Background: Pulmonary regurgitation (PR) is often known as an acquired condition after surgical correction of tetralogy of Fallot (TOF). Therefore, the present study aimed to compare the use of monocusp valve (MV) implantation and transannular patch (TAP) angioplasty on PR and right ventricular (RV) failure following surgery to repair TOF. Methods: This prospective randomized clinical trial (RCT) was performed on a total number of 60 patients undergoing reconstructive surgery on TOF. For this purpose, TAPs without and with monocusp reconstruction were used in Group I (n = 30 patients) and Group II (n = 30 patients), respectively. Then, echocardiographic parameters, mortality rates, and clinical data from pediatric intensive care unit (PICU) were evaluated during a follow-up period for both groups. Results: Out of the 60 patients undergoing surgery and evaluated, 39 individuals were male (65%) and the rest were female (n = 21 patients, 35%). No significant difference was observed in terms of age, body weight, body surface area (BSA), mortality rate, and ejection fraction (EF) between the two study groups. The findings revealed that the number of patients with severe PR was higher in the group receiving TAP angioplasty. Furthermore, the difference between the two groups with regards to severity of PR was significant (p = 0.012). Conclusion: It was concluded that MV reconstruction of TOF is effective in reducing pulmonary artery (PA) and pulmonary valve (PV) insufficiency.

Background: Determining the level of consciousness is one of the main responsibilities of nurses in intensive care unit (ICUs). Scales used to determine the level of consciousness should be less affected by the injection of analgesics and sedatives and should provide proper vision of the patient's status.

Background: It is widely accepted that increased prevalence of antibiotic resistance of pathogens grown in the respiratory system in intensive care unit (ICU) patients is a very serious problem causing expansion of mortality. The most important strategy to prevent the occurrence and appropriate solution to control the antibiotic resistance is to thoroughly investigate the pattern of resistance in the studied ward. Therefore, the purpose of this study was to determine the antibiotic resistance pattern of organisms isolated from endotracheal tube secretions of patients admitted to ICU of Khatam-Al-Anbia Hospital at Zahedan in Iran. Methods: In the present retrospective and descriptive cross-sectional study, the medical records of patients hospitalized during 2013-2018 were included by census method and then selected based on inclusion criteria (n=1387). The required data, including age, gender, type of microorganism isolated from endotracheal tube cultures, antibiotic resistance and sensitivity, duration of intubation and cause of hospitalization, were recorded for each patient. Finally, the data were analyzed by descriptive statistics using SPSS 16 software. Results: Mean age of patients was 44.66 ± 21.39 years and mean duration of intubation was 17.96 ± 10.99 days. Stroke was the most common cause of hospitalization with a prevalence of 553 patients (49%). The prevalence of positive culture of endotracheal tube secretions was 1128 (81.3%) of which 71.5% were male (n=807) and 28.5% were female (n=321). The cultures of endotracheal tube secretions resulted in 933 (82.7%) gram-negative bacteria, 191 (16.9%) grampositive bacteria and 4 (0.4%) mixed isolates. The most prevalent gram-negative bacterium was Acinetobacter baumannii (37.2%) with the highest and lowest antibiotic resistance to Meropenem (95.1% resistance) and colistin (99.5% sensitivity), respectively. In addition, the most prevalent gram-positive bacterium was Staphylococcus epidermidis (50.3%) with the highest and lowest antibiotic resistance to Meropenem (85.7% resistance) and Vancomycin (92.2% sensitivity). Conclusion: The findings of the present study illustrate that there was widespread bacterial resistance to respiratory tract infections in our ICU patients. Due to the high sensitivity of gram-negative bacteria to colistin, the use of antibiotic combination with colistin in the control of pulmonary infections caused by these organisms can be a good choice. In addition, in the case of gram-positive bacteria, the highest sensitivity was to vancomycin; therefore, it can be the selective antibiotic to control infections caused by these bacteria.

Introduction: Oropharyngeal colonization with pathogenic organisms contributes to thedevelopment of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oralhygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients.This study aimed to evaluate recent OHC strategies to decrease VAP.Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase,Cochrane Library, and Web of Science databases from inception to September 10, 2020 werereviewed to compare the effects of selective oropharyngeal decontamination (SOD) on theincidence of VAP in adult patients requiring mechanical ventilation.Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for finalanalysis. The results showed that the use of chlorhexidine for oropharyngeal decontaminationreduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria.Also, it was observed that the combined use of colistin and chlorhexidine was more effectivethan chlorhexidine alone in preventing VAP. The results of studies on the use of toothbrushes toreduce the incidence of pneumonia are unclear since they used chlorhexidine at the same time.However, tooth brushing is one of the best ways to maintain oral hygiene. Using povidoneiodine,Nanosil, and non-absorbable topical antibiotics reduced the incidence of VAP, whileIseganan did not show a significant effect in this regard.Conclusion: The prophylactic use of topical bactericidal agents in critically-ill patients is effectivein reducing the incidence of VAP. However, the use of non-absorbable topical antibiotics ismore effective than other methods in oropharyngeal decontamination.

Introduction: Adding ketamine to bupivacaine in caudal anaesthesia is likely to increase its analgesic effect. However, it is not clear which dose of ketamine will have the greatest impact and the lowest level of complications. Thus, the purpose of this study was to compare the effects of three different doses of caudal ketamine plus bupivacaine on pain control after pediatric surgery. Methodology: The present double-blinded clinical trial was conducted on 69 pediatric patients, of age ranging from 6 months to 10 years. Patients were assessed via the American Society of Anaesthesiologists (ASA) physical status classification system (ASA I-II), and had been also hospitalized for herniorrhaphy and orchidopexy. The patients were randomly divided into three groups. The first group received 0.75 mg/kg of 0.25% bupivacaine plus 0.25 mg/kg of ketamine, the second group received 0.75 mg/kg of 0.25% bupivacaine and 0.5 mg/kg of ketamine, and the third group received 0.75 mg/kg of 0.25% bupivacaine with 0.75 mg/kg of ketamine (as caudal anaesthesia). The duration of motor block and analgesia, as well as sedation levels, were measured for each study group. Each patient's level of pain was also measured (at 1, 2, 3, 4, 6 and 24 hours after the surgery) via the All India Institute of Medical Sciences (AIIMS) pain discomfort scale. The data were then compared using SPSS Statistics (Version 22), with descriptive statistics, analysis of variance (ANOVA), and Chi-square test. Results: The findings revealed that gender distribution did not differ significantly in the three study groups (p=0.896). The mean age of the first, second, and third group were reported to be 2.82±1.86, 3.1±2.4, and 2.48±1.06, respectively; thus, there was no significant difference in terms of age between the three groups (p=0.569). Upon examining the AIIMS pain discomfort scale scores during the first 24 hours following surgery, it was observed that the pain intensity was higher in the first group than in the second and third groups. Moreover, evaluation of the pain intensity in the first and the second groups revealed comparable results, while those of the second and the third groups did not show a significant difference in this respect. Conclusion: The results demonstrated that the most effective and safest dose of ketamine, in this study, for pain control after pediatric surgery in the inguinal region was the 0.5 mg/kg dose.

Background: Pulmonary changes and their respiratory consequences in patients with chronic obstructive pulmonary disease (COPD) could lead to many physical complications and are one of the major causes of hospitalization. Objectives: In this regard, the present study explores the efficacy of self-care training on spirometric indices of COPD patients. Methods: This clinical trial was performed on 70 patients with COPD who had been admitted in 2017 to Ali Ibn Abi Talib Hospital in Zahedan, Southeast Iran. The subjects were recruited through convenience sampling based on the inclusion criteria and were subsequently randomized to the intervention and control groups. The self-care program was administered to the intervention group during eight 30-minute sessions organized within 4 weeks. Data collection tools included a demographic questionnaire and Vitalograph Alpha Spirometer. Data were analyzed in SPSS V. 21 using chi-square, Independent t-test, and Paired t-test at the significance level of 0.05. Results: The results of 8 sessions of self-care training revealed that the mean FVC index of patients before self-care education was 43.40 ± 8.54 in the intervention group and 46.54 ± 10.73 in the control group. After the educational program, the mean score of this index changed significantly in the intervention group (48.62 ± 9.30) (P = 0.01), but no such alteration occurred in the control group (47.11 ± 10.27) (P = 0.16). Furthermore, the mean FEV1 index of the two groups differed significantly after the self-care program (P = 0.01). Conclusions: Given the impact of self-care training on improving spirometric indices in patients with COPD, it is recommended that nurses help ameliorate breathing status of these patients and relieve their symptoms by providing them with self-care instructions.

Background and Objectives: Weaning decision for the patients undergoing mechanical ventilation (MV) is often made based on personal judgments and experiences, which results in longer MV length of stay and higher costs. Therefore, the present study aimed to evaluate the effect of Burn's wean assessment program on the success rate of weaning from ventilator in patients admitted to the Intensive care unit (ICU).

Background: One of the highly important duties at the intensive care units (ICUs) for maintaining airway and improving ventilation and oxygenation is suctioning; however, it must be done in a way so that, in addition to the mentioned advantages, it can have the least complications for the patient.