Risk factors and prevention of nosocomial pneumonia in polytrauma

2020 ◽  
Vol 30 (4) ◽  
pp. 493-503
Author(s):  
Yu. G. Shapkin ◽  
P. A. Seliverstov ◽  
N. Yu. Stekol'nikov
Keyword(s):  
Risk Factors ◽  
Nosocomial Pneumonia ◽  
Distress Syndrome ◽  
Early Mobilization ◽  
Lung Ventilation ◽  
Selective Decontamination ◽  
Artificial Lung Ventilation ◽  
Promising Area ◽  
Post Traumatic

Nosocomial pneumonia (NK) is one of the most frequent complications of polytrauma leading to death. Meanwhile, the recommendations on prevention of NK in case of polytrauma have not been specified so far. This is due in large part to the lack of study of the pathophysiology of severe combined trauma. The review presents the results of modern experimental and clinical studies of the effect of shock, immune distress syndrome, posttraumatic immunosuppression, the phenomenon of mutual aggravation of lesions, age, sex, concomitant pathology on the risk of NK in polytrauma. The role of iatrogenic risk factors for NK in polytrauma – intubation of trachea and artificial lung ventilation (AVL), massive hemotransfusions, immobilization, the phenomenon of “second strike” after multiple surgeries has been determined. The most effective measures of NK prevention are reduction of the duration of AVL, prevention of oropharyngeal colonization and aspiration in case of AVL, use of inhalation antibacterial drugs, antishock measures, early mobilization of the patient, the earliest possible stable functional osteosynthesis by minimally traumatic methods. The data on the effectiveness of selective decontamination of intestines, probiotics and glucocorticosteroids for the prevention of NK in polytrauma are inconsistent. A promising area of NK prophylaxis may be the development of agents that regulate the complex mechanisms of immune response to polytrauma and prevent secondary acute lung injury and post-traumatic immunosuppression.

scholarly journals The impact of mobilization protocols on the length of postoperative hospitalization among cardiac surgery patients

2021 ◽  
Vol 23 (2) ◽  
pp. 259-265
Author(s):  
V. V. Vitomskyi ◽  
O. B. Lazarieva ◽  
E. Yu. Doroshenko ◽  
M. V. Vitomskа ◽  
T. М. Kovalenko ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Time Management ◽  
Physical Therapist ◽  
Early Mobilization ◽  
Lung Ventilation ◽  
Functional Class ◽  
Artificial Lung Ventilation ◽  
Heart Contractility ◽  
The Impact

The aim. To determine the impact of implementing the extra early mobilization protocol (EEM) on the length of intensive care unit (LICU) stay and postoperative unit (LPOU) stay and to assess the role of age, heart contractility, functional class and surgical outcomes. Materials and methods. Participants – adult patients of 2018–2019 with less than 24-hour artificial lung ventilation (ALV). The first group were treated according to the early mobilization protocol (EM, patients of 2018); the second group were treated according to the EEM protocol (patients of 2019). Design: a retrospective analysis. Settings: cardiosurgical unit. Interventions: the major difference is that the resources of patient mobilization team have expanded since 2019, namely it included a physical therapist, which made it possible to modify the EM protocol (standing on the 2 postoperative day (POD), activation with the help of medical staff, respiratory exercise) to the EEM protocol (standing on the 1 POD following consultation with an anesthesiologist, exercises with a physical therapist, respiratory exercise). The main outcomes: LICU, LPOU and total postoperative hospitalization (LTPO) (number of nights). Results. There were no differences between the EEM and EM groups in LICU (3 (2; 4) vs. 2 (2; 4); P = 0.182), LPOU (7 (6; 10) vs. 8 (6; 10); P = 0.118), LTPO (10 (8; 13) vs. 10 (9; 13); P = 0.308). Correlation analysis revealed absence, weak and very weak relations between the LICU, LPOU, LTPO indicators and other criteria, including age, ejection fraction, ALV. Conclusions. The effectiveness of the EEM protocol seems doubtful to reduce LICU, LPOU, and LTPO as compared to the EM protocol. The obtained results also raise the importance of physical therapist time management.

Prognostic factors for development of acute respiratory distress syndrome following traumatic injury – a systematic review and meta-analysis

2021 ◽  
pp. 2100857
Author(s):  
Alexandre Tran ◽  
Shannon M. Fernando ◽  
Laurent J. Brochard ◽  
Eddy Fan ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Respiratory Distress Syndrome ◽  
Prognostic Factors ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Traumatic Injury ◽  
Clinical Risk Factors ◽  
Factors Associated ◽  
Post Traumatic

PurposeTo summarise the prognostic associations between various clinical risk factors and the development of the acute respiratory distress syndrome (ARDS) following traumatic injury.MethodsWe conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched six databases from inception through December 2020. We included English language studies describing the clinical risk factors associated with the development of post-traumatic ARDS, as defined by either the American-European Consensus Conference or the Berlin definition. We pooled adjusted odds ratios for prognostic factors using the random effects method. We assessed risk of bias using the QUIPS tool and certainty of findings using GRADE methodology.ResultsWe included 39 studies involving 5 350 927 patients. We identified the amount of crystalloid resuscitation as a potentially modifiable prognostic factor associated with the development of post-traumatic ARDS (adjusted odds ratio [aOR] 1.19 for each additional liter of crystalloid administered within first 6 h after injury, 95% CI 1.15 to 1.24, high certainty). Non-modifiable prognostic factors with a moderate or high certainty of association with post-traumatic ARDS included increasing age, non-Hispanic white race, blunt mechanism of injury, presence of head injury, pulmonary contusion, or rib fracture; and increasing chest injury severity.ConclusionWe identified one important modifiable factor, the amount of crystalloid resuscitation within the first 24 h of injury, and several non-modifiable factors associated with development of post-traumatic ARDS. This information should support the judicious use of crystalloid resuscitation in trauma patients and may inform the development of a risk-stratification tools.

scholarly journals Severe Acute Infection Due to Serratia marcescens Causing Respiratory Distress in An Immunocompetent Adult

2016 ◽  
Vol 54 (2) ◽  
pp. 134-136 ◽  
Author(s):  
Pablo Ruiz-Sada ◽  
Mikel Escalante ◽  
Eva Lizarralde
Keyword(s):  
Risk Factors ◽  
Respiratory Distress ◽  
Serratia Marcescens ◽  
Distress Syndrome ◽  
Acute Infection ◽  
Human Pathogen ◽  
Immunocompetent Adult ◽  
Uncommon Presentation ◽  
Opportunistic Human Pathogen

AbstractThe role ofSerratia marcescenschanged from a harmless saprophytic microorganism to an important opportunistic human pathogen. It often causes nosocomial device-associated outbreaks and rarely serious invasive community acquired infections. We present a case of a community-acquiredSerratia marcescensbacteremia leading to Respiratory Distress Syndrome in a previously healthy 51-year-old man without identifiable risk factors. Full recovery was achieved with solely medical treatment and observation in ICU during three days. To our knowledge it is an extremely uncommon presentation and just few cases have been previously reported in the literature.

scholarly journals Analysis of the Etiological Structure and Profile of Drug Resistance of Causative Agents of Nosocomial Pneumonia in Young Children Who Were on Mechanical Ventilation

2019 ◽  
pp. 16-19
Author(s):  
V.V. Danilova ◽  
S.I. Bevz ◽  
S.S. Ovcharenko ◽  
O.S. Shevchenko ◽  
L.D. Todoriko
Keyword(s):  
Antibiotic Resistance ◽  
Intensive Care ◽  
Young Children ◽  
Antibiotic Therapy ◽  
Nosocomial Pneumonia ◽  
Lung Ventilation ◽  
Artificial Lung ◽  
Aim Analysis ◽  
Gram Negative ◽  
Artificial Lung Ventilation

Background. The results of the treatment of young children who are on artificial lung ventilation in the departments of anesthesiology and intensive care (DAIC) depend directly on the antibiotic therapy policy used in the department. Aim. Analysis of the etiological structure and the level of antibiotic resistance of pathogens of nosocomial pneumonia (NP) in young children in the conditions of the DAIC of the Regional Children’s Clinical Hospital № 1 in Kharkov for the period 2000-2018. Materials and methods. 89 children with nosocomial pneumonia who were undergoinig artificial lung ventilation in the anesthesiology and intensive care unit up to 3 year-olds. Results. Gram-negative microorganisms (MOs) were isolated in 84.3% (n=75), gram-positive MOs – in 12.35% (n=11), micosis of different species in 3.37% (n=3). The study of antibiotic resistance of strains of microorganisms isolated from endotracheal aspirate in infants with nosocomial pneumonia, significantly indicates the predominance in the structure of pathogens of gram-negative microorganisms having multiple or panresistant microorganisms Conclusions. Carrying out regular monitoring of antibiotic sensitivity will allow more flexible implementation of antibiotic therapy policy in the DAIC, which, in turn, will increase the effectiveness of treatment, will reduce the economic costs and mortality of this contingent of patients.

Analysis of the etiological structure of nosocomial pneumonia associated with artificial lung ventilation

2019 ◽  
pp. 86-88
Author(s):  
A. I. Lokotkova ◽  
T. Yu. Shlyapchenkova ◽  
E. Kh. Mamkeev ◽  
I. S. Abaseva ◽  
D. V. Lopushov
Keyword(s):  
Nosocomial Pneumonia ◽  
Lung Ventilation ◽  
Artificial Lung ◽  
Artificial Lung Ventilation

THE ROLE OF DEXAMETHASONE DOSING IN THE TREATMENT OF COVID-19 AND ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS): A SYSTEMATIC REVIEW

2021 ◽  
pp. 21-26
Author(s):  
Ж.К. УТАРОВ ◽  
К.К. КУРАКБАЕ
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Distress Syndrome ◽  
Lung Ventilation ◽  
Cytokine Storm ◽  
Main Effect ◽  
The World

Новый тип коронавируса был обнаружен в декабре 2019 года в провинции Ухань Китайской Народной Республики и получил называние SARS-CoV-2, а болезнь назвался COVID-19. Болезнь проявляется многими клиническими симптомами (лихорадка, кашель, одышка, повторяющийся озноб, мышечные боли, головная боль, боль в горле, потеря обоняния (аносмия) и / или вкуса (агевзия) и диарея), но в основном повреждает верхние и нижние дыхательные пути. Поскольку COVID-19 в основном вызывает вирусное поражение легких, многие пациенты попадают в больницу в тяжелом состоянии с острым респираторным дистресссиндромом (ОРДС). Ухудшение состояния при вирусной пневмонии идёт быстрыми темпами, и у многих пациентов уже в течение нескольких часов развивается дыхательная недостаточность, требующая немедленной респираторной поддержки. Учитывая, что новый тип коронавируса пришел в нашу жизнь на десятилетия, уже сейчас необходимо рассмотреть новые направления лечения. В настоящее время рассматриваются различные варианты лечения с целью полного уничтожения вируса или прекращения его дальнейшего развития, в том числе препарат дексаметазон, принадлежащий к группе глюкокортикоидов, который продемонстрировал основную эффективность. На сегодняшний день проведено несколько рандомизированных клинических испытаний (РКИ) с применением дексаметазона, но оптимальная доза и продолжительность применения препарата до сих пор не определены. Currently, a lot of research is being conducted using various medicines to treat COVID-19 disease, which puts the world at a standstill. In particular, we are talking about the drug dexamethasone, which has the main effect on ensuring that patients are not transferred to the intensive care unit and are not connected to articial lung ventilation. Although several randomized clinical trials have been conducted, the dose of dexamethasone has not yet been rened to suppress or stop the cytokine storm.

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