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Background & Objective: The diameter of the internal jugular vein changes with variations in intrathoracic pressure during inhalation and exhalation and this difference increases during hypovolemia. One of the causes of increased intrathoracic pressure in patients under mechanical ventilation is the tidal volume, which can affect the diameter of the internal jugular vein. On this basis, the present study was designed to investigate the effect of tidal volume on the internal jugular collapsibility index. Materials & Methods: In this clinical trial, 30 hypovolemic patients under mechanical ventilation were studied and three tidal volumes of 8, 10, and 12 cc/kg were applied to the patients. Subsequently, patients received fluid therapy and the measurements were repeated. Finally, the internal jugular vein diameters and the indices before and after the fluid therapy were measured in the three mentioned tidal volumes. A repeated measures t- test was used to compare the data. Results: The means of the internal jugular collapsibility index in the three tidal volumes of 8, 10, and 12 cc/kg were 27.78 ±8.87, 28.11±10.24, and 29.67±11.72(p=0.577) respectively before fluid therapy. These values were 27.78±8.87, 28.11±10.24, and 29.67±11.72 (p= 0.288) respectively, after fluid therapy. Conclusion: The results of this study showed that the internal jugular collapsibility index does not correlate with the tidal volume in hypovolemic patients and after fluid therapy. [ABSTRACT FROM AUTHOR]

Background: Preventing Ventilator-Associated Pneumonia (VAP) is an important strategy to increase the quality of provided care for patients under mechanical ventilation. Rose water is the main product of Rosa damascena which is a popular medicinal plant and has been widely used in alternative medicine. It has antibacterial activity against gram-negative and gram-positive bacteria which can potentially cause VAP. Materials and Methods: This study was a randomized, controlled, single-center trial. 88 patients in a 21-bed surgical Intensive Care Unit (ICU) who were under mechanical ventilation met the inclusion criteria, and 80 patients fulfilled the study. Based on receiving either rose water and chlorhexidine solution or chlorhexidine solution alone, the patients were divided into two groups of control and intervention. The incidence of VAP up to 14 days was the primary outcome. Duration of mechanical ventilation, the ICU length of stay, and mortality in ICU were the secondary outcomes. Results: There was no significant difference in demographic data, the incidence of VAP, the incidence of late-onset VAP, mechanical ventilation days, length of the ICU stay, and mortality between the two groups. However, the incidence of early-onset VAP in the intervention group was significantly lower than in the control group (p= 0.021). Conclusion: Rose water mouthwash significantly reduced the risk of earlyonset VAP without any effect on late-onset VAP. [ABSTRACT FROM AUTHOR]

Introduction: Providing for patients' comfort and reducing their pain is one of the important tasks of health care professionals in the Intensive Care Unit (ICU). The current study was conducted to determine the effect of a protocol using a Richmond Agitation-Sedation Scale (RASS) on some clinical outcomes of patients under mechanical ventilation (MV) in 2017. Methods: This single-blind clinical trial was conducted on 79 traumatic patients in the ICU who were randomly allocated into the intervention (N=40) and the control groups (N=39). The sedation was achieved, using a sedation protocol in the intervention group and the routine care in the control group. The clinical outcomes of the patients (duration of MV, length of staying in ICU, final outcome) were measured. As the participants had different lengths of MV and staying in ICU, the data were restructured, and were analyzed, using proper statistical methods. Results: The patients' level of sedation in the intervention group was significantly closer to the ideal score of RASS (-1 to +1). The duration of MV was significantly reduced in the intervention group, and the length of stay in the ICU was also significantly shorter. There was no difference in terms of final outcome. The ICU cost in the control group was twice as high as the cost in of the intervention group. Conclusion: The applied sedation protocol in this study would provide better sedation and could consequently lead to significantly better clinical outcomes, and the cost of caring as a result. [ABSTRACT FROM AUTHOR]

Background: Ventilator-Associated Pneumonia (VAP) is one of the common causes of mortality and morbidity. Subglottic secretion suction decreases the incidence of VAP. In this study, the effect of 5% sodium chloride (NaCl) in subglottic area in addition to secretion suction in VAP prevention was investigated in patients who were admitted to the intensive care unit. Materials and Methods: All patients were intubated by an intubation tube with subglottic suction. In the intervention group, subglottic area was washed with 10 ml of 5% sodium chloride solution, and in the control group the subglottic area was washed with 10 ml distilled water. Patients were monitored for a maximum of two weeks, and the incidence of VAP was monitored by a Clinical Pulmonary Infection Score (CPIS). Results: There was no significant difference between the two groups in terms of age and sex. Four (27%) patients in the intervention group, and 7 (37%) in control group were diagnosed with VAP, which was not statistically significant between the two groups (P=0.225). The duration of hospitalization, duration of intubation and mortality did not show any significant difference between the two groups. Conclusion: It was expected that in this study the rate of VAP became significantly lower with the intervention of using antimicrobial solution in addition to suction. Although the rate decreased clinically, it was not statistically significant, which may be due to the low number of patients. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury accounts for the majority of trauma deaths and there has been increased interest in the understanding the role of prognostic factors. C-Reactive Protein (CRP) level increases rapidly in response to trauma. Aim: Aim of the present study was to indicate the role of C-reactive protein as a predictor of outcome in traumatic brain injury patients based on their gender category. Materials and Methods: A prospective cohort study in a surgical intensive care unit in one of the Zanjan University of Medical Science hospital was designed. Fifty nine head trauma patients were divided into two groups based on their gender. Serum CRP was measured 48 hours after trauma. All data including the length of intensive care unit stay, the duration of mechanical ventilation, the Glasgow Coma Scale (GCS) at discharge, and mortality were collected. The relationship between the clinical features and serum CRP level was also studied. Results: In the male group, CRP level was not significantly correlated with the length of intensive care unit stay, the duration of mechanical ventilation and GCS at discharge. In the female group, CRP level was positively correlated with the length of intensive care unit stay and the duration of mechanical ventilation; however, CRP level was not significantly correlated with GCS at discharge. These results remain constant in female sub group with severe head injury contrast to female with mild injury. Conclusion: The GCS level can predict the outcome of females with severe head injury better than females with mild head injury and males. [ABSTRACT FROM AUTHOR]

Background/aim: Mortality and morbidity still remain high in patients with traumatic brain injuries. Understanding the role of new treatments in these patients is critical. The aim of this study was to determine the effect of simvastatin on survival and outcome in traumatic brain injury patients. Materials and methods: Forty-four patients were assigned to receive either simvastatin or a placebo. The serum interleukin-6 and C-reactive protein levels were measured at the first 24 h and 48 h after trauma. All data, including the Glasgow Coma Scale score, survival at discharge, length of intensive care unit stay, and duration of mechanical ventilation, were collected. The effect of simvastatin on the collected data was then investigated. Results: The Glasgow Coma Scale level at discharge was significantly higher in the simvastatin group. The overall mortality rate, duration of mechanical ventilation, and length of intensive care unit stay were similar between the 2 groups. The C-reactive protein concentration 48 h after trauma was significantly lower in the simvastatin group, but there was no significant difference according to the interleukin-6 level 48 h after trauma between the 2 groups. Conclusion: Simvastatin could be suggested as an adjunctive therapy in traumatic brain injury patients. [ABSTRACT FROM AUTHOR]