mohammad niakan lahiji

Acid-base disturbances are frequently found in intensive care unit (ICU) patients. Base excess (BE) is commonly used to quantify the degree of metabolic impairment. We aimed to compare the predictive value of BE and Sequential Organ Failure Assessment (SOFA) score for mortality in ICU patients.  

This prospective and observational investigation was performed on 87 ICU patients who underwent mechanical ventilation. SOFA score and acid-base variables at 6 hours of ICU admission were analyzed and compared between survivors and non-survivors. Receiver-operating characteristic (ROC) curve was applied to analyze the predictive value of BE and SOFA for mortality.  

Mean age of patients was 63.91±5.03 years, and 60 (69%) were male. The non-survived patients had significantly higher SOFA (P = 0.001) and APACHE II scores (P = 0.001). The non-survived patients had a lower bicarbonate (P = 0.002), PO2 (P = 0.001), pH (P = 0.0021), and a higher PCO2 (P = 0.001) compared with survivors, and most patients who died (80%) had a low BE value (< -2) (P = 0.002). The estimated AUC of SOFA and BE was 0.83 (95% CI, 0.73 - 0.92) and 0.71 (95% CI, 0.57 – 0.85), respectively.  

BE is, to some extent capable of predicting mortality in ICU patients. However, the SOFA score is a more accurate and reliable parameter in comparison to BE for prediction.

Medical errors cause disability and mortality in intensive care units (ICUs). We aimed to determine the occurrence and causes of medical errors in the ICUs of Iran.  

In this cross-sectional study, data from the family complaint files referred to The disciplinary authority of Iran Medical Council was retrospectively reviewed to explore the causes of medical errors. Statistical analysis was performed in SPSS Version 26.0.  

A total of 293 complaint files were referred to the disciplinary commission from 2014 to 2019, of which 95 files were related to medical errors in ICUs. The median age of patients was 62 years (46-74 years) and 52 (54.7%) patients were men. Also, 37 (38.9%) patients had decreased levels of consciousness and 42 (42.2%) patients had cardiovascular disease. A total of 40 (42.1%) patients experienced a single medical error and 55 (57.9%) patients experienced more than 1. Causes of medical errors in patients were physician's or nurse’s negligence in 53 (55.8%) patients, weak interaction of physician and nurse with the patient and family members in 11 (11.6%) patients, weak interprofessional interaction among physicians in 7 (7.4%) patients, equipment and structure of ICUs in 7 (7.4 patients, nature of ICUs and patients in 6 (6.3%) patients, weak physician-nurse interprofessional interaction in 5 (5.2%) patients) patients, low attention of the physician and the nurse to medication safety in 6 (6.3%) patients.  

  Patient safety is impacted by a variety of medical mistakes. Interprofessional strategies can be developed and put into action to mitigate medical errors in ICUs.

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.

Nutrition and infectious diseases are 2 influential factors. Mini nutritional assessment (MNA) score is one of the indicators for assessing the nutritional status of the patients. The present study aimed to evaluate the relationship between MNA– short form (SF) and the infectious status of patients admitted to the intensive care unit (ICU) of Hazrat-e-Rasoul hospital in Tehran.  

This was a cross-sectional study performed at Hazrat-e-Rasoul hospital in Tehran from 2019 to 2020. Each patient completed the MNA–SF questionnaire. The questionnaire has 6 factors with a score range of 0 to 14, with 12 to 14 indicating "normal nutrition," 8 to 11 indicating "at risk of malnutrition," and 0 to 7 indicating "malnutrition." The patients were monitored for clinical and paraclinical signs and symptoms of infectious disease for the first 14 days after being admitted to the ICU. Then, the relationship between infection level and MNA–SF scores were recorded and the chi-square, independent samples t test, and Pearson correlation test were used.  

In this study, 119 patients (60 men and 59 women), with a mean age of 53.82 ± 19.76 years were selected, and 71 (59.67%) of the patients had an infection. Women without infection were significantly more than men (p=0.021). In the assessment of the MNA–SF questionnaire, we found that 62 (52.1%) patients had "normal nutrition" status, 30 (25.2%), and 27 (22.7%) had "at risk for malnutrition" and "malnutrition" status, respectively. MNA–SF scores were significantly different in different age groups (p=0.040). There was a significant relationship between weight loss, mobility, and neuropsychological problems with age (p<0.001). Also, there was a meaningful relationship between nutritional status and infection (p=0.032). The results determined that noninfected cases among the patients with "normal nutrition" status were more than those "at risk for malnutrition" (p=0.007). The results of this study showed that clinical outcomes had a significant relationship with nutritional status (p=0.043).  

Based on the present study, good nutritional status can reduce infection and mortality in patients who are admitted to ICU, and the nutritional status assessed with MNA-SF can play an essential role in patients' susceptibility to infection.

Selenium depletion has been reported in critical illness correlates with an increase in mortality and morbidity. In this study, we aimed to access the selenium plasma levels of septic patients early at the Intensive Care Unit (ICU) admission in order to compare with reference range.

We conducted a cross-sectional study in a university affiliated hospital aiming to assess the early plasma level of selenium in ICU admitted patients. eighty patients diagnoses with sepsis were included and considered for characteristic evaluation, monitoring criteria assessment and also blood sampling. All blood sampling was performed during 48 hours of the ICU admission in order to determined the plasma Selenium level by atomic absorption method.

The mean plasma levels of selenium in male and female was 98.14 ± 23.52 and 78.1 ± 24.46 µ/L, respectively. Although selenium plasma levels was higher in the ICU male patients significantly, both had near normal range (80 µ/L).

In this study we found that in early admitted Iranian ICU patients in Tehran, selenium deficiency has not routinely seen but probably will happen during ICU hospitalization

Ventilator-Associated Pneumonia (VAP) is a hospital pneumonia that is considered in patients on mechanical ventilation for at least 48 hours with symptoms of new lower respiratory tract infections being reported in them. The present study reviews the effect of adding inhaled colistin in the treatment of ventilator-induced pulmonary infections in Intensive Care Unit (ICU) patients. In this single blind clinical trial, patients admitted to the ICU with diagnosis of pulmonary infections caused by ventilator were investigated. In the treatment group, patients received 150 mg of colistin plus 1,000,000 units inhaled colistin every eight hours and in the control group only 300 mg of colistin every eight hours intravenously was given. Patients were followed up in terms of clinical findings for seven days after the initial diagnosis of infection. The results of this study showed that administration of inhaled colistin in patients admitted in ICU significantly improved culture indices, leukocyte, white blood cell count, chest X-ray, chest secretion, CPIS score and saccharification (SpO2) on the third and seventh days after treatment compared to the first day. Considering the positive effect of adding inhaled colistin to the treatment of patients admitted to ICU with pulmonary infections caused by ventilator with multi-drug resistant Acinetobacter, the use of combination drug therapy is recommended.

With regards to the importance of traumatic brain injury (TBI) and its high incidence rate in Iran as well as its severe consequences, it is important to determine the safety and efficiency of modafinil to increase the level of consciousness in hospitalized TBI patients.

This double-blind randomized controlled trial was done during 2016. Sixty patients with TBI and moderate GCS score between 9 and 13 had the inclusion criteria and entered the study and were divided into two groups. Patients in the treatment group received 200 mg of modafinil once a day and the control group received the placebo. Overall, 24 hours after admission, defined as base day, modafinil was prescribed for 196 hours after admission and GCS scores were recorded: this period was defined as the last day. Level of consciousness in both treatment and control groups was assessed by the GCS score. Data were analyzed by SPSS version 21 software using the independent t-test with intention-to-treat approach.

Among 60 patients, there were 34 (56.66%) males and 26 (43%) females; 45 (75%) survived. The ITT analysis was employed to assess changes in the level of consciousness (LOC) after prescribing modafinil and placebo. Based on the findings, modafinil prescription was not associated with significant differences in LoC in the first time period (24 hours after) and the last day (196 hours) (P > 0.05).

Prescribing modafinil was not associated with significant changes in LoC in comparison with the placebo.

Systematic inflammatory syndrome causes death in many conditions. Inflammation and anti-inflammation parameters variation monitoring were done by different clinical and lab methods, however, determining the progression of inflammation is very important for on time interference, gaining best results, and cost controlling. In this condition, adrenal insufficiency’s variation causes water and electrolyte disorders, circulatory failure, and uncontrolled progression of inflammatory response, which is very important. Routine serum total cortisol level monitoring for SIRS is not advised as yet, and corticosteroid was used blindly according to hemodynamic condition and physician diagnosis.

In this pilot study, the ability of first three days monitoring serum total cortisol level in SIRS of burned ICU traumatic patients was studied for outcoming improvement.

A total of 60 patients, 15 - 70 years old, < 80% burn, with systemic inflammatory response syndrome, during first three days of admission in the ICU, that weren’t included in the exclusion criteria (patients with history of clinical adrenal insufficiency or corton usage, or recent drug history of etomidate or ketoconazole), were divided randomly between two groups with 30 patients. The first group considered under the routine clinical treatment and in the second group, besides the routine methods cortisol daily measurement at 8 o’clock, was done during three days to find the cortisol level under 15 ug/dL, and replacement therapy with 50 mg hydrocortisone IV, four times a day.

None of the patients had a cortisol drop during their first three days. Among patients with cortisol more than normal, 20% (6 patients) died.

Despite the fact that total serum cortisol drop during systemic inflammatory response syndrome may happen, it is not prevalent, however, it is wise to consider it as an effective parameter on monitoring of treatment measures.

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.

Anesthesiologists perform minimally invasive bedside precutanous dilated tracheostomy and it is expected that it should have fewer complication for being less invasive. Tracheo-inniminate artery fistula (TIF) is a rare, life threatening and catastrophic complication, which may occur 7 to 14 days after surgery. The incidence rare of TIF is 0.1-1% and survival rate of patient is 14.3%. Herein, we describe TIF in a PDT patient improved because of timely diagnosis and surgical treatment.

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.