Comparative study of the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation.

Introduction: Providing a stable hemodynamic in extubation is important. We aimed to compare the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation. Methods: This double-blind randomized trial was performed in 2019-2020 in Isfahan on 72 patients under general anesthesia. Patients using Random Allocation software were divided into three groups and received 0.1 mg/ kg or 0.2 mg/kg labetalol and normal saline intravenously 10 min before extubation. Hemodynamic variables including heart rate (HR), Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral blood oxygen saturation(SPO2) was measured for each patient before induction of anesthesia and 1, 3, 5 and 10 minutes after extubation. Results: SBP changes were significantly different between the three groups at 1, 3, 5 minutes after extubation (P=0.036, P=0.009, P=0.005 respectively) unlike the other two groups, patients who received 0.2 mg/kg labetalol did not have an increase in DBP after extubation (P>0.05). DBP was significantly different between the three groups one minute after extubation (P=0.03). At minutes 1 and 3 following extubation, there was a significant difference in the MAP between the three groups. (P=0.029 and P=0.012 respectively). There was no significant difference between the three groups regarding heart rate (P>0.05). Conclusion: Tracheal extubation is usually associated with an increase in hemodynamic variables. Both doses of labetalol attenuate the hemodynamic response accompanying tracheal extubation. But labetalol 0.2 mg/kg in reducing hemodynamic response to extubation acted more effectively than labetalol 0.1mg/kg.

Effect of Oral Care Program on Prevention of Ventilator-associated Pneumonia in Intensive Care Unit Patients: A Randomized Controlled Trial.

BACKGROUND: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections that increase mortality rate and the length of hospitalization. Oral care can improve patient's oral health, however, the role of oral care in the reduction in incidence rate of VAP is indisputable. The aim of this study was to investigate the effect of oral care on the frequency of VAP of patients in intensive care unit. MATERIALS AND METHODS: This clinical trial was conducted on 80 participants who were randomly assigned to a control group and an intervention group from 2016 to 2017. Data were collected at the first, third, and fifth days of the study using a demographic and clinical characteristics questionnaire and the Clinical Pulmonary Infection Score for detecting pneumonia. Data analysis was performed using descriptive and inferential statistics in SPSS software. RESULTS: The results of this study showed that the frequency of pneumonia on the third and fifth days was 15.80% (6) and 23.70% (9) in the control group and 10.50% (4) and 7.90% (3) in the intervention group, respectively. Chi-square test did not show a significant difference (p = 0.059); however, the frequency of pneumonia in the intervention group reduced compared with the control group. CONCLUSIONS: According to the results of this study, the oral care program could not significantly decrease the incidence of VAP in critically ill patients compared with routine oral care practices. Similar studies with a larger sample size and longer duration should be conducted for better results.

Evaluating the Efficacy of Nanosil Mouthwash on the Preventing Pulmonary Infection in Intensive Care Unit: a Randomized Clinical Trial.

INTRODUCTION: Oral and Oro-pharynx colonization and Micro-aspiration of discharges are two important processes in ventilator-associated pneumonia (VAP). So, this study design to investigated the preventive effect of oral decontamination program by Nanosil mouthwash on incidence of ventilator-associated pneumonia. METHODS: 80 newly hospitalized patients who admitted in intensive care unit (ICU) of Amin Medical Education Center were enrolled to a randomized clinical trial study. Patients were randomly divided into two equal groups. In the intervention group, a multi-stage oral decontamination program was performed by using Nanosil mouthwash three times a day, and in the control group oral decontamination was performed by Chlorhexidine 0.12% with same method. The oral decontamination program was continuing for five days. The VAP was diagnosed with a version of modified clinical pulmonary infection scale (MCPIS) on the first and fifth days. RESULTS: In compare the case and control groups, there wasn't observed significant difference in age, gender, underling disease, smoking, and primary mean scores of MCPIS, sequential organ failure assessment (SOFA) and Glasgow coma scale (GCS) (P>0.05). In the both groups, the mean scores of SOFA and GCS were significantly improve in fifth day (P<0.05). After five days follow up, the mean score of MCPIS (1.2±0.1 vs. 3.5±0.3, P<0.001) and pneumonia rate (2.7% vs. 23.7%, P=0.008) were significantly lower in case group. But, the mortality rate was same in both groups (P>0.05). DISCUSSION: The use of oral care program with Nanosil mouthwash is better than Chlorhexidine for the prevention of VAP in patients who admitted in ICU.

The Effects of Aloe vera-Peppermint (Veramin) Moisturizing Gel on Mouth Dryness and Oral Health among Patients Hospitalized in Intensive Care Units: A Triple-Blind Randomized Placebo-Controlled Trial.

OBJECTIVE: Mouth dryness is one of the most prevalent problems in Intensive Care Units (ICUs). It facilitates dental plaque formation. The aim of this study was to analyze the effects of Aloe vera-Peppermint (Veramin) moisturizing gel on mouth dryness and oral health among patients hospitalized in ICUs. METHODS: This triple-blind two-group randomized placebo-controlled clinical trial was undertaken in 2016-2017 on a convenient sample of 80 patients. Patients were randomly allocated to an intervention and a placebo group. Oral care for patients in the intervention and the placebo groups was provided for 5 successive days using Veramin moisturizing gel and a placebo gel, respectively. Data were collected at the 1st, 3rd, and 5th days of the study using a demographic and clinical characteristics questionnaire, the Challacombe scale (for mouth dryness assessment), and the Mucosal-Plaque Index (for oral health assessment). The Chi-square, Fisher Exact, Mann-Whitney U, and Friedman tests were used for data analysis. FINDINGS: In the 5th day, the mean score of mouth dryness in the intervention group was significantly lower than the placebo group (P = 0.0001). On the other hand, in the third and the 5th days, the oral health mean score in the intervention group was significantly lower than the placebo group (P = 0.0001). CONCLUSION: Veramin moisturizing gel is effective in significantly relieving mouth dryness, preventing dental plaque formation, and improving oral health. Thus, it can be used for improving oral care outcomes in ICUs.

The barriers to the prevention of ventilator-associated pneumonia from the perspective of critical care nurses: A qualitative descriptive study.

AIMS AND OBJECTIVES: The aim of this study was to explore the perspectives of Iranian critical care nurses on the barriers to ventilator-associated pneumonia prevention in intensive care units. BACKGROUND: Most patients hospitalized in intensive care units need mechanical ventilation. One of the most prevalent and serious complications of mechanical ventilation is ventilator-associated pneumonia. There are different barriers to the prevention of this kind of pneumonia. DESIGN: Qualitative descriptive design was used. METHODS: In this qualitative study, 23 critical care nurses were recruited via purposive sampling. Semi-structured interviews were done for data collection. The interviews were recorded digitally, transcribed word by word, and analyzed using the inductive content analysis approach. RESULTS: The barriers to the prevention of ventilator-associated pneumonia fell into three main categories, namely nurses' limited professional competence, unfavorable environmental conditions, and passive human resource management. The 10 subcategories of these main categories were unfavorable professional attitude, limited professional knowledge, low job motivation, limited professional accountability, non-standard physical structure, inadequate or inappropriate equipment, heavy workload, staff shortage, inadequate staff training, and ineffective supervision. CONCLUSION: The barriers to the prevention of ventilator-associated pneumonia in intensive care units are very diverse and complex and include a wide range of interrelated personal, environmental, and organizational barriers. RELEVANCE TO CLINICAL PRACTICE: This study created a better understanding of the barriers to ventilator-associated pneumonia prevention. Moreover, highlighted the importance of sufficient resources, adequate staffing level, and contextually-appropriate evidence-based guidelines for effective ventilator-associated pneumonia prevention.

The effect of lidocaine on reducing the tracheal mucosal damage following tracheal intubation.

BACKGROUND: The aim of this study was to investigate the efficacy of lidocaine solution in the cuff of the endotracheal tube in reducing mucosal damage following tracheal intubation. MATERIALS AND METHODS: This was a randomized controlled trial study undertaken in the intensive care unit patients. Participants, who met all eligibility criteria, were randomly assigned to one of two groups of patients, according to whether lidocaine or air was used to fill the tracheal tube cuff. The tracheal mucosa at the site of cuff inflation was inspected by fiberoptic bronchoscopy and scored at the 24 h and 48 h after intubation. RESULTS: In all, 51 patients (26 patients in the lidocaine group and 25 patients in the control group) completed the study. After 24 h, erythema and/or edema of tracheal mucosa were seen in 2 patients (7.7%) of lidocaine group and 6 patients (24%) of air group (P = 0.109). Binary logistic regression analysis showed that lidocaine has a significant protective effect against mucosal damage (odds ratio = 0.72, confidence interval = 0.60-0.87). CONCLUSION: The inflation of the tracheal tube cuff with lidocaine was superior to air in decreasing the incidence of mucosal damage in the 24 h and 48 h post intubation.