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Biomedical subjects

B Quinio

Publications and source records attributed to B Quinio.

4 recordsLinked to original sources
PubMed1996

Selective decontamination of the digestive tract in multiple trauma patients. A prospective double-blind, randomized, placebo-controlled study.

STUDY OBJECTIVE: The aims of the study were to evaluate the technique of selective digestion decontamination (SDD) in preventing the development of nosocomial infections in a selected population and to assess the effects on colonization of the oropharynx, nares, and bronchi. A financial assessment was also performed. DESIGN: Prospective, double-blind, randomized placebo-controlled trial using amphotericin B, colistin sulfate (polymixin E), and gentamicin applied to the nares, the oropharynx, and enterally; no parenteral antibiotics were given during the study period. The SDD was applied every 6 h during the study period. SETTING: Multidisciplinary ICU in a university hospital. PATIENTS: A total of 148 trauma patients admitted emergently and intubated within less than 24 h were enrolled. Seventy-two patients who received placebo and 76 treated patients were analyzed on an "intention-to-treat" basis. INTERVENTIONS: Microbiologic surveillance samples of oropharyngeal and bronchial secretions, urine, and any other potentially infected sites were taken at the time of ICU admission and twice weekly thereafter until discharge from the unit. MEASUREMENTS AND RESULTS: With the use of SDD, colonization was significantly reduced in the oropharynx and nares (<0.05) but not in bronchi. However, episodes of bronchopneumonia were significantly reduced (19 in the active group vs 37 in the placebo group; p,0.01). Staphylococcus aureus remained the main potential pathogen causing bronchial colonization and subsequent bronchopneumonia. There was no reduction in the incidence of other infections. Days in the ICU, duration of mechanical ventilation, and mortality rate were unchanged. After the use of SDD, Gram-positive colonization tended to increase and this was mainly due to methicillin-resistant coagulase-negative staphylococci. The total cost of antibiotic therapy ($62,117 [US] in the placebo group and $36,008 in the SDD group) was decreased by 42% with the use of SDD. Clinically important complications of SDD were not encountered. CONCLUSIONS: The use of SDD in this population of trauma patients reduced the incidence of bronchopneumonia and the total charge for antibiotics. Stay in the ICU, mechanical ventilation, and mortality rate were unchanged. Methicillin-resistant coagulase-negative staphylococci were selected by SDD in some patients and the clinical relevance of this colonization needs further evaluation.

Amphotericin B↗
PubMed1995

Comparing two heat and moisture exchangers with one vaporizing humidifier in patients with minute ventilation greater than 10 L/min.

STUDY OBJECTIVE: To evaluate in patients submitted to minute ventilation > 10 L/min the ability to preserve patients' heat and humidity of two heat and moisture exchangers (HMEs) and one vaporizing humidifier (VH). DESIGN: Prospective, randomized, comparative, non-blinded study. SETTING: Intensive care unit of a university hospital. PATIENTS: Nine tracheally intubated, mechanically ventilated patients, sedated and submitted to mechanical ventilation with minute ventilation > 10 L/min. INTERVENTIONS: Using the psychrometric method, relative humidity (RH) and absolute humidity (AH) of inspired gas were obtained as well as temperature of inspired gas and tracheal temperatures (maximal and minimal). Following a randomized order, each patient was ventilated for two 24-h periods with a vaporizing humidifier (Bennett Cascade 2, Bennett; France) and one of two HMEs: Pall Ultipor filter BB50 (Pall Biomedical; France) or DAR Hygroster filter (Peters; France). Both were first tested for a 45-min period and then the HME that achieved the best performance in terms of temperature and water preservation was tested for 24 h. MEASUREMENTS AND RESULTS: During the 45-min test period, the Pall Ultipor HME achieved a lower performance than the other two systems for any of the studied parameters (p < 0.05 to p < 0.0001). The DAR Hygroster HME achieved lower temperature of inspired gas (29.9 vs 32.0 degrees C, p < 0.005) and lower absolute humidity (29.3 vs 33.2 mg H2O/L, p < 0.005) than the Bennett Cascade 2. After 24 h of use, lower values of temperature of inspired gas (28.5 vs 32.0 degrees C, p < 0.002) and of AH (28.0 vs 33.6 mg H2O/L, p < 0.001) were obtained with the DAR Hygroster HME than with the Bennett Cascade 2. No differences were found between the two systems for the other tested parameters. At that time, no patients had RH lower than 97% and absolute humidity lower than 23 mg H2O/L with the use of the DAR Hygroster HME. CONCLUSIONS: In patients with minute ventilation > 10 L/min, the DAR Hygroster HME showed a thermic and humidification capability similar to the reference system, the Bennett Cascade 2 VH. In these patients, the Pall Ultipor HME had a significantly lower capability.

Adolescent↗
PubMed1994

[Selective digestive decontamination in patients under reanimation].

Nosocomial infections increase morbidity and mortality in hospitalized patients. ICU patients are at high risk of sustaining them, due to the high rate of invasive procedures and their poor health state. Conventional methods for decreasing the incidence of infection in ICU patients include handwashing, catheter care, strict antibiotic policy, and reduction of environmental sources of infection. Despite these measures, the colonization in these patients is always high, because of the presence of pathogens in the own patients' flora. Nosocomial pneumonia which is a major cause of mortality in ICU patients arises from retrograde colonization of the lung by pathogens originating from oro-pharyngeal and gastric secretions. Since 1984, selective decontamination of the digestive tract (SDD) has been advocated in ICUs to prevent from bacterial and fungal gastrointestinal/oropharyngreal colonization, nosocomial infection, subsequent multiple organ failure (MOF) and death. The SDD regimen is usually an extemporaneously prepared suspension of antimicrobial agents. Appropriate antibiotics for this regimen should ideally be nonabsorbable, to prevent from the development of resistant pathogens and avoid systemic toxicity. They should also be able to selectively eliminate enterobacteriaceae and yeasts, without decreasing the protective anaerobic flora. The most used combination is a suspension of colistin, amphotericin B and aminoglycoside, administered four times day through the nasogastric tube, in association with a paste consisting of 2 p. 100 colistin/amphotericin B/aminoglycoside, applied to the oropharynx. A parenteral antibiotic is also often co-administered during the first four days to prevent from early infections until the SDD regimen reaches its full effect; cefotaxime is usually used for this. SDD significantly decreases colonization rates in the oropharynx, gastrointestinal (GI) tract and trachea. This effects is primarily attributable to a decrease of Gram-negative bacilli (GNB) and yeasts, although several studies also reported decreased isolates of Gram-positive cocci (GPC). Oropharyngeal and GI colonization significantly decrease after four days of such a regimen, but tracheal decontamination in uncertain. Several studies recognized an emergence of GPC during or after SDD and resistance occurrence in GNB (especially against aminoglycosides). Recolonization occurs rapidly, about 4 to 8 days after the discontinuation of SDD. SDD decreases significantly the nosocomial infections, especially Gram-negative pneumonia. This benefit is most obvious in trauma patients, severely burned patients and after orthopic liver transplantation. Several studies reported a significant decrease in the overall rate of infections, especially extrapulmonary infections, including blood, urinary tract, wounds, abdominal, and catheter related infections. Despite a major decrease in infection rates with SDD, most studies did not show lowered mortality rates.(ABSTRACT TRUNCATED AT 400 WORDS)

Anti-Bacterial Agents↗