فهرست مطالب محمدامین ولیزاد حسنلویی

Delirium can be dangerous for the patient and worsen the patient's prognosis. This study aimed to investigating the the delirium frequency and its outcomes after urologic surgeries admitted to Intensive Care Unit of Urmia Imam Khomeini Hospital.

In this Descriptive-cross-sectional study, whole 680 patients undergoing urology surgery who were admitted to the special care department of Imam Khomeini Hospital in Urmia during 2018-2019 were included. Demographic characteristics, underlying diseases, duration of mechanical ventilation, duration of hospitalization in the intensive care unit, duration of hospitalization, mortality and delirium were extracted from patient files and analyzed using SPSS version 23 software. The significance level in this study was considered 0.05.

12 patients (1.8%) had delirium. The average length of mechanical ventilation, length of stay in the hospital and in the intensive care unit was significantly higher in patients with delirium than in patients without delirium (p<0.05).

Psychosis has a relatively rare prevalence. However, in order to reduce it, the length of hospitalization should be reduced.

 Colorectal cancer is one of the most common cancers and one of the leading cause of morbidity and mortality worldwide. Accounting that the risk of colorectal cancer is associated with blood sugar indices as well as the role of CEA in the prognosis of patients with colorectal cancer, this study was fulfilled to determine the relationship between serum level of CEA and HOMA2-IR in colorectal patients.

 In this case-control study, 40 colorectal cancer patients and 40 healthy subjects, as the control group, were included. Serum levels of CEA, insulin, and fasting blood sugar were measured in all participants. The HOMA2-IR index was calculated based on the standard formula. Data were analyzed using SPSS version 26 software.

The mean of CEA was 7.08±1.9 in colorectal patients and 2.21±1.5 in control group, and difference between them was significant (p = 0.003). Totally, the mean insulin among patients with CEA below 3 and CEA equal or more than 3 was 11.06±6.9 and 14.34±8.28, respectively (p = 0.026). Also, mean FBS for two groups were 110.67±42.7 and 135.9±52.5 (p = 0.01) and mean of HOMA2-IR for two groups were 1.49±0.98 and 2.04±1.25, (P = 0.011), respectively. All these differences between two groups were significant.

 colorectal patients had higher levels of CEA than the control group. The mean values of all three indices of insulin, FBS و and HOMA2-IR among patients with colorectal cancer were higher in both groups of patients with CEA below 3 and patients with CEA equal or more than 3 than control group. There was strong positive correlations between CEA with insulin, FBS, and HOMA2-IR indices in colorectal patients compared to the control group.

Sepsis is a syndrome involving physiological, pathological, and biochemical abnormalities caused by infection. Very few studies have been performed to evaluate the prognostic value of the neutrophil-to-albumin ratio. The present study aimed to evaluate the neutrophil-to-albumin ratio in patients with sepsis admitted to the intensive care unit (ICU).

All patients admitted to the ICU with a diagnosis of sepsis were included in the study. The inclusion criteria entailed the age range of ≥18 years, having sepsis, and hospitalization in the ICU for more than two weeks.

A total of 75 patients with a mean age of 72.34 years were evaluated, and 57.8% of cases died. There was a significant difference between neutrophils on the second and third days between deceased and discharged patients. The neutrophil-to-albumin ratio at the time of admission, the second day, and the third day were 31.62, 33.36, and 34.31, respectively; nonetheless, no significant difference was observed between the deceased and discharged (P>0.05).

As evidenced by the results of this study, the neutrophil-to-albumin ratio in deceased patients was higher than that in discharged ones; however, this difference was not statistically significant. Moreover, neutrophil percentage, duration of mechanical ventilation, and duration of hospitalization in deceased patients were significantly higher, as compared to those in discharged patients.

According to widespread use of pulse oximetry as the most common method of monitoring arterial hemoglobin oxygen saturation, it is very important to identify the factors that may interfere with this continuous monitoring. One of the things that can distort the result of this monitoring is the use of nail polish. As there was no consensus in previous studies, the present study was performed to investigate the effect of different colors of nail polish on the pulse oximetry values of healthy volunteer girls.

The present study was a prospective cross-sectional study on 90 healthy female volunteers by convenience sampling method. 8 color nail polishes of blue, green, purple, brown, black, yellow, red, and glitter were applied in two layers and then the arterial blood oxygen level of each finger was measured and recorded separately for each volunteer. One finger of each hand was considered as a control finger without varnish. Data analysis was performed by Wilcoxon signed-rank test using SPSS-22 software.

Among the polishes, green color showed the lowest (96%) and glitter showed the highest (97.06) mean arterial hemoglobin oxygen saturation in the pulse oximetry. Blue had the highest (96.06 ± 2.81) and yellow had the lowest (96.86 ±1.14) standard deviation.

The results of this study showed that different colors of nail polish have different effects on measuring oxygen saturation of arterial blood. Green, blue, and black interfered with the measurements, but other colors did not have a significant effect.

Thromboembolism is a serious complication in patients admitted to the intensive care unit. Education of the effective prophylaxis guidelines by physicians can be reduces the incidence of this illness in at-risk patients. The purpose of this study was to investigate the effect of education on the correct prophylaxis of deep vein thrombosis in patients admitted to the intensive care unit of Imam Khomeini Hospital in Urmia.

This cross-sectional study was carried out on 252 patient records. In this study, the correct prophylaxis of deep vein thrombosis, according to the Harrison Principles of Internal Medicine Textbook, 19th edition (2015), was taught. This education was given to the physicians in the intensive care unit in terms of prophylaxis indications, proper dosage, type of prophylaxis and unnecessary prophylaxis.

Most of the patients were male (51.59%). Their age in pre and post intervention groups was 58.12 and 56.58 years respectively. After the training intervention, unnecessary prophylaxis (from 7.9% to 4.8% (p=0.54)], inappropriate administration of anticoagulant dose [from 51.6% to 18.2% (p = 0.025), and type of anticoagulant [from 10.3% to 4% (p=0.038)] were reduced. Correct prophylaxis frequency was increased from 30.2% to 73% (p= 0.045).

Education sessions on the prophylaxis of venous thrombosis in high-risk patients can lead to the use of correct prophylaxis and maybe it reduces the frequency of deep vein thrombosis and its complications

Ventilator-acquired pneumonia is common in invasive mechanical ventilatory patients. There are various methods to prevent and reduce the incidence of ventilator-acquired pneumonia, one of which is the use of combined mouthwashes. The purpose of this study was to evaluate the effect of combined mouthwash on the prevention of ventilator-acquired pneumonia.

In this clinical-trial study, patients were randomly selected and divided into control and study group. The patients with GCS = 3 and brain death and mechanical ventilation less than 48 hours were excluded from the study. The control group received 0.2% chlorhexidine for mouthwash and the study group received gentamicin 2%, colistin 2% and vancomycin 2%. Mouthwashes were used until the creation of pneumonia symptoms, patient mortality, and endotracheal intubation. Statistical analysis was completed after the study.

The incidence of pneumonia was 19 (30.64%) in the study group and 16 (25.8%) in the control group (P = 0.23). In the study group, 39 (62/9%) patients and in the control group 40 patients (64/5%) were discharged (P = 49/0). Cultures endotracheal secretions were reported negatively in 40 patients (5.64%) of study group and 45 patients (58.72%) in control group (P = 0.04). The isolated bacteria in the study group included 11 cases of Acinetobacter (50%), four cases of Pseudomonas (18.18%), two cases of E.coli (9.09%), two cases of Klebsiella (9.09%) and three cases of Gram -positive (16.63%). Also these bacteria were reported as 11 cases of Acinetobacter (64.7%), three cases of Klebsiella (17/64%), two cases of Pseudomonas (11.76%), one case of E.coli (5.9%) in control group (P = 0.001).

This study showed that a mouthwash with a combination of Gentamicin-Clestin and Vancomycin, compared to chlorhexidine, was not more effective in preventing ventilator-associated pneumonia in patients undergoing mechanical ventilation.

Patients undergoing mechanical ventilation have verbal communication deficits due to endotracheal intubation. As there is s trend towards light sedation patterns nowadays, communicating is considered to be one of the major challenges for these mechanically ventilated patients. The purpose of this study was to describe the communication experiences of mechanically ventilated conscious patients in the intensive care units.

In this study, the phenomenological method was used to explain the experiences of conscious patients undergoing mechanical ventilation communication in the intensive care unit of Imam Khomeini Hospital in Urmia. For data collection, 10 participants who had at least 24 hours of mechanical ventilation consciousness in the intensive care unit were interviewed over a 6-month period in 2019-2018. The researchers used the Colaizzi method to analyze the data and in order to facilitate the classification of the primary codes, the MAXQDA version 10 software was used.

From the primary codes, the two main themes of "psychological suffering" and "resilience" were formed. The main themes of psychological suffering included the sub-themes of "fear of deprivation" and "being ignored by others" and the main theme of resilience included the sub-themes of "understanding the role of care providers and family" and also the "use appropriate alternatives".

Mechanically ventilated conscious patients are in an effort to increase communication, and when health providers continue to communicate with these patients, a sense of hope, increased levels of self-esteem and controlling conditions is developed in patients.

Considering the high prevalence of constipation and its possible impact on the outcomes of patients admitted to the intensive care unit, we decided to conduct a retrospective cross-sectional study with the aim of investigating the frequency and consequences of constipation in patients undergoing mechanical ventilation in General Intensive Care Unit (GICU) of Urmia Imam Khomeini Hospital in a 5-years period (2012-2016).

In this study, patients were divided into two groups (with and without constipation). Demographic information, APACHE II score, frequency of constipation, duration of mechanical ventilation, length of staying in intensive care unit, length of hospitalization, and mortality of patients were extracted from clinical records of the patients and entered in the checklist and were statistically analyzed at the end of the study (p <0.05).

The mean duration of mechanical ventilation was 14.37± 10 10.08 days, the mean length of staying in the intensive care unit was 18.67± 11. 11.31 days, and the mean of hospitalization was 28.82 17± 17.71 days. There was a significant difference between the duration of mechanical ventilation, length of staying in ICU, and hospitalization in patients with and without constipation (p <0.05). While there was a statistically significant difference between patients’ mortality and sex (p <0.05).

This retrospective cross-sectional study with a slight difference in the frequency of constipation with confirmation of previous studies showed a relationship among duration of mechanical ventilation, staying in intensive care unit, and hospitalization with constipation. Although no significant difference was found in mortality between the two groups, there was a statistically significant difference between mortality and sex of patients.

Esophageal cancer is the eighth common cancer worldwide. In recent years, the improvement in surgical procedures and pre and postoperative care has reduced its incapacity and mortality rates in the intensive care unit. The aim of this study was to investigate the early outcomes of patients with esophageal cancer who were admitted to the intensive care unit of Urmia Imam Khomeini Hospital during 2011-2017.

This retrospective cross-sectional study was performed in the intensive care unit of Imam Urmia Hospital during a 7-year period (2011-2012). , Type of surgery, duration of mechanical ventilation, length of stay in intensive care unit, mortality were extracted. The data were analyzed using independent t-test and chi-square test

The mean length of admission in the ICU among patients with SCC esophageal cancer was 8.46 ± 5.86 days and among adenocarcinoma patients was 6.74 ± 3. 59 days (P = 0.001). The mean length of hospitalization among patients with SCC esophageal cancer was 13.19 ± 6.4 and was 12.02 ± 6. 02 days, respectively (P = 0.04). Mean duration of mechanical ventilation among patients with SCC esophageal cancer was 5.58 ± 5.31 days and 4.69 ± 2.91 days among patients with adenocarcinoma. (P=0.001). Of 481 patients with esophageal cancer, 375 (78) discharged and 106 (22%) died.

The results of the present study confirm the limited results of limited studies on the outcome and characteristics of patients with operated esophageal cancer admitted in ICU.

Poisoning as an important dilemma of public health. In this study, we investigated the effects of Silymarin on decreasing elevated levels of liver enzymes and early outcome in patients with drug poisoning admitted to the intensive care unit. In this cross-sectional study, 65 patients with poisoning were evaluated during 1394. The patients’ demographic information (age - sex), the initial level of liver enzymes was checked at the time of admission and after taking the drug and also the outcome of the patients was evaluated. Patients with history of alcohol consumption, another co-morbidity such as viral hepatitis and pregnancy were excluded. In the group receiving the drug, ALT was decreased in 24 patients (58. 5%) and was not decreased in 17 patients (41. 5%), compared with the control group, the difference was statistically significant (P = 0. 04). In the intervention group, 21 patients (51. 2%) had recovery in the AST levels, but in 20 (48. 8%) cases, there was no reduction in AST. This difference is significant in comparison with the control group (P = 0. 03). In the control group, AST was decreased in 6 patients (20%), but in 18 (75%) patients no decrease was observed, this difference was significant between the two groups (P=0. 03). There was no significant difference in serum alkaline phosphates between interventio and control groups (P = 0. 26). According to Kaplan-Meier analysis, the patients in the intervention group had a faster recovery in the level of enzymes and have been transmitted to ward or discharged earlier. The present study shows that Silymarin reduces liver enzymes and causes the patients be discharged or transmitted earlier than usual to the ward and can be used in other cases in addition to the current treatment of poisoning.

Central Diabetes Insipidus is caused by the reduction or lack of production of antidiuretic hormone in neurohypophysis, which has many causes. The aim of this study was to determine the frequency and outcome of diabetes Insipidus in operated neurosurgical patients admitted to the intensive care unit of Imam Khomeini in a 5-year period (1393-1393). This cross-sectional study was conducted in a period of 5 years. Patients' demographic information (age, sex), underlying disease, surgical agent, insignificant diabetes, duration of mechanical ventilation, length of hospitalization in intensive care unit, mortality of patients were extracted from files and entered into a researcher-made form. SPSS 21 was used for analyzing the data. P <0.05 was considered significant. Of 741 patients, 135 (18.2%) had central diabetes insipidus and 606 (81.8%) were without it. The mean of S.G. urinary tract in patients with diabetes insipidus was 1003.86 ± 4.35 and in non-diabetic patients was 1015.76 ± 13.35 (P <0.05). The mean serum sodium level in patients with diabetes insipidus was 152.69 ± 4.96 and in non-diabetic patients was 139.26 ± 3.61 (P <0.05). The mean urinary output level in patients with central diabetes insipidus was 12.44 ± 12.127-12.127 and in non-central diabetic patients was 97.58 ± 587.186 (P <0.05). Of 135 patients with diabetes insipidus, 72 (53.3%) discharged and 63 (46.7%) died. Of 606 patients without diabetes insipidus, 455 (75.1%) discharged and 151 (24.9%) died (P <0.05). The results of this study show that patients with central diabetes insipidus have a poor outcome after brain surgery in comparing with patients without the disease.

Patients admitted to the intensive care unit (ICU) due to their critical conditions are at life-threatening situations, and cardiopulmonary resuscitation (CPR) is one of the most commonly used treatments in this area. Physicians and staff working in this section should be familiar with the basic and advanced life support. This study aimed to assess the outcomes of cardiopulmonary resuscitation in patients with surgical and non-surgical diseases in ICU of Imam Khomeini hospital in Urmia City, Iran. In this cross-sectional study, the medical record of patients admitted to the ICU and underwent CPR during a 7-year period (2010-2016) were analyzed. Demographic characteristics, medicines used in the course of CPR, time of cardiopulmonary arrest, duration of CPR, and its outcome were extracted and analyzed. Findings: Of 6365 patients admitted to the ICU of Imam hospital in Urmia City, 728 (11.43%) had cardiac arrest and received CPR. Of 728 CPRs performed in the ICU, 117 cases (16.1%) were successful and 611 (83.9%) were unsuccessful. Out of 433 patients with non-surgical diseases, 52 (12%) had successful CPR, and out of 295 patients with surgical diseases, 65 (22%) had successful CPR (P = 0.001). There was a statistically significant difference between patients with non-surgical and surgical diseases in visible dysrhythmia (P = 0.001). The mean duration of CPR was 32.72 ± 9.90 and 33.02 ± 8.90 minutes in patients with non-surgical and surgical diseases, respectively (P = 0.600).

Delirium is one of the most commonly occurring disorders in the intensive care unit. Various studies have been done in this regard. In this study, we investigate the frequency and effect of Delirium on the short-term outcome of patients admitted to Imam Hospital in Urmia province. This cross-sectional study was conducted to determine the frequency and effect of delirium on short-term outcomes (duration of mechanical ventilation, duration of hospitalization in ICU, duration of hospitalization, mortality) in patients admitted to the General Intensive Care Unit (GICU) of Imam Hospital in Urmia province during 2015. Demographic characteristics, underlying illness, duration of mechanical ventilation, length of hospitalization in intensive care unit, duration of hospitalization, mortality and delirium of patients entered the check Listed. Independent T test and Fisher exact test was used to analyze data. This study was included 322 patients. There was no significant difference between patients in term of age, sex and mortality (P> 0.05). Although, there were significant difference between two groups of patients in term of underlying disease, duration of mechanical ventilation and the length of hospitalization and duration of hospitalization in intensive care unit(P<0.5). Moreover, 18.94% of the patients suffered from delirium and the rest did not have delirium. The present study showed that delirium is a relatively common disorder in ICU. Moreover, its prevalence is different in compared to other studies. Furthermore, delirium can affect duration of mechanical ventilation, duration of hospitalization in intensive care unit and length of hospitalization.

Exposure Keratitis (EK) is a common problem in critically ill patients admitted to the Intensive Care Unit (ICU). We conducted exposure keratitis in mechanical ventilatory patients in the intensive care unit of Imam Khomeini Hospital in Urmia for five years.

In this retrospective cross-sectional study, the records of the patients were taken from the medical records unit of the hospital and also the demographic characteristics, patients’ consciousness level (GCS), APACHE II score, PCO2 from arterial blood gases, exposure keratitis, duration of mechanical ventilation and hospitalization in the intensive care unit, and the mortality of patients were extracted and entered into a checklist. Patients with GCS ≤12 were enrolled in the study and patients with GCS ≥ 13and=3 were excluded. At the end of the study, T-test, Chi-Square test, and Fisher exact test were used to analyze the data. P<0.05 was considered statistically significant.

The frequency of exposure keratitis was 33.4%. There was a significant difference between patients in term of their genders, the levels of consciousness (GCS), APACHE II, duration of mechanical ventilation and hospitalization in the intensive care unit, mortality rate, and the frequency of exposure keratitis (P<0.05). However, there was no significant difference between patients in term of the mean age, PaCO2 and the frequency of exposure keratitis (P>0.05).

The frequency of exposure keratitis was expected in our study. Moreover, the most common factor was the low-level of consciousness and the patients’ age group

Refeeding syndrome (RFS) is comprised of severe electrolyte disturbances and metabolic abnormalities that occur after the reinstitution of nutrition to starved patients.
This prospective study was conducted on patients aged over 18 years who were admitted to the Intensive Care Unit (ICU) of Taleghani and Emam hospitals in Urmia, Iran, during the first half of 2017. The included participants had the ICU stay of more than 48 h, were kept on nil per os, and were under nutritional support. The patients’ serum levels of phosphorus, magnesium, and potassium were measured on the 1st, 3rd, and 7th days of hospital stay. The frequency of RFS, hypophosphatemia, hypomagnesemia, hypokalemia, and the short-term outcomes of patients were obtained and compared. The patients with acute and chronic renal failure, cancer, previous gastrointestinal and hepatic diseases, and electrolyte disorder were excluded from the study.
The mean length of ICU stay and duration of mechanical ventilation were 35 and 28.5 days, respectively. The frequency of mortality among the patients was 36.96% (n=95). Furthermore, RFS, hypophosphatemia, hypokalemia, and hypomagnesemia had the frequencies of 13.23%, 25.7%, 21.4%, and 37.7%, respectively. There were significant differences between the patients with RFS and those without RFS in terms of the body mass index, duration of mechanical ventilation, ICU length of stay, and mortality (P In this study, despite the differences of our findings with those of the literature, the frequency of electrolyte disturbances during the onset of re-feeding was within an acceptable range.

Intracerebral hemorrhage (ICH) is caused by bleeding within brain parenchyma and the formation of regional hematoma. In this study, we compared the effects of trinitroglycerin (TNG) and labetalol in controlling arterial hypertension in patients with ICH admitted to the intensive care unit (ICU) of Imam Hospital in Urmia city, Iran.
We selected 54 patients, 20 of whom were treated with labetalol (preferred treatment) and 34 received TNG serum infusion. Demographic information, disease severity (using ICH score, Acute Physiologic Assessment and Chronic Health Evaluation II [APACHEII] score, and Glasgow Coma Scale [GCS]), and the initial size of the hematoma (by computed tomography scan imaging) were recorded. Systolic and diastolic blood pressure were measured every one hour for 24 hours. The data were analyzed using the appropriate statistical tests in SPSS, version 20.
The mean GCS scores in the labetalol and TNG groups were 10.45±4.11 and 10.17±4.44, respectively (P=0.82). At the time of detection, the mean amount of hematoma in the labetalol group was 65.15±24.2 cc, and in TNG group, it was 63.16±28.1 cc (P=0.66). The mean reduction in the size of hematoma after 24 hours in the labetalol and TNG groups was 41.3±16 cc and 45±17.4 cc, respectively (P=0.95). Hypotension was observed in 10% of the labetalol group and in 17.4% of the TNG group (P=0.01). Changes in mean systolic and diastolic blood pressure were not significantly different between the two groups during 24 hours (P=0.83 and P=0.99, respectively).
Both drugs are effective in reducing blood pressure and no significant differences were observed between the two drugs in this regard.

Potassium disturbances are common, hyperkalemia is less common but hypokalemia is one of the most common electrolyte disorder in hospitalized patients, its prevalence in the ICU according to present findings is unknown, although studies have shown different levels of it.
After ethic committee of Urmia university approval this retrospective cross sectional study was conducted during 2015 in Emam hospital. During this period, clinical records of patients admitted to intensive care unit with mechanical ventilation were studied. Demographic characteristics (age, gender), duration of mechanical ventilation, length of stay in the ICU, medication intake, potassium intake, potassium level of admission time, mortality rate extracted and entered in the questionnaire. After completion of the study results were analyzed with SPSS software version 20 .P In this study, 400 patients were enrolled. The mean age of patients was 57.99±22.57 years old and 69% male and the rest were females. Potassium level of admission time was 4.11±0.72 meq/l. The separation of potassium level in patients showed 15% hypokalemia, 4% hyperkalemic and 81% were normokalemic. 25% of patients intake pulmonary inhaler drugs, 42% had received furosemide and corticosteroids 72.2%. 32.5% of patient intake supplementary potassium and further rate was 87.7 percent. 40% of patients with hypokalemia and 62.5% with hyperkalemia during the study were died, there was significant difference between mortality and mechanical ventilation and intensive care unit length of stay with and without hypokalemia and hyperkalemia versus normokalemia (P The frequency of hypokalemia in patients in our study was 15% and hyperkalemia 4%. and the expected outcomes in patients with hypo and hyperkalemia was statistically significant difference versus normokalemic patients.

Upper gastrointestinal bleeding occurs more frequency in critically ill patients admitted to intensive care unit. Various studies have been done in this regard. In this study, we investigated the frequency and outcome of upper gastrointestinal bleeding in patients admitted to intensive care unit of Urmia Emam hospital at 2015-2017.
This cross-sectional study was carried out after confirmation at the Ethics Committee of Urmia University with the aim of investigating the frequency and outcome of upper gastrointestinal bleeding in patients admitted to the intensive care unit of Urmia Imam Hospital in during a two-year period. During this study, all hospitalized patients were enrolled during these two years and patients with brain death and GCS = 3, hospitalization period and receiving mechanical ventilation less than 48 hours and hospitalized patients due to bleeding from the digestive system were excluded from the study. Patient's profile (age, gender) underlying illness, upper gastrointestinal bleeding, mechanical ventilation duration, length of hospitalization in the intensive care unit and the hospital, prevention of stress ulcer, mortality of the patient entered the checklist and after the completion of the study, data with SPSS software, ver20 were analyzed. P Five hundred seven patients with mean age of 56.27 ± 21.25 years were studied. 52.85% of the patients were male and the rest were female. Multiple trauma and pulmonary disease and CNS were the most common kind of admission diseases. The frequency of upper gastrointestinal bleeding was 12.42%. 91.12% of patients received stress ulcer prophylaxis. The frequency of mortality in patients with gastrointestinal bleeding was 27 (42.85%). There was a significant difference between the duration of mechanical ventilation and the duration of hospitalization in ICU and hospital and mortality in patients with and without bleeding in ICU (P Despite of the reception of stress ulcer prophylaxis in patients who have been admitted to the intensive care unit, upper gastrointestinal bleeding has often occurred, which can challenge the outcome of the above mentioned patients.

Control of the endotracheal tube cuff pressure and complications due to its incompatibility are one of the main challenges of care in most intensive care units. In this study, we investigated the effect of changing from supine to lateral decubitus position on the cuff pressure of intubated patients admitted to intensive care unit of Urmia Imam Hospital.
After approving the project at the University's Ethics Committee, this prospective cross-sectional study was carried out in patients admitted to the intensive care unit with a range of 18-70 years old, who were intubated for any reason and receiving mechanical ventilation, in a 3-month period. First, the pressure of the cuff of the endotracheal tube was measured and recorded at the supine position and then 2 hours later. Then, patients were restored to the right and left side, and 2 hours later, and at the end of the second hour, the cuff pressure was measured and recorded. For all patients, SUPA endoteracheal tube with appropriate size were used based on the gender of patients with low cuff pressure and high volume.
In this study, 105 eligible patients were enrolled. The mean age of the patients was 14.35 ± 60.0 years. 57.1% of the patients were male and the rest were female. Internal diseases, CNS, surgery and trauma were the most common causes of hospitalization in this study. There was no statistically significant difference between the mean cuff pressure in the baseline state and 2 hours later in 3 positions in the supine, right and left lateral (p> 0.05).
Although there was no statistically significant difference in the mean of cuff pressure in the 3 different conditions, but it was necessary to monitored the condition of the intubated patients and measured at the acceptable intervals of the cuff pressure of the endotracheal tube to prevent the continuation of the increase in the pressure of the tube cuff and preventing complications from it.

Pharmacological treatment of cancer is associated with serious adverse effects including drug-drug interaction (DDI). The purpose of this study was evaluating DDIs in cancer patients hospitalize in the Intensive Care Unit (ICU) and identifying the type and severity of DDI.
The study population was all patients with cancer admitted to the ICU of Imam Khomeini hospital during 21 March 2013 to 20 March 2014. Patients’ information were extracted from the medical records. Then the recording demographic features and prescribed drugs in the first 24 hours of hospitalization were extracted and were investigated. DDIs were classified in terms of severity to as mild, moderate and severe into five groups.
Almost 101 patients were evaluated (63 male and 38 female). The mean age was 59.47±1.69 and the average prescribed medications was 5.23±0.23. Then, 162 DDIs were identified that 14.81% of them were major, 77.16% moderate and 8.03% minor in the point of severity. In the basis of documentation 14.19% of DDIs were established. The most DDIs were in the age group 61-80 years and the most involved drugs were: ranitidine (79.16), cephalosporins (63.162), anticoagulants (24.162) and narcotic analgesics (18.162).
This study shows that a high percentage of DDIs occurs in the ICU. Therefore, we suggest treating patients in ICU relying on a teamwork in drug prescribing.

Endotracheal intubation is commonly performed in the intensive care unit. Many international guidelines for difficult intubation management are available and the intensivists think that any endotracheal intubation in ICU is potentially difficult with several complications.
After obtaining ethical approval, this descriptive and analytical study was conducted from 2014 to 2015 in the Urmia Emam hospital GICU. Demographic characteristic (Age, Sex), underlying diseases, mean of intubation, mechanical ventilation, ICU and hospital length of stay, frequency of difficult intubation, drugs used for intubation, mortality of patients were extracted from the medical information unit and entered to check lists. The data were analyzed with SPSS software ver.20. . P The mean of variables were as follows: intubation period 14.56±4.71, mechanical ventilation 13.24±5.54, ICU length of stay 18.11±10.16 and hospital 21.04±13.09 days. Frequency of difficult intubation was 9.31%. Mean number of attempts was 1.31 times for intubation and frequency of mortality was 35.17%. The Mean of intubation, mechanical ventilation, ICU and hospital length of stay period between 2 groups (difficult and non difficult intubation) were significantly different (P This study, like previous studies showed that difficult intubation had a negative influence on patients’ outcome in the intensive care unit.

Failure of extubation means to need to provide ventilatory support during 24-48 hours after endotracheal tube extubation and several studies have been conducted about it.
This study was performed on mechanically ventilated patients who admitted to intensive care unit of Urmia Emam Khomeini hospital during March 2014 -March 2015. Demographic charachtristics (age, sex), duration of mechanical ventilation, duration of endotracheal intubation, ICU and hospital stay, failure of extubation, endotracheal reintubation and mortality rates obtained from patients medical records and collected in data sheets, and assessed by means of SPSS ver. 20 at the end of study.
Data related to 580 patients were enrolled in this study. Almost 53 percent of patients were male. Among patients who were studied, 72.8% of them had been discharged and 27.2% had been dead. In present study, the frequency of extubation failure was 11.7%. The outcome measures that were studied, were statistically significant between two groups of patients (with and without failure of extubation) (p In our study, the rate of extubation failure and related outcomes were in acceptable range.

Central venous catheter insertion in the most of critically ill patients is needed. Central venous catheter insertion complications including infectious and mechanical complications. Which can be divided into two categories , early or delayed. Several studies have been done in this regard. In this study we compare two approach (supra &infraclavicular) of subclavian catheter insertion in patients admitted to the General intensive care unit of Urmia emam hospital .
After approval of the Ethics Committee of the Urmia university of medical sciences this study conducted in the General intensive care unit of Urmia emam Hospital in second half of 1394, And 260 patients randomly into two groups of 130 patients were enrolled.
Demographic: characteristics (age, gender), the success, the number of attempts for central venous catheter insertion, central venous catheters complications included pneumothorax, cutaneous infection, hematoma, thrombosis, catheter infection in special forms made by researchers arrived and after completion of the study the data were analyzed. Statistical tests and SPSS statistical software version 20 used for this purpose.
The mean age of patients was 16.72 ± 65.23 totally. 56.53% of patients were male and the rest were female. The mean age and sex distribution of patients in both groups there was no significant difference (P> 0.05). The mean frequency of pneumothorax and trying to CVC placement between two groups was statistically significant (P 0.05)
The number of attempts and pneumothorax during infra clavicular approach of subclavian catheter insertion was lower than that of infra clavicular method. There was no statistically significant difference between other complications .

Aim and Nausea and vomiting after surgery takes place in20-30% of patients and these two together are the second most common complains of patients after surgery. We perform this study hoping that use of proper intravascular fluids has a role in decreasing nausea and vomiting after surgery.
Methods and Materials: This clinical trial study was performed on 60 female patients who aged between 20 to 60 years old and with score 1 and 2 of ASA who underwent diagnostic laparoscopy under general anesthesia. Fluids were injected 15 minutes before general anesthesia in all patients. We used 10ml/kg of ringer lactate in crystalloid group, and 10ml/kg voluven in colloid group. Incidence Frequency of nausea and vomiting during recovery was recorded and collected in special formes of this study.
Findings: According to p-value= 0.121 in Chi-square test which is more than 0.05, nausea variant was not significantly different in two groups. The two study groups were assessed and compared about vomiting incidence which according to p-value=0.136 they did not have any statically significant difference.
In this study we used from voluven to increase intravascular volume which had no statically significant difference in incidence of nausea and vomiting comparing to other group which we used ringer lactate in it.

Although intraspinal opioid has been presented to be effective in providing analgesia after cesarean delivery, pruritus as a side-effect remains a common cause of dissatisfaction. We undertook a study to assess the efficacy of ondansetron for treatment or prophylaxis of intrathecal fentanyl-induced pruritus. The role of ondansetron has been studied in preventing pruritus but the results have been contradictory.
We randomized 110 patients undergoing elective cesarean section using spinal anesthesia with Marcaine 10 mg plus fentanyl 25 µg and into a double-blinded trial to receive ondansetron 4 mg (study group) or placebo (control or placebo group) after clamping of umbilical cord. Intra and post-operative itching, nausea and vomiting, and shivering in the recovery room were registered.
Forty percent of the patients in the placebo group and 23.6% in the ondansetron group had itching intraoperative (P=0.04). The incidence of post-operative itching was 38.2%, 21.8% in placebo and ondansetron groups, respectively (P=0.04). The patients reported less intra and post-operative nausea and vomiting in the ondansetron group than in the placebo group (P=0.01). There was no difference in the incidence of shivering between two groups.
This study showed that the prophylactic ondansetron reduced itching, nausea and vomiting intra and postoperative caused by intrathecal fentanyl with marcaine