scholarly journals Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii

2016 ◽  
Vol 10 (10) ◽  
pp. 1129-1134 ◽  
Author(s):  
Shaher Samrah ◽  
Yazan Bashtawi ◽  
Wail Hayajneh ◽  
Basima Almomani ◽  
Suleiman Momany ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Late Onset ◽  
Therapeutic Option ◽  
Multidrug Resistant ◽  
Treatment Delay ◽  
Apache Ii Score ◽  
Ventilator Associated Pneumonia ◽  
The Difference ◽  
The Impact

Introduction: There has been increased incidence and high mortality in cases with ventilator-associated pneumonia (VAP) caused by colistin-only-susceptible Acinetobacter baumannii (COS-AB). Colistin has emerged as a therapeutic option for VAP caused by multidrug-resistant Gram-negative organisms including COS-AB. A retrospective study was conducted to examine the impact of early versus late initiation of colistin on 30-day mortality of critically ill patients with VAP caused by COS-AB. Methodology: Critically ill patients with VAP caused by COS-AB who received colistin were enrolled. The receiver operating characteristic (ROC) curve was used to identify the temporal breakpoint that maximized the difference in 30-day mortality. Results: A total of 56 patients (34 men and 22 women) were included in the study. About 86% of all cases were late-onset VAP. The 30-day mortality was 46.4%. The rate was higher among patients with admission Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 18 and patients with a delay of more than four days in initiating colistin treatment. The mortality rate was 26.9% among patients with treatment delay of four or fewer days and 63.3% for patients with a treatment delay of more than four days. Conclusions: A delay of four days or more in initiating colistin in patients with VAP caused by COS-AB significantly increases mortality. Colistin should be considered in the empirical protocols in late-onset VAP cases when COS-AB is highly suspected.

scholarly journals Evaluating probiotics for the prevention of ventilator-associated pneumonia: a randomised placebo-controlled multicentre trial protocol and statistical analysis plan for PROSPECT

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e025228 ◽  
Author(s):  
Jennie Johnstone ◽  
Diane Heels-Ansdell ◽  
Lehana Thabane ◽  
Maureen Meade ◽  
John Marshall ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Controlled Trial ◽  
Statistical Analysis Plan ◽  
Hospital Length Of Stay ◽  
Sensitivity Analyses ◽  
Ventilator Associated Pneumonia ◽  
Increased Risk ◽  
The Impact

IntroductionVentilator-associated pneumonia (VAP) is the most common healthcare-associated infection in critically ill patients. Prior studies suggest that probiotics may reduce VAP and other infections in critically ill patients; however, most previous randomised trials were small, single centre studies. The Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT) aims to determine the impact of the probioticLactobacillus rhamnosusGG on VAP and other clinically important outcomes in critically ill adults.MethodsPROSPECT is a multicentre, concealed, randomised, stratified, blinded, controlled trial in patients ≥18 years old, anticipated to be mechanically ventilated ≥72 hours, in intensive care units (ICUs) in Canada, the USA and Saudi Arabia. Patients receive either 1×1010 colony forming units ofL. rhamnosusGG twice daily or an identical appearing placebo. Those at increased risk of probiotic infection are excluded. The primary outcome is VAP. Secondary outcomes are other ICU-acquired infections includingClostridioides difficileinfection, diarrhoea (including antibiotic-associated diarrhoea), antimicrobial use, ICU and hospital length of stay and mortality. The planned sample size of 2650 patients is based on an estimated 15% VAP rate and will provide 80% power to detect a 25% relative risk reduction.Ethics and disseminationThis protocol and statistical analysis plan outlines the methodology, primary and secondary analyses, sensitivity analyses and subgroup analyses. PROSPECT is approved by Health Canada (#9427-M1133-45C), the research ethics boards of all participating hospitals and Public Health Ontario. Results will be disseminated via academic channels (peer reviewed journal publications, professional healthcare fora including international conferences) and conventional and social media. The results of PROSPECT will inform practice guidelines worldwide.Trialregistration numberNCT02462590; Pre-results.

The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients

2017 ◽  
Vol 30 (2) ◽  
pp. 69-73 ◽  
Author(s):  
Abdullah Haghighi ◽  
Vida Shafipour ◽  
Masoumeh Bagheri-Nesami ◽  
Afshin Gholipour Baradari ◽  
Jamshid Yazdani Charati
Keyword(s):  
Health Status ◽  
Oral Health ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Oral Care ◽  
Oral Health Status ◽  
Ventilator Associated Pneumonia ◽  
The Impact

Rapid Muscle Loss Negatively Impacts Survival in Critically Ill Patients With Cirrhosis

2018 ◽  
Vol 35 (7) ◽  
pp. 663-671 ◽  
Author(s):  
Sunmi Ju ◽  
Sun Mi Choi ◽  
Young Sik Park ◽  
Chang-Hoon Lee ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Muscle Mass ◽  
Critically Ill Patients ◽  
Mass Change ◽  
Apache Ii Score ◽  
Muscle Loss ◽  
Icu Mortality ◽  
Skeletal Muscle Index ◽  
The Impact

Purpose: To assess the impact of rapid muscle loss before admission to intensive care unit (ICU) in critically ill patients with cirrhosis. Materials and Methods: Patients with cirrhosis who had undergone 2 or more recent computed tomography scans before admission to the medical ICU were included. Muscle cross-sectional area at the level of the third lumbar vertebra was quantified using OsiriX software. The rate of muscle mass change and skeletal muscle index (SMI) were also calculated. Multivariable Cox proportional hazards regression was used to evaluate the association between muscle loss and mortality. Results: Among 125 patients, 113 (90.4%) patients were classified as having sarcopenia. The mean body mass index was 22.6 (3.9) kg/m2. Thirty-nine (31.2%) patients were within the normal range for muscle mass change, while 86 (68.8%) patients demonstrated rapid decline in muscle mass before admission to the ICU. Patients with rapid muscle loss showed high ICU mortality (59.3%) and in-hospital mortality (77.9%). Multivariate Cox analysis showed that ICU mortality and in-hospital mortality were independently associated with malignancy, Acute Physiology and Chronic Health Evaluation (APACHE) II score, SMI, and rapid muscle loss. Conclusion: Rapid muscle decline is correlated with increased ICU mortality and in-hospital mortality in critically ill patients with cirrhosis.

scholarly journals Spectrum of Early Onset and Late Onset Ventilator Associated Pneumonia (VAP) in a Tertiary Care Hospital of Bangladesh: A Prospective Cohort Study

2015 ◽  
Vol 3 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Uzzwal Kumar Mallick ◽  
Mohammad Omar Faruq ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Onset ◽  
Prospective Cohort ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital

Objective : To compare the outcome of critically ill patients developing early onset Ventilator-associated pneumonia (VAP) occurring within 96 h of ICU admission and late onset VAP occurring after 96 h of ICU admission in critically ill patients admitted in the ICU of BIRDEM General Hospital of Bangladesh.Study Design: Prospective cohort study.Material and Methods: Study data obtained over a period of 24 months (July 2012 - June 2014) in the ICU of a tertiary care hospital was prospectively analyzed. Subjects were classified by ventilator status: early onset VAP (< 96 hrs of mechanical ventilation) or late-onset VAP (?96 hrs of mechanical ventilation). Baseline demographics and bacterial etiology were analyzed according to the spectrum of status of VAP.Results: The incidence of VAP was 35.73 per 1,000 ventilator days. In our study 52% of the cases were early-onset VAP, while 48% were late-onset VAP. Acinetobacter was the commonest organism isolated from late-onset VAP (p = 0.029) while Pseudomonas was the commonest isolates obtained from early-onset VAP (p = 0.046). Klebsiella, MRSA and E. coli were almost identically distributed between groups (p > 0.05). There is significant difference of sensitivity pattern of Acinetobacter baumannii and pseudomonas aeruginosa in both early and late-onset VAP (p=0.01). The overall mortality rate in our study was 44%. The mortality was significantly higher in the late-onset VAP (62.5%) than that in the early-onset VAP (26.9%) (p=0.011).Conclusion: From this study we conclude that late-onset VAP had poor prognosis in terms of mortality as compared to the early-onset type. The higher mortality in the late-onset VAP could be attributed to older age, higher co-morbidities like diabetes mellitus, COPD and CKD. The findings are similar to findings of other international studiesBangladesh Crit Care J March 2015; 3 (1): 9-13

scholarly journals Point-of-Care Ultrasound-Guided Conservative Fluid Therapy Improved the Outcome of Critically Ill Patients: A Before-and-After Study

2021 ◽  
Author(s):  
Hui He ◽  
Mingqiang Zeng ◽  
Jing Chen ◽  
Lei Deng ◽  
Youdai Chen
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Apache Ii Score ◽  
Point Of Care Ultrasound ◽  
Icu Mortality ◽  
Icu Stay ◽  
The Impact ◽  
Cumulative Fluid Balance

Abstract ObjectivesTo study the impact of fluid balance on the outcome of critically ill patients.MethodsCritically ill patients managed with point-of-care ultrasound were compared with those managed without. Distended internal jugular veins and inferior vena cava with reduced collapsibility were taken as signs of hypervolemia.ResultsCompared with critically ill patients admitted before application of point-of-care ultrasound assessment (from March, 2019 through October, 2019; 291 cases), cases admitted after (from November, 2019 through June, 2020; 285 cases) had significantly lower in-ICU mortality (34.7% vs 26.7%, p=0.038; Fisher’s exact test), together with a dramatic change from overall positive fluid balance to negative one (for cumulative fluid balance during ICU stay, 2820±1381ml vs -10±39ml; p=0.001). Multiple logistic regression showed that cumulative fluid balance during ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score on admission were independent risk factors for in-ICU mortality (p<0.001, p<0.001 and p=0.043 respectively). After controlling for disease severity, Cox hazard ratio of cases with a negative cumulative fluid balance during ICU stay was 0.683 (95% confidence interval 0.475-0.981; p=0039).ConclusionsNegative cumulative fluid balance during ICU stay was associated with a reduced in-ICU mortality.

scholarly journals Nutritional Assessment in the Critically Ill Patients

2020 ◽  
Author(s):  
Elham Bagheri ◽  
Farzaneh Hematian ◽  
Mandana Izadpanah ◽  
Mahbobeh Rashidi
Keyword(s):  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Nutritional Assessment ◽  
Apache Ii ◽  
Nutritional Risk ◽  
Apache Ii Score ◽  
Number Of Patients ◽  
Study Results ◽  
The Impact

Background: Malnutrition is a prevalent complication among critically ill patients. It has very detrimental effects on the patients' clinical course. This study aimed to investigate the impact of nutrition in the intensive care unit (ICU) patients. Methods: In this epidemiologic-analytic study conducted in the surgical ICU of Imam Khomeini hospital, Ahvaz, Iran, 34 patients were selected and divided into two groups. The first group of patients received the appropriate nutrition. The second group received an inappropriate diet, and the nutritional risk was evaluated according to the modified- Nutrition Risk in Critically ill (m-NUTRIC) score. The energy was calculated by using 25 Kcal/kg, also the two groups were compared in terms of ICU mortality, ICU stays, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II Scoring, and the Sequential Organ Failure Assessment (SOFA) Score. Results: Baseline data, such as APACHE II score and mean age, except sex, were not significantly different between the two groups. In this study, results were toward shorter ICU stay, less mortality, and better SOFA score in the group receiving appropriate nutrition compared to the other group. However, due to the low number of patients, no significant differences were observed in the two groups. Conclusion: Our data suggest that nutritional support should be considered as an essential part of the medication during critical illness.

scholarly journals Incidence of multidrug-resistant bacteria in tracheal secretions from critically ill patients in the intensive care unit

2020 ◽  
Vol 93 (2) ◽  
pp. 77-83
Author(s):  
Berki Ádám-József ◽  
Benkő Csongor ◽  
Székely Edit ◽  
Szász Izabella Éva ◽  
Vas Krisztina Eszter
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bacterial Flora ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Multidrug Resistant Bacteria ◽  
Cell Counts

Abstract Ventilator-associated pneumonia is a severe nosocomial infection that affects the disease course of critically ill patients. Awareness of potential pathogens is essential for prevention, early detection, and proper treatment, as well. In this retrospective cross-sectional study, we investigated the tracheal secretions collected from critically ill patients with the aim to detect the occurrence of multidrug-resistant bacteria. We examined the bacteriological culture results of the tracheal secretions of the patients hospitalized at the Intensive Care Unit of Tîrgu Mureș Emergency Clinical County Hospital between 1st November 2017 and 31st January 2018. Admission diagnoses and comorbidities were recorded, and white blood cell counts were monitored. We determined the quality of the lower respiratory samples by microscopic examination and the results of the microbiological tests, taking into account the germ count of pathogens and the antibiotic-resistance pheno-type. During the three months, 194 samples were received from 107 patients for bacteriological examination. After the first sample collection 34 (31.77%) tracheal secretions were positive for pathogens, while in the remaining samples normal upper respiratory bacterial flora was found. From the 34 positive samples, 22 were colonizing pathogens and 30 were isolated in a clinically significant amount. Predominantly Staphylococcus aureus (n=14; 26.9%), Klebsiella pneumoniae (n=9; 17.3%), Escherichia coli (n=8.1%) and other Gram-negative bacteria (n=21; 40.4%) were identified. Among these strains 38 (73.07%) were not multidrug-resistant. The rate of positivity of individual sampling showed a positive correlation with the average duration of hospital stay (p=0.0016; r=0.8740). A total of 26 patients developed early-onset or late-onset ventilator-associated pneumonia. Potential risk factors for infection with multidrug-resistant bacteria were found. We can conclude that recently admitted patients in the intensive care unit are rarely carriers of multidrug-resistant bacteria, but become colonized or infected with multidrug-resistant strains during long-term intensive care.

scholarly journals The Impact of Fluid Balances in the First 48 Hours on Mortality in the Critically Ill Patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Azrina Md Ralib ◽  
Norhalini Hamzah ◽  
Majdiah Syahirah Nasir ◽  
Mohd Basri Mat Nor
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Elective Surgery ◽  
Secondary Analysis ◽  
Severity Of Illness ◽  
Apache Ii Score ◽  
Positive Fluid Balance ◽  
The Impact ◽  
Cumulative Fluid Balance

Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid balance in critically ill patients. The postulated mechanism of harm is the development of interstitial oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary analysis of a single centre, prospective observational study. All ICU patients more than 18 years were screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI) showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21 (1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort of AKI patients.

scholarly journals Estimation of the Difference in Colistin Plasma Levels in Critically Ill Patients with Favorable or Unfavorable Clinical Outcomes

Pharmaceutics ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 1630
Author(s):  
Jose Sanabria ◽  
Vivian Garzón ◽  
Tatiana Pacheco ◽  
Maria-Paula Avila ◽  
Julio-Cesar Garcia ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
Bacterial Infections ◽  
University Hospital ◽  
Therapeutic Window ◽  
P Value ◽  
The Difference ◽  
The Impact

In recent decades, antimicrobial resistance (AMR) has led to an increased use of therapeutic alternatives. Among these options, colistin continues to be an option for the treatment of multi-resistant (MDR) Gram-negative bacterial infections. However, due to its high toxicity (nephrotoxicity and neurotoxicity) and narrow therapeutic window, colistin treatment must be utilized carefully. Colistin-treated patients have been observed to have higher mortality due to inadequate therapeutic levels. The objective of this study was to estimate the difference in colistin plasma levels in critically ill patients, and its relationship to favorable or unfavorable clinical outcomes. This prospective observational study was conducted between September 2017 and June 2020 at the Universidad de La Sabana Clinic, in patients who had been treated with colistimethate sodium (CMS) for at least 72 h until day 7 of drug treatment in the critical care unit of a university hospital. There were no statistically significant differences in colistin levels between groups with favorable or unfavorable clinical outcomes (0.16 SD vs. 0.54 SD p-value = 0.167). There was higher mortality in patients with subtherapeutic levels (18% vs. 0%), and additionally, there was a greater rate of renal failure in the group with higher therapeutic levels (50% vs. 20.7%). Due to the loss of power of the study, we were unable to demonstrate a possible difference between colistin levels related to favorable or unfavorable clinical outcomes at day 7. However, we recommend further studies to evaluate the impact of measuring levels in terms of mortality and security.

scholarly journals Reproducibility of Protected Brush Catheter Specimen Cultures in Critically Ill Patients with Suspected Nosocomial Pneumonia

1995 ◽  
Vol 2 (3) ◽  
pp. 173-178 ◽  
Author(s):  
George A Fox ◽  
David J Leasa ◽  
William J Sibbald ◽  
David G McCormack
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Excellent Agreement ◽  
Nosocomial Pneumonia ◽  
Critically Ill Patients ◽  
Significant Relationship ◽  
Kappa Statistic ◽  
Central Nervous System Disease ◽  
Apache Ii Score ◽  
Ventilator Associated Pneumonia

OBJECTIVE: To determine the reproducibility of two protected brush catheter (PBC) specimens obtained during the same bronchoscopy in critically ill patients with suspected ventilator associated pneumonia.DESIGN: Prospective, observational study.SETTING: Two university-affiliated multidisciplinary intensive care un its with a combined total of 50 beds.PATIENTS: A total of 75 (50 male. 25 female) patients with 84 episodes of suspected ventilator associated pneumonia were studied be tween January 1, 1991 and June 30, 1992. Age was 60.7±1.9 (mean ± SEM) years, and mean APACHE II score was 22.4±2.0. Twenty-four patients were admitted from various medical services, 19 from surgical services including the operating room, 16 with central nervous system disease and 16 following multiple trauma. Twenty patients were transferred directly to the intensive care unit from peripheral hospitals.INTERVENTIONS: All patients had lower respiratory tract secretions obtained for culture by both aspiration through the endotracheal n1be (tracheal aspirates) and flexible bronchoscopy, with separate samples obtained by two PBCs (PBC-A and PBC-8).MAIN RESULTS: The overall proportion of agreement between the results of t he two PBC specimens was 0.928, with a calculated kappa statistic (κ) = 0.853 (P<0.01 versus κ=0.4, 95% CL 0.692, 1.014) indicating excellent agreement between the two specimens. Both PBC specimens had significant (ie, more than 103colony-forming units/mL) growth (positive/positive) in 33 cases, nonsignificant growth in 45 cases (negative/negative) and discordant results in six (positive/negative, n=3 or negative/positive, n=3 ). There was a significant relationship (P<0.05) between the concurrent use of antibiotics and a negative PBC result. However, after exclusion of patients on antibiotics, the overall proportion of agreement between the two PBCs was 0.94 with κ=0.875 (P<0.01 versus κ=0.4, 95% CL 0.721, 1.029), which also indicates excellent agreement between the two tests.CONCLUSIONS: Although discordant results were observed in 7.2% cases, the overall reproducibility of the PBC results appears to be high. The significant relationship between concurrent antibiotic use and a negative PBC result is of concern clinically since many patients arc being treated with antibiotics al the time of bronchoscopy. Therefore, when the diagnosis of nosocomial pneumonia in critically ill patients is established, the PBC result should be considered only in association with all the other clinical data, particularly in patients receiving concurrent antibiotics.

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