Does airway pressure release ventilation mode make difference in cardiopulmonary function of ICU patients?

Introduction: Mechanical ventilation is essential in intensive care unit [ICU] patients who are unable to maintain adequate gas exchange without support. Different ventilation modalities have been introduced to imitate normal respiratory pattern but there are some disadvantages in each modality. The aim of present study was to compare the cardiopulmonary and airway pressure changes in ICU patients undergoing pressure controlled ventilation [PCV], one of the basic modalities with airway pressure release ventilation [APRV], an advanced ventilation mode which allows spontaneous breathing in any time of respiratory cycle

Materials and Methods: In this cross over study, 18 patients were randomized to receive either PCV or APRV ventilation for 30 minutes then after washout period, switched to another group. Cardiopulmonary and arterial blood gas variables and airway pressure were recorded prior to study and after 30 minutes of starting each modalities and compared between groups

Results: Airway pressure were significantly higher in APRV mode [9.3 +/- 3.3 vs. 6.9 +/- 1.5, p=0.044 in PCV group and 9.1 +/- 3.4 vs. 6.6 +/- 1.4, p=0.021 in APRV group] and arterial blood gas in PCV mode was insignificantly higher than APRV mode in both protocols. There was no significant difference in other cardiopulmonary variables

Conclusion: This study has shown no hemodynamic change's difference due to two studied protocol. The mean airway pressure in APRV mode was more than PCV mode with lower arterial blood O2 pressure in both protocols

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

[Comparison between intrathecal midazolam and tramadol with conventional method for postoperative pain and shivering control after elective cesarean section]

Adding new supplements when performing spinal anesthesia can increase the duration of analgesia. The aim of the present study has been to compare intrathecal midazolam and tramadol with the conventional method for postoperative pain and shivering control after elective caesarean section. In this double-blind clinical trial, 210 ASA class I, II women, aged 20-35 years, candidate for elective caesarean section were randomly allocated to three groups. All patients received hyperbaric intrathecal lidocaine and additionally group I received 2 mg subarachnoid midazolam, group II received 25 mg subarachnoid tramadol and the control group received 5cc normal saline. Postoperative pain score, the painless duration and postoperative shivering were assessed in the three groups. The mean painless duration in tramadol, midazolam and the control group were 192.5 +/- 12.2, 111.3 +/- 16.6 and 86.1 +/- 9.9 minutes, respectively [p<0.001]. The mean painless duration in the midazolam group was significantly more than two other groups and this duration in the tramadol group was also more than the control one. The mean postoperative pain score, shivering occurrence and the frequency of requested painkiller in the first 24 hours, were also compared. In the midazolam group, they were all significantly less than the two other groups. In the meanwhile, these indexes in the tramadol group were less than the control one [p<0.001]. Adding intrathecal midazolam and tramadol to lidocaine 5% in elective caesarean section can increase the painless duration and lead to a reduction in postoperative shivering. Midazolam demonstrates a stronger effect

Midazolam versus neostigmine adding to lidocaine in post operation pain in colporrhaphy surgery in spinal anesthesia

To compare the effect of intrathecal midazolam versus neostigmine added to lidocaine on the duration of sensory block and the duration of postoperative pain relief in women undergoing colporaphy in spinal anesthesia. In this double blind clinical trial we evaluated 60women [ASA] I,II that were candidate to elective colporaphy. The patients were randomly divided in three groups ,first group [midazolam group]received hyperbaric lidocaine and 1mg midazolam [0.5cc],second group [neostigmine group] received hyperbaric lidocaine and 50 micro g midazolam [0.5cc] and third group were considered as control and received hyperbaric lidocaine plus normal saline[0.5cc].VAS pain score 4,12 and 24 hours after surgery and duration of analgesia in tree groups were compared. The duration of sensory block in the midazolam group was 98.4 +/- 18.2minuts, 74.5 +/- 32.6 in neostigmine and 64.5 +/- 9.9 in control group and difference between three groups was significant [p=0.001]. Postoperative pain scores in midazolam group was 1.5 +/- 1.3, in neostigmine group was 2.4 +/- 1.6 and in control group was 3.5 +/- 2.7 and difference between three groups was significant [P=0.009]. Midazolam and neostigmine added to lidocaine 5% prolonged postoperative analgesia in colporrhaphy surgery in spinal anesthesia but midazolam was more effective than neostigmine