Pakistan Journal of Intensive Care Medicine 2024-05-28T16:59:52+00:00 Asim Rana Open Journal Systems <p>Articles for Pakistan Journal of Intensive Care Medicine (eISSN: 2789-2905; pISSN: 2789-2891) must be original reports of research not simultaneously submitted to or previously published in any other scientific or technical journal and must make a significant contribution to the advancement of knowledge or toward a better understanding of existing scientific concepts. The study reported should be applicable to a sizable geographic area or an area of ecological or economic significance and of potential interest to a significant number of scientists. Each calendar year will have one volume. PJICM publishes articles as soon as the final copy-edited version is approved by the authors rather than waiting for a collection of articles for a specific issue. Also, each article is published in its respective category (editorial, review, original or commentary). As a result, the page numbers in the ‘Table of Contents’ displayed for each issue will reflect this rather than numerical order. The journal aims to provide a platform of publications under the banner of <a href=""><em>Med</em>EYE Publishers</a> following eminent standards to the researchers, scholars, scientists and professionals of Biological and Medical Sciences. Inclusion of multiple academic disciplines helps in pooling the knowledge from two or more fields of study to handle better suited problems by finding solutions established on new understandings. The authors can submit manuscripts online through OJS. Authors can submit their manuscripts to editorial office along with any query through email at, <a href=""></a></p> THE USE OF EMPIRICAL ANTIBIOTICS IN THE CRITICAL CARE UNIT 2024-05-28T16:59:52+00:00 R PERVAIZ H AHMED AHA AWAD <p><em>Antimicrobial therapy plays a crucial role in managing infections in critically ill patients, yet its indiscriminate use can lead to adverse outcomes. Here, we propose a systematic approach for guiding empirical antimicrobial therapy in intensive care unit (ICU) patients with suspected infections. Diagnostic evaluation, including imaging, laboratory tests, and physical examination, is essential to assess the necessity of antimicrobial treatment. Despite advances, no gold standard biomarker for differentiating infection from inflammation necessitates thorough diagnostic assessment. Prompt microbiological sampling is crucial for accurate diagnosis and tailored treatment. Emergency initiation of antimicrobial therapy is recommended for conditions like sepsis and septic shock, emphasizing the need for timely intervention. Pathogen profiling and consideration of multidrug resistance risk factors are essential for selecting appropriate empirical therapy. Customized evaluation based on patient characteristics and regional trends is paramount for optimal antibiotic selection. Pharmacokinetic and pharmacodynamic parameters should guide dosing to ensure adequate antibacterial levels while minimizing adverse effects. Future research should focus on AI-powered decision-making systems, optimal timelines for starting or postponing therapy, and the environmental impacts of antibiotic use to enhance patient outcomes and reduce antimicrobial resistance.</em></p> 2024-05-29T00:00:00+00:00 Copyright (c) 2024 R PERVAIZ , H AHMED , AHA AWAD IMPACT OF NOREPINEPHRINE DOSAGE INCREASE AND VOLUME EXPANSION ON CAPILLARY REFILL TIME IN SEPTIC SHOCK PATIENTS 2024-05-22T12:57:49+00:00 R PERVAIZ B ARIF H AHMED SZ BUKHARI LH ISSA S RAZA <p><strong><em>Background:</em></strong><em> When evaluating patients with acute circulatory failure, one clinical feature that may be quickly determined at the bedside is the capillary refill time (CRT).<strong>Objective:</strong> The objective of this observational study was to describe the changes in CRT that occur as a result of volume expansion and increased dosages of norepinephrine, along with related macro-circulatory variables, in patients suffering from septic shock. Study <strong>Design:</strong> This was an observational study. <strong>Setting:</strong> The study was conducted at Bahria Town International Hospital Lahore and Services Institute of Medical Sciences. <strong>Duration of Study:</strong> The study was conducted over six months from January 2, 2023, to July 30, 2023. <strong>Methods:</strong> We measured mean arterial pressure (MAP), cardiac index (CI), and five consecutive CRT readings in 40 septic shock patients. These measurements were taken before and after a 500 mL saline infusion in 20 patients and before and after an increase in norepinephrine dosage in another 20 patients. <strong>Results:</strong> The "norepinephrine" group had lower SAPS II and SOFA scores than the "volume expansion" group. When all patients were assessed together, volume expansion significantly lowered heart rate while increasing MAP, diastolic arterial pressure, CI, CVP, and CRT. Fluid-induced increases in CI of ≥ 15% were observed in 11 patients (55%). In fluid responders, fluid infusion significantly raised MAP by 31% (11-49%) and CI by 26% (20-42%). Increased norepinephrine levels may lower CRT in patients with a baseline value of fewer than 3 seconds. Increasing norepinephrine has a low possibility of decreasing CRT in patients with baseline CRT ≥ 3 seconds if the MAP increase is &lt;15%. However, the decrease in CRT is inconsistent in patients with baseline CRT ≥ 3 seconds when norepinephrine increases MAP by ≥ 15%. Univariate regression analysis revealed a correlation between the absolute value of CRT and lactate levels, heart rate, norepinephrine dosage, gender, SAPS II, and ICU mortality. In a multivariate analysis that included all physiological parameters with a p-value &lt;0.1 in univariate linear regression, only lactate upon admission had a significant association with the absolute value of CRT. <strong>Conclusion:</strong> CRT uncommonly improves with therapy in individuals with septic shock and prolonged CRT when volume expansion raises cardiac output by &lt;15% and increasing the dosage of norepinephrine increases MAP by &lt;15%. CRT's response varies when there are significant effects of fluid infusion on cardiac output and norepinephrine on MAP; in some patients, it decreases while remaining consistent in others. CRT functions as an indicator of microcirculation in this context.</em></p> 2024-03-20T00:00:00+00:00 Copyright (c) 2024 R PERVAIZ , B ARIF , H AHMED , SZ BUKHARI , LH ISSA , S RAZA EARLY TRACHEOSTOMY MIGHT DECREASE THE DURATION OF HOSPITALIZATION AMONG ICU PATIENTS 2024-04-06T10:55:44+00:00 T SARWAR R PERVAIZ S AKASH HMH ARIF AM ABDELBAKY AHA AWAD S BANO S RAZA <p><strong><em>Background: </em></strong><em>Prolonged invasive mechanical ventilation in critically ill patients can result in adverse outcomes, prompting consideration of tracheostomy (TQT) as a potential intervention. However, the optimal timing for TQT remains uncertain, necessitating further investigation into the clinical characteristics of patients undergoing early versus late TQT. <strong>Objectives:</strong> To compare outcomes, including duration of mechanical ventilation, ICU and hospital stays, and mortality rates, between patients undergoing early TQT (within approximately ten days of oro-tracheal intubation) and those undergoing late TQT (after ten days). <strong>Study Design:</strong> This study utilised a retrospective cohort design. <strong>Setting:</strong> Data were collected from patients admitted to Bahria International Hospital's ICU. <strong>Duration of Study:</strong> Data collection occurred between January 2022 and December 2023. <strong>Material and Methods:</strong> Patients were stratified based on the timing of TQT placement, and clinical outcomes were analysed accordingly. Parameters assessed included duration of mechanical ventilation, ICU and hospital stays, and mortality rates. <strong>Results:</strong> Patients in the early TQT group demonstrated shorter ICU and hospital stays (20 ± 17 vs. 33 ± 23 days, p = 0.03; 43 ± 33 vs. 53 ± 49 days, p = 0.01, respectively), reduced duration of mechanical ventilation (18 ± 15 vs. 31 ± 19 days, p &lt; 0.001), and a higher ICU survival rate (64% vs. 55%). <strong>Conclusion:</strong> Early tracheostomy placement, performed within ten days of mechanical ventilation initiation, appears to confer benefits in shorter ICU and hospital stays, reduced mechanical ventilation duration, and improved ICU survival rates. These findings highlight the importance of timely TQT placement in critical care management strategies.</em></p> 2024-03-16T00:00:00+00:00 Copyright (c) 2024 T SARWAR , R PERVAIZ , S AKASH , HMH ARIF , AM ABDELBAKY , AHA AWAD , S BANO , S RAZA THE IMPACT OF SURAH AL-REHMAN RECITALS HEARING ON PAIN AND LENGTH OF ICU STAY 2024-05-27T17:33:43+00:00 R PERVAIZ B ARIF S RAZA M JAVED hajsdJAAEF@GMAIL.COM S ZARTASH H WASEEM <p><strong><em>Background</em></strong><em>: Pain management is crucial for patients admitted to the ICU, particularly those with significant pain levels. Non-pharmacological interventions, including spiritual practices, have been proposed to alleviate pain. <strong>Objective:</strong> To evaluate the effects of listening to the Surah Al-Rehman on pain and length of stay (LoS) in the ICU and hospital among patients with a pain score greater than 5 on the visual analog scoring system (VAS). <strong>Study Design</strong>: Prospective case-control study. <strong>Setting:</strong> The study was conducted at Bahria Town International Hospital Lahore. <strong>Duration of Study</strong>: September 2021 to August 2023. <strong>Material and Methods:</strong> Patients who met the inclusion criteria (aged 18 years or older, ICU admission, VAS pain score &gt;5, ability to engage with the investigator, signed consent form, no hearing impairments, and no hemodynamic disturbances, minimum stay of four days at ICU) were enrolled. The intervention group (n=50) listened to Surah Al-Rehman for 20 minutes thrice daily for seven days. The control group (n=50) received standard care. Pain levels were measured using a numerical scale (0-10) at baseline and on the fourth day. Statistical analysis was performed using SPSS version 21. <strong>Results:</strong> The study included 100 patients admitted to the Department of Internal and Critical Care Medicine at Bahria International Hospital Lahore. Baseline pain levels were similar between groups. Post-intervention, the intervention group reported significantly lower pain scores (4.59 ± 2.41) than the control group (5.54 ± 2.64, p=0.03). A paired t-test showed a significant reduction in pain scores within the intervention group (p=0.03). The intervention group also had a significantly shorter ICU length of stay (LoS) (5.1 ± 4.18 vs. 6.41 ± 4.25 days, p&lt;0.05) and hospital LoS (10.54 ± 3.45 vs. 15.84 ± 6.36 days, p&lt;0.05). <strong>Conclusion:</strong> Listening to the Surah Al-Rehman significantly reduced pain and shortened ICU and hospital stays for patients admitted with high pain levels. These findings suggest that incorporating spiritual care, such as Quran recitation, may enhance postoperative recovery and reduce the need for pharmacological pain management.</em></p> 2024-04-15T00:00:00+00:00 Copyright (c) 2024 R PERVAIZ, B ARIF, S RAZA, M JAVED, S ZARTASH, H WASEEM ASSESSMENT OF CRITICAL CARE NURSES’ ADHERENCE TO ETHICAL CODES AND ITS RELATION TO SPIRITUAL WELL-BEING AND MORAL SENSITIVITY 2024-05-18T16:32:13+00:00 . ADEEL A ASGHAR F FIAZ A LATIF I HAIDER S BIBI . QASIR <p><strong><em>Background:</em></strong><em> Adherence to ethical standards is a vital component of nursing care and is influenced by various circumstances. Identifying such aspects can improve ethical performance. <strong>Objective:</strong> This study examined critical care nurses' compliance with ethical rules and their impact on spiritual well-being (SWB) and moral sensitivity (MS). <strong>Study Design:</strong> The research was primarily descriptive and correlational. <strong>Setting</strong>: The study was conducted at Bahria Town International Hospital Lahore. <strong>Duration of Study:</strong> This study was conducted from May 1, 2023, to December 10, 2023. <strong>Methods</strong>: Data were compiled on the individuals' demographics and three essential questionnaires: the adherence to ethical norms questionnaire, the moral sensitivity questionnaire (MSQ), and the spiritual well-being scale (SWBS). The study included 51 nurses, with the bulk of participants being female (76.4%), single (64.7%), without kids (72.54%), possessing a diploma in nursing (84.3%), and graduates of public universities (66.9%). <strong>Results:</strong> The mean score of adherence to ethical codes was 64.06±7.11, indicating a satisfactory level of commitment to ethical principles. The mean SWB score was 91.67±10.54, with 74.5% (n=38) falling into the moderate category. The mean scores for existential and religious health were 44.85±6.73 and 47.72±5.53, respectively. The mean MS score was 135.63±10.53, with most subjects falling into the moderate category. Multivariate regression analysis revealed a significant correlation between SWB, MS, and ethical code adherence among nurses (P&lt;0.05).<strong>Conclusion:</strong> Critical care nurses demonstrated a solid commitment to ethical standards. MS and SWB also improved their commitment to ethical rules. Nursing managers may use these findings to promote MS and SWB among nurses, leading to better ethical performance.</em></p> 2024-03-03T00:00:00+00:00 Copyright (c) 2024 . ADEEL, A ASGHAR , F FIAZ , A LATIF , I HAIDER , S BIBI , . QASIR A SINGLE-CENTER STUDY EVALUATING THE PREVALENCE, RISK FACTORS, AND CONSEQUENCES OF ACUTE KIDNEY INJURY IN THE INTENSIVE CARE UNIT 2024-04-06T10:40:53+00:00 R PERVAIZ MA QAYYUM SA KHALID T HAFEEZ MU MUNAWAR HMH ARIF H KANDEEL WG ELMASRY S RAZA <p><strong><em>Background: </em></strong><em>Acute kidney injury (AKI) is a significant complication in critically ill patients in intensive care units (ICUs), impacting morbidity, mortality, and overall patient outcomes. <strong>Objectives:</strong> To assess the frequency, risk factors, and implications of AKI among individuals admitted to the medical ICU at Bahria International Hospital between 2021 and 2022. <strong>Study Design:</strong> This study utilized a retrospective design. <strong>Setting:</strong> The study was conducted at Bahria International Hospital's medical ICU. <strong>Duration of Study:</strong> Data were collected between September 2022 and September 2023. <strong>Material and Methods:</strong> AKI frequency and risk factors were assessed using the Acute Kidney Injury Network (AKIN) criteria for staging. Risk factors such as age, hypertension, ACEI/ARB usage, and severity of underlying illnesses (measured by APACHE II scores) were analyzed. Multivariate analysis was performed to identify independent predictors of AKI occurrence. <strong>Results:</strong> The study found that 32.7% of ICU patients experienced AKI, primarily categorized as stage 1 AKI (60.12%). Advanced age, hypertension, ACEI/ARB usage, and higher APACHE II scores were significant risk factors for AKI development. Multivariate analysis identified age (HR 1.3, 95% CI 1.2-1.5, P = 0.01) and APACHE II score (HR 1.6, 95% CI 1.3-1.8, P = 0.02) as independent predictors of AKI occurrence. <strong>Conclusion:</strong> The incidence of AKI among ICU patients is substantial and associated with increased mortality and morbidity. Early identification and management of modifiable risk factors are crucial for mitigating AKI-related complications and improving patient outcomes. Proactive measures in critical care settings are necessary to reduce AKI burden and enhance patient care.</em></p> 2024-01-15T00:00:00+00:00 Copyright (c) 2024 R PERVAIZ , MA QAYYUM , SA KHALID , T HAFEEZ , MU MUNAWAR , HMH ARIF , H KANDEEL , WG ELMASRY , S RAZA