Intensive Care Units In Greece Research Articles

Predicting the risk of treatment-requiring retinopathy of prematurity in preterm infants in Greece. External validation of DIGIROP prognostic models.

To assess the predictive performance of DIGIROP-v1.0 models in identifying treatment-requiring ROP among infants undergoing ROP screening at a tertiary neonatal intensive care unit in Greece. Retrospective cohort analysis of 640 consecutive screened preterm infants with gestational age (GA) 240/7 to 306/7 weeks and known ROP outcome in the 2nd Neonatology Department of Aristotle University of Thessaloniki (2009-2021). The primary outcome was the development of type 1 ROP according to the Early Treatment of ROP criteria or treatment based on the ophthalmologist's judgement. Sensitivity, specificity, area under the curve (AUC) with corresponding 95% confidence intervals (CI) and calibration plots for the DIGIROP-v1.0 models were displayed. The DIGIROP-Birth-v1.0 model correctly identified 35/43 treated infants (sensitivity 81.4% [95% CI, 66.6%-91.6%], specificity 61.5% [95% CI, 57.4%-65.4%], AUC 0.82 [95% CI, 0.75-0.90]). During the postnatal weeks 6-14 the sensitivity of the DIGIROP-Screen-v1.0 model ranged from 82.6% to 100%. Eleven infants, all with severe comorbidities, that is, congenital malformation(s), syndrome(s), hydrocephalus or history of intestinal surgery, that were treated, were missed by the model, but met criteria for screening according to DIGIROP-v1.0 models' recommendations, and to our unit's routine standards. The DIGIROP-v1.0 models resulted in lower sensitivity and higher specificity in this Greek cohort compared with the Swedish development group. Despite higher GA and BW, infants in our cohort had higher incidence of treated ROP than in Sweden, resulting in an under-estimation of their risk for treatment-requiring ROP. Further validation of the DIGIROP-v2.0 models and potential adjusting are recommended to maximize generalizability in populations with different characteristics.

A combination of mild-moderate hypoxemia and low compliance is highly prevalent in persistent ARDS: a retrospective study

BackgroundThe Acute Respiratory Distress Syndrome (ARDS) is characterized by lung inflammation and edema, impairing both oxygenation and lung compliance. Recent studies reported a dissociation between oxygenation and compliance (severe hypoxemia with preserved compliance) in early ARDS and COVID-19-related-ARDS (CARDS). During the pandemic, in patients requiring prolonged mechanical ventilation, we observed the opposite combination (mild-moderate hypoxemia but significantly impaired compliance). The purpose of our study was to investigate the prevalence of this combination of mild-moderate hypoxemia and impaired compliance in persistent ARDS and CARDS.MethodsFor this retrospective study, we used individual patient-level data from two independent cohorts of ARDS patients. The ARDSNet cohort included patients from four ARDS Network randomized controlled trials. The CARDS cohort included patients with ARDS due to COVID-19 hospitalized in two intensive care units in Greece. We used a threshold of 150 for PaO2/FiO2 and 30 ml/cmH2O for compliance, estimated the prevalence of each of the four combinations of oxygenation and compliance at baseline, and examined the change in its prevalence from baseline to day 21 in the ARDSNet and CARDS cohorts.ResultsThe ARDSNet cohort included 2909 patients and the CARDS cohort included 349 patients. The prevalence of the combination of mild-moderate hypoxemia and low compliance increased from baseline to day 21 both in the ARDSNet cohort (from 22.2 to 42.7%) and in the CARDS cohort (from 3.1 to 33.3%). Among surviving patients with low compliance, oxygenation improved over time. The 60-day mortality rate was higher for patients who had mild-moderate hypoxemia and low compliance on day 21 (28% and 56% in ARDSNet and CARDS), compared to those who had mild-moderate hypoxemia and high compliance (20% and 50%, respectively).ConclusionsAmong patients with ARDS who require prolonged controlled mechanical ventilation, regardless of ARDS etiology, a dissociation between oxygenation and compliance characterized by mild-moderate hypoxemia but low compliance becomes increasingly prevalent. The findings of this study highlight the importance of monitoring mechanics in patients with persistent ARDS.

Evaluation and Treatment of Dysphagia in Public and Private Intensive Care Units (ICUs) in Greece.

Introduction Dysphagia is a significant but underrecognized clinical issue in the intensive care unit (ICU), and it is associated with various complications. Despite its clinical importance, there is limited research and no Greek ICU-specific guidelines for managing dysphagic patients. Additionally, only a few ICUs in Greece have dysphagia specialists, specifically speech-language pathologists (SLPs) providing their expertise. Objective Τo identify the current practices for dysphagia management (screening, assessment, treatment) and gain insight into ICU directors' awareness/perceptions of the prevalence, complications, and risk of dysphagia. Materials and Methods We identified 138 Greek ICUs. Data were collected from ICU (including pediatric and neonatal) directors, working in public and private hospitals, via a 24-item, anonymous online questionnaire, within a 4-month period. Results Our survey was completed by 45 ICU directors. Most participants (84.4%) reported that dysphagia is a relevant clinical problem in their ICU, and 51.1% estimated a frequency rate < 20%. Non-instrumental approaches are mainly utilized to screen and diagnose dysphagia, whereas enteral nutrition and diet modifications are used to manage dysphagia. Additionally, 64.4% of ICU directors agreed that SLPs are essential for the management of dysphagic patients, and 66.7%, that awareness of dysphagia in their ICU could be increased. Conclusion The current study documented the methods and approaches used to manage dysphagic patients in Greek ICUs. The ICU directors seem to recognize the clinical significance of dysphagia and its complications. According to our findings, the employment of SLPs could result in a more comprehensive and intensive approach and improve the quality of care for these patients.

1437. Successful Control of Candida auris Outbreak in a Tertiary Hospital Intensive Care Unit in Greece

Abstract Background Candida auris is an emerging pathogen, which can spread efficiently and cause outbreaks in healthcare settings.The purpose of this study is to highlight the importance of strict infection control measures to prevent in-hospital C. auris transmission. Methods Single-center retrospective observational study in hospitalized patients at the 2nd Department of Intensive Care Medicine (ICU) of G. Papanikolaou General Hospital from 02-11-2022 until 28-02-2023. Patient outcomes and epidemiologic indices were recorded. In total 79 surveillance cultures in 18 patients (male: 75%, median age: 51 years) were performed, while 187 surface samples were collected. Results After C. auris isolation from the index patient, colonization screening was performed in all ICU patients. C. auris was detected in a neighboring patient, 24 hours later, and in another patient from a central venous catheter tip culture 2 months later. An environmental culture from a pulse oximeter, was also positive. Immediately, an epidemiologic investigation was conducted, and an intensive infection control program was implemented in the ICU. Measures included strict adherence to standard and contact precautions and hand hygiene, isolation of positive cases, dedicated staff to care for patients with C. auris, disposable or specialized equipment for patient care, and cleaning and disinfection of frequently touched surfaces and equipment. In addition, surveillance cultures were performed twice weekly for each patient and once weekly for the environment. Also, to control the transmission to other departments, patient transfer was limited. At the same time, ICU personnel was educated on the significance and implementation of infection control bundles. The above measures resulted in the control of transmission of Candida auris in our hospital. Conclusion Strengthening appropriate infection control interventions and increasing compliance to their implementation, combined with continued surveillance and healthcare worker engagement by education, can prevent the transmission of pathogens such as Candida auris in healthcare settings. Disclosures All Authors: No reported disclosures

Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study

BackgroundWorking as a neonatologist in a neonatal intensive care unit (NICU) is stressful and involves ethically challenging situations. These situations may cause neonatologists to experience high levels of moral distress, especially in the context of caring for extremely premature infants (EPIs). In Greece, moral distress among neonatologists working in NICUs remains understudied and warrants further exploration.MethodsThis prospective qualitative study was conducted from March to August 2022. A combination of purposive and snowball sampling was used and data were collected by semi-structured interviews with twenty neonatologists. Data were classified and analyzed by thematic analysis approach.ResultsA variety of distinct themes and subthemes emerged from the analysis of the interview data. Neonatologists face moral uncertainty. Furthermore, they prioritize their traditional (Hippocratic) role as healers. Importantly, neonatologists seek third-party support for their decisions to reduce their decision uncertainty. In addition, based on the analysis of the interview data, multiple predisposing factors that foster and facilitate neonatologists’ moral distress emerged, as did multiple predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. The predisposing factors that foster and facilitate neonatologists’ moral distress thus identified include the lack of previous experience on the part of neonatologists, the lack of clear and adequate clinical practice guidelines/recommendations/protocols, the scarcity of health care resources, the fact that in the context of neonatology, the infant’s best interest and quality of life are difficult to identify, and the need to make decisions in a short time frame. NICU directors, neonatologists’ colleagues working in the same NICU and parental wishes and attitudes were identified as predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. Ultimately, neonatologists become more resistant to moral distress over time.ConclusionsWe concluded that neonatologists’ moral distress should be conceptualized in the broad sense of the term and is closely associated with multiple predisposing factors. Such distress is greatly affected by interpersonal relationships. A variety of distinct themes and subthemes were identified, which, for the most part, were consistent with the findings of previous research. However, we identified some nuances that are of practical importance. The results of this study may serve as a starting point for future research.

Compassion Fatigue and Compassion Satisfaction in Pediatric Intensive Care Professionals.

Paediatric ICU doctors and nurses' quality of professional life is influenced by the intense emotions and distress experienced when caring for suffering children and their families. The aim of this study was to examine the prevalence of compassion satisfaction (CS) and compassion fatigue (CF) in Paediatric Intensive Care Units in Greece. Out of 147 intensive care professionals in public hospitals in Greece completed the ProQOL-V scale as well as a socio-demographic and professional-life characteristics questionnaire. Almost two thirds of participants reported medium-risk for CF (74.8%) while 23.1% and 76.9% of professionals expressed high or medium potential for CS respectively. More than half of doctors and nurses in paediatric ICUs report being overprotective towards members of the family as a result of their professional life and that their work-life affects their attitude towards life in general. Recognizing factors related to CF may support paediatric intensive care professionals in avoiding the costs of exposure to the trauma and loss experiences of patients and their families. A trauma-informed intensive care culture and continuing trauma-informed education may shield professionals from the erosive effects of lingering emotions which may trigger secondary traumatic stress symptoms and also facilitate adequate reflection on their emotional reactions in the landscape of intensive care.

Optimised versus standard dosing of vancomycin in infants with Gram-positive sepsis (NeoVanc): a multicentre, randomised, open-label, phase 2b, non-inferiority trial

Vancomycin is the most widely used antibiotic for neonatal Gram-positive sepsis, but clinical outcome data of dosing strategies are scarce. The NeoVanc programme comprised extensive preclinical studies to inform a randomised controlled trial to assess optimised vancomycin dosing. We compared the efficacy of an optimised regimen to a standard regimen in infants with late onset sepsis that was known or suspected to be caused by Gram-positive microorganisms. NeoVanc was an open-label, multicentre, phase 2b, parallel-group, randomised, non-inferiority trial comparing the efficacy and toxicity of an optimised regimen of vancomycin to a standard regimen in infants aged 90 days or younger. Infants with at least three clinical or laboratory sepsis criteria or confirmed Gram-positive sepsis with at least one clinical or laboratory criterion were enrolled from 22 neonatal intensive care units in Greece, Italy, Estonia, Spain, and the UK. Infants were randomly assigned (1:1) to either the optimised regimen (25 mg/kg loading dose, followed by 15 mg/kg every 12 h or 8 h dependent on postmenstrual age, for 5 ± 1 days) or the standard regimen (no loading dose; 15 mg/kg every 24 h, 12 h, or 8 h dependent on postmenstrual age for 10 ± 2 days). Vancomycin was administered intravenously via 60 min infusion. Group allocation was not masked to local investigators or parents. The primary endpoint was success at the test of cure visit (10 ± 1 days after the end of actual vancomycin therapy) in the per-protocol population, where success was defined as the participant being alive at the test of cure visit, having a successful outcome at the end of actual vancomycin therapy, and not having a clinically or microbiologically significant relapse or new infection requiring antistaphylococcal antibiotics for more than 24 h within 10 days of the end of actual vancomycin therapy. The non-inferiority margin was -10%. Safety was assessed in the intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT02790996). Between March 3, 2017, and July 29, 2019, 242 infants were randomly assigned to the standard regimen group (n=122) or the optimised regimen group (n=120). Primary outcome data in the per-protocol population were available for 90 infants in the optimised group and 92 in the standard group. 64 (71%) of 90 infants in the optimised group and 73 (79%) of 92 in the standard group had success at test of cure visit; non-inferiority was not confirmed (adjusted risk difference -7% [95% CI -15 to 2]). Incomplete resolution of clinical or laboratory signs after 5 ± 1 days of vancomycin therapy was the main factor contributing to clinical failure in the optimised group. Abnormal hearing test results were recorded in 25 (30%) of 84 infants in the optimised group and 12 (15%) of 79 in the standard group (adjusted risk ratio 1·96 [95% CI 1·07 to 3·59], p=0·030). There were six vancomycin-related adverse events in the optimised group (one serious adverse event) and four in the standard group (two serious adverse events). 11 infants in the intention-to-treat population died (six [6%] of 102 infants in the optimised group and five [5%] of 98 in the standard group). In the largest neonatal vancomycin efficacy trial yet conducted, no clear clinical impact of a shorter duration of treatment with a loading dose was demonstrated. The use of the optimised regimen cannot be recommended because a potential hearing safety signal was identified; long-term follow-up is being done. These results emphasise the importance of robust clinical safety assessments of novel antibiotic dosing regimens in infants. EU Seventh Framework Programme for research, technological development and demonstration.

Methicillin-resistant Staphylococcus aureus transmission and hospital-acquired bacteremia in a neonatal intensive care unit in Greece

BackgroundStaphylococcus aureus is a common pathogen causing hospital acquired infections (HAIs) in neonates. In this study, the epidemiology of methicillin-resistant S. aureus (MRSA) colonization and infections in a 30-bed, level III university-affiliated neonatal intensive care unit (NICU) located in a children's hospital was retrospectively investigated for the period 2014–2018. MethodsGenes encoding Panton-Valentine Leukocidin (lukS/lukF-PV, PVL), toxic shock syndrome toxin (tst), exfoliative toxins (eta, etb), and the resistance genes mecA, mecC and fusB, were defined in 46 representative strains by PCRs. Relatedness of strains was assessed by MLST. ResultsOf 1538 neonates, 77 (5%) had a positive culture for MRSA (23/77 were NICU-acquired and 54/77 imported cases). Four MRSA bacteremias occurred. Most isolates were multi-resistant. One major clone was identified, ST225, among 40 tested neonatal strains (23/40, 58%). Of these, 14/23 were imported from the same maternity hospital (MH). Another clone, ST217, was predominant (4/6) among health care workers (HCWs), found colonized. Four isolates classified as ST80 were PVL-positive. Additional four strains carried tst (10%), belonging to ST30 and ST225 (two strains each), and two etb. The implicated MH was notified for the problem, decolonization treatment was successfully performed in HCWs and neonates. Strengthening of infection control measures with emphasis on hand hygiene was applied. ConclusionsUncovering reservoirs for on-going MRSA transmission in NICUs has proved challenging. Well known nosocomial MRSA clones are being constantly introduced and transmitted via MHs and HCWs. Effective infection prevention and control requires constant vigilance.

Admissions due to vaccine preventable diseases in a large paediatric intensive care unit in Greece over a 10-year period.

Childhood immunisation is an important preventive measure. However, care givers may delay routine immunisations or seek exemptions from state vaccine mandates. Vaccine refusal creates barriers on vaccine coverage and leads to morbidity and mortality. Our study reviews morbidity and mortality from vaccine preventable diseases (VPDs) in a large paediatric intensive care unit in Greece over a 10-year period. During the study period, 73 cases of VPDs were recorded, corresponding to 3.5% of total paediatric intensive care unit admissions. Influenza was the most prevalent VPD, followed by pneumococcal disease, measles, pertussis and meningococcal disease. Most patients (83.3%) were unvaccinated for the admission's VPD. Outcome was unfavourable for 31.9% of the patients (17 children died, 6 developed chronic impairment). Absent or incomplete vaccination may result in serious morbidity and mortality from preventable diseases. Strengthening vaccination strategies are needed to improve individual protection as well as herd immunity.

Recognition of Neonatal Hospitalization Cost in an Intensive Care Unit in Greece and the Deviation from Its Current Reimbursement System.

In this paper efforts have been made to record the actual, real cost of health care services in a Neonatal Intensive Care Unit (N.I.C.U.) of a public hospital. It is well known that, in recent years, the hospitals have been reimbursed with the system of Diagnosis-Related Groups (D.R.G.'s). The purpose of this study is to determine whether the costs according with D.R.G.'s correspond to the actual-real cost, as this is recorded in the N.I.C.U. This cost is called direct cost. Here is a case study of a premature neonate in the intensive care unit (N.I.C.U.). From the outset, the age of pregnancy, the birth weight, the duration of hospitalization in N.I.C.U. and the needs of the newborn in oxygen, medication, as well as nutrition are defined which are very important in shaping the cost. Then, the cost is calculated according to the D.R.G.'s system. By setting three basic diagnoses (I.C.D.-10), we find the D.R.G. which better describes the case, as well as the associated costs. Then, we calculate the direct cost and list all the consumables, exams, staff costs, overheads. Comparing the two results we find that the cost of D.R.G. does not meet the direct cost of hospitalization. There is a significant deviation from the actual real cost, which proves the under-costing of the health services. The D.R.G.'s system leads hospitals to increase their financial deficits and provide degraded quality health services. It is necessary to readjust the D.R.G.'s according to the reality and the redefinition of the hospital's reimbursement system to meet the direct - real cost of the health services offered.

Qualitative Analysis of Psychological Intervention in Intensive Care Unit in Greece: A Case Study of An Adult Woman with Septic Shock

We report a case study of a woman with Septic Shock who attended Psychological Intervention after medical treatment in the Intensive Care Unit of a Greek Teaching Hospital in Athens. Qualitative analysis of data was collected from Focused Interview, Genogram as a family history tool and Psychological Intervention based on Short/ Systemic Psychotherapy. The study focuses on the deep understanding of the patient’s changes in terms of thoughts, emotions and behaviors after the invasion of a serious disease, like Septic Shock

Qualitative Analysis of Psychological Intervention in Intensive Care Unit in Greece: A Case Study of An Adult Woman with Septic Shock

We report a case study of a woman with Septic Shock who attended Psychological Intervention after medical treatment in the Intensive Care Unit of a Greek Teaching Hospital in Athens. Qualitative analysis of data was collected from Focused Interview, Genogram as a family history tool and Psychological Intervention based on Short/ Systemic Psychotherapy. The study focuses on the deep understanding of the patient’s changes in terms of thoughts, emotions and behaviors after the invasion of a serious disease, like Septic Shock.

Physicians\u2019 attitudes in relation to end-of-life decisions in Neonatal Intensive Care Units: a national multicenter survey

BackgroundEnd-of-life decisions for neonates with adverse prognosis are controversial and raise ethical and legal issues. In Greece, data on physicians’ profiles, motivation, values and attitudes underlying such decisions and the correlation with their background are scarce. The aim was to investigate neonatologists' attitudes in Neonatal Intensive Care Units and correlate them with self-reported practices of end-of-life decisions and with their background data.MethodsA structured questionnaire was distributed to all 28 Neonatal Intensive Care Units in Greece. One hundred and sixty two out of 260 eligible physicians answered anonymously the questionnaire (response rate 66%). Demographic and professional characteristics, self-reported practices and opinions were included in the questionnaire, along with a questionnaire of 12 items measuring physicians’ attitude and views ranging from value of life to quality of life approach (scale 1–5).ResultsContinuation of treatment in neonates with adverse prognosis without adding further therapeutic interventions was the most commonly reported EoL practice, when compared to withdrawal of mechanical ventilation. Physicians with a high attitude score (indicative of value of quality-of-life) were more likely to limit, while those with a low score (indicative of value of sanctity-of-life) were more likely for continuation of intensive care. Physicians’ educational level (p:0.097), involvement in research (p:0.093), religion (p:0.024) and position on the existing legal framework (p < 0.001) were factors that affected the attitude score.ConclusionsPhysicians presented with varying end-of-life practices. Limiting interventions in neonates with poor prognosis was strongly related to their attitudes. The most important predictors for physicians' attitudes were religiousness and belief for Greek legal system reform.

The effects of live singing on the biophysiological functions of preterm infants hospitalized in a Neonatal Intensive Care Unit in Greece: A pilot study

The aim of the study was to investigate the effects of live singing on the biophysiological functions, weight gain, head circumference, body length, and duration of hospitalization of preterm infants hospitalized in a neonatal intensive care unit (NICU) in Greece. Forty-one preterm infants 25-33 + 6 days of PCA took part in the study. 14 infants were assigned to the Mother Singing group (MS) in which mothers sang to their infants for 15 minutes every day during the fourteen-day intervention, 13 to the Music Therapist Singing group (MTS) in which a music therapist sang to the infants for 15 minutes every day during the fourteen-day intervention, and 14 in the control group (CG) which did not receive any additional intervention. Infants of both MS and MTS presented statistically significant improvements in heart rate and blood oxygen saturation, compared to CG. No significant differences between groups were found in weight, head circumference, body length, and duration of hospitalization. The use of live singing by mothers or music therapists appears to elicit positive effects on vital biophysiological functions of premature infants. Further investigation of the role of live singing in NICU is warranted.

Neuropeptide y levels are increased during pain in critically ill children: data from a paediatric intensive care unit in Greece

Neuropeptide y levels are increased during pain in critically ill children: data from a paediatric intensive care unit in Greece

Current physiotherapy practice in Greek intensive care units: a national study

Background: The purpose of the study was to investigate the responsibilities and frequency of clinical procedures that physiotherapists perform within the intensive care unit (ICU) in Greece, along with the level of education and training of these physiotherapists.Methods: Physiotherapists who work in general ICUs of hospitals were invited to complete a developed questionnaire. The questionnaire consisted of 83 items, of closed and opened–ended format. Items for service provision and physiotherapists’ employment were included, along with participants’ involvement in respiratory care, early mobilisation and the use of the ICU equipment.Results: One hundred forty physiotherapists completed the questionnaire. Seventy-three respondents (52%) reported working in ICU in Athens and 67 (48%) in other cities of Greece. Almost all the physiotherapists’ performed early mobilisation and respiratory techniques; although the frequency of procedures and use of equipment were variable. Sixty-one (44%) and 70 (50%) respondents participated in the weaning procedure and mobilised the patient whilst using the ventilator, respectively.Conclusion: The physiotherapists are from ICUs all over Greece. The results reflect the differences among the procedures that physiotherapists perform, regarding early mobility and respiratory physiotherapy. The results indicate the need for a national up-to-date job description of the physiotherapy services in ICUs in Greece.

Conception of family and friends on euthanasia in intensive care unit in Greece

BackgroundEuthanasia poses a hot topic of argument in all modern societies. While in several countries the law allows euthanasia under certain conditions, in others, such as Greece, there is no established legal background. This is essentially derived from the conflict on the right to life, which is constitutionally guaranteed. The purpose of this study was to investigate the attitude of relatives or friends of critically ill patients hospitalized in the Intensive Care Unit (ICU) towards euthanasia in a Greek hospital.MethodsThis is a prospective study based on questionnaires completed by relatives and friends of patients hospitalized in the ICU. Relatives/friends of critically ill patients hospitalized in the ICU with APACHE Score ≥ 20 completed a questionnaire consisting of information about their relationship to the patient and another part with psychometric questions on euthanasia. SPSS 19.0 was used for analysis of the data.ResultsOne hundred forty-three questionnaires were collected (50.7% female, 33.6% patients’ parents). 62.9% of responders considered the quality of life (QOL) of the patient more important compared to the value of life. 48.3% were in favor of euthanasia and 66.4% knew little about euthanasia. 48.3% agreed in institutionalizing euthanasia under certain circumstances. Consensus to discontinue the therapeutic interventions significantly correlated to patient’s age and severity of the disease.ConclusionsIn the present study we found that the more the APACHE II score increased the more positive were the participants when asked to give consent or decide to accelerate the end of life of the patient. Overall, the level of knowledge of the relatives of critically ill patients on euthanasia and the currently used law in Greece on euthanasia is poor.

Clinical factors affecting costs in patients receiving systemic antifungal therapy in intensive care units in Greece: Results from the ESTIMATOR study

Early administration of antifungal drugs was not a substantial component of total hospital costs. However, there was a significant adverse impact on costs with increasing LOS in febrile patients in ICU for whom diagnosis of fungaemia was delayed before starting SAT, and with initial treatment failure. Awareness of potential candidaemia and initiation of pre-emptive or empirical strategy as early appropriate treatment may improve ICU patient outcomes while reducing direct medical costs.

Characteristics of Bordetella pertussis infection among infantsand children admitted to paediatric intensive care units in Greece: A multicentre, 11-year study.

To describe children with pertussis who required intensive care. This is a retrospective analysis of pertussis admissions to all (six) national intensive care units in Greece from 2003 to 2013. A total of 31 children were included, 28 of whom were younger than 12 months old. Cough was the most prominent symptom, being present in 27 of 31 (87%) patients, and on admission, only 7 (22.6%) satisfied the case definition. Mechanical ventilation was initiated in 13 (42%) patients. Six patients died because of respiratory failure (two) or multi-organ system failure (four). The patients who died had significantly higher white blood cell counts (WBC) (77 800-31 600, P = 0.031) and neutrophils (29 016-12 795, P = 0021) than those who survived and lower minimum values of serum sodium (125-133, P = 0002). They also had a longer duration of hospitalisation prior to their paediatric intensive care unit admission (6-1 days, P = 0022). Three patients were diagnosed with pulmonary hypertension, and only one of them survived. Age, gender and immunisation status did not differ between survivors and non-survivors. Two patients received exchange blood transfusion, and survival benefit was not apparent. Young infants are at risk of severe pertussis, resulting in serious complications or death. Elevated WBC and low serum sodium are associated with higher mortality. Despite advances in life support and treatment of organ failure in childhood critical illness, pertussis still has substantial mortality.

Postextubation Dysphagia in Critical Patients: A First Report From the Largest Step-Down Intensive Care Unit in Greece.

This study provided preliminary data on the occurrence and impact of postextubation dysphagia in the largest Greek step-down intensive care unit (ICU) over 2 years. A retrospective observational cohort study of patients referred for swallowing assessment postextubation was conducted from November, 2011, to August, 2013. Of the 357 patients admitted to the unit during this period, 87, aged 55.8 ± 18.1 years (61 male, 26 female), were referred and evaluated. Of these, 2.3% were found to have no dysphagia, and 21.8% and 75.9% were diagnosed with mild and moderate/severe dysphagia, respectively. Across severity levels, 23% of patients in the unit were found to have dysphagia. Patients with moderate/severe dysphagia were more likely to have had prolonged intubation (> 48 hr; p = .02) and exhibit signs of aspiration (p = .002) than those with no or mild dysphagia. Prolonged intubation was associated with increased likelihood of moderate/severe dysphagia by a factor of 12 (p = .042, odds ratio = 12.355) compared to short intubation. Moderate/severe dysphagia was correlated with pneumonia (p = .02), feeding tube placement (p = .004) and in-hospital mortality (p = .034). In this sample, moderate/severe dysphagia was correlated with prolonged intubation, and was found to increase the risk for pneumonia and in-hospital mortality. Our results suggest the importance of early dysphagia management in critical patients in Greece and globally.