The role of systemic antibiotics in acquiring respiratory tract colonization with gram-negative bacteria in intensive care patients: a nested cohort study.

Objective: Colonization of the respiratory tract with Gram-negative bacteria in intensive care patients increases the risk of subsequent infections. Application of systemic antibiotics may prevent colonization with Gram-negative bacteria, but this effect has never been quantified. The objective of this study was to determine associations between systemic antibiotic use and acquisition of respiratory tract colonization with Gram-negative bacteria in ICUs.

Changes in heart rate, mean arterial pressure, and oxygen saturation after open and closed endotracheal suctioning: a prospective observational study.

Purpose: It is widely assumed that closed suction systems (CSSs), as compared with open suction systems (OSSs), better guarantee optimal oxygenation with less disturbance of physiologic parameters in mechanically ventilated intensive care patients. We, therefore, quantified changes in heart rate (HR), mean arterial pressure (MAP), and peripheral oxygen saturation (Spo(2)) in patients undergoing endotracheal suctioning (ES) with CSS and OSS.

Materials And Methods: We performed a prospective observational study nested within a crossover trial in 4 intensive care units between January 2007 and February 2008.

Antibiotic exposure and resistance development in Pseudomonas aeruginosa and Enterobacter species in intensive care units.

Objectives: We quantified the association between antibiotic exposure and acquisition of antibiotic resistance in Pseudomonas aeruginosa and Enterobacter species in intensive care unit patients.

Design: Prospective cohort study.

Setting And Patients: In 1,201 patients, respiratory tract colonization was determined through regular screening on admission, twice weekly, and on discharge.

Effect of open and closed endotracheal suctioning on cross-transmission with Gram-negative bacteria: a prospective crossover study.

Objective: Cross-transmission of Gram-negative bacteria increases the likelihood of acquisition of infections and emergence of antibiotic resistance in intensive care units. Respiratory tracts of mechanically ventilated patients are frequently colonized with Gram-negative bacteria and endotracheal suctioning may facilitate cross-transmission. It is unknown whether closed suction systems, as compared with open suction systems, prevent cross-transmission.

Outbreak of infection with a multiresistant Klebsiella pneumoniae strain associated with contaminated roll boards in operating rooms.

An outbreak with a multiresistant Klebsiella pneumoniae (MRKP) strain among seven patients admitted to the adult intensive care unit (ICU) of a regional teaching hospital in The Netherlands was investigated. Epidemiologic investigations revealed a short delay between an operation and the acquisition of the MRKP strain. A case-control study comprising 7 cases and 14 controls was conducted to identify the risk factors associated with the acquisition of the MRKP strain.

Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial [ISRCTN50308308].

Introduction: This randomised, open-label, observational, multicentre, parallel group study assessed the safety and efficacy of analgesia-based sedation using remifentanil in the neuro-intensive care unit.

Methods: Patients aged 18-80 years admitted to the intensive care unit within the previous 24 hours, with acute brain injury or after neurosurgery, intubated, expected to require mechanical ventilation for 1-5 days and requiring daily downward titration of sedation for assessment of neurological function were studied. Patients received one of two treatment regimens.

[Chylous ascites following surgical repair of a ruptured abdominal aortic aneurysm].

Two patients, a man aged 65 years and a woman aged 75 years, developed chylous ascites after emergency abdominal aortic aneurysm repair. Both patients were still on artificial ventilation at the time of diagnosis. The first symptoms were high ventilation pressure, elevated diaphragm and abdominal distension.

A re-appraisal of the tri-axial chart for monitoring arterial acid-base values.

Objective: To demonstrate the practicability of a tri-axial chart for the graphical and quantitative monitoring of arterial pH, arterial carbon dioxide partial pressure (PaCO2) and actual arterial bicarbonate-ion concentration (a[HCO3-]) in intensive care patients.

Design: Case report.

Setting: A general intensive care unit (ICU).

[Continuous pressure is preferred to flow triggering of respiration in the apnea test following the protocol for brain death determination].

The apnea test is part of the brain death protocol of the National Health Council. If the patient is being given positive end-pressure respiration, he must not be uncoupled from the respirator. The apnea test should then be done by means of continuous positive airway pressure.

Meropenem versus cefuroxime plus gentamicin for treatment of serious infections in elderly patients.

In this multicenter study, the efficacy of and tolerability for meropenem were compared with those for the combination of cefuroxime-gentamicin (+/- metronidazole) for the treatment of serious bacterial infections in patients > or = 65 years of age. A total of 79 patients were randomized; thirty-nine received meropenem (1 g/8 h), and 40 received cefuroxime (1.5 g/8 h) plus gentamicin (4 mg/kg of body weight daily) for 5 to 10 days.

[Adequate preservation of organs in brain-dead patients with a view to transplantation].

There exists a shortage of donor organs. Inadequate medical treatment of brain-dead patients results in one-third of the available organs not being suitable for transplantation. Adequate preservation of organs in brain-dead patients increases the supply and quality of donor organs.

Metastatic staphylococcal lung abscess due to a cutaneous furuncle.

A seemingly trivial infection of the skin can lead to fulminant staphylococcal pneumonia and death. This case history describes the evolution of a fatal Staphylococcus aureus sepsis complicated by the development of multiple lung abscesses in a 17-year-old patient. A pre-existing cutaneous furuncle was the only identifiable cause.

Pulmonary rehabilitation at moderate altitude: a 1-year follow-up.

Background: In order to evaluate a pulmonary rehabilitation program (PRP) at moderate altitude (1560 m) 62 patients with obstructive lung disease were asked to participate; 37 patients completed a 1-year follow-up at sea level, and 25 patients dropped out. The exercise training program lasted for 10 weeks and consisted of a cycling and running program of 20 min daily, 5 days a week.

Methods: Incremental exercise testing, spirometry and histamine provocation tests were performed at sea level before the PRP, on admission to the Dutch Asthma Centre, Davos, after 5 weeks of exercise training, at discharge from the Centre and 6 and 12 months after discharge at sea level.

Severe bronchial asthma improved on bamifylline. Case report and review.

We describe a 25-year-old patient with severe bronchial asthma, which was difficult to treat with oral theophylline. Bamifylline, a xanthine derivative, clearly improved the clinical signs, symptoms and lung function. We critically review the literature on bamifylline.

[Favorable effects of a stay in the Dutch Asthma Center Davos on medical consumption and quality of life in COPD patients].

The Dutch Asthma Centre Davos in Switzerland is a clinic where patients with chronic nonspecific lung disease (CNSLD) are given multidisciplinary treatment. In a prospective study in the clinic, data on quality of life (functional, psychological and social characteristics) and medical consumption (use of oral corticosteroids and use of health services) were collected in a group of 147 patients with CNSLD. 18 patients were lost due to non-medical reasons.

Nedocromil sodium inhibits the early and late asthmatic response to exercise.

A double-blind, crossover study was carried out to investigate the effect of nedocromil sodium on the dual asthmatic response to exercise challenge. Nineteen patients with a late response to bicycle exercise were randomly treated on two study days with 4 mg nedocromil sodium or a matched placebo aerosol, 30 min before commencing exercise. Peak flow was measured before exercise, at intervals up to 60 min after exercise, then hourly for up to 13 h.

[Lung function of adult patients with bronchial asthma or chronic obstructive lung disease prior to and following a 3-month-stay in the Dutch Asthma Center in Davos].

The effect of a multidisciplinary treatment for obstructive airway disease at high altitude has not been well established for adult patients. One hundred and fifty patients with obstructive airway disease were examined at admission and at discharge after a 3-month hospitalization period in an Alpine clinic. Body plethysmographic data were collected at admission and at discharge as was medication use.

Late asthmatic responses after exercise challenge are reproducible.

In this study the reproducibility of a late asthmatic reaction (LAR) after exercise challenge (EC) has been documented. Eighty-three hospitalized patients with asthma were challenged with exercise. The patients were examined according to a standardized protocol that comprised 8 minutes of bicycling at 90% of predicted heart rate.

Real and pseudo late asthmatic reactions after submaximal exercise challenge in patients with bronchial asthma. A new definition for late asthmatic responses after exercise challenge.

The late asthmatic reaction after exercise challenge remains a controversial issue. In this study, 21 patients recorded peak expiratory flow rate (PEFR) on two control days without performing exercise. There was no difference between both control days when PEFR at 1 h was compared with baseline PEFR and when PEFR at 4 to 13 hours was compared with baseline PEFR.

Immediate and late asthmatic responses induced by exercise in patients with reversible airflow limitation.

The existence and prevalence of late asthmatic responses to exercise in patients is uncertain. We investigated whether the late falls of peak expiratory flow rate (PEFR) after exercise challenge were still significant after comparison with the corresponding clocktime PEFR on a control day. We examined 86 patients with reversible airflow limitation, 79 with asthma and 7 with chronic obstructive pulmonary disease (COPD), all under regular treatment with bronchodilators and/or anti-inflammatory agents.

Continuous intravenous therapy with theophylline in a patient with brittle bronchial asthma.

Ambulant continuous intravenous theophylline therapy was used in a patient with frequent and severe asthmatic attacks. The patient could not tolerate oral theophylline preparations. We demonstrated a reduction in complaints and prednisone therapy.

Epitopes of apolipoprotein B-100 and B-48 in both liver and intestine. Expression and evidence for local synthesis in recessive abetalipoproteinemia.

The presence of apolipoprotein (apo) B in liver and intestine from a patient with abetalipoproteinemia was evaluated by immunohistochemistry with a polyclonal and six monoclonal antibodies to different apo B-48 and B-100 epitopes. In normal liver, apo B was present inside and outside hepatocytes. The patients liver exhibited staining in the cytoplasm with the polyclonal and three monoclonal antibodies.