scholarly journals Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Pablo Álvarez-Maldonado ◽  
Carlos Núñez-Pérez Redondo ◽  
José D. Casillas-Enríquez ◽  
Francisco Navarro-Reynoso ◽  
Raúl Cicero-Sabido
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Oxygen Saturation ◽  
Difficult Airway ◽  
Percutaneous Tracheostomy ◽  
Fiberoptic Bronchoscopy ◽  
Diagnostic Procedures ◽  
Therapeutic Procedures ◽  
Over Time

Purpose. We describe characteristics, utility, and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU). Methods. Prospective and descriptive cohort of patients admitted to a respiratory ICU from March 2010 to June 2012. Results. A total of 102 FOBs were performed in 84 patients among 580 patients that were admitted to the ICU. Mean age was 48±17 years. FOB was useful in 65% of diagnostic procedures and 83% of therapeutic procedures, with an overall utility of 75%. Indications and utility according to indication were pneumonia in 31 cases, utility of 52%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 25 cases, utility of 76%; airway exploration in 16 cases, utility of 75%; hemoptysis in two cases, utility of 100%; and difficult airway intubation in two cases, utility of 100%. A decrease in oxygen saturation (SpO2) of >5% during FOB was present in 65% of cases, and other minor complications were present in 3.9% of cases. Conclusions. Reasons for performing FOB in the ICU have remained relatively stable over time with the exception of the addition of percutaneous tracheostomy guidance. Our series documents current indications and also the utility and safety of this procedure.

scholarly journals Noninvasive Ventilation Initiation in Clinical Practice: A Six-Year Prospective, Observational Study

2010 ◽  
Vol 17 (3) ◽  
pp. 123-131 ◽  
Author(s):  
Chris Harris ◽  
Refik Saskin ◽  
Karen EA Burns
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Clinical Practice ◽  
Observational Study ◽  
Noninvasive Ventilation ◽  
Prospective Observational Study ◽  
Obstructive Sleep ◽  
Positive Airway Pressure Ventilation ◽  
Over Time

BACKGROUND: Despite evidence supporting the role of noninvasive ventilation (NIV) in diverse populations, few publications describe how NIV is used in clinical practice.OBJECTIVE: To describe NIV initiation in a teaching hospital that has a guideline, and to characterize temporal changes in NIV initiation over time.METHODS: A prospective, observational study of continuous positive airway pressure ventilation (CPAP) or bilevel NIV initiation from January 2000 to December 2005 was conducted. Registered respiratory therapists completed a one-page data collection form at NIV initiation.RESULTS: Over a six-year period, NIV was initiated in 623 unique patients (531 bilevel NIV, 92 CPAP). Compared with bilevel NIV, CPAP was initiated more often using a nasal interface, with a machine owned by the patient, and for chronic conditions, especially obstructive sleep apnea. Whereas CPAP was frequently initiated and continued on the wards, bilevel NIV was most frequently initiated and continued in the emergency department, intensive care unit and the coronary care unit. Patients initiated on bilevel NIV were more likely to be female (OR 1.8, 95% CI 1.08 to 2.85; P=0.02) and to have an acute indication compared with CPAP initiations (OR 7.5, 95% CI 1.61 to 34.41; P=0.01). Bilevel NIV was initiated more often in the emergency department than in the intensive care unit (OR 5.8, 95% CI 0.89 to 38.17; P=0.07). Bilevel NIV initiation increased from 2000 to 2005.CONCLUSIONS: The present study illustrates how NIV is used in clinical practice and confirms that NIV initiation has increased over time.

scholarly journals Perioperative Complications And Concomitant Diseases Of Patients Followed In Intensive Care Unit After Cleft Lip-Palate Surgery

2021 ◽  
Author(s):  
Murat Tümer ◽  
Ayşe Ayyıldız ◽  
Başak Akça ◽  
Aysun Ankay Yılbaş ◽  
Filiz Üzümcügil ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Difficult Airway ◽  
Difficult Intubation ◽  
Cleft Lip ◽  
Systemic Disease ◽  
Fiberoptic Bronchoscopy ◽  
Close Monitoring ◽  
Cleft Lip Palate

INTRODUCTION: Cleft lip/palate (CLCP) patients might need postoperative care in Intensive Care Unit (ICU) due to several reasons like difficult airway management, associated abnormalities and perioperative respiratory complications. Our aim was to evaluate the factors associated with difficult airway and need for postoperative ICU follow-up in CLCP patients operated in our institution. METHODS: CLCP patients followed in ICU after surgery between 2005-2013 were retrospectively reviewed. RESULTS: Twenty patients were included to the study. Ten had CLCP together, ten had isolated cleft palate. Difficult intubation was seen in 8 patients. Difficult mask ventilation was seen only in one patient with 22q11 deletion. All patients with difficult intubation had micrognathia. Nasal fiberoptic bronchoscopy was more commonly used in patients with difficult intubation. There was a statistically significant relationship between the presence of any systemic disease and difficult intubation. Main reasons for ICU follow-up were the need for close monitoring and airway related problems. DISCUSSION AND CONCLUSION: Difficult airway is a frequent problem in CLCP patients even in the absence of a diagnosed syndrome. Patients with difficult airway or risk of postoperative airway obstruction could be better followed in ICU during early postoperative period for rapid diagnosis and treatment of possible complications by experienced staff.

scholarly journals Lipoprotein concentrations over time in the intensive care unit COVID-19 patients: Results from the ApoCOVID study

PLoS ONE ◽  
2020 ◽  
Vol 15 (9) ◽  
pp. e0239573 ◽  
Author(s):  
Sébastien Tanaka ◽  
Christian De Tymowski ◽  
Maksud Assadi ◽  
Nathalie Zappella ◽  
Sylvain Jean-Baptiste ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Over Time

Shortening the Application Time of Alcohol-Based Hand Rubs to 15 Seconds May Improve the Frequency of Hand Antisepsis Actions in a Neonatal Intensive Care Unit

2017 ◽  
Vol 38 (12) ◽  
pp. 1430-1434 ◽  
Author(s):  
Axel Kramer ◽  
Didier Pittet ◽  
Romana Klasinc ◽  
Stefan Krebs ◽  
Torsten Koburger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Application Time ◽  
Improve Hand Hygiene ◽  
Independent Observer ◽  
Hand Antisepsis

BACKGROUNDFor alcohol-based hand rubs, the currently recommended application time of 30 seconds is longer than the actual time spent in clinical practice. We investigated whether a shorter application time of 15 seconds is microbiologically safe in neonatal intensive care and may positively influence compliance with the frequency of hand antisepsis actions.METHODSWe conducted in vitro experiments to determine the antimicrobial efficacy of hand rubs within 15 seconds, followed by clinical observations to assess the effect of a shortened hand antisepsis procedure under clinical conditions in a neonatal intensive care unit (NICU). An independent observer monitored the frequency of hand antisepsis actions during shifts.RESULTSAll tested hand rubs fulfilled the requirement of equal or even significantly higher efficacy within 15 seconds when compared to a reference alcohol propan-2-ol 60% (v/v) within 30 seconds. Microbiologically, reducing the application time to 15 seconds had a similar effect when compared to 30-second hand rubbing, but it resulted in significantly increased frequency of hand antisepsis actions (7.9±4.3 per hour vs 5.8±2.9 per hour; P=.05).CONCLUSIONTime pressure and workload are recognized barriers to compliance. Therefore, reducing the recommended time for hand antisepsis actions, using tested and well-evaluated hand rub formulations, may improve hand hygiene compliance in clinical practice.Infect Control Hosp Epidemiol 2017;38:1430–1434

Role of Fiberoptic Bronchoscopy in Intensive Care Unit

2011 ◽  
Vol 18 (1) ◽  
pp. 69-83 ◽  
Author(s):  
Elsa Guerreiro da Cunha Fragoso ◽  
José Manuel Rosal Gonçalves
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Fiberoptic Bronchoscopy

scholarly journals Persistence of Pneumococcal Serotype 3 in Adult Pneumococcal Disease in Hong Kong

Vaccines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 756
Author(s):  
Reema Subramanian ◽  
Veranja Liyanapathirana ◽  
Nilakshi Barua ◽  
Rui Sun ◽  
Maggie Haitian Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pneumococcal Disease ◽  
Disease Burden ◽  
Patient Characteristics ◽  
Adult Vaccination ◽  
Pneumococcal Serotype ◽  
Pneumococcal Immunisation ◽  
Microbroth Dilution ◽  
Over Time

The epidemiology of hospitalised pneumococcal disease in adults following the introduction of universal childhood pneumococcal immunisation in 2009 was assessed. Culture-confirmed Streptococcus pneumoniae (SP) from adults hospitalised between 2009 to 2017 were examined. The cases were categorised into invasive pneumococcal disease (IPD) and pneumonia (bacteraemic, non-bacteraemic, and that associated with other lung conditions). The isolates were serotyped and antimicrobial susceptibilities were determined by microbroth dilution. Patient characteristics, comorbidities, and outcomes were analysed. Seven hundred and seventy-four patients (mean age, 67.7 years, SD ± 15.6) were identified, and IPD was diagnosed in 110 (14.2%). The most prevalent serotype, 19F, was replaced by serotype 3 over time. Penicillin and cefotaxime non-susceptibilities were high at 54.1% and 39.5% (meningitis breakpoints), 19.9% and 25.5% (non-meningitis breakpoints), respectively. The overall 30-day mortality rate was 7.8% and 20.4% for IPD. Age ≥ 75 years (OR:4.6, CI:1.3–17.0, p < 0.02), presence of any complications (OR:4.1, CI:1.02–16.3, p < 0.05), pleural effusion (OR:6.7, CI:1.2–39.4, p < 0.03) and intensive care unit (ICU) admission (OR:9.0, CI:1.3–63.4, p < 0.03) were independent predictors of 30-day mortality. Pneumococcal disease by PCV 13 covered serotypes; in particular, 19F and 3 are still prominent in adults. Strengthening targeted adult vaccination may be necessary in order to reduce disease burden.

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