Pakistan Journal of Intensive Care Medicine https://pjicm.com/ojs/index.php/home <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="http://medeyepublishers.com/ojs/index.php/home/loj"><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="mailto:editorbcsrj@gmail.com">editorpjicm@gmail.com.</a></p> en-US submit@pjicm.com (Asim Rana) editorpjicm@gmail.com (Ali Hussain) Wed, 05 Jul 2023 00:00:00 +0000 OJS 3.2.1.2 http://blogs.law.harvard.edu/tech/rss 60 RISING NEED OF PHYSICAL REHABILITATION IN ICU https://pjicm.com/ojs/index.php/home/article/view/25 <p><em>This mini-review discusses the importance of physical rehabilitation in Intensive Care Units (ICUs) to mitigate physical, mental, and psychological problems among critically ill patients. Early and customised physical activities that encourage patient movement from in-bed activities to walking are highlighted. A systematic review of 60 trials (n = 5352) showed that physical rehabilitation improves physical function and reduces ICU stay duration compared to conventional treatment. Despite its benefits, physical therapy is underutilised due to perceived safety issues. Recommendations for effective physical rehabilitation include interprofessional collaboration, addressing specific hurdles, and utilising mobility equipment. Patients should be assessed daily for rehabilitation eligibility, and a proactive culture for mobilisation should be promoted. While physical therapy is generally safe, it requires balancing risks and benefits, especially for patients with extended ICU stays. Structured exercise routines and patient engagement are crucial during the ICU stay, and regular evaluation of mobilisation and physical activity outcomes is essential at ICU discharge and follow-up. The overall goal is to enhance patient recovery and independence, emphasising the need for early physical rehabilitation interventions.</em></p> R PERWAIZ , MB ATTA , M MALIK , AHA AWAD , AM ABDELBAKY , MI SHOAIB , WG ELMASRY Copyright (c) 2023 R PERWAIZ , MB ATTA , M MALIK , AHA AWAD , AM ABDELBAKY , MI SHOAIB , WG ELMASRY https://creativecommons.org/licenses/by-nc/4.0 https://pjicm.com/ojs/index.php/home/article/view/25 Sun, 15 Oct 2023 00:00:00 +0000 IMPACT OF TRAINING IN CLINICAL PRACTICE STANDARDS ON EYE CARE FOR SEDATED PATIENTS: A PRE-POST INTERVENTIONAL STUDY AMONG INTENSIVE CARE UNIT NURSES https://pjicm.com/ojs/index.php/home/article/view/20 <p><strong><em>Background: </em></strong><em>Vision is one of the most critical senses for humans, particularly in the intensive care unit (ICU) setting. Inadequate eye care for sedated patients can lead to significant ocular problems, including blindness. Nursing knowledge, attitudes, and abilities are essential for delivering effective eye care in the critical care unit. <strong>Objectives: </strong>To determine the impact of training ICU nurses on clinical practice standards for eye care in sedated patients on their knowledge, attitudes, and practices regarding eye care. <strong>Study Design:</strong> A pre-post interventional study was conducted on 40 ICU nurses. <strong>Setting:</strong> The study was conducted in the intensive care units of Bahria International Hospital, Lahore, Pakistan. <strong>Duration of Study</strong> This study was conducted from July 2022 to February 2023. <strong>Material and Methods:</strong> The experimental group received clinical guideline training for eye care for sedated patients over three sessions. Data collection utilized an eye care questionnaire assessing nurses' clinical competence, with domains including knowledge, attitude, and practice. Nurses self-assessed their competence before and three months after training. Data analysis was performed using SPSS 21. <strong>Results:</strong> Following the intervention, a significant difference was observed in the mean score of overall eye care clinical competence (ECCC) between the experimental and control groups (P ≤ 0.05). The experimental group's mean scores for knowledge, attitude, and practice significantly improved before and after the intervention (P ≤ 0.05). <strong>Conclusion:</strong> Training ICU nurses on clinical principles for eye care in sedated patients leads to improvements in their knowledge, attitudes, and practices. Ongoing training and supervision based on clinical guidelines are crucial for implementing evidence-based eye care practices in the ICU.</em></p> R PERVAIZ , S AKASH , S BANO , M MALIK , AZ RIZVI , MI SHOAIB , H KANDEEL , S RAZA Copyright (c) 2023 R PERVAIZ , S AKASH , S BANO , M MALIK , AZ RIZVI , MI SHOAIB , H KANDEEL , S RAZA https://creativecommons.org/licenses/by-nc/4.0 https://pjicm.com/ojs/index.php/home/article/view/20 Thu, 28 Dec 2023 00:00:00 +0000 ASSESSMENT OF OUTCOMES OF MALIGNANCY PATIENTS ADMITTED IN INTENSIVE CARE UNITS https://pjicm.com/ojs/index.php/home/article/view/18 <p><strong><em>Background: </em></strong><em>The decision to admit advanced cancer patients to the intensive care unit (ICU) is multifaceted, considering factors such as prognosis and quality of life. <strong>Objectives:</strong> The objective of this study was to identify mortality risk factors in critically ill advanced cancer patients admitted to the ICU<strong>. Study Design: </strong>This was an observational study. <strong>Setting:</strong> The study was conducted at Bahria International Hospital, Lahore<strong>. Duration of Study: </strong>The study was conducted between March 2022 and March 2023<strong>.Material and Methods: </strong>A total of 65 adult cancer patients admitted non-electively to the ICU were enrolled in the study. Data on demographics, clinical conditions, and outcomes were collected. Independent medical decisions were collected by ICU staff.<strong> Results: </strong>The ICU mortality rate was 34.6%, increased to 59.4% within thirty days post-discharge. Patients spent an average of 15.2 days in the ICU. Common admission reasons included respiratory failure (36.2%) and sepsis/septic shock (59.2%). Cox regression analysis revealed six significant indicators of poor outcomes: acute kidney injury (AKI), sepsis with multiple organ failure (MOF), acute respiratory distress syndrome (ARDS), uncontrolled malignancy, mechanical ventilation, and vasopressor use.<strong> Conclusion: </strong>Our findings highlight AKI, sepsis, MOF, ARDS, and uncontrolled malignancy as prognostic predictors of early death in critically ill cancer patients admitted to the ICU. Additionally, mechanical ventilation and vasopressor use are associated with increased mortality risk. These insights can aid clinicians in optimizing care strategies for cancer patients</em></p> R PERVAIZ , B ARIF , T SARWAR , AZ RIZVI, MU MUNAWAR , H KANDEEL , AHA AWAD Copyright (c) 2023 R PERVAIZ , B ARIF , T HAFEEZ , T SARWAR , MU MUNAWAR , H KANDEEL , M HASAN , AHA AWAD https://creativecommons.org/licenses/by-nc/4.0 https://pjicm.com/ojs/index.php/home/article/view/18 Mon, 14 Aug 2023 00:00:00 +0000 THE PREVALENCE, RISK FACTORS, AND OUTCOMES OF DELIRIUM AMONGST ICU PATIENTS. A STUDY FROM THE LOCAL POPULATION OF PAKISTAN https://pjicm.com/ojs/index.php/home/article/view/19 <p><strong><em>Background: </em></strong><em>Patients admitted to intensive care units (ICUs) often experience delirium, which is associated with adverse outcomes including prolonged ICU stays, increased mortality rates, and elevated healthcare costs. Despite its significance, delirium in Pakistan remains understudied.<strong> Objectives: </strong>To assess the delirium prevalence, identify predisposing factors and precipitating events, determine predictors of delirium, and explore its impact on ICU length of stay and mortality<strong>. Study Design: </strong>The study utilized a prospective observational design<strong>. Setting: </strong>The study was conducted at Bahria International Hospital ICU in Lahore, Pakistan. <strong>Duration of Study:</strong></em> This study was conducted from September 2022 to March 2023.<strong><em> Material and Methods: </em></strong><em>Utilizing the Intensive Care Delirium Screening Checklist (ICDSC), bedside nursing staff evaluated 140 patients twice daily. Data on predisposing factors, precipitating events, and clinical parameters were collected. Regression analysis was performed to identify predictors of delirium.<strong> Results: </strong>The study found a delirium prevalence of 29.2%, significantly affecting ICU length of stay. Regression analysis identified sepsis, metabolic acidosis, nasogastric tube use, and APACHE II score as independent predictors of delirium among ICU patients<strong>. Conclusion: </strong>Given the detrimental effects of delirium, implementing multidisciplinary preventive strategies targeting modifiable risk factors are recommended to improve patient outcomes.</em></p> R PERVAIZ , T SARWAR , B ARIF , S BANO , MA NAYYAR , AMH MOSTAFA , WG ELMASRY , S RAZA Copyright (c) 2023 R PERVAIZ , T SARWAR , B ARIF , S BANO , MA NAYYAR , AMH MOSTAFA , WG ELMASRY , S RAZA https://creativecommons.org/licenses/by-nc/4.0 https://pjicm.com/ojs/index.php/home/article/view/19 Sun, 17 Sep 2023 00:00:00 +0000 CORTICOSTEROIDS USAGE IN THE INTENSIVE CARE UNIT: SPECIFIC RECOMMENDATIONS BASED ON RECENT EVIDENCE https://pjicm.com/ojs/index.php/home/article/view/24 <p><em>Corticosteroids are a class of drugs that mimic the effects of cortisol, a hormone naturally produced by the adrenal glands. They exert a wide range of effects on the body's immune, metabolic, and inflammatory responses. In the context of critically ill patients in the intensive care unit (ICU), corticosteroids are frequently utilised due to their potent anti-inflammatory and immunosuppressive properties. In the ICU setting, corticosteroids are commonly employed to manage various conditions such as severe sepsis, acute respiratory distress syndrome (ARDS), exacerbations of chronic obstructive pulmonary disease (COPD), and adrenal insufficiency. Their mechanism of action involves suppression of pro-inflammatory cytokines, inhibition of leukocyte migration, and stabilisation of cell membranes, among other effects. The choice of corticosteroid, dosing regimen, and duration of therapy in the ICU depends on the specific clinical condition being treated and individual patient factors. For instance, corticosteroids such as hydrocortisone are often administered to attenuate the systemic inflammatory response and improve hemodynamic stability in the management of septic shock. Dosing may vary but commonly involves an initial bolus followed by continuous infusion or intermittent dosing. In ARDS, corticosteroids may reduce lung inflammation and prevent further tissue damage. Methylprednisolone is a commonly utilised corticosteroid in this context, with dosing typically initiated at a high dose and then tapered gradually based on clinical response. For patients with exacerbations of COPD, corticosteroids help to reduce airway inflammation and improve lung function. Oral or intravenous corticosteroids such as prednisone or methylprednisolone are often prescribed for a short duration during exacerbations. In cases of adrenal insufficiency, corticosteroid replacement therapy is essential to restore physiological cortisol levels and prevent adrenal crisis. Hydrocortisone is the corticosteroid of choice in this scenario, with dosing adjusted based on the degree of adrenal dysfunction and stress level. Despite their efficacy, corticosteroids are associated with a range of potential adverse effects, including immunosuppression, hyperglycemia, fluid retention, electrolyte abnormalities, and increased risk of infection. Therefore, carefully monitoring patients receiving corticosteroid therapy in the ICU is paramount, with adjustments to minimise risks while optimising therapeutic benefits. In summary, corticosteroids play a crucial role in managing critically ill patients in the ICU, offering potent anti-inflammatory and immunomodulatory effects. However, their use requires careful consideration of the underlying condition, patient characteristics, and potential adverse effects, with dosing and duration tailored to individual needs.</em></p> AHA AWAD , AM ABDELBAKY , MI SHOAIB , WG ELMASRY Copyright (c) 2023 AHA AWAD , AM ABDELBAKY , MI SHOAIB , WG ELMASRY https://creativecommons.org/licenses/by-nc/4.0 https://pjicm.com/ojs/index.php/home/article/view/24 Fri, 03 Nov 2023 00:00:00 +0000