The incidence of ventilator-associated pneumonia using the PneuX System with or without elective endotracheal tube exchange: A pilot study

<p>Abstract</p> <p>Background</p> <p>The PneuX System is a novel endotracheal tube and tracheal seal monitor, which has been designed to minimise the aspiration of oropharyngeal secretions. We aimed to determine the incidence of ventilator-associated pneumonia (VAP) in patients who were intubated with the PneuX System and to establish whether intermittent subglottic secretion drainage could be performed reliably and safely using the PneuX System.</p> <p>Findings</p> <p>In this retrospective observational study, data was collected from 53 sequential patients. Nine (17%) patients were initially intubated with the PneuX System and 44 (83%) patients underwent elective exchange to the PneuX System. There were no episodes of VAP while the PneuX System was <it>in situ</it>. On an intention to treat basis, the incidence VAP was 1.8%. There were no complications from, or failure of, subglottic secretion drainage during the study.</p> <p>Conclusions</p> <p>Our study demonstrates that a low incidence of VAP is possible using the PneuX System. Our study also demonstrates that elective exchange and intermittent subglottic secretion drainage can be performed reliably and safely using the PneuX System.</p

Colorimetric microwell plate reverse-hybridization assay for Mycobacterium tuberculosis detection

Direct smear examination using Ziehl-Neelsen staining for pulmonary tuberculosis (PTB) diagnosis is inexpensive and easy to use, but has the major limitation of low sensitivity. Rapid molecular methods are becoming more widely available in centralized laboratories, but they depend on timely reporting of results and strict quality assurance obtainable only from costly commercial kits available in high burden nations. This study describes a pre-commercial colorimetric method, Detect-TB, for detecting Mycobacterium tuberculosis DNA in which an oligonucleotide probe is fixed onto wells of microwell plates and hybridized with biotinylated polymerase chain reaction amplification products derived from clinical samples. The probe is capable of hybridising with the IS6110 insertion element and was used to specifically recognise the M. tuberculosis complex. When combined with an improved silica-based DNA extraction method, the sensitivity of the test was 50 colony-forming units of the M. tuberculosis reference strain H37Rv. The results that were in agreement with reference detection methods were observed in 95.2% (453/476) of samples included in the analysis. Sensitivity and specificity for 301 induced sputum samples and 175 spontaneous sputum samples were 85% and 98%, and 94% and 100%, respectively. This colorimetric method showed similar specificity to that described for commercially available kits and may provide an important contribution for PTB diagnosis

Experimentally induced epizootic rabbit enteropathy: clinical, histopathologicaI, ultrastructural, bacteriological and haematological findings

[EN] Epizootic rabbit enteropathy is an emerging disease that has appeared in French intensive enclosed rabbit farms since the beginning of 1997. Common clinical signs are mild watery diarrhoea with considerable distension of the abdomen. At necropsy, a significant dilation of the stomach and small intestine without gross evidence of acute or chronic enteric lesions (inflammation or congestion) was observed. The purpose of this study was to describe the anatomopathologic changes concerning the small intestine and those concerning the blood profile, in experimentally infected rabbits. In a first part of the experiment, thirty animals were inoculated with a reference inoculum and five were kept as controls for clinical signs examination and histopathological study. In a second part, 17 out of the inoculated rabbits and the 5 controls animals were randomly assigned to blood testing. Microscopic lesions were studied in sections from the different parts of the small intestine (duodenum, jejunum and ileum) by light microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The histological findings revealed only limited inflammation in inoculated animals. Major villous changes were atrophy, fusion, destruction and loss of epithelial cells. In inoculated rabbits, the congestion and dilation of blood vessels of jejunal lamina propria were significantly higher than in control animals (P<0.005). There was significantly more (P<0.05) apoptosis of cells of the jejunal epithelium in inoculated rabbits than in control animals. Infiltration of polymorphonuclear neutrophiles was observed into the jejunal or ileal tunica muscularis. SEM performed on the intestinal tract of 15 inoculated rabbits revealed blankets and globular particles of mucus associated with numerous bacteria on jejunum and ileum villi. This was not observed in the intestinal tract of control rabbits. Bacteria were found adhering to the epithelial surface and inside intestinal epithelial cells in a few animals by TEM and by light microscopy after Warthin-Starry staining. None of the bacteria isolated from the intestinal mixed contents and cultivated on usual media, are commonly known as rabbit's pathogens. Regarding the haematological profile, neutrophil counts significantly increased (P<0.05) and lymphocyte counts significantly decreased (P<0.01), in inoculated rabbits compared to those of the control group.Dewrée, R.; Meulemans, L.; Lassence, C.; Desmecht, D.; Ducatelle, R.; Mast, J.; Licois, D.... (2007). Experimentally induced epizootic rabbit enteropathy: clinical, histopathologicaI, ultrastructural, bacteriological and haematological findings. World Rabbit Science. 15(2). doi:10.4995/wrs.2007.602SWORD15

Reproductibilité des codages diagnostiques en réanimation Projet CIREA 1ere partie

noteInternational audienceLe codage du diagnostic par la CIM 10 permet d’identifier nos patients dans les bases de données et contribue à la valorisation des séjours. La reproductibilité du codage effectué en réanimation est mal connue. L’étude CIREA 1 se propose d’évaluer la reproductibilité dans le but d’apprécier l’utilité de la mise au point d’un outil informatique de génération automatique de codage par l’interprétation du langage naturel contenu dans les comptes rendus d’hospitalisation (CRH)