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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Independent Lung Ventilation (ILV) in ICU

Background

There has been loss of interested in Independent Lung Ventilation (ILV) over the recent years. Reasons could be unfamiliarity with the technique, lack of guidelines or even publications. On the other side, we are faced with better accessibility of extra corporeal oxygenation modalities such as veno-venous extracorporeal membrane oxygenation (V-V ECMO) and extra corporeal CO2 removal (ECO2R).

With ILV specially designed double lumen endotracheal tubes (DLET) are used that enable separate lung ventilation using 2 ventilators. While single lumen ventilation is well known to anesthesiologist, its use together the use of ILV is seldom used in ICU. ILV can offer valuable rescue therapy for refractory hypoxemia in patients with predominantly unilateral lung injury especially in non ECMO centres or as a bridge to definite therapy (ECMO, surgery, bronchial artery embolisation etc).

It is shown that ILV improves aeration, oxygenation and CO2 clearance in patients with predominant unilateral lung injury as well as reduces intrapulmonary shunt and eliminates inhomogeneity during mechanical ventilation (MV). Protective MV with 6 mL / kg Ideal Body Mass (IBM) will inevitably lead to over distention and hyperventilation ob uninjured lung leaving the injured lung under-distended or collapsed. Pendelluft phenomenon has been reported to be present in predominantly unilateral lung disease / injuries due to differences in time constants in lungs.

Unfortunately, there’s a lack of double blind multi central studies about the use of ILV. While using it, we rely on scarce body of evidence from the literature based ob observational data and case series, applying physiology principles and fallowing protective ventilation guidelines.

Key words: independent lung ventilation, ICU

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The significance of demographic factors (age, sex, preoperative physiological status) and type of surgery on patients’ outcome in ICU

Abstract

The incidence of postoperative death has changed little in recent years. Most deaths occur in older patients with coexisting medical diseases who undergo major surgery.

The objective of our research was to investigate the significance of demographic factors (age, gender, preoperational physiological status) and type of surgery on the outcome of treatment. This study included 288 patients older than 18 years of age that were treated in the intensive care unit (ICU) for at least 24 hours after a surgical procedure (both elective and emergency) between 1st January 2010 and 31st March 2011. The average age of patients included in the survey was 68 (range 19-88). APACHE II score was between 2.9 and 83.1 points, with an average value of 12.90 points. In this study, male gender (n=186) was much more common than female gender (n=102). Age of patients who died in the ICU was higher than the age of those who were discharged but it was not a statistically significant predictor of patient death. APACHE II score is associated with increased age of patients, neurosurgical operations and incidence of nosocomial infections. Patients’ age and female gender had a strong negative correlation with nosocomial infection. Actual mortality rate for patients was 21%. Ratio between actual and predicted mortality was 1.4.

Key words: demographics, ICU, APACHE, type of surgery, nosocomial infections.

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Aerosolized colistin in the treatment of multiresistant Pseudomonas aeruginosa nosocomial pneumonia

Abstract

Introduction. Multiresistant Pseudomonas aeruginosa (MRPA) nosocomial pneumonia is a significant cause of mortality and morbidity in the ICU. We report our experience with aerosolized colistin in the treatment of MRPA nosocomial pneumonia.

Patients and methods. It is a prospective, observational study performed over 2 years (2006-2007). Patients who developed MRPA nosocomial pneumonia and were treated with aerosolized colistin were included. The criteria used to assess if treatment was successful were extubation and ICU mortality rates.

Results. We report 32 patients of whom 12 were women and 20 men. The mean age was 48 ± 19 years. All patients were receiving mechanical ventilation. The mean length of ventilation was 22 ± 5.5 days. The bronchial sampling technique used was broncho-alveolar lavage. The mean delay of infection (duration between intubation and pneumonia diagnosis) was 7 ± 2 days. Isolated MRPA was susceptible only to colistin. The treatment was aerosolized colistin for all patients (4 MUI/day). A positive blood culture (n=5) was a prerequisite for administering colistin intravenously (4 MUI/day). Any potential toxicity was observed. The mean delay of extubation after starting treatment was 10 days. Sterile samples were obtained on average by the eighth day. No deaths were recorded.

Conclusion. It seems that aerosolized colistin is an important alternative to treat MRPA nosocomial pneumonia in ICU. Our results need further confirmation by other multicentre studies.

Keywords: multi-resistant Pseudomonas aeruginosa, colistin, nebulization, ICU

 

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