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Items 1 - 11 of 11 |
One page. |
A patient with Glanzmann's thrombasthenia for emergent abdominal surgery.
Uzunlar HI, Eroglu A, Senel AC, Bostan H, Erciyes N.
Department of Anesthesiology and Reanimation, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey. uzunlar@gmx.com.tr
Glanzmann's thrombasthenia is a rare autosomal recessive disease characterized by potentially major mucocutaneous complications and nose bleeds. It is considered hazardous for these surgical patients to conceive, with a high risk of urgent surgery. The treatment of bleeding or prevention of hemorrhage for surgery or invasive procedures is based on platelet transfusion. However, platelet transfusions may be responsible for the development of alloimmunization, with a high risk of future platelet refractoriness. We report a surgical case of Glanzmann's thrombasthenia complicated by nasopharyngeal bleeding and managed with platelet transfusions, recombinant activated factor VII, and postoperative airway management in the intensive care unit.
Publication Types:
PMID: 15385386 [PubMed - indexed for MEDLINE]
[Treatment in 2003 of septic shock in children in the first two hours (excluding newborns)]
[Article in French]
Dauger S, Llor J, Aizenfisz S, Benayoun M, Beaufils F.
Service de pediatrie-reanimation, hopital Robert-Debre, faculte Xavier-Bichat, universite Paris-VII, Paris, France. stephane.dauger@rdb.ap-hop-paris.fr
Despite new understandings in pathophysiology, sepsis mortality remains high in children. Recently, it has been demonstrated that early goal directed therapy may decrease septic shock mortality. The aim of this paper is to propose practical clinical guidelines based on earlier consensus recommendations. Septic shock must be rapidly suspected and early recognized. Bases of treatment are maintenance of adequate oxygenation with use of artificial ventilation if necessary, larger and faster volume resuscitation than recommended before, empiric antibiotherapy and early use of vasopressive agents associated with corticosteroids in particular situations. Treatment efficacy must be regularly assessed during first hours of resuscitation. Taking into account pediatric particularities and results of adult studies, pediatricians who take care of children at beginning of septic shock may reasonably hope to decrease mortality if they keep in mind specific therapeutic goals.
Publication Types:
PMID: 15288113 [PubMed - indexed for MEDLINE]
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[Congenital toxoplasmosis: a new case of infection during pregnancy in an previously immunized and immunocompetent woman]
[Article in French]
Lebas F, Ducrocq S, Mucignat V, Paris L, Megier P, Baudon JJ, Gold F.
Service de neonatologie, hopital d'enfants Armand-Trousseau, AP-HP, 26, avenue du Dr-Netter, 75571 Paris cedex 12, France. fanny.lebas@wanadoo.fr
Congenital toxoplasmosis is a potentially serious infection which usually affects infants born to non immune women. CASE REPORT: Our case report focuses on a baby born to a normally immunocompetent woman previously immunized against toxoplasmosis. To our knowledge only three similar cases have been published until now. CONCLUSION: We conclude that in front of a patient neonatal congenital infection picture, toxoplasmosis cannot be excluded on the ground of maternal immunity status and must be quickly investigated, given the emergency of appropriate treatment.
Publication Types:
PMID: 15288083 [PubMed - indexed for MEDLINE]
Outbreak of gastric mucormycosis associated with the use of wooden tongue depressors in critically ill patients.
Maravi-Poma E, Rodriguez-Tudela JL, de Jalon JG, Manrique-Larralde A, Torroba L, Urtasun J, Salvador B, Montes M, Mellado E, Rodriguez-Albarran F, Pueyo-Royo A.
Intensive Care Unit, Hospital Virgen del Camino, C/Irunlarrea 4, 31008 Navarre, Pamplona, Spain. enrique.maravi.poma@cfnavarra.es
OBJECTIVE: To describe a nosocomial outbreak of gastric mucormycosis caused by Rhizopus microsporus var. rhizopodiformis in five adult patients admitted to an intensive care unit (ICU). DESIGN: Epidemiological surveillance study. SETTING: A 12-bed polyvalent ICU of an acute care teaching hospital in Pamplona, Spain. PATIENTS: Five patients admitted to the ICU requiring artificial ventilation, diagnosis on admission severe pneumonia in four patients and one polytrauma patient, within a 14-week period, were diagnosed with gastric mucormycosis based on microbiological and/or histopathological characteristics. Upper gastrointestinal bleeding was the presenting manifestation in 80% of patients. INTERVENTIONS: Filamentous fungi isolated at the microbiology laboratory of the hospital were examined at the national Mycology Reference Laboratory in Madrid. MEASUREMENTS AND RESULTS: Rhizopus microsporus var. rhizopodiformis growth was detected in gastric aspiration samples, environmental samples, wooden tongue depressors used to prepare oral medications (and given to patients through a nasogastric catheter), and in some tongue depressors stored in unopened boxes unexposed to the ICU environment. All depressors were purchased from the same supplier. R. microsporus was not isolated from batches purchased at different times from the same supplier and from another supplier. The outbreak terminated when contaminated tongue depressors were withdrawn from use. CONCLUSIONS: Wooden tongue depressors contaminated by R. microsporus var. rhizopodiformis used to prepare oral medications caused an outbreak of fungal gastritis with an attributable mortality of 40%. Wooden material should not be used in the hospital setting.
PMID: 14991098 [PubMed - indexed for MEDLINE]
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Outcome of older patients receiving mechanical ventilation.
Esteban A, Anzueto A, Frutos-Vivar F, Alia I, Ely EW, Brochard L, Stewart TE, Apezteguia C, Tobin MJ, Nightingale P, Matamis D, Pimentel J, Abroug F; Mechanical Ventilation International Study Group.
Servicio de Cuidados Intensivos, Hospital Universitario de Getafe, Carretera de Toledo km 12500, 28905 Madrid, Spain. aesteban@ucigetafe.com
OBJECTIVE: To determine the threshold of age that best discriminates the survival of mechanically ventilated patients and to estimate the outcome of mechanically ventilated older patients. DESIGN: International prospective cohort study. SETTING: Three hundred sixty-one intensive care units from 20 countries. PATIENTS AND PARTICIPANTS. Five thousand one hundred eighty-three patients mechanically ventilated for more than 12 h. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Recursive partitioning and logistic regression were used and an outcome model was derived and validated using independent subgroups of the cohort. Two age thresholds (43 and 70 years) were found, by partitioning recursive analysis, to be associated with outcome. This study focuses on the analysis of patients older than 43 years of age, divided in two subgroups: between 43 and 70 years (middle age group) and older than 70 years (elderly group). Survival in hospital was 45% (95% C.I.: 43-48) for the elderly group and 55% (53-57) for the middle age group ( p<0.001). Advanced age was not associated with prolongation of mechanical ventilation, weaning or length of stay in the ICU and in hospital ( p>0.05). Variables associated with mortality in the elderly were: acute renal failure, shock, Simplified Acute Physiology Score II and a ratio of PaO(2) to FIO(2) more than 150. CONCLUSIONS: Older mechanically ventilated patients (age >70 years) had a lower ICU and hospital survival, but the duration of mechanical ventilation, ICU and hospital stay were similar to younger patients. Factors associated with the highest risk of mortality in patients older than 70 were the development of complications during the course of mechanical ventilation, such as acute renal failure and shock.
Publication Types:
PMID: 14991097 [PubMed - indexed for MEDLINE]
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What did she "really" want?
Vollmann J, Wank M, Weidtmann A, Reinhardt FM.
Publication Types:
PMID: 14966670 [PubMed - indexed for MEDLINE]
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Can the experienced ICU physician predict ICU length of stay and outcome better than less experienced colleagues?
Gusmao Vicente F, Polito Lomar F, Melot C, Vincent JL.
:Department of Intensive Care Unit, Erasme Hospital Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium.
OBJECTIVE: To assess the ability of physicians with varying degrees of experience to predict the length of stay and outcome of intensive care unit (ICU) patients. DESIGN: Prospective, interview-based study. SETTING: A 31-bed mixed medical-surgical ICU. PATIENTS: A total of 223 consecutive patients (excluding those admitted for routine post-operative surveillance) admitted to the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Physicians immediately responsible for each patient, and others fully aware of the case, were interviewed separately during the first 12 h of ICU admission to determine their assessment of the patient's likely duration of stay on the ICU and the probable outcome. Degree of predictive accuracy was assessed using the Kappa statistic with kappa < or =0.2 poor, 0.21-0.4 fair, 0.41-0.60 moderate, 0.61-0.8 good, and 0.81-1.0 very good. Physicians were graded according to their degree of experience as junior (less than 1 year ICU experience), medium (critical care fellow), and senior (staff physician with supervising functions). For lengths of stay less than 5 days, senior physicians were better predictors than less experienced doctors. For outcome prediction, physicians were generally moderately good at predicting death, with senior physicians tending to be more accurate than their less experienced colleagues (senior kappa 0.68, medium kappa 0.52, junior kappa 0.43). CONCLUSIONS: Prediction of length of ICU stay was poor amongst all physicians in patients with a length of stay greater than 5 days. Experienced physicians were better predictors of ICU lengths of stay less than 5 days and, in contrast to some reports, of ICU outcome than their more inexperienced counterparts.
PMID: 14735235 [PubMed - indexed for MEDLINE]
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Validation of C1-esterase inhibitor therapy in severe capillary leak syndrome by monitoring of extravascular lung water.
Kluge S, Kreymann G.
Publication Types:
PMID: 14727019 [PubMed - indexed for MEDLINE]
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Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients.
Carrasco MN, Bueno A, de las Cuevas C, Jimenez S, Salinas I, Sartorius A, Recio T, Generelo M, Ruiz-Ocana F.
Intensive Care Unit, Hospital Universitario de la Princesa, Diego de Leon 62, 28006 Madrid, Spain. ncarrasco.hlpr@salud.madrid.org
OBJECTIVE: To compare the incidence of catheter colonization and catheter-related bloodstream infections between heparin-coated catheters and those coated with a synergistic combination of chlorhexidine and silver sulfadiazine. DESIGN: Randomized, controlled clinical trial. SETTING: A 20-bed medical-surgical intensive care unit. PATIENTS: A total of 180 patients requiring the insertion of a trilumen central venous catheter. INTERVENTIONS. Patients were randomized to receive either a trilumen heparin or chlorhexidine and silver sulfadiazine-coated catheter. MEASUREMENTS: Catheter colonization was defined by a semiquantitative catheter tip culture yielding 15 or more colony-forming units or quantitative culture of 1,000 or more colony-forming units/ml. Catheter-related bloodstream infection as the isolation of the same microorganism from a peripheral blood culture and catheter tip. RESULTS: A total of 260 catheters were cultured. Out of 132 heparin-coated catheters, 29 were colonized and out of 128 chlorhexidine and silver sulfadiazine-coated catheters, 13 were colonized ( p=0.03), relative risk RR=2.16 (1.18-3.97). This represents an incidence of 23.5 and 11.5 episodes of catheter colonization per 1,000 catheter-days, respectively ( p=0.0059), RR=2.04 (1.05-3.84). Microorganisms isolated in catheter colonization from heparin-coated catheters were gram-positive cocci 23, gram-negative bacilli 7, and Candida spp 4. In chlorhexidine and silver sulfadiazine-coated catheters were gram-positive cocci 6 and gram-negative bacilli 11 ( p=0.009). The incidence of catheter-related bloodstream infections per 1,000 catheter-days was 3.24 in heparin-coated catheters and 2.6 in chlorhexidine and silver sulfadiazine-coated catheters ( p=0.79), RR=1.22 (0.27-5.43). CONCLUSIONS: In critically ill patients the use of trilumen central venous catheters coated with chlorhexidine and silver sulfadiazine reduced the risk of catheter colonization due to prevention of gram-positive cocci and Candida spp.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14722639 [PubMed - indexed for MEDLINE]
The impact of influenza A on children with disabilities.
Stark ZL, Buttery JP, Antolovich GC, Reddihough DS.
Publication Types:
PMID: 15151603 [PubMed - indexed for MEDLINE]
Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection.
Lam BC, Lee J, Lau YL.
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, China. lamccb@ha.org.hk
OBJECTIVE: Health care-associated infections persist as a major problem in most neonatal intensive care units. Hand hygiene has been singled out as the most important measure in preventing hospital-acquired infection. However, hand hygiene compliance among health care workers (HCWs) remains low. The objective of this study was to assess the frequency and nature of patient contacts in neonatal intensive care units and observe the compliance and technique of hand hygiene among HCWs before and after the implementation of a multimodal intervention program. METHODS: The nature and frequency of patient contacts, the hand hygiene compliance, and hand-washing techniques of HCWs were observed unobtrusively to reflect the baseline compliance and to investigate factors for noncompliance. The intervention consisted of problem-based and task-orientated hand hygiene education, enhancement of minimal handling protocol and clustering of nursing care, liberal provision of alcohol-based hand antiseptic, improvement in hand hygiene facilities, ongoing regular hand hygiene audit, and implementation of health care-associated infection surveillance. The observational study was repeated 6 months after the completion of the intervention program, which extended over 1-year period. RESULTS: Overall hand hygiene compliance increased from 40% to 53% before patient contact and 39% to 59% after patient contact. More marked improvement was observed for high-risk procedures (35%-60%). The average number of patient contacts also decreased from 2.8 to 1.8 per patient per hour. There was improvement in most aspects of hand-washing technique in the postintervention stage. The health care-associated infection rate decreased from 11.3 to 6.2 per 1000 patient-days. CONCLUSION: A problem-based and task-orientated education program can improve hand hygiene compliance. Enhancement of minimal handling and clustering of nursing procedures reduced the total patient contact episodes, which could help to overcome the major barrier of time constraints. A concurrent decrease in health care-associated infection rate and increase in hand hygiene compliance was observed in this study. The observational study could form part of an ongoing audit to provide regular feedback to HCWs to sustain the compliance.
PMID: 15492360 [PubMed - in process]
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