فهرست مطالب mohsen savaie

Serum electrolyte imbalance is very common in COVID-19 patients. However, there is conflicting evidence regarding their relationship with COVID-19 and its severity, and their prognostic value is unknown. Our aim of this study is to investigate electrolyte changes in COVID-19 patients admitted to the intensive care unit of Imam Khomeini Hospital in Ahvaz.

The present study is a cross-sectional and descriptive-analytical epidemiological type that was conducted in 1400. The target population was the COVID-19 patients admitted to the intensive care unit of Imam Khomeini Hospital in Ahvaz. Required tests were performed on all patients admitted to the special care department and diagnostic tests including Ca, K, Na, Cr, BUN, Mg, and P were collected and the effect on the prognosis of patients including intubation, mortality and extubating and discharge from the ward and The hospital was registered. Then the data were analyzed by SPSS 22 software and appropriate statistical tests.

Finally, 87 people were included in the study. Hyponatremia, hypokalemia, hypomagnesemia and hypocalcemia, Cr, and high BUN respectively in 2.55%, 3.4%, 6.27%, 8.59%, 8.82%, 5.5%, patients with covid- 19 were observed. There was a significant difference between the two groups of men and women and the average potassium was higher in women than in men (P=0.041). No significant relationship was found between other electrolytes and the variables of age, gender, history of disease, intubation, discharge, and mortality (P>0.05).

The present study showed that electrolyte imbalance is one of the common laboratory abnormalities in COVID-19 disease.

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.

 To improve the quality of intraoperative and postoperative analgesia during spinal anesthesia, intrathecal opioids are used as adjuvant drugs in combination with local anesthetics.

 This study aimed to compare the intrathecal injection of ropivacaine-fentanyl with ropivacaine-sufentanil in terms of the duration of analgesia after cesarean section (CS).

 This randomized, double-blind clinical trial study was conducted on women referred to Imam Khomeini Hospital of Ahvaz City for elective CS in 2021. A total of 51 patients were randomly divided into 2 groups. The first group (n = 25) received ropivacaine (17.5 mg) + fentanyl (25 μg), while the second group (n = 26) received ropivacaine (17.5 mg) + sufentanil (2.5 μg) for spinal anesthesia. Eventually, several parameters were investigated, including the duration of sensory and motor block, duration of analgesia (based on the Visual Analog Scale (VAS)), hemodynamic parameters, and possible complications.

 The duration of surgery (P = 0.059) and the duration of motor block (P = 0.962) were not significantly different between the 2 groups. The mean duration of analgesia (from the time of entering recovery to reaching VAS = 3) was 203.12 ± 72.93 and 207.46 ± 69.59 minutes in the fentanyl and sufentanil groups, respectively (P = 0.658). Systolic and diastolic blood pressure (SBP/DBP) drops in minute 5 were observed more frequently in the sufentanil group than in the fentanyl group (P = 0.027 and P = 0.002, respectively). At the other time points, however, no significant difference was observed between the 2 groups in terms of hemodynamic variables (P > 0.05). Finally, the frequency of pruritus was higher in the sufentanil group than in the fentanyl group (26.9% vs. 4.0%; P = 0.024).

 Adding fentanyl or sufentanil to intrathecal ropivacaine provides a similar duration of analgesia. However, fentanyl was associated with better hemodynamic stability and a lower incidence of pruritus.

The coronavirus disease 2019 (COVID-19) has become the leading source of pneumonia outbreaks in the world. The present study aimed to compare the condition of intensive care unit (ICU) and non-ICU COVID-19 patients in terms of epidemiological and clinical features, laboratory findings, and outcomes in three cities across Iran. In a cross-sectional study, 195 COVID-19 patients admitted to five hospitals across Iran during March-April 2020 were recruited. Collected information included demographic data, laboratory findings, symptoms, medical history, and outcomes. Data were analyzed using SPSS software with t test or Mann-Whitney U test (continuous data) and Chi square test or Fisher’s exact test (categorical variables). P<0.05 was considered statistically significant. Of the 195 patients, 57.4% were men, and 67.7% had at least one comorbidity. The prevalence of stroke, chronic obstructive pulmonary disease, and autoimmune diseases was higher in ICU than in non-ICU patients (P=0.042, P=0.020, and P=0.002, respectively). Compared with non-ICU, ICU patients had significantly higher white blood cell (WBC) count (P=0.008), cardiac troponin concentrations (P=0.040), lactate dehydrogenase levels (P=0.027), erythrocyte sedimentation rates (P=0.008), and blood urea nitrogen (BUN) (P=0.029), but lower hematocrit levels (P=0.001). The mortality rate in ICU and non-ICU patients was 48.1% and 6.1%, respectively. The risk factors for mortality included age>40 years, body mass index<18 Kg/m2, hypertension, coronary artery disease, fever, cough, dyspnea, ST-segment changes, pericardial effusion, and a surge in WBC and C-reactive protein, aspartate aminotransferase, and BUN.  A high index of suspicion for ICU admission should be maintained in patients with positive clinical and laboratory predictive factors.

Deep vein thrombosis, especially in the lower extremities, is one of the complications of immobility. Major surgeries, especially orthopedic surgeries and inpatient care in the intensive care unit, predispose the patients to such complications. The aim of this study was to compare the prevalence rats of venous thromboembolism between the patients treated with enoxaparin and subcutaneous heparin in the intensive care unit.

This was a retrospective cross-sectional study. Sampling method was census. All the patients who had been admitted to the intensive care units of Imam Khomeini Hospital in Ahvaz from the beginning of September 2017 to the end of December 2017, were entered into this study. Data were extracted from the patients' medical records and recorded in a checklist for every patient. Using SPSS20 software, data were analyzed by descriptive and analytical statistics.

Out of 600 patients, 64 (10.66%) patients had venous thromboembolism, of which 35 patients (54.7%) were in the heparin group and 29 patients (45.3%) in the enoxaparin group (P >0.05). 18 patients had deep venous thrombosis (3%), among them 13 (72.22%) patients were in the heparin group and 5 (27.78%) patients in the enoxaparin group (P <0.05).

In this study, enoxaparin administration was more effective than heparin in the prevention of deep vein thrombosis but the effects of these two drugs were the same in the prevention of pulmonary thromboembolism. More concrete conclusions require further studies with control of underlying and confounding factors.

Shivering is one of the most common side effects after cesarean section (C-section) under spinal or epidural anesthesia. However, it is often not treated.

The aim of this study was to evaluate the effectiveness of intravenous dexmedetomidine (DEX) in the prevention of shivering after intrathecal anesthesia in women undergoing C-sections.

This double-blind, placebo-controlled clinical trial was conducted on 80 women candidates for elective C-sections under intrathecal anesthesia who were referred to Imam Khomeini Governmental Hospital in Ahvaz, Iran, during 2020 - 2021. Patients were randomly divided into two groups of intravenous DEX (group D; 0.5 µg/kg) and normal saline (control, group C) and received the medications after umbilical cord clamping. All patients were evaluated during and after surgery for hemodynamic changes, the incidence and severity of shivering based on Chu and Tsai, side effects (e.g., nausea, vomiting), and sedation level based on the Ramsey scale.

The incidence of shivering in group C was significantly higher than in group D (P = 0.003). Moreover, the severity of shivering on minutes 20, 30, and 45 in group C was significantly higher than in group D (P < 0.05). The mean sedation score during minutes 10 - 30 in group D was significantly higher than in group C (P < 0.05). Heart rate was not significantly different between the two groups (P < 0.05). Systolic and diastolic blood pressure were higher in group D than in group C (P < 0.05).

The administration of intravenous DEX effectively reduces the incidence and severity of shivering and provides appropriate sedation in patients undergoing C-sections, and it does not cause remarkable side effects.

This study aimed to prevent and control the pain after arthroscopy that leads to patient satisfaction, rehabilitation, and return to normal life as soon as possible. It is hypothesized that there is no difference between intraarticular injection of dexmedetomidine and placebo after knee arthroscopy regarding pain level. 

This double-blind randomized clinical trial was conducted on 70 patients aged 18-60 years who were candidates for elective knee arthroscopic surgery with the American Society of Anesthesiologists Classification I-II. All patients underwent spinal anesthesia equally and were randomly divided into two groups of 35 cases per group. The drug group (D) received 2 μg/kg dexmedetomidine with 0.9% normal saline reached to a volume of 20 ml, and 20 ml of 0.9% normal saline was injected into the knee joint through the cannular sheath in the control group (C). Postoperative pain intensity was recorded 1, 2, 4, 8, 16, 24 h after injection using the Visual Analogue Scale. The time of requesting the first analgesic and the amount of analgesics consumed were recorded after 24 h.

There was no significant difference between the two groups in terms of age, height, weight, duration of spinal anesthesia, and duration of surgery (P>0.05). In group D, there was a decrease in postoperative pain, a decrease in the amount of analgesic consumed, and an increase in the time of the first analgesic request, compared to group C (P<0.05).

This study showed that intra-articular injection of dexmedetomidine relieved postoperative pain, reduced analgesic consumption, and increased the time of first analgesic request after knee arthroscopy. Level of evidence: I

Thoracotomy is one of the most painful surgeries, and failure to alleviate patients' pain can have dangerous consequences.

This study aimed to evaluate the addition of dexmedetomidine to ropivacaine in the intercostal block for postoperative pain control in patients undergoing thoracotomy.

In this randomized clinical trial, 74 patients aged 18 to 60 years with ASA class I or II, BMI less than 40, and no severe systemic problems referred to a teaching hospital in Ahvaz to undergo thoracotomy were included in the study and randomly divided into two groups. After surgery, an ultrasound-guided intercostal block was done with ropivacaine (5 cc of 0.25% solution; group R) or ropivacaine (5 cc of 0.25% solution) plus dexmedetomidine (0.5 µg/kg; group RD) per dermatome. Two dermatomes above and two dermatomes below the level of surgical incision were used. Pain, total opioid consumption, length of ICU stays, time to first rescue analgesic, and time to get out of bed were compared between the two groups.

The intercostal block significantly reduced pain in both groups (P < 0.0001). The pain was lower in the RD group than in the R group from six hours after the intervention up to 24 hours after (P < 0.001). The number of patients who needed rescue analgesia at 12 hours was significantly lower in the RD group (P < 0.05). The RD group also had lower total opioid consumption and a longer time to receive the first rescue analgesia (P < 0.01). There was no significant difference between the two groups in the length of hospitalization and the time to get out of bed.

Dexmedetomidine is an effective and safe choice to be used as an adjunct to ropivacaine in ICB, and it extends the duration of analgesia in combination with ropivacaine after thoracotomy.

Trace elements deficiencies in trauma patients admitted to intensive care unit (ICU) affects the duration of mechanical ventilation, length of stay in ICU, and patients' mortality rate. This study was conducted to investigate the effect of Trace elements on therapeutic and healthcare outcomes of ventilated trauma patients admitted to ICUs in 2019.

In this clinical trial, 60 trauma patients admitted to the ICUs in Golestan hospital in Ahwaz City, Iran, were randomly assigned to intervention and control groups according to the inclusion criteria. The intervention group received Addamel injections for 5 days, whereas the control group received only the routine care. Patients’ levels of consciousness and ability to move were assessed in both groups when entering the ward and then one, three and five days after the study began. In addition, the durations of weaning from mechanical ventilation and mortality in patients were calculated in a 28-day interval.

There was a significant difference between the intervention and control groups in terms of length of stay in ICU (P = 0.007) and duration of connection to ventilator (P = 0.010). Nevertheless, there was no statistically significant difference between the mean motor ability (P = 0.512) and the level of consciousness (P = 0.512) between the intervention and control groups.

According to the findings of our study, the medical staff are recommended to pay particular attention to the importance of trace elements in their therapeutic strategies for trauma patients.

Mechanical ventilation is the most basic supportive care in patients admitted to the intensive care units. Some factors such as increase in airway resistance due to bronchospasm, may affect ventilation, that measured by different methods. The aim of this study was to compare the diagnosis of bronchospasm based on the calculation of airway resistance using ventilator data and clinical examination in patients admitted to the intensive care unit.

This descriptive cross-sectional study was performed on 180 patients, who admitted in the intensive care units of Ahvaz teaching hospitals and undervent mechanical ventilation. Patients were included in the study according to the inclusion criteria and were evaluated daily in terms of increasing airway resistance in two ways: clinical examination (presence of wheezing or Ronchi) and ventilator data (calculation of airway resistance). Data was recorded in a researcher-made checklist.

Among 180 patients enrolled in the study, the mean age was 57.77±18.95 years. There was a significant relationship between diabetes, asthma, hypertension and hyperlipidemia with an increase in airway resistance (P<0.05). Airway resistance was higher in women than men (P=0.004). There was a statistically significant difference between airway resistance detection through clinical examination and airway resistance detection based on ventilator data (p <0.001).

The results showed that detecting increased airway resistance through ventilator data was more sensitive than physical examination, So the use of it, in patient management is recommended.

The effective design and implementation of the nursing interventions to evaluate the patients’ readiness for ventilator weaning will reduce their connection time to the ventilator and the complications of their connection to it. This study was conducted to examine the effect of nursing interventions based on the Burns Wean Assessment Program (BWAP) on successful weaning from Mechanical Ventilation (MV).

In this clinical trial, 70 patients undergoing MV in the Intensive Care Units (ICUs) of Golestan Hospital (Ahvaz, Iran) in 2018 were randomly assigned to intervention and control groups. The nursing interventions designed based on BWAP were implemented on the patients in the intervention group, who were later weaned from the device according to this program. The recorded data included demographic information, BWAP score, vital signs, and laboratory values, which were analyzed using the Pearson correlation coefficient, Chi‑Square, Fisher, and Mann‑Whitney U tests.

There was a statistically significant and inverse correlation between the BWAP score and the MV duration such that a high BWAP score was associated with a shorter MV time (p = 0.041). Also, the mean number of re‑intubation (p = 0.001) and the number of re‑connection to the ventilator in the intervention group were significantly lower (p = 0.005).

The results showed that nurses’ assessment of patient’s readiness for weaning from MV based on this tool and designed nursing care reduced the duration of MV, re‑intubation, and re‑connection.

Patients with severe respiratory distress due to Covid-19 may require endotracheal intubation due to severe hypoxemia. To facilitate intubation and minimize the risk of staff contamination, most guidelines recommend rapid sequence intubation using hypnotics, narcotics, and muscle relaxants. The use of muscle relaxants may be associated with risks for some patients with Covid-19: Stressful environment, inexperienced nurses in newly established wards, cumbersome clothing, premature respiratory fatigue due to mask wearing, Also, the limited vision due to the formation of fog on the glasses and the surface of the face shield during laryngoscopy can make intubation difficult and time consuming. These factors, along with severe lung involvement and hypoxemia, and underlying cardiovascular diseases may exacerbate hypoxemia and expose the patient to hypoxic brain damage or cardiac arrest. Therefore, in Covid-19 patients, endotracheal intubation with full personal protective equipment and the use of hypnotics and narcotics to inhibit airway reflexes while maintaining the patientchr('39')s spontaneous respiration (deep sedation) seems to be a safer method. Otherwise, as a secondary solution, intubation is suggested by the most experienced person.

Headache is the most common complication caused by spinal anesthesia. Systematic educational programs about conservative treatments could be effective in the reduction of headache after spinal anesthesiz. This study aimed to evaluate the effects of training programs on the headache of patients after spinal anesthesia. This empirical study was conducted on 120 patients within the age range of 16-40 years who were candidates for general, orthopedic and urology surgeries in Dr. Shahidzadeh Hospital of Behbahan, Iran in 2015. Patients were randomly divided into two groups of intervention and control. Scheduled training was provided for the intervention group, and the control group received routine training. Intensity of headache was recorded using the visual analogue scale (VAS). Data analysis was performed in SPSS V.14 using Chi-square and independent T-test. In this study, Chi-square test showed a statistically significant difference between the groups in terms of incidence and time of occurrence of headaches. In total, eight patients (25.8%) in the intervention group and 23 patients (74.2%) in the control group had headaches (P=0.001). In the first 48 hours after anesthesia, all patients in the intervention group and 11 patients (47.8%) in the control group had headaches (P=0.03). Moreover, independent T-test revealed a significant difference between the mean of pain intensity in patients of the intervention (5.0±1.8) and control groups (7.1±2.1) (P=0.01). Implications for Practice: According to the results of this study, systematic education of patients could effectively reduce the occurrence and intensity of headaches after spinal anesthesia. Therefore, it is recommended that patient training be included in the preoperative preparation program in order to prevent headaches after surgery.