intensive care unit

Acute kidney injury (AKI) is a common and critical condition faced by patients in the intensive care units (ICUs), which significantly increases morbidity and mortality rates among affected individuals. Additionally, individuals in the ICU often present with a multitude of comorbidities, which significantly influence the risk of developing acute renal failure and the associated mortality rates. Common underlying conditions such as hypertension, diabetes, heart disease, and chronic kidney disease (CKD) predispose patients to acute renal failure. Hypertension and diabetes are particularly noteworthy as they distort renal hemodynamics, leading to increased susceptibility to acute renal failure during critical illness. Moreover, older patients consistently exhibit higher mortality rates associated with AKI, as advancing age correlates with deteriorating organ function and increased prevalence of comorbid conditions.

Hypotonia in children is an important and common clinical symptom that can manifest in various neurological disorders. It often poses a serious diagnostic challenge for physicians, frequently leading to inaccurate evaluations and unnecessary investigations. The purpose of this study was to investigate the causes of hypotonia, various diagnostic methods, and the final outcomes of these patients. 

Children with hypotonia who were hospitalized in the pediatric intensive care unit (PICU) of Bahrami Children's Hospital and Children's Medical Center during a two-year period (2017-2018) were enrolled. All relevant information, including key points from their medical history, clinical examinations, and paraclinical data that could lead to diagnosis, were recorded. The patients was followed up for two years after hospitalization through phone calls or visits to the neurology clinic. 

Out of 65 children examined, 28 patients (43.07%) had peripheral nervous system involvement, 20 (30.76%) had central nervous system involvement, and 4 (6.17%) had both central and peripheral nervous system involvement. The most common causes for peripheral and central involvement were spinal muscular atrophy (SMA) and syndromic causes, respectively. In 20% of cases however an,  specific underlying cause  was  found. The most common diagnoses were SMA (16.9%) and Guillain-Barre syndrome (13.8%). Finally, 15 children (23.1%) recovered, 31 (47.7%) had neurological sequelae, and 19 (29.2%) died. 

Understanding the underlying causes and outcomes of patients hospitalized with hypotonia in the PICU enhances physicians’ diagnostic skills. It is also useful for selecting effective treatment strategies and avoiding the complications associated with delayed diagnosis.

Pressure ulcers represent a significant financial burden in healthcare, ranking as the third most costly condition following heart disease and cancer. The prevalence of pressure ulcers serves as a key indicator of the quality of healthcare and nursing services. Nurses are integral to the prevention and management of pressure ulcers; thus, this study aimed to assess the knowledge, attitudes, and practices of nurses in this area. Conducted in 2022, the study employed a descriptive methodology. A convenience sample of 200 nurses from an educational and medical center affiliated with Lorestan University of Medical Sciences was utilized. Data were collected via a four-part questionnaire and analyzed using SPSS version 16, employing both descriptive and analytical statistical methods. The mean scores for nurses' knowledge, attitudes, and practices in the prevention and management of pressure ulcers were 51.1 ± 7.5, 60.35 ± 16.53, and 50.1 ± 10.5 out of 100, respectively. The findings indicate that nurses' knowledge and practices in pressure ulcer prevention and management are at a relatively satisfactory level. Given the threat that pressure ulcers pose to patient safety, it is imperative for healthcare center managers to implement strategies to enhance the capabilities of the healthcare team, particularly nurses.

Delirium is a prevalent acute-onset neuropsychiatric disorder affecting individuals across all age groups, with its presence in critically ill patients serving as a significant warning sign. This study aimed to review the application of delirium assessment instruments in intensive care units. A narrative literature review was conducted by searching the SID, IRANDOC, PubMed, Scopus, and Web of Science databases using related MeSH and Free Text terms, including “Delirium Scale,” “Intensive Care Unit,” “Screening,” and “Cognitive Disorder.” The primary inclusion criteria were full-text published articles in English and Persian between 1990 and 2024. The review identified 56 delirium screening and diagnostic instruments, many of which focus on issues such as sleep disturbances, inattention, acute onset, or fluctuating periods of cognitive changes. These instruments have been psychometrically evaluated in different countries, each exhibiting varying degrees of validity and reliability in diagnosing, screening, and assessing delirium. To enhance the effectiveness of these instruments, it is recommended to validate their psychometric properties across diverse populations in Iran.

Pneumonia is a common and frequently occurring disease in pediatric patients.

This study aimed to evaluate the effects of family-centered nursing on psychological well-being and quality of life (QOL) in children with severe pneumonia in the intensive care unit (ICU).

A total of 98 children admitted between April 2021 and January 2023 were selected and divided into an observation group (n = 49) and a control group (n = 49) using a random number table. The control group received routine nursing care, while the observation group received family-centered nursing in addition to routine care. All children were cared for from admission until transfer out of the ICU or discharge. Clinical manifestations, blood gas analysis indicators, QOL scores, psychological status scores, and family satisfaction with care were compared between the two groups before and after two weeks of care.

After two weeks of nursing, ICU stay length, time to return to normal temperature, and resolution time for lung moist rales were all shorter in the observation group compared to the control group. The observation group showed greater improvements in partial pressure of oxygen, partial pressure of carbon dioxide, and oxygen saturation compared to the control group. Additionally, scores for physical function, social function, emotional function, and family satisfaction in the observation group were higher than those in the control group.

Family-centered nursing effectively improves clinical manifestations, blood gas levels, psychological well-being, and QOL in children with severe pneumonia in the ICU, while also enhancing family satisfaction with care.

 The COVID-19 pandemic, caused by a novel coronavirus, has infected over 91 million people globally, with Iran being severely impacted, reporting 7.6 million cases and nearly 946,837 deaths. This study examines hospitalization trends among COVID-19 patients in Iran to improve resource allocation and patient care.

A cross-sectional analysis was conducted using data from 4,372 confirmed COVID-19 patients admitted to Dr. Masih Daneshvari Hospital in Tehran during the first 50 days of the outbreak. The study evaluated admissions to general wards and intensive care units (ICUs).

Findings revealed an average daily hospitalization rate of 193.86 patients, with 149.42 (76.94%) admitted to general wards and 44.44 (23.06%) to ICUs. Over time, general ward admissions showed a declining trend, while ICU admissions increased, indicating a potential rise in severe cases.

The study underscores the importance of monitoring hospitalization patterns to optimize medical resources, including equipment, medications, and staffing. By understanding these trends, healthcare systems can enhance hospital efficiency and improve patient care during future outbreaks.

Ventilator-associated pneumonia (VAP) is a highly prevalent complication of ICU admission. the aim study This systematic review and meta-analysis aimed to determine the effect of an oral care program on oral health (OH) status and prevention of VAP in ICUs in Iran.

This systematic review and meta-analysis were conducted on the group of articles published on patients hospitalized in ICUs in Iran in 2024. This review included published articles that aimed to assess the effectiveness of care programs or educational interventions in preventing VAP in patients hospitalized in ICUs in Iran. Data search and extraction were performed by two independent researchers in Persian and English between 2004 and 2024. The extracted articles were entered into EndNote software and analyzed using CMA software.

The results showed that, at the beginning of the search, 92 articles were found, and after the final conclusion, five articles entered the meta-analysis stage. Also, VAP prevalence in intervention group was 15% (CI: 6.2-31.9%), and VAP prevalence in control group was 39.5% (CI: 21.1-61.4%).

It is recommended for preventing VAP that OH programs and interventions be carried out in an ICU.

Traumatic Brain Injury (TBI) is a type of trauma that can be caused by various factors. The aim of the study is to determine the prevalence and outcome of acute respiratory distress syndrome (ARDS) in TBI.

This study is part of the Iran ICU Registry (IICUR) Australian and New Zealand ICU (ANZICS). This study included TBI patients admitted to Hospital's surgical ICU, excluding those who died within 48 hours. The diagnosis of ARDS was based on the Berlin scale. Also, the data collected were collected using the IICUR and ANZICS registry data checklist. The data were entered into SPSS 18 software, and data analysis was performed using regression analysis.

The findings showed that out of 350 patients with a diagnosis of TBI, 32 (9.1%) had ARDS symptoms. There was also a significant difference between ARDS status and mortality (P=0.000), smoking (P=0.004), hospital LOS (P=0.009) and median APACHE II (P=0.000).

Since ARDS patients had a higher mortality rate, therapeutic interventions must be implemented to reduce ARDS incidence in TBI patients.

Rheumatic diseases can lead to increased mortality and decreased quality of life. Therefore, we conducted this study to determine the clinical characteristics of patients with rheumatic diseases hospitalized in the ICU.

In this study, which was conducted in Tehran province, patients who were diagnosed with underlying rheumatic diseases and were admitted to the ICI department were included in the study. Thus, the study encompassed 120 patients diagnosed with rheumatic diseases. In this study, the researchers extracted the list of hospitalized patients by referring to the ICU department. Then, a history was taken from the patients, and if they were suffering from underlying rheumatic disease according to the history taken (from the patient or the patient's companion), they were included in the study. The tools used included a demographic profile form and a patient clinical information checklist. and analyzed using SPSS software version 18.

The results showed there was a significant relationship between gender, history of hospitalization, smoking, pressure ulcer, and age with the mortality of ICI patients (P value < 0.05). Also, a higher mortality rate was reported in all patients who had at least one type of underlying disease (P value < 0.05). Therefore, the ICU hospitalized the older patients for longer periods of time.

Variables such as age, sex, and underlying diseases were effective in the clinical condition of patients with RA. For this reason, it is necessary to pay attention to this issue in providing clinical care.

One of the surgeries that led to the hospitalization of the patient in the ICU and the creation of postoperative delirium (POD) is neurosurgery. We conducted this study to investigate the relationship between preoperative diabetes and delirium in patients undergoing neurosurgery in the ICU.

In this study, before performing the surgery, the checklist designed by the researchers was completed by interviewing the patients, and the necessary information was completed through clinical examination, interviewing the patient, and studying the documents in the patient's file. Then, the research tool to identify POD was reviewed and completed on a daily basis from the time the patient entered the ICU until the time the patient was discharged. In order to investigate delirium, the researchers conducted a clinical examination, observed the patient's clinical record, and completed the CAM-ICU-7 questionnaire. After completing the research tools, the data were entered into SPSS software, and their analysis was done using version 18 data analysis.

Results showed, in patients with diabetes, the prevalence of POD in patients with a history of smoking, high creatinine, agitation, and intubation was higher than in other patients (P value < 0.05). Also, the prevalence of POD diabetic patients was 54 (38.57%), which is 38 (54.28%) in diabetic patients and 16 (22.85%) in non-diabetic patients.

Considering that a significant relationship was observed between diabetes and the prevalence of POD, it is important to carry out the necessary prevention in this field.

Nurses, as professionals in the caring profession, try to perform safe and effective nursing interventions all the time and support patients to achieve the most favorable treatment outcomes. Nowadays, one of the important and international issues in nursing is distress tolerance. This study aimed to determine distress tolerance and affecting it among nurses working in the COVID-19 intensive care unit.

This study is cross-sectional. The sample consisted of 128 nurses working in the intensive care unit. A non-randomized convenience sampling method was used to select the samples based on the inclusion criteria. The data collection instruments included two questionnaires: a demographic characteristics questionnaire and a standardized distress tolerance questionnaire. The data were analyzed using SPSS software version 25, employing both descriptive and inferential statistical tests.

The mean age of the samples was 34.95 ± 6.77 years. The highest scores of distress tolerance subscales included appraisal (17.89±3.62), tolerance (8.97±2.60), absorption (8.83±2.30), and regulation (2.25 ±8.39), respectively. The statistical test of linear regression showed that service history and shift work have a significant power to predict nurses' distress tolerance.

The distress tolerance of nurses working in the ICU units was low. Factors such as service history and shift work influence their distress tolerance. Accordingly, it is necessary to plan to improve nurses' distress tolerance.

Cancer patients are admitted to the ICU due to their poor clinical condition, and patients admitted to these units suffer. Given the prevalence of cancer, the aim of this study was to determine the clinical characteristics of cancer patients admitted to the ICU.

In this study, 90 patients admitted to the ICU due to underlying cancer were included in the study; and patients who were discharged, died, or discharged within the first 24 hours of admission were excluded from the study. The researchers collected information and completed a researcher-made checklist form by visiting the ICU and studying the patient's clinical record, interviewing the patient, and performing a clinical examination. For data analysis and reporting in the findings section, all extracted information was reviewed, and if the patient's data were completely completed and there was no incomplete information in this regard, it was entered into SPSS software. Then, data analysis was performed with descriptive and analytical statistical tests.

The findings showed that the rate of delirium in patients who died, had a history of smoking, had pressure ulcers, were older, and had a longer duration of stay in the ICU was higher than in other patients, and this difference was statistically significant (P value < 0.05).  Also, the result showed the prevalence of pressure ulcers was higher in patients with a history of smoking, lung cancer, older age, and longer duration of stay in the ICU than in other patients, and this difference was statistically significant.

Identifying the clinical characteristics of cancer patients can help health policymakers and medical staff to improve the health status of patients. Also, the prevalence of delirium and pressure ulcers was high in this study, which requires necessary interventions in this field.

Ventilator-Associated Pneumonia (VAP) is one of the most common nosocomial infections that occurs after intubation in patients with mechanical ventilation.

This cross-sectional descriptive study was conducted in a group of patients admitted to the ICU with a sample size of 120 patients. patients were visited daily at the beginning of admission to the ICU and the study began by considering the entry and exit criteria. To achieve the research objectives, researchers visited the ICI department daily and identified eligible patients. Also, in this study, the demographic profile form of the patients was designed, and their information was completed by the researchers according to the information in the patients' clinical records. The questions of the demographic profile form were completed using an interview with the patient's companion and a study of the patient's hospitalization records. The data from this study were entered into SPSS version 18 and analysed using chi-square, regression, Mann-Whitney and other statistical tests.

According to the findings, 120 patients admitted to the ICU were included in the study, of which 48.3% were male and 51.7% were female. The incidence of VAP in 24 patients (20%) was reported. most of the VAP Group patients were male with a rate of 70.8%, age group 70-80 years with a rate of 66.7%, a history of smoking with a rate of 100% and consciousness above 9 with a rate of 70.8%. Also, in patients with VAP, 91.7% of patients with cancer and 41.7% of patients with rheumatoid arthritis had comorbidities, which was significant compared to the No-VAP Group (P value<0.05).

Given the high prevalence of VAP and its role in patient mortality, preventive interventions are recommended to reduce the incidence of VAP.

Headache may be aggravated by factors such as contracting new diseases, taking medications, or being hospitalized. One of the diseases that is effective in causing pain, especially headaches in patients, is the Covid-19 disease. for this reason, this study was conducted with the aim of the prevalence and factors affecting headache in covid-19 patients admitted to the ICU.

This study is a part of the registry related to covid-19 patients, and the researchers analyzed the data after obtaining the code of ethics in the research. in this study, the tool that was used included a demographic profile form and a checklist for examining pain and its influencing factors in patients admitted to the ICU.  data analysis was done using SPSS version 16 software and independent t-tests, ANOVA, linear regression and confirmatory statistics.

Result showed 1114 (78.8%) of the patients reported headache and 300 (21.2%) of the patients had no complaints about headache. regarding the type of pain, it was shown that 341(30.6%) had Pressure type, 360(32.3%) had Tightening type, 335(30.1%) had Throbbing type and 78(7%) had Irritability type. Also, in relation to the duration of pain, it was shown that 228(20.5%) had pain less than 1 hour, 171(15.4%) had pain between one hour and 24 hours and 715(64.2%) had pain more than 24 were hours. Also, 178(16%) of the patients had moderate headache and 936(84%) of the patients had severe headache.

Considering the high prevalence of headache in patients with covid-19 hospitalized in the ICU, it is necessary to take necessary intervention measures to reduce the patient's headache.

 
One of the primary objectives of nursing is to provide safe care, prevent injury, and promote patient health. Patient safety in the intensive care unit is compromised due to various factors. This study aimed to assess the Patient Safety Culture from nurses' perspectives in the intensive care unit. This cross-sectional study was conducted in 2023. Convenient sampling was employed. The sample comprised 200 nurses working in the intensive care units of a teaching hospital affiliated with Lorestan University of Medical Sciences. Data were collected using the Hospital Survey on Patient Safety Culture. Descriptive statistics and SPSS 16 software were utilized for data analysis. Among the 12 dimensions of safety culture, nurses assigned the highest score to "teamwork within units" (93.1%) and "organizational learning-continuous development" (92.0%). They assigned the lowest score to "hospital handoffs & transitions" (25.0%) and "non-punitive response to errors" (33.3%). Overall, the average percentage of positive responses across the 12 areas of patient safety culture was 55%, indicating a moderate level of patient safety culture. The patient safety culture dimensions that exhibited low levels necessitated adequate attention, such as providing sufficient staff and developing a checklist for handoffs and transitions. Furthermore, to increase error reporting and promote a culture of patient safety, a system-based approach to address errors is recommended.

 During the COVID-19 pandemic, different drug protocols were used to treat and manage patients. Considering the diversity in these protocols and the high costs associated with the disease, we aimed to evaluate the costs and effects of the most common therapeutic protocols among critically ill COVID-19 patients.

  In this retrospective cross-sectional study,  a total of 235 critically ill COVID-19 patients  were randomly selected from those hospitalized in the Intensive Care Units of Alzahra Hospital, Isfahan, Iran, between July and December 2020. The study assessed demographic data, outcomes (mortality rate), severity of the disease (SOFA score), and average direct costs of each therapeutic regimen. Statistical analysis included Cox-Regression analysis and Kaplan-Meier survival curve.

 We identified 21 therapeutic protocols based on prescribed medications, with six protocols being the most commonly used. The protocol containing dexamethasone + methylprednisolone showed the highest survival probability (0.79) with a median length of hospital stay of 17 days. Cost evaluation revealed that the dexamethasone protocol had the lowest average cost per patient, while the dexamethasone + methylprednisolone + remdesivir protocol had the highest. Hoteling costs accounted for 45% of the total costs, followed by medication costs (25%).

 The dexamethasone + methylprednisolone therapeutic regimen demonstrated the highest effectiveness in terms of survival probability and was also associated with the lowest average cost per patient.

This study aims to analyze the trends and developments of the study on Hospital and Intensive Care Unit (ICU) Management based on bibliometric data from 2014 to 2023.

This study uses a qualitative method with a literature study approach and bibliometric analysis. Data was obtained from reputable international journals indexed by Scopus. Data analysis and visualization were carried out using VOSviewer software to identify research trends, relationships between topics, and geographical distribution of studies.

The results of the analysis show that the number of publications on Hospital and ICU Management increased significantly, especially during the COVID-19 pandemic, with the highest spike occurring in 2021. The most frequently popping up keywords include "Patient care", "Healthcare system", "Healthcare policy", "COVID-19", as well as "Medical staff" and "Patient safety", emphasizing the importance of patient safety aspects and healthcare policies in hospital management. The United States is the country with the highest number of publications with 45 documents, followed by the United Kingdom with 20 documents and France with 15 documents.

This study provides insight into the research trends of Hospital and ICU Management and points to opportunities for further research in the aspects of "Training", "Infection Control", and "Critical Care of Risk Factors". The study also highlights the urgency of developing artificial intelligence-based technologies and telemedicine to improve the efficiency of care in ICUs.