Objective: The purpose of this study was to quantitatively evaluate if the use of the optic nerve sheath diameter (ONSD) can be a suitable noninvasive surrogate approach for repeated invasive intracranial pressure (ICP) measures. Methods: The study used a sample of 22 adult patients with traumatic brain injury (TBI) from an in intensive care unit (ICU). ICP levels were measured using the gold standard and recorded in cmH20. ONSD was measured using ultrasonography with 5.6-5.7 MHz linear probe and recorded in millimeters. The data analysis was done using STATA software version 15. Results: The results showed a strong positive correlation between ICP and ONSD (r = 0.743, p = 0.001). The accuracy of the sonographic ONSD declined over time, starting from a high of 90.9% at the baseline and declining to a low of merely 20.0% after 48 hours. Conclusion: These findings indicate that the ONSD approach could be very useful alternative and noninvasive method for monitoring ICP.

Objectives: Poor pain control in burn patients as a great public health problem disrupts the healing and rehabilitation process and results in several adverse outcomes. The aim of this study was to investigate the efficacy and safety of intravenous lidocaine in reducing the pain of burn injuries. Materials and Methods: From August 2014 to March 2015, 66 eligible burn patients participated in the study and were randomly divided into two groups of lidocaine (L) and placebo (P). In group L, lidocaine 2% was injected at a bolus dose of 1.5 mg/kg followed by infusion at the dosage of 1.5 mg/kg/h, and in group P, saline was administrated. Pain severity was measured during 24 hours at baseline and 1, 2, 4, 8, 12, 16, 20, 24 hours after intervention based on Numerical Rating Scale (NRS-11). Morphine consumption, Ramsay score, and side effects were also documented. Results: Finally the data from 60 patients were analyzed. Comparing baseline with 24 hours after intervention, NRS-11 scores decreased from 7.12±1.42 to 3.33±0.76 (P<0.001) in group P and from 6.45±1.02 to 2.50±0.72 (P<0.001) in group L. Moreover, the mean of NRS scores during 24 hours in the lidocaine group was significantly lower compared to the placebo group, 3.93±0.72 vs 4.73 ±1.14, (P=0.03). The mean amounts of morphine consumption in group L were significantly lower compared to group P, 14.41 ± 4.86 vs 21.07±6.86, (P=0.001). The mean of Ramsay score in group L was significantly lower compared to group P, 1.38±0.59 vs 1.45±0.6, (P=0.014). Conclusions: This study revealed that intravenous lidocaine was an effective and safe drug for pain reduction in burn patients.

Background: Several studies have examined the possible role of beta-blockers, including esmolol, in controlling intracranial pressure (ICP). This study aimed to evaluate the effect of esmolol on ICP in patients with severe traumatic brain injury. Methods: In this case-control study, all TBI patients with ICP > 20 cmH2O, who were admitted to ICU during the study period, were included. Some patients received standard treatment plus esmolol (500 μg/kg and then 50 mg/kg/min for 24 hours), and some others just received standard treatment with no esmolol. The patients were monitored, and the ICP measurement was performed via inserted intra-ventricular catheter. The ICP and vital signs were measured and recorded before, 8, 16, and 24 hours after starting the treatment in the two groups, and the findings were then compared. Results: Twenty-two patients (13 males and 9 females) were included in this study, of whom 12 patients received esmolol, and 10 patients were in the control group. The mean age of those who received esmolol was smaller than those who did not receive it (46.6 ± 18.5 vs. 62.3 ± 19.1 years; P = 0.08). Moreover, the mean length of the ICU stay was smaller in the esmolol receivers than the control group (5.6 ± 1.1 vs. 17.3 ± 7.7 days; P = 0.04 (there was no significant difference between the two groups in terms of mortality rates (P = 0.30). The variations of the vital signs over time was not significantly different between the two groups (P > 0.05); however, the mean of ICP was lower in those who received esmolol compared to the control group at all checkpoints (P < 0.05). Conclusions: Those patients with TBI who received esmolol as part of their ICP control management in ICU had lower ICP than those who received no esmolol.

Objective: The present study was conducted to compare mechanically ventilated patients with and without COVID-19 in terms of hemodynamic instability using cardiovascular indicators. Methods: This prospective cohort study assigned intubated and mechanically ventilated patients to two groups, i.e. with COVID-19 and without COVID-19. The hemodynamic parameters measured and compared between the two groups on the first day of ICU admission and the following four consecutive days using an ultrasonic cardiac output monitor (USCOM) included cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV), flow time corrected (FTc), minute distance (MD) and potential kinetic energy (PKE). Results: Forty-three patients (males: 62.7%) were assigned to the COVID-19 group and 40 (males: 64.1%) to the one without COVID-19. Insignificant differences were observed between the two groups at baseline in terms of the mean homodynamic variables measured using the USCOM (P>0.05). The mean CO increased (P=0.020), the mean SVR insignificantly changed (P=0.267), the mean MD increased (P=0.005) and PKE decreased (P=0.066) in the COVID-19 group during the five days of evaluation. In the same period, the mean CO insignificantly changed (P=0.937), the mean SVR increased (P=0.028) and changes in MD (P=0.808) and PKE (P=0.539) were insignificant in the group without COVID-19. The two groups were not significantly different in terms of the other homodynamic parameters during the follow-up (P>0.05). Conclusion: The five-day changes in the USCOM-measured homodynamic parameters were lower in the group without COVID-19 compared to in that with COVID-19. In the group without COVID-19, no statistically-significant differences were observed between the mean follow-up values of the variables, excluding SVR, and their baseline values.