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Items 1 - 11 of 11 |
One page. |
The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas.
Lebuffe G, Dosseh ED, Tek G, Tytgat H, Moreno S, Tavernier B, Vallet B, Proye CA.
Department of Anaesthesiology and Intensive Care, Huriez Hospital, University Hospital of Lille, France. g-lebuffe@chru-lille.fr <g-lebuffe@chru-lille.fr>
The peri-operative management of patients undergoing surgery for phaeochromocytoma or paraganglioma with calcium channel blockers (CCB) and their impact on postoperative morbidity and mortality were studied. The medical records of 105 patients undergoing surgery between 1991 and 2002 were analysed retrospectively. In all patients, the calcium channel blocker nicardipine was used for the peri-operative management of haemodynamic changes. Sixty-five patients (61.9%) showed transient intra-operative hypertension. Systolic blood pressure (SBP) > 220 mmHg and SBP > 180 mmHg for > 10 consecutive minutes was observed in 14 (13%) and four patients (2.8%), respectively. SBP < 80 mmHg for > 10 consecutive minutes occurred in 13 patients (12.3%). Eleven patients (10.4%) developed postoperative complications and three patients died (2.8%). The median (range) ICU and hospital length of stay were, respectively, 1 (0-7) day and 10 (2-35) days. The sole use of calcium channel blockers for the peri-operative management of phaeochromocytoma and paraganglioma resection does not prevent all haemodynamic changes; however, its use was associated with a low morbidity and mortality.
PMID: 15819762 [PubMed - indexed for MEDLINE]
Half of patients in intensive care receive suboptimal care.
Kmietowicz Z.
Publication Types:
PMID: 15891212 [PubMed - indexed for MEDLINE]
Antimicrobial treatment of community-acquired pneumonia.
Restrepo MI, Anzueto A.
Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
Community-acquired pneumonia (CAP) is a clinical diagnosis that has a significant impact on health care management around the world. Early clinical suspicion and prompt empiric antimicrobial therapies are mandatory in patients with CAP. This article provides a review of recent studies and guidelines addressing antimicrobial therapy for hospitalized patients with CAP.
Publication Types:
PMID: 15802167 [PubMed - indexed for MEDLINE]
Comment on:
Tsunami disaster and infection: Beware what pathogens the transport delivers to your intensive care unit!
Masur H, Murray P.
Publication Types:
PMID: 15891375 [PubMed - indexed for MEDLINE]
Comment on:
Cross-transmission in the intensive care unit: one piece of the puzzle.
Castillo JR, Gordon SM, Arroliga AC.
Publication Types:
PMID: 15891354 [PubMed - indexed for MEDLINE]
Comment on:
Coupling quality improvement with quality measurement in the intensive care unit.
Glance LG, Osler TM.
Publication Types:
PMID: 15891352 [PubMed - indexed for MEDLINE]
Comment in:
Lack of alteration of endogenous nitric oxide pathway during prolonged nitric oxide inhalation in intensive care unit patients.
Lukaszewicz AC, Mebazaa A, Callebert J, Mateo J, Gatecel C, Kechiche H, Maistre G, Carayon A, Baudin B, Payen D.
Department of Anesthesiology and Critical Care Medicine, Hospital Lariboisiere, University Paris 7, Paris, France.
OBJECTIVE: To compare hemodynamic and gasometric variables and the plasma concentrations of nitric oxide metabolites (cyclic guanosine monophosphate and nitrate and nitrite), endothelin-1, and renin-angiotensin metabolites before and after the start of nitric oxide inhalation, after prolonged nitric oxide inhalation, and before and after nitric oxide withdrawal. DESIGN: Prospective study. SETTING: Surgical intensive care unit, university hospital. SUBJECTS: Patients with acute lung injury and right ventricular failure. INTERVENTIONS: Nitric oxide inhalation (10-12 ppm) during a median of 2.9 days (12 hrs to 6.5 days). MEASUREMENTS AND MAIN RESULTS: The pulmonary vasodilator effects of inhaled nitric oxide improved arterial oxygenation in patients with acute lung injury (p < .05) and reduced right atrial pressure in patients with right ventricular dysfunction (p < .01). These beneficial effects lasted the whole period of prolonged inhaled nitric oxide therapy up to 6.5 days. However, when inhaled nitric oxide was withdrawn, pulmonary vasodilator effects rapidly disappeared, and Pao2/Fio2 ratio markedly deteriorated in all studied patients to return to pre-inhaled nitric oxide levels. Changes in plasma cyclic guanosine monophosphate and nitrate and nitrite paralleled those of pulmonary vasodilatory effects. An immediate increase in plasma cyclic guanosine monophosphate with a slightly delayed increase in plasma nitrate and nitrite was observed at inhaled nitric oxide start with no attenuation during the prolonged inhaled nitric oxide therapy. A marked decrease toward pre-inhaled nitric oxide levels was seen within hours of inhaled nitric oxide withdrawal. In addition, no alteration of plasma endothelin-1 or renin-angiotensin mediators was observed during or after inhaled nitric oxide therapy. CONCLUSIONS: Our study showed a lack of attenuation in the beneficial effects of inhaled nitric oxide and a lack of alteration of endogenous nitric oxide, endothelin-1, and renin-angiotensin pathways during prolonged nitric oxide inhalation.
Publication Types:
PMID: 15891329 [PubMed - indexed for MEDLINE]
Comment in:
How many infections are caused by patient-to-patient transmission in intensive care units?
Grundmann H, Barwolff S, Tami A, Behnke M, Schwab F, Geffers C, Halle E, Gobel UB, Schiller R, Jonas D, Klare I, Weist K, Witte W, Beck-Beilecke K, Schumacher M, Ruden H, Gastmeier P.
European Antimicrobial Resistance Surveillance System, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
OBJECTIVE: The proportion of intensive care unit (ICU)-acquired infections that are a consequence of nosocomial cross-transmission between patients in tertiary ICUs is unknown. Such information would be useful for the implementation of appropriate infection control measures. DESIGN: A prospective cohort study during 18 months. SETTING: Five ICUs from two university hospitals. PATIENTS: All patients admitted for >/=48 hrs. MEASUREMENT: ICU-acquired infections were ascertained during daily bedside patient and chart reviews. Episodes of potential cross-transmission were identified by highly discriminating genetic typing of all clinical and surveillance isolates of the ten bacterial species most frequently associated with nosocomial infections in ICUs. Isolation of indistinguishable isolates in two or more patients defined potential transmission episodes. MAIN RESULTS: During 28,498 patient days, 431 ICU-acquired infections and 141 episodes of nosocomial transmissions were identified. A total of 278 infections were caused by the ten species that were genotyped, and 41 of these (14.5%) could be associated with transmissions between patients. CONCLUSION: Infections acquired during treatment in modern tertiary ICUs are common, but a causative role of direct patient-to-patient transmission can only be ascertained for a minority of these infections on the basis of routine microbiological investigations.
Publication Types:
PMID: 15891318 [PubMed - indexed for MEDLINE]
Comment in:
Variation in outcomes in Veterans Affairs intensive care units with a computerized severity measure.
Render ML, Kim HM, Deddens J, Sivaganesin S, Welsh DE, Bickel K, Freyberg R, Timmons S, Johnston J, Connors AF Jr, Wagner D, Hofer TP.
VAMC-Cincinnati, Ohio 45220, USA.
OBJECTIVE: To quantify the variability in risk-adjusted mortality and length of stay of Veterans Affairs intensive care units using a computer-based severity of illness measure. DESIGN: Retrospective cohort study. SETTING: A stratified random sample of 34 intensive care units in 17 Veterans Affairs hospitals. PARTICIPANTS: A consecutive sample of 29,377 first intensive care unit admissions from February 1996 through July 1997. INTERVENTIONS: Standardized mortality ratio (observed/expected deaths) and observed minus expected length of stay (OMELOS) with 95% confidence intervals were estimated for each unit using a hierarchical logistic (standardized mortality ratio) or linear (OMELOS) regression model with Markov Chain Monte Carlo simulation. We adjusted for patient characteristics including age, admission diagnosis, comorbid disease, physiology at admission (from laboratory data), and transfer status. MEASUREMENTS AND MAIN RESULTS: Mortality across the intensive care units for the 12,088 surgical and 17,289 medical cases averaged 11% (range, 2-30%). Length of stay in the intensive care units averaged 4.0 days (range, mean unit length of stay 3.0-5.9). Standardized mortality ratio of the intensive care units varied from 0.62 to 1.27; the standardized mortality ratio and 95% confidence interval were <1 for four intensive care units and >1.0 for seven intensive care units. OMELOS of the intensive care units ranged from -0.89 to 1.34 days. In a random slope hierarchical model, variation in standardized mortality ratio among intensive care units was similar across the range of severity, whereas variation in length of stay increased with severity. Standardized mortality ratio was not associated with OMELOS (Pearson's r = .13). CONCLUSIONS: We identified intensive care units whose indicators for mortality and length of stay differ substantially using a conservative statistical approach with a severity adjustment model based on data available in computerized clinical databases. Computerized risk adjustment employing routinely available data may facilitate research on the utility of intensive care unit profiling and analysis of natural experiments to understand process and outcome links and quality efforts.
Publication Types:
PMID: 15891316 [PubMed - indexed for MEDLINE]
Colonization by high-level aminoglycoside-resistant enterococci in intensive care unit patients: epidemiology and clinical relevance.
Rodriguez-Bano J, Ramirez E, Muniain MA, Santos J, Joyanes P, Gonzalez F, Garcia-Sanchez M, Martinez-Martinez L.
Seccion de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani, 3, 41071 Sevilla, Spain.
A cohort study was performed to investigate the risk factors for colonization with high-level aminoglycoside-resistant enterococci (HLARE) in intensive care unit (ICU) patients. Colonization was investigated by performing surveillance samples during ICU stay. Clonal relatedness of the isolates was assessed by pulsed-field gel electrophoresis. Eighty-six patients with an ICU stay of >48h were included; two were colonized with HLARE at admission, and 24 (28.5%) acquired HLARE during their stay in the ICU. HLARE were initially isolated from rectal swabs alone. Thirty-five percent of Enterococcus faecalis and 57% of E. faecium showed high-level resistance to gentamicin or streptomycin. Most isolates were clonally unrelated. Using multi-variate analysis, the only variable associated with HLARE colonization was previous antimicrobial use. Five patients had HLARE isolated from clinical samples, three of them with infection; in all of these, colonization with the same clone had been detected previously by surveillance samples. We conclude that most infections due to HLARE in the ICU are preceded by previous colonization, and that antimicrobial use is the main risk factor for colonization.
PMID: 15893852 [PubMed - as supplied by publisher]
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Changes in antibiotic resistance of the most common Gram-negative bacteria isolated in intensive care units.
Makedou KG, Tsiakiri EP, Bisiklis AG, Chatzidimitriou M, Halvantzis AA, Ntoutsou K, Alexiou-Daniel S.
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
We studied the changes in antibiotic resistance of the most common Gram-negative bacteria isolated in the intensive care units at our hospital in 2000 and 2002. Bacterial identification was performed by use of the VITEK 60 analyser, and antibiotic susceptibilities were tested by the VITEK 60 analyser and the disk diffusion agar method. The bacteria isolated most frequently were Pseudomonas aeruginosa (132 strains in 2000 and 106 in 2002), Acinetobacter calcoaceticus (98 and 109 strains, respectively) and Klebsiella pneumoniae (53 and 83 strains, respectively). Acinetobacters presented the highest percentage resistance, with significant increases in resistance to imipenem (15% in 2000 and 67% in 2002) and piperacillin/tazobactam (41% and 72%, respectively). P. aeruginosa presented a significant increase in resistance to all antibiotics, except ceftazidime. A large increase was observed in the resistance of K. pneumoniae to amikacin (from 10% to 50%), ceftazidime (from 80% to 90%) and tobramycin (from 80% to 90%). No imipenem-resistant strains of K. pneumoniae were found.
PMID: 15890431 [PubMed - as supplied by publisher]
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