Background Timely and successful extubation is an essential step forward in clinical practice to minimize complications of mechanical ventilation and unsuccessful weaning processes. Thus, research into predictive factors of weaning outcome to optimize spontaneous breathing trial (SBT) precision before extubation is critical in intensive care practices. In this study, we aimed to investigate the predictive factors of the weaning outcome before and during SBT in mechanically ventilated patients. Methods In this cross‐sectional study, 159 mechanically ventilated patients who were eligible for SBT were enrolled. Of these patients, 140 had successful extubation, whereas the remainder failed. Each patient's PaCO2 and PaO2 levels, respiratory rate (RR), SpO2, mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) values at the start of SBT, 3 min later, and at the end of SBT were measured. These values, along with the patients' clinical characteristics, were then investigated to determine if there was any correlation between these variables and the weaning outcome. Results Our analysis revealed that increase in CVP, independent of hemoglobin (Hb) concentration, PaO2, SpO2, duration of mechanical ventilation (MV), length of intensive care unit (ICU) stay, and SBT process, as well as underlying disease, was positively correlated with extubation/weaning failure. While age, gender, vital signs (MAP, RR, and HR), sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation (APACHE) scores had no significant correlation with patients' extubation outcomes. Conclusion According to our findings, integrating CVP assessment into SBT besides routine indices measurement and monitoring can be considered for the prediction of weaning outcome in critically ill mechanically ventilated patients.
Objectives: CRP (C -reactive protein) is more often used to show hidden infections with the bacterial origin. CRP is most likely activated due to bacterial infection. The researcher in this study examined the effect of selenase on acute phase protein response. Methods: In this clinical trial, all patients were men and women in the age range of 20 -90 years old who were suffering from septic shock and the presence of positive bacterial cultures, Peoria, positive radiographic abscess, pneumonia, cellulites, gangrene, and infection in the presence of a urinary catheter that since the adoption of the proposal were admitted. To evaluate the mean level changes of plasma variables in the two groups, t-student test was used. The software used for statistical analysis was SPSS-18 and statistical values less than 0.05 were considered significant (P < 0.05). Results: Laboratory findings where markers of the acute phase response were examined in this study include the increased platelet count and CRP. Both variables in the two groups were statistically significant (P < 0.05). The frequency of patients who had a platelet count below 150,000 dL in the case group (selenium) was 5 patients and in the control group (placebo) was 9 individuals. This decrease in platelet count among patients was in the 70,000 -120,000 range. In the control group, elevated levels of CRP in test results was observed in the 13 patients and in the case group, this increase was seen in 8 patients. Conclusions: Effect of the acute phase response for detection infection in patients with sepsis is still controversial. This study showed the positive effect of Selenium on patients who have suffered from septic shock.
Background: Performing cardio pulmonary resuscitation at hospitals by clinic staffs requires skills, knowledge, precision, and speed for obtaining proper results. The main purpose of the present study was to identify mistakes and errors that occur during cardio pulmonary resuscitation by clinic staffs. Methods: The present study was observational and was performed between years 2014 and 2016, in a way that the researchers, as presenting the resuscitation code, observed patients, who had cardiac arrest, and recorded all actions performed by the clinical staff. The sampling method of the study was convenient sampling and was performed for 48 cases of CPR. Collected data were analyzed without mentioning the patients' and hospitals' name. Results: Most common and important errors or mistakes made during CPR included treating monitors instead of patients, problems in identifying proper equipment, ignoring clinical symptoms of the disease, such as agonal gasp, deciding to terminate the CPR, improper placement of the staffs' palm for circulation, and increasing the speed and number of times for circulating. Over hyperventilation, inability in patients ventilation with bag valve mask, wasting time in difficult vein puncture, delay in circulation, inability in realizing actions priority during CPR, broken and out of service equipment, forgetting to check the pulse, rhythm and shock discharge without shock indication, lack of attention to device sync bottom status, device discharge without informing others, and over use and excessive fluid therapy. Conclusions: The obtained results from the present study indicate that level and quality of presenting clinical care in the emergency section in studied hospitals was not at a desirable and acceptable level and indicates lack of proper education and training for clinical staffs and physicians. Educational needs assessment and optimizing human resource, and proper investment are key factors in developing clinical care and can increase efficiency and reduce casualties.
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