Volume 7 Number 1

Gut overgrowth harms the critically ill patient requiring treatment on the intensive care unit (Views : 1652 times)


Overgrowth is defined as ≥105 potential pathogens per ml of saliva and/or per g of faeces. There are six 'normal' potential pathogens carried by healthy individuals and nine 'abnormal' potential pathogens carried by individuals with underlying disease both chronic and acute. Surveillance cultures of throat and/or rectum are required to identify overgrowth of 'normal' and/or 'abnormal' potential pathogens. There is a qualitative and quantitative relationship between surveillance samples and diagnostic samples of tracheal aspirate and blood, i.e., as soon as potential pathogens reach overgrowth concentrations in the surveillance samples, the diagnostic samples become positive for identical potential pathogens. Digestive tract decontamination aims at the eradication of overgrowth in order to prevent severe infections of lower airways and blood. Parenteral cefotaxime controls overgrowth of 'normal' bacteria, and enteral polyenes control overgrowth of 'normal' Candida species. Enteral polymyxin and tobramycin (with or without) vancomycin control 'abnormal' overgrowth.

Key words: overgrowth, 'normal' potential pathogens, 'abnormal' potential pathogens, surveillance samples, diagnostic samples, selective digestive decontamination (SDD)


Continuous infusion versus bolus injection of furosemide in pediatric patients after cardiac surgery: a meta-analysis of randomized studies (Views : 2807 times)


Introduction. Acute renal failure and fluid retention are common problems in pediatric patients after cardiac surgery. Furosemide, a loop diuretic drug, is frequently administered to increase urinary output. The aim of the present study was to compare efficacy and complications of continuous infusion of furosemide vs bolus injection among pediatric patients after cardiac surgery.

Methods. A systematic review and meta-analysis was performed in compliance with The Cochrane Collaboration and the Quality of Reporting of Meta-Analysis (QUORUM) guidelines. The following inclusion criteria were employed for potentially relevant studies: a) random treatment allocation, b) comparison of furosemide bolus vs continuous infusion, c) surgical or intensive care pediatric patients. Non-parallel design randomized trials (e.g. cross-over), duplicate publications and non-human experimental studies were excluded.

Results. Up to August 2008, only three studies were found, with 92 patients randomized (50 to continuous infusion and 42 to bolus treatment). Overall analysis showed that continuous infusion and bolus administration were equally effective in achieving the predefined urinary output, and were associated with a similar amount of administered furosemide (WMD=-1.71 mg/kg/day [-5.20; +1.78], p for effect=0.34, p for heterogeneity<0.001, I2=99.0). However, in the continuous infusion group, patients had a significantly reduced urinary output (WMD=-0.48 ml/kg/day [-0.88; -0.08], p for effect=0.02, p for heterogeneity <0.70, I2=0%).

Conclusions. Existing data comparing furosemide bolus injection with a continuous infusion are insufficient to confidently assess the best way to administer furosemide to pediatric patients after cardiac surgery. Larger studies are needed before any recommendations can be made.

Key words: furosemide, cardiac surgery, meta-analysis, intensive care unit, paediatric, acute kidney failure


Terlipressin/adrenaline is better than adrenaline alone in a porcine model of prolonged ventricular fibrillation A randomized controlled study (Views : 1779 times)


Objectives. Vasopressors have been routinely used in cardiopulmonary resuscitation. Recent data show that terlipressin may restore blood pressure in asphyxial and prolonged arrests but its potential role in ventricular fibrillation (VF) remains unknown. The aim of this study was to compare coronary (CorPP) and cerebral (CPP) perfusion pressures achieved by terlipressin/adrenaline versus placebo/adrenaline in VF.

Methods. Fourteen domestic pigs were randomly assigned into group A and B. After 5 min of untreated VF, compression-only resuscitation was applied for 10 min, followed by advanced life support. Terlipressin in a single-dose of 30 µg·kg-1 was added to the first dose of adrenaline in group A, while placebo was given in group B. CorPP and CPP were calculated from right atrial, aortic and intracerebral pressures. Data were analyzed using repeated measurements ANOVA and a Fisher´s protected LSD post hoc test.

Results. Terlipressin/adrenaline maintained CorPP above 10 mmHg for 17.7 min longer than adrenaline alone (P=0.003) unable to prevent refractory hypotension. CorPP (mean±SD) measured at 35, 45, and 55 min after the onset of VF was 12 ± 4, 11 ± 6, and 10 ± 5 mmHg in the terlipressin group A; and 6 ± 4, 1 ± 5, and -1 ± 5 mmHg in placebo group B (P=0.03, <0.001, and <0.001). CPP measured at the same times was 23 ± 7, 20 ± 7, and 23 ± 7 mmHg in group A; and 13 ± 7, 6 ± 5, and 6 ± 7 mmHg in group B (P=0.01, <0.001, and <0.001).

Conclusion. The study showed that a single dose of terlipressin, when added to adrenaline, was effective for achievement of higher vital organ perfusion pressures compared to adrenaline alone.

Key words: cardiopulmonary resuscitation (CPR), cardiac arrest, terlipressin, vasopressor therapy, cerebral perfusion pressure, coronary perfusion pressure, ventricular fibrillation


Comparıson of extubatıon tımes between protocolızed versus automated weanıng systems after major surgery ın the ıntensıve care unıt (Views : 1484 times)


Background. Prolonged mechanical ventilation is associated with adverse clinical outcomes for critically ill patients.

Objective. To assess the the extubation times of protocolised versus automated weaning systems in patients after major surgery in intensive care unit.

Design. Retrospective analysis.

Measurements and results. We analyzed 70 patients with major abdominal or pelvic surgery. Patients that were used Draeger Evita2 Dura for weaning process named as the C (control) group (n=35) and patients that were used Draeger Evita2 XL Smartcare/PS named as the SC group (n=35). A physician evaluate the patient every 5 or 10 minutes in group C. Gender, age, weight, operation time, operation type, the total volume of intravenous infusion, bleeding, total dose of propofol, fentanyl citrate, rocuronium during surgery and extubation time were all recorded. All side effects included reintubation, bleeding, stroke, death, postoperative myocardial infarction were all recorded. The partial oxygen pressure (Pa02) and partial carbondioxide pressure (PaC02) were recorded before and after extubation.

Results. Demographic data and operative data were similar between groups (p>0.05). The extubation time was similar between groups (SC group versus C group: 191,14±79,1 min versus 188,29±51,47 min, p=0,534. There was significant decrease in arterial PO2 and increase in arterial PCO2 after extubation in all groups. No side effects were observed.

Conclusion. In conclusion, although we found no differences between SmartCare and control groups, the evaluating of the patient increased the workload in the control group. We think that SmartCare decreased the workload. Thus, it can be recommended for weaning process of patients after major surgery in intensive care unit.

Key words: weaning, smartcare, protocols


Does the change of educational strategy for chest compression based on the change of guidelines affect on the quality of prehospital chest compression? (Views : 1275 times)


Background and Aims. International guidelines for cardiopulmonary resuscitation (CPR) changed their strategy with respect to the rate of chest compression (CC) and ventilation from 15:2 to 30:2. The object of this study was to clarify the effect of this change on the quality of CPR.

Subjects and Methods. We recorded the frequency of CC and ventilation performed by Emergency Life Support Technicians (ELSTs) during CPR in ambulances, and compared the period when ELSTs performed 15:2 CPR with that when they performed 30:2 CPR.

Results. During the first period, ELSTs actually performed CCs 15 times per 7.2 sec (128.1 times per minute), and performed 2 ventilations per 4.5 sec. Thirty-six percent of patients received appropriate CCs (100-120/min), while 43% received high-frequency CCs (120-150/min) and 13% received CCs that were too fast (more than 150/min). During the second period, ELSTs performed CCs 30 times per 18.1 sec (101.6 times per minute), and performed 2 ventilations per 4.3 sec.

Conclusions. The change in the CC-to-ventilation ratio for CPR in the international guidelines from 15:2 to 30:2 can improve the exactness of the frequency of CCs. However, ELSTs may not be able to perform CCs exactly as recommended. It is important to evaluate the exact frequency of CCs by ELSTs or paramedics in ambulances and to evaluate the relationship between the frequency of CCs and patient outcome.

Key words: organized and nonorganized rapid response system, rapid response team, in-of-hospital cardiac arrest, in-hospital whole paging system




Most Accessed Articles

Original Articles


Abstract Introduction. The contribution of tracheotomy in comparison to intubation in patients on the resuscitation ward ...

Clinical s

Abstract Elevated intraabdominal pressure (IAP) has been claimed to play a role in abdominal compartment syndrome. ...


Abstract Objectives. We examined the relationship between partial end-tidal CO2 (pet) and mean arterial pressure in ...

Case Reports

Severe barium sulphate aspiration: a report of two cases and review of the literature

Abstract Aspiration of barium sulphate is a well-recognized complication, occurring accidentally during examinations of the upper gastrointestinal system using contrast media. Rarely, large amounts of barium sulphate are inadvertently aspirated into ...

Pulmonary hypertension leading to right heart failure in a patient with IgA gammapathy

Abstract Amyloidosis is a rare disorder characterized by the deposition of amorphous, extracellular, insoluble fibrillar protein in various tissues of the body. Pulmonary hypertension usually occurs in the last stages of ...

Myotubular myopathy associated with hypoxic-ischemic encephalopathy as a cause of prolonged ventilat

Keywords: myotubular myopathy, muscle biopsy, genetic analysis hypoxic-ischemic ...

Review Articles

Venous oximetry

Abstract Tissue hypoxia is the central pathophysiological process in shock and an important co-factor in the development of organ dysfunction. Hemodynamic parameters, usually used to assess the perfusion of organs and ...

Inpatient management of alcohol withdrawal: a practical approach

Abstract Alcohol intake contributes directly or indirectly to 15 to 20% of medical problems in primary care or an inpatient setting. It is estimated that approximately 500,000 episodes of withdrawal will ...

Pediatric Shock

Abstract Millions of children die of shock due to various etiologies each year. Shock is a state of circulatory dysfunction where the metabolic demands of the tissue cannot be met by ...

© 2014. Signa Vitae. All rights reserved.
Designed and developed by IvichStudios