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Background and purpose: Laser bean produces thin incision along with hemostasis, sterility and decreased postoperative complications, hence facilitate air way surgery, but due to proximity of endotracheal tube to operation site, the risk of occupying and burning of endotrachel tube and surrunding tissues in each surgery is about 0.5% to 1.5%. This study is about the complications arised by apnea technigue of general naesthesia and continued controlled ventilation with coated endothracheal tube, done in Tehran Âmir Âlam hospital in 1998-1999.
Materials and methods: Two groups of laser therapy candidates, each with 22 patients of 10 to 60 years of age and ÂSÂ 1 to 2 with less than 100kg weight, undergone anesthesia by the two above mentioned techniques. Both groups recieved the same anesthetic agent and mainteined in the same condition. Monitorings included electrocardiography (ËÇG, NÏBP) pulse oxymeter and capnograph.
Results: Hemodynamic changes were the same in both groups, hypoxia or arrythmia was not observed in any of the patients. Ïn the apnea technique operated patients, most of the surgical procdure was done in 2 to 3 a bneic episodes. Duration for each apnea was 2 to 4 minuts. Ïn the apnea technique group pet Ço2 was 38 to 47 mm Hg. Duration of laser therapy in apnea group was 9 to 10 minutes less than the coated tube group.
Çonclusion: Çonsidering the results of this study, in the apnea technique group there was no hypoxia arrythmia and threatening prolonged hypocapnia. Due to omition of endotrachial tube from the laser field, laser therapy would be done without any risk of fire and is done in the shorter time. The surgon would do a good and non risky surgery.

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Background and purpose: Anesthesiologists have become the first priority since they can play an important role in crisis situations to support respiratory and cardiac urgencies. In this survey, the effects of the resident anesthesiologists were studied on the death of patients having been hospitalized in the Intensive Care Unit of Imam Khomeini training and treatment center, Sari from 2000 to August 2004.
Materials and Methods: In this survey, the subjects of the "case group" (passed-away patients during the residency of the anesthesiologist) have been compared to the subjects of the "control group" (having no resident anesthesiologist). The following variables were considered for analysis: age, gender, hospitalization reasons, the original ward, reason of and the service of reference to the Intensive Care Unit, the cause of death, hospitalization period in the original ward and Intensive Care Unit, as well as the number of the visits paid by anesthesiologist. Other interfering variables (such as facilities) were not taken into account, since they had been the same for both groups. Data were analyzed using the SPSS software and the descriptive and analytical (X2,Z,T) statistical tests.
Results: The findings of this survey showed that men have died more than women (61.9% vs 38.1%) in the intensive care unit. The total hospitalization period reduced from 14 to 11 days, having an anesthesiologist residing in this ward. It was revealed that the presence of an anesthesiologist reduced the death rate from 24% to 14%.
Conclusion: According to the findings of this survey, it has been revealed that the presence of an anesthesiologist can have an outstanding effect on the reduction of the death rate. It is taken for granted that choosing patients must be done in accordance with Classic Indications since there are limited number of beds in ICU and the admission request for different patients. In equal situations, those patients who have better opportunity and less mortality probability and better prognosis in this unit have priority.

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Background and purpose: The aim of this study was to determine the incidence and presence of a relationship between predictors of body mass index (BMI) or C-reactive protein (CRP) and duration of mechanical ventilation, in trauma patients who were admitted to the intensive care unite (ICU). Furthermore, we compared their prognostic significance, with known indicators such as, the Sequential Organ Failure Assessment (SOFA) score.
Materials and Methods:This prospective observational study was preformed on 72 admitted critically ill trauma patients in a general ICU setting, in Alzahra Medical Center of Isfahan University. Patients were categorized by duration of mechanical ventilation to the group A (≤ 7 days) and group B (> 7 days). The severity of illness was assessed by the Revised Trauma Score (RTS) calculated on the first admission to the ICU unit. The biological status of the patients was assessed by the serial measurement of CRP on admission to ICU (T1), at 48, 72 hours subsequently, and on the beginning day (T2) or discontinuation (T3) from mechanical ventilation. Data on BMI, serum albumin, and the SOFA score, were also collected on T2 and T3.
Results:There was no significant difference between two groups in demographic characteristic or RTS.On T3, the SOFA score, BMI, albumin, and CRP were significantly higher within group B patients, as compared with group A (P < 0.01). The incidence of low BMI (≤ 20 kg/m²) or high CRP (> 10 mg/L) on T2 was 72.2% (52/72) and 81.9% (59/72) respectively. The incidences of low BMI or high CRP in group B patients were significantly higher on T2 or T3, as compared with group A (P < 0.05). CRP or BMI on T3 had high specificity for predicting more than seven days of MV. On T3, the SOFA score, serum albumin, CRP, and BMI provided significantly good discrimination (area under curve > 0.5) in descending order. Mean serum CRP level within 72 hours after admission to the ICU or on T3 was significantly more in group B patients, as compared with group A (P < 0.01). The most significant predictor more than seven days of mechanical ventilation was CRP followed by BMI on T3.
Conclusion:Both the BMI and CRP comparables with the SOFA score can be used in estimating the risk of prolonged mechanical ventilation. It is also concluded that maintaining the level of BMI or CRP in normal range, could shorten the duration of mechanical ventilation.

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Background and purpose: Respiratory disorders and need for mechanical ventilation are common complications in preterm infants. Âttention has been drawn to premature weaning from ventilator and also removal of endotracheal tube with an approach towards reduction of risks. This study has been carried out to compare the outcomes of two methods of NÏMV and NÇPÂP in infants afflicted with respiratory distress syndrome under mechanical ventilation.
Materials and methods: This study is a randomized clinical study that has been conducted throughout 2009 to 2010. Â total of 40 infants in two groups of case and control have been studied. Ïnfants of 28 to 32 and 32 to 37 weeks of age were randomly placed in two NÏMV and NÇPÂP groups and re-intubation, and complications of the two methods were compared in infants.
Results: Ïnfants in the two groups were identical regarding gender, gestational age, birth weight, type of delivery, mechanical ventilation period and use of surfactant and steroids prior to delivery. Re-intubation, respiratory acidosis and intra-ventricular hemorrhage were less in NÏMV group (p<0.05). There was no significant difference in apnea, hypoxia, pneumothorax, feeding intolerance, abdominal distention, length of hospitalization and death rates.
Çonclusion: The study has shown that respiratory acidosis in NÏMV group is less in comparison to NÇPÂP group. Therefore, in order to prevent re-intubation and occurrence of respiratory acidosis and to reduce occurrence of intra-ventricular hemorrhage in infants suffering from respiratory distress syndrome in time of weaning from mechanical ventilation, it is necessary to use the NÏMV method.

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Background and purpose: One person cardiopulmonary resuscitation (CPR) has a significant role in the survival of cardiac arrest victims. In this study, two techniques of single-rescuer CPR and over-the-head CPR with mouth-to-mouth ventilation were compared. Materials and methods: This crossover study was carried out among 100 medical students who were previously trained in CPR. They performed regular single-rescuer CPR and chest compressions on manikins. The numbers of mouth-to-mouth ventilation and chest compressions were recorded during a 2-min CPR. The data was analyzed using parametric and non-parametric tests. Results: The participants included 45 female and 55 male. The mean number of correct chest compression was 17.06 ± 22.5 while this number was 176.6 ± 21.1 for over-the- head CPR (P<0.053). The numbers of correct ventilations and over-the-head CPR were 10 ± 2.1 and 10.2 ± 2.1, respectively (P<0.402). Incorrect chest compression was found to be 31% but it was 24% in over the head CPR (P= 0.368). Conclusion: This study verified over-the-head CPR without ambo bag as an effective alternative standard technique when performing one person CPR.

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Background and purpose: Cleft palate is one of the most common anomaly of face and hearing loss is one of its main complications. In this study, we evaluated the status of tympanometry and the need for ventilation tube (VT) in patients with cleft palate.

Materials and methods: A descriptive study (during 11 years) was done in children between one to two years of age referring for cleft palate repair. Before operation, tympanometry was performed in all patients and results were recorded in the form of standard groups A, B, and C. If the tympanogram had shown type B or C, VT was placed in tympanic membrane. The type of middle ear discharge in the form of serosa, glue or purulent were recorded. Finally, these observations were compared with the results of tympanometry and type of cleft palate.

Results: A total of 48 patients entered the study, of whom 22 were boys and 26 were girls. The mean age of the subjects was 15 months. Tympanometry before surgery had shown type A in 21 ears, type B in 68 ears and type C in others. In fact, 87.5% of patients had shown at least one abnormal ear that needed VT insertion. Middle ear effusion was seen in 93.3% of cases. The effusions were viscous or purulent in 80% of the cases, and there was a significant relationship between the type of discharge and tympanometry results.

Conclusion: The majority of patients with cleft palate have impaired tympanogram, therefore, insertion of VT is acceptable even without performing initial evaluation by tympanometry.

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Background and purpose: This study aimed at comparing the influences of airway pressure release ventilation (APRV) and Synchronized Intermittent Mechanical Ventilation (SIMV) on cerebral hemodynamic and intracranial pressure in patients with traumatic brain injuries.

Materials and methods: A clinical trial was carried out in 40 patients with traumatic brain injuries in the intensive care unit in Kamyab neurosurgery Hospital, Mashhad, Iran. The patients meeting the study inclusion criteria were randomly assigned into two groups; intervention (APRV, n= 20) and control (SIMV, n= 20). The ICP, CPP, MAP, pulse pressure and heart rate in both groups were measured before and after conditioning. Analysis of data was done using independent t-test in SPSS V.22.

Results: The mean ICP remained unchanged in both groups (P= 0.421). After the intervention, the CPP, MAP, heart rate, and pulse pressure in APRV group were not significantly different compared with those in the two groups before the intervention (P> 0.05).

Conclusion: The results showed APRV as a safe mode that can be beneficial in patients with traumatic brain injury without concerns for increased intracranial pressure and hemodynamic disorders.

(Clinical Trials Registry Number: IRCT2015070623104N1)

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Background and purpose: Gastrointestinal complications in mechanically ventilated patients with feeding tube is common and causes feeding intolerance. Discharge of gastric gases is believed to reduce these complications. This study aimed at assessing the effect of gastric gases discharge on gastrointestinal complications in ICU patients on mechanical ventilation with feeding tube.

Materials and methods: A single-blind randomized controlled clinical trial was performed in 64 patients undergoing mechanical ventilation with CPAP mode in Shahid Kamyab Hospital, Mashhad, Iran in 2015. In experimental group gastric gases were discharged through a nasogastric tube but the control group did not receive any intervention. Gastrointestinal complications including abdominal distention, diarrhea, and vomiting were compared between the two groups before and after the intervention.

Results: There was no significant difference between the two groups in incidence of diarrhea (P=0.23) and vomiting (P=1.00) but the groups significantly differed in distention (P=0.004).

Conclusion: Discharge of gastric gases in patients on mechanical ventilation decreases gastric distention. Therefore, this method could be used in such cases but further studies are suggested to clarify its application.

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Background and purpose: Critical care nurses could actively participate in the decision made by the healthcare team especially if they have the knowledge on the factors that affect extubation time following coronary artery bypass surgery. This study aimed to evaluate the duration of intubation after coronary artery bypass surgery and related factors in Mazandaran Heart Center, Sari, Iran.

Materials and methods: A descriptive analytical study was carried out in 200 patients with a diagnosis of coronary artery disease undergoing coronary artery bypass surgery. Relevant information was obtained via observation, patients medical records, and nursing notes. Data analysis was performed using frequency and central tendency, dispersion indices, Spearman correlation, Mann-Whitney, Kruskal-Wallis, chi-square, and regression tests.

Results: The duration of intubation was 9.39±2.27 hours. Meanwhile, the relationship between demographic variables and preoperative clinical factors was examined using regression models. In this study, respiratory disease, history of MI, age, and weight were found to be significantly associated with duration of intubation.

Conclusion: Considering demographic and clinical factors on admission and preparation of patients undergoing coronary artery bypass surgery results in earlier detection of patients at risk of prolonged intubation, and makes it possible to schedule and perform care plans accurately to prevent physical and psychological complications of prolonged mechanical ventilation and increased healthcare costs.

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Background and purpose: Ventilator-associated pneumonia is a common, serious and costly disorder in intensive care units (ICUs) that rank first in hospital infections. So, appropriate interventions are needed to prevent this condition. Eucalyptus is a plant with antibiotic properties, therefore, current study aimed at investigating its effects on prevention of endotracheal tube-associated pneumonia in ICU.
Materials and methods: A double-blind clinical trial was performed in 100 patients with endotracheal tube and on ventilator in ICU in Kermanshah Imam Reza Hospital, Iran. The patients were divided into two groups. In intervention group (n=50) 4 cc of 2% eucalyptus solution was mixed with 6 cc distilled water and in control group (n=50) 10 cc distilled water was given three times daily through a nebulizer kit connected to mechanical ventilation devices. Data on the rate of early and late pneumonia were compared based on CPIS criteria applying t-test and Chi-square.
Results: The incidence of early and late pneumonia was lower in intervention group compared to that of the controls. The decrease was significantly more in onset of late pneumonia (P=0.01). The onset of pneumonia due to mechanical ventilation was significantly higher in intervention group than that of the control group (P=0.01).
Conclusion: Eucalyptus was found to be an effective prophylaxis that could delay the development of pulmonary infection in patients on ventilation. Therefore, it is suggested in ICUs in patients with tracheal tubes.
 
(Clinical Trials Registry Number: IRCT2017010727819N2)
 

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Background and purpose: In the last months of 2019, the new coronavirus infection (COVID-19) spread worldwide. This study investigated the need for mechanical ventilation in children who were admitted for COVID-19.
Materials and methods: This article provides a systematic review of studies about children with COVID-19 requiring invasive or non-invasive mechanical ventilation. Electronic databases including SID, Iran Medex, Magiran, PubMed, and Google Scholar were searched using related keywords in Persian and English until July 20, 2020. Also, references in the selected articles were screened.
Results: Twenty studies were selected in which 1709 hospitalized children were included. Mechanical ventilation methods were used in 15% of the patients, while in 260 non-invasive ventilation (n=130, 7.6%) and invasive ventilation (n=130, 7.6%) were used. In critically ill children or those who needed intensive care (n=302), non-invasive ventilation and invasive mechanical ventilation were performed in 72 (23.8%) and 71 (23.5%), respectively. Mortality occurred in 1.3% of all admitted patients and 4% of critically ill children.
Conclusion: According to this review, 15% of hospitalized children with COVID-19 needed a form of mechanical ventilation.

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 Background and purpose: Tympanostomy surgery and ventilation tube (VT) placement are reliable methods to reduce the complications of eustachian tube dysfunction and inadequate middle ear ventilation. However, tympanostomy is associated with some complications. This study aimed to investigate the frequency distribution of tympanostomy surgery, success rate, its complications and the demographic characteristics of patients during 2011-2017 in Sari, Iran.
Materials and methods: This retrospective descriptive study was performed using data from the records of 512 patients who underwent VT surgery in Sari during 2011-2017. A checklist was used to collect the data and SPSS V24 was used for data analysis.
Results: The most common complaint at the time of referral was hearing loss (38.3%). In 79%, bilateral VT was performed and 6.5% had complications after the operation. The most common complication was purulent otorrhea (4.1%). Postoperative success rate of VT was found to be 93%.
Conclusion: Given the high success rate of VT surgery, this procedure could be a good method in treatment of hearing loss, acute recurrent middle ear infections, and the adverse effects of tonsillitis and allergy on middle ear.

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Background and purpose: The present study investigated the effect of six weeks of endurance and resistance training on pulmonary indices, physical performance, and quality of life in COVID-19 patients after discharge from hospital.
Materials and methods: Thirty six patients with COVID-19 (mean age: 38.76±0.98 years, mean weight: 81.86±2.88 kg) were selected. At the beginning and end of the study, pulmonary (FEV₁, FVC, FEV₁/FVC, and MVV), physical (6-minute walk test), quality of life (SF-36), and anthropometry tests were performed. The patients were divided into three groups: Endurance training (45 minutes at 60-75% estimated HR), Resistance training (45 minutes at 40-70% of I-RM), and controls. The intervention was conducted for 6 weeks (3 sessions). One-way ANOVA test was used for statistical analysis.
Results: Findings indicated a significant increase in FEV₁ (P=0.029), FVC (P=0.047), FEV₁/FVC (P=0.043) in the endurance training group compared to the control group, while difference was observed in MVV (P=0.041) and FEV₁/FVC (P=0.022) between endurance training and resistance training groups. The 6-minute test distance increased in the endurance training (P=0.0001) and resistance training (P=0.001) groups compared to the control group, but no difference was observed between the training groups (P=0.48). Endurance and resistance training programs induced significant improvements in physical performance (P=0.024 and P=0.09, respectively) and general health (P=0.022 and P=0.015, respectively) dimensions compared to the control group.
Conclusion: Moderate-intensity endurance training can improve pulmonary function, physical performance, and quality of life in patients with COVID-19 after discharge from hospital and can be used in rehabilitation programs of these patients.
 

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Background and Purpose: Infant mortality is one of the most important health indicators for any country, and understanding the causes and timing of infant deaths can aid in health and hygiene planning. Respiratory diseases are a leading cause of infant mortality, particularly among premature infants. This study was conducted to investigate the status of respiratory care for infants in neonatal intensive care units (NICUs) in hospitals in Mazandaran province.
Materials and Methods: In this descriptive, retrospective study, information related to infants hospitalized during the year 1400 (2021-2022) in the NICUs of hospitals under the Mazandaran University of Medical Sciences was extracted from the Iman system and from patients' medical records. This system, launched in 1397 (2018-2019) under the supervision of the Infant Health Department, a subsidiary of the Deputy of Health of the Ministry of Health, Treatment, and Medical Education, has been verified for accuracy through the use of trained personnel and repeated validation processes. As of 1399 (2020-2021), its data are considered reliable. The study population included all infants hospitalized in the NICUs of hospitals affiliated with Mazandaran University of Medical Sciences. Given the availability of data for all infants hospitalized in the province's hospitals, there was no need for sampling. Therefore, all infants hospitalized in the NICUs during 1400 (2021-2022) were included in the study by census, amounting to 2,531 infants, according to the Iman system. The inclusion criteria were infants hospitalized in the NICUs, while the presence of major congenital anomalies at birth was an exclusion criterion. In this study, intubation was categorized as invasive ventilation, while other methods were classified as non-invasive ventilation. For the statistical analysis, parametric tests were used to test the study hypotheses after confirming the normality of the data. All data analyses were performed using SPSS software version 26.
Results: The gestational age of mothers ranged from 22 to 41 weeks, with a median and interquartile range of 37.0 (34.0-39.0) weeks. Of the 2,531 infants hospitalized in the NICUs during 1400 (2021-2022), 1,505 (59.5%) were boys and the rest were girls. Of all infants requiring respiratory support, 248 (9.8%) underwent invasive ventilation, while 579 (22.9%) underwent non-invasive ventilation. Pneumothorax was reported in 42 (1.7%) of the infants. A total of 112 (4.4%) infant deaths were reported. This mortality rate was 89 (21.5%) for infants under 32 weeks and 23 (1.1%) for infants over 32 weeks.
Conclusion: The findings of this study showed that, while the overall mortality rate of infants hospitalized in the NICUs was low, the mortality rate for very premature infants (under 32 weeks) was higher than that of developed countries and warrants further attention and investigation into the contributing factors. Additionally, about one-tenth of the hospitalized infants were transferred to other hospitals due to a need for more advanced equipment. Providing these hospitals with the necessary resources, including invasive ventilation devices, could potentially reduce infant mortality. The most common causes of death in NICU infants were respiratory distress syndrome, prematurity, and congenital malformations, respectively.