Impact of diagnostic criteria on the incidence of ventilator-associated pneumonia

BACKGROUND: Ventilator-associated pneumonia (VAP) is a frequent complication of prolonged invasive ventilation. Because VAP is largely preventable, its incidence has been used as an index of quality of care in the ICU. However, the incidence of VAP varies according to which criteria are used to identify it. We compared the incidence of VAP obtained with different sets of criteria. METHODS: We collected data from all adult patients admitted to our 35-bed ICU over a 7-month period who had no pulmonary infection on admission or within the first 48 h and who required mechanical ventilation for .48 h. To diagnose VAP, we applied six published sets of criteria and 89 combinations of criteria for hypoxemia, inflammatory response, purulence of tracheal secretions, chest radiography findings, and microbiologic findings of varying levels of severity. The variables used in each diagnostic algorithm were assessed daily. RESULTS: Of 1,824 patients admitted to the ICU during the study period, 91 were eligible for inclusion. The incidence of VAP ranged from 4% to 42% when using the six published sets of criteria and from 0% to 44% when using the 89 combinations. The delay before diagnosis of VAP increased from 4 to 8 days with increasingly stringent criteria, and mortality increased from 50% to 80%. CONCLUSIONS: Applying different diagnostic criteria to the same patient population can result in wide variation in the incidence of VAP. The use of different criteria can also influence the time of diagnosis and the associated mortality rate.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

How to manage withdrawal of sedation and analgesia in mechanically ventilated covid-19 patients?

COVID-19 patients suffering from severe acute respiratory distress syndrome (ARDS) require mechanical ventilation (MV) for respiratory failure. To achieve these ventilatory goals, it has been observed that COVID-19 patients in particular require high regimens and prolonged use of sedatives, analgesics and neuromuscular blocking agents (NMBA). Withdrawal from analgosedation may induce a “drug withdrawal syndrome” (DWS), i.e. clinical symptoms of anxiety, tremor, agitation, hallucinations and vomiting, as a result of adrenergic activation and hyperalgesia. We describe the epidemiology, mechanisms leading to this syndrome and our strategies to prevent and treat it.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Thoracoscopic Talc Pleurodesis in Malignant Pleural Effusions: impact of high frequency jet ventilation on outcome

Malignant pleural effusion is a complication of several types of advanced malignancy, which may significantly reduce the quality of life of patients.Thoracoscopic talc pleurodesis is a feasible and effective treatment, but not devoid of complications such as respiratory complications. Airways management may play a role in the occurrence of these complications.The purpose of the study is to evaluate the efficacy and safety of high frequency jet ventilation in the management of Thoracoscopic Talc Pleurodesis in Malignant Pleural Effusionsinfo:eu-repo/semantics/publishe

Cytotoxic lesions of the corpus callosum (CLOCCs) associated with SARS-CoV-2 infection.

info:eu-repo/semantics/publishe

The Acquisition of Multidrug-Resistant Bacteria in Patients Admitted to COVID-19 Intensive Care Units: A Monocentric Retrospective Case Control Study.

Whether the risk of multidrug-resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is modified by the COVID-19 crisis is unknown. In this single center case control study, we measured the rate of MDRB acquisition in patients admitted in COVID-19 ICU and compared it with patients admitted in the same ICU for subarachnoid hemorrhage (controls) matched 1:1 on length of ICU stay and mechanical ventilation. All patients were systematically and repeatedly screened for MDRB carriage. We compared the rate of MDRB acquisition in COVID-19 patients and in control using a competing risk analysis. Of note, although we tried to match COVID-19 patients with septic shock patients, we were unable due to the longer stay of COVID-19 patients. Among 72 patients admitted to the COVID-19 ICUs, 33% acquired 31 MDRB during ICU stay. The incidence density of MDRB acquisition was 30/1000 patient days. Antimicrobial therapy and exposure time were associated with higher rate of MDRB acquisition. Among the 72 SAH patients, 21% acquired MDRB, with an incidence density was 18/1000 patient days. The septic patients had more comorbidities and a greater number of previous hospitalizations than the COVID-19 patients. The incidence density of MDRB acquisition was 30/1000 patient days. The association between COVID-19 and MDRB acquisition (compared to control) risk did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93-3.21)). Thus, we conclude that, despite strong physical isolation, acquisition rate of MDRB in ICU patients was at least similar during the COVID-19 first wave compared to previous period.info:eu-repo/semantics/publishe