Sputum Aspirate Research Articles

Strengthened respiratory management for lower tracheostomy risks in patients with complete cervical spinal cord injury

To access the feasibility of reducing tracheostomy rates in patients with complete cervical spinal cord injury through a systemic respiratory management mode. A retrospective review was performed for 239 patients on a systemic respiratory management mode after complete cervical spinal cord injury in Shanghai Changzheng Hospital from 2006 to 2012. Their demographic and clinical data, including age, gender, cause of injury, level of cervical spinal cord injuries, surgical approaches, tracheostomy rates and mortality rates, were collected and analyzed. Tracheostomy rates were compared with those of patients with complete cervical spinal cord injury. Tracheostomy rates were compared with those patients with complete cervical spinal cord injury from 1991 to 2005. The new respiratory management mode for patients with severe cervical spinal cord injury included maintaining adequate energy and water for patients, relieving bronchospasm, loosening phlegm, strengthening body-turning and backslapping, sputum aspiration with suction tube through nasal cavity or bronchofibroscope, strengthening deep breath and cough training, strict control of tracheostomy indications and short-term postoperative intubation reserving if necessary. 32 patients were implemented tracheostomy. The tracheostomy rate was 13.4%. 10 patients died, the mortality rate was 4.18%. However, the tracheostomy rate was 19.1% and mortality rate 21.4% from 1991 to 2005. The tracheostomy rate was significantly lower than before and survival rate improved significantly. The systemic respiratory management mode can effectively reduce tracheostomy rate of patients with complete cervical spinal cord injury and improve their survival rate.

Effect of fiberoptic bronchoscopy iavage sputum suction on sputum aspiration in thoracic neoplasm patients with difficulty in postoperative expectoration

Objective To explore the effect .of fiberoptic bronchoscopy lavage sputum suction on sputum aspiration in thoracic neoplasm patients with difficulty in postoperative expectoration. Methods Sixty thoracic neoplasm patients with postoperative expectoration difficulty who met the inclusion criteria were divided into the control group and the observation group according to the order number in ICU, each with 30 cases. The control group received the conventional sputum suction, and the observation group received the fiberoptie bronchoscopy lavage sputum suction on the basis of routine sputum suction. The effect of sputum aspiration was compared between the two groups. Results The cases of complications including mucosa damage, atelectasis, pulmonary infection were respectively 7, 2 and 5 cases in the observation group, and were lower than those in the control group, and the differences were statistically significant （ X2 = 4. 59,4.01,4. 02, respectively; P 〈0. 05）. The time of staying in the ICU was （6. 25 ±2. 58） d in the observation group, and was （8.29 ±3.52） d in the control group, and the difference was statistically significant （t = 2. 56 ,P 〈0. 05）. The average times of sputum aspiration every day were （5.0 ±2.0 ） in the observation group, and were lower than （ 7.5 ± 2. 8 ） in the control group, and the difference was statistically significant （ t = 3.98, P 〈 0. 01 ）. Conclusions The methods of fiberoptic bronchoscopy lavage sputum suction combined with routine clinical sputum suction can effectively maintain the normal lung ventilation function, and reduce the duration of hypoxemia and the occurrence of postoperative complications, and shorten the time of staying in the ICU. Key words: Thoracic neoplasms; difficulty Bronchoscopy; Lavage ; Sputum aspiration; Expectoration

Determining of The Prevalence of Nosocomial Infections and Causative Gram Negative Bacilli in The Intensive Care Unit

Purpose: Nosocomial infections develop after 48-72 hours of hospitalization. Gram negativebacilli are generally the causative agent. 25% of all nosocomial infections develop in theintensive care units. Therefore, patients in the intensive care units are at high risk. This studyaimed to determine the prevalence of nosocomial infections and causative gram negative bacilliin the Intensive Care Unit (ICU).Materials and Methods: 269 patients who were hospitalized in internal medicine intensivecare unit (IMICU) of Dicle University Faculty of Medicine between june 2010- December 2010were included in this study. Culture samples were taken from all of the patients who developsfever ( ≥38.5 C) after the hospitalization to the IMICU. Culture of blood, urine, sputum, centralvenous catheters, open wounds and deep tracheal aspirate were taken. Source and the prevalenceof infection and distribution of the isolated causative pathogens were determined in the patientswith gram negative bacilli reproduction.Results: 158 of the patients were male ( 58.7%) and 111 of the patients were female ( 41.3%).The mean ages of men and female were 58.81±16.91 and 56.44±19.16 years, respectively (p=0.286). culture samples were taken from blood (16%), urine ( 8.6%), central venous cathetertips ( 6.3%), deep tracheal aspirates (10%), sputum (2.2%) and wound stabs (2.2%). Nosocomialinfections were detected in 109 patients ( 40.5%). Pneumonia, urinary tract infections andgastrointestinal system infections were the most frequent infections respectively.Microorganisms were isolated from one sample in 97 patients, while 12 patients had more thanfocus. The most commonly isolated organisms were E.Coli (13.8%) and PseudomonasAeruginosa (7.4%), followed by Acinetobacter Baumannii (6.3%) and StenotrophomonasMaltophilia (3.3%). Conclusion: Nosocomial infections in intensive care units have proved to be a serious problem.Surveillance studies should be performed for the isolated causative pathogens and measuresshould be taken to prevent the development of the ICU infections

Clinical research on treatment of children with severe pneumonia by nasal continuous positive airway pressure combined with Budesonide

Objective To explore clinical effect of nasal continuous positive airway pressure (NCPAP)combined with budesonide for treatment of children with severe pneumonia.Methods A total of eighty cases of 1-5-year-old children with severe pneumonia who were treated in our hospital from January 2011 to March 2013 were enrolled in this study.They were randomly divided into control group (36 cases) and treatment group (44 cases).The control group received routine treatment including anti-infection therapy,sputum aspiration,and oxygen atomization.In the treatment group,the children were provided with NCPAP combined with budesonide on the basis of the conventional treatment.The respiratory frequency and the changes of arterial blood gas before and after the treatment were observed and compared.Results The respiratory frequency and the changes of arterial blood gas in the treatment group were improved more significantly than those in the control group after treatment (P ＜ 0.05).The treatment group was significantly better than the control group in the diminution of pulmonary rales,return of arterial blood gas,and reducing the average length of stay(P ＜ 0.01).Conclusion NCPAP is effective in treating respiratory failure in children with severe pneumonia,and it can also reduce the application of intubation and mechanical ventilation. Key words: Nasal continuous positive airway pressure; Budesonide; Severe Pneumonia; Children

Abstract A36: Quantitative determination of methylation patterns in FHIT and APC genes in NSCLC: comparative analysis in tumor and normal lung tissue, peripheral blood, sputum and bronchial aspirate

Abstract Introduction and objective. Quantifying and comparing the degree of methylation in the promoter region of APC gene and coding region of FHIT gene in patients (p) with non small cell lung cancer (NSCLC) in different samples. Correlate these methylation patterns with clinical variables. Methods. DNA was extracted from peripheral blood simples (B), sputum (S) and bronchial aspirate (BA), obtained from patients with NSCLC prior to the completion of surgery, as well as resected lung tumor tissue (TT) and normal lung tissue (TN). Methylation patterns were analyzed by bisulfito conversion and subsequent pyrosequencing (QIagen PyroMark System).We analyzed 5 CpG islands in the promoter region of the APC gene and 5 CpG islands in the coding region of the FHIT gene. Results: We analyzed 20p, with a median age of 64 years (range 48-70), 16 men and 4 women. Smoking status: 2p never smokers, 11p former smokers, 7p current smokers. Histology: 10p adenocarcinoma, 9p squamous, 1p large cell. Stage: I 8p, II 8p, III 4p. No statistically significant differences were observed between the samples studied to any of the islands analyzed. The degree of methylation in TT CpG1 was higher in smokers and former smokers <5 years, compared to never smokers and ex-smokers >5 years, mean 4 (0-10) vs 0, p=0.022. There was no other difference when analyzing the degree of methylation as a function of the variables age, sex, smoking status, cumulative tobacco consumption, histological type and clinical stage. Respect FHIT gene, no statistically significant differences were found between the tissues studied respect to any of the CpG islands analyzed and likewise, no differences were observed when analyzed for degree of methylation depending on the clinical variables studied. Conclusions. The area of the APC gen promoter and FHIT coding region analyzed showed a low degree of methylation, with no significant difference observed between the samples studied. The degree of methylation in the TT CpG1 island of the APC gene was higher in current smokers and former smokers <5 years. However, these findings have to be confirmed in a larger sample. *This study was funded by the Carlos III Health Institute (PS09/00308), Spain. Note: This abstract was not presented at the conference. Citation Format: Rocio Lavado-Valenzuela, Sr., Carlos Pagés, Sr., Roberto Mongil, Sr., Francisco Páez, Sr., Enrique Bermejo, Sr., Miguel Angel Berciano, Sr., Dolores Bautista, Sr., Cynthia Robles, Jr., Ricardo Arrabal, Sr., Jose Luis De la Cruz, Sr., Manuel Benavides, Sr., Manuel Cobo, Sr.. Quantitative determination of methylation patterns in FHIT and APC genes in NSCLC: comparative analysis in tumor and normal lung tissue, peripheral blood, sputum and bronchial aspirate. [abstract]. In: Proceedings of the Third AACR International Conference on Frontiers in Basic Cancer Research; Sep 18-22, 2013; National Harbor, MD. Philadelphia (PA): AACR; Cancer Res 2013;73(19 Suppl):Abstract nr A36.

Abstract C20: Quantitative determination of EGFR gene aberrant methylation in NSCLC: a comparative analysis in tumor tissue, normal lung tissue, peripheral blood, sputum and bronchial aspirate

Abstract Introduction and objective. To evaluate and compare quantitatively aberrant methylation in the promoter area of EGFR gene in patients (p) with in non small cell lung cancer (NSCLC) lung tumor tissue (TT), lung normal tissue (NT), blood (B), bronchial aspirate (BA) and sputum (S). Correlate these methylation patterns with clinical variables. Methods. DNA was extracted from samples of B, S and BA from patients with NSCLC prior to surgery and resected TT and NT. Methylation patterns were analyzed by the bisulfite conversion and subsequent pyrosequencing (QIagen PyroMark System). We analyzed three CpG islands in the promoter region of EGFR gene. Results. 43p were included, median age 66 years (range 46-79), 35 men and 8 women. Histology: 26p adenocarcinoma, 14 squamous and 3 others. 2p had EGFR mutation. Smoking status: 4p never smokers, 21p former smokers, 18p smokers. Significant differences in methylation percentage (%Mth) were observed between TT and S in the following islands: CpG2 (11.8vs7.1, p = 0.008), CpG3 (10vs7.4, p = 0.037) and in overall promoter area (10.6vs7. 6, p = 0.034). The %Mth was higher in women vs men in TT CpG1 island (16.2vs24.9, p = 0.042) and TT CpG2 island (15.8vs26.5, p = 0.013). The %Mth was higher in squamous histology compared to adenocarcinoma in NT CpG2 island (22.6vs14.1, p = 0.017) and S CpG1 island (13.7vs8.2, p = 0.047). However, the %Mth was higher in the overall promoter area of adenocarcinoma respect to squamous histology (19.7vs12.8 TT, p = 0.042). The %Mth was higher in overall promoter area of NT respect Stage I vs II vs III (22.3 vs 13 vs 17.5, p = 0.03). The %Mth was higher in former smokers compared to current smokers and non smokers in NT CpG3 (22.8 vs 13 vs 14.1, p = 0.032). The %Mth in NT CpG3 was higher in never smokers and former smokers > 5 years, respect to current smokers and former smokers <5 years, (23.3 vs 15.8, p = 0.05). Conclusion. EGFR aberrant hypermethylation was higher in tumor tissue respect to sputum, with no correlation with EGFR mutation. The %Mth in normal tissue was higher in never smoker and former smokers > 5 years patients. * This study was funded by the Carlos III Health Institute (PS09/00308), Spain Note: This abstract was not presented at the conference. Citation Format: Rocio Lavado-Valenzuela, Enrique Bermejo, Roberto Mongil, Francisco Páez, Carlos Pagés, Miguel Angel Berciano, Ricardo Arrabal, Dolores Bautista, Jose Luis De la Cruz, Cynthia Robles, Manuel Benavides, Manuel Cobo. Quantitative determination of EGFR gene aberrant methylation in NSCLC: a comparative analysis in tumor tissue, normal lung tissue, peripheral blood, sputum and bronchial aspirate. [abstract]. In: Proceedings of the Third AACR International Conference on Frontiers in Basic Cancer Research; Sep 18-22, 2013; National Harbor, MD. Philadelphia (PA): AACR; Cancer Res 2013;73(19 Suppl):Abstract nr C20.

Effect of intermittent aspiration of subglottic secretion on patients with tracheotomy

Objective To investigate the effect of intermittent aspiration of subglottic secretion on patients with tracheotomy.Methods Fifty-one patients treated with percutaneous tracheostomy in ICU from November 2010 to November 2012 were randomly divided into the control group (n =25) and the observation group (n =26).Control group received conventional aspiration,while intermittent aspiration of subglottic secretion was applied in the observation group.The volume of sputum,the incidence of ventilator-associated pneumonia (VAP) and the bucking times while aspiration of sputum in two groups were observed and compared.Results The volume of sputum in the observation group (46.8 ± 1.3) ml were higher than that in the control group(32.7 ± 2.1) ml,and the difference was statistically significant (t =13.63,P ＜ 0.05).The times of aspiration of sputum [(9.2 ±0.6) vs (13.1 ± 1.1)],the bucking times while aspiration of sputum [(5.7 ± 0.9)vs (8.2 ± 1.7)] and the incidence of VAP (26.8％ vs48.0％)in observation group were significantly lower than those in the control group (t =11.75,9.91,respectively; x2 =9.62 ; P ＜ 0.05).Conclusions Intermittent aspiration of subglottic secretion vail can effectively reduce the incidence aspiration of sputum,VAP and bucking times. Key words: Ventilator-associated pneumonia; Incision of trachea; Intermittent aspiration of subglottic secretion

Improved outcome of ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus in a trauma population

BackgroundThe treatment of ventilator-associated pneumonia (VAP) secondary to methicillin-resistant Staphylococcus aureus (MRSA) remains controversial. MethodsWe performed a review of all blunt trauma patients diagnosed with MRSA VAP from June 2005 to June 2011. VAP for the first 3 years was diagnosed by sputum aspiration and treated with vancomycin. For the last 3 years of the study period, VAP was diagnosed with bronchoalveolar lavage and treated with linezolid. ResultsMRSA VAP patients treated with vancomycin had an average hospital length of stay (LOS) of 49 days (range 9–99 days), an average intensive care unit (ICU) LOS of 43 days (range 6–98 days), and average ventilator days of 34.4 (range 3–76 days). Seventeen MRSA VAP patients treated with linezolid had an average hospital LOS of 27 days (range 11–61), an average ICU LOS of 22 days (range 10–42) days, and average ventilator days of 16.6 (range 2–42). ConclusionsTrauma patients who develop MRSA VAP appear to have fewer ventilator days and shorter ICU and hospital LOS when treated with linezolid.

Approaches for airway humidity in patients undergoing tracheal resection due to inhalation injury

Objective To explore effective humidity therapies for patients undergoing tracheal resection due to inhalation injury.Methods 36 patients undergoing tracheal resection due to inhalation injury were randomly divided into study group and control group.The study group received continuous intratracheal drip of sterilized water for injection and the speed of dripping was adjusted according to the viscosity of the aspired sputum.The control group received conventional therapy with intratracheal drip of 0.9％ sodium chloride solution of 2 to 4ml for airway humidity every 2 hours.Viscosity of sputum,efficacy of sputum aspiration,and incidence of airway complications were compared between the two groups.Results In the study group,the rate of grade Ⅲ viscosity was 5.6％,the frequency of daily sputum aspiration was (17.72 ± 1.57)times,and the positive rate of sputum culture was 11.1％; while in the control group,the rate of grade Ⅲ viscosity was 55.6％,the frequency of daily sputum aspiration was (20.61 ± 1.26)times,and the positive rate of sputum culture was 50％.Dilution of sputum,efficacy of sputum aspiration,and incidence of airway complications differed significantly between the two groups (P ＜ 0.05).Conclusions For patients undergoing tracheal resection due to inhalation injury,continuous intratracheal drip of sterilized water for injection with a proper speed of dripping is superior to regular intratracheal drip of 0.9％ sodium chloride solution.The previous approach can effectively dilute sputum,humify airway,and reduce the frequency of sputum aspiration and the airway complications. Key words: Inhalation injury; Tracheal resection; Airway humidity

Diagnosis and treatment of tracheobronchial foreign bodies in 1024 children

ObjectiveThis study sought to summarize the experience of diagnosis and treatment of tracheobronchial foreign bodies in children to effectively reduce complications and mortality. MethodsThe medical records of 1024 pediatric patients admitted to our hospital from January 1997 to September 2011 and diagnosed with clinically suspected tracheobronchial foreign body aspiration were retrospectively analyzed. ResultsOf the 1024 children patients, 674 were boys (65.8%) and 350 girls (34.2%). Two died of respiratory and circulatory failure (foreign bodies detected upon bronchoscopy but not retrieved) before surgery, 65 patients underwent direct bronchoscopic removal of foreign bodies due to their critical status, and 957 received chest radiographs and chest fluoroscopy or multidetector spiral computed tomographic scans (941 positive). Foreign bodies were expectorated before surgery in 3 cases. There were 953 cases of bronchoscopically proven airway foreign body aspiration, with a diagnostic accuracy of 94.5%. Ninety-eight foreign bodies were lodged in the main bronchus and/or bilateral bronchi, 506 in the right main bronchus, and 349 in the left main bronchus. Atelectasis was noted in 42 patients, including 11 with pulmonary consolidation, whose lungs were re-expanded by endobronchial lavage and sputum aspiration. In 3 patients with bronchiectasis, conservative treatment following foreign body removal was followed by no improvement, and pulmonary lobectomy was performed. Foreign bodies were successfully extracted at the first bronchoscopic attempt in 948 cases, accounting for 99.7% of the total. However, 3 patients had to undergo another bronchoscopy to remove the foreign bodies. The most common types of foreign bodies were peanuts, melon seeds, and beans. ConclusionsTimely accurate diagnosis and treatment of tracheobronchial foreign bodies in children can avoid delay in treatment and effectively reduce complications and mortality.

Application of the sputum aspiration in AECOPD respiratory failure patients with noninvasive ventilation

Objective To observe and compare the effect of opening the glottis deep suction scheme and conventional sputum suction method on the AECOPD respiratory failure patients with noninvasive ventilation.Methods Totals of 63 patients AECOPD respiratory failure patients with noninvasive ventilation were randomly divided into observation group and control group,the opening of glottis deep suction scheme was adopted in the observation group and conventional sputum suction method was adopted in the control group.Sputum suction effect such as the incidence of airway injury and pulmonary infection complication,and the blood oxygen saturation of two groups were compared.Results 18 cases had a effective treatment,one case had airway injury in the observation group,and that of the control group was 10 and 8 respectively,and the difference was statistically significant( P ＜ 0.05 ).No significant difference was found in the blood oxygen saturation before suction between two groups( P ＞ 0.05),while after suction,the blood oxygen saturation of the observation group was(98.03 ± 1.42) ％ which was significantly higher than that of the control group [ ( 96.22 ± 1.62 ) ％ ] ( P ＜0.05 ).And 2 cases had pulmonary infection in the observation group,and 5 cases of the control group,and the difference was statistically significant ( P ＜ 0.05 ).Conclusions Open glottal deep suction scheme is more effective than the conventional sputum suction method,which can reduce the incidence of complications,alleviate the suffering of patients,and improve the quality of nursing care. Key words: Nursing; AECOPD; Respiratory failure; Noninvasive ventilation; Sputum suction

Recent advances in diagnosis of tuberculosis

Abstract The diagnosis of tuberculosis (TB) in childhood continues to be surrounded by considerable uncertainty, especially due to the difficulty in collecting sputum samples in children and the paucibacillary nature of childhood TB. Till date direct-smear microscopy, solid and liquid culture and chest radiography remain the cornerstones of diagnosis. But over the last decade significant changes have occurred in TB diagnostics. Hypertonic saline-induced sputum collection has been assessed in various settings and it is advisable that in all intrathoracic TB patients, an attempt should be made to do at least one induced sputum and gastric aspirate sample on ambulatory basis. Various diagnostic techniques such as fluorescence LED microscopy, improved culture techniques, antigen detection, nucleic acid amplification, line probe assays and IGRAs have been developed and evaluated to improve diagnosis of childhood TB. Tests based on nucleic acid amplification are a promising advance but relatively less experience in children, need for technical expertise and high cost are limiting factors for their use in children with TB.

Metallic stent implantation in the treatment of malignant tracheal stenosis under general anaesthesia

Objective To evaluate the safety and feasibility of the tracheal stent implantation for treatment of malignant tracheal stenosis under general anaesthesia. Methods Eighteen patients with malignant tracheal stenosis underwent preoperative 64-slice spiral CT scan and airway reconstruction. The stenotic sites were located in main tracheal trunk(5 patients),in right main bronchus( 1 patient),in trachea and left main bronchus (4 patients),in trachea and right main bronchus (3 patients),in main tracheal trunk and bilateral main bronchus(5 patients).The degree of stenosis was rated 51％ to 70％ in 7 cases,71％ to 90％ in 11 cases.All patients,17 patients of ASA grade 1V and 1 patient of grade Ⅲ,presented with severe dyspnea. Under general anaesthesia,implantation of metallic stent was performed through the sputum aspiration hole of the connecting tubing with DSA guidance.The NBP,ECG,RR,SaO2 of the patients were recorded and compared with t test during the entire procedure. At the end of the procedure,relief of dyspnea,complications related to anesthesia and operation were recorded. Results The success rate of stent placement was 18/18,and dyspnea was significantly relived in all patients. Slightly bloody sputum occurred in 7 cases.The stent was obstructed by sputum in 1 case,and the patient was treated with medication.There were no severe complications.The operative course were rated 11 to 9 in 17 cases,and 6 to 8 in 1 case.All 18 patients were cooperative during the procedure.Sixteen patients rated the procedure as very comfortable and 2 rated the procedure as comfortable.Respiratory rate (RR) and heart rate (HR) decreased in all patients after the operation [ ( 37.1 ± 2.8 )/min and ( 106.5 ± 14.2 ) bpm before the operation respectively,( 18.6 ± 1.4)/min and ( 73.2 ± 7.6) bpm after the operation respectively ],t =17.81 and 3.80,P ＜ 0.01.Pulse oxygen saturation ( SaO2 ) during the operation [ ( 91.2 ± 1.8 ) ％ ]increased [ (76.3 ± 8.6 )％ before the operation ] and increased further after the operation [ (94.5 ±4.3 ) ％ ],t =2.06 and 2.26,P ＜ 0.01.Blood pressure (BP) showed no changes throughout the operation (P ＞ 0.05 ).The conprehensive assessment of operation were favorable in all patients. Conclusion With careful preoperative evaluation and planning, tracheal stent implantation under general anaesthesia in patients with malignant tracheal stenosis is feasible and safe. Key words: Anesthesia, general; Tracheal stenosis ; Stents ; Radiology, interventional

Antimikrobielle Therapie bei intensivpflichtigen Patienten mit akuter Exazerbation einer COPD

Chronic obstructive lung disease (COPD) is a leading cause of death worldwide. In patients with acute exacerbations admitted to an intensive care unit (ICU), potentially pathogenic microorganisms can be found in approximately 50%, with Haemophilus influenzae and Streptococcus pneumoniae as the leading strains, followed by enterobacteria and Pseudomonas aeruginosa. Viruses can also be detected in a large proportion of patients. The indication for antimicrobial treatment of acutely exacerbated COPD is still controversial but recommended by guidelines for all patients admitted to an ICU. Appropriate agents for an empiric initial treatment are penicillins + betalactamase inhibitor, 2(nd) and 3(rd) generation cephalosporins, carbapenems, and quinolones. Antimicrobial treatment should be adjusted according to the results of microbial investigation of sputum or endotracheal aspirate.

Differences in management and mortality with a bronchoalveolar lavage-based diagnostic protocol for ventilator-associated pneumonia

Directed antibiotic therapy based on accurate bacteriology is critical to ventilator-associated pneumonia (VAP) treatment. Bronchoalveolar lavage (BAL) has been reported to be more accurate than endotracheal sputum aspirate (ESA) in VAP diagnosis. Our objective was to determine the frequency with which BAL results differ from ESA cultures and the outcomes of VAP with a BAL-based VAP protocol. Prospectively collected microbiologic data on all trauma patients with VAP from 2007 through 2009 were reviewed. Per protocol, a positive ESA prompts a BAL and initiation of broad empiric antibiotics with de-escalation based on BAL results. Patients diagnosed with VAP by the protocol were compared with those diagnosed outside of the protocol using univariate and multivariate linear regression analysis. Concordance of ESA and BAL results was evaluated, and cause of death was determined. Of 137 patients with VAP, 96 were diagnosed by the protocol (protocol group) and had 102 pairs of cultures. Twenty-six patients (27%) with 28 pairs of cultures (27.4%) had discordant results. Of discordant pairs, 17 (61%) showed bacteria of a different Gram's stain. Methicillin-sensitive Staphylococcus aureus was the most common causative organism. Mortality was lower in the protocol group (6.3%) than the nonprotocol group (22%, p = 0.014) and mechanically ventilated patients without VAP (24%, p = 0.35) but with comparable Injury Severity Score (ISS). VAP-attributable mortality in the protocol group was 1%. Use of a BAL-based diagnostic protocol affects management of trauma patients with VAP by improving identification of causative microorganisms and is associated with low overall mortality and VAP-attributable mortality.

Comparison of two different ways of sputum aspiration for food reflux in stroke patients with mechanical ventilation

Objective To comparison the effect of two different ways of sputum aspiration for food reflux in stroke patients with mechanical ventilation.Methods Experimental sputum aspiration method and conventional sputum aspiration method were applied in 26 stroke patients with mechanical ventilation to conduct the self-control study.Two different ways of sputum aspiration for food reflux were compared ( experimental sputum aspiration in odd numbered days VS routine sputum aspiration in even numbered days).Results There were significantly differences in food reflux rate with two ways: experimental sputum aspiration method was 7.0％,and another was 13.7％(x2 =11.24,P＜0.05).Conclusions Experimental sputum aspiration method applied in stroke patients with mechanical ventilation can reduce food reflux rate,thereby reduce the incidence of aspiration pneumonia and was beneficial for the rehabilitation of patients. Key words: Stroke; Sputum aspiration; Mechanical ventilation; Food reflux

Influence of lung suctioning method on mechanical ventilation related pulmonary infection of patients after cardiac valve replacement

Objective To observe the effect of lung suctioning method on mechanical ventilation related pulmonary infection of patients after cardiac valve replacement. Methods 102 patients of mechanical ventilation related pulmonary infection after cardiac valve replacement were randomly divided into the treatment group( 50 patients )and the control group( 52 patients ). The treatment group received intervention of lung suctioning method and the control group adopted routine sputum aspiration. The pulmonary infection rate and blood gas analysis before and after the treatment were observed and the cure rate and the positive rate of specimen of sputum were recorded. Results The pulmonary infection rate of the treatment group was lower than the control group;PaO2 and SaO2 were obviously different after treatment in the control group, but no difference in the treatment group. The cure rate of pulmonary infection patients in the treatment group was higher than those in the control group. Conclusions The intervention of lung suctioning method was a safe and effective method to improve hypoxemia and abate the rate of pulmonary infection. Key words: Lung suctioning method; Mechanical ventilation; Pulmonary infection

The application of sputum suction by tracheal intubation via nasal approach on the patients with acute deteriorating cor pulmonale

Objective To explore the application and effect of sputum suction by tracheal intubation via nasal approach on patients with acute deteriorating chronic cor-pulmonale.Methods A total of 100 cases of patients with acute deteriorating chronic cor-pulmonale in our hospital were randomly divided into observation group ( 50 cases ) and control group (50 cases ). The observation group was received sputum suction by tracheal intubation via nasal.Control group was sputum drainage via nasal directly.The times and the quantity of sputum drainage in 24 hours and the effect on oxyhemoglobin saturation and myocardial oxygen consumption were observed.Results As compared with control group, there were significant difference in observation group as following :the times and the quantity of sputum drainage in 24 hours,the occurrence of mucosa injury, the effect on oxyhemoglobin saturation and myocardial oxygen consumption. There were statistical differences before and after aspiration of sputum in HR, SBP and myocardial oxygen consumption. Those of observation group were better than those of control group.Conclusions The effect of sputum suction by tracheal intubation via nasal approach was better than that of traditional way of sputum suction. It could clean the sputum retention, improve ventilation function, reduce hypoxemia and mucosa injury caused by suction, reduce myocardial oxygen consumption, improve oxyhemoglobin saturation. Key words: Acute deteriorating cor pulmonale; Sputum suction by tracheal intubation via nasal sputum; Oxyhemoglobin saturation; Myocardial oxygen consumption

Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report

IntroductionTuberculosis is still a serious infection among recipients of renal transplants. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity. We report a case of concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant.Case presentationA 27-year-old Iranian woman, who had been the recipient of a renal transplant five years earlier, presented with a two-week history of coughing, fever and weight loss. The cause of her end-stage renal disease was chronic pyelonephritis. There were fine crackles noted during a chest examination, and a plain chest radiography showed fine miliary nodules throughout her entire lung fields. Sputum and bronchial aspirate examination was positive for acid-fast bacilli, suggestive of Mycobacterium tuberculosis infection. A chest computed tomography scan revealed widespread miliary nodules, compatible with miliary tuberculosis. She developed severe abdominal pain and abdominal surgery disclosed a perforated appendicitis. Histopathological examination of the resected appendix revealed widespread caseating epithelioid granulomas, suggestive of tuberculosis.ConclusionOur case report highlights a rare presentation of tuberculosis in a patient who has undergone renal transplant. Such unusual presentation of tuberculosis, particularly among patients receiving potent immunosuppressive protocols, should be considered by clinicians.

Effect of sputum aspiration appliance on respiratory tract infection of patients with tracheotomy

Objective To explore the influence of sputum aspiration appliance on respiratory tract infection of patients with tracheotomy. Methods 34 patients with tracheotomy from June 2008 to May 2009 (the first stage) and 30 patients with tracheotomy from June 2009 to May 2010 (the second stage) were analyzed retrospectively. The difference of the rates of species of infection pathogens and pneumonia complications in two stages were compared. Results In two stages, there was a significant difference of multiple antibiotic resistant strains respectively in the first week (acinetobacter baumannii, S. epidermidis, Pseudomonas aeruginosa) and in the second week (acinetobacter baumannii, S. epidermidis, Pseudomonas aeruginosa, Klebsiella pneumoniae,Staphylococcus aureus) (P < 0. 05 ). The rates of pneumonia complications in the second stage is lower than the first stage, the difference was significant (P < 0. 05 ). Conclusions It is an important component element tosterilize and isolate the sputum aspirators to decrease the incidence of Pulmonary multiple antibiotic resistant strains infection of patients with tracheotomy. Key words: Tracheotomy; Sputum aspirators; Sterilize and isolate; Pulmonary infection