RESUMEN
OBJECTIVE: To evaluate the impact of noninvasive positive pressure mechanical ventilation (NPPV) on ventilator-associated pneumonia (VAP). DESIGN: Prospective observational study. SETTING: Medical intensive care unit (ICU) of a university teaching hospital. PATIENTS: Cohort of 320 consecutive patients staying in the ICU more than 2 days and mechanically ventilated for > or = 1 day. MEASUREMENTS AND RESULTS: VAP was diagnosed when, satisfying classical clinical and radiological criteria, fiberoptic bronchoalveolar lavage and/or protected specimen brush grew > or = 10(4) and > or = 10(3) CFU/ml, respectively, of at least one microorganism. Patients were classified into four subgroups according to the way in which mechanical ventilation was delivered: NPPV then tracheal intubation (TI) (n = 38), TI then NPPV (n = 23), TI only (n = 199), and NPPV only (n = 60). Occurrence of VAP was estimated by incidence rate and density of incidence. Risk factors for VAP were assessed by logistic regression analysis. Twenty-seven patients had 28 episodes of VAP. The incidence rates for patients with VAP were 18% in NPPV-TI, 22% in TI-NPPV, 8% in TI, and 0% in NPPV (p < 0.0001). The density of incidence of VAP was 0.85 per 100 days of TI and 0.16 per 100 days of NPPV (p = 0.04). Logistic regression showed that length of ICU stay and ventilatory support were associated with VAP. CONCLUSIONS: There is a significantly lower incidence of VAP associated with NPPV compared to tracheal intubation. This is mainly explained by differences in patient severity and risk exposure.
Asunto(s)
Infección Hospitalaria/prevención & control , Máscaras , Neumonía/prevención & control , Respiración con Presión Positiva/métodos , APACHE , Adulto , Anciano , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Contaminación de Equipos , Femenino , Humanos , Incidencia , Unidades de Cuidados Intensivos , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neumonía/epidemiología , Neumonía/etiología , Respiración con Presión Positiva/efectos adversos , Estudios ProspectivosRESUMEN
A series of 30 cases of post-operative peritoneal irrigation dialysis for generalised peritonitis. In the light of peritoneal physiology, details are given of the technique for insertion of the peritoneal drains as well as the composition of the dialysate. In addition to its mechanical role, continuous lavage of this type is useful in restoring and maintaining water and electrolyte balance, the limitations of which are described, together with a direct anti-infectious action and temperature equilibration. P.I.D. seems to be associated with a considerable reduction in mortality from acute generalised peritonitis (1 case out of 30). It also limits morbidity, since only 5 minor complications were seen. The simplicity and harmlessness of the method makes it possible to widen, without major reservations, the scope of therapeutic solution to the problem of acute generalised peritonitis.
Asunto(s)
Diálisis Peritoneal/métodos , Peritonitis/cirugía , Enfermedad Aguda , Antibacterianos/uso terapéutico , Drenaje/instrumentación , Estudios de Seguimiento , Humanos , Infecciones/tratamiento farmacológico , PronósticoRESUMEN
The authors describe two cases of secreting paragangliomas of the organ of Zuckerkandl, beinging the number of known cases to 78. They underline the interest of arteriographic and phlebographic explorations which define more accurately the origin and spread of these tumours.