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Comparison of the outcomes of weaning with currr ent and IWI-based methods in patients admitted to ICU of selected hospitals in Tehran

Title (persian) :

مقايسه پيامدهاي جداسازي از تهويه مكانيكي با دو روش جاري و استفاده از اندكس IWI در بيماران بستري در بخش مراقبت هاي ويژه بيمارستان هاي منتخب شهر تهران

Author(s):
Homeira Sedighi Nezhad , Seyed Davood Tadrissi , Abbas Ebadi , Seyed Jalal Madani*

Paper language: Persian

Abstract:
Introduction: Determining the patient’s readiness for weaning from mechanical ventilation and predicting the weaning outcomes are important issues that should be carefully evaluated and the risks of delay in weaning and increased mortality rates should be avoided. The aim of this study was to compare the outcomes of weaning with current and IWIbased methods in patients admitted to the intensive care units.

Materials and methods: This was a prospective clinical trial – one blind – multicenter study where 124 adult patients, who were mechanically ventilated for more than 24 hours, were evaluated in 2 groups of current and IWI-based methods (62 in each group). Initially, in current method, the rates of successful and unsuccessful weaning were evaluated in 62 patients and the threshold value of IWI was determined. In this group, the readiness for weaning and the decision to return to mechanical ventilation was made by physician in charge (who was completely blind to the result of the indexes evaluated). Then, after training the IWI to the medical team responsible for weaning, in 62 patients of the second group, weaning was made based on this index and the rates of successful and unsuccessful weaning were assessed. Ultimately, the rate of successful and failure weaning of the two groups was compared.

Conclusion: In Current method among 62 patients studied, 35 were successful and 27 unsuccessful. APACHE II in successful group was 15.09±5.68, in unsuccessful group 18.70±5.39, Carrico index (PaO2 / FiO2) in successful group was 214.102±40.35, in unsuccessful group 182.87±76.22, DO index (dissolved oxygen (SaO2)) in successful group was 96.74±2.46, in unsuccessful group 95.37±3.28, GCS Score in successful group was 9.57± 1.22, in unsuccessful group 9.30±1.54, duration of mechanical ventilation (hour) in successful group was 82.54±72.31, in unsuccessful group 89.74±82.30, IWI in successful group was 42.30±12.16, in unsuccessful group 28.24±10.70. In IWI method among 62 patients studied, 58 were successful and 4 unsuccessful. APACHE II in successful group was 13.47±4.97, in unsuccessful group 13.25±4.57, Carrico index (PaO2/FiO2) in successful group was 212.80±42.15, in unsuccessful group 176.87±14.04, DO index(dissolved oxygen(SaO2)) in successful group was 95.30±3.12, in unsuccessful group 94.25±3.86, GCS Score in successful group was 9.03±1.75, in unsuccessful group 9.25±1.50, duration of mechanical ventilation (hr) in successful group was 141.43± 63.48, in unsuccessful group 51±15.10, IWI in successful group was 65.77±26.28, in unsuccessful group 40.15± 8.13. According to the research findings and studies that examined the predictive indexes of weaning from mechanical ventilation, it is indicated that in addition to objective and subjective criteria to determine the optimal time for successful weaning, predictive indexes should be used. The use of IWI index that integrates important weaning parameters can evaluate the weaning outcome with better accuracy.

Keywords:
Integrative weaning index(=IWI), ICU, weaning outcomes, Carrico Index, RSBI

ref : magiran

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Effect of Progressive Muscle Relaxation on Patients Lifestyle with Myocardial Infarction: A Double-Blinded Randomized Controlled Clinical Trial

Abstract:
Introduction: Nowadays, Non-communicable diseases are widespread due to modernization of societies, technology
development, population density in urban areas and changes in life style. Variety of cardiovascular diseases are the most
common causes of death and important factors of failure in most countries including Iran. This study was conducted to
determine the effect of progressive muscle relaxation on the lifestyle of patients with myocardial infarction.
Methods: In this randomized double-blind clinical trial, after sampling, 66 patients were randomly selected and assigned
to either the control or test group. An orientation session was held to explain the research goals and intervention. The test
group did the progressive muscle relaxation technique, two 20-30 minutes sessions daily for 2 months (120 sessions). Data
collection tools were demographic information questionnaire, lifestyle questionnaire and self report check list.
Results: Independent t- test and mann-whitney U showed there are no significant differences in four aspects of life before
the intervention, but these differences were significant after the intervention(P<0.05). ANOVA with repeated measures in
three different times (before, 1 and 2 months after intervention) showed significant difference between the two groups
(P<0.05).
Conclusion: Applying progressive muscle relaxation technique would modify, adjust and improve various aspects of
lifestyle of patients suffering myocardial infarction.
Keywords: Progressive muscle relaxation, Life style, Myocardial infarction, RCT.

ref : article in persian

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Comparison of acid–base and electrolyte imbalances between normal saline and 1.4% sodium bicarbonate intravenous fluids therapy during cervical and lumbar laminectomy

Abstract

Introduction

Large amounts of normal saline infused in surgeries can cause hyperchloremic metabolic acidosis.

Aim

This study was designed to evaluate electrolyte and acid–base imbalances in the common fluid therapy method (normal saline) and the use of 1.4% sodium bicarbonate with normal saline fluid therapy during surgical laminectomy.

Material and methods

In this double-blind randomized clinical trial patients from 35 to 70 years in age, having American Society of Anesthesiologists physical status class I–II, candidation for cervical and lumbar laminectomy in Baqiyatallah Hospital (Tehran, Iran) in 2015 were enrolled. Patients were randomized into either two groups receiving 1.4% sodium bicarbonate and normal saline intravenous solutions for deficit fluid therapy during the surgery. Hemodynamics, arterial blood gases, and electrolytes levels were measured before and after surgery. Data were compared between the groups by SPSS.

Results and discussion

Forty patients with a mean age of 49.9 ± 12.7 years were evaluated. There were no significant differences in demographic data, mean surgery duration, blood loss, urine output, and infused fluid volumes between the two groups (P > 0.05). The mean PCO2and HCO3 values significantly increased in the bicarbonate group, whereas they decreased significantly in the normal saline group. The mean serum lactate increased significantly in the bicarbonate group while the mean serum Cl? increased significantly in the normal saline group (P < 0.05).

Conclusions

The results of this study showed the superiority of 1.4% sodium bicarbonate fluid in controlling acid–base and electrolyte imbalances during this kind of surgery, but it should be verified by further studies.

Keywords

  • Crystalloid solutions;
  • Fluid therapy;
  • Laminectomy;
  • Sodium Bicarbonate;
  • Water-electrolyte balance

ref : sciencedirect.com

Download present : researchgate.net

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Board and Committees of Trauma Monthly

SECTION EDITORS

CARDIOVASCULAR TRAUMA 
Hamidreza Taghipour, Tehran, IR IranMohammad Hasan Kalantar Motamedi, Tehran, IR Iran

CRITICAL CARE OF TRAUMA PATIENTS

Seyed Jalal Madani, Tehran, IR Iran

Mohammad Javad Frouzan Mehr, Tehran, IR Iran

Board of Trauma Monthly : link
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Validity of Integrative Weaning Index of Discontinuation From Mechanical Ventilation in Iranian ICUs

Abstract

Background: Today, usage of weaning index is a controversial issue. Proper use of these indexes is beneficial for prevention of the losses caused by weaning failure, rapid and reliable identification of patients who are potentially ready for spontaneous breathing and accelerating the weaning of mechanical ventilation.

Objectives: This study is to determine the validity of integrative weaning index as a mechanical ventilation discontinuation predictor in patients hospitalized in the Iranian intensive care units.

Patients and Methods: This scale was evaluated on 124 adult patients who were on mechanical ventilation for more than 24 hours, in two 24-hour phases, in six ICUs (Surgery-Trauma-Medical-Poisoning) of selected hospitals in Tehran, totaling 60 beds, by the researcher as a single blind test. Inclusion criteria were: Patient 18 to 80 years old, none of them suffering from neurological and neuromuscular diseases, none or a minimal dose of sedative drugs being used (15 – 18 points based on Palma and Cook criteria), non-addict or heavy smokers, not admitted in ICU-OH. The study was conducted from November 2011 to December 2012. The ventilators used were from Rafael brand.

Results: There were 80 successful and 44 unsuccessful as well as 72 successful and 8 unsuccessful weaning cases in the first and second phase of the study, respectively. The area under the ROC curves for IWI was 0.967, with standard error of 0.020, 95% Confidence interval of 0.899 to 0.993 and Significance level of P = 0.001, SE = 94.59, SP = 66.67, PPV = 97.22, NPV = 50, DA = 92.5 and likelihood ratio of positive test being 2.84 besides the lowest likelihood ratio of negative test equal to 0.08), with Diagnostic odds ratio being 97% and Confidence interval of 0.82 to 0.97.

Conclusions: Integrative weaning index has appropriate predictive validity for weaning patients from mechanical ventilation in Iranian intensive care units.

Keywords: Intensive Care Units; Respiration, Artificial; Ventilator Weaning

ref : Thrita

Download Full article : http://thritajournal.com/30257.pdf

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Survival after in-hospital cardiopulmonary resuscitation in a major referral center.

Abstract

AIM:

This study was undertaken to assess the demographics, clinical parameters and outcomes of patients undergoing cardiopulmonary resuscitation (CPR), by the code blue team at our center to compare with other centers.

MATERIALS AND METHODS:

Data were collected retrospectively from all adult patients who underwent CPR at our hospital from 2007 to 2008. CPR was performed on 290 patients and it was given 313 times. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from the hospital. Factors associated with survival were evaluated via binomial and chi square-tests.

RESULTS:

Of the 290 patients included, 95 patients (30.4%) had successful CPR. However, only 35 patients (12%) were alive at discharge. The majority requiring CPR were above 60 years of age (61.7%). Males required CPR more than females. There were 125 women (43.1%) and 165 males (56.9%) aged 3 to 78 (average 59.6) years. Majority (179) of the cases (61.7%) were above 60 years of age. Regarding the various wards, 54 cases (17.3%) were in the internal medicine ward, 63 cases (20.1%) in the surgery ward, 1 case (0.3%) in the clinic, 11 cases (3.5%) in the paraclinic, 116 cases (37.1%) in the emergency (ER), 55 cases (17.5%) in the Intensive Care Unit (ICU) and Coronary Care Unit (CCU), and 13 cases (4.2%) were in other wards. Cardiac massage was done in 133 cases (42.5%), defibrillation only via electroshock 3 cases (1%), and both were used in177 cases (56.5%). The ER had the most cases of CPR. Both cardiac massage and electroshock defibrillation were needed in most cases.

CONCLUSION:

In-hospital CPR for cardiopulmonary arrest was associated with 30.4% success at our center at the end of CPR but only 12% were alive at discharge. Duration of CPR >10 minutes was predictive of significantly decreased survival to discharge.

ref : Madani.S.J Articles

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Pulmonary infections in ICU patients without underlying disease on ventilators.

Abstract

BACKGROUND:

At present, the use of ventilator support is an important part of treatment in ICU patients. However, aside from its well-known advantages, the use of these devices is also associated with complications, the most important of which is pulmonary infection (PI). PI has a high rate of morbidity and mortality.

OBJECTIVES:

This study aimed to evaluate the prevalence of PI in mechanically-ventilated patients and the role that factors, such as age, sex, and duration of intubation, play in this regard.

MATERIALS AND METHODS:

This descriptive cross-sectional study evaluated the prevalence of PI in mechanically ventilated patients, with no underlying condition which could compromise their immune system. Age, sex, and duration of intubation were assessed. Data were analyzed using SPSS (version 16) software.

RESULTS:

A total of 37 ICU patients on ventilators were evaluated, including 21 males (56.8%) and 16 females (43.2%). The mean age of the patients was 54 ± 19 years (range 19 to 86 years), with a mean age of 52 ± 20 years in men, and 56 ± 18 years in women (P = 0.52). The mean duration of ventilation was 6 ± 4 days (range 2 to 20 days). The mean duration of ventilation was 5 ± 2 days in men, and 6 ± 5 days in women (P = 0.42). A total of 16 patients (43.2%) developed ventilator-associated pneumonia (VAP); of whom, 50% were male and 50% female (P = 0.46). Patients who developed a pulmonary infection had a significantly longer duration of ventilation. The mean duration of ventilation was 8 ± 4 days in patients who had developed VAP, while this duration was 4 ± 2 days in the non-affected patients (P = 0.005). Overall, 17 patients died, and 7 of these deaths were attributed to VAP.

CONCLUSIONS:

The prevalence of VAP in this study was approximately 43%, which is relatively high. In total, the percentage of deaths due to VAP among the patients was 18.91%. Duration of ventilator support was significantly correlated with the prevalence of PI.

ref : Madani.S.J Articles

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Cardiac rehabilitation using the Family-Centered Empowerment Model versus home-based cardiac rehabilitation in patients with myocardial infarction: a randomised controlled trial.

Abstract

OBJECTIVE:

To determine if a hybrid cardiac rehabilitation (CR) programme using the Family-Centered Empowerment Model (FCEM) as compared with standard CR will improve patient quality of life, perceived stress and state anxiety of patients with myocardial infarction (MI).

METHODS:

We conducted a randomised controlled trial in which patients received either standard home CR or CR using the FCEM strategy. Patient empowerment was measured with FCEM questionnaires preintervention and postintervention for a total of 9 assessments. Quality of life, perceived stress, and state and trait anxiety were assessed using the 36-Item Short Form Health Survey (SF-36), the 14-item Perceived Stress, and the 20-item State and 20-item Trait Anxiety questionnaires, respectively.

RESULTS:

70 patients were randomised. Baseline characteristics were similar. Ejection fraction was significantly higher in the intervention group at measurements 2 (p=0.01) and 3 (p=0.001). Exercise tolerance measured as walking distance was significantly improved in the intervention group throughout the study. The quality of life results in the FCEM group showed significant improvement both within the group over time (p<0.0001) and when compared with control (p<0.0001). Similarly, the perceived stress and state anxiety results showed significant improvement both within the FCEM group over time (p<0.0001) and when compared with control (p<0.0001). No significant difference was found either within or between groups for trait anxiety.

CONCLUSIONS:

The family-centred empowerment model may be an effective hybrid cardiac rehabilitation method for improving the physical and mental health of patients post-MI; however, further study is needed to validate these findings. Clinical Trials.gov identifier NCT02402582.

TRIAL REGISTRATION NUMBER:

NCT02402582.

ref : Madani.S.J Articles