nahid aghdaei

Tracheostomy is a widely used procedure for airway maintenance and long-term ventilation of critically ill patients in ICUs or operating rooms. Although several complications, such as bleeding, leakage, infection, and stenosis, have been previously reported due to tracheostomy, cuff herniation is a rare complication of this commonly performed procedure. The first sign of herniation is a sudden drop in oxygen saturation. Since cuff herniation is not among the first differential diagnoses for a drop in oxygen saturation, it should be considered in the absence of other common causative agents.In this study, we delineate a case of tracheostomy cuff herniation after cardiac arrest in a 64-year-old woman who underwent coronary artery bypass graft surgery. The patient experienced a cerebrovascular accident and mediastinitis postoperatively, necessitating tracheostomy due to extended tracheal intubation, during which the cuff herniated for the first time. Furthermore, a repeat tracheostomy was performed; however, the patient ultimately expired due to complications from mediastinitis.

The novel SARS‑CoV‑2 virus, also known as COVID‑19, has started a global pandemic since late December 2019. The infection is primarily manifested with fever, coughing, and myalgia, and in more severe cases causes acute respiratory distress syndrome. Older people and patients with underlying conditions such as diabetes and those who are immune compromised are more susceptible for developing COVID-19 infection and more severe complications. Several cases have reported other uncommon and rare complications in young or adult cases with COVID-19 infection. Several studies have reported bacterial co-infection with COVID-19 which caused infective endocarditis. However, there has been no report of bacterial endocarditis in infants following COVID-19 infection. In this report, we present a case of bacterial endocarditis with advanced progression in a 15-month-old child following COVID-19 infection.

Detecting pain is crucial in sedated and mechanically ventilated patients, as they are unable to communicate verbally..
This study aimed to compare Bispectral index (BIS) monitoring with the Critical-care pain observation tool (CPOT) and vital signs for pain assessment during painful procedures in intubated adult patients after cardiac surgery..
Seventy consecutive patients who underwent cardiac surgery (coronary artery bypass graft or valvular surgery) were enrolled in the study. Pain evaluations were performed early after the operation in the intubated and sedated patients by using BIS and CPOT, and also checking the vital signs. The pain assessments were done at three different times: 1) baseline (immediately before any painful procedure, including tracheal suctioning or changing the patient’s position), 2) during any painful procedure, and 3) five minutes after the procedure (recovery time)..
The mean values for CPOT, BIS, and mean arterial pressure (MAP) scores were significantly different at different times; they were increased during suctioning or changing position, and decreased five minutes after these procedures (CPOT: 3.98 ± 1.65 versus 1.31 ± 1.07, respectively (P ≤ 0.0001); BIS: 84.94 ± 10.52 versus 63.48 ± 12.17, respectively (P ≤ 0.0001); MAP: 92.88 ± 15.37 versus 89.77 ± 14.72, respectively (P = 0.003)). Change in heart rate (HR) was not significant over time (95.68 ± 16.78 versus 93.61 ± 16.56, respectively; P = 0.34). CPOT scores were significantly positively correlated with BIS at baseline, during painful stimulation, and at recovery time, but were not correlated with HR or MAP, except at baseline. BIS scores were significantly correlated with MAP but not with HR..
It appears that BIS monitoring can be used for pain assessment along with the CPOT tool in intubated patients, and it is much more sensitive than monitoring of hemodynamic changes. BIS monitoring can be used more efficiently in intubated patients under deep sedation in the ICU..

Renal failure is a frequent event after coronary artery bypass grafting (CABG). Hemodynamic alterations during surgery as well as the underlying disease are the predisposing factors. We aimed to study intermittent furosemide therapy in the prevention of renal failure in patients undergoing CABG. In a single-blind randomized controlled trial, 123 elective CABG patients, 18-75 years, entered the study. Clearance of creatinine, urea and water were measured. Patients were randomly assigned into three groups: furosemide in prime (0.3-0.4 mg/kg); intermittent furosemide during CABG (0.2 mg/kg, if there was a decrease in urinary excretion) and control (no furosemide). There was a significant change in serum urea, sodium and fluid balance in “intermittent furosemide” group; other variables did not change significantly before or after the operation. Post-operative fluid balance was significantly higher in “intermittent furosemide” group (2573 ± 205 ml) compared to control (1574 ± 155 ml) (P < 0.010); also, fluid balance was higher in “intermittent furosemide” group (2573 ± 205 ml) compared to “furosemide in prime” group (1935 ± 169 ml) (P < 0.010). The study demonstrated no benefit from intermittent furosemide in elective CABG compared to furosemide in prime volume or even placebo.

Background Given the importance of the effect of muscle relaxants on the extubation time in coronary artery bypass grafting (CABG) patients, we sought to assess the difference in “time to extubation” and “intensive care unit (ICU) length of stay” between the primary bolus doses of Pancuronium and Cisatracurium without using the maintenance dose of them during surgery. Methods This double blind clinical trial divided 110 patients into two equal groups receiving either Cisatracurium or Pancuronium. The patients’ surgical and cardiopulmonary bypass variables were evaluated, and the extubation time and ICU length of stay were compared between the two groups. Results There was no difference between the two groups regarding the depth of anesthesia, train-offour (TOF) scores at the beginning of anesthesia, and the surgical and cardiopulmonary bypass variables. However, the Cisatracurium patients were extubated earlier and had a shorter ICU length of stay than the Pancuronium patients. Conclusions An appropriate depth of anesthesia facilitates the administration of the induction dose of Cisatracurium, which confers earlier extubation and shorter ICU length of stay by comparison with Pancuronium.

Background Given the importance of the effect of muscle relaxants on extubation time in coronary artery bypass grafting patients, we sought to assess the difference in “time to extubation” and “intensive care unit length of stay” between the primary bolus doses of pancuronium and cisatracurium, without using maintenance doses during the operation. Method This double-blind clinical trial divided 110 patients into two equal groups, receiving either cisatracurium or pancuronium. The patients’ surgical and cardiopulmonary bypass variables were evaluated, and extubation time and ICU length of stay were compared between the two groups. Result There was no difference between the two groups regarding the depth of anesthesia, train-of-four (TOF) scores at the beginning of anesthesia, and the surgical and cardiopulmonary bypass variables. However, the cisatracurium patients were extubated earlier and had shorter ICU length of stay than the pancuronium patients Conclusion An appropriate depth of anesthesia facilitates the administration of the induction dose of cisatracurium, which confers earlier extubation and shorter ICU length of stay in comparison to pancuronium.