Prevention of ventilator-associated pneumonia by a nose care program combining with oral care among patients hospitalized in intensive care units: a single-blind randomized controlled trial

Objective: Ventilator-associated pneumonia (VAP) is one of the most common ICU-acquired infections. Preventing nasal canal colonization through an effective nasal cavity care, along with oral care seem to be an important issue. Methods: This single-blind randomized controlled trial was conducted on 31 patients in each intervention and control group in Alzahra and Kashani hospitals, Iran. The interventional program was considered every 8 h for 5 days. It included cleaning the nasal cavities with cotton swabs soaked in sterile normal saline, then 2 puffs of 65% sodium chloride nasal spray were used for each nostril, and finally the nasal canal was moistened with a swab dipped in Veramin gel (0.5 ml into each nostril). For the control group, routine nasal care including cleaning the outer nostrils was offered. Oral care in 2 groups was performed according to the standard protocol. Data collected through demographic and clinical questionnaire as well as modified pulmonary infection clinical scale. The chi-square and independent tests were used to determine the homogeneity of basic characteristics. Also, we estimated and compared the incidence of VAP between 2 groups by chi-square test. Results: The incidence of VAP was not statistically different in the intervention and control groups on the third day after intervention (29.1% vs. 32.3%, respectively, P = .915), while this rate on the sixth day was significantly lesser in the intervention than control (32.3 vs. 58%, P = .041). Conclusion: The present nasal care program along with oral care is an effective strategy to prevent VAP. Resumen: Objetivo: La neumonía asociada al ventilador (NAV) es una de las infecciones adquiridas en la UCI más comunes. La prevención de la colonización del canal nasal a través de un cuidado efectivo de la cavidad nasal, junto con el cuidado oral, parece ser un tema importante. Métodos: Este ensayo controlado aleatorio simple ciego se realizó en 31 pacientes en cada grupo de intervención y control en los hospitales de Alzahra y Kashani, Irán. Se consideró el programa intervencionista cada 8 horas durante 5 días. Incluyó la limpieza de las fosas nasales con hisopos empapados en solución salina normal estéril, luego se aplicaron dos inhalaciones de cloruro de sodio al 65% en aerosol nasal por cada fosa nasal y finalmente se humedeció el canal nasal con un hisopo humedecido en gel Veramin (0,5 ml en cada uno). fosa nasal). Para el grupo de control, se ofreció atención nasal de rutina, incluida la limpieza de las fosas nasales externas. El cuidado oral en dos grupos se realizó de acuerdo con el protocolo estándar. Datos recogidos mediante cuestionario demográfico y clínico, así como escala clínica de infección pulmonar modificada. Se utilizó la prueba de chi cuadrado y la prueba independiente para determinar la homogeneidad de las características básicas. Además, estimamos y comparamos la incidencia de VAP entre dos grupos mediante la prueba de chi cuadrado. Resultados: La incidencia de VAP no fue estadísticamente diferente en los grupos de intervención y control al tercer día después de la intervención (29,1% vs. 32,3%, respectivamente, p = 0,915), mientras que esta tasa al sexto día fue significativamente menor en el grupo de intervención. que el control (32,3 vs. 58%, p = 0,041). Conclusión: El presente programa de cuidado nasal junto con el cuidado oral es una estrategia efectiva para prevenir la VAP

Electrical stimulation of acupuncture points for analgesia during bone marrow aspiration and biopsy: A randomized double-blind placebo-controlled trial

Background: Bone marrow aspiration and biopsy (BMA/BMB) is a painful procedure mostly used in diagnosing and staging of a broad spectrum of hematological diseases. In spite of local anesthesia, the prevalence and intensity of the pain and patient discomfort caused by this procedure are considerable. The effect of acupuncture and electrical stimulation of acupoints (acupuncture points) in the treatment of many medical conditions, including pain, have been approved. The study is designed to evaluate the effect of electrical stimulation of acupoints to decrease the pain during BMA/BMB in adults. Materials and Methods: In a double-blind controlled clinical trial, 50 patients undergoing BMA/BMB were randomly allocated into two groups, to receive either true or placebo electrical stimulation of acupoints LI-4 (large intestine 4, Hegu) and LI-11 (large intestine 11, Quchi), bilaterally. Both groups received infiltrative local anesthesia. The pain level caused by BMA/BMB was measured using the Visual Analog Scale (VAS). Results: The means of the VAS in the case and control groups were 41.84 ± 20.54 and 69.40 ± 20.06 respectively (P < 0.001). The systolic and diastolic blood pressure and pulse rate rose significantly in both the groups compared to the basal values. The rise was lower in the acupuncture group compared to the placebo group regarding systolic blood pressure and pulse rate (P = 0.018 and P < 0.001, respectively). Conclusions: The results of this study show that the electrical stimulation of acupoints significantly decreases the pain caused by BMA/BMB and some of the complications of the pain

Comparative evaluation of Glasgow Coma Score and gag reflex in predicting aspiration pneumonitis in acute poisoning

Nastaran Eizadi-Mood, Mahmood Saghaei, Sam Alfred, Amir Hooshang Zargarzadeh, Chanh Huynh, Farzad Gheshlaghi, Ahmad Yaraghi and Yousef Shadi Saa