scholarly journals Hiccups in the Neuro-Critical Care Unit: A Symptom Less Studied?

2017 ◽  
Vol 1 (2) ◽  
pp. AX1-AX3
Author(s):  
Charu Dutt Arora ◽  
Jaya Wanchoo ◽  
Garima Khera
Keyword(s):  
Critical Care ◽  
Respiratory Alkalosis ◽  
Accurate Estimate ◽  
Transient Condition ◽  
Ventilator Associated Pneumonia ◽  
Pharmacological Management ◽  
Mechanically Ventilated ◽  
Keywords Anaesthesia ◽  
Decompressive Craniotomy ◽  
Intractable Hiccups

Background: Hiccups (also referred to as “hiccoughs”) are usually a transient condition that affects almost everyone in their lifetime. However, persistent and intractable hiccups are the types which are often linked with unfavorable outcomes and can also result in respiratory alkalosis in the intubated patients. There is no accurate estimate of the prevalance of hiccups in the patients admitted in the neuro-ICU.The most commonly witnessed hiccups in the neuro-ICU are intractable and neurogenic in nature. In this communication, we discuss the strategy of respiratory care and pharmacological management of hiccups in an adult male post decompressive craniotomy in view of unilateral basal ganglion bleed.  He suffered from persistent hiccups and was managed conservatively with intravenous Metachlorpromide 10 mg on as and when needed (SOS) basis. In conclusion, it seems that persistent and intractable hiccups as a risk factor for ventilator-associated pneumonia in patients who are intubated and mechanically ventilated should be given due attention. We encourage clinical trials in this area of critical care medicine and should also encourage more studies to analyse the effectiveness of non-pharmacological methods. Keywords: Anaesthesia, Critical care, Hiccups, Mechanical ventilation, Basal ganglia.

scholarly journals Chlorhexidine Oral Care in Critically Ill Adults

2021 ◽  
Vol 1 (10) ◽  
Author(s):  
Anusree Subramonian ◽  
Jennifer Horton
Keyword(s):  
Critical Care ◽  
Randomized Clinical Trials ◽  
Oral Care ◽  
Clinical Effectiveness ◽  
Ventilator Associated Pneumonia ◽  
Specific Recommendation ◽  
Mechanically Ventilated ◽  
Care Protocol ◽  
Significant Difference ◽  
Critically Ill Adults

Three systematic reviews and 2 randomized clinical trials were identified regarding the clinical effectiveness of chlorhexidine oral care in adult patients who were in critical care and being mechanically ventilated. The evidence was of limited quality, with methodological limitations. Compared to ozonated water and to Nanosil, chlorhexidine oral care was associated with a significantly higher risk of ventilator-associated pneumonia. Compared to bicarbonate, chlorhexidine oral care was associated with a significantly lower risk of ventilator-associated pneumonia. There was no significant difference in the risk of ventilator-associated pneumonia between chlorhexidine and other agents, such as potassium permanganate, hydrogen peroxide, or miswak. There was no significant difference in the risk of mortality between oral care with chlorhexidine and that with other oral care drugs. An evidence-based guideline targeting individuals who require assistance on oral care recommended a multi-component oral care protocol. No specific recommendation regarding the use of oral care agents for the prevention of ventilator-associated pneumonia was made because of lack of evidence. There is a lack of evidence on the safety or cost-effectiveness of chlorhexidine oral care in adults who are in critical care and being mechanically ventilated.

Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults?

2019 ◽  
Vol 28 (11) ◽  
pp. 682-689 ◽  
Author(s):  
Laura Jackson ◽  
Melissa Owens
Keyword(s):  
Critical Care ◽  
Oral Cavity ◽  
Critically Ill ◽  
Oral Care ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Oral colonisation by pathogens contributes to contracting ventilator-associated pneumonia (VAP). The aim of this review was to determine whether the use of the antiseptic chlorhexidine in the intra-oral cavity reduced its incidence in the critically ill, mechanically ventilated adult. The findings from this review led to the conclusion that chlorhexidine reduced the occurrence of VAP. Although a recommendation to implement the use of intra-oral chlorhexidine for mechanically-ventilated patients within critical care can be made, further exploration into required frequency and method of administration would be beneficial to reduce unnecessary exposure and hinder pathogenic resistance.

scholarly journals Prognostic biomarkers in predicting mortality in respiratory patients with ventilator-associated pneumonia

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nermeen A. Abdelaleem ◽  
Hoda A. Makhlouf ◽  
Eman M. Nagiub ◽  
Hassan A. Bayoumi
Keyword(s):  
Sofa Score ◽  
Diagnostic Performance ◽  
Mortality Prediction ◽  
Ventilator Associated Pneumonia ◽  
Distribution Width ◽  
Mechanically Ventilated ◽  
Neutrophil Lymphocyte Ratio ◽  
Prognostic Accuracy ◽  
Severity Scores ◽  
Critical Patients

Abstract Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection. Red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) are prognostic factors to mortality in different diseases. The aim of this study is to evaluate prognostic efficiency RDW, NLR, and the Sequential Organ Failure Assessment (SOFA) score for mortality prediction in respiratory patients with VAP. Results One hundred thirty-six patients mechanically ventilated and developed VAP were included. Clinical characteristics and SOFA score on the day of admission and at diagnosis of VAP, RDW, and NLR were assessed and correlated to mortality. The average age of patients was 58.80 ± 10.53. These variables had a good diagnostic performance for mortality prediction AUC 0.811 for SOFA at diagnosis of VAP, 0.777 for RDW, 0.728 for NLR, and 0.840 for combined of NLR and RDW. The combination of the three parameters demonstrated excellent diagnostic performance (AUC 0.889). A positive correlation was found between SOFA at diagnosis of VAP and RDW (r = 0.446, P < 0.000) and with NLR (r = 0.220, P < 0.010). Conclusions NLR and RDW are non-specific inflammatory markers that could be calculated quickly and easily via routine hemogram examination. These markers have comparable prognostic accuracy to severity scores. Consequently, RDW and NLR are simple, yet promising markers for ICU physicians in monitoring the clinical course, assessment of organ dysfunction, and predicting mortality in mechanically ventilated patients. Therefore, this study recommends the use of blood biomarkers with the one of the simplest ICU score (SOFA score) in the rapid diagnosis of critical patients as a daily works in ICU.

scholarly journals Gastroesophageal reflux in mechanically ventilated pediatric patients and its relation to ventilator-associated pneumonia

Critical Care ◽  
2009 ◽  
Vol 13 (5) ◽  
pp. R164 ◽  
Author(s):  
Tarek A Abdel-Gawad ◽  
Mostafa A El-Hodhod ◽  
Hanan M Ibrahim ◽  
Yousef W Michael
Keyword(s):  
Gastroesophageal Reflux ◽  
Pediatric Patients ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated

A Comparative Cross-Sectional Study to compare the Isolated Organism and their Antibiotic Sensitivity Pattern Between Community-Acquired Pneumonia (CAP) and Ventilator-Associated Pneumonia (VAP) in Intensive Care Unit (ICU).

2021 ◽  
Vol 11 (Number 2) ◽  
pp. 26-34
Author(s):  
Nahian Ahmed Chowdhury ◽  
Dipak Kumar Mitra ◽  
Afrin Ahmed Clara ◽  
Md. Suhail Alam ◽  
MD. Zahed Hossain
Keyword(s):  
Medical Information ◽  
Antibiotic Sensitivity ◽  
Cross Sectional Study ◽  
Community Acquired Pneumonia ◽  
Ventilator Associated Pneumonia ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mechanically Ventilated ◽  
Sensitivity Pattern ◽  
Staphylococcus Spp

Background: The moment most common cause of in-hospital infection is pneumonia. Pneumonia is prevalent within the ICU (Intensive Care Unit) setting and can be deadly. The Incidence of pneumonia is approximately 17% in the therapeutic ICU2 but can be 6 to 20 times increased in mechanically ventilated patients. The duration of hospital stay and expenditure are both expanded in patients who develop ventilator-associated pneumonia. This study aims to identify the causative microorganism responsible for CAP (Community-Acquired Pneumonia) and VAP (Ventilator-Associated Pneumonia) and their antibiotic sensitivity pattern. Methods: This was a comparative cross-sectional study that was carried out at two ICU in Sylhet city. The data was collected from the patient's medical information, the patient's file, and the hospital information system. Culture and sensitivity (C/S) were collected from the electronic medical information system (MIS). All data from January 2019 to December 2020, including patient's information, course of the disease (in terms of death or recovery-if available), clinical features, and investigation reports, was transferred to an electronic data collection sheet (Microsoft Excel). After completion of all data collection, analysis was conducted through a spreadsheet. Comparison between two disease groups was made by independent t-test. Within the group, the analysis was done by the Chi-Square test. Results: In this thesis study, it was found that the most common organism responsible for CAP was Streptococcus spp. (34.70%) and is sensitive to Meropenem (92.21%), Imipenem (88.16%), Amikacin (70.67%), Piperacillin (70.91%), Moxifloxacin (70.96%), Levofloxacin (67.95%), Amoxiclav (67.92%), and Ceftriaxone(63.95%). The most common causative organism responsible for VAP was Staphylococcus spp. (36.51%) and it was sensitive to Imipenem (100%), Moxifloxacin (100%), Meropenem (94.73%), Amikacin (85.71%), Ceftriaxone (60%), Amoxiclav (66.66%), Levofloxacin (57.14%), and Cefuroxime (50%). Conclusion: Pneumonia is still one of the most common reasons for hospitalization, particularly for those admitted to ICU. It has been observed in several studies that the majority of the cases are communityacquired pneumonia. Many mechanically ventilated patients often develop VAP, which is fatal if timely diagnosis and appropriate antibiotics administration are not made. Streptococcus spp. was the most common organism responsible for CAP, and Staphylococcus spp. mainly was responsible for VAP.

scholarly journals Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

2015 ◽  
Vol 9 (12) ◽  
pp. 1323-1330 ◽  
Author(s):  
Basima Abdalla Almomani ◽  
Amanda McCullough ◽  
Rawan Gharaibeh ◽  
Shaher Samrah ◽  
Fatimah Mahasneh
Keyword(s):  
Critical Care ◽  
Acinetobacter Baumannii ◽  
Case Series ◽  
Positive Culture ◽  
Multidrug Resistant ◽  
Ventilator Associated Pneumonia ◽  
Retrospective Case ◽  
Critical Care Units ◽  
Susceptibility Data ◽  
Case Series Study

Introduction: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) is common in hospitals and impacts patient survival. We determined the incidence of MDR-AB VAP in critical care units and examined the predictors of 14-day mortality in these patients. Methodology: A retrospective case series study was conducted at a tertiary referral teaching hospital in north Jordan. A list of patients with a positive culture of A. baumannii between January 2007 and June 2013 was retrieved using computerized hospital databases. Medical records of all these patients were reviewed, and cases of VAP infected with MDR-AB were identified. Predictors of 14-day mortality were determined using multivariable logistic regression adjusted for possible confounders. Results: Out of 121 A. baumannii-VAP cases, 119 (98.3%) were caused by MDR-AB. The incidence rate of MDR-AB VAP was 1.59 cases per 100 critical care unit admissions. The mortality of A. baumannii-VAP cases in critical care units was 42% (50/119). Being prescribed two or more definitive antibiotics (prescribed based on susceptibility data) (OR = 0.075, 95% CI = 0.017–0.340, p = 0.001) and ipratropium/salbutamol during mechanical ventilation (OR = 0.140, 95% CI = 0.028–0.705, p = 0.017) were independently associated with lower hospital mortality. Conclusions: Our results suggest incidence of MDR-AB VAP in critical care units is high and that prescription of antibiotics based on antibiotic susceptibility and use of bronchodilators is associated with lower mortality in this population. Larger prospective studies are needed to explore whether these findings can be replicated in different clinical settings.

Subsequent Pressure Injury Development in Mechanically Ventilated Critical Care Patients with Hospital-Acquired Pressure Injury

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jenny Alderden ◽  
Allen Cadavero ◽  
Yunchuan “Lucy” Zhao ◽  
Desiree Dougherty ◽  
Se-Hee Jung ◽  
...  
Keyword(s):  
Critical Care ◽  
Mechanically Ventilated ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

Frequent problems and their management among mechanically ventilated critically ill elderly patients

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Watchara Tabootwong ◽  
Frank Kiwanuka
Keyword(s):  
Elderly Patients ◽  
Critically Ill ◽  
Health Care Professionals ◽  
Respiratory Infections ◽  
Psychological Problems ◽  
Pharmacological Management ◽  
Content Type ◽  
Mechanically Ventilated ◽  
Age Related ◽  
Management Of Complications

Purpose Multiple pathologies and age-related physiological changes lead to acute respiratory failure. This necessitates mechanical ventilation among elderly patients. Mechanically ventilated critically ill elderly patients may confront various problems, including physical and psychological issues. Therefore, the purpose of this paper is to present the frequent problems encountered by critically ill elderly patients and management of such problems. Design/methodology/approach This paper reviews relevant literatures. Findings Physical problems include pain and respiratory infections. Additionally, psychological problems include anxiety and stress. Such problems should be managed by physicians, nurses and family members. Pharmacological and non-pharmacological approaches can be used to manage these problems. Pharmacological management involves use of medications, while non-pharmacological interventions include use of music therapy, acupuncture and sensory stimulation. Originality/value The paper indicates physical and psychological problems of mechanically ventilated critically ill elderly patients. To ensure effective management of complications encountered by mechanically ventilated elderly patients, health-care professionals ought to be aware of physical and psychological age-related changes.

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