Evaluation of an arterial blood sampling device and its function in accelerating and facilitating blood sampling

Background: Arterial blood sampling is among the basic standards in critically ill patients. The aim of this study was to examine an inventive sampling device in facilitating arterial blood sampling in comparison to the conventional method using an insulin syringe.Methods and materials: This randomized interventional clinical trial was performed on 100 patients admitted to Qaem and Imam Reza Hospitals in Mashhad in 2016 for whom two arterial blood gas (ABG) samples were indicated. The patients were randomly selected by the visiting operator on a daily basis. The operator visited the hospital on certain days and took two samples from the selected patients.Results: The patients' mean age was 45.31±16.15 years. In the insulin syringe group, venous blood gas sampling was in 24% and arterial sample in 76%. In the designed device group, same figures were 12.1% and 87.9%, respectively. Sampling score (p=0.01), unsuccessful attempts with and without needle removal from the skin (p=0.01), and need for vertical and horizontal needle displacement for sampling (p=0.01) were significantly differed between the two groups. Localized swelling score and its size, localized bruising, palpable arterial spasm and the spasm duration was significantly less for the inventive device (p<0.05). Satisfaction score of patients and operator were significantly higher in the device group (p=0.01).Conclusion: The study device had desirable function in facilitating and accelerating arterial blood sampling. Its application can be further approved by future studies.Keywords: Arterial blood sampling, Facilitated sampling, Accelerated sampling, Intensive Care Uni

Prognosis of patients with severe burns based on plasma base excess and serum lactate level and comparison with ABSI

Background and Aim: This study was aimed to evaluate the prognosis of patients with severe burns by measuring the plasma base excess and serum lactate levels and comparing it with the ABSI scoring system as an important indicator in the resuscitation of burn patients.Methods: This prospective cohort study was performed on all patients hospitalized in the burn ward of the hospital. The demographic data and ABSI scoring of all patients were recorded. Patients' clinical information and routine tests, gasometry (for measuring plasma base excess) and serum lactate levels were measured at the time of admission, 12 hours, and 24 hours after admission.Results: A total of 311 burning patients were evaluated in this study. Mann-Whitney test showed a significant difference in the mean plasma BE1 (at the time of admission) and BE2 (24 hours after admission) between the patients who were discharged and the patients who died (P <0.001). The results indicated a difference in the process of lactate changes between two groups of patients in terms of intensity of ABSI(P <0.001). The multivariate logistic regression with the entry of BE and lactate at the time of admission and ABSI as predictive variables indicated a significant BE and ABSI.Conclusion: The results of this study confirmed that the plasma base excess can be used as a valuable tool in the monitoring of burn patients' resuscitation along with clinical criteria. On the other hand, the ABSI scoring system is still a valuable tool to predict the deaths of burn patients

Evaluate the Therapeutic Effect of Allicin (L-cysteine) on Clinical Presentation and Prognosis in Patients with COVID-19

The antiviral effectiveness of allicin (L-cysteine) has been shown by numerous studies in both levels of clinical and animals. The aim of this study was to evaluate the therapeutic effect of allicin (L-cysteine) on clinical presentation and prognosis. In the current study, 66 patients with COVID-19 based on clinical, radiological presentations and RT-PCR results, were enrolled in two groups of placebo and allicin. In the both allicin (L-cysteine) and placebo groups (n=33 in each group), the capsules were prescribed two times a day for two weeks. Clinical signs and symptoms, blood parameters and chest CT scan were evaluated before and two weeks after treatment. The results showed that allicin (L-cysteine) could significantly impact on improvement of signs and symptoms of COVID-19 after two weeks of treatment in comparison to placebo. Allicin (L-cysteine) not only improve the clinical signs, but also ameliorate the lab and radiological data, which suggest a therapeutic effect for this agent in COVID-19. Our data suggest the therapeutic effect of allicin (L-cysteine) on COVID-19 through improvement of clinical symptoms and acceleration of the healing process

The effect of proton-pump inhibitors on development of arrhythmia and hypomagnesaemia after off-pump coronary artery bypass surgery

Introduction: Long-term use of proton-pump inhibitors (PPI) can result in hypomagnesaemia and arrhythmia.The aim of this study was to compare the effect of PPI and histamine 2-receptor antagonists (H2RA) on the incidence of hypomagnesaemia and arrhythmia in patients following off-pump coronary artery bypass surgery (CABG).Method: In this randomized-controlled clinical trial 290 patients admitted ICU after off-pump CABG were randomly divided into two groups of H2RA (n=145) and PPI (n=145).For patients in the H2RA group, 50 mg intravenous ranitidine was prescribed every 8hrs after during the nothing by mouth (NPO) period followed by 40mg famotidine tablet after starting the oral regimen (PO). The PPI group received 40 mg pantozol IV injections every 12 hrs during the NPO period and 40mg pantozol tablets once daily after becoming PO.The patients were investigated for development of hypomagnesaemia and associated arrhythmia.Results: In total 271 patients with the mean age of 59.3±10 yrs completed the study (female/male=32.8%). Hypomagnesaemia occurred in 60.1% of the patients; 76 (56.7%) in the H2RA group and 87 (63.5%) in the PPI group (P=0.245) whereas arrhythmia had a prevalence of 12 (9.6%) and 15 (11.1%), respectively (P=0.690). The mean time of occurrence of hypomagnesaemia and arrhythmia were 1.75±1.08 and 3.0±0.9 days after the operation in the H2RA group and 1.47±0.7 and 2.9±1.5 days in the PPI group, respectively (P=0.111 and P=0.897).Conclusion: Our study revealed that the short-term use of PPIs does not result in higher rates of hypomagnesaemia and associated arrhythmia in comparison to H2RAs after off-pump CABG

Stress-Related Mucosal Disease in Critically Ill Patients

Mucosal damage in Gastro Intestinal (GI) system happens due to stress and is more common in upper part of GI tract in patients admitted to Intensive Care Unit (ICU). This kind of injuries occurs in critically ill patients. Stress ulcer prophylaxis is necessary and increases the gastric (Power of Hydrogen) pH (more than 4) especially in stress exposure time. In this paper we provide an overview of stress ulcer and currently used preventive approaches for this complication in critically ill patients in ICU. Recent promotion in ICU care and increase in scientific knowledge about Stress-Related Mucosal Disease (SRMD) risk factors help us to reduce the number of patients develop stress ulcer. Prophylaxis can prevent significant bleeding and mortality

Effect of intravenous magnesium on postoperative pain control for major abdominal surgery: a randomized double-blinded study

Background This study aimed to evaluate the postoperative analgesic effect of magnesium sulfate during abdominal surgery. Methods This randomized double-blinded study involved 84 patients candidates for abdominal surgery into two same groups. In the magnesium group, at first 25 mg/kg/1 h magnesium sulfate; and then, 100 mg/kg/24 h was infused in the intensive care unit. The pain intensity (the primary outcome), was assessed using the numeric rating scale (NRS) every 3 h. If the NRS was > 3, morphine (as a secondary outcome) was used and evaluated. The results were analyzed using SPSS ver. 19 software, and statistical significance was set at P < 0.05 Results Demographic parameters were similar between the groups. The pain intensity were similar at first and then at the third hour in both groups (P = 0.393 and P = 0.172, respectively), but thereafter between 6 and 24 h, the pain severity was significantly lower in the magnesium group (4.4 ± 1.3 in the control and 3.34 ± 1 in the magnesium group at 6th hour and P = 0.001). In addition, morphine intake in the first 24 h in the two groups had a significant difference, with 13.2 ± 5.7 mg in control group and 8 ± 3.5 mg in magnesium group (P = 0.001). Conclusions In this study, intravenous magnesium sulfate after abdominal surgeries for 24 h resolved the pain intensity after six hours and reduced morphine dosage

Comparison of Patient-Controlled Analgesia Using Morphine With and Without Paracetamol in Postoperative Pain Control

Introduction: Postoperative pain control plays a pivotal role in reducing postoperative complications, hospitality time, and increasing satisfaction. This study aimed to evaluate the effect of paracetamol on the pain and complications caused by gastrectomy. Materials and Methods: This randomized prospective study was conducted on 60 patients (two same group) who were candidate for gastrectomy in Imam Reza Hospital of Mashhad, Iran during August-September 2015. The first group received Patient-Controlled Analgesia (PCA) with morphine only, and in the second group, paracetamol (1 gram) infused with morphine every six hours. Level of pain, morphine intake, and side effects were evaluated in both groups. Results:No significant difference was observed in the four-scale score of pain in the patients (morphine group: 0.64±0.1, morphine-paracetamol group: 0.6±0.1) (P=0.72). During the first 24 hours after the surgery, the morphine group had lower consciousness level (2.3±0.2) compared to the morphine-paracetamol group (1.7±0.3) (P=0.001). Moreover, infusion of paracetamol with morphine to control the pain after gastrectomy reduced the need for morphine analgesia. Morphine intake was 21.4±7.7 in morphine group, while it was 14.3±5.8 in the morphine-paracetamol group within the first 24 hours after the surgery (P=0.001). However, this level had no significant effect on postoperative complications such as itching, nausea, and arterial oxygen saturation. Conclusion: According to the results of this study, intravenous paracetamol (one gram) administered every six hours with PCA using morphine could decrease morphine intake leading to better consciousness level during the first 24 hours after gastrectomy without further complications

The Effect of ringer Lactate as the Priming Solution of the Cardiopulmonary by Pass Circuit on Plasma Potassium Levels after Open Heart Surgery in Children

Background: Conduct of cardiopulmonary bypass (CPB) due to the higher volume of priming solution in comparison to the total blood volume in children requires careful consideration. Recently attention has been focused on the potential risk of hyperkalemia in these patients. Given its significant effects on cardiac rhythm, hyperkalemia is considered a medical emergency. In this cross-sectional study we aimed to determine the changes in K+ and other electrolytes following CPB in a pediatric cardiac surgery setting. Method: Sixty children scheduled for pediatric cardiac surgery weighing more than 5 kilograms with Hct level above 30% were enrolled. The prime solution used was Ringer-lactate. Venous blood were collected at defined time points: before, during and after CPB and at discharge. A p-value of less than 0.05 was considered statistically significant. Results: Mean age of the studied patients was 3.69±2.77 years. A rise in potassium levels during surgery was recorded. Also a significant difference in the potassium levels before surgery and at discharge were observed (p=0.007). A significant drop and a subsequent rise in the Hct level was seen overtime whereas a significant decrease in the PH and bicarbonate levels were detected. 31 experienced cardiac arrhythmia after undergoing CPB. Conclusion: A K+-free crystalloid that will offset the K+ load of stored blood is highly anticipated in these patient

Evaluation of the Effect of Amino Acid Administration on Hypothermia during General Anesthesia in Hypospadias Surgery on Children Aged 2 to 6 Years

Background: Hypothermia is an important complication during surgery, especially in children and is highly associated with serious adverse outcomes. One of the preventive methods is the intraoperative administration of amino acids, which can be effective through increasing thermogenesis and stimulating energy consumption. No studies have been conducted in this regard on children; therefore, we evaluated the preventive effect of intraoperative administration of amino acid on hypothermia in children. Methods: Forty children, aged 2 to 6 years, who were candidates for hypospadias surgery, were divided into two groups. In the case group, 10% amino acid (2 cc/kg/h) was administered two hours before the operation, and in the control group, normal saline was given as required. All patients underwent a similar method of anesthesia. body temperature was recorded before the anesthesia, immediately after it, and every ten minutes. Results: The mean age and weight had no difference between the groups. Duration of patients' awakening time was 13.60 ± 4.91 min, which in the case and control groups was reported as 11.90 ± 5.27 and 15.30 ± 3.96 min, respectively(