Pain in patients in the intensive care unit (ICU) who are on mechanical ventilators has a range of consequences that impact both their physical and mental recovery. Therefore, this study aims to assess the severity of pain at rest and the factors associated with it among patients on mechanical ventilators in the intensive care units. A multi-center prospective observational study was conducted among patients on mechanical ventilators in the intensive care unit of comprehensive specialized hospitals in the Amhara Region of North-West Ethiopia, from October 10, 2024, to January 15, 2025. Data were collected using a semi-structured questionnaire. Pain status was assessed every four hours on the first day of ICU admission using the Behavioral Pain Scale (BPS). Consecutive sampling was employed to select participants. Data were entered into EPI-data version 4.6 and transferred to Stata version 17 for analysis. Both bivariable and multivariable logistic regression analyses were performed to identify factors associated with pain. This study was conducted among 234 patients. We found the severity of pain as follows: 60 patients (25.64%) experienced no pain, 118 patients (50.43%) experienced mild pain, and 56 patients (23.93%) experienced unacceptable (significant) pain. Additionally, in this study, being female (AOR = 2.45, 95% CI 1.42–4.22), surgical cause of admission (AOR = 2.27, 95% CI 1.31–3.93)), anxiety (AOR = 3.78, 95% CI 2.03–7.04), and Combination of analgesia (opioid and non-opioid) (AOR = 0.37, 95% CI 0.21–0.65) had a significant association with pain. This study revealed that a significant proportion of patients (23.93%) experienced unacceptable levels of pain. Factors significantly associated with increased pain severity included being female, having a surgical cause for admission, and experiencing anxiety. Conversely, the use of a combination of opioid and non-opioid analgesics was significantly linked to reduced pain severity. These findings underscore the importance of recognizing demographic, clinical, and psychological factors in pain assessment. Based on the findings, it is recommended to prioritize routine pain assessments, especially for female and surgical patients. Additionally, anxiety screening and management should be integrated into patient care, and the use of combined opioid and non-opioid analgesics should be encouraged to effectively reduce pain severity.

Agitation is a common psychomotor disorder among critically ill patients on mechanical ventilators, posing significant risks to patients and adding strain to clinical services. Despite its importance, there is a lack of data on the incidence and contributing factors of agitation in the study area and across Ethiopia. This study, therefore, aims to assess the incidence and factors associated with agitation in patients on mechanical ventilators in the intensive care units of comprehensive specialized hospitals in the Amhara Region, North-West Ethiopia. A multi-center prospective follow-up study was conducted among 253 critically ill adult patients on mechanical ventilators in the Amhara region of Ethiopia from April 17, 2024, to July 16, 2024. Data were collected using a semi-structured questionnaire through chart reviews, observations, and interviews. Participants were selected using a consecutive sampling technique. The data were entered into Epi-Data version 4.6 and transferred to Stata version 17 for analysis. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with agitation. Variables with a p value of less than 0.2 in the bivariable analysis were included in the multivariable analysis. Crude and adjusted odds ratios with 95% confidence intervals were used to identify factors associated with agitation. The results were presented in the form of text, tables, and figures. In the multivariable analysis, variables with a p value of less than 0.05 were considered statistically significant predictors. The overall incidence of agitation among patients on mechanical ventilators in intensive care units was 87.35% (95% CI 82.6, 91.2). Anxiety (Adjusted Odds Ratio (AOR) 3.5; 95% CI 1.28, 9.45), delirium (AOR 3.01; 95% CI 1.13, 7.97), pain (AOR 3.23; 95% CI 1.18, 8.85), hyperthermia (AOR 3.49; 95% CI 1.004, 12.15), hyponatremia (AOR 3.64; 95% CI 1.009, 13.11), and the use of restraints (AOR 3.49; 95% CI 1.11, 8.67) were statistically significant factors associated with agitation. In this study, the majority of participants experienced agitation. To reduce the incidence of agitation, we recommend addressing or preventing the development of anxiety, pain, delirium, hyperthermia, and hyponatremia, as well as minimizing the use of restraints in intensive care units.

Objective To assess the incidence of delirium and its predictors among adult patients admitted to the intensive care units of comprehensive specialised hospitals in the Amhara region of northwest Ethiopia from 18 October 2024 to 20 February 2025. Design A multicentre prospective observational study was conducted. Setting Four comprehensive specialised hospitals in the Amhara region of northwest Ethiopia, from 18 October 2024 to 20 February 2025. Participants A total of 351 patients were included in the final analysis during the study period. Outcome measures The primary outcome measure of this study was the incidence of delirium. Additionally, the study investigated the factors associated with delirium incidence among adult patients admitted to intensive care units. Results The incidence of delirium among adult patients in intensive care units was 42.17% (95% CI: 37.08 to 47.42). Pain (adjusted HR (AHR) = 4.74; 95% CI: 2.38 to 9.44), mechanical ventilation (AHR = 2.96; 95% CI: 1.56 to 5.63), age 65 years or older (AHR = 2.18; 95% CI: 1.48 to 3.21) and agitation (Richmond Agitation-Sedation Scale (RASS) ≥1) (AHR = 3.26; 95% CI: 2.09 to 5.09) were statistically significant factors associated with delirium. Conclusion and recommendation In the present study, more than one-third of patients developed delirium. Pain, mechanical ventilation, age 65 or older and agitation (RASS≥1) were significantly associated with delirium occurrence. To reduce the incidence of delirium, the current study recommends treating or preventing pain and agitation. Additionally, special attention should be given to patients receiving mechanical ventilation and those aged 65 or older during care.

Background: Rebound pain (RP) is an acute, burning, or dull‐aching type of pain that occurs following the resolution of regional anesthesia. It is a common but understudied problem in orthopedic patients undergoing surgery under regional anesthesia. This study aimed to determine the prevalence and predictors of RP severity in patients undergoing orthopedic surgeries. Methods: A cross‐sectional study was conducted involving 364 patients who underwent orthopedic surgery and received regional anesthesia. To determine factors associated with the severity of RP, bivariable and multivariable ordinal logistic regression analyses were conducted. Both crude and adjusted odds ratios with their corresponding 95% confidence interval were calculated to determine the strength of association. Result: The prevalence of RP after resolution of regional anesthesia was 70.9% (95% CI: 65.9–75.5). Among all participants, 30.2% experienced mild RP, 19.2% had moderate pain, and 21.4% reported severe RP. Age less than 60 years (AOR: 2.34, 95% CI: 1.38–3.95, and p : 0.001), ASA physical status III or above (AOR: 5.84, 95% CI: 2.17–15.69, and p < 0.001), and having moderate (AOR: 2.86, 95% CI: 1.21–6.78, and p : 0.017) and severe (AOR: 7.48, 95% CI: 4.09–13.68, and p < 0.001) preoperative pain were significantly associated with increased odds of RP. In contrast, premedication with intravenous dexamethasone (AOR: 0.24, 95% CI: 0.14–0.43, and p < 0.001) and using local anesthetic adjuvants (AOR: 0.05, 95% CI: 0.02–0.11, and p < 0.001) were significantly associated with reduced odds of severe RP. Conclusion: Our study found a high incidence of RP following the resolution of regional anesthesia in patients undergoing orthopedic surgery. To reduce its incidence and severity, it is essential to effectively manage and alleviate preoperative pain, incorporate local anesthetic adjuvants into nerve block solutions, utilize intravenous dexamethasone, and incorporate multimodal analgesia before the resolution of regional anesthesia.

Background Postoperative ileus (POI) is a common consequence following abdominal surgeries; however, its incidence and risk factors in non-abdominal procedures remain unknown. Identifying clinical indicators of POI in this population is essential for early detection and treatment. Objective This study aims to assess the incidence and determinants of postoperative ileus (POI) in patients undergoing non-abdominal surgeries at Debre Tabor Comprehensive Specialized Hospital. Methods A prospective cohort study was conducted between September 1, 2024, and January 30, 2025. Demographic characteristics, comorbidities, surgical details, and perioperative parameters were recorded. Data were analyzed using SPSS version 27, with continuous and categorical variables summarized using descriptive statistics. Independent predictors of postoperative ileus (POI) were identified through bivariate and multivariate logistic regression analyses. Results Among the 400 patients who underwent elective non-abdominal surgery, 31 (7.75%) developed postoperative ileus (POI). Significant predictors included opioid use (OR = 3.28 [95% CI, 2.25–7.12], P < 0.01), neuromuscular blockers (OR = 2.33 [95% CI, 2.01–5.12], P < 0.01), poor postoperative functional status (OR = 5.67 [95% CI, 3.41–8.91], P < 0.01), and delayed postoperative mobility (OR = 4.45 [95% CI, 2.05–8.17], P < 0.01). Recommendation and conclusion POI occurs in a significant proportion of patients undergoing non-abdominal surgery. Implementing targeted perioperative strategies may reduce the incidence of POI and enhance postoperative outcomes.

Background: Agitation is a common and clinically significant phenomenon among patients admitted to intensive care units (ICUs), particularly those receiving mechanical ventilation or experiencing critical illness. Previous studies have shown inconsistent results regarding the prevalence and predictors of agitation in intensive care units. Aim: To assess the pooled prevalence and associated factors of agitation among adults in the intensive care unit. Study Design: A systematic review and meta‐analysis was conducted. The review protocol has been registered in the Prospero database under registration number CRD420251022240, following PRISMA guidelines. Results: This systematic review and meta‐analysis included 10 studies. The pooled prevalence of agitation in the intensive care unit was 55.65% (95% CI: 40.07, 71.24). The pooled analysis revealed a significant association between hyperthermia (≥ 37.5°C) and the prevalence of agitation in adult patients in the intensive care unit. The adjusted odds ratio (AOR) for hyperthermia was 3.24 (95% CI: 1.51–4.91, p < 0.0002). Conclusion: This meta‐analysis highlights the significant burden of agitation among adult patients in intensive care units, revealing that over half of critically ill individuals experience agitation during their ICU stay. Among the various contributing factors examined, elevated body temperature emerged as the only one with a statistically significant association with agitation. Relevance to Clinical Practice: This study underscores the importance of vigilant temperature monitoring and timely management of fever in ICU patients. Hyperthermia was found to be associated with a higher likelihood of agitation, although a direct causal relationship cannot be established from the available data. Maintaining normothermia remains a reasonable clinical goal that may contribute to overall patient stability. Implementing structured temperature control protocols as part of routine ICU care could help reduce agitation‐related complications such as unplanned extubation, increased sedation needs and prolonged ICU stays, thereby supporting improved patient safety and outcomes.