The effect of implementation of evidence-based eye care protocol for patients in the intensive care units on superficial eye disorders

Abstract Background Superficial eye disorders are one of the most common complications of improper eye care in intensive care units that can lead to corneal ulcers and permanent eye damage. The aim of this study was to determine the effect of the implementation of eye care protocol on the incidence of infection and superficial eye disorders in patients admitted to intensive care units. Methods This study was a cross-over clinical trial that was performed on 32 patients admitted to the intensive care unit with reduced or no blink reflex following loss of consciousness or receiving sedatives. The eye of the test group received eye care according to the protocol and the eye of the control group received the routine care of the ward. The data collection form included demographic and clinical information and the clinical score scale of superficial eye disorders, which were completed in 7 days for both eyes. Data analysis was performed by McNemar and Cochran tests with a 95 % confidence interval. Results In the study of superficial eye disorders, the frequency of dacryorrhea and hyperemia was not significantly different in the second to seventh days in the control and test eyes (P < 0.05). The frequency of xerophthalmia was not significantly different between the control and the test eyes on the second to third days (P < 0.05), but there was a significant difference on the fourth, fifth, sixth, and seventh days (P = 0.0001). Also, the frequency of corneal opacity was not significantly different in the second and third days (P < 0.05), but in the fourth (P < 0.05), fifth, sixth, and seventh days, this difference was significant (P = 0.0001). Conclusions Based on the results, although the implementation of eye care protocol has been able to have a significant effect on reducing ocular complications and problems, routine eye care in the intensive care unit also has clinical effectiveness. Therefore, in order to prevent and completely eliminate eye disorders in the intensive care unit, more evidence and research are needed. Trial registration The trial was retrospectively registered on https://en.irct.ir/trial/43493 on 13 November 2019 (13.11.2019) with registration number [IRCT20140307016870N5].

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Abstract TP329: Early Initiation of Oral Antihypertensives Reduces Intensive Care Unit Stay and Hospital Cost in Patients With Hypertensive Intracerebral Hemorrhage

Stroke ◽

10.1161/str.51.suppl_1.tp329 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Zhu Zhu ◽

Matthew Bower ◽

Sara Stern-Nezer ◽

Steven Atallah ◽

Dana Stradling ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intracerebral Hemorrhage ◽

Resource Utilization ◽

Hospital Cost ◽

Early Initiation ◽

Control Group ◽

Study Group ◽

Significant Difference ◽

Hypertensive Intracerebral Hemorrhage

Background and Purpose: Intravenous nicardipine infusion is effective for intensive blood pressure (BP) control in patients with hypertensive intracerebral hemorrhage (ICH). However, its use requires close hemodynamic monitoring in the intensive care unit (ICU). Prompt transition from nicardipine infusion to oral antihypertensives may reduce ICU length of stay (LOS). This study aimed to examine the effect of early verse late initiation of oral antihypertensives on hospital resource utilization in patients with hypertensive ICH. Methods: This is a retrospective study of patients with hypertensive ICH and initial systolic BP ≥ 180 mmHg from January 1, 2013 to December 31, 2017. Only patients who received nicardipine infusion were included. Based on timing of receiving oral antihypertensives within or after 24 hours of emergency department arrival, patients were divided into study or control group, respectively. Baseline characteristics, duration of nicardipine infusion, ICU and hospital LOS, functional outcome at hospital discharge, and the cost were compared between the 2 groups using univariate and multivariate analysis to adjust for dependent variables. Results: A total of 166 patients (90 in study group, 76 in control group) were identified. There was no significant difference in demographic features, past medical history or initial SBP between the 2 groups. Patients in study group had lower initial NIHSS and ICH scores but higher GCS score than those in the control group. Using multivariant regression analysisto adjust for initial SBP, NIHSS, GCS and ICH scores, early initiation of oral antihypertensives was associated with significant shorter ICU LOS (median 2 vs 5, p =0.004), decreased duration of nicardipine infusion (55.5 ±60.1 vs 121.6 ±141.3, P =0.002), less pharmaceutical cost (median $14207 vs $ 29299, p =0.007) and total hospital cost (median $ 24564 vs $ 47366, p =0.007). After adjustment of confounders, there was also no significant difference in functional independence (mRS 0-2, 42.2% vs 17.1%, p =0.112) or mortality (6.7% vs 13.2%, p = 0.789) between the 2 groups. Conclusions: Early initiation of oral antihypertensive therapy is associated with reduced resource utilization and hospital cost in patients with hypertensive ICH.

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Comparing Neonatal Intensive Care Unit Nursing Support in Mothers With ‎Newborn Abstinence Syndrome (NAS) and Mothers of Healthy Neonates ‎

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v9i4.26184 ◽

2019 ◽

Vol 9 (4) ◽

Author(s):

Seyedeh Najmeh Hosseini ◽

Arash Ghodousi ◽

Narges Sadeghi ◽

Somayeh Abbasi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Control Group ◽

Abstinence Syndrome ◽

Nursing Support ◽

Study Results ◽

Significant Difference ◽

The Impact

Background: The experience of having neonates in the Neonatal Intensive Care Unit (NICU) is a psychological crisis. It might cause many emotional problems for parents. Entire parental support is among the duties of the healthcare team. Therefore, this study aimed to compare the nursing support received by the mothers with Newborn Abstinence Syndrome (NAS) and the mothers of other neonates admitted to the NICU. Methods: The present cross-sectional descriptive-analytic study was conducted in the selected hospitals in Kerman Province, Iran. In total, 62 mothers with NAS and 61 non-addicted mothers with neonates admitted to the NICU were selected through convenience sampling method. The inclusion criteria were neonates under the care of parents, neonate admitted to the NICU for at least 24 hours, opiate dependence in the case group mothers, and no substance dependence in the control group mothers. The amount of nursing support for mothers having neonates with NAS was compared with that of the control mothers. The study groups were homogenized in terms of the study variables (neonate age, gender, and the duration of hospitalization). The required data were collected by the Nurse-Parent Support Tool (NPST) and analyzed in SPSS. Results: The study results revealed that among the neonates of 123 mothers, 75(60.97%) were boys, and 58(39.02%) were girls. The majority of neonates in both groups were breastfed. The mean±SD age of the mothers in the case and control group were 31.93±7.25 and 28.99±4.36 years, respectively. The nursing support level was desirable in both groups, and no significant difference was found in this regard (P>0.05). Furthermore, the level of nursing support in emotional, information-communication, self-esteem, and quality caregiving support dimensions was desirable in both groups. Conclusion: The obtained results revealed that nurses’ support was desirable in both groups. The prevalence of maternal addiction and the impact of this social harm on neonates who were admitted are essential. Furthermore, families having neonates with NAS need more support from the healthcare staff and nurses, in comparison with healthy parents; thus, the importance of this issue should be addressed in training and briefing courses for nurses.

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Dialyzable Leukocyte Extract (Transferon™) Administration in Sepsis: Experience from a Single Referral Pediatric Intensive Care Unit

BioMed Research International ◽

10.1155/2019/8980506 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Maria Isabel Castrejón Vázquez ◽

Aldo Arturo Reséndiz-Albor ◽

Mario A. Ynga-Durand ◽

Ivonne Maciel Arciniega Martínez ◽

Vanessa Ivonne Orellana-Villazon ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Laboratory Data ◽

Pediatric Intensive Care ◽

Control Group ◽

Immunomodulatory Agents ◽

Reactive Protein ◽

Significant Difference ◽

Pediatric Sepsis

Immunomodulatory agents have been proposed as therapeutic candidates to improve outcomes in sepsis. Transferon™, a dialyzable leukocyte extract (DLE), has been supported in Mexico as an immunomodulatory adjuvant in anti-infectious therapy. Here we present a retrospective study describing the experience of a referral pediatric intensive care unit (PICU) with Transferon™ in sepsis. We studied clinical and laboratory data from 123 patients with sepsis (15 in the DLE group and 108 in the control group) that were admitted to PICU during the period between January 2010 and December 2016. Transferon™ DLE use was associated with lower C reactive protein (CRP), increase in total lymphocyte counts (TLC), and decrease in total neutrophil count (TNC) 72 hours after Transferon™ DLE administration. The control group did not present any significant difference in CRP values and had lower TLC after 72 hours of admission. There was no difference in PICU length of stay between control and Transferon™ DLE group. Transferon™ DLE administration was associated with a higher survival rate at the end of PICU stay. This study shows a possible immunomodulatory effect of Transferon™ on pediatric sepsis patients.

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Feasibility of a Mindfulness-Based Intervention for Surgical Intensive Care Unit Personnel

American Journal of Critical Care ◽

10.4037/ajcc2017444 ◽

2017 ◽

Vol 26 (1) ◽

pp. 10-18 ◽

Cited By ~ 32

Author(s):

Beth A. Steinberg ◽

Maryanna Klatt ◽

Anne-Marie Duchemin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Units ◽

Work Engagement ◽

Intervention Group ◽

Surgical Intensive Care Unit ◽

Control Group ◽

Negative Effects ◽

Surgical Intensive Care ◽

Utrecht Work Engagement Scale

Background Surgical intensive care unit personnel are exposed to catastrophic situations as they care for seriously injured or ill patients. Few interventions have been developed to reduce the negative effects of work stress in this environment. Objective This pilot study evaluated the feasibility of a workplace intervention for increasing resilience to stress. The intervention was implemented within the unique constraints characteristic of surgical intensive care units. Methods Participants were randomly assigned to an intervention or control group. The mindfulness-based intervention included meditation, mild yoga movement, and music and was conducted in a group format 1 hour a week for 8 weeks in a surgical intensive care unit during work hours. Assessments were performed 1 week before and 1 week after the intervention. Results The intervention was well received, with a 97% overall retention rate and 100% retention in the intervention group. Work satisfaction, measured with the Utrecht Work Engagement Scale, increased significantly in the intervention group with no change in the control group. Negative correlations were found between the vigor subscale scores of the Utrecht Work Engagement Scale and scores for emotional exhaustion on the Maslach Burnout Inventory and scores for burnout on the Professional Quality of Life scale. Participants rated recognizing their stress response as a main benefit of the intervention. Conclusion Workplace group interventions aimed at decreasing the negative effects of stress can be applied within hospital intensive care units. Despite many constraints, attendance at weekly sessions was high. Institutional support was critical for implementation of this program.

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The Effects of Aromatherapy on Intensive Care Unit Patients’ Stress and Sleep Quality: A Nonrandomised Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2017/2856592 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Eun Hee Cho ◽

Mi-Young Lee ◽

Myung-Haeng Hur

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Intensive Care ◽

Sleep Quality ◽

Controlled Trial ◽

Experimental Treatment ◽

Stress Index ◽

Control Group ◽

Nursing Interventions ◽

Significant Difference

Background. Stress has both physiological and psychological effects and can negatively impact patients’ treatment and recovery. We examined whether the aromatherapy alleviated patients’ stress and improved their sleep quality and provided data that can be utilized in clinical settings. Methods. This was a nonrandomised controlled experimental study. Participants included lucid adult patients who were admitted to the intensive care unit and had spent more than two nights there. The experimental treatment required participants to engage in deep breathing with essential oils as part of the aromatherapy. The control group was instructed to go to sleep without receiving the lavender aroma oil. Results. The experimental group and control group showed a significant difference in perceived stress (F=60.11, p<.001), objective stress index (F=25.65, p<.001), systolic blood pressure (F=9.09, p<.001), diastolic blood pressure (F=2.47, p=.046), heart rate (F=5.71, p<.001), and sleep quality (F=109.46, p<.001). Conclusions. The results revealed that aromatherapy alleviated stress and improved sleep quality in intensive care unit patients after 2 days of the experimental treatment. These results demonstrate that aromatherapy affects stress and sleep quality, thus indicating its value in nursing interventions. This trial is registered with KCT0002344.

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Infliximab and Intravenous Gammaglobulin in Hospitalized Severe COVID-19 Patients in Intensive Care Unit

Archives of Iranian Medicine ◽

10.34172/aim.2021.22 ◽

2021 ◽

Vol 24 (2) ◽

pp. 139-143

Author(s):

Mohsen Farrokhpour ◽

Nader Rezaie ◽

Najmeh Moradi ◽

Fatemeh Ghaffari Rad ◽

Shirin Izadi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Combination Therapy ◽

Clinical Symptoms ◽

Observational Research ◽

Control Group ◽

Therapeutic Effects ◽

Significant Difference ◽

Intravenous Gammaglobulin ◽

Underlying Diseases

Background: Severe coronavirus disease 2019 (COVID-19) may lead to the cytokine storm syndrome which may cause acute respiratory failure syndrome and death. Our aim was to investigate the therapeutic effects of infliximab, intravenous gammaglobulin (IVIg) or combination therapy in patients with severe COVID-19 disease admitted to the intensive care unit (ICU). Methods: In this observational research, we studied 104 intubated adult patients with severe COVID-19 infection (based on clinical symptoms, and radiographic or CT scan parameters) who were admitted to the ICU of a multispecialty hospital during March 2020 in Tehran, Iran. All cases received standard treatment regimens as local protocol (Oseltamivir + hydroxychloroquine + lopinavir/ritonavir or sofosbuvir or atazanavir ± ribavirin). The cases were grouped as controls (n = 43), infliximab (n = 27), IVIg (n = 23) and combination (n = 11). Results: There was no significant difference between controls and treatment groups in terms of underlying diseases or the number of underlying diseases. The mean age (SD) of cases was 72.42 (16.06) in the control group, 64.52 (12.965) in IVIg, 63.40 (17.57) in infliximab and 64.00 (11.679) in combination therapy; (P = 0.047, 0.031 and 0.11, respectively). Also, 37% in the infliximab group, 26.1% in IVIg, 45.5% in combination therapy, and 62.8% in the control group expired (all P < 0.05). Hazard ratios were 0.31 in IVIg (95% CI: 0.12-0.76, P = 0.01), 0.30 in infliximab (95% CI: 0.13-0.67, P = 0.004), 0.39 in combination therapy (95% CI: 0.12-1.09, P = 0.071). Conclusion: According to the findings of this study, it seems that infliximab and IVIg, alone or together, in patients with severe COVID-19 disease can be considered an effective treatment.

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Virtual Reality Hypnosis for Anxiety and Pain Management in Intensive Care Units. A Prospective Randomized Trial Among Cardiac Surgery Patients.

10.21203/rs.3.rs-60523/v1 ◽

2020 ◽

Author(s):

Floriane Marie Rousseaux ◽

Nadia Dardenne ◽

Paul B Massion ◽

Didier Ledoux ◽

Marie-Elisabeth Faymonville ◽

...

Keyword(s):

Virtual Reality ◽

Cardiac Surgery ◽

Intensive Care ◽

Intensive Care Units ◽

University Hospital ◽

Control Group ◽

Controlled Clinical Trial ◽

Significant Difference ◽

Before And After ◽

French Speaking

Abstract Background: Although non-pharmacological tools are nowadays commonly used in medical settings, virtual reality and hypnosis are little studied in complex contexts such as intensive care, where patients need significant physical and psychological assistance. The aim of the project is to evaluate the benefits of hypnosis, virtual reality (VR) and the combination of hypnosis and virtual reality (VRH) on anxiety and pain on patients before and after a cardiac surgery.Methods: This prospective randomized and controlled clinical trial was conducted in the University Hospital of Liege (Belgium). Participants are adults undergoing cardiac surgery, French speaking. Exclusion criteria are patients with psychiatric diseases, claustrophobia, acrophobia, heavy hearing impairment, visual impairment, extreme fatigue, verbal incoherence, surgery cancelled or postponed. The day before the surgery, patients were randomly assigned to four arms (control, hypnosis, VR and VRH) and had 20 minutes of one of the technique. They received the same intervention one day after surgery, in intensive care units. Anxiety, pain, fatigue, relaxation and physiological parameters were evaluated before and after each session.Results: 100 patients (66.38 ± 11.48 years; 76 men, 24 women) were included. Results showed that anxiety decreased from baseline to postoperative day in all groups. Relaxation increased in all groups in preoperative (p = .000) and postoperative period (p = 0.03). There were no significant results for pain and fatigue (p > 0.05). There was no significant difference between control group and hypnosis, VR or VRH.Conclusion: Anxiety decreased and relaxation increased in all groups, including control group. We cannot affirm that one technique is better than another is. Nevertheless, this study helps to expand the knowledge regarding application of virtual reality, hypnosis and virtual reality hypnosis in the specific contexts of cardiac surgery and intensive care units. Additional studies are required to compare and evaluate the costs-effectiveness of these techniques for critical care patients and caregivers (see Figure 1).Trial registration: ClinicalTrials.gov: NCT03820700. https://clinicaltrials.gov/ct2/show/NCT03820700. Registered on January 29 2019. Retrospectively registered.

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The results of a multicenter retrospective controlled clinical study of the efficacy and safety of L-lysine aescinate® in the treatment of traumatic and postoperative cerebral edema

INTERNATIONAL NEUROLOGICAL JOURNAL ◽

10.22141/2224-0713.16.8.2020.221957 ◽

2021 ◽

Vol 16 (8) ◽

pp. 21-32

Author(s):

Yu.Yu. Kobeliatskyi ◽

I.S. Bobryk ◽

A.M. Netliukh ◽

I.I. Ilashchuk ◽

D.S. Ivakhnenko

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intracranial Pressure ◽

Cerebral Edema ◽

Standard Therapy ◽

Injury Severity ◽

Control Group ◽

Combination Drug ◽

Brain Functions ◽

Significant Difference

In modern guidelines, the control of intracranial pressure is recognized as an important prerequisite for quality reco-very of brain functions after severe traumatic brain injury (TBI). Among the relatively new approaches to the control of intracranial pressure in severe TBI, a combination drug L-lysine aescinate® is considered. It has endotheliotropic, venotonic, anti-inflammatory, antiplatelet and other effects that allow it to be regarded as a mean for preventing and reducing cerebral edema after TBI. To evaluate the efficacy and effects of L-lysine aescinate®, a multicenter retrospective study was conducted that included 988 patients aged 18 to 65 years with isolated or combined severe or moderate TBI. The median injury severity index was 17 points, i.e. most people had a serious injury. Patients were randomized into two groups, one of which (n = 335) received only standard therapy, while the other (n = 653) — additionally L-lysine aescinate®. L-lysine aescinate® was prescribed on the first day of hospitalization (median — 2.75 hours) and for a course of 2 to 8 days (median — 7 days). Mortality in the intensive care unit (primary endpoint) was 10.3 and 24.2 % in the main and control groups, respectively (difference 13.9 %; 95% confidence interval (CI): 8.93–19.21 %; p < 0.001). Logistic regression method revealed that L-lysine aescinate® was the most important factor influencing patient survival (p < 0.001). Its use increased the chances of survival of a patient with TBI in the intensive care unit by 3.3 times (odds ratio (OR) = 3.311; 95% CI: 2.108–5.200). Similar results were obtained for 30-day hospital mortality. The frequency of recovery of clear consciousness during the hospital stay was 87.0 % in the group of L-lysine aescinate® and 66.0 % in the control group, with a significant difference between them (p < 0.001). Administration of L-lysine aescinate® increased the chances for restoring clear consciousness in a patient with TBI by 3.8 times (OR = 3.823; 95% CI: 2.535–5.765). The results of the study allow us to recommend the inclusion of L-lysine aescinate® in the standard therapy of patients with isolated or combined severe or moderate TBI.

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Procalcitonin-guided antibiotic therapy for suspected and confirmed sepsis of patients in a surgical-trauma ICU: a prospective, two-period cross-over, interventional study

10.21203/rs.2.15320/v1 ◽

2019 ◽

Author(s):

Rispah Chomba ◽

Maeyane Steve Moeng ◽

Warren Lowman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Antibiotic Treatment ◽

Intervention Group ◽

Control Group ◽

Surgical Trauma ◽

Trauma Patients ◽

Significant Difference ◽

Antibiotic Duration

Abstract Background: Biomarkers like procalcitonin (PCT) are an important antimicrobial stewardship tool for critically ill patients. The purpose of our study was to compare a procalcitonin guided antibiotic algorithm to standard antibiotic treatment in surgical trauma patients admitted to the intensive care unit (ICU).Methods: A prospective, two period cross-over study was conducted in a surgical trauma intensive care unit in South Africa. In the first period, 40 patients were recruited into the control group and antibiotics were discontinued as per standard of care. In the second period, 40 patients were recruited into the procalcitonin group and antibiotics were discontinued if the PCT decreased by ≥ 80% from the peak PCT level, or to an absolute value of less than 0.5 µg/L. Antibiotic duration of treatment was the primary outcome. Patients were followed up for 28 days from the first sepsis event.Results: For the first sepsis event the PCT group had a mean antibiotic duration of 9.3 days while the control group had a mean duration of 10.9 days (p=0.10). Patients in the intervention group had more antibiotic free days alive (mean 7.7±6.57 days) compared to the control group ﴾mean 3.8±5.22 days, (p=0.004﴿. The length of ICU stay and length of hospital stay for the two groups were similar. The in-hospital mortality was reduced in the intervention group (15%) compared to the control group (30%).Conclusion: There was no significant difference in duration of antibiotic treatment between the two groups. However, the PCT group had more antibiotic free days alive and lower in-hospital mortality compared to the control group.Trial registration: Pan African clinical trial registry, PACTR201909715467725, date of registration: 20.9.2019; retrospectively registered, https://pactr.samrc.ac.za/Search.aspx

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DOES THE USE OF DEXMEDETOMIDINE AFFECT THE OUTCOMES IN PATIENTS WITH SEVERE COVID-19?

10.22541/au.162704120.08475182/v1 ◽

2021 ◽

Author(s):

Kubilay İşsever ◽

Ahmed Cihad Genç ◽

Deniz Çekiç ◽

Ahmed Bilal Genc ◽

Selcuk Yaylaci ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Patient Group ◽

Ivig Therapy ◽

Daily Practice ◽

Mortality Rates ◽

Control Group ◽

Significant Difference ◽

Patients With Diabetes ◽

The Difference

Objective: Dexmedetomidine (DEX) is a highly selective α2-adrenoceptor agonist that is increasingly used in the daily practice of intensive care units (ICUs) with its sedative, analgesic, anxiolytic, and immunoprotective effects. In this study, we aimed to analyze whether Dexmedetomidine improves the outcomes in patients treated in ICU. Design: A retrospective study Place and Duration of Study: Intensive care units (ICU) of Sakarya University Training and Research Hospital, Sakarya, Turkey, from October 2020 to February 2021 Methodology: The medical records of the patients were analyzed retrospectively. We included 134 patients in the study, in 45 of whom the treatment regimen included dexmedetomidine and 89 of whom were not treated with dexmedetomidine. Patients treated with DEX were defined as the “patient group”, whereas patients not treated with DEX were defined as “control group” and the parameters were compared between these groups. Obtained data were analyzed in the biostatistical program. Results: The median age of all patients was 64 and 62.7% of them were male. No significant difference was found between the groups in terms of median ages (p>0.05). The patients with diabetes mellitus (DM), congestive heart failure (CHF), and undergoing insulin treatment were significantly less treated with DEX (p=0.04, p=0.03, and p=0.016 respectively) whereas intravenous immunoglobulin (IVIG) therapy was found to be more frequently applied to the patient group (p=0.043). The median duration between ICU admission and the time of intubation was 4 days for the control group whereas it was 1 day for the patient group and the difference was strongly significant (p=0.000, p<0.001). The other analyses concerning lab parameters, mortality rates, intubation rates and durations, applied treatments, and comorbidities revealed no significant difference between the groups. Conclusion: Our study revealed that DEX therapy can help us to gain time before intubation however can not reduce mortality rates in severe COVID-19.

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