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Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

RESPONSE OF HIGH LEVEL GENTAMICIN RESISTANT ENTEROCOCCI

In the present study the incidence of high level resistance (HLR) to gentamicin (MIC~500flg/ml) was determined for 138 clinical enterococcal isolates, representing 108 E. jaecalis , 26 E. jaecium and 4 other Enterococcus spp. A 28.3% of the isolates, comprising 42.3% of E,faecium and 25.9%of E,jaecalis isolates were found to be HLR to gentamicin, A 5% of the isolates were resistant to 2000 flg/ml of gentamicin, representing one (0,9%) of E,faecalis isolates and 7 (23%) of E,faecium isolates, Eight selected isolates were used to evaluate the bactericidal activity of penicillin--gentamicin combination by the time-kill curve method, Bactericidal synergy for the combination was obtained for two E. jaeciunt isolates (No, I 6 and 32) whereas a synergistic bacteriostatic activity was observed for a third E. jaecium isolate (NoJ5), despite their resistance to penicillin alone, No synergy was obtained for the other two E,faecalis isolates (No.19 and 32), No synergy was obtained for the other non-E. jaecium isolates. Although penicillin alone was bactericidal, the two E, jaecalis isolates (No,2 and 137) did not show synergistic bactericidal activity for the combination, irrespective of the level of resistance to gentamicin (No, 2 is not HLR but 137 is), For the other Enterococcus raffinosus (isolate), although it was not HLR to gentamicin and being susceptible to penicillin neither bactericidal effect for penicillin nor for the combination was observed

Coordination versatility of N2O4 polydentate hydrazonic ligand in Zn(II), Cu(II), Ni(II), Co(II), Mn(II) and Pd(II) complexes and antimicrobial evaluation

New polydentate hydrazone ligand, was synthesized by the condensation of 1,5-dimethyl-3-oxo-2-phenylpyrazole-4-carbaldehyde with adipodihydrazide. The structure of the synthesized ligand, Nâ²1,Nâ²6-bis((1,5-dimethyl-3-oxo-2-phenyl-2,3-dihydro-1H-pyrazol-4-yl) methylene) adipohydrazide was elucidated by various analytical and spectroscopic techniques. The reactions of the ligand with zinc(II), copper(II), nickel(II), cobalt(II), manganese(II) and palladium(II) salts afforded homobinuclear metal complexes. Characterization and structure elucidation of the prepared complexes were achieved using different analytical and spectroscopic techniques. The analyses data indicated that this ligand behaved as N2O4 dibasic hexadentate ligand bonded covalency to the metal ions through the enolic carbonyl oxygen of hydrazide moiety and coordinated via carbonyl oxygen of antipyrine moiety and azomethine nitrogen atoms forming distorted octahedral geometry around the metal ions. The ESR spectra of copper(II) complexes (3) and (4) showed an axial symmetry with g||>gâ¥>ge, indicating distorted octahedral structure and presence of the unpaired electron in d(x2ây2) orbital. The microbicide studies of the ligand and its metal complexes (2), (3), (4), (5), (8), (11) and (13) showed that, all these complexes exhibit moderate to mild inhibitory effects on B. subtilis, E. coli while complexes (2), (3), (4) and (13) exhibit moderate to mild inhibitory effects on A. niger. Keywords: Hexadentate, Hydrazone, Antipyrine, ESR, Adipohydrazide, Microbicid

Synthesis, physicochemical studies and biological evaluation of unimetallic and heterobimetallic complexes of hexadentate dihydrazone ligands

A new coordination unimetallic and heterobimetallic complexes of hexadentate N2O4 donor dihydrazone ligands were prepared by the condensation of 4-formyl antipyrine with adipic dihydrazide and succinic dihydrazide. The ligands (1) and (11) and their complexes thoroughly characterized using various analytical, physical and spectroscopic techniques, which indicate a distorted octahedral geometry around the metal ions. The ESR spectra of solid copper(II) complexes (2–4) and (12–14) showed axial symmetry with g||>g⊥ > ge, indicating distorted octahedral structure and the presence of the unpaired electron in a d(x2−y2) orbital with significant covalent bond character. The antimicrobial activity results of the metal compounds (2–5), (7), (10), (12–15) and (17) show that, all these complexes exhibit inhibitory moderate to mild effects towards Bacillus subtilis, Escherichia coli and Aspergillus niger