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Abstract Background Multiple trauma has serious complications, which increases the risk of morbidity and mortality in the patients. This study aimed to evaluate the impact of supplementation with phytosomal curcumin on clinical and laboratory factors in critically ill patients with multiple trauma. Methods In this double-blind trial, 53 patients with multiple trauma, who were admitted to the intensive care unit (ICU) were randomized to receive either 2 capsules, each capsule containing 250 mg phytosomal (a total of 500 mg daily) as an intervention group or 2 identical capsules (placebo capsules), each containing 250 mg maltodextrin for 7 days. Clinical and laboratory were parameters assessed before and after the intervention. Results After seven days of intervention, the mean increase from baseline in the Glasgow coma scale (GCS) score was significantly higher in the curcumin compared with the placebo group (P-value: 0.028), while the reduction in the APACHE-II score in the curcumin group was greater than that the placebo group in a marginally non-significant fashion (P-value: 0.055). Serum total bilirubin (P-value: 0.036) and quantitative C-reactive protein (CRP) (P-value: 0.044) levels significantly decreased while potassium (P-value: 0.01) significantly increased in the curcumin compared with the placebo group. Moreover, supplementation with phytosomal curcumin significantly increased platelet count (P-value: 0.024) as compared with placebo. The 28-day mortality rate was 7.7% (n: 2 patients) and 3.7% (n: 1 patients) in the placebo and curcumin groups, respectively (P-value > 0.05). Conclusion Phytosomal curcumin had beneficial effects on several clinical and laboratory factors including GCS, APACHEII, serum total bilirubin, CRP, and platelet count in ICU-admitted patients with multiple trauma. Trial registration IRCT20090306001747N1, Available on: https://www.irct.ir/trial/52692 . The first registration date was 12/01/2021.

Abstract Background Sepsis, a life-threatening organ dysfunction caused by a host’s dysregulated response to infection with an inflammatory process, becomes a real challenge for the healthcare systems. L-carnitine (LC) has antioxidant and anti-inflammatory properties as in previous studies. Thus, we aimed to determine the effects of LC on inflammation, oxidative stress, and clinical parameters in critically ill septic patients. Methods A randomized double-blinded controlled trial was conducted. A total of 60 patients were randomized to receive LC (3 g/day, n = 30) or placebo (n = 30) for 7 days. Inflammatory and oxidative stress parameters (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), superoxide dismutase (SOD), malondialdehyde (MDA), total antioxidant capacity (TAC), 28-day mortality rate, and some monitoring variables were evaluated. Results There was no statistically significant difference between study arms in baseline characteristics and disease severity scores. CRP (p

Abstract Background COVID-19 is a very harmful pandemic, and its recovery process is highly influenced by nutritional status; however, an appropriate nutritional scale has not yet been proposed for these patients. Therefore, the purpose of this study was to evaluate the effectiveness of the modified Nutrition Risk in the Critically ill (mNUTRIC) score in critically ill patients affected by COVID-19 admitted to the intensive care unit (ICU). Material and methods This was a cross-sectional study performed on 204 critically ill patients affected by COVID-19 admitted to the ICU wards. Evaluated indicators include the mNUTRIC Score as well as demographic, and biochemical indicators. Results A high percentage of COVID-19 patients (67.2%) had severe disease. Hospital and ICU stay (p > 0.001) and PH (p > 0.001) values were significantly lower in non-survivors than in survivors. mNUTRIC score (p > 0.001), PCO2 (p = 0.003), and CRP levels (p = 0.021) were significantly higher in non-survivors than survivors. mNUTRIC score had a direct correlation with age (p > 0.001), AST (p = 0.000), LDH (p = 0.026), and CRP (p = 0.014) and an inverse correlation with hospital duration (p = 0.031), albumin (p = 0.003) and PH (p

Background: Nowadays, the use of mechanical ventilation devices has a vital use in the treatment of patients hospitalized in intensive care units, while different modes of mechanical ventilation devices had different outcomes, thus this study aimed at comparing two modes of mechanical ventilation, that is the outcome of pressure regulated volume-controlled (PRVC) and Adaptive support ventilation (ASV) on hemodynamic changes and time taken to separate the patient from the device in the intensive care unit. Methods: This study is a single-blind randomized clinical trial conducted in Alzahra hospital during 2018-2019. The research population of the study included 74 patients admitted to the intensive care unit who were selected by convenience sample. The patients were ramdomly divided into two groups. The device parameters were adjusted on PRVC mode for the first group and ASV mode for the second group. The data were compared between two groups using. Data were analyzed using Chi-square tests, T-test, and repeated measures of ANOVA and ANCOVA. Findings: There was no significant difference between the two groups at different intervals in terms of systolic and diastolic blood pressure and heart rate, pH and HCO3, RAMSY score. The analysis of variance with repeated observations showed that both, the group and time had significant effects on SPO2 and PCO2. The average length of time connected to the mechanical ventilation device and the duration of hospitalization in the ASV group was significantly lower than the PRVC Group. Conclusion: The ASV mode more than PRVC mode decreased the length of stay and need for ventilation of hospitalized patients in intensive care units.

Abstract Background Sepsis is a common cause for admission to the intensive care unit (ICU), and its incidence has been increasing. It is associated with a significant increase in serum inflammatory biomarkers such as C-reactive protein (CRP) and cytokines such as interleukin 1 (IL-1), IL-6, and tumor necrosis factor (TNF). Sepsis is also associated with pathophysiological changes that include fluid accumulation in the lungs, eventually leading to acute respiratory distress syndrome (ARDS), tissue edema, hypotension, and acute kidney injury (AKI). Conventional therapies include antibiotics, but these may have important adverse effects, so novel therapeutic approaches are required. In animal studies, l-carnitine improves antioxidant status, and in some clinical trials, it has been shown to reduce inflammation. It has also been shown to improve respiratory distress and help maintain coenzyme A homeostasis, metabolic flexibility, promoting the normal function of the tricarboxylic acid (TCA) cycle, and oxidation of fatty acids by peroxisomes. We aim to determine the effects of very high doses of l-carnitine on inflammatory factors, oxidative stress, and clinical outcomes of patients with sepsis in ICU. Method and design In this double-blind, randomized controlled clinical trial, we will use block randomization of 60 patients with sepsis, aged between 20 and 65 years from Al-Zahra Hospital, Isfahan, Iran. The intervention group (n = 30) will receive three capsules of l-carnitine (each capsule contains 1000 mg l-carnitine; totally 3000 mg/day) for 7 days, and a control group (n = 30) will receive a placebo with the same dose and for the same duration in addition to usual care. At baseline, scores for clinical and nutritional status (Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), and NUTRIC Score) will be assessed. At beginning and end point of the study, inflammatory markers (CRP, erythrocyte sedimentation rate (ESR)), oxidative stress status (total oxidative stress (TOS), total antioxidant capacity (TAC)), and clinical variables will be evaluated also. The mortality rate will be assessed within 28 days of the beginning of the intervention. Discussion Because of the anti-inflammatory and antioxidant properties of l-carnitine, it is possible that using a high dose of 3000 mg daily of this nutritional supplement may reduce inflammation and oxidative stress and improve subsequent mortality of critically ill patients with sepsis. Trial registration Iranian Registry of Clinical Trials IRCT20201129049534N1 . Registered on 2 May 2021.

Background: Arterial Blood Gas (ABG) analysis is a commonly ordered test to investigate respiratory, circulatory, and metabolic status in traumatic patients with inappropriate perfusion and ventilation situations. Difficult sampling, hemorrhage risk of arterial puncture, and other vascular complications lead us to use saliva sampling as a safer non-invasive approach to evaluate PaO2, PaCO2, pH, and HCO3 values. This study was aimed to evaluate the correlation of PaO2, PaCO2, pH, and HCO3 values between ABG and saliva gas in traumatic patients under mechanical ventilation. Methods: This was a retrospective cross-sectional study of 18-85-year-old traumatic patients under mechanical ventilation conducted in an academic medical hospital. They were investigated based on age, sex, and ABG values as well their saliva gases values. The Paired t-test, Pearson χ2, and Pearson correlation were used to evaluate the correlation between the gases values in ABG and saliva. Data were analyzed using Mann–Whitney U test and Kolmogorov–Smirnov test. Results: There were 120 patients including 53 men and 67 women enrolled. None of the factors of arterial and salivary gases were significantly different between men and women. And the amount of these factors is homogeneous in both groups (P

Abstract Objectives This study aims to investigate the efficacy of curcumin-piperine co-supplementation on oxidative stress factors, clinical symptoms, and mortality rate in patients with coronavirus (COVID-19) admitted to the intensive care unit (ICU). Trial design This study is a randomized, placebo-controlled, double-blind, parallel-arm clinical trial. Participants The study participants will be recruited from patients admitted to the ICU of Al-Zahra hospital with a definitive diagnosis of COVID-19. The inclusion criteria are aged between 20 and 75 years, confirmation of COVID-19 based on the PCR test, and admitted to the ICU. The exclusion criteria include the present use of parenteral nutrition support, a history of underlying diseases such as congenital disorders, immune diseases, renal and hepatic insufficiency, and pancreatitis, a history of sensitivity to herbal remedies such as turmeric and pepper, and regular use of anticoagulant drugs such as warfarin. This study will be performed in the Al-Zahra hospital, an academic hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. Intervention and comparator Sixty eligible patients will be randomly assigned, in a 1:1 ratio, to receive curcumin-piperine capsules (three capsules/day; each capsules containing 500 mg curcumin plus 5 mg piperine; in total 1500 mg curcumin and 15 mg piperine/daily) for seven days (n=30) or matching placebo capsules (three capsules/day; each capsules containing 505 mg maltodextrin; totally 1515 mg, maltodextrin/ daily) for same duration (n=30). Capsules will be administered after oral or enteral feeding at 9, 15 and 21 o’clock. Main outcomes The primary outcome is the time from initiation of supplementation (curcumin-piperine or placebo) to normalization of fever, respiratory rate, and blood oxygen saturation. The secondary outcomes are the mortality rate, length of stay in ICU, temperature, levels of blood oxygen saturation, ventilator dependency, respiratory rate, levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), levels of liver markers (ALT, AST, LDH), and levels of kidney function markers (BUN, Creatinine). Follow up All of the parameters will be assessed at baseline and end of the study (7 days intervention). In addition, the rate of mortality will be collected after 4 weeks (28 days’ mortality in the ICU, 4 weeks follow up). Randomisation Eligible patients will be randomly assigned to either the intervention group (Curcumin-piperine) or the control group (Placebo). Randomization sequences will be generated using an electronic table of random numbers to allocate the included participants into either control or intervention groups (in a 1:1 ratio) using the stratified block randomization method. Stratification was conducted according to sex (male and female), with a block size of four. The allocation sequences will be prepared by an independent statistician and will be kept inside sealed, opaque, and consecutively numbered envelopes. Participants, investigators, nurses, and physicians will be unaware of the trial-group assignment. Blinding (masking) This study is a double-blind clinical trial (participants, investigators, nurses, and physicians). The curcumin-piperine and placebo supplements will be similar in the terms of texture, taste, color, odor, and weight. Both tablets will be provided in containers that are completely identical in weight, shape, labeling, and packaging. All participants, investigators, nurses, and physicians will be unaware of the trial-group assignment. Numbers to be randomised (sample size) The sample size is estimated at 60 participants, including 30 patients in the intervention group and 30 patients in the placebo group. Trial Status The protocol is Version 2, registered on May 13, 2021. Recruitment began May 20, 2021, and is anticipated to be completed by September 20, 2021. Trial registration This trial has been registered in Iranian Registry of Clinical Trials (IRCT) with the title of “Evaluation of the effect of curcumin-piperine supplementation in patients with coronavirus admitted to the intensive care unit (ICU): a double-blind clinical trial study”. IRCT registration number is IRCT20121216011763N52 . The registration date was May 13, 2021. Full Protocol The full protocol is attached as an additional file, accessible from the Trials website (File 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Background: As published in literature, vitamin D deficiency lead to increased morbidity and mortality rate in patients who hospitalized in intensive care units (ICUs). The present study conducted to evaluate the effect of vitamin D supplement on outcomes in patients with traumatic injuries hospitalized in ICU. Methods: In a clinical trial study, 55 patients with low levels of vitamin D (less than 30 ng/ml) and 55 patients with normal levels of vitamin D were selected from the patients admitted to the ICU of Alzahra hospital, Isfahan, Iran. The patients suffering hypovitaminosis D (interventional group) received 300,000 units of vitamin D intramuscularly. Patients who had adequate vitamin D levels were considered as control group. The patients’ recovery from the ICU was evaluated and compared by the Sequential Organ Failure Assessment (SOFA) index. Findings: SOFA scores were significantly higher in vitamin D deficiency group in first 2 weeks after hospitalization. Serum vitamin D levels at the end of the 3rd week had no statistical different between the two groups. The discharge rate in vitamin D deficiency group in first 2 weeks were lower than control group significantly. But at the end of the third week, the difference between the two groups was not significant. Conclusion: The results of our study showed that vitamin D supplement increased discharge rate of traumatic patients hospitalized in ICU.

Background: Some studies have shown that serum levels of troponin increase in some other diseases in addition to heart diseases. The aim of this study was to determine the frequency and factors associated with increasing troponin in patients admitted to the intensive care unit. Methods: In this cross-sectional study, 62 patients admitted to intensive care units (ICU) of Alzahra hospital, Isfahan, Iran, during the Years 2018-2019, were selected. Patients’ serum troponin levels were measured, and based on the outcomes including cardiac, pulmonary, systemic, and renal complications, frequency of mortality, duration of hospitalization in ICU, and duration of intubation were analyzed. Findings: The mean serum level of troponin I was 47.12 ± 4.38 and 50.00 ± 2.59 ng/l in the living and dead patients, respectively (P = 0.033). The mean serum level of troponin T was 0.57 ± 0.05 and 1.07 ± 0.08 ng/l in the living and dead patients, respectively (P < 0.001). Moreover, troponin I level was significantly different based on the age groups, and serum level of troponin T was different based on the causes of admission in ICU. Conclusion: Our study shows that in addition to patients with myocardial infarction (MI), other patients such as the elderly who hospitalized in the ICUs and patients with intracerebral hemorrhage, may also be at increased troponin levels.

Background: The aim of the present study was to evaluate the effect of ipratropium bromide with violet flower extract, ipratropium bromide with budesonide, and ipratropium bromide alone on the cuff-leak of the endotracheal tube and changes in hemodynamic parameters in intubated patients admitted to the intensive care unit. Materials and Methods: The present randomized clinical trial study was performed on 195 intubated patients in three groups of 65 patients. The first group received nebulized ipratropium bromide with budesonide (I + B group), the second group in addition to ipratropium bromide, received one tablespoon of the violet flower extract syrup every 8 hours (I + V group), and the third group received nebulized ipratropium bromide alone (I group). Hemodynamic parameters and the cuff-leak ratio (CLR) of patients were evaluated up to 72 hours after intubation. Results: The results of the present study revealed that 12 hours after intubation, the mean of CLR was significantly lower in group I (with a mean of 0.14 ± 0.02) as compared with that of the I + V and I + B groups (with the means of 0.16 ± 0.05 and 0.23 ± 0.05, respectively) (P < 0.001). In addition, 24 hours after intubation, the mean of CLR in group I + V was higher than that of I + B and I groups (P < 0.05). Conclusion: According to the results of this study, the use of violet extract syrup in patients under intubation can significantly improve patients' ratio of cuff-leak and SpO2. It seems that the use of violet extract syrup is effective to prevent unwanted complications during intubation and to facilitate patients' breathing.

Background: It is important to synchrony the time, intensity, and respiratory signal of the phrenic nerve between the patient and the ventilator. This study aimed to evaluate the effect of switching from volume-controlled to pressure-controlled ventilation on respiratory distress and asynchrony index improvement. Materials and Methods: In this randomized controlled clinical trial, 70 patients admitted to the intensive care unit under mechanical ventilation were included. Asynchronous evaluation was performed by examining the patient and evaluating and analyzing the graphic flow curve and ventilator pressure, which included trigger and flow asynchronous and asynchronous cycling. In the intervention group, the mode of ventilation was switched to PSIMV such that peak inspiratory pressures would be equivalent to positive end-expiratory pressure (PEEP) in the volume-controlled mode. Finally, again at 60, 75, and 90 min, information about the ventilator and the patient's symptoms, and arterial carbon dioxide levels were sent by arterial gas sample. The asynchronous index was also recorded in both groups. Results: This study showed that the mean of variables such as height, ideal body weight, tidal volume, set rate; Sense, FiO2, PEEP did not differ significantly between the two groups. The mean of asynchrony was significantly reduced in both control group (16.51 ± 3.35–14.51 ± 2.90; P < 0.001) and intervention group (18.26 ± 6.13–13.32 ± 5.53; P < 0.001). Conclusion: Regardless of the type and severity of the disease, switching the ventilation mode from volume-controlled to pressure-controlled can improve patient adaptation to the ventilator, especially in cases with frequent asynchrony.

Background: The hypo-perfusion of the kidneys can lead to impairment in renal function and induce renal injury in case of delayed diagnosis and treatment. To date, laboratory markers are routinely used to determine the fluid volume status of the patients. The current study aims to evaluate the values of inferior vena cava (IVC) collapsibility index in hypovolemia diagnosis among critical patients admitted at the intensive care unit (ICU). Materials and Methods: This is a cross-sectional study performed on 67 patients admitted to the ICU due to acute kidney injury from May 2018 to October 2019. Hypovolemia was assessed assessing IVC collapsibility using ultrasonography. Laboratory data, including urine osmolality, urine-plasma creatinine ratio, sodium excretion fraction and urinary sodium level were checked. Afterward, IVC collapsibility index was measured for each patient using ultrasonography and the values of this index in accordance with the mentioned criteria was evaluated. Accordingly, reciever operating curve was depicted. Results: There was no significant asosociation between IVC collapsibility index with fractional excretion of sodium (P = 0.69), urine Na (P = 0.93) and urine osmolality ([P = 0.09]), while urine: Plasma creatinie ration revealed a significant association with IVC collapsibility index at cut point of 40.5% with sensitivity and specificity of 96% and 44% (P = 0.017, area under the curve: 0.67, 95% confidence interval: 0.551–0.804), respectively. Conclusion: According to the findings of this study, IVC collapsibility detected via ultrasonography was not an appropriate index to figure out hypovolemia in ICU patients. Furthermore, detailed studies are recommended.

Background: Ventilator-associated pneumonia (VAP) is among the most common etiologies of mortality in intensive care unit (ICU). Studies about VAP among patients under mechanical ventilation admitted for neurosurgery procedures are limited while probability of VAP among these patients is high, because of oropharyngeal aspiration following brain injury. In the current study, the etiology of early- and late-onset VAP was assessed among the patients admitted for neurosurgical procedures. Methods: Current cross-sectional study was conducted on 82 patients with VAP following neurosurgical procedure. Information about patients including demographics, early/late-onset VAP, the score of Acute Physiology and Chronic Health Evaluation II (APACHE II), Clinical Pulmonary Infection Score (CPIS), underlying reason of neurosurgical procedure, medical history, smoking history, and smear/culture, and antibiograms were recorded and analyzed. Findings: VAP type was not in association with age (P = 0.560), gender (P = 0.270), etiology of neurosurgery (P = 0.960), and medical history (P = 0.930), but was statistically in association with admission duration (P = 0.034), smoking (P < 0.001), APACHE II score (P < 0.001), and CPIS score (P < 0.001). Duration of admission [odds ratio (OR) = 4.71; confidence interval of 95% (95%CI): 1.04-21.35; P = 0.040) and smoking (OR = 1.07; 95%CI: 1.01-1.14; P = 0.015) were independently in association with VAP. There was no association between type of VAP and Gram staining (P = 0.330) and antibiogram (P = 0.140). Conclusion: Based on the current study, duration of admission, mortality, smoking, APACHE II score, and CPIS score were significantly higher among late-onset VAP. Moreover, admission duration and smoking was independently in association with VAP regardless of its type. The microbial pattern was not in association with late/early-onset VAP.

Background. Statins reportedly have anti-inflammatory effects aside from their lipid-lowering impact. We investigated the effects of statin therapy on the level of C-reactive protein (CRP) or highly sensitive CRP (hs-CRP), a liver-derived marker of systemic inflammation, among stroke patients. Methods. An online search was performed in Scopus, PubMed/MEDLINE, ISI Web of Science, and Google Scholar up to November 2020 to recognize clinical trials investigating the effects of statins on the CRP level in stroke patients. Results. Overall, nine studies (11 treatment arms) with 1659 participants met the inclusion criteria. Six out of 9 studies (8 out of 11 arms) were categorized as studies with a high-quality methodological approach using the Cochrane Collaboration’s tool. Data from 5 treatment arms indicated a significant decrease in CRP concentration, and in one treatment arm, CRP concentration did not suggest any considerable alteration following statin therapy. Moreover, two treatment arms showed a significant reduction in hs-CRP concentration and three treatment arms revealed no significant alteration in hs-CRP concentration following statin therapy. Generally, results were heterogeneous and independent of the type of statin, statin dose, treatment duration, and changes in plasma low-density lipoprotein cholesterol concentration. Conclusion. The results suggest that statin therapy could reduce and, therefore, could be considered in these patients as potential anti-inflammatory agents.

Mechanical ventilation (MV) is among the main basics of supportive treatment for respiratory failure in the intensive care unit (ICU). This supportive treatment may cause undesirable complications that led to the introduction of various MV modes. The current study was aimed to assess and compare outcomes of volume support ventilation (VSV) and pressure support ventilation (PSV) regarding spontaneous breath return, weaning and hemodynamic changes among patients admitted at ICU following surgical procedures. This single-blinded randomized-clinical-trial (RCT) was conducted on 100 patients admitted at ICU in 2018-2019. Patients were randomly divided into two fifty-member groups treated with PSV and VSV modes. Oxygen saturation, systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), arterial blood gas (ABG), extubation and MV time and sedation based on RAMSY criteria were recorded and compared. Mean age (P=0.79) and gender distribution (P=0.57) were not statistically different in the two groups. Time has no effect on patients' hemodynamic (P>0.05) while hemodynamic stability was superior in VSV (P0.05) except for arterial oxygen pressure that was higher in the VSV group (P

Background: This study aimed to compare respiratorily, arterial blood gas (ABG), and hemodynamics parameters among patients undergoing surgery who were admitted to intensive care unit (ICU), using three ventilation modes, including volume-assured pressure support (VAPS), volume support (VS), and spontaneous modes. Materials and Methods: One hundred and thirty-two patients were randomly assigned into three groups of VAPS, VS, and spontaneous modes utilizing randomized block procedure. Patients were followed between 12 and 30 h until extubation. Respiratory parameters including; peak inspiratory pressure (PIP), static compliance, resistance, rapid shallow breathing index (RSBI), and P 0.1(P0.1 correlates with respiratory drive and is defined as the negative pressure measured at the airway opening 100 ms after the initiation of an inspiratory effort), along with ABG parameters including; pH level, PaCO2, HCO3, PaO2/FiO2 ratio, extra hydrogen ion, and hemodynamics parameters including; mean arterial blood pressure and heart rate were measured every 3 h and compared among groups. Results: All studied parameters in three groups improved during the study. PIP, Resistance, PH, HCO3, extra hydrogen ion, PCo2, PaO2/FiO2 ratio, mean arterial blood pressure were similar among the three groups in most of the time points (P > 0.05). In most of the time points, RSBI (from 92.7 to 55.4), P 0.1 (from 6.8 to 1.7) in the VAPS group, static compliance (from 55.3 to 55.7) in the VS group, and heart rate (from 108.5 to 90.1) in spontaneous groups were significantly better than other modes (P < 0.05). Changes in RSBI, P 0.1, PCo2, HCO3, and heart rate during the study were significantly different among studied groups (P < 0.05). The length of stay in the ICU in patients who underwent VAPS was significantly shorter than the other modes. Conclusions: VAPS mode with better effects or at least as effective as VS and spontaneous modes could be select as the best mode of ventilation in postoperative early extubated patients admitted to ICU.

Background: The ratio of partial pressure of oxygen in arterial blood (PaO2) to the fraction of inspiratory oxygen concentration (FiO2) is an indicator of pulmonary shunt fraction. PaO2/FiO2 (P/F) ratio is used to classify severity of acute respiratory distress syndrome (ARDS). With the same shunt fraction, P/F ratio decreases with increases in FiO2 which may lead to errors in classifying severity of ARDS. The effect of FiO2 on P/F ratio has not been investigated in COVID-19 pneumonia. In this study, we estimated the best FiO2 for the calculation of P/F ratio in a sample of patients with ARDS due to COVID-19 pneumonia. Materials and Methods: Blood gas and ventilatory data of 108 COVID-19 ARDS patients were analyzed in a cross-sectional observational study. Using Oxygen Status Algorithm the calculated shunt fraction served a basis for calculating P/F ratio for different FiO2. The severity of ARDS determined by P/F ratios at each FiO2s was compared with the shunt-based severity to find the optimum FiO2 for calculation of P/F ratio so the resulting classification has the best match with the reference classification. Results: A FiO2 of 1.0 for calculation of P/F ratio and ARDS classification showed the best match with shunt-based ARDS classification. A regression model was obtained with the PaO2, patient's original FiO2, Hemoglobin concentration, and SaO2 as the independent predictors of the P/F ratio for the FiO2 of 1.0. Conclusion: This study shows a FiO2 of 1.0 as the best value for correct calculation of P/F ratio and proper classification of ARDS.

Background: Suitable mechanical ventilation strategies can reduce the incidence and severity of ventilator-associated lung injury in patients with acute respiratory distress syndrome (ARDS). In this study, the effects of adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) on respiratory parameters and arterial blood gases (ABGs) parameters were compared in ARDS patients. Materials and Methods: Twenty-four patients were randomly divided into two groups of ASV and SIMV. Patients were followed up for 3 days, and respiratory parameters including rapid shallow breathing index (RSBI), spontaneous breathing rate (SBR), minute volume, and peak inspiratory pressure (PIP) as the primary outcomes and ABG parameters including PaO2, FiO2, PaCO2, HCO3, and PaO2/FiO2 ratio as the secondary outcomes were measured. Results: PIP in patients in the SIMV group on the 1st day (P = 0.013), 2nd day (P = 0.001), and 3rd day (P = 0.004) was statistically significantly more compared to those in patients in the ASV group. RSBI, SBR, and minute volume between the ASV and SIMV groups during the 3 days were not statistically significantly different (P > 0.05). The mean arterial blood pressure, heart rate, PaO2, and PH between both groups were similar (P > 0.05). At the end of the 2nd and 3rd days, the level of FiO2 and PaCO2 in ASV was significantly lower than those in ASV group. HCO3 in each of the 3 days in the ASV group was statistically significantly lower than that in the SIMV group (P < 0.050). PaO2/FiO2 ratio in patients in the ASV group in the 3 days was statistically significantly higher than that in the SIMV group (P < 0.050). Conclusion: By reducing PIP and improving oxygenation and ABG parameters, ASV mode may be a safe and feasible mode during mechanical ventilation in patients with ARDS.

Background: Ventilator-associated pneumonia (VAP) is a prevalent infection occurs in intensive care unit (ICU) accompanied with increased complications and mortality. In this study, effects of chlorhexidine mouthwash versus herbal stop-snoring mouthwash on VAP among ICU admitted patients have been compared. Methods: 86 patients admitted at ICU were randomly divided to two equal groups including; group C treated with chlorhexidine mouthwash and group S treated with stop-snoring mouthwash. Patients of both groups were similarlytreated for three times a day (including amount, technique and times of mouth washing). Time of incidence and frequency of VAP were compared in two groups. Findings: 74.41% of group S and 62.79%of group C presented VAP (P-value = 0.353). 22.22% of patients presented VAP in first-5-days and 77.77% after 5 days and in group S while 6.25% of patients of group C presented VAP in first-5-days and 93.75% after 5 days(P-value = 0.126). Conclusion: Time of VAP incidence or frequency of VAP was not different using chlorhexidine mouthwash versus herbal stop-snoring mouthwash for prevention of VAP.

Background: Hemostasis is a hemodynamic process in which the platelet play a major role. Platelet transfusion is one of the effective treatments in patients with thrombocytopenia, which has been increased during the recent decades. There is limited data regard the factors that influence the amount of increase in platelet levels in patients with thrombocytopenia who undergo platelet transfusion. Methods: 35 patients with thrombocytopenia who underwent platelet transfusion in Alzahra hospital, Isfahan, Iran, between the years 2012 and 2014 were enrolled. Platelet levels were measured 1 hour before and 24 hour after platelet transfusion. Changes in platelet levels were evaluated considering demographic and clinical characteristics of patients. Findings: The average platelet count after platelet transfusion was significantly higher than before it (P = 0.001). Gender, splenomegaly, fever, and receiving heparin had significant effect on the change in platelet count (P < 0.050 for all) whereas bleeding had no significant effect (P ≥ 0.050). Conclusion: Variable factors could influence the efficacy of platelet transfusion in patients with thrombocytopenia. Future prospective studies with enough sample sizes are needed in order to warrantee the results.

Background: Because of the importance of antioxidant role of selenium as one of the components of selenoproteins, we designed this study to assess the effect of intravenous (IV) selenium with anti-inflammatory and immunomodulatory properties, on the ratio of partial pressure of arterial oxygen and fraction of inspired oxygen (PaO2/FiO2), and arterial blood gases in patients admitted to intensive care unit (ICU). Methods: In this randomized double-blind clinical-trial study, 90 patients under mechanical ventilation in intensive care units of Alzahra hospital, Isfahan, Iran, were selected and randomly divided into three groups. First group of patients received selenium 1000 µg daily; the second group received selenium 500 µg daily; and finally the third group did not received the drug as control group. Findings: There was no significant difference between the mean PaO2/FiO2 ratio in the first group (291.20 ± 28.60) with the second (291.63 ± 20.42) and the third (288.73 ± 20.77) groups (P = 0.50). The mean partial pressure of arterial oxygen was not also significantly different in the first group (95.90 ± 4.21) with the second (94.36 ± 5.18) and the third (94.46 ± 5.09) groups (P = 0.24). The average duration of extubation was not significantly different among the three groups (P = 0.16). Conclusion: Administration of intravenous selenium has no effect on the PaO2/FiO2 ratio as well as arterial blood gases, and also the duration of extubation in patients admitted to intensive care units. Furthermore, administration of intravenous selenium with no effect on respiratory parameters is not associated with hemodynamic changes in these patients.

مقدمه: هموستاز، روند همودینامیکی است که پلاکت و جدار عروق در آن نقش اصلی را ایفا می‌کنند. درمان با تزریق پلاکت، یک مراقبت استاندارد برای بیماران ترومبوسیتوپنیک محسوب می‌شود. اگر چه برخی مطالعات، کاهش پیش‌رونده‌ در میزان افزایش بعد از تزریق پلاکت را طی 1، 18 و 24 ساعت گزارش کرده‌اند. روش‌ها: در این مطالعه‌ی گذشته‌نگر، از پرونده‌ی 35 بیمار بستری بالای 40 سال که در سال‌های 94-1392 در بیمارستان الزهرای (س) اصفهان تحت تزریق پلاکت قرار گرفته بودند، استفاده شد. سطح پلاکت خون این بیماران در قبل و بعد از تزریق پلاکت اندازه‌گیری گردید و ارتباط میزان افزایش سطح پلاکت با متغیرهای دموگرافیک و بالینی بیماران تعیین و مقایسه گردید. یافته‌ها: میانگین تعداد پلاکت‎ خون بعد از تزریق پلاکت به طور معنی‌داری بیشتر از میانگین آن قبل از تزریق پلاکت بود (001/0 = P). عوامل جنسیت، اسپلنومگالی، تب و هپارین تأثیر معنی‌داری در تغییر تعداد پلاکت خون داشتند (050/0 > P)، اما عامل خونریزی، تأثیر قابل ملاحظه‌ای در این مورد نداشت. نتیجه‌گیری: ميزان بروز ترومبوسيتوپني و مرگ در بيماران بستري در بخش مراقبت‌های ویژه بالا می‌باشد و جاي نگراني دارد. نتایج این مطالعه نشان می‌دهد که تزریق پلاکت در بیماران نیازمند به آن مؤثر است و باعث افزایش سطح پلاکت در این بیماران بعد از تزریق می‌شود. همچنین، عوامل متعددی مانند جنسیت، اسپلنومگالی، تب و هپارین بر میزان افزایش سطح پلاکت بعد از تزریق تأثیر می‌گذارد.

Background: Coagulopathy is a common complication in patients hospitalized in intensive care units that leads to increase mortality rate, hospitalization, and hospital costs. This study aimed to detect the prevalence of coagulopathy and its related risk factors in patients with trauma hospitalized in intensive care units of Alzahra hospital, Isfahan, Iran, during 2013-2016. Methods: In a cross-sectional study, medical reports of 400 traumatic patients admitted in intensive care unit of Alzahra hospital from 2013-2016 were studied and the prevalence of coagulopathy was determined. Findings: Thrombocytopenia was seen in 20 percent of patients. In addition, 16.5, 12.8, and 30.0 percent revealed prolonged prothrombin time (PT), prolonged partial thromboplastin time (PTT), and prolonged international normalized ratio (INR), respectively. Conclusion: Prevalence of coagulopathy in patients with trauma hospitalized in intensive care units is high and probably is related to some factors such as blood transfusion, drug consumption, level of consciousness, body temperature, acid-base status, and the site of trauma.

Background: Electrolytes imbalance is one of the most prevalent complications among the patients hospitalized in intensive care unit (ICU) and for early detection of it, concentrations of blood gases are measured. But, phlebotomy is related to secondary complications such as infection in these patients. This study aimed to determine the relationship between the concentrations of blood gases and saliva gases in patients hospitalized in internal care units. Methods: This was a cross-sectional study in internal care units of Alzahra hospital, Isfahan, Iran during 2015-2016. 120 patients admitted in internal care unit were selected and amounts of blood gases including pH, partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3), and partial pressure of oxygen (PO2) were measured in blood and saliva and compared between the two samples. Findings: There were statistically significant direct correlation between the amounts of pH, PCO2, HCO3, and PO2 in blood and saliva (Pearson correlation coefficient of 0.25, 0.74, 0.72, and 0.58, respectively) (P < 0.050 for all). Conclusion: The direct correlation between the concentration of blood and saliva gases suggests that water-electrolyte imbalance probably can be predicted via measuring gases concentration in saliva. This can decrease interventional procedures and finally decrease secondary complications due to repeated phlebotomy in patients hospitalized in intensive care units. More studies are recommended.

Background: Some of previous studies showed that risk of mortality in patients who need hemodialysis and hospitalized in intensive care unit is higher but and biomarker is not detected for prediction of mortality in these patients. So, this study aimed to evaluate the diagnostic values of troponin I and T for prediction of mortality in patients hospitalized in intensive care unit and need hemodialysis. Methods: In a cross-sectional study in Alzahra hospital, Isfahan, Iran, during 2015-16, 70 patients hospitalized in intensive care unit were selected and serum levels of troponin I and T were measured and its relation with mortality was studied. In addition, the diagnostic values of troponin I and T for prediction of mortality was evaluated. Findings: The best cut-off point of troponin I and T for prediction of mortality were 1.5 and 1.2 µg/ml, respectively. In addition, sensitivity, specificity, false positive, false negative, positive predictive values, negative predictive value and accuracy were 26.7%, 81.8%, 18.2%, 73.3%, 28.6%, 80.4%, and 67.1% for troponin I, respectively, and 26.7%, 78.2%, 21.8%, 73.3%, 25.0%, 79.6%, and 70% for troponin T, respectively. Conclusion: Troponin I and T are not suitable markers for prediction of mortality in patients hospitalized in intensive care units and need hemodialysis.

Background: Some of studies showed that using proton-pump inhibitors (PPIs) in hospitalized patients is one of the causes of decreased serum magnesium level that leads to electrolytic imbalance. This study aimed to compare serum level of magnesium in patients who received pantoprazole or ranitidine in intensive care unit. Methods: In a clinical trial study, 50 patients hospitalized in intensive care units of Alzahra hospital, Isfahan, Iran, were randomly divided in to two groups of 25. Patients were treated with pantoprazole and ranitidine in first and second groups, respectively. Serum level of magnesium was measured during two weeks after entrance to intensive care units and compared between the groups. Findings: Mean serum level of magnesium in the two groups of pantoprazole and ranitidine in second day of hospitalization was 1.90 ± 0.11 and 1.98 ± 0.13 mg/dl, respectively and there was statistically difference between the two groups (P = 0.017). Serum level of magnesium until the 10th day of hospitalization was significantly different between the two groups. In addition, the trend of serum level of magnesium was different between the two groups (P < 0.001). Conclusion: Our study showed that consumption of ranitidine led to less decrease of serum level of magnesium among patients hospitalized in internal care units. But, considering our limitations as the amount of cases, more studies on using ranitidine are recommended.

Background: Previous studies showed that patients receiving blood transfusion under mechanical ventilation may be encounter to respiratory problems. The aim of this study was to determine the effect of high-dose selenium on maximum inspiratory pressure in critically ill patients who received blood transfusion and under mechanical ventilation in intensive care units (ICUs). Methods: In a clinical trial study, 102 patients with history of blood transfusion in intensive care units of Alzahra hospital, Isfahan, Iran, were randomly divided in three groups of receiving 1000, 500, and 0 µg intravenous selenium. Maximum inspiratory pressure and respiratory parameters were evaluated and compared between the three groups. Findings: The mean maximum inspiratory pressure in the first time of ventilation was -28.12 ± 2.67, -29.41 ± 2.65, and -28.5 ± 2.16 cmH2O in the three groups of control, and 1000 and 500 µg selenium, respectively, without any statistically difference between the three groups (P = 0.10). The mean maximum inspiratory pressure was -30.29 ± 1.47, -30.12 ± 1.39, and -30.74 ± 1.91 cmH2O at pressure support ventilation (PSV) of 8 cmH2O in mentioned groups, respectively, and no statistically difference were seen between the groups (P = 0.28). At pressure support ventilation 5 cmH2O, the mean maximum inspiratory pressure was -31.82 ± 1.91, -32.53 ± 2.68 and -30.76 ± 5.22 cmH2O in three mentioned groups, respectively, without statistically difference between the groups (P = 0.10). Conclusion: Different doses of selenium did not decrease airway resistance in patients receiving blood transfusion under mechanical ventilation. Therefore, more studies with larger sample sizes is recommended to determine the role of selenium in improving breathing and ventilation parameters, timing and weaning from mechanical ventilation and other related parameters.

Background: The aim of this study was to determine the effects of selenium on the maximum inspiratory pressure in patients under mechanical ventilation admitted to the intensive care units. Methods: In a clinical-trial study, 50 patients under mechanical ventilation in intensive care units of Alzahra hospital, Isfahan, Iran, were selected and randomly divided in to two groups. First group of patients received selenium 1 µg daily orally with meal when were connected to the ventilator; the second group did not received the drug. The two groups were compared in terms of time separating device parameters, respiratory, hemodynamic parameters, duration of weaning from ventilation, and outcomes. Findings: Weaning extubation was done in 17 (68%) and 16 (64%) cases of selenium and control groups, respectively, without any significant difference between the two groups (P = 0.77). The mean (± SD) maximum inspiratory pressure was -20.36 ± 2.73 and -21.04 ± 2.41 cmH2O at the beginning of ventilation (P = 0.360), -24.72 ± 2.73 and -22.16 ± 1.52 cmH2O at the pressure support ventilation (PSV) of 8 cmH2O (P < 0.001), and -24.52 ± 2.58 and -29.12 ± 4.61 cmH2O at the pressure support ventilation of 5 cmH2O (P < 0.001) in intervention and control groups, respectively, which showed the significant difference between the two groups. Conclusion: Prescribed selenium led to reduced airway resistance in patients receiving mechanical ventilation, but weaning of extubation and time of separation were not difference with and without selenium. More studies are recommended to be done in this case.

Background: Regardless of the exact reason, it is important to identify patients who are at greater risk for pain. There are few studies about the effects of age and gender in pain perception during and after deep vitrectomy; so, we performed this study to evaluate the effects of these two factors in this regard. Methods: In a descriptive study, 440 patients scheduled for deep vitrectomy were randomly allocated to three age groups, group 1: 17-34, group 2: 35-52, and group 3: 53-70 years old. General anesthesia was performed in the same manner in all the groups. Pain intensity [based on the visual analog scale (VAS)] and additional opioid consumption was assessed on entrance to the recovery room, and 30 and 60 minutes and 2, 4, 8, 16 and 24 hours after arrival it. Findings: Pain intensity in time of entrance to recovery room was 3.73 ± 1.46, 3.05 ± 1.08 and 4.19 ± 2.03 in groups of 17-34, 35-52 and 53-70 years, respectively and the difference between the groups was significant (P < 0.001). The patients aged 53-70 years had more pain intensity compared with the other age groups from arrival to the recovery room until 24 hours postoperatively (P < 0.050 for all the times). In addition, the pain intensity was significantly higher in women compared to men from arrival to the recovery room until 4 hours postoperatively (P < 0.05 for all the times). The number of patients requiring pethidine was not significantly different between the three groups all the times during 24 hours postoperatively (P > 0.050 for all). Conclusion: Women and elder patients experience more intense pain after deep vitrectomy.

Background: This study aimed to compare the weaning rate in three mechanical ventilation methods, automatic tube compensation and pressure support ventilation with airway pressure of five and eight centimeters of water. Methods: In a clinical trial study, 105 patients admitted to the intensive care unit who needed ventilation distributed randomly in three groups of 35 individuals, under ventilation with automatic compensation tube mode (group 1), and under ventilation with pressure support ventilation with airway pressure of five (group 2) or eight (group 3) centimeters of water. The patients were placed in isolation and the rate and the time of success weaning from the device were compared between the three groups. Findings: The rate of success in weaning from the ventilator in was 88.6, 57.1 and 85.7 percent in groups 1, 2, and 3, respectively; and the difference between the groups was statistically significant (P = 0.002). Mean (± SD) time of weaning in the three groups was 6.9 ± 3.7, 8.9 ± 6.4 and 7.1 ± 10.6 days, respectively; and there was not any significant difference between the three groups (P = 0.490). Conclusion: The rate of success in weaning from the device in patients undergoing mechanical ventilation under automatic tube compensation mode was higher and therefore, selecting this mode in these patients is better. In addition, morbidity and mortality rates and hospital costs would decrease in this method and bed capacity in intensive care units which is now a major problem for hospitals and health centers would increase.

مقدمه: پنومونی وابسته به ونتیلاتور (VAP یا Ventilator associated pneumonia)، شایع‌ترین عفونت در بخش‌های مراقبت‌های ویژه می‌باشد که موارد زیادی از آن‌، به آنتی‌بیوتیک‌های رایج در درمان، پاسخ نمی‌دهند. مطالعه‌ی حاضر با هدف تعیین الگوی مقاومت آنتی‌بیوتیکی پاتوژن‌های شایع در VAP و بررسی عوامل خطر مقاومت چند دارویی در بخش‌ مراقبت‌های ویژه‌ی مرکز آموزشی- درمانی الزهرای (س) اصفهان، به عنوان یک بخش فوق تخصصی ارجاعی سطح سوم در استان، به انجام رسید. روش‌ها: در این مطالعه‌ی مقطعی، پرونده‌ی 196 بیمار مبتلا به VAP، که در سال 1393 در بخش‌های مراقبت ویژه‌ی بیمارستان الزهرای (س) اصفهان بستری شده بودند، مورد مطالعه قرار‌گرفت. به منظور تعیین پاتوژن‌های شایع و الگوی مقاومت آنتی‌بیوتیکی آن‌ها، نتایج کشت ترشحات برونکوآلوئولار این بیماران بررسی شد. پاتوژن‌های عامل در دو گروه با و بدون مقاومت چند دارویی تقسیم‌بندی شدند و برخی عوامل دموگرافیک و عوامل خطر مقاومت بین دو گروه مقایسه شد. یافته‌ها: از 196 بیمار مورد بررسی، 63 مورد مبتلا به پنومونی زودرس و 133 مورد مبتلا به نوع دیررس بودند. فراوانی پاتوژن‌های مقاوم به چند دارو بین دو گروه زودرس و دیررس، تفاوت معنی‌داری نداشت. در مقایسه‌ی دو گروه با و بدون مقاومت چند دارویی، تفاوت معنی‌داری از نظر سن، جنس، نقص ایمنی، مدت بستری و مصرف آنتی‌بیوتیک، مشاهده نشد. شایع‌ترین جرم‌های هر دو نوع زودرس و دیررس Acintobacter baumannii (4/40 درصد) و Klebsiella pneumoniae (8/31 درصد) بودند و کمترین میزان مقاومت این دو باکتری، مربوط به آنتی‌بیوتیک‌های Colistin و Amikacin بود. نتیجه‌گیری: به نظر می‌رسد میزان مقاومت به آنتی‌بیوتیک‌‌ها بیشتر تحت تأثیر شرایط محلی است که مطالعه در آن انجام می‌شود. با در نظر گرفتن این موضوع و با توجه به شیوع زیاد و رو به افزایش مقاومت آنتی‌بیوتیکی، اقداماتی از قبیل تهیه‌ی نمونه جهت کشت قبل از تجویز آنتی‌بیوتیک و شروع درمان تجربی بر اساس فراوانی پاتوژن‌های عامل و میزان مقاومت آنتی‌بیوتیکی آن‌ها و همچنین، پرهیز از تجویز بدون اندیکاسیون آنتی‌بیوتیک‌ها، ضروری به نظر می‌رسد.

مقدمه: این مطالعه، با هدف تعیین ارتباط بین سرعت رسوب گلبول قرمز و پروتئین فعال C با بروز دلیریوم در پیش‌آگهی بیماران بستری در بخش مراقبت‌های ویژه‌ی بیمارستان الزهرای (س) اصفهان در سال‌های 94-1393 به انجام رسید. روش‌ها: طی یک مطالعه‌ی توصیفی- تحلیلی، 100 بیمار بستری در بخش‌ مراقبت‌های ویژه‌ی بیمارستان الزهرای (س) اصفهان طی 5 روز بعد از نظر سطح سرعت رسوب گلبول قرمز و پروتئین فعال C و ارتباط آن با بروز دلیریوم تعیین و مقایسه گردید. یافته‌ها: در طی 5 روز بستری، 46 نفر دچار دلیریوم شدند. میانگین سرعت رسوب گلبول در دو گروه مبتلا و غیر مبتلا به دلیریوم به ترتیب برابر با 00/2 ± 11/9 و 02/2 ± 73/8 میلی‌متر بر ساعت بود و اختلاف معنی‌داری بین دو گروه دیده نشد (340/0 = P). میانگین سطح پروتئین واکنشی C در دو گروه مبتلا و غیر مبتلا به دلیریوم، به ترتیب 06/6 ± 20/12 و 27/4 ± 55/9 میلی‌گرم بر لیتر بود و بیماران مبتلا به دلیریوم از میانگین سطح پروتئین واکنشی C بالاتری برخوردار بودند (012/0 = P). نتیجه‌گیری: تغییرات سطح عوامل التهابی اعم از پروتئین واکنشی C در طی مدت بستری بیماران در بخش مراقبت‌های ویژه، به خصوص در روزهای اول بستری و به ویژه در افراد مسن، می‌تواند شاخص قابل قبولی برای پیش‌گویی بروز دلیریوم در این بیماران باشد، اما در مورد سرعت رسوب گلبول به علت تفاوت‌ها و اختلالاتی که در مطالعات مختلف مشاهده می‌شود، توصیه می‌گردد مطالعات بیشتر و با حجم نمونه‌ی بالاتری انجام گیرد.

Background: Ventilator-associated pneumonia (VAP) is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients. Materials and Methods: In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA), Chi-square, and independent t-test. Results: The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05). Conclusions: The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.

Background: Selenium (Se), mainly through its incorporation into selenoproteins, plays an important role in in ammation and immunity. Evidence has emerged regarding roles for individual selenoproteins in regulating in ammation and immunity: The aim of the study was to evaluate of the effect of selenium administration on rapid shallow breathing index (RSBI) in ill patients. Methods: In this single blinded clinical trial study, 105 patients under mechanical ventilation were randomly divided into three groups, a received 1mg of Selenium, group B received 0/5 mg of selenium and group C received 2cc normal saline daily. Patients at the time of breathing spontaneously, and when receiving pressure support ventilation 8 and 5 cmH2o, and at the time of extubation were evaluated for Rapid Shallow Breathing Index and then compared between the groups. Results: There were no significant differences in the three groups in terms of distribution of age, sex, and cause of hospitalization and the mean of RSBI index at breathing spontaneously and when ventilator setting were reached to pressure support ventilation 8 cmH2o, however the difference was significant between the three groups from the pressure support ventilation 5 cmH2o until the extubation time. Conclusion: The results of the study showed a positive effect of selenium high dose (1mg) on the reduction of extubation time and RSBI, but due to the limitations of our study, further studies are recommended.

Background: Daily use of Chlorhexidine mouthwash following endotracheal intubation is done routinely in intensive care units (ICU). Matrika (Chamomile extract) has shown antibiotic activities, and several articles report it has similar preventive effect as Chlorhexidine on ventilator associated pneumonia, and also on oral cavity hygiene. Our study aimed to compare rate of VAP occurrence in two groups of intubated patients receiving Chlorhexidine and Matrika in Alzahra hospital’s ICU. Methods: In this trial 90 ICU patients who were intubated endotracheally, were randomly divided into two groups who will receive one of Chlorhexidine (group A) or Matrika (group B) mouthwash every 8 hours. Occurrence of VAP was determined in the following 5 days after intubation, using the standard VAP diagnosis criterion. Results: 8 of 45 (17%) patients experienced VAP in the first five days after intubation in the Chlorhexidine group, and, 9 of 45 (20%) patients in the Matrika group experienced the same condition. VAP rate was not significantly lower in the Chlorhexidine group (p value= 0.73). Conclusion: The results show that VAP occurs in Chlorhexidine and Matrika group approximately at a similar rate. Our findings recommend further studies on Matrika as an alternative to Chlorhexidine.

Background: Selenium (Se), mainly through its incorporation into selenoproteins, plays an important role in inflammation and immunity. Evidence has emerged regarding roles for individual selenoproteins in regulating inflammation and immunity. The aim of this study was to evaluate the response on the inflammatory biomarker C-reactive protein, and its possible impact on the incidence of delirium. Methods: This prospective, non-randomized, open-label, single-center clinical trial included 100 critically ill patients. Patients in the Selenium group (n = 50) received Se for 5 days (500 μg twice daily infused over 2 hours). Plasma levels of C-reactive protein (CRP), was determined on days 1-5. The incidence of delirium was assessed by the Confusion Assessment Method (CAM) on a daily basis. Results: CRP decreased in the selenium group from day 1 onwards. The mean of CRP was 11.1 ± 2.20 in the Se group compared to 16.7±1.6 in the control group, the difference was significant (P < 0.0001). 32% of patients in the selenium group and 52% in the control group had delirium (P = 0.07). Conclusions: Se administration in critically ill patients decreased CRP levels, but did not reduce the incidence of delirium

Background: There is no known biomarker to predict the mortality risk in patients undergoing dialysis in the intensive care unit (ICU). Therefore, the current study aimed to determine the diagnostic value of troponin I and T in this respect. Methods: This prospective study included 70 patients, admitted to the intensive care unit, during 2016-2017, who need hemodialysis. In these participants, the serum levels of troponin T and I were measured and the result of treatment was recorded in the patient’s profile whether it was improvement or death. Finally, we analyzed the diagnostic value of troponin T and I was predict the mortality in these patients in SPSS software version 20 through the Rock analysis. Results: The mean of troponin I and T levels in alive patients were 0.47±0.11 ng/ml and 0.67±0.15 ng/ml, respectively and in dead were 0.49±0.23 ng/ml and 1.06 ± 0.36 ng/ml, respectively. There was no significant difference between alive and dead patients in the mean of both troponins levels (P value> 0.05). On the other hand, Rock analysis also demonstrated that statistically these two biomarkers did not have any significant diagnostic value to predict mortality (P value> 0.05). Conclusion: According to the results, it is conceivable that troponin I and T are not proper biomarkers to predict the mortality in patients undergoing dialysis in ICU and these biomarkers do not have a proper sensitivity and specificity for this purpose.

Background: This study aims to determine the prevalence of early (less than 4 days of hospitalization) –and late-onset (more than 4 days after hospitalization) ventilator-associated pneumonia in the intensive care units of Al-Zahra center in Isfahan. Methods: Through a prospective study, 100 patients with ventilator-associated pneumonia who were hospitalized in the intensive care units of Al-Zahra hospital during 2015 were investigated, and early and late onset pneumonia were determined. Moreover, the etiology of bacterial strains and other clinical and demographic characteristics were compared in two groups. Results: The patients, 23 and 77 suffered from late –and early-onset pneumonia, respectively. The mean score of pneumonia in the two groups (early –and late-onset pneumonia) was 7.3± 2.1 and 7.2±1.6, respectively, which showed no significant difference (P: 0.8). The most common types of bacteria that caused pneumonia were methicillin-resistant Staphylococcus aureus (MRSA) (43% of frequency) and Acinetobacter Baumannii (34% of frequency) in early –and late-onset pneumonia, respectively. However, the frequency distribution of the type of bacteria by the type of pneumonia was not significantly different (P:0.1). Conclusion: A significant percentage of pneumonia in intensive care units are of early-onset type, which can lead to patients’ prolonged hospitalization in intensive care units and it may be lead to increased mortality rate among them. Therefore, it is recommended that the patients hospitalized in intensive care units should be carefully examined in terms of the occurrence of pneumonia symptoms.

Background: Mechanical ventilation (MV) is a life-saving intervention that should be considered for patients with respiratory failure. This study was conducted to evaluate the predictive value of physiologic dead space for weaning success and compare it with rapid shallow breathing index (RSBI). Materials and Methods: This cross-sectional study was conducted on 80 intensive care unit (ICU) patients who were under MV and candidate for weaning; among them, 68 patients experienced weaning success. RSBI was measured by dividing the respiratory rate by tidal volume. End-tidal CO2(PETCO2) was obtained using caponometry, then dead-space was calculated as (VD/VT = (PaCO2− PETCO2)/PaCO2). PaCO2was also obtained from arterial blood gas recorded chart. Results: Age, PaCO2, PETCO2, and RSBI were significantly different between those patients with and without weaning success (P < 0.05). RSBI ≤ 98 could predict the success of weaning with sensitivity 91.7%; specificity 76.5% and (AUC) area under the ROC curve (AUC = 0.87; 95% confidence interval [CI]: 0.78–0.94; P < 0.001). Dead space was not statistically significant prognostic index (AUC = 0.50; 95% CI: 0.31–0.69;P= 0.09). Conclusion: In our study, RSBI was an effective predictive index for weaning success in ICU patients under MV, but dead space did not show significant predictive value. Further studies with larger sample sizes for providing more evidence are recommended.

Background: Constipation is an intestinal syndrome that can be created alone or in the context of another disease in patients admitted to intensive care units (ICUs). Given the role of sennosides in increasing the transfer rate of materials from the large intestine, we aimed to compare the effect of senalin with bisacodyl on the treatment of constipation in patients admitted to ICUs. Materials and Methods: In this randomized, double-blind study, 70 patients admitted to the ICU were divided into two groups. The senalin recipient group received senalin with a dose of 500 mg daily for 3 days. The bisacodyl recipient group received bisacodyl with a dose of 10 mg daily for 3 days. Results: The mean of defecation frequency during the 2nd day of treatment of constipation was significantly higher in the group receiving bisacodyl than in the senalin group (P < 0.01). There was no significant difference between the two groups in terms of fecal consistency in any of the study days (P < 0.05). The prevalence of complications in the 3rd day of treatment was significantly higher in bisacodyl group than in the senalin group (P = 0.04). Conclusion: Given the lack of difference in the efficacy of two drugs, fecal consistency, daily defecation frequency and fewer complications of senalin compared to bisacodyl, it s eems that this drug can be used as an appropriate treatment for constipation in patients admitted to ICUs.

Background: Postoperative pain is a major problem following laparoscopic cholecystectomy, and there is no general agreement on the effective method of pain relief. Rectal morphine suppositories are one of the newly released morphine forms. The aim of this study is to compare the impact of suppository morphine with placebo on pain relief after laparoscopic cholecystectomy. Materials and Methods: Seventy patients scheduled for elective laparoscopic cholecystectomy under general anesthesia, were randomly allocated to two groups according to the drug used for postoperative analgesia: Group morphine suppository (MS - 10 mg) just before induction of anesthesia And Group placebo suppository (PS) (the pills were made from cocoa butter, physically similar to the real drug). Pain intensity based on visual analog scale (VAS) and opioid consumption were assessed 30 and 60 min, and 2, 4, 8, 16, and 24 h after arrival of the patient to the recovery room. Results: VAS scores were significantly lower in MS group (from 3.8 ± 1 to 5.3 ± 1.6) compared with PS group (from 4.9 ± 0.9 to 6.7 ± 1) from 30 min after arrival to the recovery room until 16 h postoperatively (P < 0.05). There were no additional analgesic requirements in the first 2 h after the entrance of the patient to the recovery room in MS group. The number of patients requiring pethidine was significantly different between two groups (P < 0.05) in all periods except for 24 h postoperatively. Conclusion: Suppository morphine administration is more effective than placebo to reduce pain and analgesic requirements after laparoscopic cholecystectomy.

Background: This study aimed to compare pressure regulated volume control (PRVC) and synchronized intermittent mechanical ventilation (SIMV) modes of ventilation according to respiratory and hemodynamic stability in patients with traumatic brain injury (TBI) admitted to Intensive Care Unit (ICU). Materials and Methods: In a randomized, single-blinded, clinical trial study, 100 patients who hospitalized in ICU due to TBI were selected and randomly divided into two groups. The first and second groups were ventilated by PRVC and SIMV modes, respectively. During mechanical ventilation, arterial blood gas and respiratory and hemodynamic parameters were also recorded and compared between the two groups. Results: According to the t-test, the mean rapid shallow breathing index (RSBI) after the first 8 h of mechanical ventilation was significantly higher in SIMV group compared with PRVC group (107.6 ± 2.75 vs. 102.2 ± 5.2, respectively, P< 0.0001). Further, according to ANOVA with repeated measures, the trend of RSBI changes had a significant difference between the two groups (P < 0.001). The trend of ratio of partial pressure arterial oxygen and fraction of inspired oxygen was different between the two groups according to Mann–Whitney–Wilcoxon test (P < 0.001). Conclusions: Using PRVC mode might be more desirable than using SIMV mode in patients with TBI due to better stability of ventilation and oxygenating. To ensure for more advantages of PRVC mode, further studies with longer follow-up and more detailed measurements are recommended.