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Introduction: Healthcare-associated infection is an important cause of mortality and morbidity worldwide. Well-regulated infection control and hand hygiene are the most effective methods for preventing healthcare-associated infections. This study evaluated and compared conventional hand hygiene observation and an electronic hand-hygiene recording and reminder system for preventing healthcare-associated infections. Methodology: This pre- and post-intervention study, employed an electronic hand-hygiene recording and reminder system for preventing healthcare-associated infections at a tertiary referral center. Healthcare-associated infection surveillance was recorded in an anesthesia and reanimation intensive care unit from April 2016 to August 2016. Hand-hygiene compliance was observed by conventional observation and an electronic recording and reminder system in two consecutive 2-month periods. healthcare-associated infections were calculated as incidence rate ratios. Results: The rate of healthcare-associated infections in the electronic hand- hygiene recording and reminder system period was significantly decreased compared with that in the conventional hand-hygiene observation period (incidence rate ratio = 0.58; 95% confident interval = 0.33-0.98). Additionally, the rate of central line-associated bloodstream infections and the rate of ventilator-associated pneumonia were lower during the electronic hand hygiene recording and reminder system period (incidence rate ratio= 0.41; 95% confident interval = 0.11-1.30 and incidence rate ratio = 0.67; 95% confident interval = 0.30-1.45, respectively). Conclusions: After implementing the electronic hand hygiene recording and reminder system, we observed a significant decrease in healthcare-associated infections and invasive device-associated infections. These results were encouraging and suggested that electronic hand hygiene reminder and recording systems may reduce some types of healthcare-associated infections in healthcare settings.

Introduction: Vitamin D plays a role in host defense and is known to be associated with mortality in patients in the intensive care unit (ICU). We aimed to evaluate the relationships between vitamin D levels and predictors of mortality in patients with ventilator-associated pneumonia (VAP) caused by extensively drug-resistant Acinetobacter baumanii (XDR A. baumanii). Methodology: A retrospective single-center study was conducted in an 18-bed adult ICU of a teaching hospital, including all patients with VAP due to XDR A. baumanii. Levels of 25(OH)D, procalcitonin (PCT), C-reactive protein (CRP), n-terminal pro-BNP (NT-proBNP), as well as clinical scores (Sequential Organ Failure Assessment [SOFA], Acute Physiology And Chronic Health Evaluation [APACHE II], Clinical Pulmonary Infection Score [CPIS) were recorded. Results: Forty-for patients were studied over six months. All patients had vitamin D deficiency. The 28-day mortality in patients with 25(OH)D levels ≤ 10 ng/mL was higher than in patients with 25(OH)D > 10ng/mL (p = 0.001). The fourth- and seventh-day SOFA scores (p= 0.04 and p= 0.001) and first- and fourth-day procalcitonin levels (p = 0.03 and p = 0.004) were higher in patients with 25(OH)D levels ≤ 10 ng/mL. The clinical scores (SOFA, CPIS, and CEPPIS) and biomarkers (NT-proBNP, PCT) were negatively correlated with 25(OH)D levels in all study groups. Conclusions: Severe vitamin D deficiency was associated with adverse outcome in VAP due to XDR A. baumanii. Vitamin D levels may be a prognostic predictor of VAP. It is also important to evaluate the effect of rapid vitamin D replacement on mortality.

Purpose. The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods. We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results. The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p<0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions. With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.

Background Several studies have shown that ketamine has an effect on mood and depression in the perioperative context; however, little is known about ketamine’s effect on patients’ emotional recovery after day-case surgery. We aimed to examine whether a single subanaesthetic dose of ketamine could improve acute mood in patients shortly following fractional curettage. Methods One hundred forty women from 202 consecutive fractional curettage patients were enrolled in this randomised, double-blind placebo-controlled single-centre trial. In addition to propofol and fentanyl anaesthesia, subjects were randomly assigned to receive a single dose of iv ketamine 0.5 mg/kg (ketamine group) or saline (control group). The main objective of this study was to analyse the total mood score between the two groups by using the Profile of Mood States (POMS) questionnaire performed before and 120 min after the procedure and to evaluate the impact of menstrual status and obesity on the total mood score among patients in the ketamine and control groups, as well as in the entire study group separately. Pain, haemodynamic changes, sedation levels, and adverse medication effects were all studied as secondary outcomes. Results After surgery, both the ketamine and control groups showed a statistically significant decline in the total mood scores, although there were no apparent differences between the groups. Separate multiple linear regression analyses among ketamine group patients revealed that the presence of obesity was inversely related to total mood scores after surgery. Conclusions Our study showed that compared with the patients in the control group, a single subanaesthetic intravenous dosage of ketamine did not improve the total mood scores of patients in the ketamine group, as measured by the POMS questionnaire. On the other hand, obesity was an independent predictor of improvement in total mood scores among patients who received 0.5 mg/kg ketamine. Further studies are needed to evaluate the relationship between ketamine, obesity and patients’ emotional recovery after surgery. Trial registration This randomised controlled double-blind trial was retrospectively registered at ClinicalTrials.gov (trial number: NCT05752110; date of registration: 02/03/2023).

Introduction:Sedation of coronavirus disease-2019 (COVID-19) acute respiratory distress syndrome (ARDS) patients on mechanical ventilation (MV) has lately become a concern. The purpose of this study was to report the sedation strategy used in COVID-19 ARDS patients who were mechanically ventilated at a single institution.Methods:In this study, we performed a retrospective review of the sedation strategy in mechanically ventilated COVID-19 ARDS patients in our 37-bed intensive care unit. All mechanically ventilated COVID-19 ARDS patients who were sedated and hospitalized between March 2020 and September 2021 were included in this study. Patients reported using sedatives and analgesics as well as suffering from delirium.Results:This study involved 100 patients with COVID-19 ARDS who were both eligible to participate. In all patients, a triple sedation regimen was required. Ketamine attitudes reduced patients’ opioid and benzodiazepine needs (p<0.05). Furthermore, the following ketamine administration, the need for vasopressors was significantly reduced (p<0.05). There were no drug interactions documented.Conclusion:We showed that extremely high sedative doses were required in this group of patients with COVID-19 ARDS who needed MV. However, our findings suggest that when ketamine infusion was introduced, benzodiazepine, opiate, and vasopressor doses were reduced without adverse pharmacological effects. Further research will be required to determine appropriate dosing regimens.

Acute kindney injury (AKI) is a clinical syndrome which is generally defined as an abrupt decline in glomerular filtration rate, causing accumulation of nitrogenous products and rapid development of fluid, electrolyte and acid base disorders. In intensive care unit sepsis and septic shock are leading causes of AKI. Sepsis-induced AKI literally acts as a biologic indicator of clinical deterioration. AKI triggers variety of immune, inflammatory, metabolic and humoral patways; ultimately leading distant organ dysfunction and increases morbidity and mortality. Serial mesurements of creatinine and urine volume do not make it possible to diagnose AKI at early stages. Serum creatinine influenced by age, weight, hydration status and become apparent only when the kidneys have lost 50% of their function. For that reason we need new markers, and many biomarkers in the diagnosis of early AKI activity is assessed. Historically \"Risk-Injury-Failure-Loss-Endstage\" (RIFLE), \"Acute Kidney Injury Netwok\" (AKIN) and \"The Kidney Disease/ Improving Global Outcomes\" (KDIGO) classification systems are used for diagnosing easily in clinical practice and research and grading disease. Classifications including diagnostic criteria are formed for the identification of AKI. Neutrophil gelatinase associated lipocalin (NGAL), cystatin-C (Cys-C), kidney injury molecule-1 (KIM-1) and also \"cell cycle arrest\" molecules has been concerned for clinical use. In this review the pathophysiology of AKI, with the relationship of sepsis and the importance of early diagnosis of AKI is evaluated.

Introduction: Chronic obstructive pulmonary disease (COPD) is a worldwide public health challenge because it affects more than 5% of the population. Early identification of the patients at risk of severe disease or death gives the clinician the chance to initiate rapid and aggressive treatment, and thereby save lives. Methods: This was a single-center observational retrospective study. We included all patients aged ≥40 years admitted to the respiratory intensive care unit with a diagnosis of acute exacerbation of COPD (AECOPD) between January 2014 and December 2018. Co-morbidities, hemogram and biochemistry values, and inflammatory markers were evaluated in both survivor and non-survivor groups. Results were evluated with SPSS. Results: A total of 1,454 patients were assessed, 315 (21.6%) patients died during the hospital stay, and 1,139 (78.3%) patients were discharged. In the non-survivor group, mean white blood cell counts were higher than in survivors [14.1 (9.7-20.3), vs 11.8 (8.5-16.1), p<0.001]. However, the survivor group had significantly higher hemoglobin count [12.3 (10.6-14) vs 11.5 (9.8-13.2), p<0.001], lymphocyte % [6.9 (3.9-11.7) vs 5.2 (2.8-10.6), p=0.001], and eosinophil % [0.20 (0.00-0.90), vs 0.10 (0.00-0.60), p=0.001]. Additionally, C-reactive protein, and neutrophil to lymphocyte ratio were significantly lower in the survivor group on admission. Conclusion: The findings of the current study may provide crucial information on several variables associated with in-hospital mortality for AECOPD patients.

Ancillary tests can be used for the diagnosis of brain death in cases wherein uncertainty exists regarding the neurological examination and apnoea test cannot be performed. Transcranial Doppler ultrasonography (TCD) is a useful, valid, non-invasive, portable, and repeatable ancillary test for the confirmation of brain death. Despite its varying sensitivity and specificity rates with regard to the diagnosis of the brain death, its clinical use has steadily increased in the intensive care unit because of its numerous superior properties. The use of TCD as an ancillary test for the diagnosis of brain death and cerebral circulatory arrest is discussed in the current review.

Introduction: On admission to the intensive care unit (ICU), functional and general health stata are important baseline characteristics of critically ill patients with chronic obstructive pulmonary disease (COPD). The measurement of total psoas muscle area (PMA) is under investigation to determine physical frailty and sarcopenia, especially encountered in the elderly, to predict adverse outcomes and mortality in patients requiring inhospital and ICU management. We aimed to assess the clinical value of total PMA for the prediction of mortality in COPD patients requiring ICU management of acute exacerbations. Methods: The clinical data of 62 patients whose abdominal computed tomography (CT) scans were available in the hospital Picture Archiving Communication System were collected. The mean duration of stay in the ICU was 7.7±8.8 and 9.4±12.3 days in survivors and non-survivors. The main causes of mortality in non-survivors were respiratory failure and cardiac arrest. For measurements from CT scans, images of the caudal end of the third lumbar vertebra were used. Right and left PMAs were measured to obtain the total PMA and density. Results: Of 62 patients, 20 (32.2%) were non-survivors (male: 13, female: 7), and 42 were survivors (male: 32, female: 10). There was no significant difference between non-survivors and survivors regarding total PMA and density values (p>0.05). In non-survivors and survivors, females had lower total PMA (p<0.05). There was no significant association between clinical and PMA data (p>0.05). Conclusion: The total PMA lacks sufficient power to predict mortality in patients managed with acute exacerbations of COPD in intensive care settings. There is a need for further studies with different sets of findings to assess the contribution of physical frailty and sarcopenia to adverse outcomes in the ICU management of COPD patients.

Objective: Postoperative nausea and vomiting (PONV) is a common problem associated with general anaesthesia. The incidence can be as high as 80% in high-risk patients. Our primary objective was to compare the efficacy of the combination of dexamethasone-ondansetron and dexamethasone-aprepitant in patients undergoing laparoscopic surgery. Methods: Seventy 18 to 60 years old patients scheduled for laparoscopic surgery were included in the study. Sixty-seven patients completed the study. Patients in the dexamethasone-aprepitant group (group DA, n=35) received 40 mg of aprepitant orally 1-2 hours before the induction of anaesthesia and 2 mL saline intravenously (iv) within the last 30 minutes of surgery; patients in the dexamethasone-ondansetron group (group DO, n=35) received oral placebo identical to aprepitant 1-2 hours before the induction of anaesthesia and 4 mg ondansetron iv within the last 30 minutes of surgery. All patients received 8 mg dexamethasone iv after the induction of anaesthesia. The primary outcome was a complete response (no postoperative nausea, retching and vomiting and no need for rescue antiemetic); the secondary outcomes were the incidence of nausea, retching, vomiting, the need of rescue antiemetic and opioid consumption within 24 hours after surgery. Results: A complete response was not significantly different between the groups (group DO: 67%, DA: 69%) at 24 hours (p=0.93). The incidence of PONV and postoperative opioid consumption was similar between the groups. Conclusion: The study was designed to evaluate whether the combination of dexamethasone-aprepitant is better than the combination of dexamethasone-ondansetron regarding the complete response for PONV in patients undergoing laparoscopic surgery. The results however showed that dexamethasone-aprepitant has not improved the complete response for PONV compared to dexamethasone-ondansetron.