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Introduction: Sensory stimulation of comatos patients is an important nursing intervention for increasing their LOC and tactile stimulation especially massage is one of the most important stimulations. The nurse as a person, who is responsible for this, must know the effects of this intervention on patients. But there are some conflicts about this intervention's effects especially on vital signs (pulse, blood pressure and respiration). This study was done to determine the effect of massage on comatos patient's vital signs who were hospitalized in intensive care unit. Materials and Methods: This study is a clinical trial. Samples were consisted of 100 comatos patients, divided into two equal groups randomly. The two groups were matched in age, geneder and glascow coma scale. Samples in experimental group received 20 minutes massage on their back, feet and hands in three continuous days. Vital signs in experimental group were measured before and immediately after intervention and vital signs in control group were measured at the same time with experimental group. A check list used was used for collecting data. Data was analyzed using descriptive and analytic statistics (T, paired T and Chi-square tests). Results: Findings showed that massage decreased vital signs significantly as followed: pulse rate and diastolic blood pressure in each three days (p<0.05), systolic blood pressure in first and third days (p<0.05), respiration rate in second day (p<0.05). Conclusion: This study showed that massage can decrease comatos patients' vital signs which can be the indicator of their relaxation and decreasing stress.

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Introduction:Decubitus ulcer is a pressure-induced tissue injury that may affect skin, muscle, connective tissue, cartilage and bone. The present study was designed to find out risk factors of decubitus ulcer in head and spinal cord injured patient admitted to intensive care units (ICU). Materials and Methods: In this cross - seetional analythical study all consecutive craniospinal trauma patients admitted to intensive care unit were included.Upon arrival at the hospital and every 48 hours, all patients were examined for existence of bed sore. Braden scale, age, kind of mattress, site of primary injury and level of consciousness were used to determine risk factors. Data was analyzed using T and Chi square tests and logistic regretion. Results: Among 198 patients (171 male, 27 female with mean age of 31.4=19.8), 166 patients (3.8%) had cranial and 32 (16.2%) patients had spinal trauma. Of samples, 45 (22.7%) patients had 67 sores in 13 different sites. Incidence of bed sore was 22.7% (in cranial and spinal injured patients was 4.54% and 18.18% respectively). The most common sites were intergluteal cleft (33.3%) and sacral regions (28.9%). Bed sores were observed more frequently in immobile patients and those with impaired sensation, the difference were statistically significant (p<0.005 and p<0.005 respectively) hence immobility and impaired sensation are known as risk factors. Patient’s sores were not influenced by age, moisture, activity, nutrition and type of mattress variables. Time of hospital stay in patients with bed sore was significantly more than those without bed sore (P<0.00001). Coma patients (GCS 8) had developed bed sore more frequently than conscious ones (OR=6.1, RR=4.4, P=0.00001). Conclusion: Results show that risk factors of deubitus ulcers in ICU admitted craniospinal trauma patients were decreased sensation, activity and level of conciousness and lenglt of hospital stay.

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Introduction: It is well recognized that hearing is critical to speech and language development, communication, and learning. Otoacoustic emission (OAE) is an efficient and sensitive method to identify subjects at risk for auditory impairment. Infants who require admission to neonatal intensive care unit are reported to be at 10-20 times greater risk for hearing impairment. The porpuse of this study was to investigate the incidence of hearing impairment in neonates screened by OAE. Materials and Methods: In a cross-sectional study, 148 newborns having risk factors for hearing impairment reffering to Taleghani hospital of Arak and Aboozar hospital of Ahwaz were evaluated. All clients had normal otoscopic findings. Transient evoked (TEOAE) and distortion-product otoacoustic emissions (DPOAEs) were measured in both ears. If the results of otoacoustic emissions were not normal, these tests were repeated one month later. Patients who did not pass the second stage were reffered for comprehensive auditory evaluations. Data analysis was performed using Kolmogrov-Smirnov and t-tests. Results: 41 and 28 cases could not pass the examining test at the first TEOAE and DPOAE examination, respectively. Also, 23 and 16 cases did not pass the examining test at the second TEOAE and DPOAE evaluations, respectively. These participants underwent auditory brainstem response evaluation and 11 of them had abnormal responses. In 5 cases of confirmed ones, hearing impairment was due to aminoglycoside side effects. Conclusion: OAE hearing screening of at-risk newborns is a clinically beneficial approach to early detection of hearing impairment. Regarding the high prevalence of hearing loss in our subjects (7.43%), prevention of its complications is highly recommended in this population.

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Introduction: Homocysteinemia is currently regarded as an independent risk factor in venous thrombosis and vascular diseases. So noticing its causes and risk factors in high risk populations, such as elderly and chronically ill patients is of much importance. This research is designed, considering the important role of homocysteinemia and the lack of statistics and adequate information about the prevalence of this disease among hospitalized patients in Intensive Care Unit (ICU). Materials and Methods: The is a descriptive, cross-sectional study, done by census sampling method on patients admitted in ICU of Rasoul-Akram hospital, during a 6 months period. Epidemiologic data was collected from the patients' files. A blood sample was taken from the patient to measure homocysteine level. Data was introduced using descriptive statistics. Results: 52 patients with the mean age of 58.42 were included in this study. Among these, 12 (23.1%) had a high homocysteine level and the other 40 patients (76.9%) had a normal range of homocysteine. The mean homocysteine level in patients with normal levels was 9.28(3.08-15.48) micromol/dl and the mean in patients with homocysteinemia was 21.05(11.05-31.05). Among patients with homocysteinemia, 25% had renal failure and 25% were presented with cerebrovascular accident (CVA). There was no significant difference between homocystein level in patients with renal failure and those with CVA. Conclusion: According to the 23.1% frequency of hyperhomocysteinemia in hospitalized patients of our study, also considering the Folate and vitamin B6 and B12 role in homocysteinemia, and also due to previous epidemiologic studies, it seems that evaluating Folate, vitamin B6 and B12, creatinine clearance and plasma albumin level may clarify the role of these factors as the probable predictive factor in patients with homocysteinemia

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Background: Recognition of mortality-related factors in Intensive Care Units (ICUs) could increase efficiency and effectiveness of these units. This research determined the relationship between the physical structure, human resources and their relevance to mortality rate in Intensive Care Units. Methods and Materials: In this cross-sectional study, all ICUs of hospitals in Markazi province were considered. Data gathering tools were resource (human, physical and training) questionnaires and checklists which their reliability and validity were accepted by Monitoring and Validation Center of Ministry of Health. Mortality rate after 24 hours of admition was also determined in relation to hospital resources and activities. Data were analyzed with descriptive statistics, Spearman and Kruskal-Wallis tests. Results: Total score of human, physical and training resources in hospitals of Markazi Province is 55 percent of the country standard score. Mortality ratio after 24 hours of admission, to all patients (released and deceased patients) was highest in Vali-e-Asr hospital (25%) and lowest in Saveh Shahid Chamran Hospital (5%). There wasn’t significant difference in this ratio among hospitals. There were no significant difference between obtained scores of each resource (human, physical and training) among University, Social Insurance and Qods (private) hospitals with respect to mortality rate 24 hours of admission. Conclusion: Human, physical and training resources have not direct effect on decreasing mortality rate after 24 hours of admission but can create necessary conditions for providing higher quality services.

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Background: Hospitalization of a child in pediatric intensive care unit (PICU) is a very stressful experience for parents. High stress in father can product decline in psychological adaptation and associated problems. The present study aimed to determine effect of fathersʼ participation in the care of hospitalized child in PICU on fathersʼ stress and coping strategies.

Materials and Methods: This is a clinical trial with 60 fathers with children admitted to the PICU in intervention and control groups. Fathers in intervention group, participated in the care of the child in 5 times, during a 5-days course. Fathersʼ stress and coping strategies were surveyed in intervention group before and after participation course and in control group before and after a 5-days course.

Results: Fathersʼ stress in intervention group decreased significantly after participation (p˂0.001) but in control group difference was not significant after time course. Fathers in both groups applied similar coping strategies that majority were emotion focused.

Conclusion: Fathers having children in PICU would experience a lot of stress. Their participation in the care of the children would be very effective to decline their stress and reach most adaptation with disease, cure and cares in children.

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Background: The main purpose of this study was to measure the level of lipids in ICU patients and its clinical outcome, specially the mortality rate and the relationship between level of lipids and APACHE IV score.

Materials and Methods: This descriptive and cross-sectional study was conducted on 100 ICU patients. Cholesterol level was measured on the first and second days after admission of patients. This was followed by examination of clinical outcome (e.g. mortality rate) and duration of their real and predicted stay through APACHI IV. The results were analyzed by Pearson correlation using SPSS.

Results: Mean serum of HDL, LDL, and cholesterol was lower than normal. These values for the first day were 33.16, 67.97, and 131.38 and for the second day were 23.63, 54.99, and 119.88, respectively. Mean APACH E IV score was 67.72. Result of Pearson correlation coefficient showed significant relationship (p<0.05) between APACHI IV score and cholesterol level of the first and second day, LDL level of the first and second day, HDL level of the second day. Moreover, there were significant relationships were observed between the real mortality rate and the cholesterol level of the first and second days, LDL level of the first and second days, and HDL level of the first day. There was a significant significant correlation between cholesterol level and LDL of the first and second days as well as HDL of the first day and duration of admission in ICU as predicted by APACHI IV.

Conclusion: The significant relationship between lipoprotein level of serum and APACHI IV indicates considering serum lipid beside other physiologic parameters for prediction of clinical consequences including mortality rate of ICU patients

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Background: Reducing the duration of the effect of sedatives and increasing their quality is one of the tasks of ICU staff. The aim of this study is to compare the sedative effects of these medications on neurosurgery patients under mechanical ventilation.

Materials and Methods: In this double-blind clinical trial, 70 patients requiring mechanical ventilation in neurosurgery ICU were enrolled. Patients were randomly assigned to one of remifentanil or fentanyl groups. The first group received 0.05 µg/kg/min remifentanil and the second group received 1 µg/kg/hr fentanyl infusion for sedation and analgesia in the first 24 hours. Sedation score, Minogue scale and hemodynamic parameters were evaluated throughout the study and at regular intervals. 

Results: There was no significant statistical difference in demographic variables such as age, sex, and body weight between two groups. The results of this study showed a significant difference in sedation score (p=0.0001) and Minogue scale (p=0.0001) and both variables were lower in remifentanil group. Also, heart rate (p=0.011) and mean arterial blood pressure (p=0.007) were significantly higher in fentanyl group.

Conclusion: Generally, sedative effect of remifentanil has several relative advantages over older medication of fentanyl and causes more effective sedation and better control of hemodynamic parameters in patients under mechanical ventilation.

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Abstract

Background: Probiotics are known as a factor for prevention of infectious diseases such as urinary tract infection(UTI). The present study aimed to investigate the positive effects of probiotics on urinery truct infection of cateterized intensive care unit patients.

Materials and Methods: In a triple blind clinical trial, 125 cateterized intensive care unit patients were randomly selected and divided into two groups, Treatment group (n = 63) was well matched with placebo group (n = 62) for age and sex and duration of admission .Case group received one lactocare capsule for 10 days and control group with a same method received placebo for 10 days. In both groups urine analysis and urine culture were measured with a same method at the first day and then twentieth day and finally data were analysed with t-test.

Results: The incidence of urinary tract infection between treatment and control group (respectively 17.4% and 22.5%) had no statistically significant difference (p=0.672). But, in terms of sex, incidence of urinary tract infections in women compared to men with the same condition was significantly different(p=0.002). In treatment group with long term cathetrization, urinary tract infections significantly were significantly different(p=0.041).

Conclusion: Administration of lactocare capsule has no statistically significant impact on the incidence of urinery truct infection of cateterized intensive care unit patients. In comparsion of cateterized men and women receiving probiotics, the reduction of urinary tract infection in women was more than in men. Probiotics had preventive effects on long term catheterization.

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Abstract

Background: Ventilator-associated pneumonia (VAP) is one of the most important causes of mortality in intubated traumatic patients admitted in ICU. The aim of current study was to determine correlation between blood products transfusion with incidence of VAP in traumatic patients under mechanical ventilation in ICU.

Materials and Methods: This study was a prospective descriptive-analytical study. Current study was carried out on traumatic patients under mechanical ventilation admitted to Imam Khomeini hospital ICU wards of Sari city, from September 2015 to September 2016. In addition to demographic data, patients' clinical information were daily recorded.

Results: Of total of 2304 patients admitted to ICU, 186 traumatic patients under mechanical ventilation longer than 48 hours were reviewed and analyzed. Among patients infected with VAP, 36 persons(87.8%) had transfusion of blood products before VAP incidence. Blood products transfusion (before and / or after 48 hours) had the highest adjusted risk ratio in the incidence of VAP (Odds ratio; OR=3.58). Also, amount of injected Packed Red Blood Cells and platelet were significantly higher in patients infected with VAP (p<0.005).

Conclusion: Considering remarkable increase in incidence of VAP following blood products transfusion and its correlation with injected PRBC and platelet, considering these modifiable risk factors for controlling and preventing the incidence of VAP in traumatic patients under mechanical ventilation in ICU is necessary and reasonable.