Adaptive Phage Therapy in the Treatment of Patients with Recurrent Pneumonia (Pilot Study)

Aim. To evaluate the safety and efficacy of the adaptive phage therapy technique in patients with recurrent pneumonia in neurological critical care.Material and methods. The clinical study included 83 chronically critically ill patients with severe brain damage. The bacteriophage cocktail selected against specific hospital strains was administered by inhalation to 43 patients. The control group included 40 patients who received conventional antimicrobial therapy. The changes in clinical, laboratory and instrumental parameters, levels of biomarkers, microbiological and PCR tests of bronchoalveolar lavage fluid were assessed, including those in the «phage therapy with antibiotics» (n=29) and «phage therapy without antibiotics» (n=14) subgroups.Results. The groups were comparable in terms of basic parameters (age, sex, diagnosis, organ dysfunction according to APACHE II, use of vasoactive drugs) and the level of airway colonization with antibioticresistant bacterial strains. Good tolerability and absence of clinically significant side effects were observed during inhaled administration of the bacteriophage cocktail. Computed tomography on day 21 showed a significant reduction in lung damage in patients who received bacteriophages. Patients treated with bacteriophages without antibiotics had significantly lower need for mechanical ventilation. The mortality rate on day 28 did not differ significantly and was 4.7% (2/43) in the bacteriophage-treated group vs 5% (2/40) in the control group.Conclusion. The first experience of using the adaptive phage therapy technique in chronically critically ill patients in neurological intensive care demonstrated the safety of inhalational administration of the bacteriophage cocktail. The efficacy of the technique was confirmed by the treatment results obtained in the phage therapy group, which were not inferior to those in the group with conventional antibiotic therapy, while several clinical and laboratory parameters tended to improve even in patients who received bacteriophages and did not receive antibiotics.

Nursing Care of the Chronically Critically ill: An Exploratory Descriptive Study

<p>Background:There is an emerging group of intensive care unit (ICU) patients known as the chronically critically ill (CCI). This patient group is steadily increasing worldwide (Nelson et al., 2004).No published literature was located that focused on the nursing experience of caring for CCI patients, however studies alluded to CCI patients as frustrating to look after.This is pertinent because these patients are costly to care for and considered burdensome to nurses and physicians. (Daly, Rudy, Thompson & Happ, 1991). In a working environment where turnover and shortage of nursing staff is evident and predicted to worsen, this is cause for real concern about future resourcing for this patient group (Carasa & Nespoli, 2002). Research Aims: The aim of this study was to explore and describe nurses' experiences of caring for CCI patients. ICU nurses are the key providers of bedside care to all ICU patients. They have valuable contributions concerning the planning and implementation of patient-focused care, including that of long-stay and CCI patients. Method: A qualitative approach was used with an exploratory descriptive design. Semistructured interviews were conducted which generated in-depth description of participant experiences. Findings: Six key themes are identified: 1. Nursing autonomy and control 2. Work-related stress, compassion fatigue and staff allocation 3. The CCI patient in the ICU environment 4. Teamwork, nursing practice and continuity of care 5. The culture of ICU 6. Withdrawal of care and palliation. Summary: Six nurses from two tertiary level ICUs within New Zealand were interviewed using a semi-structured approach. Participants were encouraged to comment on several issues including access to training and resources, cultural issues within ICU and any suggestions for how CCI patient care might be improved.The interviews were transcribed to allow a thorough content analysis. These topics were explored and generated recommendations for changing practice.</p>

Nursing Care of the Chronically Critically ill: An Exploratory Descriptive Study

<p>Background:There is an emerging group of intensive care unit (ICU) patients known as the chronically critically ill (CCI). This patient group is steadily increasing worldwide (Nelson et al., 2004).No published literature was located that focused on the nursing experience of caring for CCI patients, however studies alluded to CCI patients as frustrating to look after.This is pertinent because these patients are costly to care for and considered burdensome to nurses and physicians. (Daly, Rudy, Thompson & Happ, 1991). In a working environment where turnover and shortage of nursing staff is evident and predicted to worsen, this is cause for real concern about future resourcing for this patient group (Carasa & Nespoli, 2002). Research Aims: The aim of this study was to explore and describe nurses' experiences of caring for CCI patients. ICU nurses are the key providers of bedside care to all ICU patients. They have valuable contributions concerning the planning and implementation of patient-focused care, including that of long-stay and CCI patients. Method: A qualitative approach was used with an exploratory descriptive design. Semistructured interviews were conducted which generated in-depth description of participant experiences. Findings: Six key themes are identified: 1. Nursing autonomy and control 2. Work-related stress, compassion fatigue and staff allocation 3. The CCI patient in the ICU environment 4. Teamwork, nursing practice and continuity of care 5. The culture of ICU 6. Withdrawal of care and palliation. Summary: Six nurses from two tertiary level ICUs within New Zealand were interviewed using a semi-structured approach. Participants were encouraged to comment on several issues including access to training and resources, cultural issues within ICU and any suggestions for how CCI patient care might be improved.The interviews were transcribed to allow a thorough content analysis. These topics were explored and generated recommendations for changing practice.</p>

Host-Microbiome Interactions Mediated by Phenolic Metabolites in Chronically Critically Ill Patients

The community structure and metabolic potential of gut microbiome is not well investigated, especially in chronically critically ill patients with prolonged dependence on support systems after severe brain disorders. Microbial phenolic metabolites can target the brain function by the direct and indirect modulation of inflammation. The aim of this study was to investigate the features of the gut microbiota and profile of certain metabolites in the progression and reversibility of neurological disorders in chronically critically ill patients. Fecal samples were collected in dynamics from such patients (n = 44) and analyzed using 16S rRNA sequencing. Serum microbial and mitochondrial metabolites were measured by GC-MS and compared with the biomarkers and clinical neurological scores. The identified associations between specific bacterial taxa in fecal samples, neurological status and serum levels of metabolites suggest that impacts on specific members of the gut microbiota and their metabolism might be a promising tool for regulating brain function in future.

Health-related expectations of the chronically critically ill: a multi-perspective qualitative study

Background Those who survive critical illness only to become chronically critically ill (CCI) experience a high symptom burden, repeat episodes of illness exacerbation, communication barriers, and poor health outcomes. Yet, it is unclear how CCI individuals and their family understand their health and the importance of prognostic information following hospitalization. The research purpose was to examine expectations about health and disease prognosis of CCI residents in long-term care from the perspectives of the CCI themselves and their family members, as well as to describe healthcare provider (HCP) interpretations of, and reactions to, these health-related expectations. Methods In this qualitative interpretive descriptive study, conducted in British Columbia, Canada, 38 semi-structured interviews were conducted (6 CCI residents, 11 family members, and 21 HCPs) and inductively analyzed using thematic and constant comparative techniques. Results There was divergence in CCI resident, family and HCP expectations about health and the importance of disease prognosis, which contributed to conflict. CCI residents and family viewed conflict with HCPs in relation to their day-to-day care needs, while HCPs viewed this as arising from the unrealistically high expectations of residents and family. The CCI residents and family focussed on the importance of maintaining hope, and the HCPs highlighted the complexity of end-of-life decisions in conjunction with the high expectations and hopes of family. Conclusions The emotional and ongoing process of formulating health-related expectations points to the need for future research to inform the development and/or adapting of existing communication, psychosocial and health services interventions to ease the burden experienced by those who are CCI.

Single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in Germany

ObjectivesTo assess the delirium severity (DS), its risk factors and association with adverse patient outcomes in chronically critically ill (CCI) patients.DesignA prospective cohort study.SettingA tertiary care hospital with postacute intensive care units (ICUs) in Germany.ParticipantsN=267 CCI patients with critical illness polyneuropathy and/or critical illness myopathy, aged 18–75 years, who had undergone elective tracheotomy for weaning failure.InterventionsNone.MeasuresPrimary outcomes: DS was assessed using the Confusion Assessment Method for the Intensive Care Unit-7 delirium severity score, within 4 weeks (t1) after the transfer to a tertiary care hospital. In post hoc analyses, univariate linear regressions were employed, examining the relationship of DS with clinical, sociodemographic and psychological variables. Secondary outcomes: additionally, correlations of DS with fatigue (using the Multidimensional Fatigue Inventory-20), quality of life (using the Euro-Quality of Life) and institutionalisation/mortality at 3 (t2) and 6 (t3) months follow-up were computed.ResultsOf the N=267 patients analysed, 9.4% showed severe or most severe delirium symptoms. 4.1% had a full-syndromal delirium. DS was significantly associated with the severity of illness (p=0.016, 95% CI −0.1 to −0.3), number of medical comorbidities (p<0.001, 95% CI .1 to .3) and sepsis (p<0.001, 95% CI .3 to 1.0). Patients with a higher DS at postacute ICU (t1), showed a higher mental fatigue at t2 (p=0.008, 95% CI .13 to .37) and an increased risk for institutionalisation/mortality (p=0.043, 95% CI 1.1 to 28.9/p=0.015, 95% CI 1.5 to 43.2).ConclusionsIllness severity is positively associated with DS during postacute care in CCI patients. An adequate management of delirium is essential in order to mitigate functional and cognitive long-term sequelae following ICU.Trial registration numberDRKS00003386.