Non-invasive mechanical ventilation for diagnostic bronchoscopy using a new face mask: an observational feasibility study

Contains fulltext : 89809.pdf (publisher's version ) (Closed access)PURPOSE: Bronchoscopy is an indispensable tool for invasive pulmonary evaluation with high diagnostic yield and low incidence of major complications. However, hypoxemia increases the risk of complications, in particular after bronchoalveolar lavage. Non-invasive positive pressure ventilation may prevent hypoxemia associated with bronchoalveolar lavage. The purpose of this study is to present a modified total face mask to aid bronchoscopy during non-invasive positive pressure ventilation. METHODS: A commercially available full face mask was modified to allow introduction of the bronchoscope without interfering with the ventilator circuit. Bronchoscopy with bronchoalveolar lavage was performed in 12 hypoxemic non-ICU patients during non-invasive positive pressure ventilation in the ICU. Results : Patients had severely impaired oxygen uptake as indicated by PaO(2)/FiO(2) ratio 192 +/- 23 mmHg before bronchoscopy. Oxygenation improved after initiation of non-invasive positive pressure ventilation. In all patients the procedure could be completed without subsequent complications, although in one patient SpO(2) decreased until 86% during bronchoscopy. A microbiological diagnosis could be established in 8 of 12 patients with suspected for infection. CONCLUSIONS: Our modified face mask for non-invasive positive pressure ventilation is a valuable tool to aid diagnostic bronchoscopy in hypoxemic patients.1 januari 201

Results of the REPAIR Randomised Controlled Trial - Renal Protection Against Ischaemia Reperfusion in Transplantation

Nephrolog

Huid infecties in niertransplantatie-patienten in relatie met zonlichtblootstelling

We investigated whether exposure to solar UVR would influence the occurrence of skin infections in a cohort of renal transplant recipients. In various experimental studies, exposure to UVR was demonstrated to possibly cause immunosuppression and impaired resistance to infections. We expected that such effects could be demonstrated more easily in the patients who were already immunocompromised. The lifetime cumulative exposure to solar UVR was estimated on the basis of self-reported data: the season in which the diagnosis was made was regarded as providing a rough estimate of the exposure just prior to or at the time of infection. In a Multivariate Poisson Regression Model for repeated measurements, we found the highest incidence of Herpes Simplex, Herpes Zoster and fungal/yeast infections to be associated with the summer season. There was no consistent association found between the lifetime cumulative estimate of exposure and the infection. The seasonal fluctuation may be due to the circannual rhythm in ambient levels of UVR.Dit rapport beschrijft een studie waarin werd nagegaan of blootstelling aan zonlicht van invloed is op het optreden van huidinfecties in een cohort niertransplantatie patienten. Dit deden wij, daar uit diverse met name experimentele studies bekend is dat blootstelling aan ultraviolette straling (UV) een immuunsuppressie en een verlaagde weerstand tegen diverse infecties kan veroorzaken. Wij verwachtten dat in deze groep patienten door de reeds aanwezige immuunsuppressie dergelijke effecten eerder aan het licht zullen treden. De 'life-time' cumulatieve blootstelling aan zonlicht werd retrospectief geschat op basis van zelf-gerapporteerde gegevens; seizoen van diagnose werd gezien als ruwe maat voor de blootstelling vlak voor of op het moment van het optreden van de infectie. In een multivariaat Poisson regressie model voor herhaalde waarnemingen werd gevonden dat Herpes Simplex-, Herpes Zoster- en schimmel/gist infecties het meest in het zonnige seizoen gevonden werden, terwijl er geen duidelijke samenhang bleek te zijn met de 'life-time' cumulatieve maat voor zonlicht blootstelling. De gevonden seizoenseffecten zouden samen kunnen hangen met het jaarritme in de UV belasting

Huid infecties in niertransplantatie-patienten in relatie met zonlichtblootstelling

Dit rapport beschrijft een studie waarin werd nagegaan of blootstelling aan zonlicht van invloed is op het optreden van huidinfecties in een cohort niertransplantatie patienten. Dit deden wij, daar uit diverse met name experimentele studies bekend is dat blootstelling aan ultraviolette straling (UV) een immuunsuppressie en een verlaagde weerstand tegen diverse infecties kan veroorzaken. Wij verwachtten dat in deze groep patienten door de reeds aanwezige immuunsuppressie dergelijke effecten eerder aan het licht zullen treden. De 'life-time' cumulatieve blootstelling aan zonlicht werd retrospectief geschat op basis van zelf-gerapporteerde gegevens; seizoen van diagnose werd gezien als ruwe maat voor de blootstelling vlak voor of op het moment van het optreden van de infectie. In een multivariaat Poisson regressie model voor herhaalde waarnemingen werd gevonden dat Herpes Simplex-, Herpes Zoster- en schimmel/gist infecties het meest in het zonnige seizoen gevonden werden, terwijl er geen duidelijke samenhang bleek te zijn met de 'life-time' cumulatieve maat voor zonlicht blootstelling. De gevonden seizoenseffecten zouden samen kunnen hangen met het jaarritme in de UV belasting.We investigated whether exposure to solar UVR would influence the occurrence of skin infections in a cohort of renal transplant recipients. In various experimental studies, exposure to UVR was demonstrated to possibly cause immunosuppression and impaired resistance to infections. We expected that such effects could be demonstrated more easily in the patients who were already immunocompromised. The lifetime cumulative exposure to solar UVR was estimated on the basis of self-reported data: the season in which the diagnosis was made was regarded as providing a rough estimate of the exposure just prior to or at the time of infection. In a Multivariate Poisson Regression Model for repeated measurements, we found the highest incidence of Herpes Simplex, Herpes Zoster and fungal/yeast infections to be associated with the summer season. There was no consistent association found between the lifetime cumulative estimate of exposure and the infection. The seasonal fluctuation may be due to the circannual rhythm in ambient levels of UVR.Inspectie GW

Efficacy and safety of selective decontamination of the digestive tract (SDD) to prevent recurrent hepatic cyst infections in polycystic liver disease: a retrospective case series

Background Hepatic cyst infection is a complication of polycystic liver disease (PLD) that causes substantial morbidity. Repetitive infection is frequent and is increasingly difficult to treat. As translocated gut bacteria are considered the cause, we hypothesize that selective decontamination of the digestive tract (SDD) reduces recurrence of hepatic cyst infection. Methods We performed a retrospective, observational study in two referral centres. All patients with PLD treated with SDD for hepatic cyst infection were included. Efficacy was determined by calculating the infection incidence (hepatic cyst infections per month) before and during SDD therapy. Adverse events were scored according to the Common Terminology Criteria for Adverse Events (CTCAE). Results We identified eight patients who received SDD (88% female, 88% polycystic kidney disease). The median age was 65 years (IQR: 51–74 years). SDD lowered the median incidence from 0.09 episodes per month (IQR: 0.06–0.25 episodes per month) to 0.01 episodes per month (IQR: 0.00–0.05 episodes per month) (P = 0.12). Discontinuation of SDD led to rapid recurrence of cyst infection (71% within 6 weeks). SDD consisted of polymyxins with/without aminoglycosides. The median SDD treatment duration was 20 months (range: 3–89 months). Six patients (75%) developed adverse events [CTCAE Grade 1 (gastrointestinal: n = 3) or Grade 3 (ototoxicity: n = 1; fungal infection: n = 1)], mostly attributable to aminoglycosides; one patient developed polymyxin E resistance. Conclusions SDD prophylaxis provides a novel strategy for limiting recurrent hepatic cyst infection in PLD patients. However, adverse events are frequent and curtail its use. As most were attributable to aminoglycosides, polymyxin E is considered the preferred therapy