Frequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: Systematic review and meta-analysis

SummaryObjectiveTo clarify issues regarding the frequency, prevention, outcome, and treatment of patients with ventilator-associated tracheobronchitis (VAT), which is a lower respiratory tract infection involving the tracheobronchial tree, while sparing the lung parenchyma.MethodsWe performed a systematic review and meta-analysis of relevant available data, gathered though searches of PubMed, Scopus, and reference lists, without time restrictions. A conservative random effects model was used to calculate pooled odds ratios (OR) and 95% confidence intervals (CI).ResultsOut of the 564 initially retrieved articles, 17 papers were included. Frequency of VAT was 11.5%. Selective digestive decontamination was not proved an effective preventive strategy against VAT (OR: 0.62, 95% CI: 0.31–1.26). Presence, as opposed to the absence, of VAT was not associated with higher attributable mortality (OR: 1.02, 95% CI: 0.57–1.81). Administration of systemic antimicrobials (with or without inhaled ones), as opposed to placebo or no treatment, in patients with VAT was not associated with lower mortality (OR: 0.56, 95% CI: 0.27–1.14). Most of the studies providing relevant data noted that administration of antimicrobial agents, as opposed to placebo or no treatment, in patients with VAT was associated with lower frequency of subsequent pneumonia and more ventilator-free days, but without shorter length of intensive care unit stay or shorter duration of mechanical ventilation.ConclusionsApproximately one tenth of mechanically ventilated patients suffer from VAT. Antimicrobial treatment of patients with VAT may protect against the development of subsequent ventilator-associated pneumonia and improve weaning outcome

Open-Circuit Mouthpiece Ventilation: Indications, Evidence and Practicalities

Open-circuit mouthpiece ventilation (MPV) is a method of noninvasive ventilation, which can be used to provide full-time support, induce lung volume recruitment, increase cough efficacy, defer tracheostomy and possibly improve survival and quality of life in advanced-stage neuromuscular patients. MPV might also be applicable to other chronic respiratory diseases as well as in acute exacerbations of chronic obstructive pulmonary disease and can also be employed for the extubation of unweanable neuromuscular patients. A candidate for MPV should be able to rotate his neck adequately, grab the mouthpiece with his lips and maintain sufficient control of the upper airway muscles. MPV is usually provided in the volume assisted-controlled mode with a tidal volume between 0.7 and 1.5 L, zero PEEP and backup rate set to the lower allowed value, allowing the patient to define his own ventilatory pattern. The “low pressure” and “apnea” alarm should be switched off, if possible, or special setting adjustments should be used to prevent their activation. Comprehensive patient training and dedicated nursing time are important for the application of MPV. MPV is considered a safe method for the majority of the patients, but accidental mouthpiece loss is an important concern

Effect of the Independent Acid Base Variables on Anion Gap Variation in Cardiac Surgical Patients: A Stewart-Figge Approach

Purpose. To determine the effect of each of independent acid base variables on the anion gap (AG) value in cardiac surgical patients. Methods. This retrospective study involved 128 cardiac surgical patients admitted for postoperative care. The variation of AG (AGvar) between the day of admission and the first postoperative day was correlated via a multiple linear regression model with the respective variations of the independent acid base variables, that is, apparent strong ion difference (SIDa), strong ion gap (SIG), carbon dioxide (PCO2), and albumin and phosphate concentrations. Results. The variations of all the above variables contributed significantly to the prediction of AGvar (adjusted R2=0.9999, F=201890.24, and P<0.001). According to the standardized coefficients (β),  SIGvar (β = 0.948, P<0.001), [Albumin]var (β = 0.260, P<0.001), and [Phosphate]var (β = 0.191, P<0.001) were the major determinants of AGvar with lesser contributions from SIDa, var (β = 0.071, P<0.001) and PCO2, var (β = −0.067, P<0.001). Conclusions. All the independent acid base variables contribute to the prediction of the AG value. However, albumin and phosphate and SIG variations seem to be the most important predictors, while AG appears to be rather stable with changes in PCO2 and SIDa

Functional Comorbidity Index and health-related quality of life in patients with obstructive sleep apnea

Introduction: The role of comorbidities in determining health-related quality of life (HRQL) in obstructive sleep apnea (OSA) pa-tients has not been thoroughly investigated. Commonly used comorbidity tools, such as Charlson Comorbidity Index (CCI), have been designed with mortality as the outcome variable. A new tool, the Functional Comorbidity Index (FCI), has been especially developed to assess the effect of comorbidities on the “physical functioning” subscale of the Medical Outcomes Short Form-36 Health Survey (SF-36). 1) To determine the role of FCI in the prediction of the effect of comorbidities on HRQL in OSA. 2) To determine whether FCI and CCI are equally robust in predicting the effect of comorbidities on HRQL in OSA. Material and methods: Two hundred and fifty-five OSA patients were enrolled. Patients completed the SF-36 and the Medical Outcomes Study Sleep Scale (MOS-SS) forms, while their comorbidity status was assessed by FCI and CCI. The SF-36 physical (PCS-36) and mental component summary (MCS-36) scores were also calculated. Results: PCS-36 was predicted by FCI (p &lt; 0.001), male gender (p = 0.001), BMI (p = 0.002) and the “awakening with “breathlessness/headache” MOS-SS subscale (p = 0.011) (R2 = 0.348). Among these predictors, FCI exerted the most important quantitative effect. MCS-36 was predicted only by the “sleep disturbance” (p = 0.005) and the “awakening with breathlessness/headache” MOS-SS subscales (p &lt; 0.001) (R2  = 0.221). Conclusions: In patients with OSA, FCI is an independent predictor of the physical aspect of their HRQL. FCI is more robust than CCI in assessing the effect of comorbidities on HRQL in OSA

A semi-automatic process for estimating fetus velocity using ultrasound imaging and videos

Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS, Volume 2015-November, 4 November 2015, Article number 7319840, Pages 6330-6333Contemporary technologies have positively affected everyday medical practice for the benefit of faster and more objective diagnoses. Image and video processing techniques have added potential to this effort, but still there is a long road ahead. In this paper a specially developed video processing methodology is described which determines the fetus velocity using B-mode ultrasonic video imaging. For that purpose, a semi-automated process using advanced computer vision and image processing tools is presented and evaluated. The results are presented with a detailed statistical analysis to verify the repeatability ad reliability of the method

Functional Comorbidity Index and Health-Related Quality of Life in Patients with Obstructive Sleep Apnea

Introduction: The role of comorbidities in determining health-related quality of life (HRQL) in obstructive sleep apnea (OSA) pa-tients has not been thoroughly investigated. Commonly used comorbidity tools, such as Charlson Comorbidity Index (CCI), have been designed with mortality as the outcome variable. A new tool, the Functional Comorbidity Index (FCI), has been especially developed to assess the effect of comorbidities on the “physical functioning” subscale of the Medical Outcomes Short Form-36 Health Survey (SF-36). (1) To determine the role of FCI in the prediction of the effect of comorbidities on HRQL in OSA. (2) To determine whether FCI and CCI are equally robust in predicting the effect of comorbidities on HRQL in OSA. Material and Methods: Two hundred and fifty-five OSA patients were enrolled. Patients completed the SF-36 and the Medical Outcomes Study Sleep Scale (MOS-SS) forms, while their comorbidity status was assessed by FCI and CCI. The SF-36 physical (PCS-36) and mental component summary (MCS-36) scores were also calculated. Results: PCS-36 was predicted by FCI (p &lt; 0.001), male gender (p = 0.001), BMI (p = 0.002) and the “awakening with “breathlessness/headache” MOS-SS subscale (p = 0.011) (R2 = 0.348). Among these predictors, FCI exerted the most important quantitative effect. MCS-36 was predicted only by the “sleep disturbance” (p = 0.005) and the “awakening with breathlessness/headache” MOS-SS subscales (p &lt; 0.001) (R2 = 0.221). Conclusions: In patients with OSA, FCI is an independent predictor of the physical aspect of their HRQL. FCI is more robust than CCI in assessing the effect of comorbidities on HRQL in OSA

Ventilator-associated sinusitis in adults: Systematic review and meta-analysis

SummaryObjectiveTo review the epidemiology, risk factors for, treatment and outcome of ventilator-associated sinusitis (VAS).MethodsWe performed a systematic review and meta-analysis of available data without time restrictions. A conservative random effects model was employed to calculate pooled odds ratios (OR) and 95% confidence intervals (CIs).ResultsOut of 620 retrieved reports, 31 papers fulfilled our inclusion criteria. Infectious sinusitis affects 27% of mechanically ventilated patients and was found to be the cause of undetermined fever in 25% of the cases. Although radiographic VAS was higher in nasotracheally compared to orotracheally intubated patients (OR 4.66, 95% CI 1.35–16.13), clinical VAS was not (3.67, 0.80–6.81). The presence of VAS has been associated with the presence of VAP (3.66, 1.81–7.37) or bacteremia (6.85, 2.14, 21.92); however, it is unknown whether an etiologic relationship between them exists. In patients with concomitant VAS and VAP or bloodstream infections identical pathogens are isolated in 59% and 20% of the cases, respectively. The presence as opposed to absence of VAS was not associated with excess mortality (1.02, 0.35–3.01).ConclusionVAS is a common infection in critically ill adults and correlates with other important infectious complications