Morbidity In Intensive Care Unit Research Articles

Pediatric Intensive Care: Immunomodulation With Activated Protein C ex vivo.

Objective: Sepsis is major cause of morbidity and mortality in the Pediatric Intensive Care Unit (PICU). PICU patients may develop transient immune deficiency during sepsis. Activated Protein C (APC) has significant anti-inflammatory and cytoprotective effects. Clinical trials of APC in adult sepsis initially showed improved outcome but recent trials showed no benefit in adults or children. We aimed to assess the effects of APC treatment on innate immune responses in children.Design and Subjects: We compared neutrophil and monocyte responses to lipopolysaccharide (LPS) with and without APC treatment in PICU patients at the time of evaluation for sepsis compared with healthy adults and age-matched pediatric controls. We used flow cytometry to examine cell activation (CD11b expression), function [intracellular reactive oxygen intermediate (ROI) release] and LPS recognition [Toll like Receptor 4 (TLR4) expression].Results: PICU patients had significantly decreased protein c levels and LPS responses compared with adult and pediatric controls for all parameters. APC reduced LPS-induced neutrophil PICU TLR4 and adult ROI (p < 0.05). PICU non-survivors had increased LPS induced neutrophil and monocyte ROI production vs. survivors which was significantly reduced by APC.Conclusion: PICU patients demonstrate significantly reduced endotoxin reactivity which may predispose them to sepsis and alter effective antibacterial responses. APC reduces LPS-induced ROI production in adults and may have a role in treating severely compromised PICU patients especially given that newer APC forms are associated with decreased bleeding risk and enhanced anti-inflammatory effects.

The effect of recombinant human thrombopoietin (rhTPO) on sepsis patients with acute severe thrombocytopenia: a study protocol for a multicentre randomised controlled trial (RESCUE trial)

BackgroundSepsis is still a common critical disease with high morbidity and mortality in intensive care unit. Despite published guidelines for sepsis, development of antibiotic therapy and advanced organ support technologies, the mortality of sepsis patients is still 25% or more. It is necessary to distinguish the subtypes of sepsis, and the targeted therapy for the patients need to be explored. Platelets have various biological functions in hemostasis and thrombosis, host defense, inflammatory/immune responses and tissue repair/regeneration. Moreover, severe thrombocytopenia or sustained thrombocytopenia was closely associated with multiply organ dysfunction and higher mortality in sepsis patients. The clinical therapies for thrombocytopenia are platelet transfusion and platelet-elevating drugs. However, platelet transfusion has many defects in clinical practice in sepsis patients, and the impact of platelet-elevating drugs for sepsis patients is still unclear. RESCUE trial is aim to explore the effect of a platelet-elevating drug, recombinant human thrombopoietin (rhTPO), as an effective rescue therapy on sepsis patients with acute severe thrombocytopenia.MethodsIt is a randomized, open-label, multi-center, controlled trial in 5 tertiary academic hospitals including medical, surgical or general ICUs. In this study, a total of 200 sepsis patients with severe thrombocytopenia will be randomly assigned in a 1:1 ratio to the control and rhTPO group. The patients will be followed up to 28 days after randomization. All patients in two groups receive the same treatment based on the guideline of Surviving Sepsis Campaign. Primary outcome is 28-day mortality. Secondary outcomes are the changes of PCs, blood transfusion, biomarkers of infection and organ function, days free from advanced organ support, drug-related adverse events, the length of ICU and hospital stay.DiscussionRESCUE trial is the first randomized controlled trial to explore the impact of rhTPO for severe thrombocytopenia in sepsis patients diagnosed by sepsis-3.0 standard. Furthermore, RESCUE trial results will be of significant clinical value on the targeted therapy and add clinical evidence that rhTPO is an effective rescue therapy for these sepsis patients.Trial registrationClinicalTrials.gov: NCT02707497. Registered Date: March 3rd, 2016. Protocol Version 3. Protocol Date: January 25th, 2019.

Association of Gene Polymorphism of Bactericidal Permeability Increasing Protein Rs4358188, Cluster of Differentiation 14 Rs2569190, Interleukin 1β Rs1143643 and Matrix Metalloproteinase-16 Rs2664349 with Neonatal Sepsis.

BACKGROUND:Neonatal sepsis is a health problem because it causes serious morbidity and mortality in neonate intensive care units. The susceptibility of neonates occurs due to the immaturity of immune system development as well as due to maternal and environmental risk factors that can cause infection. Identification of genetic variation in genes involved in the inflammatory process can help clarify the pathophysiology of sepsis in high-risk patients, useful for the development of new diagnostic tools, and specific management plans for more accurate predictions of patient’s prognosis.AIM:This study aims to determine the association between gene polymorphism of BPI rs4358188, CD14 rs2569190, IL1β rs1143643 or MMP16 rs2664349 and the incidence of neonatal sepsis.METHODS:Cross-sectional observational studies with genomic DNA samples from infants with sepsis and non-sepsis which were stored according to the standard storage of genetic materials in the Biomedical Laboratory of Faculty of Medicine Universitas Andalas Padang City, Indonesia. This study is part of a previous study by Rukmono P. Continued with PCR examination, sequencing and bioinformatics analysis.RESULTS:Only IL1β rs1143643 G > A gene polymorphism was associated with the incidence of neonatal sepsis and was statistically significant (p = 0.017). No significant association was found between gene polymorphisms of BPI rs4358188 G > T, CD14 rs2569190 A>G or MMP16 rs2664349 G > A and neonatal sepsis (p > 0.05).CONCLUSION:Gene polymorphism of IL1β rs1143643 G > A is associated with the incidence of neonatal sepsis.

Microbial Community Profiling in Intensive Care Units Expose Limitations in Current Sanitary Standards.

Hospital-associated infections (HAIs) are a leading cause of morbidity and mortality in intensive care units (ICUs) and neonatal intensive care units (NICUs). Organisms causing these infections are often present on surfaces around the patient. Given that microbiota may vary across different ICUs, the HAI-related microbial signatures within these units remain underexplored. In this study, we use deep-sequencing analyses to explore and compare the structure of bacterial communities at inanimate surfaces of the ICU and NICU wards of The Medical School Clinics Hospital (Brazil). The data revealed that NICU presents higher biodiversity than ICU and surfaces closest to the patient showed a peculiar microbiota, distinguishing one unit from the other. Several facultative anaerobes or obligate anaerobes HAI-related genera were classified as biomarkers for the NICU, whereas Pseudomonas was the main biomarker for ICU. Correlation analyses revealed a distinct pattern of microbe-microbe interactions for each unit, including bacteria able to form multi-genera biofilms. Furthermore, we evaluated the effect of concurrent cleaning over the ICU bacterial community. The results showed that, although some bacterial populations decreased after cleaning, various HAI-related genera were quite stable following sanitization, suggesting being well-adapted to the ICU environment. Overall, these results enabled identification of discrete ICU and NICU reservoirs of potentially pathogenic bacteria and provided evidence for the presence of a set of biomarkers genera that distinguish these units. Moreover, the study exposed the inconsistencies of the routine cleaning to minimize HAI-related genera contamination.

Neonatal mortality risk assessment using SNAPPE- II score in a neonatal intensive care unit

BackgroundThere are many scoring systems to predict neonatal mortality and morbidity in neonatal intensive care units (NICU). One of the scoring systems is SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal extension-II). This study was carried out to assess the validity of SNAPPE-II score (Score for Neonatal Acute Physiology with Perinatal Extension-II) as a predictor of neonatal mortality and duration of stay in a neonatal intensive care unit (NICU).MethodsThis prospective, observational study was carried out over a period of 12 months from June 2015 to May 2016. Two hundred fifty five neonates, who met the inclusion criteria admitted to NICU in tertiary care hospital, BPKIHS Hospital, Nepal were enrolled in the study and SNAPPE-II score was calculated. Receiver Operating Characteristic (ROC) curve was constructed to derive the best SNAPPE-II cut-off score for mortality.ResultsA total of 305 neonates were admitted to NICU over a period of one year. Among them, 255 neonates fulfilled the inclusion criteria. Out of 255 neonates, 45 neonates (17.6%) died and 210 were discharged. SNAPPE-II score was significantly higher among neonates who died compared to those who survived [median (IQR) 57 (42–64) vs. 22 (14–32), P < 0.001]. SNAPPE II score had discrimination to predict mortality with area under ROC Curve (AUC): 0.917 (95% CI, 0.854–0.980). The best cut - off score for predicting mortality was 38 with sensitivity 84.4%, specificity 91%, positive predictive value 66.7% and negative predictive value 96.5%. SNAPPE II score could not predict the duration of NICU stay (P = 0.477).ConclusionSNAPPE- II is a useful tool to predict neonatal mortality in NICU. The score of 38 may be associated with higher mortality.

Hemodynamic monitoring of ARDS by critical care echocardiography

Acute respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality in intensive care units and affects about 10% of critically ill patients and almost 25% of mechanically ventilated patients. It is characterized by life-threatening impairment of pulmonary gas exchange, but in two-thirds of cases is associated with hemodynamic instability. Shock is the primary factor influencing mortality and is driven by sepsis in half of the cases and by a more specific mechanism of ARDS in the other half, which is pulmonary vascular dysfunction, i.e., pulmonary hypertension related to the inflammatory process in the lung, which is very sensitive to a respiratory strategy. ARDS-related right ventricular failure, which is also named acute cor pulmonale (ACP), occurs in 20–25% of patients in the area of lung protective ventilation. In this condition, critical care echocardiography (CCE) plays a central role in adequate hemodynamic assessment and management at the bedside because of its ability to yield information quickly on cardiac dimensions and function, respiratory variations of vena cava dimensions and changes in cardiac output in response to therapy. Added to clinical and laboratory data, with invasive blood pressure monitoring and a central venous catheter, such information can be used to define the cause of circulatory failure, to evaluate the benefit and risk balance of fluid expansion, and to consider a strategy for right ventricle protection. Moreover, in the most severe situations, CCE can also guide the establishment and good functioning of extracorporeal membrane oxygenation (ECMO). In this article, we illustrate and summarize the value of CCE in ARDS and give some physiological pointers to its appropriate use.

Fungal Colonization among Iranian Infants Hospitalized in the Neonatal Intensive Care Unit: Occurrence Rate, Risk Factors and Health Outcome

Background: Fungal infections with high morbidity and mortality in neonatal intensive care unit are usually preceded by colonization. We aimed to investigate the prevalence of fungal colonization, determine the risk factors and health outcome such as any change in the patient's improvement in hospitalized infants of Neonatal Intensive Care Unit (NICU). Materials and Methods: This prospective cohort study was conducted on all newborns who were hospitalized in Namazee NICU which is the largest neonatal center in Southwestern Iran during the six- month period from January to July 2018. The eye, urine, perineum, nose, throat, umbilicus and blood were sampled within 72 hours following NICU admission and repeated one week later. Each newborn with at least one positive fungi culture from surveillance site was defined as fungal colonization. All newborns were categorized into two groups based on results of fungal colonization; they were evaluated for baseline perinatal and neonatal characteristic data, probable risk factors (such as prior antibiotics, presence of an endotracheal tube and neonatal disease) and health outcomes (cure, improvement or death). Statistical analysis was done using SPSS software (version 22.0). Results: From a total of 105 (37 girls, 68 boys) hospitalized newborns in NICU, forty-eight (45.7%) of them were colonized by Candida spp. which was the only fungus isolated from the cultures. There were significant differences for the level of hemoglobin (p= 0.04) and cardiac diseases (p= 0.04) between the two groups of fungal colonization and non -colonized newborns. One-third of the newborns that had fungal colonization passed away vs. one-tenth without fungal colonization. Conclusion Based on the results, there was a 45.7% rate of fungal colonization in hospitalized newborns in NICU. Hemoglobin level and cardiac diseases were a risk factor for fungal colonization in these patients. The rate of death was approximately three-fold in hospitalized infants with fungal colonization vs. non fungi infected.

Relationship between thrombocytopenia and mortality and morbidity in the internal medicine intensive care unit

Amaç: Bu çalışmada bir Üniversite Dahiliye Yoğun Bakım Ünitesinde (DYBÜ) trombositopeni sıklığı, nedenleri, klinik sonuçları ile mortalite ve morbiditeye olan katkısını saptamayı amaçladık.Gereç ve Yöntemler: Temmuz 2011-Ağustos 2012 tarihleri arasında yoğun bakımda takip edilen vetrombosit sayısı 150.000/uL’nin altında olan 165 hasta çalışmaya dahil edildi. Trombositopeni nedenleri araştırıldı. Trombositopenisi olan ve trombositopenisi olmayan hastaların mortalite ve yoğun bakım yatış sürelerikarşılaştırıldı.Bulgular: Çalışma döneminde DYBÜ’de hastaların %30,1’inde trombositopeni gelişti (165/548). Hastaların 30 (%18)’unda trombositopeni nedeni sepsis, 18 (%10,9)’inde dissemine intravasküler koagülasyon (DİK) idi. Çalışma süresince 165 trombositopenik hastanın 115’i (%69,7), trombositopenik olmayan 383 hastanın 173’ü (%45,1) kaybedildi. Trombositopenisi olan hastalarda mortalite daha fazlaydı. Hastalarda trombosit düzeyi düştükçe mortalitenin istatistiksel olarak anlamlı düzeyde arttığı gözlendi. Aynı APACHE II skoruna sahip hasta gruplarında trombosit sayısı düştükçe mortalitenin istatistiksel olarak anlamlı olarak arttığı saptandı.Sonuç: Trombositopeninin en sık sebepleri sepsis ve DİK olup trombositopeni yoğun bakımda mortaliteyi arttıran bir etkendir.

Intraoperative changes in blood lactate levels are associated with worse short-term outcomes after cardiac surgery with cardiopulmonary bypass.

A high perioperative blood lactate level has been reported to be associated with poor outcomes after cardiac surgery. More than isolated peaks of lactate values, it should be more interesting to take into account changes in intraoperative blood lactate level (∆Lact). This large-scale retrospective study evaluated the relationship between ∆Lact and overall intensive care unit morbidity and 30-day all-cause mortality. Perioperative data from consecutive patients undergoing on-pump cardiac surgery between September 2010 and June 2016 were retrospectively analysed through our institutional database including clinical, transfusion and laboratory test results implemented prospectively by physicians. Blood lactate levels were initially measured after induction of anaesthesia (baseline) and periodically during the surgery. The ∆Lact was defined as the difference between the highest intraoperative blood lactate and the baseline lactate level and offered the opportunity to stratify patients into four subgroups: ⩽0, 0.1-0.9, 1-1.9 and ⩾2 mmol L-1. From the 7,795 patients found eligible during the study period, 7,447 patients were analysed. The median ∆Lact of our patients was 0.6 (0.3-1) mmol L-1. Most of the studied patients (65.9%) exhibited a ∆Lact between 0.1 and 0.9 mmol L-1. A concentration-dependent relationship was observed between ∆Lact and intensive care unit morbidity and 30-day mortality. After adjustment for co-variables, all ∆Lact > 0 was associated with an increase in overall intensive care unit morbidity. An independent relationship was also found between ∆Lact and 30-day mortality as of a 1 mmol L-1 increase. Our results suggest that ∆Lact is associated with poor short-term outcomes in adult cardiac surgical patients.

Risk factors for necrotizing enterocolitis in neonates:a prospective study

Background: Necrotizing enterocolitis (NEC) is mostly limited to preterm babies due to immaturity of gut. NEC is one of important cause of neonatal mortality and morbidity in the neonatal intensive care units all over the world.Aim of study is to find the antenatal and post-natal risk factors associated with necrotizing enterocolitis in neonates admitted to NICU.Methods: A prospective study was conducted on 45 neonates with necrotizing enterocolitis fulfilling the predetermined inclusion criteria. A detailed antenatal history including all maternal risk factors, birth history including the need for resuscitation and type of resuscitation was recorded. The gestational assessment was done by the New Ballard Score.Results: Pregnancy induced hypertension accounts as a risk factor to most of the cases of NEC 18 (40%), followed by setting for sepsis 12 (26.6%), least being gestational diabetes mellitus 1 (2.2%).Conclusions: Prematurity is found to be the most common risk factor followed by patent ductus arteriosus and sepsis. Most common antenatal risk factor was PIH (Pregnancy induced hypertension).

Describing organ dysfunction in the intensive care unit: a cohort study of 20,000 patients

BackgroundMultiple organ dysfunction is a common cause of morbidity and mortality in intensive care units (ICUs). Original development of the Sequential Organ Failure Assessment (SOFA) score was not to predict outcome, but to describe temporal changes in organ dysfunction in critically ill patients. Organ dysfunction scoring may be a reasonable surrogate outcome in clinical trials but further exploration of the impact of case mix on the temporal sequence of organ dysfunction is required. Our aim was to compare temporal changes in SOFA scores between hospital survivors and non-survivors.MethodsWe performed a population-based observational retrospective cohort study of critically ill patients admitted from January 1, 2004, to December 31, 2013, to 4 multisystem adult intensive care units (ICUs) in Calgary, Canada. The primary outcome was temporal changes in daily SOFA scores during the first 14 days of ICU admission. SOFA scores were modeled between hospital survivors and non-survivors using generalized estimating equations (GEE) and were also stratified by admission SOFA (≤ 11 versus > 11).ResultsThe cohort consisted of 20,007 patients with at least one SOFA score and was mostly male (58.2%) with a median age of 59 (interquartile range [IQR] 44–72). Median ICU length of stay was 3.5 (IQR 1.7–7.5) days. ICU and hospital mortality were 18.5% and 25.5%, respectively. Temporal change in SOFA scores varied by survival and admission SOFA score in a complicated relationship. Area under the receiver operating characteristic (ROC) curve using admission SOFA as a predictor of hospital mortality was 0.77. The hospital mortality rate was 5.6% for patients with an admission SOFA of 0–2 and 94.4% with an admission SOFA of 20–24. There was an approximately linear increase in hospital mortality for SOFA scores of 3–19 (range 8.7–84.7%).ConclusionsExamining the clinical course of organ dysfunction in a large non-selective cohort of patients provides insight into the utility of SOFA. We have demonstrated that hospital outcome is associated with both admission SOFA and the temporal rate of change in SOFA after admission. It is necessary to further explore the impact of additional clinical factors on the clinical course of SOFA with large datasets.

Evaluation of Healthcare-Acquired Infection Rates in a Pediatric Intensive Care Unit in Turkey

AbstractHealthcare-acquired infections (HAIs) have become a major concern and a significant cause of morbidity and mortality in pediatric intensive care units (PICUs). The purpose of this study was to evaluate HAI rates as well as the rates of invasive device utilization at a PICU at a large tertiary care pediatric teaching hospital from a developing country over a 4-year period, and to compare findings with those of the National Health Safety Network United States, the International Nosocomial Infection Control Consortium, and Turkey's national HAI rates. An active prospective surveillance was performed at a tertiary care PICU from January 2014 to December 2017. It was especially analyzed for nosocomial infections, related to invasive devices: the central line catheter (CL), mechanical ventilator (MV), and the urinary catheter (UC). During the 4-year period, a total of 2,855 patient admissions and 30,499 patient-days were evaluated. The device-associated (DA)-HAI incidence density was 17.57 per 1,000 patient-days, and the incidence rate was 18.8 per 100 admissions. The most common site of the DA-HAIs was ventilator-associated pneumonia (VAP) with the highest rate (60.9%). The second was the central line-associated bloodstream infection (CLA-BSI) rate (24.8%). Catheter-associated urinary tract infections (CA-UTI) rank third (14.3%). The HAI location was VAP in 187 patients (11.31/1,000 MV-days), CLA-BSI in 76 patients (4.39/1,000 CL-days), and CA-UTI in 44 patients (3.35/1,000 UC-days). The most frequent pathogens, isolated from the overall DA-HAIs as being causative microorganisms were Acinetobacter baumannii (23%), followed by Pseudomonas aeruginosa (14%). Resistance of Acinetobacter baumannii to Carbapenem was 76.47%, and methicillin-resistance Staphylococcus aureus was 50% at the pediatric ICU. This study reported data on incidence rates as well as pathogens of HAIs from a developing country's PICU, which may later supply useful data about other pediatric hospitals.

Bacterial Nosocomial Infection: Experience of the Neonatal Intensive Care Unit at the University Hospital of Marrakech

Background and AimNosocomial infections are one of the major causes of morbidity in the Neonatal Intensive Care Unit (NICU). Known risk factors include birth weight, gestational age, severity of illness and its related length of stay, and instrumentation.Objective:The purpose of this article is to determine the occurrence of Nosocomial Infections (NIs), including infection rates, main infection sites, and common microorganisms.Methods:A retrospective study was conducted between June 2015 and December 2016.Results:The incidence of nosocomial infection was 16%. The primary reasons for admission were intauterin growth retardation (52.5%).Klebsiella Pneumoniaewas the most commonly identified agent in the blood cultures and in the hospital unit (43.6%). The mortality rate from nosocomial infection was 52.6%. The proportion of infected newborns with a lower than normal birth weight was predominant (58.13%).Conclusion:Thus, prevention of bacterial infection is crucial in these settings of unique patients. In this view, improving neonatal management is a key step, and this includes promotion of breast-feeding and hygiene measures.

Necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the intestine which primarily affects preterm infants and is a leading cause of morbidity and mortality in the neonatal intensive care unit. From a clinical standpoint, and during the early course of the disease, NEC can be difficult to distinguish from other diseases and conditions common to the preterm infant, and this warrants the need for specific disease biomarkers. The pathogenesis of NEC is only partly understood but likely involves an altered intestinal barrier immune response to feeding and the developing microbiome. Recent evidence points toward a role of the enteric nervous system in NEC pathogenesis. In this issue, Meister and colleagues use a rodent model of NEC to demonstrate that NEC is associated with diminished vagal tone, as determined by decreased high-frequency heart rate variability (HF-HRV), and altered myenteric nitrergic inhibitory neurotransmission. These results augment their previous findings that describe decreased HF-HRV in human preterm infants with NEC. This mini-review provides a brief summary of clinical and pathophysiologic aspects of NEC with focus on certain aspects of neurogastroenterology.

The use of beta-D-glucan in Australia

Introduction: Invasive fungal infection (IFI) results in significant morbidity and mortality in high risk intensive care unit (ICU) patients. Current culture based and non-culture based diagnostic methods are suboptimal. Beta-D-glucan (BDG) is a fungal biomarker now included in European guidelines for this purpose.

Resistant gram-negative infections in a pediatric intensive care unit: a retrospective study in a tertiary care center.

Aim:Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital.Material and Methods:In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively.Results:One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1–205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobacter baumannii (n=28, 21.5%). Among A. baumannii isolates, the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance.Conclusion:Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.

Bacteriology and antibiotic susceptibility pattern of ventilator-associated pneumonia in a tertiary care hospital

Background: Ventilator-associated pneumonia (VAP) is one of the most important hospital-acquired infections. VAP is pneumonia that develops 48 h or more after patients have been intubated and received mechanical ventilation by means of an endotracheal tube or tracheostomy. VAP is usually suspected when an individual develops a new or progressive infiltrates on chest radiograph, leukocytosis, and purulent tracheobronchial secretions. This is diagnosed based on positive end-expiratory pressure, fraction of inspired oxygen, bacteriological evidence, and signs of pulmonary infection. VAP is considered as one of the leading causes of morbidity and mortality in intensive care units (ICUs). Objectives: The objectives of this study were to assess the common pathogenic bacteria causing VAP and to determine its antibiotic susceptibility pattern. Materials and Methods: This study was conducted on 100 patients with clinical diagnosis of VAP. Bacterial culture was done for patient’s endotracheal aspirates. Antibiotic sensitivity test was done for culture-positive cases by Kirby–Bauer disk diffusion method. Results: A total of 72 patients (72%) showed positive culture. Gram-negative bacilli accounted for 91% of the isolated organisms with Acinetobacter species accounting for 40% followed by Pseudomonas species (26%) and Klebsiella pneumoniae (14%). Majority of the organisms were sensitive to imipenem with Acinetobacter being sensitive in 51% cases, Pseudomonas in 56%, and Klebsiella in 42% cases. Conclusion: Surveillance of VAP in ICUs is required to find out common causative organism and its antibiotic susceptibility to different antibiotics. This type of surveillance study is helpful for formulating antibiotic policy that would be more rational to reduce mortality and morbidity associated with VAP.

Fluid management in Acute Respiratory Distress Syndrome: A narrative review.

Acute Respiratory Distress Syndrome remains a major source of morbidity and mortality in the modern intensive care unit (ICU). Major advances in the understanding and management of this condition were made in the last two decades. The use of low tidal ventilation is a well-established therapy. Conservative fluid management is now another cornerstone of management. However, much remains to be understood in this arena. Assessing volume status in these patients may be challenging and the tools available to do so are far from perfect. Several dynamic measures including pulse pressures variation are used. Ultrasound of the lungs and the vascular system may also have a role. In addition, the type of fluid to administer when needed is still open to debate. Finally, supportive measures in these patients, early during their ICU stay and later after discharge continue to be crucial for survival and adequate recovery.

Glycemic control in intensive care unit: Experience of a tertiary care center

Background: Hyperglycemia complicates the course of illness of many critically ill patients and contributes to the increased morbidity and mortality in adult intensive care units (ICUs). Objective: The objective of this study is to compare the effectiveness of a modified nurse-implemented insulin infusion protocol (NIIP) against the original protocol used in the adult ICUs, in terms of controlling hyperglycemia while averting significant hypoglycemia. Methodology: Blood glucose (BG) readings that were collected over 3 months in medical and surgical ICUs (SICUs) while on the original insulin infusion protocol were retrospectively reviewed. A modified insulin infusion protocol was prepared by a dedicated adult ICU quality focus group composed of physicians, nurses, clinical pharmacists, and quality representative. The rate of insulin infusion was increased by 10%–20% for the BG ranges above 13.1 mmol/L, allowing early transition from a mild-to-moderate scale. The new protocol was implemented for 2 months, and BG readings were compared to the results of the original insulin infusion protocol. Results: A total of 3490 BG readings in the medical ICU and 3006 in SICU were analyzed. Hyperglycemia was found in 1743 readings (26.83%) while on the original insulin protocol. When the modified insulin infusion protocol was applied, hyperglycemia was significantly less (19.83%, P

Porous Se@SiO2 nanospheres attenuate ischemia/reperfusion (I/R)-induced acute kidney injury (AKI) and inflammation by antioxidative stress.

ObjectivesAcute kidney injury (AKI) is a growing global health concern, and is associated with high rates of mortality and morbidity in intensive care units. Se is a trace element with antioxidant properties. This study aimed to determine whether porous Se@SiO2 nanospheres could relieve oxidative stress and inflammation in ischemia/reperfusion (I/R)-induced AKI.MethodsMale 6- to 8-week-old C57bl/6 mice were divided into four groups: sham + saline, sham + Se@SiO2, I/R + saline, and I/R + Se@SiO2. Mice in the I/R groups experienced 30 minutes of bilateral renal I/R to induce an AKI. Porous Se@SiO2 nanospheres (1 mg/kg) were intraperitoneally injected into mice in the I/R + Se@SiO2 group 2 hours before I/R, and the same dose was injected every 12 hours thereafter. Hypoxia/reoxygenation (H/R) was used to mimic I/R in vitro. PBS was used as a control treatment. Human kidney 2 cells were seeded into 12-well plates (5×105 cells/well) and divided into four groups: control + PBS group, control + Se@SiO2 group, H/R + PBS group, and H/R + Se@SiO2 group (n=3 wells). We then determined the expression levels of ROS, glutathione, inflammatory cytokines and proteins, fibrosis proteins, and carried out histological analysis upon kidney tissues.ResultsIn vitro, intervention with porous Se@SiO2 nanospheres significantly reduced levels of ROS (P<0.05), inflammatory cytokines (P<0.05), and inflammation-associated proteins (P<0.05). In vivo, tubular damage, cell apoptosis, and interstitial inflammation during AKI were reduced significantly following treatment with porous Se@SiO2 nanospheres. Moreover, the occurrence of fibrosis and tubular atrophy after AKI was attenuated by porous Se@SiO2 nanospheres.ConclusionPorous Se@SiO2 nanospheres exhibited a protective effect in I/R-induced AKI by resisting oxidative stress and inflammation. This suggests that porous Se@SiO2 nanospheres may represent a new therapeutic method for AKI.