Subject(s)
Blood Coagulation Factors/therapeutic use , Hemophilia A/therapy , Hemophilia B/therapy , Adolescent , Adult , Canada , Capacity Building , Child , Child, Preschool , Developing Countries , Hemophilia A/epidemiology , Hemophilia B/epidemiology , Humans , India/epidemiology , Infant , International Cooperation , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Introducción: Durante la pandemia por influenza A(H1N1), Chile alcanzó una de las tasas de casos más alta del mundo. Nuestro hospital recibió numerosos afectados el 2009 y 2010. Evaluamos el impacto de ventilación en posición prono (VPP) extendida, en las variables respiratorias de pacientes con SDRA grave secundario a influenza, y comparamos estos resultados con los obtenidos en otras series de VPP. Métodos: Estudio prospectivo, intervencional en UCI. Los pacientes recibieron oseltamivir y antibióticos y fueron manejados según protocolos (ventilatorio y no ventilatorio). Aquellos con criterios de SDRA grave fueron pronados hasta un índice de oxigenación <10. Se registraron parámetros de intercambio gaseoso, ventilatorios y desenlaces clínicos. Resultados: 12 pacientes con SDRA grave (edad 46+/-12 años, 7 hombres, APACHE II 17+/-6, SOFA 9+/-3) requirieron VPP, que se instauró a las 14(7-39) horas de ventilación mecánica (VM) y se mantuvo por 72(54-96) horas. Ningún paciente experimentó complicaciones mayores. La PaO2:FiO2 mejoró de 82(63-101) mmHg a 145(138-223) mmHg, (p<0.001). El tiempo en VM fue 20+/-13 días y en UCI 22+/-13 días. La mortalidad hospitalaria fue 25 por ciento y no cambió en el seguimiento de más de 8 meses. Este comportamiento con VPP fue similar al observado en otras series de SDRA grave. Conclusión: Los resultados obtenidos sugieren que la VPP resultó segura y se asoció a mejoría del intercambio gaseoso en pacientes con SDRA por influenza A(H1N1). Aunque el número reducido de pacientes no permite sacar mayores conclusiones, la VPP extendida podría ser de utilidad en los casos más graves causados por esta nueva influenza.
Introduction: During pandemic for influenza A(H1N1), Chile achieved one of the highest rates of infection worldwide. On 2009 and 2010, our hospital received a large number of infected patients. We evaluated the impact of extended prone position ventilation (PPV) on respiratory variables from severe ARDS patients secondary to this influenza. We also compared these results with those obtained with PPV in other series. Methods: Prospective, interventional study, performed in a mixed-ICU. Patients received oseltamivir and antibiotics, and were treated according to protocols (ventilatory and non-ventilatory). Severe ARDS patients were proned until oxygenation index was < 10. Oxygen exchange, ventilatory parameters and clinical outcomes were registered. Results: 12 severe ARDS patients (46+/-12 y.o., 7 men, APACHE II 17+/-6, SOFA 9+/-3) required PPV, which was started 14(7-39) hours after mechanical ventilation (MV) initiation, and it was maintained for 72(54-96) straight hours. No major complication was described. Three patients needed two periods of PPV. PaO2:FiO2 improved significantly with PPV from 82(63-101) mmHg to 145(138-223) mmHg, (p<0.001). Time on MV was 20+/-13 days, and LOS in UCI was 22+/-13 days. Hospital mortality was25 percent and remained unchanged for at least 8 month of follow-up. PPV had the same effect than in other severe ARDS series. Conclusion: Our results suggest PPV is safe and it was associated with improvement in oxygen exchange in ARDS secondary to A(H1N1) influenza. Although the small number of patients does not allow drawing any major conclusion, we believe PPV can be useful to treat severe ARDS cases due to influenza infection.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Influenza, Human/complications , Respiration, Artificial/methods , Respiratory Distress Syndrome/therapy , Algorithms , Influenza A Virus, H1N1 Subtype , Intensive Care Units , Prone Position , Prospective Studies , Pulmonary Gas Exchange , Pulmonary Ventilation , Respiratory Distress Syndrome/virologyABSTRACT
OBJECTIVE: The practice of anaesthesiology has the potential for transmitting a number of infectious agents to the patient. In France, several recent cases have been identified, so that a wide survey on anaesthesiology practice has been enhanced. METHODS: An anonymous questionnaire, based on the recommendations of the French Society of Anaesthesiology and Intensive Care (Sfar), was send to 8,771 anaesthesiologists and intensive care practitioners and to 2,070 nurses practicing anaesthesiology. RESULTS: A total of 1,343 questionnaires were analyzed (response rate of 12.4%). The study shows that some recommendations were routinely applied, such as: availability of alcohol-based hand hygiene solution in operating rooms (94%), use of antimicrobial filters for respiratory circuits (99%), use of single-use laryngoscope blades (77%), aseptic technique for central venous catheterization (99%), hand hygiene after contact with body fluids (96%). In contrast, the study showed that some recommendations were partially applied: hand hygiene practice (52%), wear of gloves when a risk of blood exposure exists (23%), cleaning of reusable laryngoscope blades (19%), and incorrect wear of masks (71%). The reuse of the same syringe for several patients was described in 2% of the responses. CONCLUSION: This results, similar to those previously described in the literature, must be followed by appropriate training and education of anaesthesia personnel, implementation of the recommendations, and evaluation of practices. Reuse of the same syringe for several patients have to be eradicated because of the high risk of viral transmission.
Subject(s)
Anesthesia/adverse effects , Anesthesiology/standards , Cross Infection/prevention & control , France , Hand Disinfection , Humans , Hygiene , Internet , Surveys and QuestionnairesABSTRACT
In this paper the use of nitrogen compounds in garnacha must inoculated with active dry wine yeast Saccharomyces cerevisiae subsp. cerevisiae strain Na33 has been studied. The results are compared to garnacha must fermented with indigenous yeasts (control must). In the samples where the inoculated yeast predominated, no qualitative differences were appreciated in the use of amino acids with respect to the control samples, although there were quantitative differences. In the musts where the Na33 strain dominated, a lesser quantity of amino acids were consumed at the beginning of fermentation than in the control samples. For that reason, probably, this yeast showed problems in competing for the nitrogen nutrients of the must; this could have made its implantation in one of the inoculated samples more difficult. At the end of fermentation the Na33 strain continued to consume amino acids at high concentrations of ethanol. Its high tolerance to this toxic could be favored by the production and rehydration of dry wine yeast in the presence of air.
