Background:Patients undergone mechanical ventilation need rapid and reliable evaluation of their respiratory status. Monitoring of End-tidal carbon dioxide (ETCO2) as a surrogate, noninvasive measurement of arterial carbon dioxide (PaCO2) is one of the methods used for this purpose in intubated patients.Objectives:The aim of the present trial was to study the relationship between end-tidal CO2 tensions with PaCO2 measurements in mechanically ventilated patients.Materials and Methods:End-tidal carbon dioxide levels were recorded at the time of arterial blood gas sampling. Patients who were undergoing one of the mechanical ventilation methods such as: synchronized mandatory mechanical ventilation (SIMV), continuous positive airway pressure (CPAP) and T-Tube were enrolled in this study. The difference between ETCO2 and PaCO2 was tested with a paired t-test. The correlation of end-tidal carbon dioxide to (ETCO2) CO2 was obtained in all patients.Results:A total of 219 arterial blood gases were obtained from 87 patients (mean age, 71.7 ± 15.1 years). Statistical analysis demonstrated a good correlation between the mean of ETCO2 and PaCO2 in each of the modes of SIMV, CPAP and T-Tube; SIMV (42.5 ± 17.3 and 45.8 ± 17.1; r = 0.893, P < 0.0001), CPAP (37 ± 9.7 and 39.4 ± 10.1; r = 0.841, P < 0.0001) and T-Tube (36.1 ± 9.9 and 39.4 ± 11; r = 0.923, P < 0.0001), respectively.Conclusions:End-tidal CO2 measurement provides an accurate estimation of PaCO2 in mechanically ventilated patients. Its use may reduce the need for invasive monitoring and/or repeated arterial blood gas analyses.
PurposeTo evaluate the return to work (RTW) rate, time and predictors among trauma patients using survival analysis.MethodsThis cohort study was conducted with a three-month follow-up on 300 trauma patients hospitalized in Shahid Beheshti Hospital, Kashan, Iran in 2014. The data were collected through conducting interviews and referring to patients' medical records during their hospital stay and follow-up information at one & three months after discharge from hospital. Final analysis was conducted on the data retrieved from 273 patients. Data were analyzed by chi-square test, Mann–Whitney U test and survival analysis method.ResultsThe rate of RTW at the end of the first and the third follow-up months was respectively 21.6% and 61.2%. Survival analysis showed that the RTW time (Time between admission to first return to work) was significantly longer among patients with illiteracy, drug abuse, hospitalization history in the intensive care unit, low socioeconomic status, non-insurance coverage, longer hospital stay, multiple and severe injuries as well as severe disability.ConclusionOur findings indicated that trauma has profound effects on the rate and time of RTW. Besides disability, many personal and clinical factors can affect the outcome of RTW.
SUMMaRYA 12-year-old boy was referred with acute asymmetric pulmonary edema (APE) four-hour after scorpion sting to Emergency department. On admission, the main clinical manifestations were: dyspnea, tachypnea, and tachycardia. Chest x-ray revealed APE predominantly on the right hemithorax. The patient was treated with oxygen, intravenous frusemide and digoxin and discharged on the sixth hospital day in a good condition. This case report emphasizes the occurrence of asymmetric pulmonary edema after severe scorpion envenomation within few hours immediately after the sting.
Background:Globally more than a billion people, 15% of the population, lives with disability and most of disabilities are caused by injuries.Objectives:The aim of this study was to describe the prevalence of disability and its predictors at 1 and 3 months post-injury in Kashan City during 2014 - 2015.Patients and Methods:In this longitudinal follow-up study, 400 injured patients 15 - 65 years referred to Shahid Beheshti hospital in Kashan and hospitalized more than 24 hours were assessed for disability status with the WHODAS II 12-item instrument at 1 and 3-months post-injury. Patients based on their disability scores were divided into 5 groups: none, mild, moderate, severe and very severe. Work status was assessed at the 3-month follow-up with one question “Are you back at work following your injury”. Also, demographic characteristics and information about injury were gathered by a checklist. Data were analyzed using chi-square, Mann-Whitney U, Kruskal Wallis, Pearson correlation coefficient and logistic regression by SPSS software. The significance level was set at P < 0.05.Results:The mean disability scores at 1 and 3 months post-injury was 30.3 (9.2) and 18.8 (8.3), respectively and there was a statistical significant difference between disability status at 1 and 3 months after trauma (P < 0.0001). The rates of return to work in 262 employed patients at 1 and 3 months after injury were 29% and 55.4%, respectively. The disability score showed a statistically significant correlation with Injury Severity Score (ISS) (P < 0.0001), work return (P = 0.033), intensive care unit transfer (P < 0.0001), trauma type (P = 0.001) and age (P = 0.004). Also, age, ISS, duration of hospital stay and injury to extremities were predictors of disability.Conclusions:More than half of the patients were disabled after 3 months of trauma. Elderly patients, patient with severe trauma, and long hospitalization and patients with extremity injuries were high risk for disability.
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