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A Net

Publications and source records attributed to A Net.

At least 37 records · Page 2Linked to original sources
PubMed1991

Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients.

This study assessed the incidence, etiology, and consequences of ventilator-associated pneumonia in 1,000 consecutive patients admitted in a medical-surgical intensive care unit (ICU). A total of 264 patients were submitted to mechanical ventilation (MV) for more than 48 hours. Fifty-eight (21.9 percent) patients developed a bacterial pneumonia after a mean of 7.9 days (range, 2 to 40 days) of MV. In addition, they were ten superinfections in nine patients, raising the mean incidence to 25.7 percent. Five patients developed secondary bacteremia, and another five had septic shock. Identification of the causative agent of pneumonia was possible in 47 episodes by means of highly specific techniques (telescoping plugged catheter, blood cultures, and/or necropsy). Thirteen (27.6 percent) of these cases were polymicrobial. The predominant pathogens isolated in the first episode of pneumonia were Gram-negative bacilli (62.6 percent), but a high incidence of Staphylococcus aureus infection (23.2 percent) was detected. Gram-negative bacilli represented 66.6 percent of the total organisms isolated in superinfections. The mortality rate in the pneumonia group was 42 percent; this percentage is similar to mortality rate among MV patients without pneumonia (37 percent). We conclude that nosocomial pneumonia is a frequent complication of MV in the medical-surgical ICU. Ventilator-associated pneumonia does not appear to increase fatality in critically ill patients with a high mortality rate (38 percent); however, it significantly prolongs the length of stay in the ICU for survivors.

Bacteria↗
PubMed1991

Evaluation of different catheter parts for identification of pulmonary artery catheter colonisation.

A prospective study was conducted over 18 months to evaluate the accuracy of the semiquantitative culture technique performed from different catheter parts for detection of catheter colonisation in critically ill patients with pulmonary artery catheters. Semiquantitative culture of the tip catheter segment alone detected 66% of catheter colonisations. Semiquantitative culture of the other intravascular catheter segments (atrial or intradermal) provided similar yield. A combination of intradermal and atrial or tip catheter segment cultures provided the best means of detecting catheter colonisation.

Bacteria↗
PubMed1990

Intrinsic PEEP on static pressure-volume curves.

The static pressure volume (PV) curve of the total respiratory system is a well established method to assess pulmonary mechanics during respiratory failure. We have tested the impact of auto-PEEP on the PV curve determination in 16 COPD patients. An isovolumic pressure increment (IPI) was found at the beginning of the curve and a close correlation between IPI and auto-PEEP level (r = 0.962) p less than 0.001) was observed. The regression equation was not significantly different from the identity line. We conclude that the appearance of IPI in PV curves is largely determined by auto-PEEP and it is a good estimate of the existing auto PEEP level.

Aged↗
PubMed1990

Gentamicin volume of distribution in critically ill septic patients.

Gentamicin intrapatient pharmacokinetics variations were studied in 40 critically ill medical patients, suffering gram-negative sepsis. These patients were studied in two phases throughout gentamicin treatment: firstly, on the second day of treatment, when aggressive fluid therapy was required, and secondly, five days later, when patients had achieved a more stable clinical condition. Pharmacokinetic parameters were determined using least squares linear regression analysis assuming a one-compartment model using the Sawchuk-Zaske method. The apparent volume of distribution (Vd) in the first phase of the study was 0.43 +/- 0.12 L/kg, while on the seventh day of treatment it was 0.29 +/- 0.17 L/kg (p less than 0.001). Statistically significant differences were also observed for peak serum concentration (p less than 0.001), total dosage recommended (p less than 0.001) and half-life (p less than 0.05), whilst differences were not found for trough levels. From the analysis of the results obtained, we recommend increasing the initial dosage and monitoring plasma levels within the first days of therapy in critically ill patients treated with gentamicin, since important variations in aminoglycoside Vd related to disease, fluid balance and renal function, commonly occur in these patients.

Adult↗
PubMed1990

Risk factors for Staphylococcus aureus nosocomial pneumonia in critically ill patients.

Staphylococcus aureus nosocomial pneumonia has become an important infection not only because of an apparently increasing incidence but also because of its high mortality rate. A total of 50 episodes of nosocomial pneumonia in critically ill patients in which etiologic diagnosis was well established were prospectively followed in a medical-surgical intensive care unit (ICU). S. aureus was isolated in a total of 13 episodes. In the univariate analysis the variables significantly associated with S. aureus nosocomial pneumonia were below 25 yr of age, coma, nonuse of corticosteroids, and antecedent trauma. A step-forward logistic regression analysis defined only coma as significantly influencing the risk of developing S. aureus nosocomial pneumonia. We suggest that antimicrobial drugs active against S. aureus must be included in the initial empirical antimicrobial regimen for treating nosocomial pneumonia in patients with coma. The identification of factors influencing the etiology and the possibility of earlier effective antimicrobial treatment may represent a further step in the control of nosocomial pneumonia in critically ill patients by improving its prognosis.

Adult↗
PubMed1989

[Malignant nongranulomatous pulmonary hypertension in a patient addicted to parenteral drugs].

We report the first case in the Spanish literature of pulmonary hypertension (PHT) caused by vascular sclerosis in a parenteral drug abuser female. The clinical diagnosis of PHT was confirmed in the necropsy study, which ruled out granulomas and discovered only vascular sclerosis and hypertrophy as causative factors of the clinical picture. The different etiological and pathogenetical mechanisms reported in the literature as causing PHT in this type of patients are reviewed.

Adult↗