Naser Mozafari; Helya Sadat Mortazavi; Tahereh Alinia; Behjat Barari; Haleh Talaie
Volume 19, Issue 1 , January 2017, , Pages 1-6
Abstract
Background: Lactate level is known to increase among the majority of patients with toxicity. This study aimed to determine whether lactate level upon admission is higher among patients with ventilator-associated pneumonia (VAP).Objectives: We aimed to determine whether serum lactate level is associated ...
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Background: Lactate level is known to increase among the majority of patients with toxicity. This study aimed to determine whether lactate level upon admission is higher among patients with ventilator-associated pneumonia (VAP).Objectives: We aimed to determine whether serum lactate level is associated with the increased risk of VAP in intensive care unit (ICU)-admitted patients with toxicity.Methods: This retrospective study was conducted in a training medical poisoning center in Iran, using convenience sampling. A total of 157 poisoned patients, aged≥ 13 years, who were admitted to the ICU over the past seven months, were included in the study. Subjects were categorized into two groups, based on their VAP diagnosis (VAP-positive and non-VAP) and the outcomes (surviving or non-surviving). The VAP-positive patients were compared with others with regard to the mean level of serum lactate level upon admission. Additionally, non-surviving patients were compared with their surviving counterparts.Results: Overall, 71 (45.2 %) VAS-positive cases were reported, in addition to 36 cases of mortality. Alkaline phosphatase (ALP) was the most common toxic agent (36%), followed by methanol. Significant differences were noted between the groups in terms of Simplified Acute Physiology Score-II (SAPS-II), Glasgow Coma Scale (GCS) score, length of ICU stay, and percentage of ventilation process. The mean levels of lactate at admission were 3.71 ± 3.35 and 4.19 ± 4.09 among VAP-positive and non-VAP patients, respectively; the difference was not statistically significant. Also, non-surviving patients had a longer ICU stay (12.20 days), compared to surviving patients (5.39) (P = 0.008). Moreover, admission lactate level was 7.06 ± 5.29 mmol/L among non-surviving patients and 3.01 ± 2.53 among surviving cases (P < 0.001).Conclusions: Based on the findings, the mortality rate was 22.9% among poisoned patients with an elevated serum lactate level. We can conclude that mortality is associated with toxicants, but not the occurrence of VAP; in fact, VAP scenarios do not elevate serum lactate level.
Roya Farzanegan; Maryam Alehashem; Behrooz Farzanegan; Sharareh R Niakan Kalhori; Mohammad Gholami Fesharaki; Farshid Rahimi Bashar; Behjat Barari; Mahdi Zangi; Mohammad Behgam Shadmehr
Volume 19, Issue 1 , January 2017, , Pages 1-11
Abstract
Background: Tracheal stenosis is one of the worst complications of endotracheal intubation, but timely diagnosis can change its natural history. Management of these patients places a great burden on the health care system and the well-being of the patients and their families. Therefore, discharged intensive-care-unit ...
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Background: Tracheal stenosis is one of the worst complications of endotracheal intubation, but timely diagnosis can change its natural history. Management of these patients places a great burden on the health care system and the well-being of the patients and their families. Therefore, discharged intensive-care-unit (ICU) patients who underwent more than 24 hours of intubation should be actively followed-up 3 months after extubation and screened for post-intubation tracheal stenosis. The present study was aimed at assessing the impact of post-discharge follow-up call interviews on increasing successful screening for post-intubation tracheal stenosis.Objectives: To determine the effect of post-discharge call interviews on improving screening of post-intubation tracheal stenosis.Methods: This experimental study was conducted in Iran in September 2014. Using the simple randomization method, 140 patients who had undergone than 24 hours of endotracheal intubation and had received oral and written educational materials upon discharge from the ICU were equally assigned to an intervention and a control groups (received a call interview before or after the follow-up due date, respectively). The needed sample size was calculated to be 70 participants in each group (considering α = 5%, the statistical power of 90%, and effect size = 0.4).Results: There was a significant difference in follow-up rates at the due date between the intervention group (50.7%, 34of 67 participants) and the control group (17.5%, 11 of 63 participants) (OR = 4.871, 95% CI = 2.172 to 10.924, P < 0.0001). In the control group, the call interviews significantly increased the follow-up rate from 17.5% to 66.7 % (42 of 63 participants) (P < 0.0001), although followup occurred after the due date. The results of the logistic regression model showed that the patients who had attempted suicide completed follow-up more than those who had not (P = 0.017), that interviews with patients and their parents were more effect than interviews with others (P < 0.05), and that phone call interviews after the follow-up due date were more effective than those before the follow-up due date (OR = 2.653, 95%CI = 1.079 to 6.526, P = 0.034).Conclusions: We highly recommend making call interviews, along with distributing the oral and written educational materials, to increase the follow-up rate among discharged ICU patients.
