Articles: intensive-care-units.
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Acta clinica Croatica · Apr 2023
Comparative StudyCOMPARISON OF TRACHEAL ASPIRATES IN THE PERIOD BEFORE AND AFTER THE START OF THE COVID-19 PANDEMIC IN THE INTENSIVE CARE UNIT IN A TERTIARY HOSPITAL.
Changes in working methods and diagnostics using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) diagnostics that occurred after the start of the COVID-19 pandemic could show differences in the prevalence of positive microbiological samples. In a retrospective study, a total of 442 tracheal aspirates in the pre-pandemic period (Period A, 2018, 198 patients, age median 69 (57-78)) and 277 samples in the pandemic period (Period B, 2021, 147 patients, age 68 (56-77) (p=0.585) obtained after the start of the pandemic were analyzed. A total of 176 patients had at least 1 positive result. ⋯ The most frequently isolated pathogens were Acinetobacter baumannii in 86 patients from Period A and 32 patients from Period B, i.e., 43% vs. 21.7% of all positive isolates (p=0.247), followed by Pseudomonas aeruginosa in 29 patients in Period A (14.6%) vs. 7 (3%) (p=0.112) in Period B. A statistically significant increase was observed in the incidence of Enterobacterales (16.6% vs. 32.6%, p=0.002), especially Klebsiellae spp. Although overall mortality decreased in Period B, changes in the working methods and diagnostics did not result in changes in the mortality of patients whose tracheal aspirates were sampled.
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Hospitals expanded critical care capacity during the COVID-19 pandemic by treating COVID-19 patients with high-flow nasal cannula oxygen therapy (HFNC) in non-traditional settings, including general internal medicine (GIM) wards. The impact of this practice on intensive care unit (ICU) capacity is unknown. ⋯ With appropriate training and resources, treatment of COVID-19 patients with HFNC on GIM wards appears to be a feasible strategy to increase critical care capacity.
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Acute kidney injury (AKI) is a risk factor for morbidity and mortality during critical illness especially in very old patients admitted to intensive care units. ⋯ Mortality was increased in very old ICU patients with AKI. Among survivors, two-thirds returned home.
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Acta clinica Croatica · Apr 2023
TRACHEOBRONCHIAL MORPHOMETRY CORRELATES WITH DEMOGRAPHIC CHARACTERISTICS AND INFECTIONS IN CRITICALLY ILL PATIENTS.
Tracheal measurements in the intensive care unit (ICU) are important for the choice of endotracheal tube and may correlate with patient demographic characteristics and infections. The study included 42 surgical patients, age 60 [48-71] years, who underwent diagnostic chest computed tomography (CT) scans during treatment in the ICU, Osijek University Hospital, in 2019 and 2020. CT scans were analyzed using AW Server 3.2. ⋯ It was right-sided in 15, left-sided in 6 and bilateral in 5 patients, and correlated significantly with the left main bronchus length (ρ=0.515, p=0.007). No correlation was observed between tracheobronchial measurements and length of ICU treatment, number of hours spent on mechanical ventilation, or survival. A larger study could provide better data on the importance of tracheobronchial tree measurements in ICU patients.