critical care

There is no definitive pharmacological strategy for COVID‑19; thus, medicinal herbs can be an appropriate option for COVID-19 management. We investigated the efficacy of a D‑reglis® tablet (root extract of licorice) as adjuvant therapy in critically ill patients with COVID-19 at intensive care units (ICUs) of Alzahra Teaching Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran.

In the present double-blind, randomized, placebo-controlled clinical trial, critically ill cases with COVID-19 (n = 52) received a D-reglis® tablet (760 mg) or a placebo tablet for 5 days. The ICU stay length was the primary outcome. The secondary outcome included the changes in oxygen saturation, duration of mechanical ventilation, mortality rate, and Sequential Organ Failure Assessment (SOFA) Score during the study period.

The ICU stay was significantly lower in the licorice group than in the placebo group (P = 0.015). No significant difference was detected between the groups regarding oxygen saturation, SOFA score, duration of mechanical ventilation, and mortality rate.

The licorice tablet (D-reglis®) as an adjuvant treatment showed promising results regarding the ICU stay length in critically ill COVID-19 patients. However, further clinical trials with larger sample sizes, further duration of intervention, measurement of inflammatory markers, and further study about the molecular mechanism of the effect of licorice on COVID‑19 should be done to obtain more conclusive findings.

This study aimed to investigate mortality risk factors among severe COVID-19 patients admitted to the intensive care unit (ICU) to inform better management strategies and reduce mortality rates.

A descriptive-analytical, cross-sectional, and retrospective study was conducted between March 2022 and April 2023 at the intensive care unit of Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. The study included patients admitted to the ICU with severe COVID-19. The main variables were demographic factors (age, gender), pre-existing medical conditions (smoking, diabetes, hypertension), disease severity markers (CT-scan scores, inflammatory and coagulation parameters), and mortality outcomes.

The study included 395 eligible patients. The mortality rate was 57.72%, with no significant difference in hospital stay duration between deceased and survived patients. Smoking, diabetes mellitus, and hypertension were significantly associated with higher mortality. Males exhibited a higher mortality rate, although not statistically significant. Patients over 65 years old had significantly higher mortality. Winter showed a significant increase in mortality, likely due to the Omicron subvariant. Higher CT scan scores and elevated inflammatory/coagulation markers correlated with increased mortality risk.

Pre-existing conditions, demographic factors, and disease severity markers are crucial predictors of mortality in severe COVID-19 patients. Tailored interventions targeting these risk factors are essential to improve outcomes.

Exploring risk factors for the development of COVID-19 in vital organs of the body is necessary to improve patient survival and reduce disability and morbidity due to disease progression. By identifying these underlying risk factors and controlling them, it is possible to prevent extra-pulmonary involvement and even alleviate pulmonary involvement in patients, resulting in a significant reduction in mortality and morbidity rates. This study aimed to identify the underlying risk factors associated with pulmonary and extrapulmonary organ complications of COVID-19.

This study was a cross-sectional descriptive-analytical study. Patients with a definitive diagnosis of COVID-19 who were admitted to the intensive care unit of Imam Khomeini Hospital in Tehran due to respiratory distress and poor clinical condition were included in the study population and were clinically followed up on. Patients' information was collected by reviewing patients' records and the hospital information system.

A total of 123 patients were included in the study (63.4% were male, mean age = 58.87 ± 12.37). Using ROC curve analysis, the calculated risk score is considered statistically significant for diagnostic accuracy (AUC = 0.862 [0.797–0.927], P value < value<0.001). A risk score cutoff greater than 1.5 (sensitivity 89.9%, specificity 38.9%) favors an increased likelihood of in-hospital mortality. According to multiple linear regression (F (9,93).369, P value=0.001), chronic obstructive pulmonary disease, asthma, diabetes, SOFA score on days 2 & 3, and ventilation support were predictors of ICU length of stay.

A history of chronic heart failure with renal impairment, liver cirrhosis with liver complication, and any underlying disease are associated with pulmonary complications in COVID-19 patients.

Providing data on the superior efficacy of vancomycin administered based on the area under the curve over 24 hours to the minimum inhibitory concentration of vancomycin (AUC24/MIC) is crucial. However, data on dosing and monitoring of vancomycin pharmacokinetics in the pediatric population are limited. Previous findings have showed that intermittent infusion of vancomycin (IIV) may not achieve the desired levels, continous infusions of vancomycin (CIV) reach the desired serum concentration faster than IIV and are associated with reduced nephrotoxicity.

This study aimed to compare the serum concentrations, AUC24, clinical variables, and adverse effects of two vancomycin administration methods in the pediatric population.

This study was a double-blind, randomized, controlled clinical trial conducted at a tertiary children's teaching hospital. Inclusion criteria were age between 2 months and 15 years and weight less than 67 kilograms, with exclusion criteria including renal impairment. Participants were divided into CIV and IIV groups following distinct administration protocols. Demographic, clinical, and laboratory data, including vancomycin serum concentrations, were compiled. Assessments included pediatric mortality risk, pediatric sequential organ failure assessment, and regular temperature monitoring. Pharmacokinetic analysis was conducted using Monolix software 2023R1. Primary endpoints were vancomycin serum levels and AUC24 between cohorts on day three, with nephrotoxicity and additional adverse drug responses evaluated.

Sixty-eight patients in the pediatric intensive care unit (PICU) were allocated to either CIV (33) or IIV (35) for vancomycin treatment. In the CIV group, 82% of patients achieved an AUC24 ≥ 400 mg.h/L, compared to 23% in the IIV group. Continuous infusions of vancomycin demonstrated a greater AUC24 (587.7 ± 184.4 mg.h/L vs. 361.9 ± 113.2 mg.h/L, P < 0.05) compared to IIV. Two cases of nephrotoxicity were reported, one in each group, with mortality and adverse events being comparable between the two groups.

This study demonstrated that continuous vancomycin infusion has a higher success rate in safely achieving therapeutic vancomycin levels in PICU patients compared to intermittent vancomycin infusion.

Artificial intelligence (AI) is transforming various medical fields, including pathology, radiology, cardiology, and surgery, by offering innovative therapeutic and interventional solutions. AI is revolutionizing medical research and has become vital in advancing medical technology. This study assessed the role of artificial intelligence in the anesthesiology field.

We search studies in the online databases such as PubMed, Scopus and google scholar. Related records were included in this study.

Its role in enhancing patient care is particularly reassuring, as it allows healthcare professionals to offer superior services through the integration of AI in medicine. Moreover, AI's indispensable role in the progress of the anesthesia field, having made significant contributions across various anesthetic applications since its early adoption, further reinforces this reassurance. Embracing AI in healthcare not only enhances treatment outcomes but also sets the stage for a healthier future. AI applications include screening symptoms, predicting adverse actions, personalizing medication dosages, and streamlining record-keeping, all of which aim to enhance patient outcomes. While integrating AI offers exciting opportunities, challenges such as data quality, technical limitations, ethical considerations, and high costs must be addressed. Inaccurate data can compromise patient safety, and insufficient security measures can lead to privacy breaches. Moreover, legal accountability for AI errors in patient management is complex.

The future is promising, with AI capable of enhancing training and education. It can modernize anesthesia education through chronic pain management tools and realistic training simulations, ultimately preparing the next generation of healthcare providers.

Pain experienced by intubated patients is caused by several extrinsic sources, including nursing care procedures such as endotracheal suctioning. Several nonpharmacological therapies, including listening to Quran recitation, have never been tested for their pain relief effects among intubated patients, despite these therapies being cost‑effective, easy to implement, and free of adverse effects. This study aimed to examine the pain‑relieving effect of listening to Quran recitation during pain‑inducing procedures in patients receiving mechanical ventilation support.

This pilot study used an experimental design with 32 intubated patients at King Abdullah University Hospital in Irbid, Jordan. The Behavioral Pain Scale and Ramsay Sedation Scale were used to assess pain levels and sedation, and physiologic parameters were monitored before and during endotracheal suctioning.

The findings showed significant differences in Behavioral Pain Scale (BPS) scores and heart rate measures between the intervention and control groups after controlling for the level of sedation. The patients in the intervention group scored lower pain and HR measures than those in the control group (F5,26 = 11.47, p < 0.001).

The findings showed significant improvement in the levels of pain and heart rate measures among intubated patients who are exposed to Quran recitation. Complementary medicine is essential to the healthcare plans of critically ill patients and their families. Holy Quran recitation has been reported to be a useful nonpharmacological intervention for critically ill Muslim patients.

Trauma is a significant global public health concern and the leading cause of morbidity and mortality in children. This study aimed to assess the independent predictors of trauma severity as well as mortality in pediatric patients admitted to the intensive care unit (ICU).

In this cross-sectional study, following the STROBE checklist, we retrospectively analyzed the clinical and baseline characteristics of pediatric patients with trauma injuries admitted to the ICU of Children’s Hospital of Zhejiang University School ofMedicine, China, over a decade.

951 pediatric patients with a mean age of 4.79 ± 3.24 years (60.78% Boys) were studied (mortality rate 8.41%). Significant associations were observed between ISS and place of residence (p = 0.021), location of the injury (p = 0.010), year of injury (p <0.001), and injury mechanism (p <0.001). The two independent factors of trauma severity were the year of injury ( = 0.47; 95%CI: 0.28 – 0.65) and injury mechanism ( = -0.60; 95%CI: -0.88 - -0.31). Significant differences were observed between survived and non-survived regarding age (p <0.001), ISS score (p <0.001), time elapsed from injury to ICU (p <0.001), duration of mechanical ventilation (p <0.001), GCS score (p <0.001), and the proportion of patients requiring mechanical ventilation (p <0.001 ). The results of multivariate analysis indicated that age (OR = 0.805; 95%CI: 0.70 - 0.914; p = 0.001) and GCS score at ICU admission (OR = 0.629; 95%CI: 0.53 - 0.735; p < 0.001) acted as protective factors, whereas mechanical ventilation in the ICU (OR = 7.834; 95%CI: 1.766 - 34.757; p = 0.007) and ISS score at ICU admission (OR = 1.088; 95%CI: 1.047 - 1.130; p < 0.001) served as risk factors for mortality.

Automobile-related injuries represent the leading cause of trauma in children, with escalating severity scores year over year among pediatric patients admitted to the ICU with trauma injuries. Based on the findings the independent predictors of mortality of pediatric trauma patients admitted to the ICU were age, GCS score at ICU admission; mechanical ventilation in the ICU, and ISS score at ICU admission. Also, the year of injury and injury mechanism were independent predictors of trauma severity.

Many areas of medicine, including pathology, radiology, cardiology, and surgery, have used AI for more therapeutic and interventional purposes.Artificial intelligence (AI) technology is developing at a rapid pace because of substantial advancements in large data sets, databases, algorithms, and computer power. AI has significant applications in medical research. Medical technology has advanced due to the integration of AI and medicine, and doctors are now able to provide patients with better care thanks to the effectiveness of medical services and equipment. Due to its tasks and characteristics, AI is also essential for the growth of the anesthesia discipline; its initial use was in many anesthetic domains.

 Sepsis, a deadly infection causing organ failure and Systemic Inflammatory Response Syndrome (SIRS), is detected early in hospitalization using the SIRS criteria, while sequential organ failure (SOFA) assesses organ failure severity. A systematic review and meta-analysis was evaluated to investigate the predictive value of the SIRS criteria and the SOFA system for mortality in early hospitalization of sepsis patients.

 Inclusion criteria were full reports in peer-reviewed journals with data on sepsis assessment using SOFA and SIRS, and their relationship with outcomes. For quality assessment, we considered study population, sepsis diagnosis criteria, and outcomes. The area under the curve (AUC) of these criteria was extracted for separate meta-analysis and forest plots.

 Twelve studies met the inclusion criteria. The studies included an average of 56.1% males and a mean age of 61.9 (±6.1) among 32,979 patients. The pooled AUC was 0.67 (95% CI: 0.60-0.73) for SIRS and 0.79 (95% CI: 0.73-0.84) for SOFA. Significant heterogeneity between studies was indicated by an I2 above 50%, leading to a meta-regression analysis. This analysis, with age and patient number as moderators, revealed age as the major cause of heterogeneity in comparing the predictive value of the SOFA score with SIRS regarding the in-hospital mortality of sepsis patients (P<0.05).

 The SOFA score outperformed the SIRS criteria in predicting mortality, emphasizing the need for a holistic approach that combines clinical judgment and other diagnostic tools for better patient management and outcomes.

Pain is a persistent concern and a common symptom in critically ill patients. It is an increasingly unpleasant experience in patients discharged from the intensive care units (ICUs). 

This study aims to evaluate the correlation of pain intensity with the acute physiology and chronic health evaluation (APACHE II) score, the Ramsay sedation scale (RSS) score, and some ventilation parameters in patients under mechanical ventilation admitted to the ICU. 

This cross-sectional study was conducted on 40 intubated patients under mechanical ventilation at the trauma ICU of a hospital in Sabzevar, Iran, from November 2020 to May 2021. The samples were selected using a convenience sampling method. Data were collected using the critical-care pain observation tool (CPOT), APACHE II, RSS, and a form surveying demographic and ventilation parameters. Data analysis was performed using descriptive statistics, Spearman’s correlation test, and Mann-Whitney U test. The significance level was set at 0.05.

Among participants, 87.5% were male (n=35) and 12.5% female (n=5). Their mean age was 42.80±17.12 years, ranged 18-83 years. The CPOT score at rest (r=0.78) and during suctioning (r=0.72) was significantly correlated with the APACHE II score (P=0.001). It also had a significant association with the RSS score at rest and during suctioning and position change (P=0.001), surgical diagnosis (P=0.002 at rest, P=0.001 during suctioning), and using sedatives (P=0.001 at rest, P=0.001 during procedure). However, no significant correlation was observed between the CPOT score and ventilation parameters. Pain intensity was significantly different among patients with and without a history of addiction (r=0.68, P=0.015 at rest; P=0.002 during suctioning).

Given the correlation of the pain intensity with the APACHE II and RSS scores in patients under mechanical ventilation, these factors should be considered by healthcare planners to promote the quality of care and effective management of pain in these patients admitted to ICUs.

Intensive Care Unit (ICU) and Emergency Department (ED) nurses have faced several moral challenges during the COVID-19 pandemic. The factors associated with nurses’ moral distress (MD) can vary depending on the cultural context.

This study aimed to determine the relationship between MD, spiritual well-being (SWB), and moral intelligence (MQ) of nurses in ICUs and EDs during the COVID-19 pandemic.

This descriptive cross-sectional study was conducted in 2020. The data were collected using self-report questionnaires, including those for personal and professional profiles, Corley’s Moral Distress Scale-Revised, Paloutzian & Ellison’s Spiritual Well-being, and Lennick & Kiel’s Moral Intelligence. Of the 543 nurses working in the ICUs and EDs of hospitals in Zanjan Province (Iran), 370 participants were selected by census sampling.

The study results indicated that 90.8% of nurses experienced high MD. The results of the partial correlation test showed no statistically significant relationship between nurses' MD and their SWB or MQ (P > 0.001). Nurses with an associate's degree (P = 0.019) and those working in the EDs (P = 0.001) and the COVID-19 care center hospital (P = 0.001) had higher levels of MD. Religious well-being and the educational level of nurses could predict only 2.5% of the variations in nurses’ MD.

This study showed that SWB and MQ of nurses are not related to nurses’ MD, unlike environmental factors. It is recommended that managers provide more support to reduce nurses’ MD in critical situations, such as during the COVID-19 pandemic.

The practice of mercy killing, also known as euthnasia or assisted suicide, is a contentious and morally complex issue in healthcare. Understanding the ethical dilemmas related to mercy killing within specific religious communities, such as Maranao Muslims, can provide valuable insights into the intersection of faith, culture, and healthcare decision-making. This study aimed to explore the practice of mercy killing among Muslim Maranao nurses in the critical care setting.

A qualitative research design based on descriptive phenomenology and criterion sampling was used to select 10 Muslim Maranao nurses with at least five years of working experience in intensive care units (ICUs) in the southern Philippines. In-depth semi-structured face-to-face interviews were conducted with the participants and Colizzi’s thematic analysis was employed to analyze the obtained data. 

Thematic analysis revealed three main themes with three corresponding subthemes: Religious beliefs (Islamic teachings, religious duties and moral responsibility), cultural norms (community values, stigma and taboo, sense of identity), and professional ethics (duty to the patient, team collaboration and ethical considerations). 

The perspectives of Muslim Maranao nurses on mercy killing are strongly influenced by their religious beliefs, cultural norms and professional ethics. Islamic teachings guide their rejection of mercy killing, emphasizing compassionate care and respect for the natural course of life. Family and community values, fear of social judgment and the preservation of cultural identity shape their perspectives. Professional ethics highlight their commitment to patient well-being, autonomy, and collaborative decision-making. Culturally sensitive and ethically sound healthcare practices are essential, and ongoing dialogue, education and policy development are needed to address the complexities surrounding mercy killing within specific cultural and religious contexts.

Faculty Development Programs (FDPs) aim to improve the academic careers of faculty members. This study was designed to assess the attitudes of faculty members and the impact of FDP on their academic improvement.

12 faculty members took part in the research from 2016 to 2019. Using a Delphi method, an open secure questionnaire was provided to 12 junior faculty members in the Department of Anesthesia, Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran. Then, the keywords of the latter were analyzed, leading to a 32-item closed-answer questionnaire, filled out by the same participants. Also, the impact of the study was assessed using bibliometric improvement indices.

Both the response rate and participation rate were 100%. Approximately all the participants considered FDP an advantageous and promising academic program. 65 percent of the participants had academic improvement, from “Assistant Professor” to “Associate Professor” rank. Besides, the cumulative number of citations to the participants had a 16.2 times improvement. Both latter results were significantly higher than the mean improvement of the cohort faculty members in the DACC, SBMU.

Faculty members of DACC, SBMU had positive attitudes towards FDP and described it as “a well-designed multilateral academic teamwork, thriving ethical, educational, managerial and research-related capacities”. Also, objective improvement in some academic indices was observed. In many academic environments including developing countries, FDPs are effective scientific investment methods.

Ventilator-associated pneumonia (VAP) is a consequence of mechanical ventilation, which can be fatal. Several markers are available to predict outcomes related to VAP. Choosing a predictor that is inexpensive, affordable, and accurate is advantageous. This study aimed to examine red cell distribution width (RDW) as a predictor of mortality in patients with VAP.

This prospective cohort study was conducted among 49 patients in the intensive care unit (ICU) of Valiasr Hospital in Tehran. A researcher-made checklist was used to collect RDW and other marker data, as well as mortality outcomes and length of stay (LOS) in the ICU. The Pearson correlation coefficient in the SPSS software and the regression model in the Eviews software were used to examine the relationship between markers and different outcomes.

Of a total of 49 patients (57.1% male; mean age = 54 ± 16), the length of ICU stays ranged from 7 to 14 days. According to the Pearson correlation coefficient, a significant association between RDW and mortality (P =.009) was noted. But no significant relationship between RDW and length of stay in the ICU (P =.81) was noted. Additionally, the regression model showed a positive relationship between RDW and white blood cells (WBC), lactate, and sequential organ failure assessment (SOFA).

Our study showed a positive but weak correlation between RDW and ICU mortality in patients with VAP. Due to its availability and low cost of measurement, RDW is an appropriate option for predicting mortality risk in patients who are admitted to the ICU and develop VAP.

Non-invasive ventilation (NIV) is amethodof oxygenation supply that eliminates the need for an endotracheal airway. Non-invasive ventilation failure is defined as the necessity for endotracheal intubation or death during the NIV trial.

This study aimed to identify the predictors and associated factors of NIV failure in coronavirus disease 2019 (COVID-19) patients admitted to an intensive care unit (ICU).

This retrospective, longitudinal cohort study utilized electronic medical records of COVID-19 patients admitted to the ICU. A total of 150 patients were included in the study. Patient demographics, medical history, laboratory tests, partial pressure of carbon dioxide (PCO2), oxygen saturation (SpO2), heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR score), and the ratio of oxygen saturation (ROX) index (the SpO2/fraction of inspired oxygen [FIO2] to respiratory rate [SF] ratio) were recorded. Non-invasive ventilation failure was determined based on the need for endotracheal intubation or cardiac-respiratory arrest while on NIV.

Of 150 patients, 55.3% were male (mean age: 55.9 years), with an NIV failure rate of 67.3%, a mortality rate of 66.7%, and 3.3% of patients requiring tracheostomy after NIV failure. The ROX index consistently decreased over time, and an increase in the HACOR score and PCO2 after 6 hours of commencing NIV were the predictors of NIV failure. Additionally, higher levels of lactate dehydrogenase, lower SF ratios, and higher APACHE scores upon ICU admission were significantly associated with NIV failure. Notably, the erythrocyte sedimentation rate (ESR) as an inflammatory index, SF ratio upon ICU admission, HACOR score, ROX index, and PCO2 after 12 hours were significant predictors of in-hospital mortality in patients receiving NIV.

The ROX index, HACOR scale, and PCO2 are significant predictors of both NIV failure and in-hospital mortality.