Background: The study aimed to investigate the out-of-range cuff pressure of endotracheal tube in mechanically ventilated patients. Methodology: This cross-sectional study was performed in Semnan, Iran in 2019. The cuff pressure was measured in patients aged over 18 years who were intubated for at least 24 hours. Out-of-range pressure was defined as a pressure of < 20 cmH2O or > 30 cmH2O. A multiple logistic regression model was used for analysis. Results: Of 222 cases, 67 (30.2%) had cuff pressure in the normal range and 155 (69.8%) were not in the normal range; 41 (18.5%) and 114 (51.4%) had low and high pressures. The two groups were not significantly different in terms of age and gender. Longer mechanical ventilation (p = 0.004) and hospitalization place (p = 0.001) were the two factors that had a relationship with the out-of-range pressure. The probability of out-of-range pressure was significantly higher in the cardiac (p = 0.001, OR = 6.91) and internal medicine (p = 0.008, OR = 4.61), compared to the emergency intensive care unit. Conclusion: The authorities should take into consideration some important factors, such as the lack of instructions in hospital units, lack of proficiency for correct measurement, deficient required facilities, and not using the facilities for regular monitoring. Keywords: Mechanical Ventilation, Endotracheal Intubation, Airway Management, Pressure. Citation: Hemmati H, Izadi S, Soltani S, Aghamohammadlou F, Mirmohammadkhani M. Prevalence and predictors of an out-of-range cuff pressure of endotracheal tube in mechanically ventilated patients in a teaching hospital in Iran. Anaesth. pain intensive care 2020;24(5): Received: 20 June 2020, Reviewed: 24, 28 June 2020, Accepted: 1 July 2020
Introduction: Doxycycline is commonly used in treating pleural effusion. Povidone-iodine is another agent that has been used for treating pleural effusion. Objectives: We aimed to compare the effects of doxycycline and povidone iodine in treating pleural effusion. Patients and Methods: Forty-one patients with pleural effusion were enrolled and randomly divided into two groups. After insertion of the chest tube, pleurodesis was performed in the first group with povidone iodine and doxycycline in the second group. The chest tube clamped and opened one hour later. Then, connected to the suction through a double chest bottle. By decreasing of drainage to less than 50 cc per day, the chest tube was removed and the patients were evaluated three days later for pain, fever, empyema, recurrent effusion and long-term side effects at 7th, 30th, 60th and 90th day. Results: The pain intensity was not different between two groups (P > 0.05). None of the patients had empyema and other side effects including hemothorax or pneumothorax were not seen too. In a 90-day follow-up, 47.6% of doxycycline recipients and 25% of povidone iodine recipients experienced the recurrent effusion (P=0.133). Three patients had fever (one on the first day and two on the second day) in the doxycycline group, while fever was not observed in povidone iodine recipients. The cost of treatment in both groups was almost the same. Conclusion: Side effects of pleurodesis include pain, fever, recurrent effusion, cost in the two groups is almost equal, and both agents can be used as an effective drug for treating pleural effusion. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT2015052918168N3; https://en.irct.ir/trial/16560, ethical code; IR.SEMUMS.REC.1394.91).
Introduction: Acute cholecystitis is one of the most common gallbladder diseases. Surgical operation is still the main treatment of biliary diseases, but there may be required a period of stabilization in the hospital before cholecystectomy. Infected bile in different studies has been reported from 50% to 75%. Therefore, identification of microbial mass followed by antibiotic treatment for this disease is important. Objectives: In this study, bacterial spectrum in patients undergoing cholecystectomy was evaluated based on clinical symptoms and laboratory parameters. Patients and Methods: In this prospective cross-sectional study, all patients requiring cholecystectomy were enrolled in the study. In the study, the data on age, gender, clinical signs of all patients and laboratory results and biliary liquid experiments were collected. Results: Fourteen cases including 13 cases of E. coli and a Staphylococcus strain had positive cultures. No significant correlation was detected between gender, fever, vomiting, tenderness right upper quadrant (RUQ), anorexia, jaundice, age group and microbial growth (P>0.05). Moreover, no significant correlation between laboratory parameters such as white blood cell (WBC), total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, amylase and microbial growth was seen (P>0.05). Conclusion: Bile culture was positive in 14% of patients undergoing cholecystectomy and E. coli was the predominant microorganism. Frequency of positive culture is low and has no relationship with demographic, clinical and laboratory factors and could not have a significant effect on the occurrence of postoperative complications; therefore, it seems that the administration of antibiotics before surgery is not necessary.
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