Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 2 2020 05 04 58 59 EN Omid Azimaraghi Department of Anesthesiology and Critical Care Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Noushin Khazaei Department of Anesthesiology and Critical Care Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Ali Movafegh Department of Anesthesiology and Critical Care Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2019 08 21 2019 10 06 No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/252

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 2 2020 05 04 60 64 Masoum Khoshfetrat Department of Anesthesiology and Critical Care, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. Majid Khorram Department of Anesthesiology and Critical Care, Shariati Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Aliakbar Keykha Faculty of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran. Hossein Ansari Health Promotion Research Center, Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran. 2019 07 23 2020 02 02 Background: The use of subcutaneous enoxaparin is a usual method for preventing venous thromboembolism (VTE) in the intensive care unit (ICU) patients, but adequate absorption of the drug is not reliable due to the illness intensity, existing edema and hypoperfusion in these patients. The aim of this study was to compare the effect of intravenous enoxaparin with subcutaneous enoxaparin to prevent VTE in ICU patients. Methods: The current double-blind Randomized clinical trial was performed on 64 patients admitted to the ICU at Khatam- Al- Anbia Hospital in Zahedan, southeast of Iran. The patients were randomly assigned into each of the subcutaneous enoxaparin and the intravenous enoxaparin groups. The blood sampling was performed aseptically and then active factor Xa level was measured. Next, the intervention group received 0.5 mg/kg of intravenous enoxaparin for 10 days and the control group was injected subcutaneously the same dosage of drug. Four hours after the first injection and 12 hours after the last injection on the tenth day, the factor Xa level and the frequency of VTE incidence was measured again. Results: In all three measurement times, the active factor Xa level in the intravenous enoxaparin group was lower than that of the subcutaneous group, but no significant difference was observed between the two groups and different times (P> 0.05). Conclusion: The results of this study showed that the use of intravenous enoxaparin is an effective way to prevent the VTE development in the ICU patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/246

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 2 2020 05 04 65 70 Prathima Padavarahalli Thammanna Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore-560054, India. Kavya Marasandra Seetharam Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore-560054, India. Tejesh Channasandra Anandaswamy Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore-560054, India. Prapti Rath Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore-560054, India. Geetha Chamanhalli Rajappa Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore-560054, India. Jancy Joseph Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore-560054, India. 2020 02 22 2020 04 11 Background: Videolaryngoscopes are now being advocated as the universal device for airway management due to their ability to provide an improved glottic visualisation. Due to their ability to see around the corners, they obviate the need to align the airway axes and thus may lead to less airway stimulation. This may result in less haemodynamic response during laryngoscopy and intubation. The present study was designed to compare the haemodynamic response to intubation with King Vision and C-MAC® videolaryngoscopes. Methods: After obtaining informed consent, adults with unanticipated difficult intubation, scheduled to undergo surgery under general anaesthesia were randomised to be intubated with either King Vision (Group K) or C-MAC® (Group C) videolaryngoscope. Following a standardised general anaesthesia induction protocol all subjects were intubated with the allocated videolaryngoscope and haemodynamic parameters (heart rate, systolic pressure, diastolic pressure and mean arterial pressure) were recorded at specific time points. Statistical analysis was done using the SPSS Software (version 18.0). Results: The changes in the heart rate, systolic pressure, diastolic pressure and mean arterial pressure following laryngoscopy and intubation with the allocated videolaryngoscope were statistically similar between the two groups at all time points. Conclusion: Haemodynamic responses to laryngoscopy and intubation with King Vision and C-MAC® videolaryngoscopes were similar. https://aacc.tums.ac.ir/index.php/aacc/article/view/282

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 2 2020 05 04 71 77 Ali Ahmadzadeh Amiri Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Kasra Karvandian Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mojgan Rahimi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ashouri Department of General Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Amir Ahmadzadeh Amiri Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. 2020 01 04 2020 04 06 Background: Two major complications of surgeries are postoperative nausea and vomiting (PONV) and also postoperative pain (POP). Several studies have compared total intravenous anesthesia (TIVA) with inhalational anesthesia regarding these two complications. Some results have shown a better postoperative recovery conditions, but other contradictory results can also be found.This study was performed to evaluate and compare the effect of inhalational and intravenous anesthesia in patients undergoing elective laparoscopic surgery, on the incidence and the severity of PONV and POP. Methods: This study was performed as a single-blinded prospective clinical trial. All patients aged 18-65, with ASA class I and II who underwent elective laparoscopy were included. Patients were divided into two groups of intravenous anesthesia and inhalational anesthesia. The incidence and the severity of PONV and POP were examined in 5 separated times after the surgery. The use of a rescue antiemetic and analgesic medication were also evaluated. Results: Overall, 67 patients received inhalational anesthesia and 55 patients received intravenous anesthesia. It was revealed that 47.8% of the patients in the inhalation group and 18.2% of the patients in the intravenous group developed PONV (P<0.001). The severity of PONV was significantly lower in the TIVA group (P<0.001), however, no statistically significant difference was found regarding the severity of abdominal pain (P=0.62). Conclusion: The incidence of PONV and the need for administration of an antiemetic rescue drug are significantly lower in the TIVA group. https://aacc.tums.ac.ir/index.php/aacc/article/view/273

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 2 2020 05 04 78 82 Omid Azimaraghi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Arash Heroabadi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Alireza Saliminia Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Reza Atefyekta Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Peyman Saberian Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hojat Dehghanbanadaki Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran. Noushin Khazaei Department of Anesthesiology and Critical Care Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ali Movafegh Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2019 10 25 2019 12 18 Background: Goal-directed fluid therapy may improve perioperative fluid management. This study aimed to evaluate the effects of Pleth variability index (PVI)-guided fluid therapy on changes in intraoperative serum lactate levels in comparison with liberal fluid therapy. Methods: This study was a randomized double-blinded clinical trial that was conducted in the operating room of a university hospital. Inclusion criteria comprised patients aged 18–60 years and classified as American Society of Anesthesiologists physical status class I and II, who were candidates for elective thyroidectomy. In total, 44 patients meeting the inclusion criteria were enrolled in the study and randomly assigned to two groups: the liberal and PVI groups. In both groups, 5 mL/kg bolus of normal saline was infused prior to the anesthesia induction. In the PVI group, 100 mL bolus of normal saline was administered every 5 min if the PVI remained >13% during the operation. In the liberal group, continuous crystalloid infusion (5–6 mL/kg/h) was administered throughout the surgery. Arterial blood samples were taken, and serum lactate levels were measured following anesthesia induction and just before tracheal extubation. Results: In the PVI group, mean serum lactate decreased at the end of the surgery, with a difference of −0.6 ± 0.13 mmol/L, whereas it increased in the liberal group (0.070 ± 0.3, P<0.05). Conclusion: In conclusion, we found that using intraoperative PVI-guided fluid therapy could decrease serum lactate levels and total fluid administration compared to the liberal method. https://aacc.tums.ac.ir/index.php/aacc/article/view/267

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 2 2020 05 04 83 88 Masoum Khoshfetrat Department of Anesthesiology and Critical Care, Khatam-Al-Anbiya Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. Aliakbar Keykha Mashhad University of Medical Sciences, Mashhad, Iran. Saman Nasrolahi Department of Anesthesiology and Critical Care, Khatam-Al-Anbiya Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. Reza Farahmandrad Department of Anesthesiology and Critical Care, Iran University of Medical Sciences, Tehran, Iran. Mohammad Behnampour Students Research Committee, Zahedan University of Medical Sciences, Zahedan, Iran. 2019 08 29 2019 09 15 Background: For patients with prolonged bed rest and immobilization because of motor or consciousness disorders, many factors may contribute to the development of pressure ulcers. To this end, the present study aimed to investigate the frequency of pressure ulcers and the factors affecting the development of this condition in intensive care units (ICUs). Methods: In this descriptive cross-sectional study, the case files and records of patients hospitalized between March 2017 and March 2018 entered the study using the census method. The necessary information including age, gender, location of pressure ulcers, number of ulcers on each part of the body, length of stay in ICU, and underlying diseases was extracted from the files and recorded in the data checklist. In the end, the extracted data were analyzed with SPSS 25. Results: Of the 781 patients studied, 71 (9.1%) had pressure ulcers, of whom 34 were men and 37 were women. A statistically significant difference was found between men and women in terms of the incidence of pressure ulcer (p = 0.0013). The most common sites of pressure ulcers were buttock with 34 cases (47.9%) and sacrum with 21 cases (29.6%). Conclusion: Old age and prolonged stay in ICU are important determinants of the development of pressure ulcers. https://aacc.tums.ac.ir/index.php/aacc/article/view/257

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 2 2020 05 04 89 102 Khosro Barkhordari Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Zahid Hussain Khan Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Akbar Shafiee Department of Cardiovascular Research, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2019 10 12 2019 12 18 Acute cardiogenic pulmonary edema (ACPE) is a common and life-threatening condition among patients with heart failure. The literature contains a large number of reviews discussing the respiratory management aspect of this entity; nonetheless, none of these studies has thoroughly probersity, Tehran, Iran Mohammad Mehdi Sepehri Professor of Healthcare Systems Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran 2019 08 22 2019 09 25 Background: Quality of Intensive care has got more attention in case of the high cost of healthcare and the potential for harm. Poor-quality care causes high cost and quality improvement initiatives in the ICU lead to an improvement in outcomes as well as a decrease in costs. One of the crucial tools that allow physicians and nurses to monitor change in a quality improvement effort is the development of an electronic database for data collection and reporting. The objective of Intensive Care Registries is to create a high-quality registry of patients through a collaboration of academic health centers performing uniform data collection with the purpose of improving the quality and accuracy of healthcare decisions and provide a data-driven clinical decision support system for critical care medicine. Methods: This article reviews real-world data sources in healthcare and considers registry as the main tool to address health services and outcomes research questions in critical care, and briefly describes objective, inputs and outputs of intensive care registries. As it can be comprehended from library research, the combination of patient clinical care data, quality parameters, and ICU operating costs, integrated into an electronic database, provides a valuable tool for quality improvement and overall efficiency of offered care. Results: Using Big Data effectively within ICUs for supporting clinical decision making can lead to predict numerous diseases and help to discover new patterns in healthcare. The ability to process multiple high-speed clinical data streams from multiple centers could dramatically improve both healthcare efficiency and patient outcomes. Conclusion: To gain this goal, developing reliable and standardized health analytics platforms as well as quality improvement processes that translate analytical results into new clinical guidelines, is recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/253

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 1 2019 12 30 41 49 EN Abbas Heydari Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Aliakbar Keykha Mashhad University of Medical Sciences, Mashhad, Iran. 2019 07 23 2019 09 15 Background: With regard to critical illness and stress, medication side effects, decreased appetite, and increased nausea and vomiting; patients admitted to intensive care units (ICUs) are at particular risk of malnutrition. Feeding behavior i.e. time and method in these patients has still remained as an unresolved issue. Thus; enteral and parenteral nutrition, with their own benefits and complications, are two commonly used methods for such individuals. The present systematic review was to compare the effects of enteral and parenteral nutrition in patients admitted to ICUs. Methods: This systematic review investigated a total number of 1642 articles on nutrition methods in ICU patients during 2010-2019 using keywords of “enteral nutrition, parenteral nutrition solutions, parenteral nutrition, critical care outcomes, critical illness, intensive care unit, and ICU” in the databases of SID, Iranmedex, MEDLIB-ED, PubMed, Scopus, Medline, Embase, Cochrane, Web of Science, and Google Scholar; and finally, 15 articles were analyzed in relation to the research objectives. Results: Studies indicated that patient mortality was not different in enteral and parenteral nutrition groups. The incidence rate of infectious complications was also reported higher in parenteral nutrition group. However, there was no significant difference in the incidence rate of infections in studies meeting total standards for parenteral nutrition. Besides, there was no significant difference between the duration of undergoing mechanical ventilation and hospitalization time in both groups. Furthermore, the incidence rate of hypoglycemia was higher in enteral nutrition group; but serum protein levels had much better status compared with those in parenteral nutrition group. Conclusion: If standards for infusion are observed and provided that rates of infectious complications are reduced, patients can benefit from starting parenteral nutrition immediately after admission to ICUs in the absence of enteral method. https://aacc.tums.ac.ir/index.php/aacc/article/view/245

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 1 2019 12 30 50 52 Girish Singh Department of Anesthesiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, India Ankita Kabi