ABSTRACT
In this study, we aim to evaluate whether thoracic ultrasound (TUS) and tracheal amylase (TA) alone or in combination can predict the development of ventilator-associated pneumonia (VAP) in neurocritical patients. Consecutive adult patients with neurocritical disease with normal chest radiographs who required intensive care unit admission and mechanical ventilation between March 2015 and July 2018 were included. TUS and Amylase levels were measured during the first 24 hours and repeated 48 hours after orotracheal intubation. Forty-three patients with a median age of 34 years (17-82) were included. TUS had a sensitivity of 100% and specificity of 96.3% as a predictor of VAP within the first 48 hours when nonpattern A was observed. TA levels > 200 UI/L in the first 48 hours had a sensitivity of 87.5%, and specificity of 63% as a predictor of VAP. Moreover, no benefit of TUS plus TA compared to TUS alone as a predictor of VAP was found. The identification of abnormal TUS patterns in the first 48 hours of orotracheal intubation is a significant predictor of VAP in neurocritical patients.
Subject(s)
Pneumonia, Ventilator-Associated , Humans , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Pneumonia, Ventilator-Associated/diagnostic imaging , AmylasesABSTRACT
A quadruplex real-time (RT) qPCR assay for the detection and quantification in 4h of Staphylococcusaureus, Pseudomonasaeruginosa, Acinetobacterbaumannii and Stenotrophomonasmaltophilia directly from bronchoalveolar lavage specimens was developed. The specificity of the assay was 100% for all four species.
Subject(s)
Bacteriological Techniques/methods , Gram-Negative Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Pneumonia, Ventilator-Associated/diagnosis , Polymerase Chain Reaction/methods , Adolescent , Adult , Aged , Aged, 80 and over , Bronchoalveolar Lavage Fluid/microbiology , Female , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacteria/isolation & purification , Gram-Positive Bacterial Infections/microbiology , Humans , Male , Middle Aged , Pneumonia, Ventilator-Associated/microbiology , Sensitivity and Specificity , Young AdultABSTRACT
El infarto agudo del miocardio es generalmente consecuencia de oclusión coronaria. Las evidencias clínicas y de laboratorio apoyan el axioma que la recuperación oportuna del flujo coronario preserva el miocardio. La terapia trombolítica administrada dentro de la primera hora de los síntomas, produce reperfusión, reduce el tamaño del infarto, aumenta el rendimiento cardíaco y reduce la mortalidad. El retraso en la trombólisis es influenciado por: a) el desconocimiento del paciente acerca de su enfermedad; b) el intervalo de tiempo entre el inicio de los síntomas y el arribo del paciente al hospital; c) la terapéutica inicial dentro del hospital; d) finalmente, debido a que en nuestro país no hay programas de trombólisis prehospitalaria (como en los Estados Unidos de América y Europa), muchos pacientes pierden la oportunidad de recibir este tratamiento
