Data collection tool had two sections. The first section included demographic and clinical characteristics and the second contained Modified Pulmonary Infection Clinical Scale. This is a standard scale including five criteria of body temperature, pulmonary secretion, WBC, PO2–FiO2 ratio based on mmHg, and a chest X-ray. Each subscale is scored 0–2 in this tool and the maximum score that could be obtained is 10. Obtaining scores over 5 in this scale reveals involvement in VAP [Table 1].[26,27] The Persian version of the Modified Pulmonary Infection Clinical Scale was used in the present study. Sabery et al. calculated the reliability of this scale through Cronbach's alpha and internal consistency was found to be 91%.[28] This scale was recorded on the third, fourth, and fifth days of the study at 8:00 AM. After random selection of the subjects and their allocation to study or control group, the researcher firstly extracted patients’ clinical demographic data from their medical records in the hospital and recorded them in the first section of the data collection tool. Before intervention, the Modified Pulmonary Clinical Infection Scale was completed for all the subjects. The subjects with VAP were excluded. Then, the researcher performed a scheduled upper respiratory care in the study group, which included oral subgluteal space suctioning before each position change, measuring and regulating the cuff pressure of tracheal tube in the range of 25 cm H2O (twice a day at 8:00 AM and 8:00 PM), and checking the bed head elevation at 45° by use of a bevel (twice a day at 8:00 PM). The subjects in the control group underwent upper respiratory routine care.
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