Surgical infections
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Surgical infections · Jan 2001
Clinical Trial Controlled Clinical TrialProphylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients.
Pneumonia is one of the most common nosocomial infections in hospitalized patients. The risk of nosocomial pneumonia increases with age, severity of acute illness and preexisting co-morbid conditions. Ventilator-associated pneumonia (VAP) significantly increases morbidity, length of stay, resource utilization and mortality. The purpose of this study was to determine whether adherence to a ventilator weaning protocol (WP) and the use of chlorhexidine gluconate (CH) oral rinse for oral hygiene would decrease the incidence of VAP in surgical ICU patients. ⋯ Improved oral hygiene via topical CH application in conjunction with the use of a WP is effective in reducing the incidence of VAP and the duration of mechanical ventilation in surgical ICU patients.
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Alcohol intoxication has long been associated with an increased risk of injury from a number of mechanisms and with trauma recidivism. It is less certain whether alcohol abuse is associated with worse outcomes for a given degree of injury. ⋯ Alcohol has a profound impact on the epidemiology of injury, but the physiology and biochemical effects in an individual patient may be difficult to predict. Identification of intoxicated persons is essential, despite economic disincentives to do so, because even brief targeted intervention programs can decrease substantially the patient's risk of subsequent injury.
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Surgical infections · Jan 2001
Neutrophil apoptosis is delayed by trauma patients' plasma via a mechanism involving proinflammatory phospholipids and protein kinase C.
Delayed apoptosis of primed neutrophils (PMNs) may facilitate PMN-mediated tissue injury leading to multiple organ failure (MOF). We previously reported delayed apoptosis and priming of PMNs in severely injured patients at risk for MOF. Our in vitro and in vivo data have implicated phospholipids in PMN cytotoxicity following trauma and shock. The phospholipid signaling pathway remains to be elucidated, but may involve protein kinase C (PKC). We hypothesized that circulating platelet-activating factor (PAF) and PAF-like proinflammatory phospholipids mediate delayed postinjury PMN apoptosis and that PKC is integral to the signaling pathway. ⋯ Trauma patients' plasma delays apoptosis of PMNs. Our data implicate PAF-like phospholipids in this effect, and PKC appears to be integral in the signaling process. Further elucidation of specific lipids and signaling pathways may reveal clinically accessible therapeutic targets to prevent PMN-mediated hyperinflammation.
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Surgical infections · Jan 2001
A prospective evaluation of the use of emergency department computed tomography for suspected acute appendicitis.
Computed tomography (CT) is used increasingly to evaluate suspected cases of acute appendicitis (AA) in the emergency department (ED). This prospective study was performed to test the hypothesis that the evaluation of AA by CT in the ED remains suboptimal and that erroneous interpretation diminishes its utility. ⋯ The ability of CT to predict AA is dependent on the interpretative skill of the individual interpreting the images. Widespread use of CT in the evaluation of patients for AA should be implemented with caution until institution-specific protocols are validated.
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Surgical infections · Jan 2001
The female gender protects against pulmonary injury after trauma hemorrhagic shock.
Previously, we have documented that lung injury after trauma-hemorrhagic shock (T/HS) is related to gut injury and that females are more resistant to T/HS-induced lung injury than males. However, it is not known if the estrus cycle stage at the time of injury influences the female rat's resistance to T/HS-induced lung injury. Therefore, the goal of this study was to determine if the protective effect of the female gender on lung injury after T/HS is estrus cycle stage-specific. To test this hypothesis, female rats were subjected to trauma (laparotomy) and hemorrhagic shock (T/HS) during different stages of the estrus cycle. Female animals subjected to trauma with sham hemorrhagic shock served as the control. ⋯ Protection against T/HS-induced lung injury was greatest during the estrus and proestrus stages of the menstrual cycle and decreased with progression to diestrus. During the diestrus stage of the menstrual cycle when gonadal hormone levels are lowest, the rats are more sensitive to T/HS-induced lung injury, indicating that gonadal hormones modulate T/HS-induced lung injury.