Efekti kombinacije ležećeg položaja i oscilatorne plućne ventilacije visoke frekvencije na razmenu gasova u krvi na modelu sindroma akutnog respiratornog šoka kod svinja

This animal study was conducted in order to verify the effects of combining high-frequency oscillatory ventilation and prone positioning and the order of application of both methods on blood gas exchange in an experimental model of acute respiratory distress syndrome.Forty domestic pigs were used for the study. Saline solution washout was produced by bilateral lung lavage. The lavage process was repeated until adequate impairment of gas exchange (defi ned as PaO2 < 100 mmHg) 60 min following the last lavage was achieved. Subsequently, lung injury was established and each model was randomized to one of fi ve groups, with differences in the type of mechanical ventilation used (conventional mechanical ventilation in accordance with the principles of protective lung ventilation or high-frequency oscillatory ventilation) and also in the positioning of the experimental model (supine position or mode changing prone and supine positions in a ratio 18:6 hours).The best oxygenation was achieved in the group prone position + high-frequency oscillatory ventilation. The most favorable combination in terms of carbon dioxide elimination is the high-frequency oscillatory ventilation + prone position. The best results in terms of oxygenation index value were obtained in the combination of a prone position with the high-frequency oscillatory ventilation and in the prone position.In conclusion, by using combinations of prone positioning and high-frequency oscillatory ventilation, one can achieve better blood gas parameters during acute respiratory distress syndrome.Ispitivanje je sprovedeno sa ciljem utvrđivanja efekata kombinacije oscilatorne ventilacije visoke frekvencije i ležećeg položaja, na razmenu gasova u krvi u eksperimentalnom modelu sindroma akutnog respiratornog šoka, kod 40 svinja. Urađena je bilateralna lavaža pluća fi ziloškim rastvorom. Postupak lavaže je ponovljan dok nije postignut adekvatan poremećaj razmene gasova (defi nisano kao PaO2<100 mmHg) 60 minuta posle poslednje lavaže. Posle toga, uočena je ozleda pluća i svaki model je nasumično raspoređen u jednu od pet grupa sa različitim tipom mehaničke ventilacije kao i prema poziciji eksperimentalnog modela (leđni položaj ili izmena stomačnog i leđnog položaja). Najbolja oksigenacija je postignuta u grupi sa stomačnim položajem + oscilatorna ventilacija visoke frekvencije. Najbolja kombinacija u odnosu na eliminaciju ugljen dioksida je bila oscilatorna ventilacija visoke frekvencije + stomačni položaj. Najbolji rezultati u odnosu na indeks oksigenacije dobijeni su primenom kombinacije stomačnog položaja + oscilatorna ventilacija visoke frekvencije kao i samo stomačni položaj. Može da se zaključi da se primenom kombinacije stomačnog položaja i oscilatorne ventilacije visoke frekvencije dobijaju bolje vrednosti gasova u krvi tokom sindroma akutnog respiratornog šoka

Classification of Infections in Intensive Care Units: A Comparison of Current Definition of Hospital-Acquired Infections and Carrier State Criterion

Background: The rate of nosocomial infection appears to depend on whether it is calculated using the Center for Disease Control (CDC) or carrier state criteria. The objective of this study was to differentiate between primary endogenous (PE), secondary endogenous (SE) and exogenous (EX) infections, and to compare this classification with CDC criteria for nosocomial infections. Methods: Children hospitalized for more than 72 h at pediatric intensive care unit during 2004–2005 were enrolled. Children, who had the infection before the admission, and or did not develop an infection within the hospitalization were excluded. Surveillance samples were sampled on admission, and then twice a week. Diagnostic samples were obtained when infection was suspected based on the clinical condition and laboratory findings. Infections were evaluated as PE, SE and EX, and their incidences were compared with CDC criteria for nosocomial infections. Results: One hundred seventy eight patients were enrolled in the study. Forty-four patients (24.7%) develop infection. Twenty-seven patients (61.3%) had PE, 10 patients (22.7%) had SE, and 7 patients (15.9%) had EX infection. Secondary endogenous and EX infections are considered as nosocomial, thus 17 patients (38.6%) had a nosocomial infection. Thirty-one patients (70.5%) met CDC criteria for nosocomial infections. Seventeen patients (55%) were classified as PE, and 14 patients (45%) as SE or EX infections.Conclusion: Seventy percent of infections (31 out of 44 patients) met the CDC criteria for nosocomial infections, but only 39% of infections (17 out of 44 patients) were classified as nosocomial based on carrier state classification

Trefoil factor 3 as a marker of intestinal cell damage during sepsis

Objective: Gastrointestinal dysfunction or gut failure frequently occurs in seriously ill patients and can be responsible for multi-organ failure. Trefoil factor 3 (TFF3) was characterized for its role in reconstitution of an epithelial barrier after mucosal injury in the jejunum. The aims of our study was an analysis of TFF3 levels dynamics in patients with sepsis and the correlation of TFF3 with severity of sepsis and mortality