جستجوی مقالات مرتبط با کلیدواژه « تهویه مکانیکی » در نشریات گروه « پزشکی »

Simulation-based medical education is effective for developing and improving critical care-related clinical skills training and reducing patient safety threats. The present study aimed to describe the technological approach of building and evaluating a prototype of a Lung Box (LB) mechanical ventilation simulator.

In this practical study with an analytical approach, the device's body, constructed from 5 mm plexiglass sheets, occupies a respiratory circuit, an airflow obstruction system, a pressure gauge manometer, a spring-loaded manual system to apply limits on the bag inflation range, a tidal volume measurement system, a respiratory trigger simulator system, and a four-layer accordion-style plastic bag assembly that can be inflated and deflated with air. Additionally, there is a user manual storage box along with it.

The design and drawing of the device's map were performed with AutoCAD software, and the parts were assembled after laser cutting. The device was connected to the ICU ventilator, and the respiratory mode of continuous forced ventilation was selected. Prior to ventilation, the tidal volumes were selected to be 0.60, 0.55, 0.50, 0.45, and 0.40 ml, and respiratory rates were set as 18, 15, 12, and 9 bpm. The simulation of the respiratory trigger was performed with different values ​​of flow sensitivity (0.05-15 lit/min). There was no statistically significant difference (P>0.05) in terms of the reproducibility of the values ​​of the selected variables for the test Lung (TL) with those chosen for LB.

In this technical study, a prototype educational mechanical ventilation simulator was developed and functionally tested using the concepts of fluid dynamics and respiratory physiology. Compared with conventional TL, this device is accurate and efficient enough.

Clinical evaluation is one of the main components in the discussion of clinical education in the field of nursing. Based on Miller's Pyramid in Education, objective structured clinical examination becomes one of the applied assessment methods to evaluate clinical skills. One of the clinical skills of nurses, especially in the Intensive Care Unit (ICU), is mechanical ventilation. This study was conducted with the aim of designing an objective structured clinical examination to evaluate the competence of nurses in mechanical ventilation.

This descriptive study was conducted in 1401 in Tehran, Iran. According to the educational content of basic mechanical ventilation principles and the purpose of the study, six stations were determined and a specialized checklist was designed accordingly for each station. Checking the validity of the content of the designed checklists was done using the opinions of experts in both qualitative and quantitative ways.

Finally, the number of six stations with 31 items with titles; Tubing connection and initial preparation of the ventilator, initial and basic settings of the ventilator, check and intervention in the oxygenation status, check and intervention in the ventilation status, management of clinical challenges and management of alarms were finalized. Scoring ranged between 1 and 5, and the sum of the scores of the stations would indicate the nurse's clinical competence in mechanical ventilation.

According to the results of the present study, the use of an objective structured clinical examination designed to evaluate the clinical competence of nurses in basic mechanical ventilation is suggested.

Increased intra-abdominal pressure, which is often hidden in the evaluating of patients, causes critical and complete-rest patients with irreparable consequences. Numerous and consecutive position changes can be effective in creating conditions to increase intra-abdominal pressure. The present study aimed to investigate the effect of position changes on intra-abdominal pressure in mechanically ventilated patients.

The present study was a clinical trial in which 68 patients were randomly selected and enrolled. Intra-abdominal pressure was measured by intrablader method using water manometer. Other hemodynamic and respiratory parameters were measured by BENNETT 840 ventilator and SAADAT hemodynamic monitoring device. Data were entered into a checklist and analyzed using SPSS software version 22 and parametric and non-parametric statistical tests. In this study, a significance level of P < 0.05 was considered significant.

The mean intra-abdominal pressure of patients in different conditions had statistically significant differences. Patients in the 15° and 45° positions had the lowest and in the 30° position to the right side, the patients had the highest intra-abdominal pressure (P<0.001). Mean arterial pressure and abdominal perfusion pressure were the lowest in the position of 30° to the right side, and the highest values were in the position of 15° and 45°. The highest values of airway pressure were observed in the position of 30° to the right side.

Changing of position for mechanically ventilated patients in Intensive Care Units can be associated with significant respiratory and hemodynamic consequences.

In the treatment process of hospitalized patients with COVID-19, one of the threatening complications is pulmonary complications such as barotrauma.

This study aims to investigate the prevalence of barotrauma in COVID-19 patients admitted to intensive care units (ICU) of two hospitals in Rasht, Iran.

This retrospective study was conducted on COVID-19 patients admitted to the ICUs of Razi and Poursina hospitals in Rasht in 2020. Their files were studied, and their demographic/clinical data and pulmonary complications were extracted using a checklist by an anesthesia resident. 

Out of 140 patients, 81(57.9%) received non-invasive mechanical ventilation and 59(42.1%) had invasive ventilation. Barotrauma was observed in 9 cases (6.4%), 8(88.9%) in the form of pneumothorax and one (11.1%) in the form of both pneumothorax and subcutaneous emphysema. The results showed that the incidence of barotrauma was significantly higher among patients who received invasive mechanical ventilation (P=0.003). No significant difference was observed among patients received non-invasive ventilation (P>0.05). 

The prevalence of barotrauma among COVID-19 patients in the study hospitals is low, which indicates the proper performance of the attending physicians and compliance with the standard guidelines.

Non-invasive ventilation with positive pressure is known as one of the main pillars in the management of patients with acute and chronic respiratory failure, which can be used at home and in hospital intensive care units. The purpose of this study is to address the challenges related to non-invasive ventilation in patients with respiratory failure.

 The present article is a systematic review study using systematic search in databases, SID, Magiran, Science Direct, PubMed and Google Scholar search engine with keywords "mechanical ventilation", "non-invasive ventilation", " Respiratory failure was performed.

Problems and complications such as skin damage, discomfort and mask intolerance in some patients, high failure rate if this method is not used correctly, as well as the possibility of spreading and transferring contamination to health workers.

Non-invasive ventilation in patients will have the best effect when it is used according to the patient's condition at the right time, with the appropriate equipment, connections and settings of the device and by skilled and trained personnel. Monitoring and continuous monitoring of the patient's clinical condition under non-invasive ventilation is one of the principles of the success of this ventilation support method. It is also recommended that medical workers use appropriate personal protective equipment while using this treatment method.

Changing position is one of the typical nursing care in intensive care units. This study aimed to investigate the effect of body positioning on intra-abdominal pressure and endotracheal tube cuff pressure and their relationship with each other in patients undergoing mechanical ventilation

This was a before-after clinical trial study performed on 70 patients over eight months. Eligible patients were placed in one of the positions of bed angle (flat, 30, and 45 degrees) and body position sideways toward an opposite direction to the mechanical ventilator. The intra-abdominal pressure and the endotracheal tube cuff pressure were measured with each change in body position and head of the bed. Data were analyzed at a significance level of 0.05.

Mean intra-abdominal pressure was different in positions (P<0.001). The mean intra-abdominal pressure at the flat angle was (7.4±0.49) CmH2O at the lowest and 45 degrees was (11.98±0.45) CmH2O at the highest. The mean intra-abdominal pressure in the supine position was significantly lower than in other positions (P<0.001). The endotracheal cuff pressure was significantly higher in lying down on the opposite side of the ventilator than in other positions (P<0.001). There is no significant relationship between intra-abdominal pressure and endotracheal tube cuff pressure (P=0.15).

The results showed that at the flat angle and opposite direction to the mechanical ventilator, the tube cuff pressure was maximal and at an angle of 45° and the position of the opposite side of the mechanical ventilator, the intra-abdominal pressure was the highest. Although there was no significant relationship between intra-abdominal pressure and endotracheal tube cuff pressure, when lying on the opposite side of the mechanical ventilator, intra-abdominal pressure and endotracheal tube cuff pressure were abnormally high. Therefore, it is recommended to avoid the patient in this situation.

Pain and restlessness are common problems in the intensive care unit. Sensory stimulation is one of the non-pharmacological methods of pain control. Dyang sensory stimulation includes visual, auditory, olfactory, tactile, and motor-sensory stimulation. In this study we investigated the effects of Dyang sensory stimulation on the level of consciousness, pain, and restlessness in the unconscious patients.

This clinical trial included 60 patients under mechanical ventilation. The patients were divided into two groups. The intervention group received Dyang sensory stimulation. Sensory stimulation was performed for one hour in the evening and at night for six consecutive days. Fifteen minutes after sensory stimulation, the level of consciousness, pain, and restlessness were measured using GlasgowComa Scale  , BPS (Behavioral Pain Scale), and Rass (Richmond Agitation Sedation Scale), respectively.

The mean values for level of consciousness of the patients in the two groups before the intervention were below 7. The mean values for pain intensity (p=0.684) and restlessness (p=0.739) did not show any significant differences between the two groups before the intervention. After sensory stimulation on the second day, the level of consciousness of the patients in the intervention group increased compared to that in the control group (p=0.016). However, there were no significant differences between the two groups in terms of pain intensity and restlessness on all days of the study (p>0.05).

Dyang sensory stimulation can increase the level of consciousness.  Therefore, this multidimensional stimulation method can be used in the patients under mechanical ventilatation.

Corona virus is a single-stranded RNA virus that has affected places with high population density. Middle-aged and elderly patients with chronic diseases seem to be at risk of respiratory failure and may have a poorer prognosis. In order to diminish the mortality caused by this disease and determine the impact of underlying factors on the consequences of patients, we decided to investigate the frequency of underlying diseases and its relationship with the prognosis of patients.

This cross-sectional study was conducted on COVID-19 patients between of February 2020 to September 2021 at Shahid Mostafa Khomeini Hospital. After data collection, underlying diseases and their effect on prognosis during hospitalization of patients were studied and descriptive as well as analytical statistics were extracted.

In this study, 158 cases were examined. Most of the underlying diseases in the patients were hypertension and diabetes. Eighty point four percent of patients had at least one underlying disease. In the meantime, was a significant relationship between oxygen saturation level and deterioration criteria (P<0.05). Meanwhile, a significant relationship was observed between the age of patients with the need for mechanical ventilation and mortality (P<0.05). Kidney diseases, diabetes and high blood pressure as well as the presence and number of underlying diseases with poor prognosis the need for mechanical ventilation and also death had a significant relationship (P<0.05).

A high percentage of people with COVID-19 are elderly and have underlying diseases, some of which are associated with bad prognosis and high mortality. Multiple underlying diseases are also a predisposing factor for worse prognosis and high mortality. To this end, the care and treatment of these people is very important.

Coronavirus in 2019 was recognized as one of the leading causes of death worldwide. According to reports, the mortality rate in people who need mechanical ventilation varies from 50 to 97 percent. The aim of this study was to evaluate the outcome of Covid-19 disease based on different characteristics in patients and mechanically ventilated variables.

This descriptive-analytical study was conducted on 160 patients with a definite diagnosis of Covid-19 who were under mechanical ventilation and admitted to the intensive care unit of Alzahra Hospital in Isfahan from March 2020 to March 2021. Data was collected by checklist. The checklist included demographic information, including age, gender, as well as information such as underlying diseases, disease outcome, length of hospitalization, etc. After collecting the data, they were analyzed in SPSS software version 22 and at a significance level of less than 0.05.

In this study, the overall mortality rate among mechanically ventilated patients was 62.5%. The mean age of patients was 69.99±17.87 years and the mean duration of hospitalization in surviving patients was 15.47±11.73 days and for deceased ones was 55.21±69.14 days. The mean age of the deceased group (65.71±16.59) was significantly higher than the surviving group 53±21.17 was (P=0.0001). The length of hospital stay in the deceased group was significantly longer than the surviving group (P=0.005). As a result, ventilator mode and inotropic agent intake during treatment increased the chance of mortality in patients under mechanical ventilation (P=0.001). There was a significant relationship between underlying diseases of hypertension, kidney disease and autoimmune disease with mortality in patients (P<0.05).

Various factors including the length of stay in the hospital, comorbidities such as hypertension, renal disease and autoimmunity may affect the outcome of critically ill ICU patients under mechanical ventilation. Patients who require long-term invasive ventilation and the use of inotropic drugs to maintain their cardiovascular status while hospitalized in the ICU are at higher risk for mortality.

Accumulation of secretions is one of the serious complications in patients under mechanical ventilation. The management of airway secretions in these patients includes using the usual methods like fluid therapy as well as techniques such as changing the patient's position and manual hyperinflation. Tracheal suction, which is performed with the aim of secretion removal, can be effective in improving airway clearance along with manual hyperinflation techniques and postural drainage. This randomized clinical trial was conducted to compare the effect of manual hyperinflation (MH) and postural drainage (PD) on respiratory parameters of patients under mechanical ventilation.

This crossover clinical trial study was conducted in the intensive care units of Imam Khomeini Hospital, Ilam in 2018. Sample size was 50 patients under mechanical ventilation who were included in the study according to the inclusion criteria through convenience sampling. After the first 24 hours, patients received routine respiratory care in ICU, each patient was randomly assigned to one of the two intervention groups, manual dilatation (MH) or postural drainage (PD) for 24 hours, and then the patient was transferred to the next intervention group. Data collection tool was a demographic questionnaire and a form for recording respiratory variables (including dynamic compliance, arterial blood oxygen saturation percentage, tidal volume, Peak Inspiratory Pressure and Positive End Expiratory Pressure). On the first day, after selecting the patient and recording the demographic information, when the patient needed suction, the patient's respiratory variables were recorded at three times including before suction, 5 and 25 minutes after suction, and the results were recorded as the basic information (control). During the second day, in addition to receiving routine respiratory care, before each suction, depending on the intervention group, the patients were subjected to MH or PD and respiratory variables were recorded before suctioning as well as 5 and 25 minutes after suction. On the third day, the patient was assigned to the next intervention group (crossover design) and the evaluation of respiratory variables was repeated and the results were recorded.

Based on the repeated measure ANOVA, atrial blood oxygen saturation (P value=0.001), tidal volume (P value=0.001) and dynamic compliance (P value=0.038) in the intervention groups at 25 minutes after suction were more than the control group, in favor of MH intervention comparing to PD intervention. Regarding the peak inspiratory pressure, the intervention of MH in 25 minutes after suction created a significant decrease compared to the PD (P value=0.001). There was no significant difference in the PEEP between any of the study phases and the investigated times.

The findings reconfirmed the necessity of nursing interventions in order to manage airway secretions, and also showed that MH intervention is more effective than PD in improving the respiratory indicators. Therefore, while emphasizing the necessity of training HCWs for respiratory care and management of airway clearance in patients under mechanical ventilation, it is suggested to prepare evidence-based clinical guidelines emphasizing the superiority of MH intervention in order to improve the respiratory indicators of patients.

Chronic Obstructive Pulmonary Disease patients are certainly the most challenging ones for weaning from mechanical ventilation. Mortality in these patients compared to others due to failure in the weaning process is more than seven times. The present study was performed on the population of ventilated chronic obstructive pulmonary disease purposes of determining cut-off points of New Integrative Weaning Index (NIWI) and conventional indexes and comparing differences between their predictive components.

The observational prospective, triple blinded study was conducted in 2012-2013 on 180 hospitalized COPD patients in critical care units of selected hospitals in Tehran in two groups including cut-off points determining group and determining different predicting weaning factors group. The process of weaning was based on the same and defined protocol. The ROC analysis was used to determine the cut-off points group and the predicting factors were used in the other group.

The highest area under the curves was devoted to Rapid Shallow Breathing Index (0.927) and NIWI (0.878). The highest sensitivity was related to NIWI with 100% and the highest specificity was related to RSBI index 90%, the positive predictive value to RSBI Index was 87.5%, the negative predictive value to NIWI with 100% and highest diagnostic accuracy related to RSBI was 98.67%. The cut-off point and the most desirable components predicting weaning were RSBI, NIWI, P0.1, and NIF indexes, respectively.

The NIWI index can be used as a complementary predictive indicator for weaning from mechanical ventilation in chronic obstructive pulmonary disease patients due to its good predictive components.

The aim of this study was to determine the effect of changes in respiration rate on the outcome of weaning from mechanical ventilation in patients admitted to the intensive care unit of Golestan Hospital in Ahvaz in 2020.

The present study was a cross-sectional and analytical study. The statistical population of the study was all patients under mechanical ventilation admitted to the intensive care unit of Golestan Hospital in Ahvaz from April to June 2020. The sample size in the present study was 135 people. SPSS 24.0 software was used for data analysis. The significance level for all tests was 0.05.

The highest frequency of the need for mechanical ventilation in the studied patients was postoperative, acute brain injury and respiratory distress. Based on the findings of the present study, a total of 52.6% of patients under mechanical ventilation had successful separation. The cut-off rate of respiration for successful separation from mechanical ventilation was RR > 20. According to the findings, for approximately 67% of patients with RR <20, the result of separation from mechanical ventilation was successful, and for 60% of patients with RR> 20, the result of separation was unsuccessful. Sensitivity and specificity were obtained by determining the cut-off RR > 20 equal to 70% and 60%. In other words, 70% of patients with unsuccessful separation resulted in RR> 20 and 60% of patients with successful outcome had RR <20.

Based on the results of the present study, the respiratory rate had a significant relationship with the result of weaning from mechanical ventilation. Patients with high respiratory rate have deliberately had the result of weaning from poor mechanical ventilation. Also, the sensitivity in the present study was obtained with a cut of RR> 20 times 70%. 60 percent of patients who had more than 20 breaths had a successful separation outcome.

Caring for patients treated with mechanical ventilation is of particular importance because of its complications. The occurrence of various diseases, including pneumonia and its resulting mortality, is affected by inadequate and improper implementation of principled and safe instructions by the care team, especially nurses.

This study aimed to evaluate the implementation of airway care safety guidelines for patients under mechanical ventilation.

This descriptive study was performed in 2020 in the intensive care units (ICUs) of selected Military hospitals in Tehran. The study population included all nurses working in these wards. The performance of 90 nurses working in these wards was observed four times. A total of 270 observations of nurses’ performance in patients’ airway care were recorded in a researcher-made observation checklist. Data were analyzed using SPSS software version 25 and descriptive and inferential statistical tests such as independent t-test, ANOVA, and Pearson correlation coefficient. The significance level was considered less than 0.05.

In total, 61.1% were male, 54.4% were married, 92.2% were bachelor, and 7.2% had a formal contract with a mean age of 33.36±8.44 years. The total amount of care in the first time was 35.08±7.59, in the second time was 35.12±7.30, and in the third time was 35.61±7.05. Safe airway care of patients had a significant relationship with the variables of gender, marital status, work experience, type of employment, shift and work history of patient safety, intensive care, and mechanical ventilation.

In this study, it was found that the status of implementation of airway safety instructions by nurses for patients under mechanical ventilation is at an unfavorable level. Further monitoring of nurses’ performance, practical and quality training on how to care for patients’ airways, and strict implementation of safety instructions are strongly recommended.

Communicating effectively with mechanically ventilated patients is difficult and challenging which can have a serious impact on the quality of nursing care. Communication board is one of the tools to communicate with these patients. In this study, we intended to investigate the effect of using a communication board on the communication dimension of perceived quality of nursing care in mechanically ventilated patients.

This randomized clinical trial was performed in the intensive care units of Imam Khomeini Hospital in Tehran. 60 patients were randomly divided into control and experimental groups. The instruments were used included two questionnaires of demographic characteristics and quality of nursing care questionnaire (Qualpacs) to measure the quality of nursing care in the communication dimension. In the intervention group, a communication board was used to communicate with the patient and in the control group, communication was done routinely. After the intervention, the Qualpacs questionnaire was completed by the research units. SPSS version 24 was used for statistical analysis.

There was no significant difference in demographic characteristics between the two groups (P>0.05). The mean score of perceived nursing care quality in the intervention group was significantly higher than the control group (19.06±3.7 vs 12.9±2.61). 96.7% of patients in the intervention group had optimal to ideal satisfaction with nursing care, while only 66.7% of patients in the control group had good satisfaction with the quality of care. (p <0/001).

The results of this study show that using a communication board in mechanically ventilated patients leads to an increase in the perceived quality of nursing care in the communication dimension.

Pain assessment and control are essential parts of the treatment of children admitted to the intensive care unit. Moreover, the connection between pain and its physiological/ psychological effects is important. This study aims to evaluate the pain caused by endotracheal tube suctioning in mechanically ventilated children admitted to the intensive care unit.

This study was performed on 50 hospitalized children who were under mechanical ventilation. In these patients, the pain was assessed according to FLACC pain criteria and physiologic indices before and after endotracheal tube suctioning following the standard suction protocol. Patients were divided based on the overall pain score as no pain, mild pain, moderate pain, and severe pain.   

In summary, the average age of the patients was approximately 34 months, and 70% (n = 35) were male. Respiratory diseases (30%, n =15) were the most common initial diagnosis. According to FLACC pain criteria, the frequency and severity of the pain increased after endotracheal tube suctioning (p-value <0.05). The relation between increasing pulse rate, respiration rate, and systolic/diastolic blood pressure with enhancing distribution and pain level after suction is meaningful (P-value <0.001). Also, the patients with higher pain scores received lower doses of analgesic drugs by continuous infusion (P-value <0.05).    

Endotracheal tube suctioning is a painful intervention and patients are distressed following it. Therefore, pain assessment methods and pharmacological and non-pharmacological methods to control the resulting pain are recommended.

Mechanical ventilation is the most basic supportive care in patients admitted to the intensive care units. Some factors such as increase in airway resistance due to bronchospasm, may affect ventilation, that measured by different methods. The aim of this study was to compare the diagnosis of bronchospasm based on the calculation of airway resistance using ventilator data and clinical examination in patients admitted to the intensive care unit.

This descriptive cross-sectional study was performed on 180 patients, who admitted in the intensive care units of Ahvaz teaching hospitals and undervent mechanical ventilation. Patients were included in the study according to the inclusion criteria and were evaluated daily in terms of increasing airway resistance in two ways: clinical examination (presence of wheezing or Ronchi) and ventilator data (calculation of airway resistance). Data was recorded in a researcher-made checklist.

Among 180 patients enrolled in the study, the mean age was 57.77±18.95 years. There was a significant relationship between diabetes, asthma, hypertension and hyperlipidemia with an increase in airway resistance (P<0.05). Airway resistance was higher in women than men (P=0.004). There was a statistically significant difference between airway resistance detection through clinical examination and airway resistance detection based on ventilator data (p <0.001).

The results showed that detecting increased airway resistance through ventilator data was more sensitive than physical examination, So the use of it, in patient management is recommended.

Endotracheal suctioning is one of the most important nursing intervention in critical care units. Increasing nurses’ knowledge about comprehensive criteria for suctioning can lead to improved nursing interventions. One of the main challenges in suctioning of the intubated patients is that nurses doing this procedure without comprehensive criteria. The purpose of this study was to examine the effect of comprehensive endotracheal suctioning training on the frequency of airway suctioning in mechanically ventilated patients.

This research was an outcome-based study. Thirty intensive care unit nurses in different work shifts were randomly selected and entered the study with personal knowledge and consent. Mechanically ventilated patients who admitted to critical care units in a hospital were assessed before and after intervention (training the nurses). The nurses were trained using lectures, installing posters in critical care units, providing educational booklet and clinical practice. The duration of the lecture was 45 minutes using slides. The results were analyzed using descriptive and inferential statistics and SPSS software version 21 and using t-test and chi-square. 

Comparison of the frequency of airway suctioning in mechanically ventilated patients before and after the intervention showed that the frequency of suctioning in mechanically ventilated patients have been decreased with  educational intervention.

Our findings show that the intervention in this study had decreased the frequency of suctioning in mechanically ventilated patients.

Patients who were been under mechanical ventilation for more than 48 hours are susceptible to ventilator-induced lung injury (VILI). Lung inflammation and pulmonary activation of coagulation are induced by mechanical stress. Clinical and preclinical studies show that heparin possesses antiinflammatory properties. Therefore, we assessed the effects of nebulized heparin in VILI.

Sixty critically ill adult patients who require mechanical ventilation for more than 48 hours were included in this prospective, nonrandomized controlled study. Patients received nebulized heparin (10000 U every 6 hours) for 5 days. The matched control group received nebulized budesonide as routine practice in our center. This study assessed changes in partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2) and rapid shallow breathing index (RSBI) during the study period as primary endpoints.

The average daily PaO2/FiO2 ratio was not statistically significant between both groups (187±11.6 versus 171±11.6, P: 0.35). The RSBI also didn’t differ between groups (P: 0.58). Heparin administration was associated with a higher number of ventilator-free days among survivors but not significantly (7.7±10.6 versus 5.1±8, 95% CI -2.2 to 7.5, P: 0.28). Successful weaning from mechanical ventilation was higher in the heparin group (P: 0.42). We didn’t observe any serious or increased adverse effects from nebulized heparin.

The results of this study show that the overall effectiveness of nebulized heparin is at least as comparable with a potent corticosteroid (budesonide). Heparin could be a safe and effective modality for patients who at risk of VILI.

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.

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.

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.

According to this review, 15% of hospitalized children with COVID-19 needed a form of mechanical ventilation.

Conscious mechanically ventilated patients are not able to communicate due to the internal tubes and many other reasons which cause them to experience many difficulties. In this regard, the present study aimed to explore the experiences of conscious mechanically ventilated patients, such as speech impairment and discovery of nonverbal communication used by them for the expression of their needs.

This qualitative content analysis was conducted on 15 conscious mechanically ventilated patients admitted to the intensive care unit in Iran during 2016. The required data were collected through semi-structured interviews and observations and the subjects were selected using the purposive sampling method from patients with enough experience in this regard. Moreover, the collected data were analyzed using conventional qualitative content analysis methods.

Based on the results of data analysis, four main themes were found in the deep descriptions of the participants. These themes were the inability to speak as the root of problems, inconvenient blockage of communication channels, unsuccessful nonverbal communication, and attempt for communication.

Conscious patients in the intensive care unit have many communication problems while undergoing mechanical ventilation. Therefore, they are not able to express their own needs and this leads to fear and disappointment in them. These patients use different methods, such as communicating via signs, tapping on the bed, lip reading, and writing to express their needs.