Association between pathogens from tracheal aspirate and oral biofilm of patients on mechanical ventilation

Abstract The aim of this study was to detect possible associations between respiratory pathogens from tracheal aspirate and oral biofilm samples in intubated patients in an intensive care unit (ICU), and to identify the most common respiratory pathogens in oral biofilm, particularly in patients that developed ventilator-associated pneumonia (VAP). Two oral biofilm samples were collected from the tongue of intubated patients (at admission and after 48 hours) and analyzed by culture with the Antibiotic Sensitivity Test. The results from the tongue biofilm samples were compared with the tracheal secretions samples. A total of 59.37% of patients exhibited the same species of pathogens in their tracheal aspirate and oral biofilm, of which 8 (42.1%) developed VAP, 10 (52.63%) did not develop pneumonia and one (5.26%) had aspiration pneumonia. There was a statistically significant association between presence of microorganisms in the tracheal and mouth samples for the following pathogens: Klebsiella pneumoniae, Candida albicans, Pseudomonas aeruginosa, Enterobacter gergoviae, Streptococcus spp and Serratia marcescens (p < 0.05). Pathogens that are present in tracheal aspirates of intubated patients can be detected in their oral cavity, especially in those who developed VAP or aspiration pneumonia. Thus, the results indicate that an improved oral care in these patients could decrease ICU pneumonia rates.

The use of dextroketamine as postoperative adjuvant analgesia in a patient undergoing thoracotomy. Case report / Uso de dextrocetamina como adjuvante de analgesia pós-operatória em paciente submetido a toracotomia. Relato de caso

BACKGROUND AND OBJECTIVES: Pain is a major source of stress for patients in the postoperative period, impairing recovery, mobility and hospital discharge. This study aimed at presenting the use of intravenous dextroketamine to treat a patient with severe postoperative pain in intensive care unit. CASE REPORT: Male patient, 36 years old, single, Caucasian, fisherman, living in the city of São Luís, submitted to major thoracic tumor removal (Shwanomma) with severe pain not controlled with opioids and simple analgesics, being necessary the use of adjuvants such as continuous intravenous dextroketamine, which has allowed mechanical ventilation weaning and patient’s recovery in the postoperative period. CONCLUSION: Low-dose intravenous dextroketamine associated to morphine has shown good safety and better control of severe postoperative pain in patient submitted to thoracotomy and admitted to an intensive care unit. .

JUSTIFICATIVA E OBJETIVOS: A dor é uma grande fonte de estresse em pacientes no período pós-operatório, dificultando a recuperação, mobilidade e alta. O objetivo deste estudo foi mostrar a utilização de dextrocetamina por via venosa no tratamento de um paciente com dor intensa pós-operatória em unidade de terapia intensiva. RELATO DO CASO: Paciente do gênero masculino, 36 anos, solteiro, branco, pescador, natural residente de São Luís submetido a exérese de grande tumoração torácica (Shwanomma) com ocorrência de dor intensa não controlada com opioides e analgésicos simples, sendo necessário uso de adjuvantes como a dextrocetamina endovenosa contínua, o que possibilitou o desmame de ventilação mecânica e reabilitação do paciente durante o pós operatório. CONCLUSÃO: A dextrocetamina por via venosa em baixas doses, associada à morfina demonstrou boa segurança e melhor efeito no controle da dor pós-operatória de forte intensidade em paciente submetido a toracotomia e internado em unidade de terapia intensiva. .