Intensive care unit staff and resource utilization: is it an effective factor?

The aim of present study was to determine the impact of two different ICU management model, open and semi closed, on resources utilization in intensive care unit. Retrospective cohort analysis using data from hospital database was applied to compare the effect of ICU management model on ICU length of stay and bed disposition of 1064 patients admitted to the general ICU of Imam Khomeini Hospital of Tehran, Iran during the two consecutive 12-month periods from Mar, 2009 to Feb, 2010. In open and semi closed interval 380 and 684 patients were admitted to ICU respectively. There was no significant difference in age, gender and severity of illness [based on APACHE-II score] and nurse to bed ratio between two groups. Average ICU length of stay, net mortality rate and bed turnover rate were lower in semi closed model than open model management significantly [P<0.05]. Semi closed model improves patient care and lead to lower mortality rate and resources utilization too

Pharmacokinetics alterations of midazolam infusion versus bolus administration in mechanically ventilated critically ill patients

There is no randomized study carried out in order to compare their pharmacokinetic parameters although midazolam, as a sedative, has been widely administered via continuous infusion as well as intermittent bolus doses in mechanically ventilated critically ill patients. We prospectively investigated the effect of these two principal methods on pharmacokinetic parameters in 23 of mentioned patients [16 males, 7 females] with the mean [ +/- SD] age of 41.22 +/- 17.5. All patients received total dose of 72 mg throughout the test days, 9 of whom received 1 mg/h [continuous infusion] and the rest obtained 4 mg / 4 h [intermittent bolus doses]. Blood samples were collected at 8 and 4 h prior to the end time of drug administration [zero time], zero time and 4, 8, 12, 20 and 30 h after it. APACHE [Acute Physiology and Chronic Health Evaluation] II required data was recorded daily and the patients' mean score was 16.26 +/- 4.38. The mean [ +/- SD] value of pharmacokinetic parameters of Midazolam in continuous infusion and intermittent bolus doses methods were as follows: [t[1/2] = 17.88 +/- 14.65 h, Cl = 21.80 +/- 14.95 L/h] vs. [t[1/2] = 19.74 +/- 12.45 h, Cl = 29.43 +/- 19.45 L/h]. Volume of distribution [Vd] was measured in continuous infusion group which was 612.58 +/- 582.93 L. The calculated clearance and half-life were found not to be significantly different [p < 0.05]. The patients might be exposed to similar undesired effects due to the large volumes of distribution following the administration methods studied

Effects of pantoprazole on systemic and gastric pro- and anti-inflammatory cytokines in critically three patients

Stress-related mucosal damage [SRMD] is a significant cause of morbidity and mortality in critically ill patients due to the gastrointestinal blood loss. Prophylaxis of SRMD with proton pump inhibitors or histamine-2 blockers has gained widespread use in intensive care units. Both demonstrated to be effective in reducing clinically significant bleedings, while PPIs has shown to exert some anti inflammatory effects including the inhibition of producing pro-inflammatory cytokines. As cytokines have role in developing SRMD, the aim of this study was to evaluate the effect of PPIs on the inhibition of cytokine release following the critical illness. A total of 27 critically ill patients with risk factors of developing stress ulcer and intragastric pH < 3.0 enrolled to this Randomized clinical trial study. Patients were randomly assigned in three treatment groups; group one received 40 mg of intravenous pantoprazole every 12 h for 48 h [four doses], group two received 80 mg of intravenous pantoprazole every 24 h continuous infusion for 48 h and the third group received 150 mg of ranitidine intravenously as 24 h continuous infusion for 48 h. Plasma and gastric juice samples were obtained at 0th, 12th, 24th and 48th h for the measurement of EGF, IL-1beta, IL-6, IL-10 and TNF-alpha. Pantoprazole infusion have decreased the plasma IL-1beta concentrations [p = 0.041]. No other significant differences in concentrations of EGF, IL-6, IL-10 and TNF-alpha were detected. There were reverse correlations between the intragastric pH with gastric juice IL-1beta and TNF-alpha concentrations and a direct correlation between the intragastric pH and gastric juice EGF in pantoprazole groups. Our data suggest that pantoprazole may have some anti-inflammatory effects on patients. However, the exact impact of this effect on patients should be assessed by further studies

Quadriplegia due to lead-contaminated opium - case report

Utilization of lead-contaminated opium may lead to severe motor neuron impairment and quadriplegia. Forty years oriented old male, opium addict, was admitted to the ICU, with headache, nausea and abdominal pain, and weakness in his lower and upper extremities without definitive diagnosis. The past medical and occupational history was negative. Laboratory investigation showed: anemia [Hb 7.7 g/dl]. slightly elevated liver function tests, elevated total bilirubin, and ESR. Abdominal sonography and brain CT scan were normal. FMG and NCV results and neurologic examination were suggestive for Guillain-Barre. He underwent five sessions of plasmapheresis. Blood lead level was > 200 micro g/dl. He received dimercaprol [BAL] and calcium disodium edetate [CaEDTA] for two five days session. Upon discharge from ICU all laboratory tests were normal and blood lead level was reduced, but he was quadriplegic. The delayed treatment of lead poisoning may lead to irreversible motor neuron defect