Intensive Care Management of The Critically Ill Elderly Population: The Case of ‘Sotiria’ Regional Chest Diseases Hospital of Athens, Greece

The aim of this study was to assess the characteristics and short-term outcome of elderly patients admitted to the ICU of ‘Sotiria’ Regional Chest Diseases Hospital of Athens. We examined retrospectively the records of 344 patients aged ≥70 years old admitted to the ICU of a tertiary hospital during a five-year period, from 2009-2013. We reported demographic and clinical data, length of ICU stay, need for mechanical ventilation and ICU mortality. Among 1730 admitted to the ICU during this period, the elderly comprised 344 (19.8%). The main causes of ICU admission were Chronic Obstructive Pulmonary Disease (COPD) exacerbation (n=169), postoperative respiratory failure (n=78), acute respiratory failure of various etiologies (n=76) and cardiogenic pulmonary edema (n=25). Overall mortality rate of elderly patients was 41.5%. According to age groups, 200 patients were 70-74 years old with a mortality rate of 47%, 42 patients were 80-84 years old presenting a mortality rate of 28.5%, while 14 patients aged over 85 years old, presented a mortality of 42.8%. The mean length of ICU stay (LOS) for the elderly patients was 11.2 days, while the corresponding LOS value for younger patients was 8.1 days. Elderly patients present highest mortality than younger population. However, mortality does not correlate exclusively with advancing age over 70 years, but mostly with the underlying disease. Therefore, age should not be the sole determinant of ICU admission

Saccharomyces boulardii fungaemia in an intensive care unit patient treated with caspofungin

We describe a case of Saccharomyces boulardii fugaemia in a critically ill patient with septic shock treated with a probiotic agent containing this yeast. We attributed this fugaemia to gut translocation. Our use of caspofugin yielded excellent results

Asthma Attacks During Pregnancy in the ICU: Just Be Alert

Background:Asthma represents one of the most common medical conditions encountered during pregnancy, which may seriously affect its outcome. Objective: To evaluate the outcome of asthma attacks during pregnancy and the role medications play for appropriate asthma management.Methods: In this prospective study, we present our 15 years’ experience from hospitalization in ICU of 11 pregnant women (13-29 weeks of gestation) with severe asthma. Results:All&nbsp; patients&nbsp; had&nbsp; a&nbsp; favorable&nbsp; outcome&nbsp; after&nbsp; being&nbsp; applied&nbsp; proper&nbsp; medical&nbsp; procedures and medications. The mean duration of patients’ stay in ICU stay was 4.6 days, they were all closely observed until birth, and none of them had further asthma attacks during pregnancy after discharge. Conclusions:In&nbsp; our&nbsp; study&nbsp; severe&nbsp; asthma&nbsp; in&nbsp; pregnant&nbsp; women&nbsp; had&nbsp; an&nbsp; unexpectedly&nbsp; favorable outcome.&nbsp; Therefore,&nbsp; proper&nbsp; medication&nbsp; seems&nbsp; to&nbsp; be&nbsp; of&nbsp; crucial&nbsp; importance&nbsp; for&nbsp; positive&nbsp; outcomes&nbsp; in the case of asthma attacks during pregnancy. Moreover, careful follow-up by clinicians experienced in managing asthma seems to be essential for pregnant asthmatic patients.</p

Chronic Obstructive Pulmonary Disease and Sacubitril: Explore the Role of Neprilysin before Its Inhibition

Based on the findings of the emblematic PARADIGM-HF study [...

Surveillance of device-associated infection rates and mortality in 3 greek intensive care units

Background: Several studies suggest that device-associated, health care-associated infections (DA-HAIs) affect the quality of care in intensive care units, increasing patients' morbidity and mortality and the costs of patient care. Objectives: To assess the DA-HAIs rates, microbiological profile, antimicrobial resistance, and crude excess mortality in 3 intensive care units in Athens, Greece. Methods: A prospective cohort, active DA-HAI surveillance study was conducted in 3 Greek intensive care units from July 2009 to June 2010. The rates of mechanical ventilator-associated pneumonia (VAP), central catheter-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) were calculated along with microbiological profile, antimicrobial resistance, and crude excess mortality. Results: During 6004 days in intensive care, 152 of 294 patients acquired 205 DA-HAIs, an overall rate of 51.7% of patients or 34.1 DA-HAIs per 1000 days (95% CI, 29.3-38.6). The VAP rate was 20 (95% CI, 16.3-23.7) per 1000 ventilator-days, the CLABSI rate was 11.8 (95% CI: 9.2-14.8) per 1000 catheter-days, and the CAUTI rate was 4.2 (95% CI, 2.5-5.9) per 1000 catheter-days. The most frequently isolated pathogen was Acinetobacter baumannii among patients with CLABSI (37.8%) and Candida species among patients with CAUTI (66.7%). Excess mortality was 20.3% for VAP and CLABSI and 32.2% for carbapenem-resistant A baumannii CLABSI. Conclusion: High rates of DA-HAIs, device utilization, and anti -microbial resistance emphasize the need for antimicrobial stewardship, the establishment of an active surveillance program of DA-HAIs, and the implementation of evidence-based preventive strategies. (American Journal of Critical Care. 2013;22:e12-e20)

Serum Angiopoietin-2 and CRP Levels During COPD Exacerbations

Background and Objective: Angiopoietin-2 (Ang-2) is an important mediator of angiogenesis and has been implicated in many inflammatory diseases. COPD is characterized by systemic inflammation, which is enhanced during exacerbations and may be assessed by measuring serum C-reactive protein (CRP). The aim of the study was to evaluate serum CRP and Ang-2 levels on the first (D1) and seventh day (D7) of hospitalization due to a COPD exacerbation and to examine possible associations of CRP and Ang-2 levels and kinetics with the length of hospital stay and outcome. Methods: We conducted a prospective study and evaluated 90 patients admitted to the hospital with a diagnosis of an acute exacerbation of COPD. A venous blood sample was obtained from all patients on D1 and D7 of hospitalization, for the measurement of Ang-2 and CRP. Results: Serum Ang-2 levels were significantly higher on D1 compared to D7 during the course of COPD exacerbation (p < 0.001). Serum CRP levels were also significantly higher on D1 compared to D7 (p < 0.001). Serum Ang-2 presented a significant positive correlation with CRP levels both on D1 and D7 (r = 0.315 and r = 0.228, respectively). Patients with unfavorable outcome had significantly higher Ang-2 levels both on D1 (p = 0.04) and D7 (p = 0.01). Conclusions: Serum Ang-2 levels are elevated at the onset of COPD exacerbations and are positively associated with CRP levels. Ang-2 levels decrease during the course of COPD exacerbations in patients with favorable outcome. Serum Ang-2 may serve as a biomarker that could predict the outcome of a COPD exacerbation