Intensive care medicine
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Intensive care medicine · Jun 2008
Influence of insertion site on central venous catheter colonization and bloodstream infection rates.
To compare colonization and catheter-related bloodstream infection (CR-BSI) rates among three insertion sites (subclavian, internal jugular, femoral) used for central venous catheter (CVC) placement. ⋯ Colonization was lowest at the subclavian site. Regional differences exist with respect to type of pathogen isolated. Colonization was influenced by insertion location and gender. The incidence of CR-BSI was not different.
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Intensive care medicine · Jun 2008
Meta AnalysisThe effect of prone positioning in acute respiratory distress syndrome or acute lung injury: a meta-analysis. Areas of uncertainty and recommendations for research.
To compare the effects of ventilation in prone and in supine position in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). ⋯ Prone position is not associated with a significant reduction in mortality from ALI/ARDS despite a significant increase in PaO(2)/FiO(2), is safe, and tends to decrease VAP. Published studies exhibit substantial clinical heterogeneity, suggesting that an adequately sized study optimising the duration of proning and ventilation strategy is warranted to enable definitive conclusions to be drawn.
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This brief review centers on the multiple inert gas elimination technique (MIGET). This technique, developed in the 1970s, measures the pulmonary exchange of a set of six different inert gases dissolved together in saline (or dextrose) and infused intravenously. It then uses those measurements to compute the distribution of ventilation/perfusion ratios that best explains the exchange of the six gases simultaneously. ⋯ After a brief history of MIGET, its principles are laid out, its information content is explained, and its limitations are described. It is noted that in addition to quantifying ventilation/perfusion inequality and pulmonary shunting, MIGET can identify and quantify diffusion limitation of O(2) exchange, when present, as well as explain the contributions of extrapulmonary influences such as inspired O(2) concentration, ventilation, cardiac output, Hb concentration/P(50), body temperature and acid/base state on arterial oxygenation. An overview of the technical details of implementing MIGET is given, and the review ends with potential future applications.
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Intensive care medicine · Jun 2008
Randomized Controlled TrialPharmacokinetics of meropenem during intermittent and continuous intravenous application in patients treated by continuous renal replacement therapy.
The clinical effect of beta-lactam antibiotics depends on the time of drug concentration above the minimal inhibitory concentration (MIC) for a susceptible bacterium. Continuous infusion (CI) of beta-lactams such as meropenem may therefore be a more rational approach than intermittent bolus injections (IB). The aim of this study was to test whether CI of meropenem achieves effective drug concentrations comparable to IB in patients treated by continuous renal replacement therapy (CRRT). ⋯ Appropriate antibacterial concentrations of meropenem in patients with CRRT are easily achievable with CI. CI may be an effective alternative dosing regimen to IB. A prospective comparison of the clinical efficacy of the two dosage regimens is warranted.
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Antibiotic-resistant bacterial biofilm may quickly form on endotracheal tubes (ETTs) and can enter the lungs, potentially causing pneumonia. In an attempt to prevent bacterial colonization, we developed and tested in an in-vitro study and animal study several antibacterial-coated ETTs (silver sulfadiazine with and without carbon in polyurethane, silver sulfadiazine and chlorhexidine with and without carbon in polyurethane, silver-platinum with and without carbon in polyurethane, chlorhexidine in polyurethane, and rose bengal for UV light). DESIGN, SETTING, ANIMALS, INTERVENTIONS: After preliminary studies, silver sulfadiazine in polyurethane (SSD-ETT) was selected among the coatings to be challenged every 24 h with 10(4)-10(6) Pseudomonas aeruginosa/ml and evaluated at 6 h, 24 h, and 72 h with standard microbiological studies, scanning electron microscopy, and confocal scanning microscopy. Subsequently, eight sheep were randomized to receive either a SSD-ETT or a standard ETT (St-ETT). After 24 h of mechanical ventilation, standard microbiological studies were performed together with scanning electron microscopy and confocal microscopy. ⋯ This study describes several effective and durable antibacterial coatings for ETTs. Particularly, SSD-ETT showed prevention against P. aeruginosa biofilm formation in a 72-h in-vitro study and lower respiratory tract colonization in sheep mechanically ventilated for 24 h.