Surgical infections
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We reported similar rates of ventilator-associated pneumonia (VAP) previously in trauma patients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. ⋯ Aspiration, along with depressed consciousness and greater injury severity, may predispose trauma patients to VAP. Prospective studies should focus on the quality and timing of aspiration relative to intubation to determine if novel interventions can prevent aspiration or decrease the risk of VAP after aspiration.
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Surgical infections · Oct 2011
Effective cohorting and "superisolation" in a single intensive care unit in response to an outbreak of diverse multi-drug-resistant organisms.
Cohorting patients in dedicated hospital wards or wings during infection outbreaks reduces transmission of organisms, yet frequently, this may not be feasible because of inadequate capacity, especially in the intensive care unit (ICU). We hypothesized that cohorting isolation patients in one geographic location in a single ICU and using enhanced isolation procedures ("superisolation") can prevent the further spread of highly multi-drug-resistant organisms (MDRO). ⋯ Cohorting patients to one area and altering work routines to minimize contact with patients with MDRO (essentially designating a "high-risk" zone) may be beneficial in stopping patient-to-patient spread of highly resistant bacteria without the need for a dedicated isolation unit.
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Surgical infections · Oct 2011
Comparative StudyAcute physiology and chronic health evaluation II score is a better predictor of mortality than IBMP-10 in patients with ventilator-associated pneumonia.
The (Immunodeficiency, Blood pressure [<90 mm Hg], Multilobular intiltrates [chest x-ray], Platelets [<100×10⁹/L], hospitalization [<10 days] before the onset of ventilator-associated pneumonia [VAP]) IBMP-10 is a new scoring system proposed as an easy-to-use alternative to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score for predicting mortality in patients with ventilator-associated pneumonia (VAP). The objective of this study was to determine the validity of the IBMP-10 score compared with APACHE II in predicting mortality for an independent population consisting predominantly of surgical and neurotrauma patients. ⋯ The IBMP-10 score was less reliable than the APACHE II score in predicting 14-day mortality in this independent population of VAP patients. This finding highlights the need for additional validation of new disease severity scoring systems in a study population independent of the population used to derive score criteria, as well as in more specific populations of critically ill patients.
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Surgical infections · Oct 2011
External validation of models for predicting pneumonia after cardiac surgery.
Approximately 20% of patients become infected after cardiac surgery. Pneumonia is one of the most serious infections, increasing the chance of death 14-fold. The higher frequency of pneumonia after cardiac surgery may be explained by surgical conditions. Focusing on high-risk groups may make several strategies more effective, and external validation is an essential phase of building prediction models to identify such groups. ⋯ The LRM model displayed superior performance. A possible advantage of the CART prediction model is that it may be easier to interpret via its graphical presentation than prediction models based on logistic regression. However, there are a number of disadvantages of the CART approach. The LRM model can be used by infection control practitioners for risk adjustment across different periods or units and for evaluation of the efficacy of new technologies.
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Surgical infections · Oct 2011
Daily multidisciplinary rounds to implement the ventilator bundle decreases ventilator-associated pneumonia in trauma patients: but does it affect outcome?
The incidence of ventilator-associated pneumonia (VAP) in trauma patients can be decreased with use of the ventilator bundle (VAPB). Our VAP rate remained high despite the adoption of the VAPB. To better implement the VAPB, a multidisciplinary team composed of the surgical intensive care unit (SICU) nursing staff, physician, and respiratory therapist reviewed briefly a checklist of VAPB goals for each patient before morning attending rounds. We hypothesized that such daily goal rounds (GR) focused on the VAPB would decrease the VAP rate. ⋯ Daily multidisciplinary GRs focused on the VAPB can decrease the incidence of VAP significantly in trauma patients. Ventilator-associated pneumonia correlated with extended mean ventilator, SICU, and hospital days. Interestingly, despite a significant decrease in VAP, a decrease in the mortality rate was not observed. Given the small number of deaths in the VAP cohort, this study has insufficient statistical power to elucidate the true impact of GR intervention or VAP on the mortality rate in trauma patients.