Comparative efficacy of honey 12.5% and chlorhexidine 0.2% mouthwashes on the oropharyngeal bacterial colonization in mechanically-ventilated patients: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of honey mouthwash 12.5% and chlorhexidine solution 0.2% to reduce the rate of oropharyngeal bacterial colonization in mechanically-ventilated patients. METHODS: This study was a randomized, single blind, phase Ⅲ controlled clinical trial. Sixty patients newly admitted to internal and trauma Intensive Care Units of the two educational hospitals of Sanandaj city affiliated with Kurdistan University of Medical Sciences were selected by convenience sampling and allocated to two groups of 30 patients using random blocks design. In each group, the mouthwash was applied twice a day for four consecutive days. Swab samples were taken from the mouth and throat of all patients three times a day (pre- intervention, two days, and four days after the intervention) and then the samples were transferred onto the blood agar and eosin methylene blue (EMB) culture plates and investigated for bacterial growth and colonization after 24-48 h. RESULTS: The findings showed that oropharyngeal colonization was not significantly different between the two groups, pre-intervention, two days, and four days after the intervention (P > 0.05). Rinsing with honey mouthwash 12.5% led to the inhibition of Staphylococcus aureus and Pseudomonas aeruginosa on the fourth day of the intervention in all samples. CONCLUSION: None of the studied solutions contributed to the reduction of oropharyngeal bacterial colonization. It seems that the growth inhibition of Staphylococcus aureus and Pseudomonas aeruginosa by the honey 12.5% mouthwash in mechanically-ventilated patients need further investigation.

Effects of different mechanical ventilation modes on severe chest injury complicated with acute respiratory distress syndrome in elderly patients / 中国基层医药

Objective To investigate and analyze the effect of different mechanical ventilation modes in the treatment of severe chest injury complicated with acute respiratory distress syndrome in the elderly .Methods From July 2016 to July 2018, 92 elderly patients with severe chest injury complicated with acute respiratory distress syndrome who were treated in Shengzhou Hospital of Traditional Chinese Medicine were selected in the research .The patients were divided into control group and observation group by envelope －type grouping,with 46 cases in each group.The control group received synchronous intermittent command ventilation combined with positive end －expiratory pressure ventilation,and the observation group was given continuous positive airway pressure ventilation combined with pressure support ventilation.The clinical efficacy,respiratory pattern parameters and blood gas indicators of the two groups were compared.Results The total clinical improvement rate of the observation group was 97.83%,which of the control group was 93.48%,the difference was not statistically significant (χ2 ＝0.426,P＞0.05).The MV,SaO2 and PaO2 in the observation group were significantly higher than those in the control group ,while PIP and PaCO2 in the observation group were significantly lower than those in the control group , the differences were statistically significant (t＝13.022,18.622,10.605,27.238,11.746,all P＜0.05).All the blood and gas indicators in the observation group were significantly better than those in the control group (t＝6.166,2.766,6.905,all P＜0.05). Conclusion Synchronous intermittent command ventilation combined with positive end －expiratory pressure ventilation and continuous positive airway pressure combined with pressure support ventilation in the treatment of elderly patients with severe chest injury combined with acute respiratory distress syndrome can achieve an ideal clinical effect .

Effects of different mechanical ventilation modes on severe chest injury complicated with acute respiratory distress syndrome in elderly patients / 中国基层医药

Objective@#To investigate and analyze the effect of different mechanical ventilation modes in the treatment of severe chest injury complicated with acute respiratory distress syndrome in the elderly.@*Methods@#From July 2016 to July 2018, 92 elderly patients with severe chest injury complicated with acute respiratory distress syndrome who were treated in Shengzhou Hospital of Traditional Chinese Medicine were selected in the research.The patients were divided into control group and observation group by envelope-type grouping, with 46 cases in each group.The control group received synchronous intermittent command ventilation combined with positive end-expiratory pressure ventilation, and the observation group was given continuous positive airway pressure ventilation combined with pressure support ventilation.The clinical efficacy, respiratory pattern parameters and blood gas indicators of the two groups were compared.@*Results@#The total clinical improvement rate of the observation group was 97.83%, which of the control group was 93.48%, the difference was not statistically significant (χ2=0.426, P>0.05). The MV, SaO2 and PaO2 in the observation group were significantly higher than those in the control group, while PIP and PaCO2 in the observation group were significantly lower than those in the control group, the differences were statistically significant (t=13.022, 18.622, 10.605, 27.238, 11.746, all P<0.05). All the blood and gas indicators in the observation group were significantly better than those in the control group (t=6.166, 2.766, 6.905, all P<0.05).@*Conclusion@#Synchronous intermittent command ventilation combined with positive end-expiratory pressure ventilation and continuous positive airway pressure combined with pressure support ventilation in the treatment of elderly patients with severe chest injury combined with acute respiratory distress syndrome can achieve an ideal clinical effect.

No difference in mechanical ventilation-free hours in critically ill patients who received intravenous, oral, or enteral phosphate replacement.

PURPOSE: To determine the impact on duration of mechanical ventilation (MV) and the need for reintubation after changing from intravenous (IV) to oral phosphate formulations, in response to a national shortage of IV phosphate. METHODS: A retrospective study was performed in adult patients who required MV for at least 48 hours. RESULTS: A total of 136 patients were included, with 68 patients in both the restricted phosphate group and unrestricted phosphate groups. There was no difference in the cumulative phosphate supplementation received (IV and oral) between groups (P=.08). The overall mean serum phosphorus concentration in unrestricted vs restricted group was 3.0 vs 2.9 mg/dL, respectively (P=.24), and the phosphorus concentration was not significantly different between groups during the first 21 days of the study (P=.24). The median MV-free hours in the unrestricted group was 462 hours compared with 507 hours in the restricted group (P=.16), and 9 (13.2%) of patients in each group required reintubation (P=.99). There was no significant difference in mortality, or hospital, or intensive care unit (ICU) length of stay. CONCLUSIONS: No difference in MV-free hours or need for reintubation was observed after a national shortage requiring the restriction of IV phosphate supplementation. Oral phosphate replacement is a safe and an efficient alternative.