Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorial
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
LinkOut
Cubby
Related Resources
Order Documents
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
Privacy Policy
|
|
-
Disinfection with 10% povidone-iodine versus 0.5% chlorhexidine gluconate in 70% isopropanol in the neonatal intensive care unit.
Linder N, Prince S, Barzilai A, Keller N, Klinger G, Shalit I, Prince T, Sirota L.
Department of Neonatology, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petah Tiqwa 49202, Israel. Linderm@netvision.net.il
AIM: The finding that 10% povidone-iodine skin disinfectant may compromise thyroid function in premature infants prompted its replacement with 0.5% chlorhexidine gluconate solution in 70% isopropanol. The objective of this study was to compare the incidence rates of true infection and contamination associated with the use of these two disinfectants in the neonatal intensive care unit. METHODS: The study population comprised two cohorts of infants admitted to our neonatal intensive care unit: 1) in 1992-1993 when only 10% povidone-iodine was used as a skin disinfectant, and 2) in 1995-1996 when only 0.5% chlorhexidine gluconate solution in 70% isopropanol was used. A retrospective chart review was conducted to determine whether all documented positive blood, CSF and suprapubic aspirate cultures indicated true infection or contamination. True infection was defined as clinical symptoms and/or laboratory abnormalities suggestive of sepsis, with positive blood, CSF or suprapubic aspirate cultures. RESULTS: 1146 infants were admitted during the study periods, 507 during the first period and 639 during the second. In the early group, 17.6% of infants had major malformations, 72.0% were premature and 25.2% had weights of < 1500 g. Corresponding percentages for the latter group were 16.0%, 80.6% and 32.9%, respectively. No statistically significant differences were found between the two research periods in rate of infants with positive blood cultures, true infections, or contamination. CONCLUSION: The use of 0.5% chlorhexidine gluconate solution in 70% isopropanol as a skin disinfectant is justified in neonatal intensive care units because it is not associated with an increased incidence of infections as opposed to 10% povidone-iodine and is devoid of detrimental effects.
PMID: 15046275 [PubMed - in process]
-
Is intensive care for very immature babies justified?
Levene M.
Department of Paediatrics and Neonatal Medicine, Leeds University School of Medicine, UK. m.i.levene@leeds.ac.uk
Neonatal intensive care is generally considered justified in the majority of very premature infants, but there is some concern about the effectiveness of the techniques used at the margins of viability (22-24 wk of gestation). The controversy that exists in this area is largely due to a lack of agreed endpoints for geographically based populations where all live births are considered. Evaluation of outcome must also take the quality of neurological function in surviving infants into consideration, and in reviewing these data the reader is struck by the few reports providing information on a high proportion of survivors. To inform this debate, the "best data" for analysis are reviewed based on a number of criteria of quality for survival and outcome studies. Based on these data sets, < 25% of babies born alive at 24 wk and below survive without major disability. CONCLUSION: An objective review of "best data" will provide the basis of an informed debate on whether providing intensive care for all very immature babies is appropriate in developed countries.
PMID: 15046261 [PubMed - in process]
-
Decisions on therapeutic intervention in neonatal intensive care.
Zetterstrom R.
Publication Types:
PMID: 15046260 [PubMed - in process]
-
Criteria for elective admission to the paediatric intensive care unit following adenotonsillectomy for severe obstructive sleep apnoea.
Walker P, Whitehead B, Rowley M.
Departments of Otolaryngology, Respiratory Medicine and Intensive Care, John Hunter Children's Hospital, University of Newcastle, Newcastle, New South Wales.
During the period 1997 to 2002, 42 children were electively admitted to the Paediatric Intensive Care Unit at the John Hunter Children's Hospital following adenotonsillectomy for severe obstructive sleep apnoea. Forty children had a preoperative sleep study, of which 33 were complete polysomnograms. Of the 42 children admitted, 35 required no intervention while seven (17%) required an additional intervention beyond supplemental oxygen. Our criteria for elective admission to Paediatric Intensive Care following adenotonsillectomy for severe obstructive sleep apnoea are presented.
PMID: 15058120 [PubMed - in process]
[The effects of active and passive humidification on ventilation-associated nosocomial pneumonia]
[Article in German]
Kranabetter R, Leier M, Kammermeier D, Just HM, Heuser D.
Institut fur Klinikhygiene, medizinische Mikrobiologie und klinische Infektiologie, Klinikum Nurnberg. r.kranabetter@klinikum-nuernberg.de
STUDY OBJECTIVE: Airway humidification of ventilated patients in an intensive care unit may be established by heated humidifying systems (active) or by the means of a (passive) heat and moisture exchange filter (HMEF). There is a controversial discussion about the influence of the type of humidification on the rate of ventilator-associated pneumonia (VAP). Among 3,585 patients both methods were tested over a period of 21 months in an open, non-randomized cohort study. The aim of the investigation was to compare the incidence of VAP caused by a change of humidification strategy. METHOD: All patients in a 16-bed surgical intensive care unit who required mechanical ventilation, were included. In the first period (period AB) 1,887 cases were handled with a heated humidifier. During the second period (period PB) 1,698 patients were treated using a HMEF. Infection control was established according to the national Infection Surveillance Program (KISS) based on the CDC criteria for VAP. RESULTS: During the period of 42 months, 99 cases of VAP were reported. The incidence for VAP was found to be 13.5 (AB) and 9.6 (PB) per 1,000 ventilator days, a rate of 32.3 and 22.4 VAP per 1,000 patients, respectively. The rate of VAP among the groups ( p=0.068) and the incidence of VAP per 1,000 ventilator days ( p=0.089) only just failed to reach a significant level, but in the group of patients requiring mechanical ventilation for more than 2 days, the difference did reach statistical significance ( p=0.012). CONCLUSION: Our results showed that the rate of VAP could be significantly reduced by changing the strategy from active to passive humidification devices, especially concerning patients requiring long-term respirator therapy. A more physiological humidification and a reduced number of airway manipulations are discussed as a possible explanation.
Publication Types:
PMID: 14749873 [PubMed - indexed for MEDLINE]
Transesophageal echocardiographic diagnosis of a liver laceration accompanied by hemodynamic instability.
Hofmann JP, Papadimos TJ.
Department of Anesthesiology, Medical College of Ohio, Toledo, Ohio 43614-2598, USA. Jhofmann@mco.edu
Transesophageal echocardiography (TEE) is a useful adjunct in the evaluation of trauma patients, particularly in the area of aortic injury and cardiac tamponade. Little has been written on the use of this modality in the evaluation of extra-cardiac injury. We present a case of a trauma patient in whom TEE was used to evaluate hemodynamic instability; during the course of the examination a previously undiagnosed liver laceration was identified. We report the diagnosis of a liver laceration in a trauma patient by novel use of the transesophageal echocardiographic imaging modality.
Publication Types:
PMID: 14980906 [PubMed - indexed for MEDLINE]
Comment on:
The spaghetti syndrome revisited.
Imhoff M.
Publication Types:
PMID: 14980899 [PubMed - indexed for MEDLINE]
Successful treatment of a critically ill patient with disseminated coccidioidomycosis, using adjunctive interferon-gamma.
Kuberski TT, Servi RJ, Rubin PJ.
Good Samaritan Hospital and Medical Center, Phoenix, Arizona, USA.
Conventional antifungal therapy was not successful for a critically ill patient who had been hospitalized for 137 days in the intensive care unit with disseminated Coccidioides immitis infection and respiratory failure. The addition of interferon- gamma to the therapeutic regimen resulted in improvement and discharge from the hospital. Adjunctive interferon- gamma used in the successful treatment of severe coccidioidomycosis has not been reported previously.
Publication Types:
PMID: 14999639 [PubMed - indexed for MEDLINE]
-
Monitoring sedation in the intensive care unit: can "black boxes" help us?
Walsh TS, Ramsay P, Kinnunen R.
New Edinburgh Royal Infirmary, Little France Crescent, EH39 4SA, Edinburgh, Scotland.
PMID: 15057513 [PubMed - as supplied by publisher]
-
Predictive factors of intensive care unit admission in patients with haematological malignancies and pneumonia.
Gruson D, Vargas F, Hilbert G, Bui N, Maillot T, Mayet T, Pillet O, Chene G, Gbikpi-Benissan G.
Department of Medical Intensive Care Unit, Units 1 and 2, University Hospital, Place Amelie Raba-Leon, Bordeaux, France.
OBJECTIVE. To describe early signs at the onset of pneumonia occurring in the haematology ward which could be associated with a transfer to the ICU. DESIGN. A 13-month preliminary prospective observational cohort study. SETTING. Department of haematology and (32-bed) medical intensive care unit (ICU). PATIENTS. Fifty-three of 302 patients hospitalised in the haematology ward who developed presumptive clinical evidence of pneumonia were enrolled. MEASUREMENTS AND RESULTS. At the onset of the clinical evidence of pneumonia (day 1), we compared variables between patients requiring an ICU admission and those who did not. Twenty-four patients (45%) required a transfer to the ICU. Factors associated with ICU admission were: numbers of involved quadrants: 2.3 vs 1, P=0.001 and oxygenation parameters (initial level of O(2) supplementation: 3.5 vs 0.9 l/min, P<0.05), the presence of hepatic failure (58% vs 10%, P<0.01), Gram-negative bacilli isolated in blood culture (7 vs 1, P=0.01). In the multivariate analysis, a decrease of 10% in the SaO(2) and the requirement of nasal supplementary O(2) at the onset of acute respiratory failure increased the risk of admission to MICU, respectively, by 18 and by 14. The overall 6-month mortality rate of the 53 patients was 28%. CONCLUSION. Parameters of oxygenation and radiological score could be associated with this transfer on day 1 of the onset of pneumonia occurrence. A further study should evaluate an earlier selection of this type of patient, followed by an "early" admission to the MICU, in order to improve ICU outcome.
PMID: 15052383 [PubMed - as supplied by publisher]
|