جستجوی مقالات مرتبط با کلیدواژه « Intensive care unit (ICU) » در نشریات گروه « پزشکی »

Dyschloremia is one of the most prevalent abnormalities that is highly associated with a high level of mortality in intensive care unit (ICU) patients. The current study evaluated serum chloride levels in COVID-19 patients hospitalized in the ICU.

This cross-sectional study was conducted on 245 patients with severe COVID-19 who were admitted to the intensive care unit (ICU). Electrolytes, albumin, liver function test, complete blood count, serum chloride, and VBG were among the laboratory markers compared. The Chi-square, t-test, and logistic regression models were used to examine the relationship between these markers and the key outcomes, which included severity, mortality, intubation, and hospitalization.

The Mean±SD age of patients was 58.16±17 years. The mean serum chloride level in the studied patients was 109.6±5.1 with a range of 100-134. According to the regression logistic model, variables like age, intubation status, pH, and chlorine levels significantly affected the outcome of COVID-19 disease. Patients with acidosis were 4.7 times more likely to die than those with alkalosis (P<0.001). The chance of dying in hyperchloremia is 2.38 times more compared to the normochloremia group (P<0.009).

Patients with severe COVID-19 may present with chlorine abnormalities, including hyperchloremia. Hyperchloremia is also associated with poor clinical outcomes and a higher mortality risk. This relationship was independent of acid-base disorder.

The experiences of patients hospitalized in the intensive care unit (ICU) can be used as one of the important components to develop and provide humane and holistic care tailored to the needs and preferences of these patients.

The current study was conducted to explain the experiences of brain injury patients hospitalized in the ICU.

This was a qualitative study using conventional content analysis. The participants included brain injury patients with a history of hospitalization in the ICU and were selected using a purposive sampling method. At least 3 months after discharge from the ICU, face-to-face unstructured in-depth interviews were conducted with the participants to explore their experiences regarding hospitalization in the ICU. Finally, the collected datawereanalyzed basedonthe content analysismodelof GraneheimandLundman.

Data analysis indicated 238 compact semantic units (initial codes). Based on their similarities and differences, these codes were organized into 22 subcategories, 6 categories, and 2 themes, including “the suffering body and soul” and “illumination in the dark”.

The results of this study showed that hospitalization in the ICU is a very difficult and unpleasant experience for brain injury patients due to enduring an immense amount of physical and mental suffering. The ICU care and treatment team can moderate this unpleasant experience to some extent by paying careful attention to the physical and mental needs of these patients. The results of the present study can serve as a clinical manual for providing humane and holistic care tailored to the needs and preferences of brain injury patients hospitalized in the ICU.

The COVID-19 pandemic created an unprecedented challenge for intensive care units (ICUs) compared to other clinical wards. In addition, it caused stressful conditions due to the increased mortality rates in these wards.

Since the identification of these challenges can serve as a road map for managers in future planning against crises, the present study aimed to identify the challenges of ICU caregiving during the COVID-19 pandemic.

This qualitative study used conventional content analysis and was conducted using unstructured deep interviews with an open question and several co-constructive questions in 2023. A total of 23 ward heads, head nurses, nurses of ICU wards, nursing managers, and supervisors of six teaching hospitals affiliated with Isfahan University of Medical Sciences and Yazd Universities of Medical Sciences were included in the study through a purposive sampling method. Data analysis was performed with MAXQDA10 using qualitative content analysis with a conventional approach.

The challenges of ICUs in the COVID-19 pandemic were identified and categorized into six main categories and 14 sub-categories. The main categories included: inefficient management of resources, weaknesses in organization, challenges to laws and regulations/policies, structural challenges, weaknesses in educational processes, and mental challenges.

The findings of this study showed that it is possible to provide quality services to patients by identifying the challenges affecting the management and provision of nursing services and taking appropriate measures to improve the quality of nursing services in the intended wards.

 Vancomycin-resistant enterococci (VRE) are recognized as nosocomial pathogens with increased importance in recent years. These bacteria are frequently isolated from patients admitted to intensive care units (ICUs). Enterococcal pathogenicity is enhanced by different antibiotic resistance and virulence determinants.

 The present study aimed to assess the prevalence of genes encoding resistance to antibiotics and virulence factors in intestinal VRE isolates from ICU patients.

 In this study, 23 VREs were investigated. Minimum inhibitory concentrations (MICs) to nine antimicrobial agents were examined using E-test. Genes encoding vancomycin resistance (vanABCDMN), aminoglycoside-modifying enzymes (aac(6')-Ie-aph(2")-Ia, aph(2")-Ib, aph(2")-Ic, aph(2")-Id, aph(3')-IIIa, ant(3')-Ia, ant(4')-Ia, ant(6')-Ia), together with genes for various virulence factor (ace/acm, asa1, cylA, efaA, esp, gelE and hyl), were detected using multiplex PCR.

 The species distribution of the tested VRE was as follows: Nine Enterococcus casseliflavus, seven E. gallinarum, and seven E. faecium. The vanA gene was found in all E. faecium, in six of which the classical VanA phenotype was observed. The vancomycin (vanC) phenotype was associated with the presence of vanC1 gene in E. gallinarum and the vanC2 gene in E. casseliflavus isolates. The aac(6')-Ie-aph(2")-Ia gene was encoding high-level gentamicin resistance (HLGR) in the studied VRE. All E. faecium were positive for acm and esp, while acm in combination with esp or hyl was detected in 2 vanC enterococci.

 According to the findings, there was a correlation between the phenotype and the genotype of glycopeptide resistance in the tested VRE. HLGR was more prevalent in E. faecium because of the presence of aac(6')-Ie-aph(2")-Ia. The higher prevalence of virulence determinants was confirmed in vanA isolates compared to the studied vanC-carrying enterococci.

Acute respiratory failure (ARF) is an important presentation in emergency department (ED). Intubation and mechanical ventilation (MV) are sometimes the ultimate decisions in such emergent situations. Many of these patients are unfortunately managed in an ED. This may endanger their outcome.
This study was aimed to compare the outcome of critically ill patients with ARF under MV admitted to ED with patients admitted to ICU.

All critically ill patients with ARF who were intubated and placed under MV were enrolled in this study. Cases were either admitted to ED or ICU. Demographic data, initial diagnosis, final diagnosis, length of hospital stay, one-month mortality rate, number of times patient was intubated and number of times patient was resuscitated were all recorded and compared between the 2 groups.

Out of all 172 patients admitted to ED and ICU, 74 (43%) were females and 98 (57%) were males. Patients had a mean±SD age of 64.2±18.1 years. ICU patients (85 patients (49.4%)) had a significantly longer hospital stay (p=0.048). ICU patients had significantly more resuscitation process (p=0.006). Mortality rate in ICU was significantly higher than ED. In the meanwhile, more patients in ED finally survived (p=0.004).

In the present study, ICU patients were admitted longer to the ward than ED patients. Overall, ED mortality rate was lower than ICU. More patients finally survived in ED in comparison to ICU.

Toexplore the application of specialist nursing teams in patients undergoing unplanned inter-ruptions in continuous renal replacement therapy.

Sixty-sixpatients admitted to the intensive care unit of Jiangsu Province Hospital, China for con-tinuous renal replacement therapy (CRRT) and experienced unplanned interruptions from Aug 2020 to Mar 2021 were enrolled as study subjects. Twenty four patients with conventional care were taken as the control group, and 42 patients in the specialized nursing team were taken as the experimental group. The age, type of disease, and degree of illness of the two groups were statistically processed and the differences were not signifi-cant (P>0.05) and were comparable. The control group received routine CRRT care after CRRT rescue, and the experimental group received CRRT care model from a specialized nursing team.

Patients in the group with specialized nursing care had 49 instances of CRRT unplanned interrup-tions, and the routine care group had 79 instances of CRRT unplanned interruptions. The number of un-planned interruptions in the experimental group was less than that of the control group, and the difference was statistically significant (P<0.001). The incidence of complications in the experimental group were lower than that of the control group (P<0.05). The satisfaction and quality of life of nurses in the specialist nursing group were clearly lower than those of the control group, and the difference was statistically significant (P<0.05).

Specialist nursing teams could reduce the occurrence of unplanned interruptions in CRRT pa-tients in intensive care and allow patients to receive continuity of care

The quality of nursing care can be affected by various factors. This study aims to determine the correlation between the quality of nursing care and the Severity of Illness (SOI) in patients admitted to the Intensive Care Units (ICUs).

This descriptive-correlational study was performed from November 2018 to January 2019 in Ayatollah Mousavi Hospital, Zanjan City, Iran. The sample included 50 ICU patients who were recruited by convenience sampling. The data were collected using the ICU quality of nursing care scale and the sequential organ failure assessment score within the first seven days of hospitalization. They were analyzed by descriptive and non-parametric statistical tests (the Friedman, Wilcoxon signed-rank, and Spearman’s rho) using SPSS v. 22 software. The significance level was set as 0.05.

The Mean±SD score of quality of nursing care was 86.62±2.19, and there was a significant difference among the seven days (P<0.001). Also, the Mean±SD score of SOI was 6.4±2.31, and it was constant in the first to third days of hospitalization and decreased by the fourth day of admission. There was a significant indirect correlation between the quality of nursing care and SOI from the fourth day onwards (P<0.05).

There was a significant inverse relationship between quality of nursing care and SOI from the fourth to the seventh day of hospitalization. It seems that nursing care delivery in the ICU is mainly routine and does not follow the holistic model of care. Therefore, the severity of the illness and the changing needs of ICU patients require that care models be tailored to these changes.

Patient safety is the precious core in the healthcare organizations aimed at minimizing adverse events and eliminating preventable damages. This study aimed at determining the rate of observation of safety standards of ICU patients by nurses before and after implementation of a training program.

This quasi-experimental single-group study was conducted in two phases: observation of nursing performance related to patient safety and the implementation of a corrective training program. In the first phase, 4104 cases of nursing care related to patient safety performed by 54 ICU nurses were observed using chronological sampling. The same samples, i.e., 4104 nursing care performed by the same nurses, were used in the second phase of the study after implementing the training program. The data collection instrument was a valid and reliable researcher-made 76-item questionnaire consisting of 12 categories about nursing care related to patient safety. The corrective training program focused on nursing care related to patient safety. The gleaned data were analyzed with SPSS18 using descriptive statistics and non-parametric Wilcoxon signed-rank tests.

The rate of correspondence between nursing care and the checklist was 44.32 % before the intervention, which increased to 95.61% after intervention by a 51.29% increase.

Implementation of the corrective intervention effectively promotespatient safety as a training program for nurses. The healthcare system's managers and authorities can reduce the damages sustained by patients and decrease treatment costs by concentrating on periodic supervision and continuous education programs to improve patient safety

It is of paramount importance to reduce the probability of clinical risks to improve the quality of health care services, make the relationship between service providers and patients more effective, enhance patient satisfaction, and decrease the rate of complaints regarding medical errors in hospitals. This study aimed at detecting potential and unacceptable risks occurring in the hospital ICUs.

In this systematic review, all studies examining the risk assessment of ICUs in hospitals using Failure Mode and Effect Analysis method were reviewed. Google scholar, PubMed, Scopus, SID, Magiran and Web of Science databases were searched to find relevant articles published from 1980 to 2019.

The most frequent failures detected in the reviewed articles consisted of high risk of infection inwards for medical and nursing operations, high infection rates inwards for medical devices’ operation within the unit, and early discharge. Moreover, the processes through which potential high-risk Failures were examined in these studies were injection or prescription process, suction process, the process of inserting or removing endotracheal tubes, the process of transferring patients from the operation room to the unit or vice versa, pressure ulcers, and processes related to the medical devices’ operation.

There are many possible reasons for failure occurring throughout these processes, and the failure modes occurring in these processes are more probable to cause serious damages to patients, have high repeatability with low probability of failure detection as the failures cannot be discovered by the personnel.

Candida auris is a rapidly emerging fungus, which is considered globally a cause of concern for public health. This report describes the first case of C. auris fungemia from a tertiary care hospital in the hilly state of Uttarakhand in India. Case report: The patient was a 37-year-old female who underwent a Whipple procedure for the carcinoma of the head of the pancreas. She developed fever 12 days after the operation while recovering from surgery in the hospital. Blood culture yielded C. auris which was identified by the matrix-assisted laser desorption/ionization-time of flight mass spectrometry (Bruker Daltonics, Germany). The patient was successfully treated with caspofungin.

In conclusion, C. auris is potentially multidrug resistant, resulting in nosocomial outbreaks and sporadic infections which can be potentially prevented when identified early by implementing contact precautionsBackground and

Candida auris is a rapidly emerging fungus, which is considered globally a cause of concern for public health. This report describes the first case of C. auris fungemia from a tertiary care hospital in the hilly state of Uttarakhand in India. Case report: The patient was a 37-year-old female who underwent a Whipple procedure for the carcinoma of the head of the pancreas. She developed fever 12 days after the operation while recovering from surgery in the hospital. Blood culture yielded C. auris which was identified by the matrix-assisted laser desorption/ionization-time of flight mass spectrometry (Bruker Daltonics, Germany). The patient was successfully treated with caspofungin.

In conclusion, C. auris is potentially multidrug resistant, resulting in nosocomial outbreaks and sporadic infections which can be potentially prevented when identified early by implementing contact precautions.