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ORJIME, Emmanuel Verem, Benjamin G. AHULE, Godwin A. AKPEHE, Solomon GBAKA, Victor Ushahemba IJIRSHAR e Kafayat O. ZAKA. "Indigenous Preservation Practices and Shelf Life of Stored Yams in Benue State, Nigeria: Implication for Post-Harvest Management and Food Security". MANAGEMENT AND ECONOMICS REVIEW 9, n.º 1 (10 de fevereiro de 2024): 25–40. http://dx.doi.org/10.24818/mer/2024.01-02.
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Several empirical studies have been conducted on the relationship between indigenous practices and yam tuber preservation. However, there is a lack of empirical evidence regarding the extent of effectiveness of the existing indigenous preservation practices in reducing yam postharvest losses with regard to prolonging the shelf life, which underscores an existing gap in knowledge. The purpose of this study is to examine the extent of effectiveness of existing indigenous preservation practices in prolonging the shelf life of stored yam tubers in Benue State, Nigeria, using a cross-sectional survey design based on a proportional sampling technique involving 255 respondents. The result of the chi-square test shows the probability value of 0.000<0.05; hence, the study rejected the null hypothesis. A symmetric Phi value of 0.635 was obtained, showing a positive association between the variables. Thus, application of the existing indigenous yam preservation practices led to the overall improvement in the shelf life of stored yams by 34%. The study recommends that government and nongovernmental organizations should provide both financial and technical assistance to rural yam farming families, in the form of loan facilities. Yam farmers should also form cooperative societies in order to borrow more funds from financial institutions. This will boost the expansion of storehouses to accommodate the increasing quantity of yam tubers harvested, provide good ventilation in stores, and enhance free traffic during the removal of sprout development in storehouses to avert yam tuber postharvest losses and prolong the shelf life of the stored yam tubers in the study area.
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Ricard, Jean-Damien, Fadia Dib, Marina Esposito-Farese, Jonathan Messika e Christophe Girault. "Comparison of high flow nasal cannula oxygen and conventional oxygen therapy on ventilatory support duration during acute-on-chronic respiratory failure: study protocol of a multicentre, randomised, controlled trial. The ‘HIGH-FLOW ACRF’ study". BMJ Open 8, n.º 9 (setembro de 2018): e022983. http://dx.doi.org/10.1136/bmjopen-2018-022983.
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IntroductionThis study protocol describes a trial designed to investigate whether high-flow heated and humidified nasal oxygen (HFHO) therapy in patients with hypercapnic acute respiratory failure (ARF) reduces the need of non-invasive ventilation (NIV).Methods and analysisThis is an open-label, superiority, international, parallel-group, multicentre randomised controlled two-arm trial, with an internal feasibility pilot phase. 242 patients with hypercapnic ARF requiring NIV admitted to an intensive care unit, an intermediate care or a respiratory care unit will be randomised in a 1:1 ratio to receive HFHO or standard oxygen in between NIV sessions. Randomisation will be centralised and stratified by centre and pH at admission (pH ≤7.25 or >7.25). The primary outcome will be the number of ventilator-free days (VFDs) and alive at day 28 postrandomisation. The secondary outcomes will encompass parameters related to the VFDs, comfort and tolerance variables, hospital length of stay and mortality. VFDs at 28 days postrandomisation will be compared between the two groups by Wilcoxon-Mann-Whitney two-sample rank-sum test in the intention-to-treat population. A sensitivity analysis will be conducted in the population of patients for whom the criteria of switching from NIV to spontaneous breathing, or conversely, are not strictly verified.Ethics and disseminationThe protocol has been approved by theComité de Protection des Personnes(CPP)Sud-Ouest & Outre-Mer IV(ref CPP17-049a/2017-A01830-53) and will be carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. A trial steering committee will oversee the progress of the study. Findings will be disseminated through national and international scientific conferences, and publication in peer-reviewed journals.Trial registration numberNCT03406572.
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Heglum, Margareth, Marita Flasnes e Susan Saga. "Barrierer for å ta i bruk høy PEEP og lungerekruttering ved generell anestesi til pasienter med fedme". Inspira 15, n.º 2 (30 de abril de 2020): 16–24. http://dx.doi.org/10.23865/inspira.v15.2764.
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Bakgrunn: Grunnet økende fedme i befolkningen, vil en større andel av pasienter i generell anestesi være pasienter med fedme. Generell anestesi og mekanisk ventilering fører til at omtrent 90 % utvikler atelektaser. Pasienter med fedme får atelektaser tidligere og i større grad enn den normalvektige, dette kan vise seg som redusert gassutveksling og hypoksi peroperativt. Dette øker risikoen for postoperative lungekomplikasjoner. Nyere forskningslitteratur anbefaler bruk av ventileringsstrategiene høyt positivt endeekspiratorisk trykk (PEEP) og lungerekruttering (LR) for å begrense utviklingen av atelektaser hos denne pasientgruppen. Vi vet imidlertid lite om hvordan bruken av disse ventileringsstrategiene er blant anestesisykepleierei Norge.
Hensikt: Å undersøke hvilke aspekter som påvirker anestesisykepleierens bruk av høy PEEP og LR peroperativt til pasienter med fedme i generell anestesi.
Metode: Studien har et kvalitativt design. Det ble gjennomført individuelle, semistrukturerte intervju med 15 anestesisykepleiere fra to sykehus. Datamaterialet ble analysert ved hjelp av Graneheim og Lundmans kvalitative innholdsanalyse.
Resultat: Studien viser at opplevelse av egen trygghet i yrkesutøvelsen samt kulturelle og organisatoriske forhold påvirker anestesisykepleierens bruk av høy PEEP og LR. Anestesisykepleierne har varierende mengdetrening i bruk av høy PEEP og LR. Andre og mer kjente strategier prioriteres ofte først hos de med lite mengdetrening. Samarbeidet med legene synes å være bra og i liten grad en hemmende faktor. Alle informantene mener bruk av høy PEEP og LR er en oppgave for anestesisykepleier hos pasienter klassifisert i ASA 1 eller ASA 2, men peker på at det mangler fagprosedyre/retningslinje knyttet til anvendelse av høy PEEP og LR.
Konklusjon: Studien viser at både individuelle, kulturelle og organisatoriske aspekter påvirker anestesisykepleiernes bruk av høy PEEP og LR hos pasienter med fedme i generell anestesi. Alt tatt i betraktning kan det å sette ventileringsstrategiene på dagsorden føre til en økt bevissthet om bruken som igjen kan føre til utvidet bruk av ventileringsstrategiene.
English abstract
Introduction: Increasing obesity in the population means that the proportion of obese patients undergoing general anesthesia is expected to increase. General anesthesia and mechanicalventilation cause approximately 90% of patients to develop atelectasis. Obese patients develop atelectasis earlier, and to a greater extent than patients with a body mass index within the normal range. Recent research literature recommends the use of ventilation strategies - high positive end-expiratory pressure (PEEP) and pulmonary recirculation (LR) - to prevent the development of atelectasis in this cohort of patients. However, we have limited knowledge regarding how these ventilation strategies are implemented in clinical practice among nurse anesthetics in Norway.
Purpose: To investigate which aspects that affect the use of high PEEP and LR perioperatively for patients with obesity in general anesthesia.
Method: A qualitative study conducted using individual semi-structured interviews. 15 nurse anesthetists from two different hospitals were interviewed. The data was analyzed using qualitative content analysis.
Result: The nurse anesthetists’ use of high PEEP and LR is affected by (1) the experience of self-confidence in professional practice and (2) organizational conditions. The amount of training within the use of high PEEP and LR varies among the anesthetic nurses interviewed, affecting the extent to which these strategies are being implemented. Other, more well-known strategies are often prioritized first. The collaboration between nurses and anesthesiologists is well functioning and cannot be considered an inhibitory factor. All informants express that the use of high PEEP and LR is a task in anesthesia nursing for patients classified within patient groups ASA 1 or ASA 2. The results however demonstrate a lack of implemented clinical procedures and guidelines regarding the use of high PEEP and LR.
Conclusion: This study shows that both individual and organisational aspects affect the nurse anaesthetists use of high PEEP and LR for patients with obesity in general anesthesia. Increasing the nurses’ self-confidence through both training and systematic implementation is critical to increase the use of recommended ventilation strategies.
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Nikolla, Dhimitri A., Brandon J. Kramer e Jestin N. Carlson. "A Cross-Over Trial Comparing Conventional to Compression-Adjusted Ventilations with Metronome-Guided Compressions". Prehospital and Disaster Medicine 34, n.º 02 (abril de 2019): 220–23. http://dx.doi.org/10.1017/s1049023x19000098.
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Introduction:Hyperventilation during cardiopulmonary resuscitation (CPR) negatively affects cardiopulmonary physiology. Compression-adjusted ventilations (CAVs) may allow providers to deliver ventilation rates more consistently than conventional ventilations (CVs). This study sought to compare ventilation rates between these two methods during simulated cardiac arrest.Null Hypothesis:That CAV will not result in different rates than CV in simulated CPR with metronome-guided compressions.Methods:Volunteer Basic Life Support (BLS)-trained providers delivered bag-valve-mask (BVM) ventilations during simulated CPR with metronome-guided compressions at 100 beats/minute. For the first 4-minute interval, volunteers delivered CV. Volunteers were then instructed on how to perform CAV by delivering one breath, counting 12 compressions, and then delivering a subsequent breath. They then performed CAV for the second 4-minute interval. Ventilation rates were manually recorded. Minute-by-minute ventilation rates were compared between the techniques.Results:A total of 23 volunteers were enrolled with a median age of 36 years old and with a median of 14 years of experience. Median ventilation rates were consistently higher in the CV group versus the CAV group across all 1-minute segments: 13 vs 9, 12 vs 8, 12 vs 8, and 12 vs 8 for minutes one through four, respectively (P <.01, all). Hyperventilation (>10 breaths per minute) occurred 64% of the time intervals with CV versus one percent with CAV (P <.01). The proportion of time which hyperventilation occurred was also consistently higher in the CV group versus the CAV group across all 1-minute segments: 78% vs 4%, 61% vs 0%, 57% vs 0%, and 61% vs 0% for minutes one through four, respectively (P <.01, all).Conclusions:In this simulated model of cardiac arrest, CAV had more accurate ventilation rates and fewer episodes of hyperventilation compared with CV.Nikolla DA, Kramer BJ, Carlson JN. A cross-over trial comparing conventional to compression-adjusted ventilations with metronome-guided compressions. Prehosp Disaster Med. 2019;34(2):220–223
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Lacerda, Rodrigo Silva, Fernando Cesar Anastácio de Lima, Leonardo Pereira Bastos, Anderson Fardin Vinco, Felipe Britto Azevedo Schneider, Yves Luduvico Coelho, Heitor Gomes Costa Fernandes et al. "Benefits of Manometer in Non-Invasive Ventilatory Support". Prehospital and Disaster Medicine 32, n.º 6 (26 de julho de 2017): 615–20. http://dx.doi.org/10.1017/s1049023x17006719.
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AbstractIntroductionEffective ventilation during cardiopulmonary resuscitation (CPR) is essential to reduce morbidity and mortality rates in cardiac arrest. Hyperventilation during CPR reduces the efficiency of compressions and coronary perfusion.ProblemHow could ventilation in CPR be optimized? The objective of this study was to evaluate non-invasive ventilator support using different devices.MethodsThe study compares the regularity and intensity of non-invasive ventilation during simulated, conventional CPR and ventilatory support using three distinct ventilation devices: a standard manual resuscitator, with and without airway pressure manometer, and an automatic transport ventilator. Student’s t-test was used to evaluate statistical differences between groups. P values <.05 were regarded as significant.ResultsPeak inspiratory pressure during ventilatory support and CPR was significantly increased in the group with manual resuscitator without manometer when compared with the manual resuscitator with manometer support (MS) group or automatic ventilator (AV) group.ConclusionThe study recommends for ventilatory support the use of a manual resuscitator equipped with MS or AVs, due to the risk of reduction in coronary perfusion pressure and iatrogenic thoracic injury during hyperventilation found using manual resuscitator without manometer.LacerdaRS, de LimaFCA, BastosLP, VincoAF, SchneiderFBA, CoelhoYL, FernandesHGC, BacalhauJMR, BermudesIMS, da SilvaCF, da SilvaLP, PezatoR. Benefits of manometer in non-invasive ventilatory support. Prehosp Disaster Med. 2017;32(6):615–620.
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Ge, Wu, Wu Wei, Pan Shuang, Zheng Yan-Xia e Lv Ling. "Nasointestinal tube in mechanical ventilation patients is more advantageous". Open Medicine 14, n.º 1 (26 de maio de 2019): 426–30. http://dx.doi.org/10.1515/med-2019-0045.
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AbstractObjectiveTo assess the effects of two different nutritional mode on the occurrence of ventilator-associated pneumonia (VAP) in patients on mechanical ventilation.Methods70 patients admitted to the ICU and under mechanical ventilation, were randomly divided into the nasointestinal tube group and nasogastric tube group. Patients from both groups received enteral nutrition, using the same nutritional agent, through intubation. The duration of stay in the ICU, duration of mechanical ventilation, incidence of VAP, nutritional state, and survival of the intestinal tract were compared between the two groups.ResultsThe duration of stay in the ICU, duration of mechanical ventilation and incidence of VAP in the nasointestinal tube group was lower than that in the nasogastric tube group (P<0.05). There was an increase in the levels of prealbumin and transferrin in the nasointestinal tube group (P<0.05). However, there were no obvious difference in the nasogastric tube group (P<0.05). The incidence of abdominal distension, diarrhea, regurgitation, aspiration, and hyperglycemia in the nasointestinal tube group was much lower than that in the nasogastric tube group (P < 0.05).ConclusionThis study showed that enteral nutrition delivery using a nasointestinal way can effectively reduce the incidence of VAP and improve the nutritional status of patients under mechanical ventilation.
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Be’eri, Eliezer, Simon Owen, Maurit Beeri, Scott R. Millis e Arik Eisenkraft. "A Chemical-Biological-Radio-Nuclear (CBRN) Filter can be Added to the Air-Outflow Port of a Ventilator to Protect a Home Ventilated Patient From Inhalation of Toxic Industrial Compounds". Disaster Medicine and Public Health Preparedness 12, n.º 6 (21 de fevereiro de 2018): 739–43. http://dx.doi.org/10.1017/dmp.2018.3.
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AbstractObjectivesChemical-biological-radio-nuclear (CBRN) gas masks are the standard means for protecting the general population from inhalation of toxic industrial compounds (TICs), for example after industrial accidents or terrorist attacks. However, such gas masks would not protect patients on home mechanical ventilation, as ventilator airflow would bypass the CBRN filter. We therefore evaluated in vivo the safety of adding a standard-issue CBRN filter to the air-outflow port of a home ventilator, as a method for providing TIC protection to such patients.MethodsEight adult patients were included in the study. All had been on stable, chronic ventilation via a tracheostomy for at least 3 months before the study. Each patient was ventilated for a period of 1 hour with a standard-issue CBRN filter canister attached to the air-outflow port of their ventilator. Physiological and airflow measurements were made before, during, and after using the filter, and the patients reported their subjective sensation of ventilation continuously during the trial.ResultsFor all patients, and throughout the entire study, no deterioration in any of the measured physiological parameters and no changes in measured airflow parameters were detected. All patients felt no subjective difference in the sensation of ventilation with the CBRN filter canister in situ, as compared with ventilation without it. This was true even for those patients who were breathing spontaneously and thus activating the ventilator’s trigger/sensitivity function. No technical malfunctions of the ventilators occurred after addition of the CBRN filter canister to the air-outflow ports of the ventilators.ConclusionsA CBRN filter canister can be added to the air-outflow port of chronically ventilated patients, without causing an objective or subjective deterioration in the quality of the patients’ mechanical ventilation. (Disaster Med Public Health Preparedness. 2018;12:739-743)
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Fancev, Tomislav, Davor Grgić e Siniša Šadek. "Verification of GOTHIC Multivolume Containment Model during NPP Krško DBA LOCA". Journal of Energy - Energija 65, n.º 3-4 (24 de junho de 2022): 116–26. http://dx.doi.org/10.37798/2016653-4118.
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New containment multivolume model of NPP Krsko for GOTHIC code is developed. It is based on plant drawings and other available data. It is supported by developed SketchUp 3D containment model. The model is subdivided in volumes following physical boundaries and clearly defined flow paths. All important concrete heat structures are taken into account. Metal heat structures are based on plant’s SAR Chapter 6 licensing model. RCFC (Reactor Containment Fan Cooler) units are explicitly modelled as well as all main ventilation ducts. The model includes two trains of containment spray system. PARs (Passive Autocatalytic Recombiner) and PCFV (Passive Containment Filter Venting) filters added during plant safety upgrade project are part of the model too. It was intention to use model for both DBA (Design Basis Accident) and for DEC (Design Extended Conditions) and BDBA (Beyond Design Basis Accident) calculations. Based on the same discretization and data, and on experience acquired during GOTHIC model development and use, containment models for MELCOR and MAAP integral codes are developed too. As part of initial verification of the GOTHIC model containment DBA LOCA calculation is performed using SAR MER (Mass and Energy Release) data. The influence of different break positions on peak containment atmosphere pressure and temperature was studied. The results were compared against results obtained in single volume containment licensing model. Beside local effects due to different containment subdivision similar results are obtained when comparing containment dome from multivolume and the single volume in licensing model. Special attention was paid to distribution of water in lower part of the containment during recirculation phase. In this case much more valuable information are obtained in multivolume model with explicit volumes for main sump, recirculation sump and sump pit. Another point of interest was influence of containment spray duration on long term pressure and temperature behaviour. The intention was to study consistency of assumed different spray operation times used in safety analyses, EQ analyses and SAMGs and related consequences for plant operation during DBA LOCA.
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R. Sujatha, Anil Singh Yadav, Dilshad Khan Dilshad Arif e Astha Gupta. "Microbial Profile and Antibiogram of Ventilator Associated Pneumonia at Tertiary Care Hospital U.P". International Journal of Current Microbiology and Applied Sciences 10, n.º 11 (10 de novembro de 2021): 10–18. http://dx.doi.org/10.20546/ijcmas.2021.1011.002.
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Ventilator associated pneumonia (VAP) is a common and serious healthcare associated infection (HAI). VAP is inflammation of lung parenchyma caused by infectious agents that develops in a patient who is on a ventilator occurring 48-72 hrs or more after tracheal intubation and mechanical ventilation (MV). The risk of VAP is highest early in the course of hospital stay, and is estimated to be 3%/day during the first 5 days of ventilation, 2%/day during days 5-10 of ventilation and 1%/day after this. Aim of this study was find out the Microbial profile and antibiogram of ventilator associated pneumonia at tertiary care hospital U.P. This study was conducted in the Department of Microbiology, Rama Medical College, Hospital & Research Centre, Kanpur India from January 2016 to December 2016. A total of 100 Endotracheal aspirated samples were collected in a sterile & labelled clean dry container from the clinically suspected cases of VAP patients. Out of 100 patients 31 patients shown growth of the bacteria & considered as Ventilator Associated Pneumonia patients. And 69 patients have not shown any kind of growth. Acinetobacter baumanni, Pseudomonas aeruginosa, Enterobacter & Klebsiella Pneumoniae were the most common pathogens from both early & late onset VAP. Proper monitoring and strict implementation of infection control practices is very essential to reduce VAP in hospital setting. Also the short term use of invasive devices and judicious use of antibiotics are important in preventing VAP caused by these MDR pathogens.
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Kristoffersen, Marte, e Anne-Marthe Rustad Indregard. "Intensivsykepleieres erfaringer med kollektiv mestring av arbeidsrelatert stress". Inspira 19, n.º 2 (22 de novembro de 2024): 41–55. http://dx.doi.org/10.23865/inspira.v19.6366.
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Bakgrunn: Intensivsykepleieres arbeidshverdag preges av høye faglige og relasjonelle krav. Intensivmiljøet er høyteknologisk og avansert, og arbeidspresset er stort. Tidligere studier viser at intensivsykepleiere har økt risiko for omfattende arbeidsbelastning, høy forekomst av utbrenthet og økt sykefravær, og mange ytrer et ønske om å forlate yrket. Det er behov for mer kunnskap om kollektive mestringsstrategier som bidrar til at intensivsykepleiere håndterer arbeidskravene de står overfor, og som forebygger negative konsekvenser av arbeidsrelatert stress. Hensikt: Å utforske og beskrive intensivsykepleieres erfaringer med kollektiv mestring av arbeidsrelatert stress. Metode: Kvalitativ pilotstudie. Utvalget besto av intensivsykepleiere med minst tre års erfaring. Fire individuelle semistrukturerte dybdeintervjuer ble gjennomført på to intensivavdelinger ved et universitetssykehus på Østlandet. Analysen ble utført etter Braun og Clarkes tematiske analysemetode. Resultater: Analysen resulterte i to hovedtemaer: 1) «Betydningen av handlingsberedskap i en kompleks arbeidshverdag» og 2) «Behov for sosial støtte fra kollegaer og ledere». Handlingsberedskap omfattet betydningen av akuttberedskap, rolleavklaring, fagutvikling, mestringstro og kompetanse om arbeidsrelatert stress og mestring. Videre kom det frem at en synlig og anerkjennende ledelse, felles refleksjon og ventilering med kollegaer var relevant for å oppleve kollektiv mestring. Konklusjon: Intensivsykepleierne i denne pilotstudien erfarte handlingsberedskap og sosial støtte fra kollegaer og ledere som vesentlige faktorer for kollektiv mestring av arbeidsrelatert stress. Resultatene anses som relevante og nyttige for utarbeidelse av nye og større studier. Videre forskning er nødvendig for å forstå kompleksiteten av kollektiv mestring for intensivsykepleiere. ENGLISH ABSTRACT Intensive Care Nurses’ Experiences with Collective Coping of Work-Related Stress Background: The working life of intensive care nurses are characterized by high professional and relational demands. The intensive care environment is technologically advanced and the work pressure is high. Previous studies show that intensive care nurses have an increased risk of substantial workload, high levels of burnout and sickness absence, and many are considering leaving the profession. There is a need for more knowledge about collective coping strategies helping intensive care nurses to manage the job demands and to prevent the negative consequences of workrelated stress. Purpose: To explore and describe intensive care nurses’ experiences with collective coping of work-related stress. Method: Qualitative pilot study. Our sample consisted of intensive care nurses with at least three years of experience. Four individual semi-structured in-depth interviews were conducted at two intensive care units at a university hospital in Eastern Norway. The analysis was conducted by using Braun and Clarke’s thematic analysis method. Results: The analysis resulted in two main themes: 1) “The importance of preparedness in a complex workday” and 2) “The need for social support from colleagues and leaders.” Preparedness included the importance of emergency preparedness, role clarification, professional development, self-efficacy and competence about work-related stress and coping. Furthermore, it became clear that visible and appreciative leadership, along with shared reflection and ventilation with colleagues, was relevant for experiencing collective coping. Conclusion: In this pilot study, intensive care nurses experienced preparedness and social support from colleagues and leaders as essential factors for collective coping with work-related stress. The results are considered relevant and useful for the development of new and larger studies. Further research is needed to understand the complexity of collective coping for intensive care nurses.
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Ranjit, S., e B. Bhattarai. "Incidence and Risk Factors for Ventilator-Associated Pneumonia in Kathmandu University Hospital". Kathmandu University Medical Journal 9, n.º 1 (7 de junho de 2012): 28–31. http://dx.doi.org/10.3126/kumj.v9i1.6258.
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Background Ventilator associated pneumonia is a major cause of morbidity in the intensive care unit. Difficulties in identification of the risk factors, in diagnosing and in prevention, have intensified the problem. Objectives To measure the incidence of ventilator associated pneumonia in intensive care unit and to identify the risk factors associated. Methods A prospective observational cohort study of 69 patients who were mechanically ventilated for more than 48 hours were evaluated to find out the development of nosocomial pneumonia and presence or absence of risk factors. Data were subjected to univariate analysis using chi-square and t-test. Level of significance was set at 0.05. Results Twenty two (31.88%) out of 69 patients developed ventilator associated pneumonia, majority of them between four days to 14 days. Reintubation, invasive lines, H2 blockers and low PaO2/FiO2 were identified as major risk factors in our study. Enteral feeding via nasogastric tube and use of steroids was not associated with development of ventilator associated pneumonia. The patients with ventilator associated pneumonia had significantly longer duration of mechanical ventilation (18.88±7.7 days vs 7.36±4.19 days) and stay (29±17.8 days vs 9.22±5.14 days). The morality was similar for both the groups with or without ventilator associated pneumonia. ConclusionThe incidence of ventilator pneumonia is high. Patients requiring prolonged ventilation, re-intubation, more invasive lines and H2 blockers, are at high risk and need special attention towards prevention.http://dx.doi.org/10.3126/kumj.v9i1.6258 Kathmandu Univ Med J 2011;9(1):28-31
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Sen, Subhajit, e Suresh Ramasubban. "A prospective study on clinical profile, severity, microbiology, and outcome of patients with ventilator associated infective complications admitted in intensive care unit of a tertiary care hospital". IP Indian Journal of Immunology and Respiratory Medicine 9, n.º 1 (15 de abril de 2024): 15–25. http://dx.doi.org/10.18231/j.ijirm.2024.004.
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: Mechanical ventilation epitomizes intensive care medicine. Ventilator‑associated complications are mainly Ventilator associated respiratory infections (VARI); These are a major cause of concern in the intensive care units (ICUs) worldwide, especially in developing countries. VARI includes patients with ventilator‑associated tracheobronchitis (VAT) and ventilator‑associated pneumonia (VAP).The clinical profile, severity, microbiology, and outcomes of such infections is not well described in Eastern India. The primary objective of the study was to study the risk factors, severity scoring, microbiological profile and 28 days outcome of patients admitted in intensive care unit of our hospital.Secondary objective of our study was to find out any correlation between risk factors, severity scoring, microbiological profile, and outcome of patients with VAT and VAP admitted in intensive care unit of our hospital.: This was a prospective observational study done in the ICU of a tertiary care centre in eastern India. A total 50 patients of clinically, microbiologically and/or radiologically diagnosed case of VAP and VAT were included in the study. A structured data collection proforma was prepared and data collection was done. Raw data was tabulated and analysed: 66% of our patients were male, Smoking was the commonest addiction(24%), VARI developed early with 17% on Day 3, 72% developed VARI within 5 days of ventilation. 16% had history of recent admission, Diabetes and hypertension were the commonest comorbidities. 58% of the patients developed VAP, the median SOFA score in VAP was 6 also similar in VAT. Patients with neurological diseases had the maximum number of VAT and VAP. Klebsiella pneumoniae was the commonest organism causing VAT (42%) while Acinetobacter Baumanii was commonest to cause VAP (44%). 51% of VAP patients were on volume control mode, while it was 52% of VAT patients. Most isolates are MDR pathogens with intermediate sensitivity to Polymyxin being most common (66%) 1 isolate was pan resistant. Mortality was 58% for VAP and 19% in VAT. Both Klebsiella and Acinetobacter accounts for 41% death in VAP group, in VAT group Klebsiella was commonest however no statistical significance with other organism.: Gram negative bacteria were the predominant cause of VAT and VAP, Acinetobacter and Klebsiella are the commonest organisms. Most Isolates are MDR with intermediate sensitivity to Polymyxins. Median SOFA scores were the same in both. Mortality was high in VAP group. Volume control mode was predominant mode of ventilation, Neurological causes was predominant cause that leads to ventilation and subsequent VARI.
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Mannan, Md Abdul, Nasim Jahan, Shahed Iqbal, Navila Ferdous, Subir Dey, Tashmin Farhana e Nondita Nazma. "Short Term Outcome of Preterm Neonates Required Mechanical Ventilation". Chattagram Maa-O-Shishu Hospital Medical College Journal 15, n.º 2 (6 de março de 2017): 9–13. http://dx.doi.org/10.3329/cmoshmcj.v15i2.31796.
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Background: Since its inception, the neonatal mechanical ventilator has been considered an essential tool for managing preterm neonates with Respiratory Distress Syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. As compared to the western world and neighboring countries, neonatal ventilation in our country is still in its infancy. To analyze the common indications and outcome of preterm neonates required mechanical ventilation.Methods: This was a retrospective observational study conducted on preterm neonates required mechanical ventilation over a period of 12 months (July 2013 to June 2014).Results: A total of 50 neonates were mechanically ventilated during the study period of which 68% (n=34) survived. The survival rate was higher (77%) in 34- <37 weeks Gestational Age (GA) group and gradually declined in 30- <34 weeks (71%) & 27- <30 weeks (56%) GA. The neonates with Birth Weight (BW) ? 2500gm were higher survivals which was 100% and lower in 1500-2499gm (81%), 1000-1499gm (68%) and 800-999gm (33%) BW groups. Inborn neonates (68%) showed marginally higher survivals than outborn (66%) and also more survivals observed in preterm baby girls (72%) than boys (65%). RDS (62%) was the commonest indication for ventilation followed by Neonatal Sepsis (14%), Perinatal Asphyxia (PNA-10%), Congenital Pneumonia (8%) and Pneumothorax (6%). And found higher survivals in RDS (77%) than other indications which were in Pneumothorax (66%), PNA (60%), Sepsis (57%) and Pneumonia (50%). RDS (n=31) with surfactant therapy (n=14) recovered earlier <7 days (71.43%) than non surfactant therapy neonates (n=17), they required prolonged ventilator support over 7days (82.35%).Conclusions: Mechanical ventilation reduces the neonatal mortality, hence facilities for neonatal ventilation should be included in the regional and central hospitals providing intensive care for neonates.Chatt Maa Shi Hosp Med Coll J; Vol.15 (2); Jul 2016; Page 9-13
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Hedley-Whyte, John. "Intraabdominal Surgery and Anesthesia Management". Anesthesiology 126, n.º 3 (1 de março de 2017): 543–46. http://dx.doi.org/10.1097/aln.0000000000001413.
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Abstract Inspired Oxygenation in Surgical Patients During General Anesthesia With Controlled Ventilation: A Concept of Atelectasis. By Bendixen HH, Hedley-Whyte J, and Laver MB. New Engl J Med 1963; 269:991–996. Reprinted with permission. Abstract The purpose of this study was to determine if the pattern of ventilation, by itself, influences oxygenation during anesthesia and surgery and examine the hypothesis that progressive pulmonary atelectasis may occur during constant ventilation whenever periodic hyperventilation is lacking, but is reversible by passive hyperinflation of the lungs. Eighteen surgical patients, ranging in age from 24 to 87 yr, without known pulmonary disease, were studied during intraabdominal procedures and one radical mastectomy. Although ventilation remained constant, changes occurred in arterial oxygen tension and in total pulmonary compliance, with an average fall of 22% in oxygen tension and 15% in total pulmonary compliance. This fall in oxygen tension supports the hypothesis that progressive mechanical atelectasis may lead to increased venous admixture to arterial blood. The influence of the ventilator pattern on atelectasis and shunting is further illustrated by the reversibility of the fall in oxygen tension that follows hyperinflation. A relation between the degree of ventilation and the magnitude of fall in arterial oxygen tension was found, where large tidal volumes appear to protect against falls in oxygen tension, while shallow tidal volumes lead to atelectasis and increased shunting with impaired oxygenation.
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Russkikh, A. A., N. V. Lukyanenko, N. Ya Lukyanenko, T. V. Safyanova e A. A. Petrova. "Comparative aspects of the influence of exogenous risk factors on the occurrence of nosocomial pneumonia among patients infected with COVID-19 in intensive care units and surgical and therapy departments of a large multidisciplinary hospital". Sanitarnyj vrač (Sanitary Doctor), n.º 5 (29 de abril de 2023): 311–18. http://dx.doi.org/10.33920/med-08-2305-04.
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The problem of lung damage in viral infection caused by COVID-19 due to high frequency is relevant for anesthesiologists, resuscitators and epidemiologists. According to scientific research, when a patient is on a ventilator, the risk of an adverse outcome can reach 42 %. This is determined by the widespread use of invasive diagnostic manipulations in patients with COVID-19, which may be associated with bacterial and viral contamination of the environment. This article presents the results of a study of the influence of exogenous risk factors on the development of nosocomial pneumonia in 164 patients infected with COVID-19 in intensive care units and departments of surgical and therapeutic profile of a large multidisciplinary hospital. The number of exogenous risk factors for nosocomial pneumonia among patients infected with COVID-19 in intensive care units exceeded by 7.3 times their presence in surgical departments with a predominance of artificial lung ventilation (90.2 %), tracheostomy (87.8 %), oxygen therapy (68.3 %). The negative impact was determined by the untimely change of air filters during artificial lung ventilation — 16.2 % and tracheal sanitation –8.1 %, poor hand treatment of medical personnel,before tracheal sanitation — 39.2 %.
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Kumari, Sanju, e Rathish Nair. "Oral Care in Intubated Patients Whether or not on Mechanical Ventilation: A Systemic Review". Nursing Journal of India CIX, n.º 05 (2018): 206–10. http://dx.doi.org/10.48029/nji.2018.cix503.
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Oral care is an important part of nursing management in intubated patients as it affects both wellness and clinical outcomes of intensive care patients. Many of the intubated patients develop nosocomial pneumonia (ventilator-associated-pneumonia when on mechanical ventilation) owing to invasion by oropharyngeal microorganisms in intensive care patients. So intensive care intubated patients need proper oral assessment and oral care to avoid complications caused by oropharyngeal bacteria. We aimed to determine the standard practice guidelines over oral hygiene intubated patients in intensive care unit. For the purpose of collection of data we searched extensively on internet databases including Pub Med, Med know, Google scholar and EBSCO HOST. The keywords used were oral care, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care and critical care. We analysed the studies performed on adult intensive care intubated patients, published in peer reviewed. Type of studies analysed were descriptive evaluation studies, randomised controlled trials, literature review and meta-analysis and randomised clinical trials. After the analysis of all study article we concluded that oral brushing with chlorhexidine solution in various strength (0.12%, 0.2%, 2%) at least twice a day can reduce the incidence of VAP in intensive care intubated patients.
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Reed, Paul, Baruch Zobrist, Monica Casmaer, Steven G. Schauer, Nurani Kester e Michael D. April. "Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial". Prehospital and Disaster Medicine 32, n.º 6 (15 de agosto de 2017): 625–30. http://dx.doi.org/10.1017/s1049023x17006860.
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AbstractIntroductionVentilation with a bag valve mask (BVM) is a challenging but critical skill for airway management in the prehospital setting.HypothesisTidal volumes received during single rescuer ventilation with a modified BVM with supplemental external handle will be higher than those delivered using a standard BVM among health care volunteers in a manikin model.MethodsThis study was a randomized crossover trial of adult health care providers performing ventilation on a manikin. Investigators randomized participants to perform single rescuer ventilation, first using either a BVM modified by addition of a supplemental external handle or a standard unmodified BVM (Spur II BVM device; Ambu; Ballerup, Denmark). Participants performed mask placement and delivery of 10 breaths per minute for three minutes, as guided by a metronome. After a three-minute rest period, they performed ventilation using the alternative device. The primary outcome measure was mean received tidal volume as measured by the manikin (IngMar RespiTrainer model; IngMar Medical; Pittsburgh, Pennsylvania USA). Secondary outcomes included subject device preference.ResultsOf 70 recruited participants, all completed the study. The difference in mean received tidal volume between ventilations performed using the modified BVM with external handle versus standard BVM was 20 ml (95% CI, -16 to 56 ml; P=.28). There were no significant differences in mean received tidal volume based on the order of study arm allocation. The proportion of participants preferring the modified BVM over the standard BVM was 47.1% (95% CI, 35.7 to 58.6%).ConclusionsThe modified BVM with added external handle did not result in greater mean received tidal volume compared to standard BVM during single rescuer ventilation in a manikin model.ReedP, ZobristB, CasmaerM, SchauerSG, KesterN, AprilMD. Single rescuer ventilation using a bag valve mask with removable external handle: a randomized crossover trial. Prehosp Disaster Med. 2017;32(6):625–630.
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Esquinas, Antonio M., Antonio Dominguez-Petit e Andrea Purro. "Failure of noninvasive mechanical ventilation". European Journal of Emergency Medicine 22, n.º 1 (fevereiro de 2015): 66. http://dx.doi.org/10.1097/mej.0000000000000181.
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Elballat, Mohammad, William Anderson e Kevin Patel. "0832 Nocturnal Tachypnea with Non-Invasive Ventilation; A case report". Sleep 45, Supplement_1 (25 de maio de 2022): A359—A360. http://dx.doi.org/10.1093/sleep/zsac079.828.
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Abstract Introduction We present a case of nocturnal tachypnea secondary to suspected auto-triggering in a patient on Bilevel device. Auto-triggering is a patient-ventilator asynchrony in which a ventilator breath is triggered in the absence of inspiratory muscle activity. This phenomenon was mostly described in postcardiac surgery and in brain dead patients on mechanical ventilation. Detecting this asynchrony is important as it can lead to patient discomfort, poor compliance and hypocarbia that can lead to apneic events. Report of Cases: An 82-year-old male with history of chronic atrial fibrillation, coronary artery disease (s/p bypass surgery) and Ischemic cardiomyopathy (EF 25-30%). He had moderate obstructive sleep apnea with central apnea. He was started on AutoPAP then was upgraded to BPAP (IPAP 16/EPAP 9 cmH2O). His wife reported episodes of nocturnal tachypnea and increased daytime somnolence. This was confirmed by the compliance reports from his BPAP device, and a portable sleep study obtained while using the BPAP (respiratory rate > 40 breaths/minute). Conclusion Vignaux et al estimated the incidence of auto-triggering with NIV to be 13%. This phenomenon can be caused by a major circuit leak or secondary to cardiogenic oscillations. Effect of cardiogenic oscillation on the pulmonary air flow was described by West and Hugh-Jones in 1961. Our patient had dilated cardiomyopathy with hyperdynamic circulation which we believe was the major cause of his auto-triggering asynchrony. Changes in intracardiac volume and cardiac movements during systole resulted in intrapulmonary flow oscillations exceeding the set flow-trigger threshold leading to the tachypnea. In our patient, the events resolved after cardiac resynchronization procedure that improved the overall cardiac function and adjusting the trigger sensitivity. Support (If Any) [1]Kondili E, Prinianakis G, Georgopoulos D.; Patient ventilator interaction, Br J Anaesth. 2003; 91: 106-119 [2] Richard Arbour; Cardiogenic Oscillation and Ventilator Autotriggering in Brain-Dead Patients: A Case Series. Am J Crit Care 1 September 2009; 18 (5): 496–488. doi: https://doi.org/10.4037/ajcc2009690 [3] Imanaka, Hideaki MD; Nishimura, Masaji MD; Takeuchi, Muneyuki MD; Kimball, William R. MD, PhD; Yahagi, Naoki MD; Kumon, Keiji MD Auto-triggering caused by cardiogenic oscillation during flow-triggered mechanical ventilation, Critical Care Medicine: February 2000 - Volume 28 - Issue 2 - p 402-407 [4]Vignaux L, Vargas F, Roeseler J, Tassaux D, Thille AW, Kossowsky MP, et al. Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med 2009;35(5):840–846
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Esquinas, Antonio M., Paolo Groff e Roberto Cosentini. "Noninvasive ventilation in the emergency department". European Journal of Emergency Medicine 21, n.º 3 (junho de 2014): 240. http://dx.doi.org/10.1097/mej.0000000000000143.
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Wenzel, Volker, Ahamed H. Idris, William H. Montgomery, Jerry P. Nolan, Michael J. Parr, Gail E. Rasmussen, Wanchun Tang, James Tibballs e Lars Wik. "Rescue breathing and bag-mask ventilation". Annals of Emergency Medicine 37, n.º 4 (abril de 2001): S36—S40. http://dx.doi.org/10.1067/mem.2001.114128.
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Akter, Shahida, Rehana Khatun e SM Shamsuzzaman. "Molecular detection of atypical microorganisms in patients with ventilator associated pneumonia". Ibrahim Medical College Journal 9, n.º 1 (7 de maio de 2016): 22–25. http://dx.doi.org/10.3329/imcj.v9i1.27636.
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Ventilator-associated pneumonia (VAP) is one of the major causes of morbidity and mortality among the critically ill patients of intensive care units (ICU). The present cross sectional study was conducted to isolate and identify bacterial causes of VAP among the patients admitted in intensive care unit (ICU) of Dhaka Medical College Hospital. The study was conducted between July, 2013 to June 2014. A total of 65 endotracheal aspirate (ETA) and blood samples were collected from patients with clinically suspected ventilator associated peumonia(VAP). Samples were collected from patients on mechanical ventilation for more than 48 hours. ETA and blood samples were cultured aerobically. Multiplex PCR was performed with ETA to detect Mycoplasma pneumoniae, Legionella pneumophila and Chlamydia pneumoniae. Among the atypical bacteria, M. pneumoniae were detected in 5 (7.69%), L. pneumophila in 4 (6.15%) cases by multiplex PCR in ETA from VAP cases. No C. pneumoniae was detected. The study revealed that in VAP cases atypical bacteria should be considered as a possible bacterial agents.Ibrahim Med. Coll. J. 2015; 9(1): 22-25
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Salehi, Mohammadreza, Sirous Jafari, Lida Ghafouri, Hossein Malekafzali Ardakani, Alireza Abdollahi, Mohammad Taghi Beigmohammadi, Seyed Ali Dehghan Manshadi et al. "Ventilator-associated Pneumonia: Multidrug Resistant Acinetobacter vs. Extended Spectrum Beta Lactamase-producing Klebsiella". Journal of Infection in Developing Countries 14, n.º 06 (30 de junho de 2020): 660–63. http://dx.doi.org/10.3855/jidc.12889.
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Introduction: Ventilator-associated pneumonia (VAP) has been considered as a healthcare-associated infection with high mortality. Acinetobacter baumannii and Klebsiella pneumoniae are the common causes of VAPs around the world.
Methodology: This research was a retrospective observational study in the intensive care unit (ICU) in a tertiary referral collegiate hospital in Tehran between March 2016 and May 2018. Patients who fulfilled VAP due to documented Multidrug Resistant Acinetobacter baumannii (MDR-AB) or Extended Spectrum Beta Lactamase-producing Klebsiella pneumoniae (ESBL-KP) criteria were enrolled. General demographic features, duration of hospital stay, antimicrobial treatment regimens, duration of ICU admission, the period of mechanical ventilation (MV) and 30-day mortality were documented and compared.
Results: 210 patients were found with clinical, microbiological and radiological evidence of VAP. In total, 76 patients with MDR-AB and 76 patients with ESBL-KP infections were matched in the final analysis. Duration of hospitalization in the patients with MDR-AB was significantly more than that of patients infected with ESBL-KP (p-value: 0.045). Patients diagnosed with MDR-AB VAP had a 65.8% mortality rate compared to 42.1% in the ESBL-KP infection group (p = 0.003).
Conclusions: Results of the present study demonstrated that VAPs caused by MDR-AB may be more hazardous than ESBL-KP VAPs because they could be accompanied by a longer hospitalization course and even a higher mortality.
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Ahmed, Akash, Nahian Sanjida Naboni, Afia Nowshen, Sadia Sultana, Fahim Haque e M. Mahboob Hossain. "A Review on The Causative Agents, Risk Factors and Management of Ventilator-Associated Pneumonia: South Asian Perspective". Journal of Medicine 23, n.º 2 (24 de julho de 2022): 151–61. http://dx.doi.org/10.3329/jom.v23i2.60633.
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Ventilator-Associated Pneumonia (VAP) is common hospital-acquired pneumonia in ICU patients. Patients with pneumonia after 48 hours of mechanical ventilation are VAP affected. INICC found that VAP rates between 2012 to 2017 are 14.1 per 1000 episodes. The most common pathogens include Acinetobacter baumannii, Pseudomonas Aeruginosa and Klebsiella pneumoniae. Developing countries seem to have a higher mortality rate compared to developed countries. Treatment protocol involves antibiotic therapy. For the early onset of VAP, cephalosporin (cefotaxime or ceftriaxone), fluoroquinolone, or piperacillin-tazobactam are found to be effective while for late-onset, ceftazidime, ciprofloxacin, meropenem, and piperacillin-tazobactam seems to have positive Results. Apart from antibiotics, other options like bacteriophage therapy can offer a good alternative to fight the rapid emergence of MDR pathogens. J MEDICINE 2022; 23: 151-161
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Angelos, Mark G., e Jason D. Stoner. "Cardiopulmonary resuscitation, ventilation, defibrillation: In what order?" Annals of Emergency Medicine 40, n.º 6 (dezembro de 2002): 571–74. http://dx.doi.org/10.1067/mem.2002.130130.
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Hasan, Md Jahidul, Raihan Rabbani, Ahmad Mursel Anam, Ario Santini e Shihan Mahmud Redwanul Huq. "The Susceptibility of MDR-K. Pneumoniae to Polymyxin B Plus its Nebulised Form Versus Polymyxin B Alone in Critically Ill South Asian Patients". Journal of Critical Care Medicine 7, n.º 1 (1 de janeiro de 2021): 28–36. http://dx.doi.org/10.2478/jccm-2020-0044.
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Abstract Introduction Critically ill patients in intensive care units are at high risk of dying not only from the severity of their illness but also from secondary causes such as hospital-acquired infections. USA national medical record-data show that approximately 10% of patients on mechanical ventilation in an intensive care unit developed ventilator-associated pneumonia. Polymyxin B has been used intravenously in the treatment of multi-drug resistant gram-negative infections, either as a monotherapy or with other potentially effective antibiotics, and the recent international guidelines have emphasised the use of nebulised polymyxin B together with intravenous polymyxin B to gain the optimum clinical outcome in ventilator-associated pneumonia cases caused by multi-drug resistant gram-negative infections. Methods One hundred and seventy-eight patients with ventilator-associated pneumonia due to multi-drug resistant K. pneumoniae were identified during the study period. Following the inclusion and exclusion criteria, 121 patients were enrolled in the study and randomly allocated to two study groups. Group 1 patients were treated with intravenous Polymyxin B plus nebulised polymyxin B (n=64) and Group 2 patients with intravenous Polymyxin B alone (n=57). The study aimed to compare the use of Polymyxin B plus its nebulised form to polymyxin B alone, in the treatment of MDR-K. pneumoniae associated ventilator-associated pneumonia in critically ill patients. Results In Group 1, a complete clearance of K. pneumoniae was found in fifty-nine patients (92.1%; n=64) compared to forty patients (70.1%, n=57) in the Group 2 (P<0.003). The average time till extubation was significantly higher in Group 2 compared to Group 1 (P<0.05). The total length-of-stay in the ICU was significantly higher in Group 2 compared to Group 1. (P<0.05). These results support the view that the Polymyxin B dual-route regime may be considered as an appropriate antibiotic therapy, in critically ill South Asian patients with ventilator-associated pneumonia.
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Almomani, Basima Abdalla, Amanda McCullough, Rawan Gharaibeh, Shaher Samrah e Fatimah Mahasneh. "Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia". Journal of Infection in Developing Countries 9, n.º 12 (30 de dezembro de 2015): 1323–30. http://dx.doi.org/10.3855/jidc.6812.
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Introduction: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) is common in hospitals and impacts patient survival. We determined the incidence of MDR-AB VAP in critical care units and examined the predictors of 14-day mortality in these patients. Methodology: A retrospective case series study was conducted at a tertiary referral teaching hospital in north Jordan. A list of patients with a positive culture of A. baumannii between January 2007 and June 2013 was retrieved using computerized hospital databases. Medical records of all these patients were reviewed, and cases of VAP infected with MDR-AB were identified. Predictors of 14-day mortality were determined using multivariable logistic regression adjusted for possible confounders. Results: Out of 121 A. baumannii-VAP cases, 119 (98.3%) were caused by MDR-AB. The incidence rate of MDR-AB VAP was 1.59 cases per 100 critical care unit admissions. The mortality of A. baumannii-VAP cases in critical care units was 42% (50/119). Being prescribed two or more definitive antibiotics (prescribed based on susceptibility data) (OR = 0.075, 95% CI = 0.017–0.340, p = 0.001) and ipratropium/salbutamol during mechanical ventilation (OR = 0.140, 95% CI = 0.028–0.705, p = 0.017) were independently associated with lower hospital mortality. Conclusions: Our results suggest incidence of MDR-AB VAP in critical care units is high and that prescription of antibiotics based on antibiotic susceptibility and use of bronchodilators is associated with lower mortality in this population. Larger prospective studies are needed to explore whether these findings can be replicated in different clinical settings.
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Kim, Kristin M., Sandro Cinti, Steven Gay, Susan Goold, Andrew Barnosky e Marie Lozon. "Triage of Mechanical Ventilation for Pediatric Patients During a Pandemic". Disaster Medicine and Public Health Preparedness 6, n.º 2 (junho de 2012): 131–37. http://dx.doi.org/10.1001/dmp.2012.19.
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ABSTRACTObjective: The novel H1N1 influenza pandemic renewed the concern that during a severe pandemic illness, critical care and mechanical ventilation resources will be inadequate to meet the needs of patients. Several published protocols address the need to triage patients for access to ventilator resources. However, to our knowledge, none of these has addressed the pediatric populations.Methods: We used a systematic review of the pediatric critical care literature to evaluate pediatric critical care prognosis and multisystem organ failure scoring systems. We used multiple search engines, including MEDLINE and EMBASE, using a search for terms and key words including including multiple organ failure, multiple organ dysfunction, PELOD, PRISM III, pediatric risk of mortality score, pediatric logistic organ dysfunction, pediatric index of mortality pediatric multiple organ dysfunction score, “child+multiple organ failure + scoring system. ” Searches were conducted in the period January 2010-February 2010.Results: Of the 69 papers reviewed, 22 were used. Five independently derived scoring systems were evaluated for use in a respiratory pandemic ventilator triage protocol. The Pediatric Logistic Organ Dysfunction (PELOD) scoring system was the most appropriate for use in such a triage protocol.Conclusions: We present a pediatric-specific ventilator triage protocol using the PELOD scoring system to complement the NY State adult triage protocol. Further evaluation of pediatric scoring systems is imperative to ensure appropriate triage of pediatric patients.(Disaster Med Public Health Preparedness. 2012;6:131–137)
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Siddique, Sana, Fareya Haider, Sharique Ahmad, Khalid Iqbal e Mastan Singh. "Role of colonizers and value of routine surveillance culture of endotracheal aspirate of patients in the diagnosis of ventilator associated pneumonia". Asian Journal of Medical Sciences 11, n.º 6 (1 de novembro de 2020): 106–12. http://dx.doi.org/10.3126/ajms.v11i6.30445.
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Background: Ventilator associated pneumonia (VAP) is considered to be second most common nosocomial infection patients requiring critical care.
Aims and Objective: The present study was conducted to study the role of colonizers and importance of surveillance cultures of endotracheal aspirate (ETA) in the diagnosis of ventilator associated pneumonia in a tertiary care hospital in Lucknow.
Materials and Methods: An observational longitudinal study was conducted over a period of 2 years, on a total of 210 critically ill patients on mechanical ventilation for >48hrs, to identify the common isolates from ETA culture. Follow up of such patients was done to know the role of these isolates in causation of Ventilator Associated Pneumonia (VAP). Patients fulfilling both clinical Pulmonary infection score (CPIS>6) and microbiological criteria were diagnosed as VAP. Those microorganisms with a colony count of less<105 cfu/ml in both the patients with VAP and those without VAP were considered as colonizers.
Results: Klebseilla pneumonia (46.2%), Pseudomonas aeruginosa (16.2%) and E.coli (13.8%) were found be the commonest colonisers followed by Acinetobacterbaumanii (8.6%), Citrobacterkoseri (3.8%), Coagulase Negative Staphylococci (2.9%), Staphylococcus aureus (2.4%) and Proteus vulgaris (1%). Of the total patients 28 developed VAP out of which 21 had late onset VAP and 7 had early onset VAP. Among the VAP positive patients the causative organism was Klebsiella pneumonia (53.6%) for majority of cases followed by Pseudomonas aeruginosa (21.4%) and Acinetobacter baumanii (17.9%).
Conclusion: Prolonged duration of mechanical ventilation increased the chances of colonization by MDR microorganisms leading to nosocomial or Hospital acquired infections (HAI) such as VAP which in turn lead to increased rate of morbidity and mortality. VAP considered to be a leading cause of HAI, routine quantitative surveillance culture of ETA(endotracheal aspirate) will allow prospectively to determine prevalence and progression of colonization in lower respiratory tract, so that strict and prompt preventive measures can be taken rather than cure.
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Rajesh, Eshwar, Radhika Katragadda e C. P. Ramani. "Bacteriological profile and antimicrobial resistance pattern of ventilator associated pneumonia in tertiary care hospital". Indian Journal of Microbiology Research 8, n.º 3 (15 de setembro de 2021): 191–95. http://dx.doi.org/10.18231/j.ijmr.2021.039.
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With an occurrence ranging from 6-52%, ventilator-associated pneumonia (VAP) is the most common ICU acquired infection, accounting for a significant portion of hospital-acquired infections (HAIs). VAP is pneumonia that develops after a period of more than 48 hours of mechanical ventilation or endotracheal intubation. To isolate and identify the potential pathogens causing VAP and to study their antimicrobial susceptibility patterns. Endotracheal aspiration (ETA) or bronchoalveolar lavage (BAL) were collected from patients on mechanical ventilation >48 hours. Bacterial isolates were identified based on culture colony characteristics and biochemical parameters. Antibiotic susceptibility profile was determined for these isolates by Kirby-Bauer disc diffusion method as per Clinical and laboratory Standards Institute (CLSI) 2020 guidelines and studied. The collected data was entered in Excel, and analyzed by using SPSS version 16. Among the isolates, the most common were (31.31%) and (31.31%). These were followed by (22.22%), (7.07%), (3.03%) and (3.03%) and (2.02%).Multi Drug Resistant (MDR) microbes causing VAP are on the increase. The patient population at risk will benefit by the application of the results of this study. The antibiotic resistance pattern of these isolates will aid clinicians in selecting the appropriate antimicrobial agents. Hence, it can lead to decreased mortality and morbidity due to life-threatening VAP.
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Hamamoto, Yukiko, Yukako Gotoh, Yoshimi Nakajo, Satoko Shimoya, Chikako Kayama, Shingo Hasegawa e Ken-Ichi Nibu. "Impact of antibiotics on pathogens associated with otitis media with effusion". Journal of Laryngology & Otology 119, n.º 11 (novembro de 2005): 862–65. http://dx.doi.org/10.1258/002221505774783476.
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Objective: To further understand the roles of bacteria and antibiotics in the development of otitis media with effusion (OME).Methods: Samples of middle-ear effusion (MEE) were collected during the placement of ventilation tubes to treat chronic OME. Children with acute otitis media within the past three months were excluded from this study. We used polymerase chain reaction (PCR) to detect pathogens and to test the susceptibility of Streptococcus pneumoniae to penicillin.Results: Among MEE samples from 52 children, PCR detected bacterial DNA in 32 per cent (24/75) of them. S. pneumoniae was detected more frequently in middle ears that required ventilation tube insertion at least twice compared with those requiring ventilation tube insertion only once (5/15 versus 4/60; p = 0.013). Higher levels of S. pneumoniae were detected in MEE from children with, than without, a long history of antibiotic administration (7/10 versus 2/14; p = 0.0187). The pbp genes of all isolated S. pneumoniae contained mutations.Conclusions: Long exposure to antibiotics might significantly influence the bacterial genome in MEE.
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Karvouniaris, Marios, Demosthenes Makris, Paris Zygoulis, Apostolos Triantaris, Stelios Xitsas, Konstantinos Mantzarlis, Efthimia Petinaki e Epaminondas Zakynthinos. "Nebulised colistin for ventilator-associated pneumonia prevention". European Respiratory Journal 46, n.º 6 (24 de setembro de 2015): 1732–39. http://dx.doi.org/10.1183/13993003.02235-2014.
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We evaluated whether prophylactic nebulised colistin could reduce ventilator-associated pneumonia (VAP) rates in an intensive care unit (ICU) setting with prevalent multidrug-resistant (MDR) bacteria.We used a single-centre, two-arm, randomised, open-label, controlled trial in a 12-bed ICU in the University Hospital of Larissa, Greece. Patient inclusion criteria included mechanical ventilation of >48 h. The two arms consisted of prophylaxis with 500 000 U colistin (Col group) or normal saline (NS group), thrice daily, for the first 10 ICU days or until extubation. The primary outcome of the study was the 30-day VAP incidence.In total, 168 patients entered the study. VAP incidence was not different between Col and NS group patients (14 (16.7%)versus25 (29.8%), respectively, p=0.07). Regarding the secondary outcomes, the intervention resulted in a lower VAP incidence density rate (11.4versus25.6, respectively, p<0.01), and less Gram-negative bacteria-VAP (p=0.03) and MDR-VAP (p=0.04). Among VAP patients (n=39), prophylaxis with inhaled colistin improved ICU survival (p=0.016). There was no evidence of increased resistance to colistin or multidrug resistance.Our findings suggest that nebulised colistin had no significant effect on VAP incidence.
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Papanikolopoulou, Amalia, Helena C. Maltezou, Athina Stoupis, Anastasia Pangalis, Christos Kouroumpetsis, Genovefa Chronopoulou, Yannis Kalofissoudis et al. "Ventilator-Associated Pneumonia, Multidrug-Resistant Bacteremia and Infection Control Interventions in an Intensive Care Unit: Analysis of Six-Year Time-Series Data". Antibiotics 11, n.º 8 (19 de agosto de 2022): 1128. http://dx.doi.org/10.3390/antibiotics11081128.
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Ventilator-associated pneumonia (VAP) occurs more than 48h after mechanical ventilation and is associated with a high mortality rate. The current hospital-based study aims to investigate the association between VAP rate, incidence of bacteremia from multidrug-resistant (MDR) pathogens, and infection control interventions in a single case mix ICU from 2013 to 2018. Methods: The following monthly indices were analyzed: (1) VAP rate; (2) use of hand hygiene disinfectants; (3) isolation rate of patients with MDR bacteria; and (4) incidence of bacteremia/1000 patient-days (total cases, total carbapenem-resistant cases, and carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae cases separately). Results: Time trends of infection control interventions showed increased rates in isolation of patients with MDR pathogens (p <0.001) and consumption of hand disinfectant solutions (p =0.001). The last four years of the study an annual decrease of VAP rate by 35.12% (95% CI: −53.52 to −9.41; p =0.01) was recorded, which significantly correlated not only with reduced trauma and cardiothoracic surgery patients (IRR:2.49; 95% CI: 2.09–2.96; p <0.001), but also with increased isolation rate of patients with MDR pathogens (IRR: 0.52; 95% CI: 0.27–0.99; p = 0.048), and hand disinfectants use (IRR: 0.40; 95% CI: 0.18–0.89; p =0.024). Conclusions: Infection control interventions significantly contributed to the decrease of VAP rate. Constant infection control stewardship has a stable time-effect and guides evidence-based decisions.
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Gaudet, Alexandre, Louis Kreitmann e Saad Nseir. "ICU-Acquired Colonization and Infection Related to Multidrug-Resistant Bacteria in COVID-19 Patients: A Narrative Review". Antibiotics 12, n.º 9 (20 de setembro de 2023): 1464. http://dx.doi.org/10.3390/antibiotics12091464.
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A large proportion of ICU-acquired infections are related to multidrug-resistant bacteria (MDR). Infections caused by these bacteria are associated with increased mortality, and prolonged duration of mechanical ventilation and ICU stay. The aim of this narrative review is to report on the association between COVID-19 and ICU-acquired colonization or infection related to MDR bacteria. Although a huge amount of literature is available on COVID-19 and MDR bacteria, only a few clinical trials have properly evaluated the association between them using a non-COVID-19 control group and accurate design and statistical methods. The results of these studies suggest that COVID-19 patients are at a similar risk of ICU-acquired MDR colonization compared to non-COVID-19 controls. However, a higher risk of ICU-acquired infection related to MDR bacteria has been reported in several studies, mainly ventilator-associated pneumonia and bloodstream infection. Several potential explanations could be provided for the high incidence of ICU-acquired infections related to MDR. Immunomodulatory treatments, such as corticosteroids, JAK2 inhibitors, and IL-6 receptor antagonist, might play a role in the pathogenesis of these infections. Additionally, a longer stay in the ICU was reported in COVID-19 patients, resulting in higher exposure to well-known risk factors for ICU-acquired MDR infections, such as invasive procedures and antimicrobial treatment. Another possible explanation is the surge during successive COVID-19 waves, with excessive workload and low compliance with preventive measures. Further studies should evaluate the evolution of the incidence of ICU-acquired infections related to MDR bacteria, given the change in COVID-19 patient profiles. A better understanding of the immune status of critically ill COVID-19 patients is required to move to personalized treatment and reduce the risk of ICU-acquired infections. The role of specific preventive measures, such as targeted immunomodulation, should be investigated.
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Jeon, Ho-Jin, e Chang-Lak Kim. "Design Change and Operational Consideration of the HVAC System during Nuclear Power Plant Decommissioning". Science and Technology of Nuclear Installations 2024 (30 de abril de 2024): 1–13. http://dx.doi.org/10.1155/2024/4701409.
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The heating, ventilation, and air conditioning (HVAC) system plays a crucial role in ensuring the safety of workers and preventing the release of gaseous radioactive materials into the environment during the decommissioning of a nuclear power plant (NPP). To establish an HVAC operation strategy, decommissioning phases were divided into four stages, and the HVAC systems were reclassified. In addition, assumptions have been made regarding design modifications and maintenance for the reactor containment building (RCB) HVAC, fuel handling building (FHB) HVAC, and main control room (MCR) HVAC. Based on these, for RCB HVAC operation, natural ventilation and RCB purge operation during the transition period are proposed. In the decommissioning stage, recirculation operation, entire ventilation operation consisting of continuous operation and purge operation, and finally partial ventilation operation to purify local space were proposed. Moreover, during the transition period, the FHB HVAC was proposed to operate as normal NPP, and the MCR HVAC was suggested to operate with safety-related equipment removed.
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Shrestha, Dipendra K., Binod Rajbhandari, Amit Pradhanang, Gopal Sedain, Sushil K. Shilpakar e Saurav Pradhan. "Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study". Journal of Institute of Medicine Nepal 41, n.º 2 (4 de dezembro de 2019): 40–44. http://dx.doi.org/10.3126/jiom.v41i2.26549.
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Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute
Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done.
Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin.
Conclusion: Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP.
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Jahnukainen, Timo, Turkka Kirjavainen, Topi Luoto, Elisa Ylinen, Laura Linkosalo, Pekka Arikoski, Mikko Pakarinen e Hannu Jalanko. "Long-term pulmonary function in children with recessive polycystic kidney disease". Archives of Disease in Childhood 100, n.º 10 (10 de julho de 2015): 944–47. http://dx.doi.org/10.1136/archdischild-2015-308451.
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BackgroundNeonatal autosomal-recessive polycystic kidney disease (ARPKD) is associated with pulmonary hypoplasia and severe respiratory distress. There is no published information on long-term lung function in ARPKD survivors.MethodsPulmonary function tests, including spirometry and diffusion capacity, were performed in a nationwide cohort of Finnish paediatric patients with ARPKD. The annual incidence of respiratory infections and the need for permanent asthma medication were also evaluated in this population.ResultsPulmonary function in 11 children surviving the neonatal period was good when measured after a median follow-up time of 10.4 years (range 5.4–16.1 years). None of the patients required oxygen supplementation, and only one patient had asthma. Patients who had received ventilator therapy during infancy had significantly lower maximal instantaneous forced expiratory flow (MEF%) (66%; 43–93% vs 105%; 63–110%; p=0.048) and forced expiratory volume/forced vital capacity (0.76; 0.7–0.81 vs 0.89; 0.77–0.91; p=0.03) than patients without a history of mechanical ventilation, suggesting tendency for airway obstruction in the former group of patients. The frequency of respiratory infections did not differ from Finnish paediatric population in general.ConclusionsThe results of pulmonary function tests were within reference values for most patients with ARPKD, which suggested good long-term lung prognosis. Lung function tests should be considered for patients with ARPKD with a history of mechanical ventilation during infancy.
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Shrestha, Dipendra K., Binod Rajbhandari, Amit Pradhanang, Gopal Sedain, Sushil K. Shilpakar e Saurav Pradhan. "Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study". Journal of Institute of Medicine Nepal 41, n.º 2 (31 de agosto de 2019): 40–44. http://dx.doi.org/10.59779/jiomnepal.1042.
Texto completo da fonteResumo:
Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done. Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin. Conclusion: Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP.
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Lim, Joel KB, Syeda Kashfi Qadri, Theresa SW Toh, Cheryl Bin Lin, Yee Hui Mok e Jan Hau Lee. "Extracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: A Narrative Review". Annals of the Academy of Medicine, Singapore 49, n.º 4 (30 de abril de 2020): 199–214. http://dx.doi.org/10.47102/annals-acadmed.sg.202046.
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Introduction: Epidemics and pandemics from zoonotic respiratory viruses, such as the 2019 novel coronavirus, can lead to significant global intensive care burden as patients progress to acute respiratory distress syndrome (ARDS). A subset of these patients develops refractory hypoxaemia despite maximal conventional mechanical ventilation and require extracorporeal membrane oxygenation (ECMO). This review focuses on considerations for ventilatory strategies, infection control and patient selection related to ECMO for ARDS in a pandemic. We also summarise the experiences with ECMO in previous respiratory pandemics. Materials and Methods: A review of pertinent studies was conducted via a search using MEDLINE, EMBASE and Google Scholar. References of articles were also examined to identify other relevant publications. Results: Since the H1N1 Influenza pandemic in 2009, the use of ECMO for ARDS continues to grow despite limitations in evidence for survival benefit. There is emerging evidence to suggest that lung protective ventilation for ARDS can be further optimised while receiving ECMO so as to minimise ventilator-induced lung injury and subsequent contributions to multi-organ failure. Efforts to improve outcomes should also encompass appropriate infection control measures to reduce co-infections and prevent nosocomial transmission of novel respiratory viruses. Patient selection for ECMO in a pandemic can be challenging. We discuss important ethical considerations and predictive scoring systems that may assist clinical decision-making to optimise resource allocation. Conclusion: The role of ECMO in managing ARDS during respiratory pandemics continues to grow. This is supported by efforts to redefine optimal ventilatory strategies, reinforce infection control measures and enhance patient selection. Ann Acad Med Singapore 2020;49:199–214 Key words: Acute Respiratory Distress Syndrome, Coronavirus disease 2019, ECMO, Infection control, Mechanical ventilation
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Vázquez-López, Rosalino, Sandra Georgina Solano-Gálvez, Juan José Juárez Vignon-Whaley, Jorge Andrés Abello Vaamonde, Luis Andrés Padró Alonzo, Andrés Rivera Reséndiz, Mauricio Muleiro Álvarez et al. "Acinetobacter baumannii Resistance: A Real Challenge for Clinicians". Antibiotics 9, n.º 4 (23 de abril de 2020): 205. http://dx.doi.org/10.3390/antibiotics9040205.
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Acinetobacter baumannii (named in honor of the American bacteriologists Paul and Linda Baumann) is a Gram-negative, multidrug-resistant (MDR) pathogen that causes nosocomial infections, especially in intensive care units (ICUs) and immunocompromised patients with central venous catheters. A. baumannii has developed a broad spectrum of antimicrobial resistance, associated with a higher mortality rate among infected patients compared with other non-baumannii species. In terms of clinical impact, resistant strains are associated with increases in both in-hospital length of stay and mortality. A. baumannii can cause a variety of infections; most involve the respiratory tract, especially ventilator-associated pneumonia, but bacteremia and skin wound infections have also been reported, the latter of which has been prominently observed in the context of war-related trauma. Cases of meningitis associated with A. baumannii have been documented. The most common risk factor for the acquisition of MDR A baumannii is previous antibiotic use, following by mechanical ventilation, length of ICU/hospital stay, severity of illness, and use of medical devices. Current efforts focus on addressing all the antimicrobial resistance mechanisms described in A. baumannii, with the objective of identifying the most promising therapeutic scheme. Bacteriophage- and artilysin-based therapeutic approaches have been described as effective, but further research into their clinical use is required
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Thorsen, Jonathan, Tine Marie Pedersen, Anna-Rosa Cecilie Mora-Jensen, Elín Bjarnadóttir, Søren Christensen Bager, Hans Bisgaard e Jakob Stokholm. "Middle ear effusion, ventilation tubes and neurological development in childhood". PLOS ONE 18, n.º 1 (13 de janeiro de 2023): e0280199. http://dx.doi.org/10.1371/journal.pone.0280199.
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Background Otitis media with middle ear effusion (MEE) can be treated with ventilation tubes (VT) insertion, and it has been speculated that prolonged MEE in childhood can affect neurological development, which in turn may be important for later academic achievements. Objective To investigate the association between middle ear effusion (MEE), treatment with ventilation tubes (VT) and childhood neurological development. Study design We examined 663 children from the Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC2010) unselected mother-child cohort study. Children were followed by study pediatricians with regular visits from pregnancy until 3 years of age. MEE was diagnosed using tympanometry at age 1, 2 and 3 years. Information regarding VT from age 0–3 years was obtained from national registries. We assessed age at achievement of gross motor milestones from birth, language scores at 1 and 2 years, cognitive score at 2.5 years and general development score at age 3 years using standardized quantitative tests. Results Children with MEE had a lower 1-year word production vs. children with no disease: (median 2, IQR [0–6] vs. 4, IQR [1–7]; p = 0.017), and a lower 1-year word comprehension (median 36; IQR [21–63] vs. 47, IQR [27–84]; p = 0.03). Children with VT had a lower 2-5-year cognitive score vs. children with no disease; estimate -2.34; 95% CI [-4.56;-0.12]; p = 0.039. No differences were found between children with vs. without middle ear disease regarding age at achievement of gross motor milestones, word production at 2 years or the general developmental score at 3 years. Conclusion Our study supports the previous findings of an association between MEE and concurrent early language development, but not later neurological endpoints up to the age of 3. As VT can be a treatment of those with symptoms of delayed development, we cannot conclude whether treatment with VT had positive or negative effects on neurodevelopment.
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Čiginskienė, Aušra, Asta Dambrauskienė, Jordi Rello e Dalia Adukauskienė. "Ventilator-Associated Pneumonia due to Drug-Resistant Acinetobacter baumannii: Risk Factors and Mortality Relation with Resistance Profiles, and Independent Predictors of In-Hospital Mortality". Medicina 55, n.º 2 (13 de fevereiro de 2019): 49. http://dx.doi.org/10.3390/medicina55020049.
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: Background and objectives: High mortality and healthcare costs area associated with ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii (A.baumannii). The data concerning the link between multidrug-resistance of A.baumannii strains and outcomes remains controversial. Therefore, we aimed to identify the relation of risk factors for ventilator-associated pneumonia (VAP) and mortality with the drug resistance profiles of Acinetobacter baumannii (A.baumannii) and independent predictors of in-hospital mortality. Methods: A retrospective ongoing cohort study of 60 patients that were treated for VAP due to drug-resistant A.baumannii in medical-surgical intensive care units (ICU) over a two-year period was conducted. Results: The proportions of multidrug-resistant (MDR), extensively drug-resistant (XDR), and potentially pandrug-resistant (pPDR) A.baumannii were 13.3%, 68.3%, and 18.3%, respectively. The SAPS II scores on ICU admission were 42.6, 48.7, and 49 (p = 0.048); hospital length of stay (LOS) prior to ICU was 0, one, and two days (p = 0.036), prior to mechanical ventilation (MV)—0, 0, and three days (p = 0.013), and carbapenem use prior to VAP—50%, 29.3%, and 18.2% (p = 0.036), respectively. The overall in-hospital mortality rate was 63.3%. In MDR, XDR, and pPDR A.baumannii VAP groups, it was 62.5%, 61.3%, and 72.7% (p = 0.772), respectively. Binary logistic regression analysis showed that female gender (95% OR 5.26; CI: 1.21–22.83), SOFA score on ICU admission (95% OR 1.28; CI: 1.06–1.53), and RBC transfusion (95% OR 5.98; CI: 1.41–25.27) were all independent predictors of in-hospital mortality. Conclusions: The VAP risk factors: higher SAPS II score, increased hospital LOS prior to ICU, and MV were related to the higher resistance profile of A.baumannii. Carbapenem use was found to be associated with the risk of MDR A.baumannii VAP. Mortality due to drug-resistant A.baumannii VAP was high, but it was not associated with the A.baumannii resistance profile. Female gender, SOFA score, and RBC transfusion were found to be independent predictors of in-hospital mortality.
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Weitz, Gunther, Jan Struck, Andrea Zonak, Sven Balnus, Boris Perras e Christoph Dodt. "Prehospital noninvasive pressure support ventilation for acute cardiogenic pulmonary edema". European Journal of Emergency Medicine 14, n.º 5 (outubro de 2007): 276–79. http://dx.doi.org/10.1097/mej.0b013e32826fb377.
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van Gemert, Johanna P., Folkert Brijker, Marja A. Witten e Loek P. H. Leenen. "Intubation after noninvasive ventilation failure in chronic obstructive pulmonary disease". European Journal of Emergency Medicine 22, n.º 1 (fevereiro de 2015): 49–54. http://dx.doi.org/10.1097/mej.0000000000000141.
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Briones Claudett, Killen H. "Intubation after noninvasive ventilation failure in chronic obstructive pulmonary disease". European Journal of Emergency Medicine 22, n.º 1 (fevereiro de 2015): 66–67. http://dx.doi.org/10.1097/mej.0000000000000182.
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van Gemert, Johanna P., e Folkert Brijker. "Intubation after noninvasive ventilation failure in chronic obstructive pulmonary disease". European Journal of Emergency Medicine 22, n.º 1 (fevereiro de 2015): 67–69. http://dx.doi.org/10.1097/mej.0000000000000183.
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Szarpak, Lukasz, Marcin Madziala e Togay Evrin. "Which airways management technique is optimal for trauma patient ventilation?" European Journal of Emergency Medicine 23, n.º 6 (dezembro de 2016): 455–56. http://dx.doi.org/10.1097/mej.0000000000000360.
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Carmona, Hugo, Andrew D. Graustein e Joshua O. Benditt. "Chronic Neuromuscular Respiratory Failure and Home Assisted Ventilation". Annual Review of Medicine 74, n.º 1 (27 de janeiro de 2023): 443–55. http://dx.doi.org/10.1146/annurev-med-043021-013620.
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Chronic respiratory failure is a common, important complication of many types of neuromuscular and chest wall disorders. While the pathophysiology of each disease may be different, these disorders can variably affect all muscles involved in breathing, including inspiratory, expiratory, and bulbar muscles, ultimately leading to chronic respiratory failure and hypoventilation. The use of home assisted ventilation through noninvasive interfaces aims to improve the symptoms of hypoventilation, improve sleep quality, and, when possible, improve mortality. An increasing variety of interfaces has allowed for improved comfort and compliance. In a minority of scenarios, noninvasive ventilation is either not appropriate or no longer effective due to disease progression, and a transition to tracheal ventilation should be considered.
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Russo, Sebastian G., Christoph Stradtmann, Thomas A. Crozier, Christiane Ringer, Hans-Joachim Helms, Michael Quintel e Christoph H. R. Wiese. "Bag-mask ventilation and direct laryngoscopy versus intubating laryngeal mask airway". European Journal of Emergency Medicine 21, n.º 3 (junho de 2014): 189–94. http://dx.doi.org/10.1097/mej.0b013e32836033b3.
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Pillai, Jayandiran, Ceyhan Yazicioglu, Steve Moeng, Thomas Rangaka, Taalib Monareng, Raja Jayakrishnan, Martin Veller e Daniella Pinkus. "Prevalence and patterns of infection in critically ill trauma patients admitted to the trauma ICU, South Africa". Journal of Infection in Developing Countries 9, n.º 07 (30 de julho de 2015): 736–42. http://dx.doi.org/10.3855/jidc.5865.
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Introduction: The aim of this study was to determine if any patterns of infection or bacterial resistance existed in critically ill polytrauma patients admitted to the intensive care unit (ICU) at the CM Johannesburg Academic Hospital (CMJAH). Methods: This was a prospective, single-center study of patient laboratory records of 73 critically injured polytrauma patients admitted to an ICU. The data collected from each patient, beginning with admission and extending until discharge from the ICU, included age, gender, admission hemoglobin levels, injury severity score, length of ICU stay, microbiological cultures and sensitivity (MCS), and types and numbers of surgical procedures. Results: Upon admission to the ICU, the injury severity score (ISS) was 40.86 (± 15.64). In total, 73.98% of the patients required the use of a ventilator during their ICU stay. The most prevalent organisms isolated from specimens were Pseudomonas aeruginosa (30.1%), Klebsiella species (25.7%), Acinetobacterbaumanni (16.4%), and Staphylococcus aureus (5.8%). Multi-drug resistance (MDR) was identified in 63% of patients, with Klebsiella (73.91%) and Pseudomonas (65.21%) occurring most frequently. Multivariate analysis showed MDR to be the only significant predictor associated with a higher risk for hospital mortality when age, gender, ventilation, duration of ICU stay, ISS score, and the number of surgeries undergone was taken into account. Conclusion: Critically ill polytrauma patients are at particularly high risk for Gram-negative sepsis.