What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study.

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is an alternative method for patients with reversible causes of cardiac arrest (CA) after conventional cardiopulmonary resuscitation (CCPR). However, cardiopulmonary resuscitation (CPR) duration during ECPR can vary due to multiple factors. Healthcare providers need to understand these factors to optimize the resuscitation process and improve outcomes. The aim of this study was to examine the different variables impacting the duration of CPR in patients undergoing ECPR. METHODS: This retrospective, single-center, observational study was conducted on adult patients who underwent ECPR due to in-hospital CA (IHCA) or out-of-hospital CA (OHCA) at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. Univariate and multivariate binary logistic regression analyses were performed to identify the prognostic factors associated with CPR duration, including demographic and clinical variables, as well as laboratory tests. RESULTS: The mean ± standard division age of the 48 participants who underwent ECPR was 41.50 ± 13.15 years, and 75% being male. OHCA and IHCA were reported in 77.1% and 22.9% of the cases, respectively. The multivariate analysis revealed that several factors were significantly associated with an increased CPR duration: higher age (OR: 1.981, 95%CI: 1.021-3.364, P = 0.025), SOFA score (OR: 3.389, 95%CI: 1.289-4.911, P = 0.013), presence of comorbidities (OR: 3.715, 95%CI: 1.907-5.219, P = 0.026), OHCA (OR: 3.715, 95%CI: 1.907-5.219, P = 0.026), and prolonged collapse-to-CPR time (OR: 1.446, 95%CI:1.092-3.014, P = 0.001). Additionally, the study found that the initial shockable rhythm was inversely associated with the duration of CPR (OR: 0.271, 95%CI: 0.161-0.922, P = 0.045). However, no significant associations were found between laboratory tests and CPR duration. CONCLUSION: These findings suggest that age, SOFA score, comorbidities, OHCA, collapse-to-CPR time, and initial shockable rhythm are important factors influencing the duration of CPR in patients undergoing ECPR. Understanding these factors can help healthcare providers better predict and manage CPR duration, potentially improving patient outcomes. Further research is warranted to validate these findings and explore additional factors that may impact CPR duration in this population.

Cardiac Rehabilitation Using the Family-Centered Empowerment Model is Effective in Improving Long-term Mortality in Patients with Myocardial Infarction: A 10-year Follow-Up Randomized Clinical Trial.

INTRODUCTION: Cardiac rehabilitation (CR) play a critical role in reducing the risk of future cardiovascular events and enhancing the quality of life for individuals who have survived a heart attack. AIM: To assess the mortality rates and stability of the effects in myocardial infarction (MI) survivors after implementing a Family-Centered Empowerment Model (FCEM)-focused hybrid cardiac rehabilitation program. METHODS: This double-blind randomized controlled clinical trial, conducted at Shariati Hospital, an academic teaching hospital in Tehran, Iran (2012-2023), involved 70 MI patients and their families. Participants were randomly assigned to an FCEM intervention group or standard CR control group. The intervention commenced after the MI patient's safe discharge from the CCU and continued for the entire 10-year follow-up period. Various questionnaires were utilized to collect data on mortality rates and health-related quality of life (HRQoL). RESULTS: The 10-year follow-up period revealed lower mortality rates in the intervention group (5.7%, 11.4%, and 17.1% at 5, 7, and 10 years, respectively) compared to the control group (20%, 37.1%, and 48.9%). After adjusting for age, gender, and BMI, the control group had a four times higher mortality risk (HR: 4.346, 95% CI 1.671-7.307, P = 0.003). The FCEM-focused program demonstrated a significant and sustained positive impact on participants' quality of life for 48 months, with greater improvement compared to the control group. CONCLUSION: This study highlights the effectiveness of FCEM-based hybrid CR programs in enhancing long-term patient outcomes and reducing mortality rates among MI survivors. Further research is needed to explore the potential benefits in larger samples and diverse populations. TRIAL REGISTRATION: This study (Identifier: NCT02402582) was registered in the ClinicalTrials.gov on 03/30/2015.

Risk factors for neurological disability outcomes in patients under extracorporeal membrane oxygenation following cardiac arrest: An observational study.

OBJECTIVES: This study aimed to identify factors associated with neurological and disability outcomes in patients who underwent ECMO following cardiac arrest. METHODS: This retrospective, single-center, observational study included adult patients who received ECMO treatment for in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) between February 2016 and March 2020. Factors associated with neurological and disability outcomes in these patients who underwent ECMO were assessed. SETTING: Hamad General Hospital, Qatar. MAIN OUTCOME MEASURES: Neurological disability outcomes were assessed using the Modified Rankin Scale (mRS) and the Cerebral Performance Category (CPC) scale. RESULTS: Among the 48 patients included, 37 (77 %) experienced OHCA, and 11 (23 %) had IHCA. The 28-day survival rate was 14 (29.2 %). Of the survivors, 9 (64.3 %) achieved a good neurological outcome, while 5 (35.7 %) experienced poor neurological outcomes. Regarding disability, 5 (35.7 %) of survivors had no disability, while 9 (64.3 %) had some form of disability. The results showed significantly shorter median time intervals in minutes, including collapse to cardiopulmonary resuscitation (CPR) (3 vs. 6, P = 0.001), CPR duration (12 vs. 35, P = 0.001), CPR to extracorporeal cardiopulmonary resuscitation (ECPR) (20 vs. 40, P = 0.001), and collapse-to-ECPR (23 vs. 45, P = 0.001), in the good outcome group compared to the poor outcome group. CONCLUSION: This study emphasizes the importance of minimizing the time between collapse and CPR/ECMO initiation to improve neurological outcomes and reduce disability in cardiac arrest patients. However, no significant associations were found between outcomes and other demographic or clinical variables in this study. Further research with a larger sample size is needed to validate these findings. IMPLICATIONS FOR CLINICAL PRACTICE: The study underscores the significance of reducing the time between collapse and the initiation of CPR and ECMO. Shorter time intervals were associated with improved neurological outcomes and reduced disability in cardiac arrest patients.

Prognostic effects of cardiopulmonary resuscitation (CPR) start time and the interval between CPR to extracorporeal cardiopulmonary resuscitation (ECPR) on patient outcomes under extracorporeal membrane oxygenation (ECMO): a single-center, retrospective observational study.

BACKGROUND: The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO). METHODS: This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA. RESULTS: The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218-2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183-0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106-0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332-3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest. CONCLUSIONS: Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.

1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study.

The aim of this study was to evaluate the association between types of ventilator and the one-year survival rate of patients with acute respiratory distress syndrome (ARDS) due to SARS­CoV-2 infection. This multi-center, retrospective observational study was conducted on 1078 adult patients admitted to five university-affiliated hospitals in Iran who underwent mechanical ventilator (MV) due to ARDS. Of the 1078 patients, 781 (72.4%) were managed with ICU ventilators and 297 (27.6%) with transport ventilators. Overall mortality was significantly higher in patients supported with transport ventilator compared to patients supported with ICU ventilator (16.5% vs. 9.3% P = 0.001). Regression analysis revealed that the expected hazard overall increased with age (HR: 1.525, 95% CI 1.112-1.938, P = 0.001), opacity score (HR: 1.448, 95% CI 1.122-2.074, P = 0.001) and transport ventilator versus ICU ventilator (HR: 1.511, 95% CI 1.143-2.187, P = 0.029). The Kaplan-Meier curves of survival analysis showed that patients supported with ICU ventilator had a significantly higher 1-year survival rate (P = 0.001). In MV patients with ARDS due to COVID-19, management with non-ICU sophisticated ventilators was associated with a higher mortality rate compared to standard ICU ventilators. However, more studies are needed to determine the exact effect of ventilator types on the outcome of critically ill patients.

Psychological Distress Impact of Coronavirus Disease (COVID-19) Outbreak on Three Continents: A Systematic Review and Meta-analysis.

BACKGROUND: The dire state of coronavirus disease (COVID-19) outbreak has had a substantial psychological impact on society. METHODS: A systematic search was performed through Medline, PubMed, Embase, Scopus, and Web of Science, to investigate the impact of the COVID-19 pandemic on the psychological health of individuals in various countries. Subgroup analyses considered gender and classification of countries into three continents of America, Europe, and Asia. Only studies that used the COVID-19 Peritraumatic Distress Index (CPDI) questionnaire as a tool to assess mental distress were included in this meta-analysis. Heterogeneity among studies was assessed by I2 statistic, and the random-effects model was utilized to obtain the pooled prevalence. RESULTS: This pooled analysis included a large data sample of 21 studies consisting of 94,414 participants. The pooled prevalence of the psychological distress during the time of COVID-19 pandemic by CPDI for the continent of Asia was 43% (34.6% mild-to-moderate and 8.4% severe) which was greater than that for Europe (35%; 30% mild-to-moderate and 5% severe) but lower than that for America (64.3%; 45.8% mild to moderate and 18.5% severe). In addition, the prevalence of psychological distress according to CPDI was higher in females (48%; 40% mild to moderate, 13% severe) compared with males (59%; 36% mild to moderate and 5% severe). CONCLUSIONS: Our findings suggest that psychological distress in the Americas is a larger problem than in Asia and European continents. Females appear to be more vulnerable and may therefore require further attention in terms of preventive and management strategies. Implementation of both digital and molecular biomarkers is encouraged to increase objectivity and accuracy of assessing the dynamic changes in mental health in the current and future pandemics.

Prognostic values of modified NUTRIC score to assess outcomes in critically ill patients admitted to the intensive care units: prospective observational study.

PURPOSE: Modified Nutrition Risk in the Critically Ill (NUTRIC) score (mNUTRIC score) have been validated as screening tool for quantifying risk of adverse outcome critically ill patients admitted to the intensive care units (ICUs). The aim of this study was to evaluate the prognostic value of mNUTRIC score to assess outcomes in this population. MATERIALS AND METHODS: This prospective, observational study was conducted on adult patients admitted to the general ICUs of two university affiliated hospital in northwest of Iran. The association between the mNUTRIC score and outcomes was assessed using the univariate and multivariate binary logistic regression. The performance of mNUTRIC score to predict outcomes was assessed using the receiver operating characteristic (ROC)-curve. RESULTS: In total 445 ICU patients were enrolled. Based on mNUTRIC score, 62 (13.9%) and 383 (86.1%) individuals were identified at high and low nutritional risk, respectively. The area under the curve (AUC) for predicting ICU mortality, using vasopressor, duration of vasopressor, and mechanical ventilation (MV) duration were (AUC: 0.973, 95% CI: 0.954-0.986, P < 0.001), (AUC: 0.807, 95% CI: 0.767-0.843, P < 0.001), (AUC: 0.726, 95% CI: 0.680-0.769, P < 0.001) and (AUC: 0.710, 95% CI: 0.666-0.752, P < 0.001), respectively. CONCLUSIONS: An excellent and good predictive performance of the mNUTRIC score was found regarding ICU mortality and using vasopressor, respectively. However, this predictive was fair for MV and vasopressor duration and poor for ICU and hospital length of stay.

Comparison of the effects of spinal anesthesia, paracervical block and general anesthesia on pain, nausea and vomiting, and analgesic requirements in diagnostic hysteroscopy: A non-randomized clinical trial.

Background: The aim of this study was to compare the effect of spinal anesthesia (SPA), paracervical block (PB), and general anesthesia (GA), on pain, the frequency of nausea and vomiting and analgesic requirements in diagnostic hysteroscopy. Methods: This single-center, non-randomized, parallel-group, clinical trial was conducted on 66 diagnostic hysteroscopy candidates who were selected by convenience sampling at Fatemieh Hospital, in Hamadan, Iran, in 2021. Results: The mean pain score during recovery and the need for analgesic injections was found to be significantly higher in the GA group compared to that in the SPA group (pain: 3.77 ± 2.25 vs. 0.10 ± 0.30, P < 0.001), (analgesic: 50 vs. 0%, P < 0.001) and PB group (pain: 3.77 ± 2.25 vs. 0.90 ± 1.37, P < 0.001), (analgesic 50 vs. 10%, P < 0.001), respectively. However, no statistically significant difference was observed between the mean pain score between SPA and PB groups (0.10 ± 0.30 vs. 0.90 ± 1.3, P = 0.661). In addition, there were no significant differences between groups on nausea/vomiting after operation (P = 0.382). In adjusted regression analysis (adjusting for age, weight, gravid, abortion, and cause of hysteroscopy), the odds ratio (OR) of pain score during recovery was increased in PB (OR: 4.471, 95% CI: 1.527-6.156, P = 0.018) and GA (OR: 8.406, 95% CI: 2.421-9.195, P = 0.001) groups compared with the SPA group. However, in adjusting based on times of surgery duration, anesthesia duration, recovery and return of motor function, the ORs of pain score between groups was not statistically significant. Conclusion: Despite reduced pain during recovery in patients receiving SPA, duration of anesthesia, recovery period, and return of motor function were significantly prolonged compared to those receiving PB or GA. It seems that PB with less recovery time and faster return of motor function than SPA and also mild pain during recovery compared to GA can be a good option for hysteroscopy. Clinical trial registration: http://www.irct.ir, identifier IRCT20120915010841N26.

Prevalence of Amiodarone Induced Hypothyroidism and Hyperthyroidism in Patients with Heart Diseases: A Systematic Review and Meta-Analysis.

BACKGROUND: Due to the importance of amiodarone-induced hyperthyroidism in patients with heart failure, the purpose of the present systematic review and metaanalysis was to determine the prevalence of thyroid dysfunction (hypothyroidism and hyperthyroidism) in patients with heart disease who received amiodarone. METHODS: Electronic databases including Scopus, PubMed, Web of Science, and Science Direct were searched by two investigators. To assess the heterogeneity between the included studies, the chi-square χ2 test (α=0.05) and I2 index were used. Additionally, a random-effects model with 95% CI was used to estimate the pooled prevalence of thyroid dysfunction due to the heterogeneity of the studies. To identify the cause of heterogeneity, a meta-regression analysis was employed. All analyses were performed using Stata ver13 (Stata Corporation, College Station, TX, USA). RESULTS: The pooled prevalence of hypothyroidism was 23.43% (95% CI: 11.54-35.33) and hyperthyroidism was 11.61% (95% CI: 7.20-16.02). There was no significant association between the prevalence of hypothyroidism and the year of the study (p=0.152), sample size (p=0.805), and mean age of subjects in the sample groups (p=0.623). However, there was a significant association between the prevalence of hyperthyroidism and the year of the study (p=0.037), but no statistically significant association between either the prevalence of hyperthyroidism and sample size (p=0.425), or the prevalence of hyperthyroidism and the mean age of subjects in the sample groups (p=0.447). CONCLUSION: The prevalence of thyroid dysfunction in patients with cardiac arrhythmias receiving amiodarone was considerable. Extreme care should be exercised to improve the monitoring of any thyroid abnormalities that may arise in patients receiving amiodarone.

Comparison between 10 and 12 mg doses of intrathecal hyperbaric (0.5%) bupivacaine on sensory block level after first spinal failure in cesarean section: A double-blind, randomized clinical trial.

Background: Reducing adverse effects during cesarean delivery and improving the quality of sensory blocks with appropriate doses of intrathecal hyperbaric bupivacaine can play an important role in the safe management of cesarean delivery. The aim of this study was to compare the doses of 10 and 12 mg of intrathecal hyperbaric bupivacaine 0.5% on sensory block level after first spinal failure in cesarean section (CS). Methods: In this double-blind, randomized clinical trial, 40 candidates of CS after first spinal failure with class I-II based on American Society of Anesthesiologists (ASA) were randomly assigned into two equal groups (n = 20). Group A and B received the spinal anesthesia with 10 mg and 12 mg of hyperbaric bupivacaine (0.5%), respectively. Maximum levels of sensory block, motor block quality, and vital signs were measured in two groups by 60 min after SPA. Incidence of SPA complications during surgery were also recorded. Data were analyzed by SPSS ver.21 software using repeated measures analysis of variance at 95% confidence interval (CI) level. Results: Excellent quality of sensory blocks and complete quality of motor blocks were achieved in all participants (100%). However, the mean time to onset of anesthesia (4.47 ± 0.69 vs. 3.38 ± 0.47, P < 0.001) and time to reach T10 level (60.73 ± 11.92 vs. 79.00 ± 19.21, P < 0.001) in the Group A, were significantly shorter than in the patients of Group B. The incidence of hypotension (P = 0.001), nausea/vomiting (P = 0.007) and bradycardia (P = 0.012) as well as administration of ephedrine and atropine were significantly higher in Group B compared to Group A. Conclusion: Spinal anesthesia can be safely repeated with a 10 mg of hyperbaric bupivacaine 0.5% in a caesarean section after the initial spinal failure. Clinical trial registration: [https://en.irct.ir/trial/40714], identifier [IRCT20120915010841N20].

Prognostic value of National Early Warning Score and Modified Early Warning Score on intensive care unit readmission and mortality: A prospective observational study.

Background: Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS) are widely used in predicting the mortality and intensive care unit (ICU) admission of critically ill patients. This study was conducted to evaluate and compare the prognostic value of NEWS and MEWS for predicting ICU readmission, mortality, and related outcomes in critically ill patients at the time of ICU discharge. Methods: This multicenter, prospective, observational study was conducted over a year, from April 2019 to March 2020, in the general ICUs of two university-affiliated hospitals in Northwest Iran. MEWS and NEWS were compared based on the patients' outcomes (including mortality, ICU readmission, time to readmission, discharge type, mechanical ventilation (MV), MV duration, and multiple organ failure after readmission) using the univariable and multivariable binary logistic regression. The receiver operating characteristic (ROC) curve was used to determine the outcome predictability of MEWS and NEWS. Results: A total of 410 ICU patients were enrolled in this study. According to multivariable logistic regression analysis, both MEWS and NEWS were predictors of ICU readmission, time to readmission, MV status after readmission, MV duration, and multiple organ failure after readmission. The area under the ROC curve (AUC) for predicting mortality was 0.91 (95% CI = 0.88-0.94, P < 0.0001) for the NEWS and 0.88 (95% CI = 0.84-0.91, P < 0.0001) for the MEWS. There was no significant difference between the AUC of the NEWS and the MEWS for predicting mortality (P = 0.082). However, for ICU readmission (0.84 vs. 0.71), time to readmission (0.82 vs. 0.67), MV after readmission (0.83 vs. 0.72), MV duration (0.81 vs. 0.67), and multiple organ failure (0.833 vs. 0.710), the AUCs of MEWS were significantly greater (P < 0.001). Conclusion: National Early Warning Score and MEWS values of >4 demonstrated high sensitivity and specificity in identifying the risk of mortality for the patients' discharge from ICU. However, we found that the MEWS showed superiority over the NEWS score in predicting other outcomes. Eventually, MEWS could be considered an efficient prediction score for morbidity and mortality of critically ill patients.

The effect of family-centered empowerment model on the quality of life of adults with chronic diseases: An updated systematic review and meta-analysis.

BACKGROUND: Family-centered empowerment model (FCEM) is a concept that strengthens the family to help a chronic patient to obtain a better quality of life (QoL). The effects of FCEM on QoL of chronic patients are still inconclusive. Therefore, this meta-analysis was conducted to evaluate the effect of FCEM on QoL of adult patients with chronic diseases. METHODS: Following an online search PubMed/MEDLINE, Scopus, Web of Science, ProQuest, OVID, EMBASE, EBSCO, PsycINFO and Persian databases (Irandoc, IranMedex, SID and MagIran), all studies that tested the impact of FCEM on QoL of patients with chronic diseases were included. Cochrane Risk of Bias Tool was used to assessment the quality of included randomized clinical trials (RCTs) and before/after studies. Analyses were conducted by STATA16. RESULTS: Six hundred and ninety-seven studies were identified for screening. After screening process, 11 eligible studies were included in this meta-analysis. There were significant intervention effects in all QoL dimensions, physical and mental subscales and QoL total score (All P < 0.05). The minimum lower bound for SMD was 0.61 (95%CI: 0.96 to 1.66), indicating an increasing effect of the intervention on all QOL dimensions. The results showed substantial heterogeneity between the studies for all QoL dimensions, physical and mental subscales and QoL total scores (P < 0.001). CONCLUSION: FCEM is an appropriate model with a simple and effective application for families with a patient suffering from a chronic illness. Nursing education planners and healthcare providers could benefit from this model for improving the nursing education curriculum and accrediting programs.

New integrated weaning indices from mechanical ventilation: A derivation-validation observational multicenter study.

Background: To develop ten new integrated weaning indices that can predict the weaning outcome better than the traditional indices. Methods: This retrospective-prospective derivation-validation observational multicenter clinical trial (Clinical Trial.Gov, NCT01779297), was conducted on 1,175 adult patients admitted at 9 academic affiliated intensive care units (ICUs; 4 surgical and 5 medical), from Jan 2013 to Dec 2018. All patients, intubated and mechanically ventilated for at least 24 h and ready for weaning were enrolled. The study had two phases: at first, the threshold values of each index that best discriminate between a successful and an unsuccessful weaning outcome was determined among 208 patients in the derivation group. In the second phase, the predictive performance of these values was prospectively tested in 967 patients in the validation group. In the prospective-validation set we used Bayes' theorem to assess the probability of each test in predicting weaning. Results: In the prospective validation group, sensitivity, specificity, diagnostic accuracy, positive and negative predictive values, and finally area under the receiver operator characteristic curves and standard errors for each index (ten formulae) were calculated. Statistical values of ten formulae for aforesaid variables were higher than 87% (0.87-0.99). Conclusion: The new indices can be used for hospitalized patients in intensive care settings for accurate prediction of the weaning outcome.

Comparison of lactate/albumin ratio to lactate and lactate clearance for predicting outcomes in patients with septic shock admitted to intensive care unit: an observational study.

The aim of this study was to evaluate the prognostic value of the Lactate to Albumin (L/A) ratio compared to that of lactate and lactate clearance in predicting outcomes in patients with septic shock. This was a multi-center observational study of adult patients with septic shock, who admitted to intensive care units (ICUs) at Shohada and Imam Reza Hospitals, Tabriz, Iran, between Sept 2018 and Jan 2021. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to explore associations of the L/A ratio, lactate and lactate clearance on the primary (mortality) and secondary outcomes [ICU length of stay (LOS), duration of mechanical ventilation (MV), need of renal replacement therapy (RRT) and duration of using vasopressors] at baseline, 6 h and 24 h of septic shock recognition. Best performing predictive value for mortality were related to lactate clearance at 24 h, L/A ratio at 6 h and lactate levels at 24 h with (AUC 0.963, 95% CI 0.918-0.987, P < 0.001), (AUC 0.917, 95% CI 0.861-0.956, P < 0.001), and (AUC 0.904, 95% CI 0.845-0.946, P < 0.001), respectively. Generally, the lactate clearance at 24 h had better prognostic performance for mortality and duration of using vasopressor. However, the L/A ratio had better prognostic performance than serum lactate and lactate clearance for RRT, ICU LOS and MV duration.

Effect of specific training course for competency in professional oral hygiene care in the intensive care unit: a quasi-experimental study for developing a standardized learning curve.

BACKGROUND: The development of evidence-based training standards can help improve the quality of educational programs for novice intensive care unit (ICU) nurses. This study was conducted to assess the application of a training course on competency development of nurses in relation to oral hygiene care in ICU patients and to develop a checklist for evaluating the competence performance. In addition, to achieve a certain level of oral hygiene competence, as well as to assess the relative importance of predicting factors and learning competency patterns in oral hygiene care, we used standard learning curve. METHODS: This quasi-experimental study with time series design was conducted on newly registered ICU nurses of a teaching hospital affiliated with Tehran University of Medical Sciences, Iran, between 2016 and 2018. In the first phase of this study, we designed a checklist to assess nurses' professional competence in oral hygiene care in three stages: before, during, and after care. Then, in the second phase, the level of competence of nurses in repeated times of oral hygiene care was determined based on checklist items and recorded in the learning curve. RESULTS: The greatest increase of oral hygiene care competency due to repetition was observed in the first and fourth times of repetition in comparison to the subsequent and previous steps. In the linear regression model, demographic variables predicted 12-19% of changes related to skill scores in repetitions. CONCLUSION: According to the learning curve, newly registered ICU nurses can reach an acceptable competency after 6 repetitions of oral hygiene care.

Evaluation Effect of Aspiration of 0.2 ml of Cerebrospinal Fluid After Completion of Injection 0.5% Bupivacaine and Reinjection Into Subarachnoid Space on Sensory and Motor Block in Cesarean Section: A Randomized Clinical Trial.

Background: Spinal anesthesia (SPA) is the most common type of anesthesia administered for cesarean section. The main aim of this study was to evaluate the effect of aspiration of CSF (0.2 mL) immediately after SPA with hyperbaric 0.5% bupivacaine on the extent of sensory and motor block. Methods: In this clinical trial, 60 women at ≥37 weeks of gestation and aged between 18 and 46 years, candidate for cesarean delivery under spinal anesthesia were randomly allocated into two equal groups (n = 30). Group A (CSF-aspiration group) received the spinal anesthesia with 10 mg of hyperbaric 0.5% bupivacaine with aspiration of 0.2 ml of CSF. Group B (no-CSF-aspiration group) received only 10 mg of 0.5% hyperbaric bupivacaine. Pin-prick analgesia and motor block were tested during the induction. Results: The mean maximum level of analgesia was T6 in each group. Although the mean time to reach the maximum level of anesthesia (4.43 ± 5.14 vs. 2.76 ± 2.04, P = 0.107) and to reach T10 level (50.56 ± 11.51 vs. 49.10 ± 13.68, P = 0.665) in the CSF-aspiration group is longer than the non-CSF-aspiration group, but this differences were not significant. There were no significant between-group differences regarding sensory and motor block quality (P = 0.389) or failed SPA (four cases in CSF-aspiration group vs. two cases in no-CSF-aspiration group, P = 0.389). The incidence of bradycardia, hypotension, headache, vomiting and nausea were similar in both groups (P > 0.05). In addition, the difference in hemodynamic parameters between the two groups over times was not statistically significant. Conclusion: Our finding indicated that the aspiration of 0.2 ml of CSF after injection of spinal anesthesia with hyperbaric 0.5% bupivacaine does not seem to affect the extent of sensory and motor block, success rate, or outcome after SPA in cesarean section. Clinical Trial Registration: [https://www.irct.ir/search/result?query=IRCT20120915010841N25], identifier [IRCT20120915010841N25].

Effectiveness of Curcumin on Outcomes of Hospitalized COVID-19 Patients: A Systematic Review of Clinical Trials.

Despite the ongoing vaccination efforts, there is still an urgent need for safe and effective treatments to help curb the debilitating effects of COVID-19 disease. This systematic review aimed to investigate the efficacy of supplemental curcumin treatment on clinical outcomes and inflammation-related biomarker profiles in COVID-19 patients. We searched PubMed, Scopus, Web of Science, EMBASE, ProQuest, and Ovid databases up to 30 June 2021 to find studies that assessed the effects of curcumin-related compounds in mild to severe COVID-19 patients. Six studies were identified which showed that curcumin supplementation led to a significant decrease in common symptoms, duration of hospitalization and deaths. In addition, all of these studies showed that the intervention led to amelioration of cytokine storm effects thought to be a driving force in severe COVID-19 cases. This was seen as a significant (p < 0.05) decrease in proinflammatory cytokines such as IL1ß and IL6, with a concomitant significant (p < 0.05) increase in anti-inflammatory cytokines, including IL-10, IL-35 and TGF-α. Taken together, these findings suggested that curcumin exerts its beneficial effects through at least partial restoration of pro-inflammatory/anti-inflammatory balance. In conclusion, curcumin supplementation may offer an efficacious and safe option for improving COVID-19 disease outcomes. We highlight the point that future clinical studies of COVID-19 disease should employ larger cohorts of patients in different clinical settings with standardized preparations of curcumin-related compounds.

Assessment of 5-year outcomes of life satisfaction in survivors after rehabilitation programs: a multicenter clinical trial.

Using a rehabilitation program for the survivors of acute respiratory distress syndrome (ARDS) could be one of the important and fundamental steps to improve the pulmonary function and health-related quality of life (HRQoL) of patients. This study was carried out to evaluate the effect of two rehabilitation techniques (Family-Based Empowerment Model (FECM)/Continuing Care Model (CCM), or both of them) on pulmonary function, and HRQoL in ARDS survivors. From December 2009 to June 2016, ARDS survivors from mixed medical-surgical ICUs at four academic teaching hospitals in Tehran, Iran, were randomly assigned to one of three intervention groups (A, B, or C) or a control group (D). Pre- and post-interventions, pulmonary functions and HRQoL status of patients in all groups were collected 48 times via clinical measurements and various questionnaires during 5 years of follow-up. Significantly improvement was seen in the intervention groups compared to the control group, and the greatest benefit was observed in patients who received mixed of FCEM and CCM rehabilitation techniques. Co-administration of FCEM and CCM can improve pulmonary function as well as the life satisfaction of ARDS survivors. As a result, the execution of the empowerment model by nurses is recommended for ARDS survivors and the participation of their families at the same time.Trial registration: NCT02787720 (ClinicalTrial.gov, 24/05/2016).

Incidence and Risk Factors of Ventilator-Associated Pneumonia among Patients with Delirium in the Intensive Care Unit: A Prospective Observational Study.

INTRODUCTION: The incidence and risk factors for ventilator-related pneumonia (VAP) in patients with delirium are deficient, and there is a lack of in-depth knowledge of the impact of VAP on outcomes in this population. We investigated the incidence, risk factors, and outcomes of VAP in patients with delirium. MATERIALS AND METHODS: This prospective observational study was performed in a surgical ICU at Be'sat Hospital in Hamadan, Iran, between 2018 and 2019. A total of 108 patients with delirium were identified using the Confusion Assessment Method (CAM) for the ICU and Intensive Care Delirium Screening Checklist (ICDSC) and enrolled in this study. The association between VAP and delirium, risk factors, and outcomes (ICU length of stay and ICU mortality) for VAP were investigated using the Cox proportional hazards model and logistic and simple linear regression analyses with a 95% confidence interval. RESULTS: Of 108 delirium patients, 86 patients (79.6%) underwent mechanical ventilation (MV) and 16 patients (18.6%) experienced VAP during ICU stay. The median onset of VAP was 6.5 (IQR 4.2-7.7) days after intubation. Delirium patients with VAP stayed longer in the ICU (21.68 ± 4.26 vs.12.93 ± 1.71, P < 0.001) and also had higher ICU mortality (31.25% vs. 0%, P < 0.001) than subjects without VAP. According to multivariate cox regression, the expected HR for VAP was 53.5% lower for patients with early-onset delirium than in patients with late-onset delirium (HR: 0.465, 95% CI: 0.241-0.894, P=0.022). However, the expected hazard for VAP was 1.854 times and 4.604 times higher in patients with longer ICU stay (HR: 1.854, 95% CI: 1.689-3.059, P=0.032) and in patients with a prolonged MV duration (HR: 4.604, 95%CI: 1.567-6.708, P=0.023). CONCLUSION: According to the results, there seems to be an inverse relationship between early onset of delirium and VAP. This finding cannot be conclusively cited, and more studies in this filed should be conducted with a larger sample size. Furthermore, VAP in delirium patients is associated with increases in poor outcomes (higher ICU mortality) and the use of medical resources (longer stay in the ICU and MV duration).