Endemic Multidrug-ResistantPseudomonas aeruginosain Critically Ill Patients

2004 ◽  
Vol 25 (10) ◽  
pp. 825-831 ◽  
Author(s):  
Bryan Ortega ◽  
A. B. Johan Groeneveld ◽  
Constance Schultsz
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multidrug Resistant ◽  
Central Venous Catheters ◽  
Lung Injury Score ◽  
Polymorphism Analysis ◽  
Central Venous ◽  
Resistant Strains

AbstractObjective:To describe the epidemiology of endemic multidrug-resistantPseudomonas aeruginosacolonizations and infections in critically ill patients.Design:Prospective study on bacterial strain typing and retrospective cohort study of charts of patients in the intensive care unit (ICU).Patients:Fifty-three patients withP. aeruginosaisolated from clinical cultures in 2001 were selected, divided into those withP. aeruginosain vitro resistant to at least two classes of antibiotics (multidrug-resistant, n = 18) and those susceptible to all or resistant to only one antibiotic (susceptible, n = 35).Results:Risk factors for multidrug-resistantP. aeruginosaincluded maxillary sinusitis, long-dwelling central venous catheters, prolonged use of certain antibiotics, a high lung injury score, and prolonged mechanical ventilation and duration of stay. The frequency of colonization (approximately 50%) versus infection (ie, ventilator-associated pneumonia) did not differ between the groups. On amplified fragment-length polymorphism analysis, 64% of the multidrug-resistant strains had been potentially transmitted via cross-colonization and 36% had probably originated endogenously. ICU mortality was 22% in the multidrug-resistant group and 23% in the susceptible group, although the duration of mechanical ventilation was longer in the former.Conclusions:Patients with sinusitis who stayed in the ICU longer, were ventilated longer because of acute lung injury, received antibiotics for longer durations, and had long-dwelling central venous catheters ran an elevated risk of acquiring multidrug-resistantP. aeruginosa.These patients did not have a higher mortality than patients with susceptibleP. aeruginosa.Prevention of the emergence of multidrug-resistant strains requires changes in infection control measures and antibiotic policies in our ICU.

Design of MEMS Based Piezo-Resistive Sensor for Measuring Pressure in Endo-Tracheal Tube

2015 ◽  
Author(s):  
Pravin Singru ◽  
Bhargav Mistry ◽  
Rachna Shetty ◽  
Satish Deopujari
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Critically Ill ◽  
Tracheal Tube ◽  
Critically Ill Patients ◽  
Membrane Thickness ◽  
Basic Design ◽  
Ventilator Induced Lung Injury ◽  
Resistive Sensor ◽  
Ventilation Modes

Mechanical ventilation is the process of providing artificial breathing support to a patient. More than half of critically ill patients require mechanical ventilation[1]. Though mechanical ventilation increases time for recuperation, it is known to have given rise to complications arising from over-distention of lungs leading to ventilator associated lung injury (VALI) and ventilator induced lung injury (VILI). This paper aims to develop a sensor to identify breathing efforts initiated by the patient and give back responses to the ventilator to regulate ventilation modes and tidal volumes delivered by the ventilator. This will significantly aid in reducing asynchrony between the patient efforts and the ventilator input, thus preventing lung injury. Towards this end, we have simulated and studied the effect of different kinds of dynamic loading and diaphragm membrane thickness of the sensor on its sensitivity on a basic design.

MURRAY'S ACUTE LUNG INJURY SCORE AS A PREDICTOR OF TRACHEOSTOMY IN CRITICALLY ILL PATIENTS

CHEST Journal ◽  
2009 ◽  
Vol 136 (4) ◽  
pp. 61S ◽  
Author(s):  
Prashant R. Gundre ◽  
Tejal Shah ◽  
Yizhak Kupfer ◽  
Yatin Mehta ◽  
Sidney Tessler
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Lung Injury Score ◽  
Injury Score

scholarly journals Extreme drug resistant A.baumannii associated with CLA-BSI in Kanpur

2017 ◽  
Vol 5 (8) ◽  
pp. 3620
Author(s):  
Nidhi Pal ◽  
R. Sujatha
Keyword(s):  
Critically Ill ◽  
Blood Stream ◽  
Central Line ◽  
Multidrug Resistant ◽  
Central Venous Catheters ◽  
Drug Resistant ◽  
Central Venous ◽  
Mortality And Morbidity ◽  
Venous Catheterization ◽  
Catheter Tip

Background: Nosocomial bloodstream infection on the critically ill patients has been associated with high mortality. Central venous catheters (CVC) have become essential in the management of patients who are critically ill and those who require long-term medical care. This study was conducted to determine the Central line associated blood stream infections (CLA-BSIs) due to A.baumannii its risk factors and antibiotic resistant patterns.Methods: A total of 52 samples (blood or central line tip) were received from patients with a clinical diagnosis of sepsis after central venous catheterization. The semi quantitative method was used for catheter tip culture. Bacterial identification and antibiotics resistant pattern was performed by Standard microbiological protocol.Results: Of 52 test samples (blood or central line tip), 2 pathogenic strains were isolated from blood, 2 strains of A.baumannii isolated from catheter tips were colonizer and 3 strains of A.baumannii were pathogenic which caused CLA-BSI. The rate of CLABSI due A.baumannii was 11.11 per 1000 catheter days. All A.baumannii were extreme drug resistant (XDR). They only sensitive for polymyxins and tegicyclines.Conclusions: Central venous catheters are increasingly being used in critical care and have been directly related to patient mortality and morbidity. Microbiological surveillance may guide management of multidrug resistant isolates and its complications. Proper infection control practices can reduce the nosocomial infection rate.

scholarly journals Mediastinal Complications Secondary to Extravasated Peripherally Inserted Central Venous Catheter: A Case Report

2019 ◽  
Author(s):  
Ana Licina ◽  
Arya Gupta ◽  
Andrew Silvers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Thoracoscopic Surgery ◽  
Signs And Symptoms ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Gradual Improvement ◽  
Relative Safety ◽  
Increased Risk

Abstract Background Peripherally inserted central venous catheters (PICC) are increasingly used in critically ill patients for the ease of access, long-term medication and total parenteral nutrition administration. There is a perception of equivalent utility of PICC lines with a lower incidence of complications as compared to central venous lines. Despite the perception of relative safety, complications can occur. Case Presentation We describe a case of a patient who developed increasing signs and symptoms of sepsis, shortness of breath, and hypoxemia following combined liver and renal transplant 11 days following the initial procedure. Computerised tomography of neck and chest demonstrated pneumo-mediastinum, extensive retropharyngeal and subcutaneous emphysema. The patient returned to theatre on post-operative day 12, for flexible bronchoscopy, video-assisted thoracoscopic surgery and mediastinal washout. Following a further clinical and imaging review, an un-anticipated diagnosis of extravasated peripherally inserted central venous cannula (PICC) as a causative factor of multiple pathologies was made. PICC line was removed. Mediastinal and thoracoscopic examinations were performed and drains inserted. The patient returned to the intensive care unit for ongoing supportive management, with a gradual improvement of sepsis and resolution of mediastinal air distribution. Conclusions Peripherally inserted central venous catheters have an ease of insertion and appreciable favourable health economic outcomes. Recent reviews however have demonstrated an increased risk of catheter tip malposition, in addition to increased risk of thrombosis as compared to central venous lines. Due to the characteristic mobility of these devices, mediastinal and intra-thoracic extravasation of these catheters can occur with consequent severe morbidity. Awareness of the tip position and accompanying clinical and radiological enquiry, must be performed both in the differential diagnosis of chest pathology and prior to use of PICC lines in critically ill patients.

scholarly journals Difficult Internal Jugular Central Venous Cannulation Using J-Tip Guidewire with Indwelling Peripherally Inserted Central Venous Catheters

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Preeti Anand ◽  
Minal Joshi ◽  
Khaja Ahmed ◽  
Joel Yarmush
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Central Venous Catheters ◽  
Venous Cannulation ◽  
Central Venous Cannulation ◽  
Central Venous ◽  
Cardioverter Defibrillator

Central venous cannulation is a commonly performed procedure while managing critically ill patients; increasingly we encounter patients with indwelling wires or devices, like pacemakers, implantable cardioverter defibrillator devices, and peripherally inserted central venous catheters which complicate insertion of central venous catheters further. We present two cases where use of standard J-tip guidewire may have exacerbated the difficulty associated with internal jugular cannulation in presence of peripherally inserted central venous catheters. Recognition and avoidance of possible complications are crucial, and we discuss complexity posed by indwelling peripherally inserted central venous catheters and possible solutions.

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