Critical Care Nursing

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    MORTALITY IN HEMODIALYSIS PATIENTS AND THE LEADING CAUSE OF DEATH IN A SINGLE CENTER AT THE NORTHERN OF WEST BANK: A RETROSPECTIVE COHORT STUDY
    (2022-12-21) Malek Isam Awni Abdelghani
    Background: Currently, there were 5 to 7 million patients who have end-stage renal disease (ESRD) that need renal replacement therapy. This study was conducted to determine the mortality rates among hemodialysis patients at An-Najah National University Hospital which is one of the main referral centers in the north of the West Bank of Palestine. The study also aimed to describe the causes of death among this group of patients. Methods: This study used a quantitative correlational retrospective cohort design. The study included all adult patients with ESRD who underwent hemodialysis irrespective of their gender, and duration of dialysis. Demographic variables, etiology of the ESRD, presence of comorbidities, and laboratory findings of the patients were collected. Results: Medical records of 348 ESRD patients who were on hemodialysis between January 2017 and December 2021 were reviewed. Of the 348 ESRD patients, 95 patients died giving an overall mortality rate of 27.3%. Of the patients who died, 68.4% were male and 91.6% were dialyzed for 1-3 years. Cardiovascular disease was the leading cause of death (43.2%) among the patients in this study. Diabetic nephropathy was the leading cause of ESRD (77.9%) among the patients who died in this study. Of the patients who died in this study, 60% had diabetes mellitus and hypertension and 88% had hypoalbuminemia. Mortality was associated with older age and smoking. Conclusions: The mortality rate among patients on hemodialysis was within the range of mortality rates reported in the regional studies. Cardiovascular disease was the leading cause of death among the patients in hemodialysis. More studies are still needed to investigate the effects of manipulating some modifiable risk factors on the mortality rates among hemodialysis patients in Palestine. Keywords: Chronic kidney disease; End-stage renal disease; Hemodialysis; Mortality.
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    HEPARINIZATION VERSUS SALINE FLUSH OF CENTRAL VENOUS CATHETER (CVC) LUMENS IN CRITICAL CARE UNIT PATIENTS IN LARGE TERTIARY HOSPITAL
    (2022-12-28) Enas Abed Al-Kareem Taleb
    Background: The central venous catheter (cvc) has a risk of complications, including catheter thrombosis. To prevent this thrombosis, flushing of CVC is needed. There are several methods for flushing (CVC): the first one is heparin with saline after each use while the second method is saline flush. Objectives: To assess the effectiveness of intermittent flushing of normal saline versus heparin to prevent occlusion in long‐term central venous catheters among adult patients in the ICU of Large Tertiary Hospital. Methodology: Randomize Control trial (RCT) design was used in this study. The sample was selected from all patients who were admitted to the ICU department of An-Najah Hospital during the period of August 2020 to October 2020 and have CVC. Patients were selected in a convenience method, and 53 patients agreed to participate in the study. These patients were distributed randomly into two groups; an experimental group (n =26 patients) and a control group (n =27 patients). The experimental group was given flush (a combination of heparin and normal saline), and the control group was given a flush with (normal saline only). To monitor the two procedures, the researcher developed a Check list that included demographic data, lab values, hemodynamic, Patency and complication of CVC. The researcher was able to fill the checklist for every patient. Results: The results showed that coagulation profile (PTT) was less than 35 seconds at admission for experimental group (76.9%) versus control group that got (48.1%) at significant level of P value; (0.031). For easy patency of CVC, the experimental group got (69.2%) which was higher than control group; (37%) while in moderate and difficult patency, the experimental group had less value than the control group (40.7% VS 26.9) and (22.2% VS 3.8%) respectively, at significant level of P value of (0.035). No differences were noticed between the experimental group and the control group in occurrence of complication such as discharge color around CVC, Swab culture result, Oozing from the CVC site. The study showed that dressing daily was for the control group (96.3%) while it was weekly for the experimental group (76.9%). Conclusion: There was a significant difference in the coagulation profile only at admission (p value is 0.031) and significant in patency (p value is 0.035). CVC of the experimental group (combination N/S with heparin group) showed easier patency than the control group (normal saline group), while there was no significant difference in the complications between the two groups. Recommendation: Nurses working at the ICU units should be oriented about the use of normal saline (0.9%) alone without heparin to flush CVC for adult patients. The benefit of this method should be emphasized as to decrease cost of heparin use, and to avoid any adverse effects with heparin use Keywords: Central Venous Catheter (CVC), Heparin, Normal Saline (NS),
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    COLD BLOOD CARDIOPLEGIA VERSUS COLD CRYSTALLOID CARDIOPLEGIA FOR CORONARY ARTERY BYPASS GRAFTING (CABG) IN PATIENTS WITH LOW EJECTION FRACTION -IN THREE LARGE HOSPITAL IN PALESTINE
    (2023-03-15) Hakeem Mustafa Sholi
    Myocardial protection during cardiopulmonary bypass surgery for coronary artery bypass graft surgery (OPCABG) is still a controversial topic. The primary method of protecting the myocardium during cardiac surgery is cardioplegia, which also facilitates surgery by providing a quiet, bloodless surgical field. These cardioplegia solutions include: Cold-crystalloid vs. cold-blood cardioplegia. However, there is still a debate about which solution for cardioplegia in cardiac surgery is the best solution. The Main goal of this study is to Comparing Cold-Blood Versus Cold Crystalloid Cardioplegia for Coronary Artery Bypass Grafting (CABG) Surgery in Patients with Low Ejection Fraction - To Determine Which Type is Appropriate for Surgical Myocardial Conservation in Three Major Palestinian Hospitals, after CABG surgery and reduce complications. A retrospective observational cohort design was used in this study. All patients with multi vessel coronary artery disease, who were admitted to an eligible hospital between January 1st, 2020 and December 30th 2021, aged ≥40 years and <80 years and require OPCABG surgery, were included in this study. Data were collected by reviewing patient medical records from the hospital information system. According to the findings, there is no significant difference between cold blood and cold crystalloid cardioplegia when it comes to intra-operative ejection fraction, cardioplegia volume, cardiopulmonary bypass time, blood loss between 4 and 6 hours after surgery, time spent on mechanical ventilation after surgery, time spent using pharmacological cardiac support after surgery, creatinine level after surgery, or post-operative complications. The findings demonstrate that there are considerable disparities between the Cold Blood Cardioplegia group and the Cold Crystalloid Cardioplegia group only in Ejection fraction pre operation, the mean of the Ejection fraction pre operation in the CBC group is (Mean=38%) which is considerably greater than the average in the CCC group (Mean=36%), the P-value of the test is 0.002, but this difference does not mean anything clinically because it happened before the cardioplegia was given. Significant differences exist at the 0.05 level. in the amount of Blood loss 2 hours post-operation, the mean in the CBC group is (Mean=153.8) which is considerably less than the average in the CCC group (Mean=183.8), the P-value of the test is 0.032.and there are significant differences at 0.05 level in Creatinine levels pre-operation, the mean in the CBC group is (Mean=0.78) which is significantly higher than the mean in the CCC group (Mean=0.63), the P-value of the test is 0.020. when using cold crystalloid cardioplegia as opposed to cold blood cardioplegia at a significant level of P value (0.05),and this difference does not mean anything clinically because it happened before the cardioplegia was given. This study concludes that the use of cold-blooded cardioplegia has the same myocardial preservation and complications as cold crystalloid cardioplegia. For clinical practice, it is recommended that cold crystalloid cardioplegia be used to decrease the cost of cold blood cardioplegia use when using the traditional methods and also it facilitates vision for the surgeon, and presenting the results of this study to the Palestinian Ministry of Health to make a comprehensive protocol and guidelines for all hospitals to follow cold crystalloid cardioplegia. Keywords: Cold Blood Cardioplegia, Cold Crystalloid Cardioplegia, Myocardium Protection, Ejection Fraction, Coronary Artery Bypass Graft.
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    INCIDENCE OF POST-OPERATIVE ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING SURGERY AFTER GIVING PERIOPERATIVE BETA BLOCKERS:A PROSPECTIVE OBSERVATIONAL STUDY IN A UNIVERSITY HOSPITAL IN PALESTINE
    (2022-08-24) Duha Zaki
    ABSTRACT Background: The most prevalent arrhythmia, after cardiac surgery, is postoperative atrial fibrillation (POAF).It affects 30% to 50% of patients and significantly increases morbidity and length of hospital stay. Also, it significantly increases hospital costs. A number of risk factors have been found to be associated with a higher frequency of post-coronary artery bypass grafting (CABG) AF. Beta-blockers emerge as the preventive drug, unanimously regarded as a therapy assisting in the reduction of POAF incidence. Aim: This study sought to determine the incidence of postoperative atrial fibrillation in patients undergoing on-pump CABG surgery after perioperative beta blocker (Bisoprolol) administration. Material and method: Patients were scheduled for elective CABG surgery in this prospective observational trial. Valve surgery, redo CABG surgery, and renal failure patients were excluded from the study. The (Already on Beta-Blockers) group and the (Newly Administered of Beta-blockers-Bisoprolol) group were afterwards formed from the original one group of the study sample for the purposes of analysis. Patients who were already taking beta-blockers (Already on Beta-Blockers) should continue taking them postoperatively after being extubated and awakened. They should start taking them the evening before surgery. For patients who were receiving beta blockers for the first time postoperatively( Newly Administered of Beta-blockers-Bisoprolol) and they were not on beta blocker preoperatively, the dose was adjusted according to heart rate, and blood pressure starting from 1.25mgBisoprolol (orally) and titrating according to previous parameters Results: The incidence of POAF stood at 17/150 (11.3%) post operatively in the whole group, when a subgroup analysis was done, the whole group was divided into two groups: group one Already on Beta-Blockers (n=54) and group two newly administered of Beta-blockers (n=96). The results showed that the percentages of AF cases in group one (n=2, (3.7%) were lower than group two (n=15, (15.6%).The p= 0.027, bradycardia 37/54(68.5%) in group one and 47/96(31.3%) in group two, p=0.000 was in favour of group two. Hypotension was 37/54(68.5%) in group one and 26/96(27.1%) in group two; p= 0.000 wasin favour of group two. CCU length of stay in days 4.00 ± 0.87 in group one and 3.57 ± 1.41 in group two; p= 0.046 was in favour of group two. Hospital length of stay in days was7.85 ± 2.79 in group one and 4.70 ± 2.68 in group two; p=0.000 was in favor of group two. Pain Assessment (VAS) was3.65 ± 0.84 in group one and 4.14 ± 1.16 in group two; p= 0.007 was in favour of group one, Conclusion: A perioperative beta blocker (Bisoprolol) could lower the risk of developing postoperative AF and lessen the intensity of pain following coronary bypass graft surgery. Patients on chronic beta blockers increased the likelihood of hospital and intensive care unit length of stay. Preoperative risk factors for AF include heart failure, and COPD. Keywords: Beta Blocker; Bisoprolol; Postoperative Atrial fibrillation; Coronary Artery Bypass Grafting (CABG); perioperative; length of stay.
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    COMPARING THE ACCURACY OF THROMBOLYSIS IN MYOCARDIAL INFARCTION SCORE AND THE GLOBAL REGISTRY OF ACUTE CORONARY EVENTS SCORE IN PREDICTING IN-HOSPITAL, SHORT AND LONG-TERM OUTCOMES AMONG PATIENTS WITH ACUTE CORONARY SYNDROME
    (2023-09-20) Ahmed Adnan Zamel
    Background: The Thrombolysis in Myocardial Infarction (TIMI) score and the Global Registry of Acute Coronary Events (GRACE) score are frequently utilized as risk assessment instruments within the discipline of cardiology. Short-term acute coronary syndrome (ACS) outcomes are immediate treatment and survival for one months while long-term outcomes are recurrence, lifestyle-focused prevention and mortality risk for 6 months from admissions hospitals. The TIMI score is used to predict unfavorable outcomes, whilst the GRACE score to estimate death rates and significant cardiovascular events in ACS patients. Aim: This study aimed to compare the accuracy of TIMI and GRACE scoring systems in predicting in-hospital, short-term, and long-term outcomes amongst ACS patients. Method: A retrospective study was conducted from June to December 2022. The sample size was 250 people. This study focused on ACS patients who got admitted to An-Najah National University Hospital (NNUH). The response rate was 92.6%. Statistical Package for Social Science (SPSS) was used to analyze the data. Results: The findings indicated that 228 patients (91.2%) survived and 22 (8.8%) died. The GRACE score exhibited remarkable accuracy of diagnosis in prediction of survival among participants. This is supported by the observation of a specificity, sensitivity, Positive Predictive Value (PPV), negative predictive value (NPV), and total accuracy of 100%. The receiver operating characteristic (ROC) curve demonstrated exceptional differentiation between survivors and those who have died, as shown by an area under the curve (AUC) value of 1.000. In contrast, TIMI score accuracy was less robust. The study of the ROC curve yielded an AUC of 0.739 (P <0.001). The sensitivity and specificity were 68.2% and 63.6% respectively. The PPV and NPV were 15.3% and 95.4%, correspondingly. Additionally, the total accuracy for prediction and diagnosing the survival status was 64.0%. Conclusion: The GRACE score demonstrated excellent diagnostic accuracy in predicting patient survival status, with perfect sensitivity, specificity, PPV, NPV, and overall accuracy. While, the TIMI score showed comparatively weaker accuracy, with lower sensitivity, specificity, PPV, NPV, and overall accuracy. Keywords: Acute Coronary Events; Acute Coronary Events Score; An-Najah National University Hospital; Predicting in-Hospital; Thrombolysis in Myocardial Infarction.