In this study, we evaluated the effect of dexamethasone used as a prophylaxis for nausea and vomiting on the incidence of postdural puncture headache (PDPH) in pregnant women receiving spinal anesthesia for cesarean section. In a prospective, randomized, double-blind, placebo-controlled study, 372 women under spinal anesthesia received 8 mg of dexamethasone or placebo intravenously just after the umbilical cord was clamped. The rate of PDPH and correlated risk factors were evaluated. The prevalence of nausea and vomiting in the dexamethasone and placebo groups was 54.4 and 51.7%, respectively. There was no statistically meaningful difference between the results (P value = 0.673). The overall incidence rate of PDPH was 10.8%, with 28 cases from the dexamethasone group compared with 11 subjects from the placebo group (P value = 0.006). This effect was most prominent on the first day (P value = 0.046) and disappeared on the second day after spinal anesthesia (P value = 0.678). Prophylactic treatment with 8 mg of dexamethasone not only increases the severity and incidence of PDPH, but is also ineffective in decreasing the prevalence of intra-operative nausea and vomiting during cesarean section. The treatment is a significant risk factor for the development of PDPH.

Background: Patients’ oral health is impaired in Intensive Care units (ICUs) due to loss of consciousness, open mouth, intubation, and mechanical ventilation. Objectives: The current study aimed to compare the effects of comprehensive and combined programs on oral health in patients under mechanical ventilation. Methods: This single-blind clinical trial with three groups was performed on 90 patients with mechanical ventilation admitted to ICUs of medical centers affiliated to the Zahedan University of Medical Sciences, Iran, in 2020. Patients under mechanical ventilation were randomly divided into three groups, including those receiving a comprehensive program, those receiving a combined program, and controls through permutated blocks. In the two intervention groups, oral care was performed for 5 minutes, three times per day, during the 5 days of the study with a specific method. The control group received routine oral care. The patients’ oral health was measured once before the intervention and then every day until the fifth day of the intervention using the Beck Oral Assessment scale. The data were analyzed using the analysis of variance and chi-square in IBM SPSS Statistics software version 26. Results: The mean oral health score in the three groups was not significantly different before the intervention and on the second day of the study (P > 0.05). However, on the third to fifth days of the study, the oral health score in the two intervention groups showed a significant decrease compared to the control group, indicating an oral health improvement in these groups (P = 0.001). The mean oral health score in the control group increased during the study days. Conclusions: Comprehensive care and combination methods can improve oral health in patients under mechanical ventilation. Nurses are recommended to use regular and codified oral care methods.

Background: Pneumonia is one of the most common hospital-acquired infections, where 86% is associated with mechanical ventilation, known as ventilator-associated pneumonia (VAP). Oropharyngeal decontamination reduces the incidence of VAP by medicinal agents. Objectives:The aim of the present study was to determine the effect of oropharyngeal decontamination using topical antibiotics on oropharyngeal and tracheal colonization of trauma patients admitted to the intensive care unit (ICU). Methods: The present double-blind clinical trial was performed on trauma patients, who underwent endotracheal intubation during the first 24 hours, at the ICU of Khatam-al-Anbia Hospital, Zahedan, during years 2017 to 2018. The sample size was 100 individuals, who were selected using the convenience sampling method and randomly assigned to intervention and control groups. The study began with the start of intubation and lasted for five days. When oral and tracheal culture samples were sent to the laboratory during the first 24 hours after endotracheal intubation, the pre-mixed solution of nystatin, polymyxin B, and neomycin was rubbed to the mouth, lips, gingiva, and cheeks of the intervention group, using syringes and gloves, four times a day. The tracheal and oral secretions were cultured in the intervention and control groups at the beginning and the end of the study. Data analysis was carried out using the SPSS version 21 software. Independent t test and paired t test were used to compare the quantitative variables, and qualitative variables were compared using the chi-square test and Fisher's exact test. The significance level was considered at 0.05. Results: When the final drop-out occurred, out of 44 remaining patients in the intervention group, the number of negative oral cultures increased from 31 cases (70.5%) in the pretest to 39 (88.6%) in the posttest. A total of 25 negative oral cultures were recorded in the control group in both the pretest and posttest stages. Also, the number of negative tracheal cultures in the intervention group increased from 38 cases (86.4%), in the first turn, to 44 (100%) cases in the second turn; while in the control group, the number of negative tracheal cultures was recorded as 39 (88.6%) in the first turn and increased to 40 cases (100%) in the second turn. Conclusions: Clinically, reduced colonization rate of invasive bacteria, as the main result of the present study, indicates a decrease in the incidence of inappropriate alterations in oral microbial flora that can subsequently be effective in reducing the incidence of diseases, such as pneumonia.

Background: Inadequate oral care in ICU patients can lead to lethal complications such as ventilator-associated pneumonia (VAP). Objectives: The purpose of this study was to compare the effect of oral care using miswak and chlorhexidine mouthwash on the incidence of VAP in ICU patients. Methods: This single-blind randomized clinical trial was carried out in 2018 on 70 patients undergoing mechanical ventilation in the intensive care units of Khatam-al-Anbia Hospital in Zahedan, Iran. The inclusion criteria were the insertion of endotracheal tube, scoring 10 or below based on Beck oral assessment scale (BOAS), scoring below 5 based on the modified clinical pulmonary infection score (MCPIS) at the beginning of the study, absence of chronic pulmonary disease, and no history of pulmonary aspiration. The subjects were selected through convenience sampling and randomly divided into the intervention (n: 35) and control (n: 35) groups. For five days, oral care was administered using miswak in the intervention group and chlorhexidine mouthwash in the control group. Data were collected through a demographic and clinical information questionnaire, MCPIS, and BOAS. After normality tests, the obtained data were analyzed in SPSS 22 using independent t-test, chi-square test, and Fisher's exact test at the significance level of P < 0.05. Results: The two groups were similar in terms of age, gender, cause of hospitalization, level of consciousness, administered antibiotics, history of ICU admission, and smoking. After oral care with miswak, none of the patients in the intervention group developed VAP, but 6 patients in the control group (17.1%) were diagnosed with this condition. The results of Fisher's exact test showed a significant difference between the two groups in terms of VAP incidence (P = 0.01). Conclusions: In addition to promoting the oral health of ICU patients, miswak can mitigate the incidence of ventilator-associated pneumonia. Therefore, because of its availability, cost-effectiveness, and fewer side effects compared to chlorhexidine mouthwash, it is strongly recommended to be administered to ICU patients.

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).