Nutritional Status Disorders and Selected Risk Factors of Ventilator-Associated Pneumonia (VAP) in Patients Treated in the Intensive Care Ward—A Retrospective Study

Introduction: The development of pneumonia in patients treated in intensive care wards is influenced by numerous factors resulting from the primary health condition and co-morbidities. The aim of this study is the determination of the correlation between nutritional status disorders and selected risk factors (type of injury, epidemiological factors, mortality risk, inflammation parameters, age, and gender) and the time of pneumonia occurrence in patients mechanically ventilated in intensive care wards. Material and method: The study included 121 patients with injuries treated in the intensive care ward who had been diagnosed with pneumonia related to mechanical ventilation. The data were collected using the method of retrospective analysis of patients’ medical records available in the electronic system. Results: Ventilator-associated pneumonia (VAP) occurred more frequently in patients over 61 years of age (40.4%), men (67.8%), after multiple-organ injury (45.5%), and those with a lower albumin level (86%), higher CRP values (83.5%), and leukocytes (68.6%). The risk of under-nutrition assessed with the NRS-2002 system was confirmed in the whole study group. The statistical analysis demonstrated a correlation between the leukocytes level (p = 0.012) and epidemiological factors (p = 0.035) and the VAP contraction time. Patients infected with Staphylococcus aureus had 4% of odds for the development of late VAP in comparison to Acinetobacter baumannii (p < 0.001), whereas patients infected by any other bacteria or fungi had about four times lower odds of the development of late VAP in comparison to Acinetobacter baumannii (p = 0.02). Patients with results in APACHE from 20 to 24 and from 25 to 29 had 13% and 21%, respectively, odds of the development of late VAP in comparison to patients with APACHE II scores ranging from 10 to 19 (respectively, p = 0.006; p = 0.028). Conclusions: The development of VAP is impacted by many factors, the monitoring of which has to be included in prophylactics and treatment.

DINAMICS OF THE RESULTS OF LOCAL MONITORING OF HOSPITAL INFECTION IN THE INTENSIVE CARE UNIT AND ANTIBIOTIC RESISTANCE

Summary. A comparative trial of hospital infection carries has been conducted in the department anesthesiology with intensive care ward (ADICW) over the past 5 years. Spectrum of nosocomial pathogens in the ADICW compared with 2012 has changes. Most often in the 2016–2018 years met Е. coli — 26,6 %, Ps. aeruginosa — 18,5%, Enterococcus faecium — 11,3%, Staphylococcus aureus — 10,2 %. Attracts attention decrease in sensitivity of nosocomial pathogens to meropenem in relationto the 2012–2014 years. Acinetobacter baumannii in 2016–2018 was the cause of hospital infection in 6 % and was almost resistant to meropenem.

STUDI FENOMENOLOGI: DUKUNGAN PADA IBU DALAM PERAWATAN BAYI PREMATUR DI RUANG RAWAT INTENSIF NEONATUS

Background: The premature birth of infants is a process that leads to physical unpreparedness, sources of stress, and traumatize effects for the parents. Mostly mothers showed unpleasant memories that interfered the parents’ ability to take care of their premature baby. Objective: This study aimed to obtain in-depth understanding of mother’s support in neonatal intensive care ward. Methods: This is a qualitative research using phenomenology approach involving eight participants. Data were collected through in-depth interview using data recording, interview protocol, and field note. Colaizzi method was used to analyse data. Results: Two research themes were gained from data analysis, the source and the type of support for mother with premature infants’ care. Conclusion: This study recommends for nurses to assist parents by discussing any problems and to facilitate bonding mother and baby through implementation continuum of discharge planning. Keywords: Care for Premature Infants, Neonatal Intensive Care Ward, Supporting Mothers

Formation of the pediatric hematology- oncology service in the Krasnodar region and its current activities

In the city of Sochi, in 1986, one of the first children’s hematology department in the USSR was opened. The characteristic features of the profile service of the Krasnodar Region are a strong school of professional doctors based on russian and foreign experience, the continuity of generations, close cooperation with leading federal centers and many years of fruitful work.Today, the Department of Oncology and Hematology with chemotherapy for 70 beds in the 24- hour in- patient department and 30 beds in the intensive care ward operates in Krasnodar. In addition, the hospital has a 30- bed oncology department for patients with solid tumors and tumors of the central nervous system. The expansion of the service is planned for 2023: a day hospital for oncohematological patients, a bone marrow transplant unit and a blood transfusion department with a cryopreservation station for hematopoietic stem cells.Krasnodar Region has been keeping a child cancer registry for more than 40 years. The article presents the main stages of the development of hematological and oncological assistance to children of the Krasnodar Region, the activities of the service now and its plans for the future.

The Features of the Formation of Antibiotic Resistance in the Causative Agents of Pyo-Inflammatory Lung Diseases

Objective: to study the features of the formation of antibacterial resistance of the causative agents of pyo-inflammatory lung diseases. Material and methods. The microbiological landscape of 59 patients with severe forms of pneumonia, the ability of the isolates to form biofilms, and the presence of the resistance genes to carbapenems and cephalosporins have been studied. Results. 73 isolates were isolated by the microbiological method. K. pneumoniae was the most common (64.4%). The microflora was not detected in 5 cases. The use of the PCR diagnostics made it possible to identify the associations of microorganisms in all the cases. P. aeruginosa was the one which formed the biofilm most intensively. The most common resistance genes were OXA-48 (63.1 %), CTX-M (35.9 %), and NDM (25 %). Conclusion. K. pneumoniae having the OXA-48 resistance gene was the most common pathogen in the patients with severe forms of pneumonia in the Resuscitation and Intensive Care Ward of Vitebsk Regional Clinical Hospital. The majority of the isolates possessed a moderate or high ability to form the biofilm with its maximum weight in P. aeruginosa 136.5 [23; 75.1] µg/well. The detection of antibiotic resistance genes by the method of the PCR diagnostics will make it possible to adjust the choice of drugs.

STUDI FENOMENOLOGI: DUKUNGAN PADA IBU DALAM PERAWATAN BAYI PREMATUR DI RUANG RAWAT INTENSIF NEONATUS

Background: The premature birth of infants is a process that leads to physical unpreparedness, sources of stress, and traumatize effects for the parents. Mostly mothers showed unpleasant memories that interfered the parents’ ability to take care of their premature baby. Objective: This study aimed to obtain in-depth understanding of mother’s support in neonatal intensive care ward. Methods: This is a qualitative research using phenomenology approach involving eight participants. Data were collected through in-depth interview using data recording, interview protocol, and field note. Colaizzi method was used to analyse data. Results: Two research themes were gained from data analysis, the source and the type of support for mother with premature infants’ care. Conclusion: This study recommends for nurses to assist parents by discussing any problems and to facilitate bonding mother and baby through implementation continuum of discharge planning. Keywords: Care for Premature Infants, Neonatal Intensive Care Ward, Supporting Mothers

Anaesthetic management and complications during hypophysectomy in 37 cats with acromegaly

Objectives The aim of this study was to describe the anaesthetic management and perianaesthetic complications encountered during hypophysectomy surgery in acromegalic cats. We explored relationships between animal demographic data, the anaesthetic protocol used and presence of perioperative complications. Methods Cats having undergone hypophysectomy surgery for the treatment of feline acromegaly at a single veterinary referral hospital were identified from hospital records. The anaesthesia records and clinical notes of these animals were retrospectively reviewed. Descriptive statistics were produced and binary logistic regression run to assess for any relationship between patient factors, anaesthetic management and complications during the perioperative period. Results Perianaesthetic complications identified included hypothermia, hypotension, bradycardia and airway obstruction. Mortality at 24 h post-anaesthesia was 8%. The use of alpha (α)2 agonists was associated with a lower incidence of hypotension. Fentanyl infusion was associated with a higher incidence of airway obstruction compared with remifentanil. Subjectively assessed anaesthetic recovery quality had an association with the number of days spent in the intensive care ward postoperatively. Conclusions and relevance The anaesthetic management described seems effective for hypophysectomy surgery in cats. Intraoperative complications were common and, while not apparently associated with 24 h patient outcome, drugs and equipment to manage these complications should be available.

Camp Bastion

The author describes Camp Bastion and its fifty-bed field hospital. Prior to its handover in late 2014, Camp Bastion covered eight square miles of desert in southwestern Afghanistan and served as the coalition's logistical hub in Helmand. Some 600 aircraft flew in and out of the camp every day. The hospital featured an ordinary and intensive care ward, a six-bed resuscitation bay (or emergency department), a four-theater (or bed) operating room, GP and dentist practices, and a pharmacy. Each day in the hospital began and ended with a meeting of department chiefs and included many of the surgeons. It was here that patients were discussed on an individual basis and life-or-death decisions made. The author discusses the hospital facilities, services, and amenities as well as day-to-day activities.