Pneumonia In Intensive Care Unit Research Articles

Effect of Vitamin C on mortality of critically ill patients with severe pneumonia in intensive care unit: a preliminary study

BackgroundCritically ill patients frequently suffer from vitamin C deficiency. Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns, and trauma. Because of the high incidence and morbidity/mortality with severe pneumonia, we aimed to investigate the effect of administration of high dose vitamin C in critically ill patients with severe pneumonia.MethodsEighty critically ill patients with pneumonia were enrolled in this randomized double-blinded clinical trial. Patients with a CURB-65 score > 3, one major criterion, or ≥ 3 minor criteria were considered as severe pneumonia. Patients were randomly assigned to intervention or placebo groups receiving standard treatment plus 60 mg/kg/day vitamin C as a continuous infusion or normal saline in the same volume correspondingly for 96 h. Serum levels of vitamin C were noted at baseline and 48 h after vitamin C administration. Duration of mechanical ventilation, ICU length of stay, PaO2/FiO2, and mortality rate were noted for all patients till the 28th day. Any complications related to the vitamin C administration were recorded.ResultsDuration of mechanical ventilation and vasopressor use were significantly lower in the intervention group (p: < 0.001 and 0.003, respectively). Baseline levels of vitamin C in both groups did not have a significant difference but its levels increased in the intervention group and decreased in the control group during the study period. Mortality rate insignificantly decreased in the intervention group (p = 0.17). Three patients showed hypotension and tachycardia during the administration of vitamin C which was self-limited with decreasing the dose of vitamin C.Our results showed that the intravenous administration of a relatively high dose of vitamin C to critically ill patients with severe pneumonia was safe and could decrease the inflammation, duration of mechanical ventilation, and vasopressor use without any significant effect on mortality.Trial registration: IRCT registration number: IRCT20190312043030N1, Registration date: 2019-08-26, Seied Hadi Saghaleini.

Management of SARS-CoV-2 pneumonia in intensive care unit: An observational retrospective study comparing two bundles.

PurposeTo compare the effects of two therapeutic bundles of management in SARS-CoV2 ICU patients.Materials and methodsOur retrospective, observational study was performed in a university ICU from March to June 2020 (first wave) and from September 2020 to January 2021 (second wave). In first wave, patients received bundle 1 including early invasive ventilation, hydroxychloroquine, cefotaxime and azithromycin. In second wave, bundle 2 included non-invasive oxygenation support and dexamethasone. The main outcome was in-hospital mortality. Secondary outcomes included ICU and hospital length of stay, ICU supportive therapies, viral clearance and antimicrobial resistance emergence.Results129 patients with SARS-CoV-2 pneumonia were admitted to our ICU. Thirty-five were treated according to bundle 1 and 76 to bundle 2. In-hospital mortality was similar in the two groups (23%, p = 1). The hospital (p = 0.003) and ICU (p = 0.01) length of stay and ventilator-free days at 28 days (p = 0.03) were significantly reduced in bundle 2. Increasing age, vasopressor use and PaO2/FiO2 ratio < 125 were associated with in-hospital mortality.ConclusionWithin the limitations of our study, changes in therapeutic bundles for SARS-Cov-2 ICU patients might have no effect on in-hospital mortality but were associated with less exposure to mechanical ventilation and reduced hospital length of stay.

Pyoverdine Inhibitors and Gallium Nitrate Synergistically Affect Pseudomonas aeruginosa.

ABSTRACTPseudomonas aeruginosa is a multidrug-resistant, opportunistic pathogen that frequently causes ventilator-associated pneumonia in intensive care units and chronic lung infections in cystic fibrosis patients. The rising prevalence of drug-resistant bacteria demands the exploration of new therapeutic avenues for treating P. aeruginosa infections. Perhaps the most thoroughly explored alternative is to use novel treatments to target pathogen virulence factors, like biofilm or toxin production. Gallium(III) nitrate is one such agent. It has been recognized for its ability to inhibit pathogen growth and biofilm formation in P. aeruginosa by disrupting bacterial iron homeostasis. However, irreversible sequestration by pyoverdine substantially limits its effectiveness. In this report, we show that disrupting pyoverdine production (genetically or chemically) potentiates the efficacy of gallium nitrate. Interestingly, we report that the pyoverdine inhibitor 5-fluorocytosine primarily functions as an antivirulent, even when it indirectly affects bacterial growth in the presence of gallium, and that low selective pressure for resistance occurs. We also demonstrate that the antibiotic tetracycline inhibits pyoverdine at concentrations below those required to prevent bacterial growth, and this activity allows it to synergize with gallium to inhibit bacterial growth and rescue Caenorhabditis elegans during P. aeruginosa pathogenesis.IMPORTANCE P. aeruginosa is one of the most common causative agents for ventilator-associated pneumonia and nosocomial bacteremia and is a leading cause of death in patients with cystic fibrosis. Pandrug-resistant strains of P. aeruginosa are increasingly identified in clinical samples and show resistance to virtually all major classes of antibiotics, including aminoglycosides, cephalosporins, and carbapenems. Gallium(III) nitrate has received considerable attention as an antipseudomonal agent that inhibits P. aeruginosa growth and biofilm formation by disrupting bacterial iron homeostasis. This report demonstrates that biosynthetic inhibitors of pyoverdine, such as 5-fluorocytosine and tetracycline, synergize with gallium nitrate to inhibit P. aeruginosa growth and biofilm formation, rescuing C. elegans hosts during pathogenesis.

Role of early tracheostomy for preventing ventilator associated pneumonia in intensive care unit: a review

&lt;p class="abstract"&gt;Tracheostomy often plays a crucial role in airway management of the patients in intensive critical unit (ICU). Tracheostomy is often helpful for improvement of the respiratory mechanics and the patient comfort. There are several advantages of the trachesotomy over the endotracheal tube intubation such as avoidance of the injury of the larynx, provide a stable airway, facilitates pulmonary toilet and facilitates ventilation. It has been suggested that tracheostomy also helpful to reduce the risk of ventilator associated pneumonia (VAP) in comparison to the trans-laryngeal intubation. VAP is a type of nosocomial infection which has been associated with presence of mechanical ventilation. Despite significant improvement in managing the intubated patients, VAP remains a common and sometimes fatal complication in the ICU. Clinician’s attitude towards trachesotomy may be still heterogeneous in ICU and the decision for performing tracheostomy is still challenging. However, early tracheostomy is associated with less VAP, less ICU stay, avoid higher number of intubation in early group of tracheostomy and higher patient comfort. The purpose of this review article was to discuss the etiopathology of VAP, epidemiology, role of early tracheostomy in VAP and prevention of the VAP in patients with mechanical ventilation in ICU.&lt;/p&gt;

Clinical Efficacy of Ceftaroline Fosamil in Patients with Severe Pneumonia in Intensive Care Unit

To evaluate our experience over the routine practice in the use of Ceftaroline fosamil (CF) as a treatment of severe community pneumonia in Intensive Care Unit (ICU) patients and to do a comparative with conventional antibiotics in terms of clinical efficacy.

Hematological characteristics of patients with novel coronavirus pneumonia in intensive care unit

BackgroundToward the end of December 2019, a novel type of coronavirus (2019-nCoV) broke out in Wuhan, China. Here, the hematological characteristics of patients with severe and critical 2019-nCoV pneumonia in intensive care unit (ICU) were investigated, which may provide the necessary basis for its diagnosis and treatment. MethodsWe collected data on patients with confirmed 2019-nCoV pneumonia in the ICU of Leishenshan Hospital in Wuhan from February 25 to April 2, 2020. Real-time reverse-transcription polymerase chain reaction was used to confirm the presence of 2019-nCoV, and various hematological characteristics were analyzed. ResultsAll patients tested positive for 2019-nCoV using nasopharyngeal swabs or sputum after admission, and interstitial pneumonia findings were noted on chest computed tomography. Sex, age and comorbidities were not significantly different between the severe and critical groups. In terms of prognosis, the survival rate of patients in the severe group reached 100%, whereas that of patients in the critical group was only 13.33% after positive treatment. Furthermore, lymphocyte percentage, blood urea nitrogen, calcium, D-dimer, myohemoglobin, procalcitonin, and IL-6 levels were high-risk factors for disease progression in critical patients. Finally, lymphocyte percentage and blood urea nitrogen, calcium, myohemoglobin, and IL-6 levels were closely associated with patient prognosis. Conclusions2019-nCoV pneumonia should be considered a systemic disease. Patients with more complications were more likely to develop critical disease. Lymphocyte percentage and blood urea nitrogen, calcium, myohemoglobin, and IL-6 levels can be monitored to prevent progression critical disease.

Protocol for an international, multicentre, prospective, observational study of nosocomial pneumonia in intensive care units: the PneumoINSPIRE study

Background: Nosocomial pneumonia in the critical care setting is associated with increased morbidity, significant crude mortality rates and high health care costs. Ventilator-associated pneumonia represents about 80% of nosocomial pneumonia cases in intensive care units (ICUs). Wide variance in incidence of nosocomial pneumonia and diagnostic techniques used has been reported, while successful treatment remains complex and a matter of debate. Objective: To describe the epidemiology, diagnostic strategies and treatment modalities for nosocomial pneumonia in contemporary ICU settings across multiple countries around the world. Design, setting and patients: PneumoINSPIRE is a large, multinational, prospective cohort study of adult ICU patients diagnosed with nosocomial pneumonia. Participating ICUs from at least 20 countries will collect data on 10 or more consecutive ICU patients with nosocomial pneumonia. Site-specific information, including hospital policies on antibiotic therapy, will be recorded along with patient-specific data. Variables that will be explored include: aetiology and antimicrobial resistance patterns, treatment-related parameters (including time to initiation of antibiotic therapy, and empirical antibiotic choice, dose and escalation or de-escalation), pneumonia resolution, ICU and hospital mortality, and risk factors for unfavourable outcomes. The concordance of ventilator-associated pneumonia diagnosis with accepted definitions will also be assessed. Results and conclusions: PneumoINSPIRE will provide valuable information on current diagnostic and management practices relating to ICU nosocomial pneumonia, and identify research priorities in the field. Trial registration:ClinicalTrials.gov identifier NCT02793141.

Clinical characteristics and risk factors for mortality in patients with coronavirus disease 2019 in intensive care unit: a single- center, retrospective, observational study in China.

Coronavirus disease 2019 (COVID-19) is a potentially life-threatening contagious disease which has spread all over the world. Risk factors associated with the clinical outcomes of COVID-19 pneumonia in intensive care unit (ICU) have not yet been well determined. This was a retrospective, single-centered, observational study, in which 47 patients with confirmed COVID-19 were consecutively enrolled from February 24 to April 5, 2020. The patients were registered from the ICU of Leishenshan Hospital in Wuhan, China. Clinical characteristics and outcomes were collected and compared between survivors and non-survivors. Multivariable logistic regression was performed to analyze the risk factors of death in patients with COVID-19. The study cohort included 47 adult patients with an average age of 70.55±12.52 years, and 30 (63.8%) patients were men. Totally 15 (31.9%) patients died. When compared to survivors, nonsurvivors showed a higher proportion of septic shock [6 (40%) patients vs. 3 (9.4%) patients], disseminated intravascular coagulation [3 (21.4%) vs. 0], and had higher score of APACHE II (25.07±8.03 vs. 15.56±5.95), CURB-65 {3 [2-4] vs. 2 [1-3]}, Sequential Organ Failure Assessment (SOFA) {7 [5-9] vs. 3 [1-6]}, higher level of D-dimer {5.74 [2.32-18] vs 2.05 [1.09-4.00]} and neutrophil count {9.4 [7.68-14.54] vs. 5.32 [3.85-9.34]}. SOFA score (OR 1.47; 95% CI: 1.01-2.13; P=0.0042) and the lymphocyte count (OR 0.02; 95% CI: 0.00-0.86; P=0.042) on admission were independently risk factors for mortality. Patients with higher lymphocyte count (>0.63×109 /L) and lower SOFA score (≤4) on admission had a significantly better prognosis than those with lower lymphocyte count (≤0.63×109 /L) and higher SOFA score (>4) in overall survival. Higher SOFA score and lower lymphocyte count at admission were connected with poor prognosis of patients with COVID-19 in ICU. Lymphocyte count may serve as a promising prognostic biomarker.

Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study.

AimVentilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection. The current study aimed to assess the efficacy of mechanical insufflation-exsufflation (MI-E) in preventing VAP in critically ill patients.Materials and methodsThis retrospective cohort study was conducted at the ICU of Chiba University Hospital between January 2014 and September 2017. The inclusion criteria were patients who required invasive mechanical ventilation ≥48 hours and those who underwent rehabilitation, including chest physical therapy (CPT). In 2015, the study institution started the use of MI-E in patients with impaired cough reflex. From January to December 2014, patients undergoing CPT were classified under the historical control group, and those who received treatment using MI-E from January 2015 to September 2017 were included in the intervention group. The patients received treatment using MI-E via the endotracheal or tracheostomy tube, with insufflation-exsufflation pressure of 15–40 cm H2O. The treatment frequency was one to three sessions daily, and a physical therapist who is experienced in using MI-E facilitated the treatment.ResultsFrom January 2015 to September 2017, 11 patients received treatment using MI-E. Of the 169 patients screened in 2014, 19 underwent CPT. The incidence of VAP was significantly different between the CPT and MI-E groups (84.2% [16/19] vs 26.4% [3/11], p = 0.011). After adjusting for covariates, a multivariate logistic regression analysis was performed, and results showed that the covariates were not associated with the incidence of VAP.ConclusionThis retrospective cohort study suggests that the use of MI-E in critically ill patients is independently associated with a reduced incidence of VAP.Clinical significanceAssessing the efficacy of MI-E to prevent VAP.How to cite this articleKuroiwa R, Tateishi Y, Oshima T, Inagaki T, Furukawa S, Takemura R, et al. Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study. Indian J Crit Care Med 2021;25(1):62–66.

Efficacy of Venner-PneuX endotracheal tube system for prevention of ventilator-associated pneumonia in intensive care units: A protocol for systematic review and meta-analysis.

Background:The pathogenic mechanism and prevention of ventilator-associated pneumonia (VAP) are substantially improved over the past several decades, but VAP remains frequently seen among the critical cases. The Venner-PneuX endotracheal tube system (VPXETS) has been proved to perform better than standard endotracheal tubes (SET) in the prevention of VAP in some studies. Therefore, this systematic review is aimed at evaluating the effectiveness of VPXETS in order to prevent VAP.Methods:Electronic databases, including PubMed, WANFANG, CENTRAL, CNKI, EMBASE, and CINAHL, are used to search relevant randomized controlled trials for evaluating the therapeutic effect of VPXETS on preventing VAP from January 2011 to December 2020. To be specific, related studies are selected, data are extracted, risk of bias is assessed, and meta-analysis is conducted in succession.Results:The present review aims to assess the therapeutic effect of VPXETS on preventing VAP in intensive care units (ICUs). Our outcome measures include the incidence and side reaction of VAP.Conclusions:The present review assesses related studies regarding the therapeutic effect of VPXETS on preventing VAP at ICUs.Dissemination and ethics:Our findings in this work are to be disseminated by means of peer-reviewed publication. No ethical approval is required in our review since it uses the published data. Moreover, anonymity is guaranteed during the data analysis process.OSF Registration number:DOI 10.17605/OSF.IO/6BERJ

Clinical and Microbiological Study of Fungi as an Aetiological Agent in Patients of Ventilator Associated Pneumonia in Intensive Care Unit of a Tertiary Care Hospital

Introduction: In Intensive Care Units (ICUs), Ventilator Associated Pneumonia (VAP) is the commonest nosocomial infection. Fungal infections especially Candida spp. have emerged as one of the commonest organisms in causing VAP. It increases morbidity and mortality to a great extent in critically ill patients, with risk factors like old age, co-morbidities like diabetes, Chronic Obstructive Pulmonary Disease (COPD), infectious or multisystem disease. Hence, it becomes necessary to isolate and speciate the fungi along with its Antifungal Susceptibility Testing (AFST) for early diagnosis and treatment. This is done by microbiological investigation where in samples (bronchoscopic/ nonbronchoscopic) are obtained from the lower respiratory tract. Aim: To study the fungal profile among clinically and radiologically diagnosed VAP cases. Materials and Methods: This was a prospective study carried out in the Department of Microbiology, Dr Vaishampayan Memorial Govt Medical College, Solapur, Maharashtra, India, in which 120 clinically and radiologically diagnosed VAP patients were included. Endotracheal Aspirate (ETA) of these patients was collected aseptically. The sample was then subjected to Gram stain, Lacto Phenol Cotton Blue (LPCB), culture on Sabouraud’s Dextrose Agar (SDA) and Chromogenic (CHROM) agar and AFST was performed by broth dilution technique. The data was statistically analysed. Results: In this study, out of 120 patients, 52 patients were diagnosed as VAP on day 5. Late onset pneumonia was more common in 61.67%. Non-infective cases were 49.17% and infective cases were 28.33%. Patients belonged to different age groups with maximum between 31-40 years. Out of 120 cases of VAP, yeast was isolated from 26 cases. Most common pathogenic yeast isolated was Candida albicans (53.85%). All yeast isolates were susceptible to fluconazole and amphotericin B except one isolate of Candida krusei, Candida tropicalis and Candida glabrata each were resistant to both fluconazole and amphotericin B. Conclusion: Candida albicans was the commonest yeast isolated. Resistance was noted among the non-albicans spp of Candida. The non-albicans Candida is growing as an emerging threat. Early diagnosis and AFST will help in reducing the morbidity and mortality.

Predictors of Mortality in Patients of COVID-19 Pneumonia in Intensive Care Unit: An Observational Study in a Tertiary Care Hospital, Lucknow, India

Introduction: Coronavirus Disease-2019 (COVID-19) is caused by the Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) which is an enveloped positive-sense single-stranded RNA virus. Initial steps of the infection involve binding of the spike protein (S) of the virus to Angiotensin Converting Enzyme-2 (ACE-2) receptor on the mucosal surfaces of various organs like lungs, kidney, heart, intestine. Pathogenesis of complications are still poorly understood. Aim: This study was designed to find out the baseline biochemical parameters at the time of admission which may predict outcome in COVID-19 patients. Materials and Methods: This observational study was conducted in a dedicated COVID-19 hospital, Dr. Ram Manohar Lohia Institute of Medical Sciences (Dr. RMLIMS), Lucknow, Uttar Pradesh, India, from 1st July, 2020 to 30th November, 2020. A total of 109 moderate to severe COVID-19 pneumonia patients who required Intensive Care Unit (ICU) admission, were enrolled. Based on their outcome, patients were divided into two groups: “Survived” and “Expired”. Biochemical characteristics of patients were compared among the two groups using univariate and multivariate analysis. Results: On Univariate analysis Coagulation profile, Prothrombin Time (PT), International Normalised Ratio (INR), Activated Partial Thromboplastin Time (APTT) and D-Dimer values were raised significantly in the expired group. Among other acute phase reactants Lactate Dehydrogenase (LDH), C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Creatinine Phosphokinase-MB (CPKMB) were raised in expired group and this difference was significant statistically too. On Multivariate analysis among all acute phase reactant only IL-6 was increased significantly. All other variables were found to be non significantly associated with mortality, statistically (p-value &lt;0.05). Conclusion: Baseline biochemical parameters have prognostic values in COVID-19 patients. Raised IL-6 levels can be viewed as an independent predictor of mortality among COVID-19 patients at the time of admission in ICU.

Estrogen Alleviates Sex-Dependent Differences in Lung Bacterial Clearance and Mortality Secondary to Bacterial Pneumonia after Traumatic Brain Injury

Traumatic brain injury (TBI) is the leading cause of injury-related death and disability in patients under the age of 46 years. Survivors of the initial injury often endure systemic complications such as pulmonary infection, and Pseudomonas aeruginosa is one of the most common causes of nosocomial pneumonia in intensive care units. Female patients are less likely to develop secondary pneumonia after TBI, and pre-clinical studies have revealed a salutary role for estrogen after trauma. Therefore, we hypothesized that female mice would experience less mortality after post-TBI pneumonia with P. aeruginosa. We employed a mouse model of TBI followed by P. aeruginosa pneumonia. Male mice had greater mortality and impaired lung bacterial clearance after post-TBI pneumonia compared with female mice. This was confirmed as a difference in sex hormones, as oophorectomized wild-type mice had mortality and lung bacterial clearance similar to male mice. There were differences in tumor necrosis factor-α secretion in male and female alveolar macrophages after P. aeruginosa infection. Finally, injection of male or oophorectomized wild-type female mice with estrogen restored lung bacterial clearance and prevented mortality. Our model of TBI followed by P. aeruginosa pneumonia is among the first to reveal sex dimorphism in secondary, long-term TBI complications.

Evaluation of empirical antibiotic usage and cost analysis of patients with nosocomial pneumonia in ICU of RSUP Dr. Sardjito, yogyakarta

The rationality of antibiotic usage has an implication on the therapeutic quality and antimicrobial resistance control. Qualitative and quantitative evaluation of this rationality becomes one quality indicator of hospitals' antimicrobial resistance programs. Therefore, this study aims to determine the relationship between the rationality of antibiotic usage with clinical outcomes and the total cost in nosocomial pneumonia patients treated in the Intensive Care Unit (ICU). The method used was descriptive-analytic observational research with a cross-sectional design analysis, and data were collected retrospectively from the medical and financial record of patients with inclusion criteria. The data were then analyzed descriptively using the Gyssens flowchart. Fisher statistical test was conducted to analyze the relationship between rationality data and therapeutic outcomes. Furthermore, the Mann Whitney statistical test was conducted to examine the relationship between rationality data and the cost, while the paired t-test was conducted to analyze the resistance pattern. The results showed that antibiotic usage in patients with nosocomial pneumonia at the ICU of RSUP Dr. Sardjito was irrational and rational by 30.21% (29 regimens) and 69.79% (67 regimens) respectively. This rationality has a relation with clinical outcome based on Fisher test with p-value = 0.001 (p &lt;0.05). Considering these results, the antibiotics cost both in the rational and irrational category has no significant difference with the p-value of 0.90 (p&lt;0.05).

The Incidence and Risk Factors of Ventilator-Associated Pneumonia in ICU

Considering the importance of ventilator-associated pneumonia (VAP) and the high mortality rate among patients diagnosed with VAP, the aim of the current study was to evaluate the incidence of VAP, and its related risk factors in patients admitted to the intensive care unit (ICU). A total of 197 patients undergoing mechanical ventilation in the ICU diagnosed with VAP was enrolled in this study. Among these patients, 59 (53.6%) cases were male, and 51 (46.4%) were female with the mean age of 69.86±14.62 years. The most common cause of ICU admission was CVA, followed by colorectal cancer, lung cancer, sepsis, and cirrhosis. Our results showed that 110 individuals (55.8%) were diagnosed with VAP. The most common bacteria were Klebsiella, which was found in 20.3% of cases. (47.7%) of patients had diabetes, 21.8% had chronic kidney disease, and 51.8% had cardiovascular disease. 32.7% of patients were bedridden before intubation. The mortality rate due to VAP was estimated at about 20%. In conclusion, the incidence of VAP in ICU is relatively high (55.8%), with a mortality rate of 20%. Among the risk factors, the presence of diabetes, bedridden, reduction in consciousness, and the time duration of mechanical ventilation are relative to this type of infection.

Thiol/Disulfide Homeostasis as an Early Biomarker to Differentiate Sepsis from Pneumonia in Intensive Care Units.

It is possible that patients with pneumonia may also have sepsis and the separation of these two clinical entities may cause some trouble to clinicians. In order to separate a patient with pneumonia and a patient with sepsis, we qualify thiol/disulfide homeostasis as a potential biomarker. This study was designed between February 2018 - February 2019 prospectively. All patients in the intensive care unit with pneumonia and sepsis were enrolled in the study. At the time of hospitalization, thiol/disulfide homeostasis was measured. Patients diagnosed with sepsis and pneumonia were compared, in regards to thiol/disulfide homeostasis. During research period, 103 patients with sepsis and 120 patients with pneumonia were enrolled into the study. When we compared native-thiol, total-thiol, and disulfide levels in both sepsis and pneumonia patients, we had similar results (p>0.05). In sepsis group, index-1 (disulfide/native thiol ratio) and index-2 (disulfide/total thiol ratio) were found to be statistically higher than the pneumonia group, and index-3 (native thiol/total thiol ratio) was statistically lower than the pneumonia group (p=0.020, p= 0.021, p=0.021, respectively). In this study, we showed that thiol/disulfide homeostasis could be used as new markers in the early period in order to separate patients with sepsis and patients with pneumonia.

The importance of oral hygiene for patients on mechanical ventilation.

The importance of oral hygiene for patients on mechanical ventilation.

Hepatic Disorders With the Use of Remdesivir for Coronavirus 2019

Remdesivir is a nucleotide analog prodrug with antiviral activity against a broad spectrum of human coronavirus in cell cultures and mouse models including severe acute respiratory syndrome-associated coronavirus 2. Recently, the Food and Drug Agency (FDA) and the European Medicines Agency (EMA) recommended remdesivir for the treatment of patients hospitalized with severe coronavirus disease 2019 (COVID-19) infection.1,2 In the remdesivir clinical development program, some cases have raised concerns regarding potential hepatobiliary disorders associated with remdesivir, including in healthy volunteers and patients with COVID-19.3 In cohort studies of patients hospitalized for severe COVID-19 who were treated with compassionate-use remdesivir, elevated hepatic enzymes were the most frequent adverse drug reaction reported.4,5 In the first randomized, double-blind, placebo-controlled clinical trial assessing the effect of intravenous remdesivir in adults admitted to hospital with severe COVID-19 (n= 237), a higher proportion of remdesivir recipients than placebo recipients had dosing prematurely stopped by the investigators because of adverse events including aminotransferase or bilirubin increases (3 versus 0).6 Although there is no signal from the available data of severe hepatotoxicity or drug-induced liver injury in clinical trials, the number of patients exposed to remdesivir was too limited. Therefore, there is an urgent need to investigate the hepatic safety profile associated with remdesivir in COVID-19 patients.

Characterization of hospital-acquired pneumonia in Intensive Care Unit. General Hospital

Objective: characterize the hospital-acquired pneumonia (HAN) in the Intensive Care Unit(ICU) of the Methods: a descriptive and cross-sectional study was carried out to characterize the hospital-acquired pneumonia in admitted patient in ICU of the General Hospital “Guillermo Domínguez López” in Puerto Padre, Las Tunas since June, 2018 to May, 2019. The population was all the patients who acquired the infection during the admission. The information was taken from de patient`s clinic file. It was created graphics and charts to pick the information. Dates was described, analyzed and compared with others national and international studies. Result: the prevalent age group was 60 -79 to 59%. Asisted mechanical ventilation was not realed with the HAN due to the procedure was only performing in 9 patients to 25%. The most frequent isolated germ was citrobacter. The deseases which was most related with (HAN) was neurological deseases. The mortality was high, 20 patients die to 58%. Conclusion: clinic and epidemiologic characterisctics of NIH was described in the ICU of the General Hospital “Guillermo Domínguez López”.

Preventing Ventilator-Associated Pneumonia in Intensive Care Unit by improved Oral Care: a Review of Randomized Control Trials.

To assess the effects of various oral care methods on the incidence of VAP in patients receiving mechanical ventilation in intensive care units, an exhaustive literature search was undertaken using MEDLINE as well as a manual review of the relevant literature and citations. Eight publications were selected for this review. The primary endpoint was the incidence of VAP. Different oral care methods for preventing VAP were the subject of this review. Two studies that were reviewed in this article showed significant statistical difference between the intervention group and the control group regarding different oral care for lowering the incidence of VAP. The rest of the studies showed no significant statistical difference between the intervention group and the control group, but showed the importance of meticulous oral hygiene in those patients. Mechanically ventilated patients who suffer from poor oral hygiene are exposed to the harmful accumulation of oral plaque and the initiation of VAP. Proper oral care by qualified care givers can reduce the incidence of VAP. Proper oral care needs to be considered part of the medical treatment plan when a patient is admitted to the ICU to lower the incidence rates of VAP. Oral care treatment of ventilated patients in the intensive care units, for prevention of ventilator-associated pneumonia, is with high clinical relevance, decreasing morbidity and mortality in the ICU. We recommend that ICU medical teams will plan a protocol of oral care treatment, based on our article results, and implement it as part of the daily routine.