Incidencija, etiologija i ishod perkutano traheotomiranih bolesnika s ventilacijskom pneumonijom

Although the incidence of ventilator-associated pneumonia (VAP) is very high, there are still many uncertainties about clinical course of VAP among tracheotomized patients. The goal of the present study was to determine the impact of tracheotomy on VAP incidence and etiology, as well as outcome of VAP patients with tracheotomy. The study was conducted in a 15-bed Surgical and Neurosurgical Intensive Care Unit (ICU), Sestre milosrdnice University Hospital Center in Zagreb, Croatia. The study included all patients undergoing only percutaneous tracheotomy during the study period. According to our data, the incidence of VAP among percutaneous tracheotomized patients was 42%, not considering the time between tracheotomy and VAP onset. However, when only patients developing VAP after tracheotomy were taken into account, the incidence of VAP among tracheotomized patients dropped to 8% only. The most commonly isolated bacterium was Staphylococcus aureus, accounting for 17 (37%) isolates, followed by Haemophilus influenzae, accounting for another 10 (22%) isolates. The development of VAP among percutaneously tracheotomized patients was associated with longer total ICU stay (regardless of whether VAP developed before or after tracheotomy), while total duration of mechanical ventilation and mortality rate remained unaffected.Iako je učestalost ventilacijske pneumonije (VAP) vrlo visoka,postoje mnoge nedoumice vezane uz klinički tijek VAP-a među traheotomiranim bolesnicima. Cilj ovoga istraživanja bio je utvrditi utjecaj traheotomije na učestalost i etiologiju VAP-a, kao i ishod traheotomiranih bolesnika s VAP-om. Istraživanje je provedeno u 15-krevetnoj kirurškoj i neurokirurškoj Jedinici intenzivnog liječenja Kliničkog bolničkog centra “Sestre milosrdnice” u Zagrebu. Svi i samo perkutano traheotomirani bolesnici tijekom razdoblja istraživanja bili su uključeni u istraživanje. Prema našim podacima, učestalost VAP-a među perkutano traheotomiranim bolesnicima bila je 42% ako se u obzir ne uzima vrijeme pojave VAP-a u odnosu na vrijeme izvođenja traheotomije. Međutim, ako se u obzir uzmu samo bolesnici u kojih se VAP javio nakon izvođenja traheotomije učestalost VAP-a među traheotomiranim bolesnicima opada na samo 8%. Najčešće izolirana bakterija je bila Staphylococcus aureus, izolirana u 17 (37%) izolata, iza koje slijedi Haemophilus influenzae, izolirana u sljedećih 10 (22%) izolata. Razvoj VAP-a među perkutano traheotomiranim bolesnicima je bio povezan s dužim ostankom u Jedinici intenzivnog liječenja (bez obzira je li se VAP javio prije ili nakon izvođenja traheotomije), dok na ukupno trajanje mehaničke ventilacije i smrtnost nije imao utjecaja

Preporuke za perioperacijski postupak kod bolesnika koji imaju ugrađene kardiovaskularne implantabilne elektroničke uređaje

Four thousand cardiac implantable electronic devices (CIED) are implanted yearly in Croatia with constant increase. General anesthesia and surgery carry some specific risk for the patients with implanted CIEDs. Since most of the surgical procedures are performed in institutions without reprogramming devices available, or in the periods when they are unavailable, these guidelines aim to standardize the protocol for perioperative management of these patients. With this protocol, most of the procedures can be performed easily and, more importantly, safely in the majority of surgical patients.U Republici Hrvatskoj na godinu se implantira oko 4000 kardiovaskularnih implantabilnih uređaja i taj broj je u stalnom porastu. Anestezija i kirurški zahvati kod bolesnika s ugrađenim implantabilnim uređajima nose određene rizike. Ove smjernice su nastale zato što se većina zahvata izvodi u ustanovama bez mogućnosti testiranja i reprogramiranja navedenih uređaja ili u vrijeme kada to nije dostupno. Cilj je standardizirati perioperacijsku skrb ovih bolesnika te učiniti kirurške zahvate dostupnima i sigurnima za veliku većinu ovih kirurških bolesnika u svim ustanovama u Hrvatskoj

Recommendations for Perioperative Management of Patients with Cardiac Implantable Electronic Devices

Four thousand cardiac implantable electronic devices (CIED) are implanted yearly in Croatia with constant increase. General anesthesia and surgery carry some specific risk for the patients with implanted CIEDs. Since most of the surgical procedures are performed in institutions without reprogramming devices available, or in the periods when they are unavailable, these guidelines aim to standardize the protocol for perioperative management of these patients. With this protocol, most of the procedures can be performed easily and, more importantly, safely in the majority of surgical patients