The Role of Oral Care in Prevention of Ventilator Associated Pneumonia: A Literature Review

Introduction: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection reported among mechanical ventilation patients in intensive care units(ICU). Ventilator-associated pneumonia is associated with increased morbidity, mortality hospital, length of stay and health care costs. Oral health can be compromised by critical illness and by mechanical ventilation and thus, it deteriorates over time. A relationship exists between oral health status and VAP that is influenced by nursing care. Oropharynx colonization is the main risk factor for the development of VAP. Also dental plaques can provide a habitat for microorganisms responsible for VAP. Oral care in critically ill patients is an important issue and nurses of intensive cares play a key role in preventing VAP. Educations for all nurses of intensive cares should focus on the risk factors for VAP as well as onthe preventive interventions. The aim of the present study was to review the literature focusing on oral care in prevention of VAP

Comparison of the antibacterial effects of Persica, Matrica and chlorhexidine gluconate mouthwashes and normal saline in mechanically ventilated ICU patients: A clinical trial

Background: Bacterial colonization in the pharynx is one of the most important risk factors for ventilator-associated pneumonia. The aim of this study was to determine and compare the anti-bacterial effects of different mouthwashes in mechanically ventilated patients. Materials and Methods: In this double-blind randomized clinical trial, 80 patients were selected from the intensive care units (ICUs) of Imam Khomeini Hospital in Sari City, Iran, during 2010-2011, and were divided into four groups of 20 cases. The first intervention group was administered with chlorhexidine gluconate (CHX) 0.2 mouthwash, the second group Persica herbal 10 mouthwash, the third group was administered with Matrica 10 and finally in the fourth group, normal saline was used. In order to culture Staphylococcus aureus and Streptococcus pneumoniae, oropharynx samples were obtained without any stimulation prior and 6 min following oral rinsing. Results: Bacterial colonies were decreased significantly after the intervention in all four groups (P<0.001). Chlorhexidine gluconate, Persica and Matrica mouthwashes caused to decrease the Staphylococcus aureus (P<0.001, P<0.008 and P=0.01, respectively) and Streptococcus pneumoniae (P<0.001) positive cultures after the intervention. Conclusion: Herbal oral mouthwashes including Persica and Matrica are effective in decreasing Staphylococcus aureus and Streptococcus pneumoniae colonized in the oropharynx of mechanically ventilated patients. Therefore, after further investigations, they can serve as suitable alternatives for CHX in ICU settings

The improvement of pulmonary artery pressure after bosentan therapy in patients with β-thalassemia and Doppler-defined pulmonary arterial hypertension

Hossein Karami,1 Hadi Darvishi-Khezri,2 Mehrnoush Kosaryan,1 Rosetta Akbarzadeh,2 Mojdeh Dabirian3 1Department of Pediatrics, Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran; 2Student Research Committee, Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran; 3Department of Cardiology, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran Introduction: Pulmonary arterial hypertension (PAH) is relatively prevalent in patients with thalassemia. PAH treatment is necessary as the prevalence of Doppler-estimated PAH and the resultant mortality is high in such patients. Materials and methods: This study aimed at evaluating the effect of bosentan therapy on patients with thalassemia suspected of PAH. Based on pulsed Doppler echocardiography, all the cases were suspected of severe PAH. Consequently, bosentan was initiated at a dose of 62.5 mg twice a day for 4 weeks, which was increased to 62.5–125 mg twice a day, if no adverse side effects were observed. Results: The results of this study showed that pulmonary artery pressure (PAP) decreased after the administration of bosentan in three cases, from 160 to 120, 110 to 65, and 60 to 25 mmHg; in other words, the PAP reduced in the mentioned cases by 25%, 36.4%, and 58.4%, respectively. Conclusion: In this study, PAP improved after bosentan therapy in patients with β-thalassemia suspected of PAH; however, further studies are required to confirm the findings. Keywords: β-thalassemia major, pulmonary arterial hypertension, pulsed Doppler echocardiography, bosentan, tricuspid regurgitation jet velocity, right ventricular pressur

Comparing sedationreceive as blouse and infusion at incidence of ventilator-associated pneumonia in intubated traumatic patients in ICU

Introduction: Ventilator-associated pneumonia (VAP) is one of the most important complications of mechanical ventilation and cause of mortality in traumatic patients under mechanical ventilation admitted in the ICU (intensive care unit). The aim of current study was&nbsp; comparing sedationreceived as bolus and infusion at incidence of VAP in intubated traumatic patients in the ICU. Methods: This study was a prospective descriptive-analytical one. Current study was carried out on the patients under mechanical ventilation admitted to ICUs in Imam Khomeini hospital of Sari city, from September 2015 to September 2016. Inclusion criteria&nbsp; included traumatic patients older than 18 years admitted to the ICU and under mechanical ventilation for more than 48 hours. In addition to demographic data, patients' clinical information&nbsp; was daily recorded. Patients&rsquo; followed-up was continued until discharge from the ICU, ventilator weaning or death. Results: total of 2304 patients were admitted to the ICU, of which 186 traumatic patients under mechanical ventilation longer than 48 hours were reviewed and analyzed. Among 66 traumatic patients receiving sedation(82.8%), 66 patients (42.9%) as blouse, and 42 patients (27.3%) as infusion had received sedationdrug. The incidences of VAP in the patients receiving sedationas bolus or infusion were 6.1% and 52.4%, respectively. The comparison of VAP incidence among the patients receiving sedationas bolus and infusion, showed a significant difference (p<0.005). Conclusion: Sedative injection as infusion and continuous for more than 24 hours can remarkably increase incidence of VAP in traumatic patients under mechanical ventilation in the ICU in comparison to the sedation injection as blouse. Therefore, paying attention to this risk factor for controlling and reducingthe incidence of VAP is necessary in these patients

Probabilistic risk assessment (Monte Carlo simulation method) of Pb and Cd in the onion bulb (Allium cepa) and soil of Iran

Recently, the exposure to heavy metals through the consumption of vegetables has become a global concern. In this regard, the current study was aimed to measure the concentrations of lead (Pb) and cadmium (Cd) in the collected onion bulb samples as well as the surrounded soil using a flame atomic absorption spectrometer (FAAS). Additionally, the target hazard quotient (THQ) for males and females in all age groups of consumers were estimated by using Monte Carlo Simulation (MCS) method. Furthermore, the soil threshold values (STVs) were evaluated to investigate the heavy metal contents in the soil based on the established standard limits. In this context, 45 onion bulbs (HashtBandi region, 25 and Ravang region, 20) and 41 soil (HashtBandi region, 21 and Ravang region, 20) samples were collected (March–May of 2016). The average concentrations of Pb in the onions from HashtBandi and Ravang regions were determined as 0.0052 ± 0.0011 and 0.0061 ± 0.0022 mg/kg, and for Cd were 0.0095 ± 0.0024 and 0.0011 ± 0.0035 mg/kg, respectively. The average concentration of Pb in the soil from HashtBandi and Ravang regions were measured as 3.99 ± 3.77 and 2.03 ± 0.69 mg/kg, and for Cd, the corresponding values were determined as 2.21 ± 3.17 and 2.22 ± 0.92 mg/kg, respectively. The average concentration of Pb and Cd in both investigated onion bulb and soil were lower than Iranian national (onion bulb: Pb = 0.1 mg/kg, Cd = 0.05 mg/kg) and FAO/WHO (onion bulb: Pb = 0.3 mg/kg, Cd = 0.1 mg/kg; soil: Pb = 50 mg/kg, Cd = 0.3 mg/kg) standard limits. Moreover, the THQ and total target hazard quotient (TTHQ) for males and females in all age groups were less than 1 value. Therefore, no risk of the exposure to Pb and Cd as result of onion bulb consumption was reported. STVs for Pb and Cd in the HashtBandi region were calculated as 3.99 and 2.21 mg/kg, and Ravang as 2.03 and 2.22 mg/kg, respectively. Due to the higher calculated STVs for Cd while compared with the established standard limit for the soil, the further revisions regarding the heavy metal standard limits in the soil were recommended. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature