ECMO in ARDS: a long-term follow-up study regarding pulmonary morphology and function and health-related quality of life.

BACKGROUND: A high survival rate can be achieved in patients with severe acute respiratory distress syndrome (ARDS) using extracorporeal membrane oxygenation (ECMO). The technique and the costs are, however, debated and follow-up studies in survivors are few. The aim of this study was to evaluate long-term pulmonary health after ECMO and severe ARDS. METHODS: Twenty-one long-term survivors of severe ARDS and ECMO were studied in a follow-up program including high-resolution computed tomography (HRCT) of the lungs, extensive pulmonary function tests, pulmonary scintigraphy and the pulmonary disease-specific St George's Respiratory Questionnaire (SGRQ). RESULTS: The majority of patients had residual lung parenchymal changes on HRCT suggestive of fibrosis, but the extension of morphologic abnormalities was limited and without the typical anterior localization presumed to indicate ventilator-associated lung injury. Pulmonary function tests revealed good restitution with mean values in the lower normal range, while T(1/2) for outwash of inhaled isotope was abnormal in all patients consistent with subclinical obstructivity. Most patients had reduced health-related quality of life (HRQoL), according to the SGRQ, but were stating less respiratory symptoms than conventionally treated ARDS patients in previous studies. The majority were integrated in normal work. CONCLUSION: The majority of ECMO-treated ARDS patients have good physical and social functioning. However, lung parenchymal changes on HRCT suggestive of fibrosis and minor pulmonary function abnormalities remain common and can be detected more than 1 year after ECMO. Furthermore, most patients experience a reduction in HRQoL due to the pulmonary sequelae.

Antibiotic prophylaxis with cefoxitin in colorectal surgery: effect on the colon microflora and septic complications--a clinical model for prediction of the benefit and risks in using a new antibiotic in prophylaxis.

Cefoxitin was administered parenterally in doses of 2 g, every six hours for two days, to 20 patients undergoing colorectal surgery. Blood and fecal specimens were obtained for five days for analysis of cefoxitin concentrations. Tissue samples from the gut wall were obtained at surgery. The maximum serum concentrations during surgery varied between 25 and 100 microgram/ml, and the cefoxitin concentrations for the fecal samples were 1.5-35 microgram/g and for the tissue samples, 2.0-50 microgram/g. Fecal samples for cultivation of aerobic and anaerobic bacteria were also obtained daily during the first five days, and after 14 day after operation. Pronounced changes in the microflora occurred during the investigation period. Among the aerobic bacteria, cefoxitin-sensitive Escherichia coli and other enterobacteria decreased markedly while cefoxitin-resistant enterococci, Pseudomonas and Enterobacter proliferated during the antibiotic prophylaxis period. Among the anaerobic bacteria, Bacteroides fragilis and other Gram-negative bacteria decreased significantly. However, after the antibiotic administration period, all cefoxitin-resistant strains decreased while the suppressed E. coli and B. fragilis strains increased. In one patient, a minor postoperative infection caused by a cefoxitin-resistant strain of Pseudomonas aeruginosa was observed.