Intensive Care
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2021 ◽  
Vol 13 (10) ◽  
pp. 1341-1350
Fernando da Silveira ◽  
Pedro H R Soares ◽  
Luana Q Marchesan ◽  
Roberto S A da Fonseca ◽  
Wagner L Nedel

2021 ◽  
Vol 61 ◽  
pp. 417-423
Maoting Tang ◽  
Min Xu ◽  
Shaoyu Su ◽  
Xiaoming Huang ◽  
Shuai Zhang

2021 ◽  
Vol 4 (1) ◽  
pp. 7-13
MAHAMANE SANI Mahamane Aminou ◽  
GBAGUIDI Aichatou Diawara ◽  
MIGITABA Hassane Moctar ◽  
SANI Rabiou ◽  
EMOUD TCHOLI Idrissa ◽  

The COVID-19 infection has highlighted the most vulnerable patients. Indeed, COVID-19 patients suffering from another pathology including NCDs such as Arterial Hypertension (Hypertension), diabetes, cancers and respiratory diseases are paying a heavy price for this pandemic. We undertook a study in Niger to better document this comorbidity in a cross-sectional study that brought together patients hospitalized at the Niamey General Reference Hospital for COVID-19 infection and suffering from one or more NCDs. Among 273 patients hospitalized from March 19 to June 03, 2020, 34.8% had a non-communicable disease associated with COVID-19. The average age of the patients was 55 years (22 years to 94 years) and the sex ratio was 2.64 (72.5 % men and 27.5% women). Hypertension was the most represented NCD with 24.5%, followed by diabetes in 17.9% of cases, respiratory diseases 3.66% and other diseases (Heart disease, Obesity, Dyslipidemia, Gout, Chronic renal failure) with 3%. Health workers were the most affected by the disease with 38.6% of cases. The average consultation time was 3.77 days with extremes ranging from 1 to 8 days. The clinical symptoms characterizing the two main groups of patients (hypertensive and diabetic) were almost identical. It consisted mainly of cough, fever, chills, sore throat and rhinorrhea. According to the WHO clinical criteria for the severity of COVID-19, 34 patients or 16.11% were severe and 177 patients or 83% moderate. The clinical severity of the disease is significantly correlated with the patient's age (over 50 years) and the presence of an NCD associated with COVID-19. A total of 35.8% were hospitalized in intensive care in the NCD and COVID-19 group and 14.6% in the NCD group (p <0.001). The average length of patient hospitalization was 6.87 days overall, it was 7 days in intensive care. In 61.7% of cases the length of hospitalization was greater than 4 days. There was 22.1% in the NCD group and 7.3% in the just COVID-19 group (p <0.001). A total of 90.6% of registered deaths occurred in intensive care.

2021 ◽  
Donatella Lombardo ◽  
Miriam Cordovana ◽  
Francesca Deidda ◽  
Marco Pane ◽  
Simone Ambretti

Aim: Acinetobacter baumannii is a pathogen of serious concern, often exhibiting multiple antibiotic resistance, frequently associated with hospital outbreaks in intensive care units. A prompt detection and tracking of these isolates is crucial. Reference methods for typing (pulsed-field gel electrophoresis, whole-genome sequencing) are accurate, but expensive and time-consuming, therefore limited to retrospective analysis. Materials & methods: In this study, the application of the FTIR-based IR Biotyper® (IRBT) to track and monitor in real time the spread of a multidrug-resistant A. baumannii outbreak was investigated. The index case and the multidrug-resistant  A. baumannii isolates collected in the following 3 weeks were investigated. Results: IR Biotyper® clustering results were fully confirmed by pulsed-field gel electrophoresis results. Conclusions: IR Biotyper represent a promising tool for real-time hospital hygiene, enabling a prompt and reliable typing.

2021 ◽  
Vol 4 (2) ◽  
Francesca Romana Greco ◽  
Grazia D’Onofrio ◽  
Filomena Ciccone ◽  
Francesco Giuliani ◽  
Sergio Russo ◽  

Introduction. Telepresence provides clinicians the ability to monitor patients as well to communicate with all the members of the healthcare staff.  Covid-19 Units cope with high complexity in providing care and an integration amount the care team and the patients’ relatives should be carried out to obtained successful outcomes and preventing complication. Virtual rounding (VR) has been successfully applied to cope with this task in the last 2000 years in medical units.  Covid-19 patients due to safety rules may be prone to isolation and lack of communication with their family. Purpose. The aim of our study was to evaluate the effect of structured virtual round protocol in a geriatric Covid-19 unit on anxiety and depression for the patients and their relatives. Methodology. All the patients admitted to the geriatric Covid-19 unit from 1 February 2021 to 30 April were studied. Inclusion criteria to the study were the followings: no severe cognitive impairment (MMSE =>24) or neuro sensorial deficits; informed consent to participate to the study. Forty-nine 49 (75% of patients) met the inclusion criteria. All the subject who were found to be eligible to the study underwent a VR standard protocol of care. VR was consisted with: 1) a video call with a tablet device conducted by a psychologist that established a cooperative communication between the health care staff (nurses and MD, their relatives) at the bed sides; 2) a video call with the patient’s relatives in which it was clearly explained the standard care and the role of each healthcare member was also included. Anxiety and depression levels were assessed for the patients at baseline after the end of the protocol by the Hospital Anxiety and Depression Scale (HADS). Patients’ relatives were investigated for depression at baseline and after the end of the protocol by the Beck Depression Inventory- Primary Care (BDI-PC). The Beck Depression Inventory for primary care has seven items with each item rated on a 4-point scale (0–3). It is scored by summing ratings for each item (range 0–21). Items are symptoms of sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts and wishes. The Hospital Anxiety and Depression Scale (HADS) is a self- assessment scale found to be a reliable instrument for detecting states of depression and anxiety. The anxiety and depressive sub-scales are also valid measures of severity of the emotional disorder. The questionnaire comprises seven questions for anxiety and seven questions for depression, and takes 2–5min to complete. For both scales, scores less than 7 indicate non- cases, 8-10 mild, 11-14 moderate, 15-21 severe. JMP software by SAS (v.16) was used for the statistical analysis. Results. The present study included forty-nine 49 patients (67% male), mean age of 69.9 ±14.7 years with one relative for each patient. The average mean of the hospitalization for each patients was 17.6 ± 5.7 days The mean VR duration time was 60±5.5 minutes. VR showed a significant decrease in both Anxiety and depression for patients: (HADS Depression baseline 10.6 ±3.1 vs 6.9 ±2.7 end p<0.01) (HADS Anxiety baseline 10.2 ±3.4 vs 6.8 ±3.0 end p<0.01). VR has also reduced depression in the relatives of patients (BDI-PC 3.6 ±2.4 vs 1.9 ±1.9 p<0.01). Discussion. VR has reduced anxiety and depression in patients hospitalized in a sub-intensive COVID 19 unit and it also has been found to be effective in decreasing depression in the relatives of these patients Limitation. However, the study has some possible limitations considering its small size and that it was mono centric Conclusions. Our data confirm the efficacy of VR in the sub-intensive care setting. This evidence supports the key role of a multidisciplinary team, focusing on the importance of social and psychological support during the hospital stay.   More studies will be consequently necessary to better validate the importance of VR as a standard care tool in intensive/sub- intensive care units for the elderly patients

2021 ◽  
pp. 088506662110471
Zia Hashim ◽  
Zafar Neyaz ◽  
Rungmei S.K. Marak ◽  
Alok Nath ◽  
Soniya Nityanand ◽  

Coronavirus disease-2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a new disease characterized by secondary Aspergillus mold infection in patients with COVID-19. It primarily affects patients with COVID-19 in critical state with acute respiratory distress syndrome, requiring intensive care and mechanical ventilation. CAPA has a higher mortality rate than COVID-19, posing a serious threat to affected individuals. COVID-19 is a potential risk factor for CAPA and has already claimed a massive death toll worldwide since its outbreak in December 2019. Its second wave is currently progressing towards a peak, while the third wave of this devastating pandemic is expected to follow. Therefore, an early and accurate diagnosis of CAPA is of utmost importance for effective clinical management of this highly fatal disease. However, there are no uniform criteria for diagnosing CAPA in an intensive care setting. Therefore, based on a review of existing information and our own experience, we have proposed new criteria in the form of practice guidelines for diagnosing CAPA, focusing on the points relevant for intensivists and pulmonary and critical care physicians. The main highlights of these guidelines include the role of CAPA-appropriate test specimens, clinical risk factors, computed tomography of the thorax, and non-culture-based indirect and direct mycological evidence for diagnosing CAPA in the intensive care unit. These guidelines classify the diagnosis of CAPA into suspected, possible, and probable categories to facilitate clinical decision-making. We hope that these practice guidelines will adequately address the diagnostic challenges of CAPA, providing an easy-to-use and practical algorithm to clinicians for rapid diagnosis and clinical management of the disease.

2021 ◽  
Muhammad Abdullah ◽  
Maria Khan ◽  
Danyal Amjad ◽  
Farah Shireen ◽  
Shah masoom ◽  

Abstract Background: Burkholderia cepacia (formerly Pseudomonas) is a gram-negative bacillus that can remain viable in low-nutrient water and is typically found in soil and moist settings. It is one of the leading causes of sepsis in infants, and it is spread by human contact with contaminated medical devices and disinfectants. B. cepacia has emerged as a significant opportunistic pathogen in hospitalized and immunocompromised patients, colonizing the lungs of individuals with cystic fibrosis. Hospital outbreaks have been associated to infected faucets, nebulizers, disinfection solutions, multi-dose antibiotic vials, drinking water, distilled water, flowmeters, nasal sprays, and ultrasound gels. We describe our investigation and successful management of a nosocomial Burkholderia cepacia sepsis outbreak in a tertiary care hospital's newborn intensive care unit in Peshawar, Pakistan.Methodology: Blood samples from 50 newborns with sepsis were collected using a standardized approach and incubated using an automated blood culture system (BACT/Alert 3D and BACTEC 9050). Disk diffusion and the Minimum inhibitory concentration methods were used to test antimicrobial susceptibility. Gram staining was used to identify bacteria, and API (Analytical Profile Index) 20 NE was used to characterize them biochemically. Environmental and epidemiological investigations were also conduct to investigate the source and route of infection.Results: All of the 50 patients admitted in NICU (Neonatal Intensive Care Unit) were included in this study, and had lately-onset neonatal sepsis, with B. cepacia. During an epidemic in the NICU from 30th, April to 21st, June 2021, B. cepacia was isolated from over 45 blood samples. In total 45 neonates 17(35%) were female and 28 (65%) were male. Average age of neonates was 14.88 days. Antibiotic susceptibility testing was performed on Muller Hinton agar using Kirby Bauer's disc diffusion method and interpreted according to Clinical Laboratory Standard Institute (CLSI 2021) guidelines. As B. cepacia has intrinsic resistant to polymyxin class (colistin sulphate) of antibiotics, the susceptibility pattern of all isolates were almost similar i.e. showing resistance to tetracycline 100% (minocycline) and cephalosporin 3rd generation 100% (ceftazidime). The isolates were 100% sensitive to fluoroquinolones (levofloxacin), carbapenem 100% (meropenem), chloramphenicol 100% and sulfonamide 100% (co trimaxazole).Conclusion: In present study, the index case might have been exposed to infection due to an intravenous fluid utilized for fluid and electrolyte replacement for intravenous delivery were the source of the current nosocomial outbreak and physiological state of low immunity (preterm, low birth weight, and mechanical ventilation). The rest of the cases might have been exposed to this organism due to inadequate hand hygiene/improper cleaning and disinfection practices. Timely reporting and implementation of infection control measures can play a significant role in curtailing this outbreak.

Hung-Hui Lee ◽  
Li-Ying Lin ◽  
Hsiu-Fen Yang ◽  
Yu-Yi Tang ◽  
Pei-Hern Wang

Ventilator-associated pneumonia is a common hospital-acquired infection. It causes patients to stay longer in the hospital and increases medical costs. This study explores the effect of applying an automatic medical information system to implement five-item prevention care bundles on the prevention of ventilator-related pneumonia. This study was a retrospective cohort study. This study was conducted from October 2017 to February 2018 and collected data from the intensive care unit of a medical center in southern Taiwan from January 2013 to May 2016. The control group (enrolled from January 2013 to June 2014) received oral hygiene. The experimental group (enrolled from July 2014 to December 2015) received five-item ventilator-associated pneumonia prevention care bundles, which consisted of (1) elevation of the head of the bed to 30–45°; (2) daily oral care with 0.12−0.2% chlorhexidine twice daily; (3) daily assessment of readiness to extubate; (4) daily sedative interruption; and (5) emptying water from the respirator tube. Results showed the incidence of ventilator-associated pneumonia in the bundle group was significantly less than the oral hygiene group (p = 0.029). The factors that significantly affected the incidence of ventilator-associated pneumonia were ventilator-associated pneumonia care bundle, ventilator-days, and intensive care unit length of stay. A significant reduction in ventilator-associated pneumonia rate in the bundle group compared to the oral hygiene group (OR = 0.366, 95% CI = 0.159–0.840) was observed, with 63.4% effectiveness. Application of an automatic medical information system to implement bundle care can significantly reduce the incidence of ventilator-associated pneumonia.

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