محمد نیاکان لاهیجی

Microbial infections are one of the main causes of death in the intensive care unit (ICU) of hospitals. The aim of this study was to investigate the epidemiology of microbial infections in the ICU of Rasoul Akram Hospital in Tehran during the years 2016 -2018.

A retrospective study was conducted on 1150 patients in the ICU of Rasoul Akram Hospital in Tehran between 2016 and 2018. The required information was extracted from the medical records of hospitalized patients and then the data were analyzed.

Out of 1150 patients, 641 (55.7%) were men. The average length of hospitalization of patients with nosocomial infections in the ICU was 18±7.6 days. The most common cause of nosocomia infection was Klebsiella pneumonia. The highest frequency of death of patients was related to Ascentobacter. Also, other findings of the study showed that there was a significant direct relationship between the death and discharge of patients with nosocomial infections with the gender, type of organism, age, and length of hospitalization (p<0.05). The findings of the study also showed that infection was significantly associated with death (39.7%).

The findings of this study showed that the variables of gender, age, type of organism, and duration of hospitalization can be risk factors for the death of patients hospitalized in ICU. Therefore, preventive policies and control of nosocomia infections should be focused on these variables.

Antibiotic resistance of pathogens responsible for nosocomial infections, has been a growing concern for healthcare system in recent decades. The aim of the current study was to identify the strains responsible for nosocomial infections and determine their frequency rates and antimicrobial resistance profiles in the patients admitted to intensive care units of Hazrat-e Rasool General Hospital in Tehran.

In this cross-sectional study we collected 936 blood, urine and sputum samples from the patients who had been admitted to the intensive care units of Hazrat-e Rasool General Hospital in Tehran between March 2020 and March 2021. Determination of strains and frequency rates of pathogens were carried out using multiple specific differential cultures. Then, we detected antibiotic resistance profile of each pathogen by using disc diffusion method.

Acinetobacter (22.5%), Klebsiella pneumoniae (18.7%), Pseudomonas aeruginosa (13.6%), Candida albicans (11.2%) and Escherichia coli (7.2%) were the most common pathogens involved in nosocomial infections in this study. Acinetobacter isolates showed the highest sensitivity to clostin (100%) and cefotaxime (97.2%), respectively, and the highest resistant rate to ampicillin sulbactam (38.9%).

The results of the present study showed that in addition to the diversity of different pathogens in causing nosocomial infections in intensive care units, antibiotic resistance of these pathogens which is on the rise should be regarded important. Results of the current study and other similar periodic studies can provide valuable information for monitoring and management of emerging drug resistant infections.

The prevention of ventilator-associated pneumonia (VAP) can decrease the duration of mechanical ventilation, length of hospital stay, and healthcare costs. One of the interventions is raising the head of bed (HOB) to 45 degrees. This study was perfomed with the aim of determining the effect of the HOB elevation to 45 degree on the incidence of VAP on hospitalized in Intensive Care Unit (ICU).
This study was a randomized clinical trial. It consisted of 80 patients who were under mechanical ventilation and hospitalized in Intensive Care Unit (ICU) from February to July 2016 in the selected governmental hospitals affiliated to Iran University of Medical Sciences. The samples were assigned to two groups, i.e. control and intervention, using a randomised block method. The patients in intervention and control groups had HOB elevation to 45 degree and routine position for three consecutive days. In both groups, HOB elevation in every shift was measured using the goniometer and was recorded by nurses in the angel of bed form. At the end of the third day, ventilator-associated pneumonia was evaluated, using the Clinical Pulmonary Infection Score (CPIS). Data analysis was performed with chi-square, Fisher’s exact test, and T- Test via SPSS v.20.
There was a statistically significant difference between two groups with regard to VAP (P-value=0.002). The incidence of VAP were 52.5% in the control group and 20% in the intervention group.
According to the results of this study, HOB elevation of 45 degree were effective in preventing VAP. Hence, it is recommended that the patients hospitalized in ICU,and under mechanical ventilation, should be positioned 45 degree according to their conditions.

Ginger is a plant widely used in complementary medicine because of its various therapeutic properties. In recent medical and compelimentary medicine textbooks, it has been stated that the oral form of ginger is antiemetic, prevents vomiting and motion sickness, is used as an analgesic and anti-inflammatory, and enhances the memory. If the patients had used specific amounts of ginger or its products routinely before surgery and anesthesia, it could have consequences such as increased bleeding and analgesic effects during surgery and anesthesia. In this Study, we assessed the side effects and warnings surgeons and anesthesiologists had stated as interactions of this plant considering reputed Iranian’s traditional and new medicine and papers that texts published in the different Database.

There is still insufficient evidence to warrant the routine use of Bispectral Index (BIS) in the intensive care unit. One way of evaluating the usefulness of BIS in monitoring the level of consciousness in ICU patients is demonstration its degree of correlation to commonly used scales of prognosis. The aim of this study is to Compare BIS with APACHE II and SOFA Score in Intubated Patients with Different Pathologic Injuries of the Brain Due to Acute Head Trauma Admitted to the ICU.
30 intubated head trauma patients over 15 years old admitted to the ICU were included in this cross-sectional study. In the first three days of admission, each patient underwent monitoring of BIS every sixty minutes just for six hours a day. All the hypnotic drugs were discontinued six hours before starting of monitoring and only opioids (fentanyl) were administered if needed. APACHE II in the first day of admission, SOFA Score in the first three days, type of cranial injury, and laboratory data were all collected. Statistical analyses were used to evaluate the data. P APACHE II and SOFA Score, had no statistically significat correlations with mean BIS in each three days of study and the mean BIS total. Mean BIS in the second and third days had statistically significant differences in different types of cranial lesions (contusion, subdural hemorrhage, subarachnoid hemorrhage).
In acute head trauma patients BIS has not acceptable conformity with APACHE II and SOFA Score. Different kinds of acute traumatic cranial lesions with different prognosis may have different values in BIS monitoring.

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). 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. 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. 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.

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.