Lack Of Effect Of N-Acetylcysteine Treatment To Ameliorate The Progression Of Multiple Organ Failure

Objective: To investigate whether prolonged infusion of the oxygen free radical scavenger N-acetylcysteine (NAC) that is commenced immediately after admission to intensive care unit (ICU) could ameliorate the development or progression of multiple organ failure (MOF). Methods: After receiving ethical committee approval, a prospective randomized, double-blind, placebo controlled study was performed in the Anesthesiology and Reanimation Intensive Care Unit, Hacettepe University Hospital, Ankara, Turkey between December 2002 and May 2003. Twenty-six patients were randomized to receive either NAC in 5% dextrose 40 mg/kg/day or the same volume of 5% dextrose both in 4 divided doses. Two patients were withdrawn due to ICU stay <24 hours. Treatment effect on organ function was assessed by the sequential organ failure assessment (SOFA) scores according to physiological parameters of respiratory, hematological, hepatic, cardiovascular, central nervous system (CNS) and renal system scores that were obtained on admission, then daily. Chi-square, Mann Whitney U tests were used for statistical analysis. Results: There was no significant difference between the 2 groups in any of the 5 organ dysfunction parameters, total maximum SOFA, delta SOFA length of intensive care stay, days of mechanical ventilation and mortality. In the NAC treatment group, the maximum SOFA coagulation score was higher than the control group (p<0.05). Conclusion: N-acetylcysteine (40 mg/kg/day) that was commenced immediately after admission to ICU did not ameliorate the progression of MOF in this small cohort of patients. We believe routine prophylactic use of low-dose NAC in all critically ill patients does not provide positive protection.Wo

The Effect Of Acute Normovolemic Hemodilution And Acute Hypervolemic Hemodilution On Coagulation And Allogeneic Transfusion

Objective: In this study, acute normovolemic hemodilution (ANH) and hypervolemic hemodilution (HHD) were compared with no hemodilution with regards to the effectiveness in blood usage and coagulation parameters. Methods: The study was performed from February to August 2001 at Hacettepe University Hospital, Ankara, Turkey. Thirty patients undergoing hip arthroplasty surgery were prospectively randomized into: ANH group [autologous blood 15 mL kg(-1) was withdrawn and replaced by 6% hydroxyethyl starch (HES)] or HHD group (HES was administered without removal of any autologous blood) or the control group (no hemodilution). In all groups, blood was given when hemoglobin concentration was <9 g dl(-1). Results: Three groups were clinically similar regarding blood loss, mean arterial pressures and coagulation parameters. But allogeneic transfusion requirements were significantly less in hemodilution groups (20% in ANH, 40% in HHD) compared to the control group (100% of patients). Conclusion: We conclude that hemodilution (both ANH and HHD) decreases the demand for homologous blood without adversely affecting hemodynamics or coagulation parameters and HHD seems to be a simple and valuable alternative to ANH in orthopedic patient undergoing hip replacement.Wo

Efficacy Of Prophylactic Ketamine In Preventing Postoperative Shivering

Background. Treatment with ketamine and pethidine is effective in postoperative shivering. The aim of this study was to compare the efficacy of low-dose prophylactic ketamine with that of pethidine or placebo in preventing postoperative shivering. Methods. A prospective randomized double-blind study involved 90 ASA I and II patients undergoing general anaesthesia. Patients were randomly allocated to receive normal saline (Group S, n=30), pethidine 20 mg (Group P, n=30) or ketamine 0.5 mg kg(-1) (Group K, n=30) intravenously 20 min before completion of surgery. The anaesthesia was induced with propofol 2 mg kg(-1), fentanyl 1 mu g kg(-1) and vecuronium 0.1 mg kg(-1). It was maintained with sevoflurane 2-4% and nitrous oxide 60% in oxygen. Tympanic temperature was measured immediately after induction of anaesthesia, 30 min after induction and before administration of the study drug. An investigator, blinded to the treatment group, graded postoperative shivering using a four-point scale and postoperative pain using a visual analogue scale (VAS) ranging between 0 and 10. Results. The three groups did not differ significantly regarding patient characteristics. The number of patients shivering on arrival in the recovery room, and at 10 and 20 min after operation were significantly less in Groups P and K than in Group S. The time to first analgesic requirement in Group S was shorter than in either Group K or Group P (P < 0.005). There was no difference between the three groups regarding VAS pain scores. Conclusion. Prophylactic low-dose ketamine was found to be effective in preventing postoperative shivering.WoSScopu

Auswirkungen der COVID-19-Pandemie auf nosokomiale Blutstrominfektionen durch multiresistente Bakterien und auf den Antibiotikaverbrauch in einem Krankenhaus der Tertiärversorgung

We investigated the change in the epidemiology of nosocomial bloodstream infections (BSIs) caused by multidrug-resistant bacteria during Coronavirus Disease (COVID-19) and antibiotic consumption rates at a pandemic hospital and at the Oncology Hospital which operated as COVID-19-free on the same university campus. Significant increases in the infection density rate (IDRs) of BSIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and ampicillin-resistant Enterococcus faecium (ARE) were detected at the pandemic hospital, whereas carbapenem-resistant Klebsiella pneumoniae BSIs were increased at the non-pandemic Oncology Hospital. Pulsed field gel electrophoresis showed a polyclonal outbreak of CRAB in COVID-19 intensive care units. Antibiotic consumption rates were increased for almost all antibiotics, and was most significant for meropenem at both of the hospitals. Increased IDRs of CRAB and ARE BSIs as well as an increased consumption rate of broad-spectrum antibiotics emphasize the importance of a multimodal infection prevention strategy combined with an active antibiotic stewardship program.Es wurden die Veränderungen in der Epidemiologie nosokomialer Blutstrominfektionen (BSI) durch multiresistente Bakterien und die Antibiotika-Verbrauchsraten während der COVID-19 Pandemie in einem mit an COVID-19 Erkrankten belegten Krankenhaus und der Onkologischen Klinik auf demselben Universitätsgelände ohne Belegung mit COVID-19 Patienten untersucht. Im Pandemiekrankenhaus wurde ein signifikanter Anstieg der Infektionsdichte (IDR) von BSI, verursacht durch Carbapenem-resistente Acinetobacter baumannii (CRAB) und Ampicillin-resistente Enterococcus faecium (ARE), festgestellt, während Carbapenem-resistente Klebsiella pneumoniae BSI in der nicht-pandemischen Onkologischen Klinik erhöht waren. Die Pulsfeld-Gel-Elektrophorese zeigte einen polyklonalen Ausbruch von CRAB auf den COVID-19-Intensivstationen. Der Antibiotikaverbrauch war bei fast allen Antibiotika erhöht, am stärksten bei Meropenem in beiden Krankenhäusern. Erhöhte IDRs von CRAB und ARE BSIs sowie ein erhöhter Verbrauch von Breitspektrum-Antibiotika unterstreichen die Bedeutung einer multimodalen Strategie zur Infektionsprävention in Kombination mit einem aktiven Antibiotic-Stewardship-Programm