نشریه پرستاری مراقبت ویژه
سال پانزدهم شماره 2 (پیاپی 54، تابستان 1401)

Fatigue and shortness of breath are the main complaints of patients after COVID-19 disease, and Determine the factors associated with them is very important for effective care of these patients. The aim of this study was to investigate the relationship between fatigue severity and shortness of breath with arterial blood oxygen saturation (SPO2) in COVID-19 patients.

The present study was a cross-sectional study. 193 patients with COVID-19 admitted to Fatemeh Al-Zahra and Lolagar hospitals in Tehran in the second half of 2021 were selected through convenience sampling method. Demographic information questionnaire, fatigue severity scale, Modified Borg Dyspnoea Scale and recording SPO2 form were used to collect data. Data were analyzed using SPSS26 statistical software using statistical tests.

In total, 56.5% were women, 72% were married, 40.9% were housewives and 82.9% were over 40 years old. Patients 'fatigue intensity (35±17.55) was low, arterial blood oxygen saturation (89.74±5.35) and patients' shortness of breath (3.35±2.03) were at the level of light activity. Based on the results, the relationship between fatigue intensity and oxygen saturation was not significant (P=0.246). There was a significant negative relationship between the severity of shortness of breath and SPO2 (P=0.005, r=-0.202). As the severity of shortness of breath increases, the SPO2 decreases.

The fatigue severity in patients with COVID-19 was moderate and the severity of shortness of breath was high, which should be given more attention as a traumatic complication. Also, due to the significant relationship between the severity of shortness of breath and arterial blood oxygen saturation, it is necessary for nurses caring for these patients to be reminded of the importance of measuring oxygen levels to seek the help of nurses and physicians in emergencies.

Mitral valve prolapse (MVP) is one of the most common valvular heart disease in humans. The general health of patients with chronic diseases is important for health care providers. Since a valid tool is needed to general health assessment, this study was conducted to validation of general health questionnaire-28 (GHQ-28) in patients with mitral valve prolapse.

Construct validity was performed in 190 patients with mitral valve prolapse.  Factors were extracted with exploratory factor analysis with maximum likelihood and Promax rotation method. 190 other patients with mitral valve prolapse were studied for confirmatory factor analysis. In this part, with maximum likelihood estimation method was evaluated model fitness.

Exploratory factor analysis after removal of 7 items showed a four-factor construct for GHQ-28. Four factor are respectively, depressive symptoms, physical symptoms, social functioning and anxiety symptoms.  These four factors explain 47.9% of the total variance of the general health in patients with mitral valve prolapse. Due to all regression coefficients in confirmatory factor analysis models and fitness indices of confirmatory factor analysis were high (>0.5), the assumed model had a good fit. Cronbach's alpha, omega McDonald, CR and the maximum reliability of the four factors extracted from the 21-item general health questionnaire were greater than 0.7.

Based on the study results, the validity and confidence of the 21-item Persian version of the General Health Questionnaire has been confirmed. This tool can be used in screening and clinical studies related to the general health dimensions of patients with mitral valve prolapse.

Chronic renal failure and hemodialysis cause major changes in the quality of life of patients, so this study was performed to Evaluation of quality of life and variables affecting its prediction in patients undergoing hemodialysis in Hojjat Koohkamari Hospital in 1400.

The present study is a cross-sectional study performed on 104 hemodialysis patients over 18 years of age in Marand in 1400. Patients were selected by full census sampling.  Data collection tool is a demographic information checklist and a standard quality of life questionnaire for kidney patients. Data analysis was performed with SPSS software version 16. Frequency index and mean standard deviation were used to describe the variables. Data were analyzed using independent t-test, analysis of variance and Pearson correlation and multiple regressions.

The results showed that the overall quality of life score of dialysis patients was 52.7±23.1, which indicates the average level of quality of life of these patients. Pearson correlation coefficient showed that with age, the quality of life of the samples decreased (p=0.004, r=-31). Also, one-way analysis of variance showed a significant relationship between quality of life and income (p=0.02) and level of education (p=0.001) and duration of dialysis (p=0.048). Stepwise regression analysis showed that the specific dimension of kidney disease with a coefficient of determination of R²=0.79 is able to significantly predict changes in quality of life as the most important variable.

According to the results of the present study, the quality of life of hemodialysis patients is moderate and the most important factor in changes in the living standards of hemodialysis patients is related to the specific dimension of kidney disease. Also, with increasing income level and education level, the quality of life has increased, but with increasing the duration of dialysis, the quality of life has decreased.

Due to the high mortality of patients admitted to the intensive care unit, the provision of high quality nursing care, especially for patients admitted to these wards, is of great importance, so the quality of death and dying in these wards is necessary. The aim of this study was to determine the quality of dying and death from the perspective of nurses working in intensive care units.

The present study was performed cross-sectional in the teaching hospitals of Kurdistan University of Medical Sciences. The research samples in this cross-sectional study were 105 nurses working in intensive care units who were selected by census. Data collection tools included two sections: demographic information, Quality of Dying and Death Questionnaire (QODD).

The results of the present study showed that the mean and standard deviation of the quality of dying and death variable were 37.15±13.47 and below the mean. Among the items related to the quality of death, the highest average was related to receiving appropriate sedation during the stay in the intensive care unit (5.80±2.41) and being touched or hugged by loved ones (4.90±2.78) and the lowest average quality of care was related to having a spiritual ceremony before the patient's death (2.12±2.59) and having one or more visits to a religious or spiritual counselor (2.24±2.66). There was a statistically significant relationship between the quality of dying and death and the history of passing training courses related to dying and death (P=0.03).

It is recommended to hold training courses related to quality dying and death care criteria for personnel working in intensive care units, as well as to evaluate the quality of mortality care from the perspective of the families of patients admitted to the intensive care unit.

COVID-19 is the third pandemic disease with respiratory manifestations after severe acute respiratory syndrome (SARS-Cov) and Middle East respiratory syndrome (MERS-Cov). One of the problems of patients with SARS-CoV2 infection is hypoxia and hypoxemia, which is considered to be seriously life-threatening. Given that there is not sufficient consensus to causes and consequences of hypoxia/ hypoxemia, therefore this study was conducted to review the causes and consequences of hypoxia/hypoxemia due to COVID-19.

This narrative review study was done through a library literature review in the databases including Science direct, Scopus, EMBASE ،Web of Science ، PubMed, SID, WHO, CDC, Springer, Elsevier and Google Scholar search engine in Persian and English 2019 to 2022. Articles were evaluated and selected based on the inclusion and exit criteria, first duplicate articles by title review and then unrelated articles are deleted through review abstract and finally, the articles analysis and them which were not consistent with the purpose of study were excluded.   

Out of 1275 searched articles, 42 were selected and analyzed. The results showed that lung injuries, activation of immune system and induction of inflammatory reactions, Central nervous system injuries and underlying diseases are the causes of hypoxia and hypoxemia. Brain and nerve damages, gastrointestinal disorders, heart damages and liver damage can be caused by hypoxia and hypoxemia and delirium, encephalopathy, encephalitis, seizures and kidney damage caused by hypoxia.

Although respiratory infection is more common in patients with Covid 19, some patients suffer from hypoxia or hypoxemia and the side effects associated with both. In order to cause oxygen homeostasis, early detection and therapeutic interventions are essential that during oxygen therapy, secondary injuries of this therapeutic intervention should be considered. Investigate the level of inflammatory and immune markers, may help in early detection them in patients.

Chemical restraints are drugs used to restraint a patient's involuntary movements or emergency control of the patient's aggressive behavior and to cause sedation and pain relief, reduce symptoms, and reduce the likelihood of harming oneself or others. Improper use of chemical restraints can lead to complications in patients and can even delay the separation of patients under mechanical ventilation from the ventilator. The aim of this study was to investigate the effective factors in nurses' use of chemical restraints in patients admitted to intensive care units.

This was an observational study. The statistical society of the research included 160 hospitalized patients in intensive care units (ICU) at Kowsar hospital, Sanandaj, Iran. After 8 hours of hospitalization and stability of their conditions, those patients in intensive care units were assessed based on administrating of chemical restraint by nurses. Data was collected through patients’ information forms, and observational checklists, then analyzed by SPSS 21, independent t-test, Chi-2, Fisher, and Mann–Whitney. Independent risk factors for the administration of chemical restraint were investigated by using the logistic regression model.

Of the 160 patients admitted to intensive care units, 105 patients (65.62%) underwent chemical restraints. The most common time to use chemical restraints was during the night shift and then the evening shift. Comparison of patients for whom chemical restraint was used or not, showed that the two groups in terms of smoking history (P=0.037), intubation (P=0.0001), dressing (P=0.001) and drain (P=0.001) as well as NGT (P=0.010), GCS (P=0.012), FOUR score (P=0.050), type of nursing shifts (P=0.017), restlessness (P=0.004) Had a statistically significant difference. Relationship between BMI variables, alcohol addiction, drug addiction, having a catheter, fixator and traction, delirium, having a dressing, nurse to patient ratio, underlying disease and mechanical ventilation mode using limiters Chemical was not significant (P>0.05). The results of logistic regression analysis showed that between smoking (P=0.041, OR=3.232), being intubated (P=0.0001, OR=75.959), having a drain (P=0.016, OR=2.669), FOUR score (P=0.0001, OR=0.944), there was a significant relationship using chemical restraints.

Regarding the results of the study, it could be concluded that the administration of chemical restraint is increasing among nurses in intensive care units (ICU). Therefore, the necessity of the clinical guidelines and policies for the administration of chemical restraint are highlighted.

Predicting the final outcome of patients with traumatic brain injury is crucial for making the right clinical decision and determining the course of treatment. The aim of this study was to compare the ability of Marshall and Rotterdam scoring systems to determine the prognosis in patients with traumatic brain injury.

The present study is cross-sectional. The statistical population of the study consisted of patients with traumatic brain injury admitted to the intensive care unit of Khatam al-Anbia Hospital in Zahedan from 2021 to 2022. 287 patients were selected by convenience sampling method based on inclusion criteria. Patients were first evaluated by an intensive care physician to determine the prognosis with the APACH II Scale. The Marshall and Rotterdam scores of each patient were then determined by a radiologist based on a brain CT scan, and the patients were evaluated for the entire period of hospitalization until the final outcome (discharge or death) was determined. Finally, the data were compared to determine the ability of the two scales to predict outcomes.

Out of 287 patients, 33(11.5%) died and 254 (88.5%) survived. The mean score of the Marshall Scale in deceased patients was 4.69±1.01 and in survived patients was 2.03±1.3. The mean score of the Rotterdam Scale in deceased patients was 5.33±0.95 and in survived patients was 2.14±0.89. In both cases, this difference was statistically significant (P=0.001). The mean score of APACH II scale was 24.04±8.2 in deceased patients and 16.08±7.3 in survived patients. The correlation between Rotterdam and Marshall Scales in determining the outcome of patients, with APACH II was positive and high. The agreement between the APACH II and Rotterdam scales was greater in predicting mortality. The results of regression model showed that gender with (OR=2.91), head injury due to accident with (OR=3.04), Marshall Score above 4 (OR=1.97), Rotterdam score above 4 (OR=2.84) and Apache II score above 15 (OR=1.97) have a significant relationship with patient mortality.

Both the Marshall and Rotterdam scales can determine the prognosis of patients with traumatic brain injury.

Accumulation of secretions is one of the serious complications in patients under mechanical ventilation. The management of airway secretions in these patients includes using the usual methods like fluid therapy as well as techniques such as changing the patient's position and manual hyperinflation. Tracheal suction, which is performed with the aim of secretion removal, can be effective in improving airway clearance along with manual hyperinflation techniques and postural drainage. This randomized clinical trial was conducted to compare the effect of manual hyperinflation (MH) and postural drainage (PD) on respiratory parameters of patients under mechanical ventilation.

This crossover clinical trial study was conducted in the intensive care units of Imam Khomeini Hospital, Ilam in 2018. Sample size was 50 patients under mechanical ventilation who were included in the study according to the inclusion criteria through convenience sampling. After the first 24 hours, patients received routine respiratory care in ICU, each patient was randomly assigned to one of the two intervention groups, manual dilatation (MH) or postural drainage (PD) for 24 hours, and then the patient was transferred to the next intervention group. Data collection tool was a demographic questionnaire and a form for recording respiratory variables (including dynamic compliance, arterial blood oxygen saturation percentage, tidal volume, Peak Inspiratory Pressure and Positive End Expiratory Pressure). On the first day, after selecting the patient and recording the demographic information, when the patient needed suction, the patient's respiratory variables were recorded at three times including before suction, 5 and 25 minutes after suction, and the results were recorded as the basic information (control). During the second day, in addition to receiving routine respiratory care, before each suction, depending on the intervention group, the patients were subjected to MH or PD and respiratory variables were recorded before suctioning as well as 5 and 25 minutes after suction. On the third day, the patient was assigned to the next intervention group (crossover design) and the evaluation of respiratory variables was repeated and the results were recorded.

Based on the repeated measure ANOVA, atrial blood oxygen saturation (P value=0.001), tidal volume (P value=0.001) and dynamic compliance (P value=0.038) in the intervention groups at 25 minutes after suction were more than the control group, in favor of MH intervention comparing to PD intervention. Regarding the peak inspiratory pressure, the intervention of MH in 25 minutes after suction created a significant decrease compared to the PD (P value=0.001). There was no significant difference in the PEEP between any of the study phases and the investigated times.

The findings reconfirmed the necessity of nursing interventions in order to manage airway secretions, and also showed that MH intervention is more effective than PD in improving the respiratory indicators. Therefore, while emphasizing the necessity of training HCWs for respiratory care and management of airway clearance in patients under mechanical ventilation, it is suggested to prepare evidence-based clinical guidelines emphasizing the superiority of MH intervention in order to improve the respiratory indicators of patients.