[Surgical tracheostomy versus percutaneous tracheostomy in the intensive care unit]

Prolonged intubation and need to mechanical ventilation is an indication for tracheostomy. This procedure can be done, surgical or percutaneous. In this study, we compare surgical and percutaneous dilated tracheostomy. In this retrospective study, which was conducted in ICU wards of Rasool Akram Hospital from Mehr 1387 to Mehr 1390. We compared complication of tracheostomized patients in two groups. In this study, early postoperative bleeding, in 11 cases, 1 case [4.2%] in PDT group and 10 cases [17.5%] in surgical group was shown [with a significant difference]. Surgical site infection in 1 case, 2 cases [7.4%] in PDT group and 1 case [4.2%] in surgical group was shown [with a non-significant difference]. Subcutaneous emphysema in 11 cases, 2 case [8.3%] in PDT group and 1 case [1.7%] in surgical group with a significant difference, was shown. Other complications such as tracheal posterior wall were not shown in both groups. Because of lower complications rate and bedside PDT doing, percutaneous tracheostomy is a safe and suitable alternative for surgical tracheostomy

[Comparing the effect of continuous and intermittent feeding on the ventilator-associated pneumonia in intensive care unit patients]

Ventilator-Associated pneumonia [VAP] is the second common infections with high mortality [24-40%].In this study designed to determined effect of continuous[infusion] and intermittent[bolus] feeding on the Ventilator-associated Pneumonia in ICU Patient. This randomized controlled trial was performed on 76 patients admitted in ICU. They were randomly allocated to equal two groups [n=38]. In case group, continuous feeding and in controlled group intermittent feeding was performed during the first five days. The incidences of early pneumonia [the first 3 to 5 days] and increase WBC [White Blood Cell] and PMN [Poly Morph Nuclear] in both groups were compared during the first 5 days. The rate of increase in WBC [>11000/ml] and PMN [band cell>50%] in continuous group was 8 patients [10.5%] and in intermittent group were 7 patients [9.2%] [pv=0.32]. The incidences of early pneumonia [CPIS >or=6] in case group were 4 patients [5.3%] and in control group were 7 patients [9.2%] [pv=0.77]. The results of this study showed that incidence of early VAP in case group was lesser, but this difference was not significant. Also, there was no significant difference in increase of WBC and PMN in both groups

[ effect of foot and hand massage on post-cesarean section pain]

Cesarean operation is the most common surgery which its prevalence is growing daily in our country. Despite the technological advances in postoperative pain managment, these routines remains inadequate and thus requires complementary therapies and intervention. On account of the inadequate postoperative pain managment wound complication ratio, infection, and health care costs have steadily increased. The aim of this study is to determine the efficiency of foot and hand massage on reducing postoperative pain in patient who went under cesare an operation. This clinical trial study was carried out on 90 women ongoing elective cesarean operation in the Yahyanejad hospital of Babol. Subjects selected by random allocated method were divided into three groups: a control group, a foot and hand massage group, and foot massage group, each of which included 30 patients. In the evening of the day surgery, the pain intensity and vital findings of the patients were measured 1 to 4 hours after a dose of pain medication, and then massage techniques were applied. Again, the pain intensity and vital findings were measured right after the massage, 60 minutes and 90 minutes after the massage. In the control group, the data's were guttered only. The statistical analysis of pain intensity were evaluated by NRS and VRS, which showed a significant decrease in both intervention groups. In comparison to the initial measurements, vital findings in both intervention groups were similar found to be higher in the measurements performed right after the massage, which was considered to be statistically significant. Foot and hand massage can be used as an effective nursing initiative in post operative pain management