaning.

Among the clinical criteria available to assess the probability of failure in the weaning, RSBI in compare to other criteria has a better sensitivity and specificity.

 Acid–base abnormalities are common in critically ill patients. Our ability to describe acid–base disorders must be precise. The aim of this study to investigate the incidence and type of perioperative metabolic disturbances and electrolyte abnormality in patients undergoing coronary artery bypass graft surgery.

 This was a prospective, observational study, performed in a university-affiliated hospital. 62 patients undergoing coronary artery bypass graft surgery were included in the study. After operation the patients were transferred to cardiac intensive care unit and electrolytes and acid-base variables were recorded. The primary endpoint of the study was the incidence of metabolic alkalemia or acidemia. Metabolic alkalemia was defined as PH >7.45 and BE >+3. Metabolic acidemia was defined as PH <7.35 and BE <-3.

 From 62 patients 34 (54.8 %) had normal acid base analysis. Respiratory alkalosis, metabolic acidosis and alkalosis were occurred in 20 (32.3), 6 (9.7 %) and 2 (3.2) of subjects respectively. Respiratory acidosis is not seen.

 Regardless of normal subjects, respiratory alkalosis occurred more frequently than other acid base disorders in patients after coronary artery bypass graft surgery.

  Due to the lack of direct potential effects and physiological outcomes of each method of weaning from ventilator, none of the weaning methods was recommended on the other. The present study was carried out in order to compare the breathing outcomes of weaning from the ventilator into two methods of ventilation with pressure support and T-piece in patients in the intensive care unit of Urmia Imam Khomeini Educational-Treatment Center in 2017-18. This descriptive analytical study After obtaining the Ethics License from the Regional Ethics Committee at the University Research was carried out on 44 patients in the intensive care unit which patients who were eligible to be considered in study, was chosen and were located the number of 22 patients in Group A (weaning by pressure support ventilation) and 22 patients in Group B (weanhng by T-piece method). Data collection were collected using the patients file, the demographic questionnaire and the checklist of the assessment of the respiratory status. Data were analyzed using SPSS software version 20 and descriptive statistics (mean and standard deviation) and analytical tests including parametric tests (T test and ANOVA) and nonparametric (Mann-Whitney, Wilcoxon and Friedman). There was a significant difference between the two weaning groups terms of the two criteria of peak inspiratory pressure and arterial blood oxygen saturation (p<0.05). In other outcomes, there was no significant difference between the two groups (P>0/05). Despite the differences in the peak inspiratory pressure and oxygen saturation of arterial blood between the two groups, there was no significant difference in terms of other weaning outcomes. So doing supplementary studies in this context is recommended.

Oral care in patients undergoing mechanical ventilation is one of the essential requirements of nursing practice, the present study was carried out in order to determine the effect of two methods mouth wash (chlorhexidine and chlorhexidine combined with hydrogen peroxide solution) on the frequency of oral plaques in patients undergoing mechanical ventilation in the intensive care unit of Imam Khomeini Hospital in Urmia. This study is a randomized, single-blind clinical trial with parallel design on two groups of patients admitted to the critical care units of Imam Khomeini Hospital in Urmia, in which 98 patients with inclusion criteria were randomly assigned to two groups A and B. Intervention in group A was oral care with chlorhexidine mouthwash (0.2%) and in group B (0.2% chlorhexidine mouthwash with 1.5% hydrogen peroxide solution). Data collection tools included demographic characteristic form, Beck oral assessment scale, and Mucosal-Plaque Score. The data were analyzed by SPSS v. 20, chi-square, independent t, and Mann-Whitney statistical test. There was a significant statistical difference between the two groups of chlorhexidine mouthwash and chlorhexidine mouthwash with hydrogen peroxide in terms of oral plaque, oral mucosal health, and ultimately Mucosal-Plaque Score (P <0.05). Based on the findings of this study, it can be concluded that chlorhexidine mouthwash with hydrogen peroxide can be effective in preventing or reducing the frequency of oral plaques in patients undergoing mechanical ventilation.

Intraoperative hypothermia is a common problem with anesthesia. Spinal anesthesia, the same as general anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect intrathecal sufentanil with meperidine on prevention of shivering during spinal anesthesia in patients underwent orthopedic surgery of the lower limb. Ninety patients were randomly recruited to receive either 3 ml of 0.5% hyperbaric bupivacaine plus 2μg of sufentanil (Group S), or 3 ml of 0.5% hyperbaric bupivacaine plus 0.2 mg/kg of meperidine (Group M), or 3 ml of 0.5% hyperbaric bupivacaine plus normal saline (Group C). The incidence and intensity of shivering, blood pressure, heart rate and total intravenous meperidine were compared in three groups.
Findings: Total incidence of shivering was lower in study groups during surgery and recovery was significantly different between three groups (P=0.03, P=0.001). Also the intensity of shivering during surgery and recovery was significantly different between three groups (P = 0.001, P=0.01). Total dose of intravenous meperidine was significantly lower in study groups versus control group (P=0.03). There is not significant different in hemodynamic parameters between three groups.

Concclusion: We concluded that intrathecal sufentanil and meperidine can decrease intensity and incidence of shivering compared to control group as well as decreasing the requirement to additional doses of meperidine for shivering the control without any hemodynamic side effect.

Mechanical ventilation devices are widely used to treat patients who are in critical conditions. Although the use of mechanical ventilation devices has unique advantages for the patient، but on the other hand، it creates a variety of problems، including the inability to verbal communication and anxiety. This study intends to investigate the impact of using communication boards to reduce the anxiety of conscious patients undergoing mechanical ventilation hospitalized in the intensive care unit. In this Quasi-experimental Study، 30 conscious patients undergoing mechanical ventilation hospitalized in the intensive care unit were enrolled consecutively، and they were randomly assigned to intervention and control groups. The control group (15 patients) was using routine methods for communication while in the intervention group (15 patients)، the communication board was given to patients to communicate. Completing Sigmund Hospital Anxiety and Depression Questionnaire was performed 24، and 72 hours after intubation for both groups. Significance level of statistical tests was considered 5%. The case study of two groups was homogenous in terms of age and sex. Statistical analysis of anxiety scores showed that after the intervention there were significant differences between intervention and control groups (p=0/003). Statistical results showed that anxiety decreased in both groups over time، but it decreased significantly in the intervention group than the control group (p=0/000). The use of a communication board in conscious patients undergoing mechanical ventilation can reduce anxiety.

Tramadol intoxication is one of the most common intoxications in Iran. In this cross sectional study, we want to evaluate of the clinical findings and complications of Tramadol intoxication in patients referred to Urmia Ayatollah Taleghanihospital at 2012-2013.

After an approval from the ethic committee, total patients with tramadol intoxication if had inclusion criteria, were included in the study and clinical situation, recovery, complications and etc recorded and then analyzed with SPSS 17 Software, p-value<0.05 was significant.

In this study 233 patients were included. No correlation between the sex and complicaltions of tramadol but between marriage and convulsion (p-value= 0.04) and gait impairment (p-value= 0.002) were significant. On the other hand betweenthe time of use of drug and elevation of heart rate (p-value= 0.04) had correlation and elevation of the hear rate in 12-24 hour after the use of drug was seen. Between the history of the use of tramadol and convulsion (p.value = 0.01) also had correlation too.

The most use of tramadol to happened in 20-40 years old and in men compared women. The greater percentage of patients in this study had intermittent use of the drug. Nausea and vomiting were the most common gastrointestinal complications. As most of the patients were admitted. 79.8% weredischarged. The time of referral to hospital could be an influencing factor in outcome. Further studies are recommended.

P lacement of gastric tubes is a common procedure in patients. Blind placement of the tubes cause inadvertent feeding tube placement into the respiratory tract which can have serious consequences. Despite the prevalence of gastric tube placement, no reliable and definitive method has been determined. The aim of this study was to evaluate the accuracy of capnography to compare with the accuracy of radiography in detecting the location of gastric tubes. In this prospective observational study (process research) 85 eligible patients were randomly selected in a convenience sample. The study was done in 2 parts, first it was done by evaluating the accuracy of capnography in detecting tracheal positioning in a control group of 10 consecutive patients receiving mechanically ventilated patients, then, all placements utilized a two-step radiographic method. Capnography was added to the procedure. Data analysis was performed using statistical software spss 16. Sensitivity, specificity, positive predictive value and negative predictive value of capnography to distinguish between gastric and respiratory tube placement was 100%. Capnography accurately identified all intratracheal feeding tube placements. Applying capnography would significantly save time and costs. Capnography should be considered as a routine method in placing feeding tubes to improve patient safety.

Postoperative nausea and vomiting is a common postoperative complication after ophthalmic surgeries. This randomized and doubleblind study was designed to evaluate the efficacy of midazolam in reducing the incidence of postoperative nausea and vomiting. Sixty ASA I، II adult patients، scheduled for elective cataract surgery، under general anesthesia were enrolled. No premedication was given. Anesthesia was induced with sodium thiopental. After induction، fentanyl 1 μ/ kg and atracurium 0. 6 mg/ kg were administered and an endotracheal tube was inserted. Afterinduction of anesthesia and before start of surgery، patients were randomly allocated into two groups، each to receive placebo and midazolam 20 μ/ kg. Episodes of nausea، and vomiting were recorded during the first 24 h after surgery. The incidence of postoperative nausea was 27. 7% and 23. 3% with placebo and midazolam respectively (p=0. 35). The incidence of vomiting was 16. 7% and 10% with placebo and midazolamrespectively (p=0. 19). The results of this study showed a relative reduction in the incidence of postoperative nausea and vomiting after midazolam premedication. But this finding wasn''t statistically significant. Further investigations with larger samplesize was recommended. Keywords: Postoperative Nausea and Vomiting، Midazolam، Cataract Surgery

Pressure ulcer is a common problem among patients specially at intensive care unit with prolonged duration of stay and it's related cost and complications are pointed to the patients and health system. In this study, 249 patients admitted during one year in the general intensive care unit Urmia of Imam Khomeini Hospital were studied. Patient's demographic characteristics including age, gender and other patient information, including the underlying disease, chronic or acute disease, patient's duration of stay, plasma albumin levels were collected in check list by the researcher and were analyzed with SPSS statistical software. Among the 249 evaluated patients, 43 (17.3%) had pressure ulcer. Prevalence of pressure ulcer was higher among the elderly, chronic illness, low level of consciousness, women and patients with longer duration of stay and it was more frequent in patients admitted for internal problems compared to traumatic patients. There was not any significant relationship between plasma albumin level and incidence of pressure ulcers. With regards to the 17.3 percent prevalence of pressure ulcer at general intensive care unit of Urmia imam khomeini hospital, considering the risk factors related to the pressure ulcer and other necessary precautions during the patient's position changes by nurses and other health care providers in the intensive care unit can be helpful in reducing its incidence.

Anemia is one of the common problems in admitted patients with long duration of stay especially at intensive care unit and it`s treatment through transfusion has a lot of complication and cost for patients and health system. In a retrospective and descriptive study, 255 patients admitted in the general intensive care unit of Imam Khomeini Hospital of Urmia during one year period, were evaluated. Patient demographic characteristics including age, gender and other patient information, including admission hemoglobin, hemoglobin while transfusion and number of units transfused was collected by check list. From 255 patients, 133 case (52.16%) were diagnosed with anemia. mean admission hemoglobin was 11.10±1.40. The mean hemoglobin concentration before transfusion was 8.41±1.70 and the mean number of transfused blood units were 7.82±6.7. Blood transfusion at general intensive care unit of Urmia Imam Khomeini hospital is being initiated at higher levels of hemoglobin. With regards to the complications and higher cost of prepare and transfusion, a need for a complete revise for indications of blood transfusion among admitted patients at these units is being felt.

Nosocomial infections cause death, increase costs and the patient’s length of stay in hospital. Proper use of disinfectants and anti-septics have an important role in reducing infections. The aim of this study was the evaluation of efficacy of Epimax S and Epimax SC disinfectants in intensive care units (ICU) of Urmia Imam Khomeini Hospital. In Thiscross-sectionalstudy, 672 samples were collected from different surfaces and medical equipments of intensive care units before and after disinfections. Cultured samples were identified using differentiation and biochemical standard methods. The results were analyzed using SPSS and Excel softwares. Culture results of samples prior to disinfection of surfaces and equipment, showed that Contamination of the samples to different bacterial strains in intensive care units including 40% Staphylococcus saprophyticus, 29.2% Staphylococcus aureus, 18.17% Klebsiella, 6.17% E. coli, 4.34%, Staphylococcus epidermidis, and 2.17% Proteus. Laboratory studies showed that all the strains present in the samples are destroyed after disinfection by Epimax S with a concentration of 3% and contact time of 30 minutes, while Klebsiella was able to grow after disinfection with a concentration of 2% Epimax SC (recommended maximum concentration by manufacturer) and contact time of 30 minutes. There are significant difference between Epimax S and Epimax SC in hospital infection. According to the results, Epimax S of 3% with contact time of 30 minutes recommended control for prevention of nosocomial infections, especially in the intensive care unit, compared to Epimax SC. It is recommended that proper selection of disinfectants and disinfection procedures, elimination of environmental reservoirs of infection and the patients talent and experience at risk for nosocomial infections are evaluated for the prevention and control of hospital infections.Environmental health principles continuing education of hospital staff should be one of the operational programs of hospital infection control committee.

The objective of this study was to investigate the endotracheal tube cuff (ETT) pressure in the intensive care unit (ICU) patients, who had been intubated. Meterials and All patients were placed in ICU during the last three month 2008. The endotracheal tube cuff (ETT) pressure in 308 cases was measured at twice by an expert. A standard manometer was used to measure the cuff pressure and it was calibrated before and after the measurement. The results show indicated that 50% of cases 1 suffered from brain injuries and 63.6% of them were intubated as a result of brain problem. The value of cuff pressure was not standard in 31 cases at both times. In addition, the cuff pressure in 49% of cases was not standard at first, but after correction it decreased to 18.5%.This emphasizes the effectiveness of having supervision over cuff pressure in acceptable regular intervals by treatment team. It is suggested that along with recording the vital signs of the patieut, ETT cuff pressure beingrecorded at appropriate intervals as well.