Critical Care / ICU, Fluids, Electrolytes and Nutrition - 2017 (The Clinical Medicine Series Book 30)
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Methods: We performed retrospective observational study on patients who were admitted to our ICU after planed surgery from May to Dec. We detected the patients who acquired BD newly and investigated the relation to the length of ICU stay. Finally, we made the logistic regression model of each cutoff day day1 to 7 and compared Odds Ratio OR and AUC of each models using stata. Results: Category day 2 or more, especially day 4 or more had significantly higher detection rate of DB compared to day 1 Table 1.
Similar results were observed in OR according to logistic regression. According to each cutoff day models of logistic regression, the day 4 model had the highest OR Introduction: The objective of this study was to evaluate the incidence density of urinary tract infection associated with bladder catheter in neurological intensive care unit and identification of actions that were related to low prevalence.
Methods: A retrospective analysis of the hospitalized patients from December to January was carried out, considering the patients who used the bladder catheter and the cases of urinary tract infection, correlating with improvement actions implemented in the period. Results: In the analyzed period, patients were hospitalized in the unit, with mean age of Of these, 27 had a urinary tract infection, which represented 1.
During the analyzed period, urological physiotherapy was monitored, daily check of the urinary tract infection prevention bundle, analysis of all cases of infection with search of barriers breaking through Ishikawa methodology, feedback to the multiprofessional team of indicators related to the presence of invasive device, monthly monitoring of the mean time of bladder catheter with established goals. Conclusions: It is possible to guarantee low prevalence of urinary tract infection, in a complex profile of patients, through a multiprofessional approach, accompanied by structured management of data analysis and monitoring.
Introduction: Surgical site infection SSI is a risk in every operation wound, as it negatively impacts patient morbidity and mortality, and also increases financial demands, such as prolonged hospital stay, further antibiotics and surgical procedures. The aim of this study was to analyse SSI and its risk factors after thoracic and lumbar surgery. Methods: A six-year monocentric observation prospective cohort study monitored the incidence of SSI, wound complications and further risk factors in consecutive patients after planned thoracic and lumbar surgery for degenerative disease, trauma and tumour.
All patients received short antibiotic prophylaxis before and during long operations. All wound complications and SSI were monitored up to 30 days and 1 year after operations. We searched for risk factors for SSI in multivariate logistic regression analysis. Results: We recorded 22 incidences of SSI 8. Predictor of SSI in multivariate logistic regression analysis was hospital wound complications OR Conclusions: Contrary to the prevailing literature, our study did not identify corticoids, diabetes mellitus or transfusions as risk factors for the development of SSI, but only wound complications and warm seasons.
There are different education measures written material with reminders, continuous feedback, interventions involving novel equipment on performance of hand hygiene.
In the present study, we assessed the impact of immediate verbal feedback on performance of hand hygiene by health care workers using a new Continuous Closed-circuit Television Monitoring CCTV method and direct, overt analog observation method. Methods: This is an interventional study. We conducted overt — direct observations and covert - CCTV observational sessions to measure hand hygiene compliance before and after interventional measures of health care workers HCWs in our ICU.
As interventional measures, we used personal verbal immediate feedback at the end of the overt observational session, performed by infection control nurse. Results: Overall, opportunities to perform hand hygiene. We believe that it needs additional scrutiny and combining additional intervention strategies to improve hand hygiene compliance.
Introduction: Cytomegalovirus CMV has been recognized as an important pathogen in immunocompromised individuals for as long time. In recent years, some studies have focused on CMV infection among immunocompetent intensive care patients.
The results are inconsistent and the impact of this virus on the prognosis of these patients is not solved. Our purpose were to determine the prevalence, the risk factors and the consequence of CMV infection in immunocompetent intensive care unit patients. Methods: Observational retrospective case-control study comparing two groups of intensive care patients: CMV-positive and CMV-negative. Patients suspected of developing CMV infection were included. CMV impact on prognosis was judged by the complications developed and mortality. Another comparison among infected patients between the deceased and the living was carried out in order to determine CMV morbidity and mortality factors.
No significant differences in age, sex, comorbidities, severity, ventilation, use of amines and corticosteroids were found. CMV was not associated with significant morbidity and mortality. Conclusions: CMV infection is common in immunocompetent intensive care patients. Transfusion history is a risk factor of infection. CMV is a marker of the severity of the underlying disease of patients rather than a cause of morbidity and mortality. Introduction: Necrotizing soft tissue infections NSTI are characterised by extensive tissue necrosis, triggering an overwhelming inflammatory response like sepsis or septic shock .
The mortality rate is high and the search for predicting factors has brought conflicting results. We hypothesized that inflammation parameters and organ dysfunctions in the first 24h may correlate with mortality on the intensive care unit ICU.
39th International Symposium on Intensive Care and Emergency Medicine
Methods: We analysed retrospectively electronic data from patients who were admitted to our University Hospital during For the statistical analysis we used SPSS, version Results: 59 patients with NSTI were admitted during the study period. There were 41 males Plotting a receiver operator characteristic curve for the SOFA score against mortality, we obtained an area under the curve of 0. Both kidney and liver dysfunction were significantly linked to a higher risk of mortality. An association of four or more organ dysfunctions increased the risk of death by a factor of 8.
Conclusions: SOFA score and presence of liver or kidney dysfunction respectively in the first 24h correlated well with an increased risk of death.
The different inflammatory markers showed no predicting value towards the risk of mortality. Introduction: Ventilator-associated pneumonia VAP is one of the leading infection in critically ill patients. The study was approved by the Ethics Committee of our institution. Patients next of kin provided written informed consent. Introduction: Immunological dysfunction is common in critically ill patients but the optimal method to measure it and its clinical significance are unknown. Methods: A secondary analysis of a phase 2 randomized, multi-centre, double-blinded placebo controlled trial .
Hospital Based Nutrition Support: A Review of the Latest Evidence | Insight Medical Publishing
There were no differences in allocation groups; all the patients were analyzed as one cohort. The primary outcome was the development of NIs; secondary outcomes included day mortality. Results: Data was available for patients. Baseline characteristics and outcomes are reported in Tables 1 and 2. Both comparisons showed no difference between NIs and clinical outcomes between tertiles. Conclusions: Admission ex-vivo stimulated TNF-a level is not associated with the occurrence of NIs or clinical outcomes. Further study is required to evaluate the ability of this assay to quantify immune function over the course of critical illness.
Introduction: We believe traditional ventilator associated pneumonia VAP is limited by its complexity, subjectivity and marginal attributable mortality. It generates debate but not a matrix. Methods: Inclusion Criteria: All patients intubated for at least 48 hours. Exclusion Criteria: All elective post-cardiac surgery. Follow Up: Extubation or death.
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Results: A total of patients were enrolled between 3rd September to 20th October in The major reason for this reduction is decrease in percentage of ventilated patients 45 vs 40 as well as slight reduction in length of stay on ventilator 3 vs 2. Introduction: There is limited information about sepsis in very old patients hospitalized with community-acquired pneumonia CAP. Methods: We conducted a retrospective study using data that were prospectively collected at the Hospital Clinic of Barcelona.
We aimed to investigate the prevalence, etiology, risk factors and clinical outcomes of this population, comparing patients with and without sepsis defined according to SEPSIS-3 criteria. Written informed consent was waived because of the non-interventional study design. There was no significant difference in the distribution of pathogens in patients with and without sepsis Figure 1.
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Male sex OR 1. One-year mortality was higher in very old patients with sepsis compared with those without sepsis Table 1.
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A propensity-adjusted multivariable analysis showed that risk factors for day mortality in septic patients were chronic renal disease OR 2. Conclusions: In very old patients hospitalized with CAP, antibiotic therapy before admission was associated with a decreased risk of sepsis, whereas diabetes mellitus was associated with a decreased risk of day mortality.
Introduction: Legionella species may cause life-threatening pneumonia and thus need early treatment. Differentiating Legionella pneumoniae LP from other types of pneumonia including Mycoplasma pneumoniae MP , Steptococcus pneumoniae SP and viral types of community-acquired pneumonia CAP has important implications regarding antibiotic therapy. Current testing options for LP infection have limited sensitivity leading to time delays in treatment and to usage of empirical broad-spectrum antibiotics.
Recently, a Legionella Scoring system based on six parameters has been proposed. We aimed to independently validate this score and investigate whether additional clinical and laboratory parameters would further improve its accuracy. Methods: We analyzed patients hospitalized in a tertiary care hospital between and with CAP and a defined etiology. Association and discrimination were assessed using logistic regression analysis and area under the receiver operator characteristic curve ROC AUC.
Results were similar for subgroups based on each of the different CAP types. Additionally, we found that a history of nausea further improves the diagnostic accuracy of the legionella score to an AUC of 0. Conclusions: In patients hospitalized with CAP, a high Legionella score on admission strongly predicts LP infection and thereby can optimize the empiric antibiotic management.
A clinical history of nausea further improves diagnosis. Systematic use of this scoring system in conjunction with other diagnostic tests may improve the diagnostic and therapeutic management of patients presenting with CAP. Introduction: Acinetobacter baumannii AcB remains one of the most prevalent ventilator-associate pneumonia VAP causing pathogen. In recent years, share of drug resistant AcB strains across Europe was found to be steadily increasing.
Consequently, in , AcB was included in the WHO global priority list of drug-resistant bacteria to highlight the need for the research development.