Oropharyngeal Secretions Research Articles

Atypical skull base osteomyelitis in the intensive care unit: A case report

Base of skull osteomyelitis is commonly seen as a complication of malignant otitis externa, involving the temporal bone. It initially presents with aural symptoms such as ear ache and discharge and cranial nerve palsies. We report an atypical presentation of skull base osteomyelitis that did not show signs of otitis externa. The patient presented with severe headache, drowsiness and signs of bulbar weakness including pooling of oropharyngeal secretions. Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) studies showed a bony erosion of the left side of base of skull involving the sphenoid bone and surrounding foramina, left sided coalescent mastoiditis and inflammation of the left parapharyngeal space. There was also inflammation of the tissues encasing the internal carotid artery and jugular veins and thrombosis of left jugular vein. These imaging findings along with cranial nerve palsies were suggestive of malignancy. However, tissue biopsy was negative for malignancy. The growth of Pseudomonas aeruginosa in the biopsy material as well as nasopharyngeal and blood cultures along with elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels led to a diagnosis of base of skull osteomyelitis. Hence diagnosis in such cases requires that biopsy material be sent for microbiological analysis, in addition to histology.

Risk factors and features of recurrent bacterial complications of upper respiratory tract viral infections in children.

. The aim of the study was to determine risk factors for recurrent bacterial complications of the upper respiratory tract viral infection (URTI) in children, as well as the clinical and immunological features of the course of such complications. We enrolled 214 children aged 3-18 years with URTIs complicated with acute otitis media or acute bacterial rhinosinusitis. Frequency of bacterial complications of URI in 128 children was low (group I) and in 86 children it met the criteria of recurrent course (group II). In addition to the standard examination, lysozyme levels in the oropharyngeal secretion were determined three times during the disease. It was found that children of group II were characterized by an early debut of respiratory morbidity (at the age of 6.00 (4.00, 12.00) months against 13.00 (4.50, 16.00) months in children of group I (p<0,0001), as well as a longer duration of catarrhal and intoxication syndromes in similar forms of the disease. The most significant risk factors for the formation of the recurring complication pattern were maternal smoking (OR=2.73, 95% CI [1.34, 5.48]), along with gastroenterological pathology and frequent URTI in the mother and a shortened period of breastfeeding. In children with recurrent bacterial complications of URTI, there was an impaired local resistance of the upper respiratory tract mucous membranes (as a decrease in the concentrations of lysozyme) in all periods of the disease, which persisted after recovery.

Correlation factors of 127 times pre-crisis state in patients with myasthenia gravis

Objective: To investigate the clinical features of the Pre-Crisis State and analyze the correlated risk factors of Pre-Crisis State of myasthenia crisis. Methods: We included 93 patients with myasthenia gravis (MG) who experienced 127 times Pre-Crisis State between October 2007 and July 2016. Those patients were hospitalized in the MG specialize center, Department of Neurological Science, first Affiliated Hospital of Sun Yat-sen University. The information of the general situation, the clinical manifestations and the blood gas analysis in those patients were collected using our innovated clinical research form. Statistic methods were applied including descriptive analysis, univariate logistic analysis, multivariate correlation logistic analysis, etc. Results: (1)The typical features of MG Pre-Crisis State included: dyspnea (127 times, 100% not requiring intubation or non-invasive ventilation), bulbar-muscle weakness (121 times, 95.28%), the increased blood partial pressure of carbon dioxide (PCO(2)) (94 times, 85.45%), expectoration weakness (99 times, 77.95%), sleep disorders (107 times, 84.25%) and the infection (99 times, 77.95%). The occurrence of dyspnea in combination with bulbar-muscle weakness (P=0.002) or the increased blood PCO(2) (P=0.042) often indicated the tendency of crisis. (2) The MG symptoms which were proportion to the occurrence of crisis includes: bulbar-muscle weakness (P=0.028), fever (P=0.028), malnutrition (P=0.066), complications (P=0.071), excess oropharyngeal secretions (P=0.005) and the increased blood PCO(2) (P=0.007). The perioperative period of thymectomy would not increase the risk of crisis. Conclusions: Dyspnea indicates the occurrence of the Pre-Crisis State of MG. In order to significantly reduce the morbidity of myasthenia crisis, the bulbar-muscle weakness, the increased blood PCO(2), expectoration weakness, sleep disorders, infection & fever and excess oropharyngeal secretions should be treated timely.

Association of Antibiotics, Airway Microbiome, and Inflammation in Infants with Cystic Fibrosis

The underlying defect in the cystic fibrosis (CF) airway leads to defective mucociliary clearance and impaired bacterial killing, resulting in endobronchial infection and inflammation that contributes to progressive lung disease. Little is known about the respiratory microbiota in the early CF airway and its relationship to inflammation. To examine the bacterial microbiota and inflammatory profiles in bronchoalveolar lavage fluid and oropharyngeal secretions in infants with CF. Infants with CF from U.S. and Australian centers were enrolled in a prospective, observational study examining the bacterial microbiota and inflammatory profiles of the respiratory tract. Bacterial diversity and density (load) were measured. Lavage samples were analyzed for inflammatory markers (interleukin 8, unbound neutrophil elastase, and absolute neutrophil count) in the epithelial lining fluid. Thirty-two infants (mean age, 4.7 months) underwent bronchoalveolar lavage and oropharyngeal sampling. Shannon diversity strongly correlated between upper and lower airway samples from a given subject, although community compositions differed. Microbial diversity was lower in younger subjects and in those receiving daily antistaphylococcal antibiotic prophylaxis. In lavage samples, reduced diversity correlated with lower interleukin 8 concentration and absolute neutrophil count. In infants with CF, reduced bacterial diversity in the upper and lower airways was strongly associated with the use of prophylactic antibiotics and younger age at the time of sampling; less diversity in the lower airway correlated with lower inflammation on bronchoalveolar lavage. Our findings suggest modification of the respiratory microbiome in infants with CF may influence airway inflammation.

The function of probiotics on the treatment of ventilator-associated pneumonia (VAP): facts and gaps.

Probiotics have been used for centuries in making fermented dairy products. The health benefits related to probiotics consumption are well recognized and they are generally regarded as safe (GRAS). Their therapeutic effects are due to the production of a variety of antimicrobial compounds, such as short-chain fatty acids, organic acids (such as lactic, acetic, formic, propionic and butyric acids), ethanol, hydrogen peroxide and bacteriocins. Ventilator-associated pneumonia (VAP) is a nosocomial infection associated with high mortality in intensive care units. VAP can result from endotracheal intubation and mechanical ventilation. These interventions increase the risk of infection as patients lose the natural barrier between the oropharynx and the trachea, which in turn facilitates the entry of pathogens through the aspiration of oropharyngeal secretions containing bacteria into the lung. In order to prevent this, probiotics have been used extensively against VAP. This review is an update containing information extracted from recent studies on the use of probiotics to treat VAP. In addition, probiotic safety, the therapeutic properties of probiotics, the probiotic strains used and the action of the probiotics mechanism are reviewed. Furthermore, the therapeutic effects of probiotic treatment procedures for VAP are compared to those of antibiotics. Finally, the influences of bacteriocin on the growth of human pathogens, and the side-effects and limitations of using probiotics for the treatment of VAP are addressed.

РІВЕНЬ ПОРУШЕННЯ МІСЦЕВОГО ІМУНІТЕТУ СЛИЗОВИХ РОТОВОЇ ПОРОЖНИНИ У ДІТЕЙ, ХВОРИХ НА ІНФЕКЦІЙНИЙ МОНОНУКЛЕОЗ

Мета роботи – визначити ступінь порушення показників місцевого імунітету слизових оболонок орофарингеальної зони у дітей, хворих на ІМ. Результати. Проведене дослідження рівня порушення важливих показників місцевого імунітету орофарингеального секрету (ФНП і сироваткового та секреторного IgА) свідчить, що ІМ перебігає не лише як вірусне запалення, а й є імунодефіцитним захворюванням, яке характеризується значними та тривалими змінами з боку показників імунітету.Висновки. Матеріалом дослідження слугував орофарингеальний секрет, який отримували неінвазивним методом. Це дає змогу застосовувати цю методику для визначення ступеня імунологічних порушень у хворих дітей як критерій ефективності лікування та прогнозувати перебіг захворювання.

Risk factors of aspiration pneumonia related to improper oral hygiene behavior in community dysphagia persons with nasogastric tube feeding

Background/purposeAspiration pneumonia (AsP) was reported to be closely related to poor oral hygiene. This study aimed to investigate the association between caregivers' oral hygiene behavior with AsP in the community dysphagia persons with nasogastric tube feeding (DPNgTF). Materials and methodsA cross-sectional study was conducted on 128 DPNgTF and their corresponding caregivers. A self-reported structuralized questionnaire was used to measure the oral care behavior of caregivers. All data analyses were performed using the SPSS. The Chi-square was used for comparison of nonparametric data. Fisher's exact test was used when the expected frequency of any cell in the table was less than five. A p value <0.05 was considered statistically significant. ResultsFifty-five DPNgTF had developed AsP (43.0%) and they had statistically significantly halitosis (adjusted OR = 4.46; 95%CI = 2.01–9.93), deposition of oropharyngeal secretion (OR = 4.39; 95%CI = 1.99–9.66), dry mouth (OR = 4.23; 95%CI = 1.81–9.85) and closing mouth and not allow to brush (adjusted OR = 2.83; 95%CI = 1.28–6.27). The poor oral hygiene status of DPNgTF was significantly correlated with the occurrence of AsP. The caregivers' oral care to DPNgTF after getting up (OR = 14.09; 95%CI = 2.92–68.08) and using sponge stick to care (OR = 3.29; 95%CI = 1.26–8.55) were the risk factors of AsP. ConclusionThe implemented oral care after getting up only, using sponge stick has a higher risk compared to the implemented oral care prior to sleeping, using toothbrush. The importance of implementing oral care prior to sleeping by using toothbrush should be reinforced in DPNgTF. Guidelines of oral care and education courses for caregivers during the process in their career training are needed.

Tracheal Tube Design and Ventilator-Associated Pneumonia.

Microaspiration of contaminated oropharyngeal and gastric secretions is the main mechanism for ventilator-associated pneumonia (VAP) in critically ill patients. Improving the performance of tracheal tubes in reducing microaspiration is one potential means to prevent VAP. The aim of this narrative review is to discuss recent findings on the impact of tracheal tube design on VAP prevention. Several randomized controlled studies have reported that subglottic secretion drainage (SSD) is efficient in VAP prevention. Meta-analyses have reported conflicting results regarding the impact of SSD on duration of mechanical ventilation, and one animal study raised concern about SSD-related tracheal lesions. However, this measure appears to be cost-effective. Therefore, SSD should probably be used in all patients with expected duration of mechanical ventilation > 48 h. Three randomized controlled trials have shown that tapered-cuff tracheal tubes are not useful to prevent VAP and should probably not be used in critically ill patients. Further studies are required to confirm the promising effects of continuous control of cuff pressure, polyurethane-cuffed, silver-coated, and low-volume low-pressure tracheal tubes. There is moderate evidence for the use of SSD and strong evidence against the use of tapered-cuff tracheal tubes in critically ill patients for VAP prevention. However, more data on the safety and cost-effectiveness of these measures are needed. Other tracheal tube-related preventive measures require further investigation.

Impact of tapered-cuff tracheal tube on microaspiration of gastric contents in intubated critically ill patients: a multicenter cluster-randomized cross-over controlled trial.

Studies on the impact of tapered-cuff tracheal tubes on rates of microaspiration and ventilator-associated pneumonia (VAP) in intubated patients have reported conflicting results. The aim of this study was to determine the influence of this shape of tracheal cuff on abundant microaspiration of gastric contents in critically ill patients. All patients intubated in the intensive care unit (ICU) and requiring mechanical ventilation for at least 48h were eligible for this multicenter cluster-randomized controlled cross-over open-label study. The primary outcome was abundant microaspiration of gastric contents, defined by the presence of pepsin at significant level in>30% of tracheal aspirates. Quantitative measurement of pepsin and salivary amylase was performed in all tracheal aspirates during the 48h following enrollment. A total of 326 patients were enrolled in the ten participating ICUs (162 in the PVC tapered-cuff group and 164 in the standard-cuff group). Patient characteristics were similar in the two study groups. The proportion of patients with abundant microaspiration of gastric contents was 53.5% in the tapered-cuff and 51.0% in the standard-cuff group (odds ratio 1.14, 95% CI 0.72-1.82). While abundant microaspiration of oropharyngeal secretions was not significantly different (77.4 vs 68.6%, p=0.095), the proportion of patients with tracheobronchial colonization was significantly lower (29.6 vs 43.3%, p=0.01) in the tapered-cuff than in the standard-cuff group. No significant difference between the two groups was found for other secondary outcomes, including ventilator-associated events and VAP. This trial showed no significant impact of tapered-cuff tracheal tubes on abundant microaspiration of gastric contents. ClinicalTrials.gov, number NCT01948635.

Effects of simulation education on oral care practices-a randomized controlled trial.

Implementation of evidence-based oral care protocols, nurse education programmes and assessment tools may reduce the risk of developing ventilator-associated pneumonia by increasing critical care nurses' knowledge and skills in adhering to current oral care recommendations. To evaluate the longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on critical care nurses' knowledge and skills in adhering to current oral care recommendations. A randomized controlled trial with repeated measurements. The data for the study were collected in a single academic centre in a 22-bed adult, mixed, medical-surgical intensive care unit in Finland from February 2012 to March 2014. The effectiveness of simulation education was evaluated through the validated Ventilator Bundle Questionnaire and Observation Schedule at baseline (n = 30) and 24 months (n = 17) after simulation education. Data were analysed using a linear mixed model and intention-to-treat analyses. During the study period, the average knowledge score in the intervention group increased significantly (44·0% to 56·0% of the total score) in the final post-intervention measurement (pt = 0·51, pg = 0·002, pt*g = 0·023). However, single-dose simulation education with structured debriefing and verbal feedback had no impact on critical care nurses' skill scores. Single-dose simulation education had only a minimal effect on critical care nurses' knowledge and skills in adhering to current oral care recommendations. Despite increased awareness, there was no significant difference in oral care practices between the study groups after simulation education. The need for regularly repeated educational sessions with theoretical training and practical exercises and direct feedback is evident. Certain aspects of oral care, such as prevention of microaspiration of oropharyngeal secretions and moistening of oral mucosa and lips, require more reinforcement than others.

Exploring Oral Health Care Awareness among Intensive Care Units Nurses at KAUH

The relationship between oral health status and systemic diseases is well established, however, literature shows that there is still lack of awareness among individuals taking care of ICU patients. This work aims to explore if ICU nurses are aware of the relationship between oral health status and systemic diseases, whether they practice oral health care on their patients and if they do, what methods they use. A pre-validated questionnaire was used and distributed to all nurses practicing at KAUH Medical and Surgical ICU. All surveys were voluntary and anonymous. A total of 45 of questionnaires were distributed to ICU nurses with a response rate of 95.6% (Tn = 43). Mean responses indicated that nurses recognize that micro-aspiration of contaminated oropharyngeal secretions is the most likely mechanism of transmission of bacteria into the lung of ventilated patients (mean = 5.6). Accordingly, our results also showed that oral care was perceived as a very high priority for mechanically ventilated patients by 95% of nurses. Mouthwash was the primary material used for oral care by the majority of nurses (n = 32; 74.4%), and chlorhexidine the most used one (n = 42; 98%). The use of manual toothbrushes was very low (n = 8; 23.5%) and not surprisingly, none of the nurses used electric toothbrushes to provide oral care for their ventilated patients. Finally, 86% of the respondents agreed on the need of better supplies and equipment to be provided by the hospital in order to perform better oral care in the ICU. Oral care provided in the ICU is not concordant with the global oral care protocols. Thus, the need for translation of oral care guidelines into clinical practice is of serious importance to improve the quality of care.

A newly developed tracheal tube offering 'pressurised sealing' outperforms currently available tubes in preventing cuff leakage: A benchtop study.

No currently used tracheal tube offers full protection against aspiration of oropharyngeal secretions into the lower airways. We developed a tracheal tube equipped with two polyvinylchloride (PVC) cuffs with a supplementary port opening between the cuffs through which a continuous positive pressure of 5 cmH2O is provided [double-cuffed PVC (PVCdc)]. We compared this PVCdc with four different cuff types (cylindrical PVC, conical PVC, cylindrical polyurethane and conical polyurethane). A comparison study using an in-vitro benchtop model of an artificial rigid trachea. Tracheal tubes were placed in the artificial trachea. Both cuffs were kept inflated at 25 cmH2O. Total 3 ml dyed water was placed above the cuff and leakage recorded under static and dynamic [5 cmH2O positive end-expiratory pressure (PEEP) alone or positive pressure ventilation plus 5 cmH2O PEEP] conditions. At the end of the dynamic experiments, PEEP was zeroed (PEEP alone) or the tracheal tubes were disconnected from the ventilator (positive pressure ventilation plus PEEP). In the static model, leakage flows [medians (range)] were 9.8 (6.2 to 20) for the cylindrical PVC, 1.3 (0.2 to 3.8) for the conical PVC, 0.03 (0.007 to 0.1) for the cylindrical polyurethane, 0.04 (0.003 to 0.2) for the conical polyurethane and 0.0 (0.0 to 0.0) ml min for the PVCdc cuff (P < 0.001, PVCdc vs. all other cuffs). In the dynamic setting, no leakage was detected for up to 60 min with any of the cuffs studied. Loss of PEEP or tracheal tube disconnection resulted in dye inflow alongside all cuffs except for the PVCdc (P < 0.001, PVCdc vs. all other cuffs). A 'pressure seal' incorporated in a double-cuffed tracheal tube prevented fluid passage into the lower airways. Clinically, this may translate into absence of inflow of bacteriologically contaminated secretions into the lungs and thus a lower incidence of ventilator-associated infection.

Composition and dynamics of the respiratory tract microbiome in intubated patients.

BackgroundLower respiratory tract infection (LRTI) is a major contributor to respiratory failure requiring intubation and mechanical ventilation. LRTI also occurs during mechanical ventilation, increasing the morbidity and mortality of intubated patients. We sought to understand the dynamics of respiratory tract microbiota following intubation and the relationship between microbial community structure and infection.ResultsWe enrolled a cohort of 15 subjects with respiratory failure requiring intubation and mechanical ventilation from the medical intensive care unit at an academic medical center. Oropharyngeal (OP) and deep endotracheal (ET) secretions were sampled within 24 h of intubation and every 48–72 h thereafter. Bacterial community profiling was carried out by purifying DNA, PCR amplification of 16S ribosomal RNA (rRNA) gene sequences, deep sequencing, and bioinformatic community analysis. We compared enrolled subjects to a cohort of healthy subjects who had lower respiratory tract sampling by bronchoscopy. In contrast to the diverse upper respiratory tract and lower respiratory tract microbiota found in healthy controls, critically ill subjects had lower initial diversity at both sites. Diversity further diminished over time on the ventilator. In several subjects, the bacterial community was dominated by a single taxon over multiple time points. The clinical diagnosis of LRTI ascertained by chart review correlated with low community diversity and dominance of a single taxon. Dominant taxa matched clinical bacterial cultures where cultures were obtained and positive. In several cases, dominant taxa included bacteria not detected by culture, including Ureaplasma parvum and Enterococcus faecalis.ConclusionsLongitudinal analysis of respiratory tract microbiota in critically ill patients provides insight into the pathogenesis and diagnosis of LRTI. 16S rRNA gene sequencing of endotracheal aspirate samples holds promise for expanded pathogen identification.Electronic supplementary materialThe online version of this article (doi:10.1186/s40168-016-0151-8) contains supplementary material, which is available to authorized users.

Swallowing frequency: Impact of accumulated oropharyngeal secretion levels and gustatory stimulation.

We conducted a prospective, descriptive study of 27 individuals with known or suspected dysphagia to investigate the relationship between swallowing frequency, accumulated oropharyngeal secretion levels, and gustatory stimulation. Assessment of the secretion level was quantified with the use of a previously published 5-point rating scale using endoscopy. Overall, we found a moderate relationship between the baseline swallowing frequency at rest and the accumulated oropharyngeal secretion level (Pearson correlation 0.470; p = 0.01). The study sample was divided into two groups based on their secretion level. Group 1 (n = 19; mean age 59.7 ± 21.5 years) included patients whose accumulated oropharyngeal secretion level was rated as 1 (normal) or 2 (mild). Group 2 (n = 8; mean age 69.78 ± 8.35 years) included patients whose accumulated oropharyngeal secretion level was rated as 4 (severe) or 5 (profound). For Group 1, swallowing frequency increased from a baseline of 1.05 to 5.26 swallows over 2 minutes, following gustatory stimulation; for Group 2 it increased from a baseline of 0.125 swallows to 3.5 swallows. These results indicate that individuals with a lower baseline swallowing frequency at rest demonstrated a higher accumulated oropharyngeal secretion level as viewed by nasal endoscopy and that, regardless of secretion level, gustatory stimulation was effective at increasing swallowing frequency. Increasing swallowing frequency may be a functional dysphagia treatment objective in efforts to improve the efficiency of the swallow and may offer better management of accumulated oropharyngeal secretions.

Risk of Stroke-Associated Pneumonia and Oral Hygiene

Background: Pneumonia is a major complication of stroke, but effective prevention strategies are lacking. Since aspiration of oropharyngeal secretions is the primary mechanism for development of stroke-associated pneumonia, strategies that decrease oral colonization with pathogenic bacteria may help curtail pneumonia risk. We therefore hypothesized that systematic oral care protocols can help decrease pneumonia risk in hospitalized stroke patients. In this study, we investigated the impact of a systematic oral hygiene care (OHC) program in reducing hospital-acquired pneumonia in patients with acute-subacute stroke. Methods: This study compared the proportion of pneumonia cases in hospitalized stroke patients before and after implementation of a systematic OHC intervention. All patients hospitalized with acute ischemic stroke or intracerebral hemorrhage admitted to a large, urban academic medical center in Boston, Mass., USA from May 31, 2008, to June 1, 2010 (epoch prior to implementation of OHC), and from January 1, 2012, to December 31, 2013 (epoch after full implementation of OHC), who were 18 years of age and hospitalized for ≥2 days were eligible for inclusion. The cohort in the first epoch constituted the control group whereas the cohort in the second epoch formed the intervention group. Multivariate logistic regression was used to control for confounders. The main outcome measure was hospital-acquired pneumonia, defined via International Classification of Diseases, Ninth Revision, Clinical Modification codes. Results: The cohort comprised 1,656 admissions (707 formed historical controls; 949 were in the intervention group). The unadjusted incidence of hospital-acquired pneumonia was lower in the group assigned to OHC compared to controls (14 vs. 10.33%; p = 0.022) with an unadjusted OR of 0.68 (95% CI 0.48-0.95; p = 0.022). After adjustment for influential confounders, the OR of hospital-acquired pneumonia in the intervention group remained significantly lower at 0.71 (95% CI 0.51-0.98; p = 0.041). Conclusion: In this large hospital-based cohort of patients admitted with acute stroke, systematic OHC use was associated with decreased odds of hospital-acquired pneumonia.

Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: study protocol for a randomized controlled trial.

BackgroundVentilator-associated pneumonia (VAP) is the most common infection in intubated critically ill patients. Microaspiration of the contaminated gastric and oropharyngeal secretions is the main mechanism involved in the pathophysiology of VAP. Tracheal cuff plays an important role in stopping the progression of contaminated secretions into the lower respiratory tract. Previous in vitro studies suggested that conical cuff shape might be helpful in improving tracheal sealing. However, clinical studies found conflicting results. The aim of this study is to determine the impact of conical tracheal cuff shape on the microaspiration of gastric contents in critically ill patients.Methods/DesignThis prospective cluster randomized controlled crossover open-label trial is currently being conducted in ten French intensive care units (ICUs). Patients are allocated to intubation with a polyvinyl chloride (PVC) standard (barrel)-shaped or a PVC conical-shaped tracheal tube. The primary objective is to determine the impact of the conical shaped tracheal cuff on abundant microaspiration of gastric contents. Secondary outcomes include the incidence of microaspiration of oropharyngeal secretions, tracheobronchial colonization, VAP and ventilator-associated events. Abundant microaspiration is defined as the presence of pepsin at significant level (>200 ng/ml) in at least 30 % of the tracheal aspirates. Pepsin and amylase are quantitatively measured in all tracheal aspirates during the 48 h following inclusion. Quantitative tracheal aspirate culture is performed at inclusion and twice weekly. We plan to recruit 312 patients in the participating ICUs.DiscussionBEST Cuff is the first randomized controlled study evaluating the impact of PVC tracheal-cuff shape on gastric microaspirations in patients receiving invasive mechanical ventilation. Enrollment began in June 2014 and is expected to end in October 2015.Trial registrationClinicalTrials.gov Identifier: NCT01948635 (registered 31 August 2013).

Epidemiological status of felid herpesvirus type-1 and feline calicivirus infections in Brazil

Feline calicivirus (FCV) and felid herpesvirus type-1 (FeHV-1) are the main infectious agents of domestic and wild felines worldwide. The FCV and FeHV-1 viruses were isolated in Brazil in 1988 and 2012, respectively. Serology surveys were performed among domestic feline in the State of Rio Grande do Sul and among wild felines in central Brazilian States. Felines with acute or chronic infections may become carriers for both viruses and, viral transmission occurs mainly by ocular and nasal secretions. In addition, FCV may be transmitted by oropharyngeal secretion and fomites. The clinical signs commonly observed in cats are fever, sneezing, coughing and nasal and ocular discharge; however, oral lesions are restricted to FCV infection. A systemic syndrome showing hemorrhagic lesions, alopecia, facial edema and jaundice has been associated with FCV. Attenuated as well as inactivated vaccines against FCV and FeHV-1 were developed in the middle 1970s, and they are effective at reducing the presentation/development of the diseases, but they are not capable of eliminating the persistence of FCV and FeHV-1. This article presents a brief review of the main aspects of the FCV and FeHV-1 infections, with an emphasis in the current situation on the domestic feline population from Brazil.

Sensitivity of the Blue Dye Food Test for Detecting Aspiration in Patients with a Tracheotomy

Aims: To explore the sensitivity and specificity values for aspiration with the blue dye food test (BDFT) in tracheotomized patients undergoing inpatient rehabilitation and explore what impact, if any, the accumulated oropharyngeal secretion level has upon the accuracy of the BDFT. Methodology: Simultaneous BDFT and fiberoptic endoscopic evaluation of swallowing (FEES) proced ure were conducted with 21 tracheotomized patients. The patient’s accumulated oropharyngeal secretion level was evaluated first using a 5 - point secretion severity scale. The patients then received ice chips and various boluses which were dyed blue. The B DFT was

Метод профилактики острых респираторных инфекций у детей с врожденными пороками сердца

Цель: изучить эффективность и безопасность рекомбинантного липосомального интерферона альфа-2β в профилактике острых респираторных инфекций (ОРИ) у детей с врожденными пороками сердца. Материалы и методы. В предэпидемический период ОРИ 31 ребенку 3–12 лет с врожденными пороками сердца (основная группа) проводили оценку эффективности профилактической программы рекомбинантным липосомальным интерфероном альфа-2β: 250 000 ЕД 1 раз в сутки 2 раза в неделю в течение 1 месяца (методика I). В связи с недостаточной эффективностью в дальнейшем продолжили профилактику по методике II: 250 000 ЕД 2 раза в сутки в течение 3 дней, затем по 250 000 ЕД 1 раз в сутки 2 раза в неделю в течение 1 месяца. Клинико-лабораторное обследование (в том числе оценку уровня лизоцима, лактоферрина и секреторного иммуноглобулина А) проводили до начала профилактического воздействия, на 30, 120, 180-й день. Оценивали удовлетворенность результатами профилактики, побочные явления. Контрольную группу составили 20 здоровых сверстников. Результаты. Исходно у детей с врожденными пороками сердца выявлено снижение в ротоглоточном секрете уровня лизоцима, лактоферрина и секреторного иммуноглобулина А. После профилактической программы по методике I констатировано уменьшение частоты и продолжительности ОРИ и осложнений. Профилактическая программа по методике II продемонстрировала большую эффективность по названным выше показателям. Все дети хорошо переносили профилактическое лечение, побочных эффектов не было. Выводы. Выявлено снижение показателей местного иммунитета у детей с врожденными пороками сердца, что повышает риск заболеваемости ОРИ. Высокая эффективность и безопасность рекомбинантного липосомального интерферона альфа-2β являются основанием для его использования у детей с целью профилактики ОРИ.

ВМІСТ АНТИМІКРОБНИХ ПЕПТИДІВ ТА КЛІТИННИЙ СКЛАД РОТОГЛОТКОВОГО СЕКРЕТУ В ДІТЕЙ З ЧАСТИМИ РЕСПІРАТОРНИМИ ЗАХВОРЮВАННЯМИ.

&lt;p&gt;В роботі проведено визначення вмісту антимікробних пептидів та клітинного складу ротоглоткового секрету (РГС) у 37 дітей з частими гострими респіраторними захворюваннями (ДЧХ). З них 20 пацієнтів з частими ГРЗ, 17 - з частими гострими респіраторними захворюванями (ГРЗ) та атопічним дерматитом (АД). Контрольну групу склали 10 дітей, які хворіли на ГРЗ менше 4 разів на рік (ЕХД — епізодично хворіючі діти). В РГС був визначений вміст дефензинів в 1 -3, лізоциму, лактоферину, секреторного імуноглобулінуА (slgA), епітеліоцитів, нейтрофілів, лімфоцитів. Встановлено,&lt;br /&gt;що у ЕХД рівень дефензинів в 1-3 у РГС становив 4,04±0,6 мкг/мл. У ДЧХ рівень дефензинів в1 -3 мав тенденцію до зниження і склав 3,05±0,04 мкг/мл. У ДЧХ з АД зареєстровано достовірне зниження вмісту дефензинів в1-3 у РГС (р&amp;lt;0,01) — 1,58±0,2 мкг/мл порівняно з ЕХД. У групі ДЧХ 4-7 років вміст факторів локального захисту не мав вагомих зрушень. Тільки у ДЧХ 8-12 років зафіксоване статистично достовірне зниження slgA - 0,14±0,05 г/л порівняно з відповідним показником у ЕХД — 0,43±0,17 г/л. У групі ДЧХ з АД (4-7 років) відзначається тенденція до зниження вмісту всіх досліджуваних захисних факторів у РГС, достовірно за рівнями дефензинів в1 -3 та лактоферину. В групі ДЧХ+АД 8-12 років зареєстровані високі рівні лактоферину та slgA. У ДЧХ з АД (4-7 років) спостерігалося достовірне збільшення вмісту лімфоцитів в РГС порівняно з ДЧХ 4-7 років.&lt;br /&gt;&lt;br /&gt;&lt;/p&gt;