Case report: Successful experience using continuous infusion of meropenem in a geriatric patient with hip fracture complicated by sepsis

This article highlights a clinical case of successful treatment of a 79-year-old multimorbid patient with a hip fracture resulting from a household injury. On the first day, the patient’s injury was complicated by infection and pneumonia. As a result, arterial hypotension, tachysystole, and respiratory failure progressed. With manifestations of sepsis, the patient was transferred to the intensive care unit. Surgical treatment in such a situation was contraindicated due to the high operational and anesthesiological risks, the unstable severe condition of the patient, as well as the presence of concomitant pathology in the form of coronary heart disease, obesity, and schizophrenia. According to the new sepsis management guideline, it was decided to use a continuous 24-h infusion of meropenem in addition to the complex treatment of sepsis. The use of continuous infusion of meropenem in this clinical situation may have caused the patient’s clinical improvement, which increased her quality of life and decreased the length of ICU stay and total hospital stay, despite an unfavorable cumulative prognosis and a high risk of in-hospital mortality

Автоматизированное отключение от респиратора у пациентов с тяжелой сочетанной травмой

Sudden cardiac arrest (SCA) is a most important cause of death. SCA bystander first aid and cardiopulmonary resuscitation (CPR) play a key role in helping protect victims. Early defibrillation that can be made just before arrival of a professional rescue service is the optimal intervention. For this, different countries are elaborating public access defibrillation (PAD) programs based on the use of automated external defibrillators (AEDs) by nonmedical professionals. Since 2009, the service vehicles of the police of the Czech Republic and the urban police of the city of Prague, which serve its districts, have been provided by AEDs. The use of the latter in a SCA victim was first documented in spring 2010. CPR and defibril-lation were successfully carried out in the victim, which permitted neurological complications to be prevented. There is no question that AEDs can effectively defibrillate in ventricular fibrillation. CPR performed by first-contact persons correctly and successively remains to play a key role. Only if AED is incorporated into the adequately operating system, its use may be of life-saving importance to protect a number of patients. Key words: automated external defibrillation, sudden cardiac arrest, ventricular fibrillation, defibrillation.Цель исследования — изучение эффективности и безопасности автоматизированной системы отлучения от респиратора у пациентов с ОРДС, находившихся на длительной ИВЛ. Материал и методы. Было обследовано 28 пациентов с диагнозом тяжелой сочетанной травмы. В связи с развитием ОРДС все пациенты находились на длительной ИВЛ. Пациенты основной группы (n=10) переводились на самостоятельное дыхание через автоматизированную вентиляционную систему Smart Care®, в контрольной группе (n=18) отлучение от респиратора под контролем реаниматолога. Учитывали продолжительность вентиляции в режиме Smart Care®, длительность периода отлучения пациентов под контролем реаниматолога, необходимость в повторной интубации, постинтубационные осложнения. Результаты. Применение режима автоматизированного процесса отлучения пациентов от респиратора позволило в 1,3 раза сократить период нахождения пациентов с тяжелым ОРДС в условиях вспомогательного режима вентиляции. Ключевые слова: респираторный дистресс-синдром, ИВЛ, отлучение от вентилятора

Automatic Disconnection from a Ventilator in Patients with Severe Concomitant Injury

Sudden cardiac arrest (SCA) is a most important cause of death. SCA bystander first aid and cardiopulmonary resuscitation (CPR) play a key role in helping protect victims. Early defibrillation that can be made just before arrival of a professional rescue service is the optimal intervention. For this, different countries are elaborating public access defibrillation (PAD) programs based on the use of automated external defibrillators (AEDs) by nonmedical professionals. Since 2009, the service vehicles of the police of the Czech Republic and the urban police of the city of Prague, which serve its districts, have been provided by AEDs. The use of the latter in a SCA victim was first documented in spring 2010. CPR and defibril-lation were successfully carried out in the victim, which permitted neurological complications to be prevented. There is no question that AEDs can effectively defibrillate in ventricular fibrillation. CPR performed by first-contact persons correctly and successively remains to play a key role. Only if AED is incorporated into the adequately operating system, its use may be of life-saving importance to protect a number of patients. Key words: automated external defibrillation, sudden cardiac arrest, ventricular fibrillation, defibrillation

Managing adult patients with infectious diseases in emergency departments: international ID-IRI study.

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries (P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required