Does airway pressure release ventilation mode make difference in cardiopulmonary function of ICU patients?

Introduction: Mechanical ventilation is essential in intensive care unit [ICU] patients who are unable to maintain adequate gas exchange without support. Different ventilation modalities have been introduced to imitate normal respiratory pattern but there are some disadvantages in each modality. The aim of present study was to compare the cardiopulmonary and airway pressure changes in ICU patients undergoing pressure controlled ventilation [PCV], one of the basic modalities with airway pressure release ventilation [APRV], an advanced ventilation mode which allows spontaneous breathing in any time of respiratory cycle

Materials and Methods: In this cross over study, 18 patients were randomized to receive either PCV or APRV ventilation for 30 minutes then after washout period, switched to another group. Cardiopulmonary and arterial blood gas variables and airway pressure were recorded prior to study and after 30 minutes of starting each modalities and compared between groups

Results: Airway pressure were significantly higher in APRV mode [9.3 +/- 3.3 vs. 6.9 +/- 1.5, p=0.044 in PCV group and 9.1 +/- 3.4 vs. 6.6 +/- 1.4, p=0.021 in APRV group] and arterial blood gas in PCV mode was insignificantly higher than APRV mode in both protocols. There was no significant difference in other cardiopulmonary variables

Conclusion: This study has shown no hemodynamic change's difference due to two studied protocol. The mean airway pressure in APRV mode was more than PCV mode with lower arterial blood O2 pressure in both protocols

Radiologic manifestations of pulmonary tuberculosis in patients of intensive care units

Tuberculosis [TB] is a serpent disease with various pulmonary manifestations, and timely diagnosis of the disease is paramount, since delayed treatment is associated with severe morbidity, particularly in intensive care units [ICU]. Therefore, it is imperative that intensivists understand the typical distribution, patterns, and imaging manifestations of TB. To describe different manifestations of pulmonary TB in patients in the ICU. In a retrospective study, all patients with a clinical and a laboratory-confirmed diagnosis of TB who were admitted to the ICU were entered in the study. All patients had a confirmatory laboratory diagnosis of TB including positive smears. The patterns of parenchymal lesions, involved segments and presence of cavity, bronchiectasis and bronchogenic spread of the lesions with computed tomography [CT] and chest/X-ray [CXR] were recorded and analyzed. Data of 146 patients with TB were entered in the study. The most common finding in CT was acute respiratory distress syndrome [ARDS]-like radiologic manifestations [17.1%], followed by parenchymal nodular infiltration [13.6%] and cavitation [10.9%], consolidation [10.2%], interstitial involvement [9.5%], calcified parenchymal mass [8.3%], ground-glass opacities [7.5%], and pleural effusion or thickening [6.9%]. Radiologic evidence of lymphadenopathy was seen in up to 43% of adults. Miliary TB was observed in 2.3% of patients, mostly in those older than 60 years of age. ARDS-like [64.5%] manifestations on CT and miliary TB [85.5%] had the highest mortality rates among other pulmonary manifestations. ARDS, interstitial involvement, and Parenchymal nodular infiltration are the most common manifestations of pulmonary TB. Various features of TB in ICU patients could be misleading for intensivists

Venous thromboembolism in medical critically ill patients: prevalence and incidence

The objective of this study was to determine the prevalence and incidence of venous thromboembolism among critically ill medical surgical patients. In this cross sectional and retrospective study, we observed 243 patients who were first admitted at the intensive care unit. Patients who were diagnosed with deep venous thrombosis or embolism either by clinical or paraclinical methods were enrolled. Among 243 patients of ICU ward 12 cases of them were confirmed to have thromboembolism [prevalence of 9.4%]. But the incidence of venous thromboembolism after 48 hour of ICU admission was 5.2% [6 cases]. Among 6 VTE cases 3 of them didn't receive any anticoagulant prophylaxis, 2 patients received LDUH 5000 unit twice a day and one patient received LMWH 60 mg daily but all developed VTE although receiving prophylaxis. We found that the prevalence of proximal lower limb DVT among medical-surgical critically ill patients remaining in the ICU for >/= 3 days is about 9.4% and the incidence of that is about 5.2%. Further studies should be performed in order to assess the benefits and risks of venous thromboprophylaxis in Iranian patients

Prevalence of oseltamivir-resistant 2009 H1N1 influenza virus among patients with pandemic 2009 H1N1 influenza infection in NRITLD, Tehran, Iran

Oseltamivir-resistant cases were reported during the 2009 pandemic influenza outbreak and therefore, widespread emergence of oseltamivir-resistant 2009 H1N1 virus is imaginable. Underlying medical conditions like immunosuppression increase the chance of oseltamivir resistance. In a retrospective cross-sectional study, respiratory tract specimens of confirmed cases of 2009 H1N1 influenza referred to the Masih Daneshvari Hospital were analyzed for presence of H275Y mutation. From November 2009 through March 2010, oseltamivir-resistant 2009 H1N1 infection was observed and confirmed in 4 patients [including 2 immunocompromised patients] by performing H275Y mutation molecular testing. Close monitoring of resistance to neuraminidase inhibitors is essential in tertiary care centers. The H275Y mutation [oseltamivir-resistant genotype] could appear in the absence or presence of selective drug pressure