The Role of Inhaled Corticosteroids and B2 Agonist in Prevention of ARDS in High Risk Patients Admitted to ICU

Abstract Background Acute respiratory distress syndrome (ARDS) is a life threatening respiratory failure due to lung injury from a variety of precipitants. Pathologically ARDS is characterised by diffuse alveolar damage, alveolar capillary leakage, and protein rich pulmonary oedema leading to the clinical manifestation of poor lung compliance, severe hypoxaemia, and bilateral infiltrates on chest radiograph. Objective The aim of this study is to evaluate the effect of inhaled corticosteroids and B2 agonist in decreasing the incidence of ARDS in high risk patients admitted to ICU. Methodology This prospective study included 100 cases admitted to Ain Shams University hospitals for variable medical problems, and were at risk of ARDS development. There were four drug groups studied in this study according to their role in progression and prevention of ARDS in those hospitalized patients. These drug groups were group C (4ml saline), group S (salbutamol), group F (budesonide), and group M (budesonide and salbutamol). Results ARDS was less likely to develop with the use of salbutamol only or combined with budesonide inhalation in groups S and M respectively. The primary outcome was development of ARDS. The secondary outcome was mechanical ventilation and prolonged ICU stay. Six cases (24%) in each of group C and F developed ARDS, mechanical ventilation and prolonged ICU stay. Just two cases (8%) in each of groups S and M developed ARDS, mechanical ventilation and prolonged ICU stay. The difference between the 4 groups in the incidence of ARDS development was not so far, but it was clearly evident. Conclusion The use of inhaled beta 2 agonists was associated with decreased risk of ARDS, mechanical ventilation and prolonged ICU stay when adjusted for baseline characteristics, predisposing conditions and severity of illness.

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The Impact of Pharmacist-delivered Motivational Interviewing on Chronic Kidney Disease Identification and Management in Patients with Diabetes Mellitus and Low Socioeconomic Status

INNOVATIONS in pharmacy ◽

10.24926/iip.v10i4.2109 ◽

2019 ◽

Vol 10 (4) ◽

pp. 8

Author(s):

Keri Lillian DePatis ◽

Catherine Harrington

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Motivational Interviewing ◽

Urinary Albumin ◽

Secondary Outcome ◽

High Risk Patients ◽

Patients With Diabetes ◽

Risk Patients

Purpose: Chronic kidney disease (CKD) is a common complication among patients with diabetes mellitus; however, noncompliance with the recommended annual screening is common. Increased screening among high-risk patients is important to identify the early stages CKD, potentially resulting in earlier treatment, slower progression, fewer complications, and decreased healthcare expenditures. Motivational interviewing (MI) has previously been shown to be effective for various behaviors, such as smoking cessation and cholesterol level control. The objective of this study is to evaluate the effectiveness of pharmacist-delivered MI compared to typical education (TE) methods in increasing CKD screening and subsequent angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) initiation in high-risk patient populations. Methods: Pharmacists screened diabetic patients within their chronic disease management clinic to identify patients that are at high-risk for CKD, indicated by a score of 4 or greater on the validated SCORED screening tool. High-risk patients were randomized to one of four groups to receive either one or two face-to-face education sessions from a pharmacist or student pharmacist using either MI or TE methods. Patients were then given the option to have their urine tested with a dipstick to detect albumin and creatinine, provided at no cost. The primary outcome was to determine the rate of urinary albumin testing, and the secondary outcome was to determine the rate of ACE-I or ARB initiation in patients found to have albuminuria. Results: There were no significant differences in the rates of urinary albumin screening (87% in TE vs. 100% in MI, P = 0.4828) or subsequent ACE-I/ARB initiation (100% in TE and 50% in MI, P = 1.000) between education groups. Of the high-risk patients who underwent urinary albumin screening, 54% (n=15) were found to have proteinuria Conclusions: While it appears that MI does not impact patient acceptance rates of microalbuminuria screening and ACE-I/ARB initiation, this study demonstrates the feasibility of pharmacist-delivered microalbuminuria screening in patients at high-risk for CKD in the outpatient setting. Article Type: Practice-Based Research

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Impact of fiber-optic laryngoscopy on the weaning process from mechanical ventilation in high-risk patients for postextubation stridor

Medicine ◽

10.1097/md.0000000000005971 ◽

2017 ◽

Vol 96 (5) ◽

pp. e5971 ◽

Cited By ~ 2

Author(s):

Malcolm Lemyze ◽

Emmanuelle Durville ◽

Mehdi Meddour ◽

Marie Jonard ◽

Johanna Temime ◽

...

Keyword(s):

Mechanical Ventilation ◽

High Risk ◽

Fiber Optic ◽

High Risk Patients ◽

Risk Patients ◽

Postextubation Stridor

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Evaluation of Usefulness of Mannheim Peritonitis Index and APACHE II Score in Predicting Mortality and Morbidity in Patients with Peritonitis- A Prospective Diagnostic Test Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/45556.14110 ◽

2020 ◽

Author(s):

D Paul Trinity Stephen ◽

Vijay Abraham ◽

Reka Karuppusami

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Sensitivity And Specificity ◽

Apache Ii ◽

Secondary Outcome ◽

Apache Ii Score ◽

Mannheim Peritonitis Index ◽

Mortality And Morbidity ◽

Icu Stay ◽

Prolonged Icu Stay

Introduction: Peritonitis, defined as inflammation of the peritoneal cavity can be of various causes, and is one of the most common surgical emergencies. This continues to be a challenge to diagnose and treat. Early intervention is essential to select patients who will need intensive care which brings out better outcome for the patients. This also helps us use the resources optimally. Over years, many scoring systems have been developed and studied to predict outcomes in patients with peritonitis. Aim: To evaluate the ability of Mannheim Peritonitis Index (MPI) and APACHE II (Acute Physiology And Chronic Health Evaluation II) scores in predicting mortality and morbidity in patients with peritonitis. Materials and Methods: A prospective, observational study was conducted at Christian Medical College and Hospital, Vellore, Tamil Nadu, India, for a period of two years from September 2014 to August 2016. A total of 78 patients were recruited for this study. These patients were scored with MPI and APACHE II scores. The primary outcome studied was in hospital death or discharge. The secondary outcome studied was morbidity in terms of local and systemic complications. The risk factors associated with mortality in patients with peritonitis were also studied. The best cut-off value for MPI and APACHE II from the data was calculated using Yuden index. The sensitivity, specificity and likelihood ratios were calculated and presented with 95% Confidence Interval(CI). The sub-group analysis was done for risk factors and complications. Results: There were more males than females. Age ≥48 years (p=0.002) and serum creatinine ≥1.3 g/dL (p=0.012) were found to be significant risk factors for mortality. The sensitivity and specificity of MPI ≥27 in predicting mortality was found to be 90% and 57% respectively. The sensitivity and specificity of APACHE II score ≥10 in predicting mortality was found to be 40% and 78%, respectively. MPI scores ≥27 were strongly associated with morbidity like prolonged ICU stay (p=0.004), mechanical ventilation requirement (p=0.001) and need for dialysis (p=0.035). Conclusion: Present study showed MPI to be a better predictor of mortality than APACHE II, though APACHE II showed better specificity. MPI score also was helpful in predicting morbidity such as prolonged ICU stay, mechanical ventilation requirement postoperatively and need for dialysis postoperatively. MPI was easier to use as it contained lesser variables. MPI could be of use in rural areas with no facility for laboratory investigations and blood gas analysis.

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Different doses of micafungin for prophylaxis of invasive fungal diseases in hemato-oncological high-risk patients: a web-based non-interventional trial in four large university hospitals in Germany

Transplant Infectious Disease ◽

10.1111/tid.12305 ◽

2014 ◽

Vol 16 (6) ◽

pp. 968-974 ◽

Cited By ~ 7

Author(s):

S.M. Heimann ◽

M.J.G.T. Vehreschild ◽

L. Meintker ◽

W. Heinz ◽

T. Schroeder ◽

...

Keyword(s):

High Risk ◽

Fungal Diseases ◽

University Hospitals ◽

Web Based ◽

Interventional Trial ◽

High Risk Patients ◽

Invasive Fungal Diseases ◽

Risk Patients ◽

Different Doses

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Intestinal carriage of vancomycin‐resistant Enterococcus spp. among high‐risk patients in university hospitals in Serbia: first surveillance report

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-021-00423-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Ana Janjusevic ◽

Ljiljana Markovic Denic ◽

Rajna Minic ◽

Anita Grgurevic ◽

Ivana Cirkovic

Keyword(s):

High Risk ◽

Genetic Relatedness ◽

Virulence Gene ◽

Microtiter Plate ◽

Close Monitoring ◽

University Hospitals ◽

Strict Adherence ◽

High Risk Patients ◽

Risk Patients ◽

Vancomycin Resistant

Abstract Background The screening for intestinal carriage of vancomycin-resistant Enterococcus spp. (VRE) among high risk patients in the Balkan region and molecular epidemiology of VRE is insufficiently investigated, yet it could be of key importance in infection control. The aim of this study was to provide baseline data on VRE intestinal carriage among high-risk patients in Serbian university hospitals, to determine the phenotypic/genotypic profiles of the isolated VRE, to obtain knowledge of local resistance patterns and bridge the gaps in current VRE surveillance. Methods The VRE reservoir was investigated using stool samples from 268 inpatients. Characterization of isolated VRE stains consisted of BD Phoenix system, genotypic identification, glycopeptide and quinupristin–dalfopristin (Q–D) resistance probing, virulence gene (esp, hyl, efaA, asa1, gelE, cpd) detection and MLVA. Biofilm formation was evaluated by the microtiter plate method. Results VRE carriage prevalence among at-risk patients was 28.7%. All VRE strains were vanA positive multidrug-resistant Enterococcus faecium (VRfm), harboring ermB-1 (38.9%), esp (84%), efaA (71.2%), hyl (54.5%), asa1 (23.4%), gelE and cpd (11.6%) each. Ability of biofilm production was detected in 20.8%. Genetic relatedness of the isolates revealed 13 clusters, heterogeneous picture and 25 unique MTs profiles. Conclusion The obtained prevalence of VRE intestinal carriage among high-risk inpatients in Serbia is higher than the European average, with high percentage of multidrug resistance. The emergence of resistance to Q–D is of particular concern. Close monitoring of pattern of resistance and strict adherence to specific guidelines are urgently needed in Serbia.

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