Mechanical ventilation in elderly patients.

Elderly patients are increasingly opting for intensive care unit (ICU) treatment with mechanical ventilation (MV). The aim of this study was to review specific aspects of MV in the older elderly (80-yrs-old and older). We retrospectively studied all patients who underwent MV during a 2-year-period in our respiratory ICU. Older elderly were compared with younger patients. Of 478 patients admitted to our unit, 58 underwent endotracheal ventilation (ETV) and 243 noninvasive ventilation (NIV). At the time of admission, older elderly patients (n = 106) were more severely ill than the younger ones, according to simplified acute physiology scores (SAPS). The history of older patients was characterized by a lower frequency of neurological abnormalities, and in the ETV group, a lower frequency of days previously spent in hospital. NIV was performed more often in older elderly (64%) than in younger patients (47%) and for a shorter time-period (8 compared to 10 days). The ICU mortality rate was higher in the older patients than in the younger ones in the overall population admitted to the unit (38 compared to 12%) and in the NIV population (21 compared to 9%) but not in the ETV population (40 compared to 44%). Long-term survival (2 yrs) was low (12%) in the older patients admitted to the unit. Several studies from the literature were reviewed. All authors agreed that age alone should not be a criterion to exclude the older elderly from intensive care, regardless of whether they found them to have the same or a poorer prognosis than younger patients. Selection biases are rarely studied. Our results indicate that some selection procedures on admission to the intensive care unit and before endotracheal ventilation are present despite the absence of any selection policy in our department. This selection enables us to obtain results from older populations which are as good as those from nonselected younger populations. When its use is practicable, noninvasive ventilation is associated with less discomfort, fewer complications and better short-term results than is endotracheal ventilation. In all cases, the long-term prognosis is poor.

Neonatal chlamydial conjunctivitis. A long term follow-up study.

Chlamydia trachomatis (Ct) was isolated from eyes of 33 out of 160 infants with neonatal conjunctivitis. In nineteen (58%) of the infants with chlamydial conjunctivitis Ct could also be isolated from the nasopharynx. All infants were treated with oral erythromycin ethylsuccinate 25 mg/kg every 12 hours for 14 days combined with lid hygiene. All were clinically cured, and none had a relapse of clinical Ct conjunctivitis during an observation period of one year. However, one infant had persistent asymptomatic chlamydial eye infection, two displayed a persistent infection of the nasopharynx, and one infant's vagina was infected despite therapy. Serum IgG antibodies to Ct were significantly more often detected in clinical cases (90%) than in controls (33%) (p less than 0.01). Infants with conjunctivitis developed detectable IgM antibodies to Ct in 43% as compared to 7% in controls (p less than 0.01).

Changes in the incidence and spectrum of neonatal septicemia during a fifteen-year period.

Over a period of 15 years the incidence of neonatal septicemia seen at St Göran's Children's Hospital has increased both per 1000 births and per 100 admitted neonates. The spectrum of causative organisms has changed towards more Gram-positive organisms and fewer Gram-negative organisms. In the initial antibiotic treatment an aminoglycoside and ampicillin derivate will still be needed to give full coverage.

Isolation of pathogenic bacteria from the nasopharynx of children with respiratory syncytial virus infection. Predictive value of chest roentgen examination and laboratory tests.

Potentially pathogenic bacteria were isolated from the nasopharynx in 33/66 hospitalized infants and children with verified respiratory syncytial virus (RSV) infection. The value of chest roentgenograms and blood counts for the prediction of concomitant bacterial infection was evaluated. Abnormal chest roentgenograms were found in 89% whether pathogenic bacteria were present or not. The most common finding was general hyperinflation of the lungs, with or without infiltrates. This occurred more frequently in the group with isolated RSV infection. Fever, leucocytosis and an elevated ESR were found during the illness in more than half the cases. These findings were more frequent in children who harboured potential pathogenic bacteria, though the difference was not significant. For optimal evaluation of a case all available information about it should be taken into consideration.

Bacterial colonization of newborn infants in a neonatal intensive care unit.

The bacterial colonization of the nose, umbilicus, perineum and faeces in 85 newborns was studied during one period of high and one of low occupancy in a neonatal intensive care unit. Cultures were taken on admission, at three days, at one week of age, and then weekly during the stay in the unit. Colonization took place early and potential pathogens were responsible for a significant part of the spectrum. At one week of age, more than 50% of the infants had Staphylococcus aureus in the nose and umbilicus, 25% had E. coli and/or Klebsiella enterobacter in the umbilicus, and 60% had Klebsiella enterobacter in the perineum. Neither the occupancy rate in the unit nor the clinical state of the infant seemed to influence the colonization pattern significantly. Changes in flora were frequent in the individual infant. However, the bacterial spectrum remained essentially the same with increasing age during the stay in the unit and during the two periods. Only on two occasions was the same phage type of Staphylococcus aureus found in two infants at the same time. Two cases of septicemia occurred in the 85 infants during the three months of the study. Both infants were colonized beforehand with the causative organism. The results may indicate that the clinical state of the infant is of greater importance for risk of septicemia than the pattern of the bacterial colonization.

Effect of radiotherapy on lymphocyte cytotoxicity in vitro.

The cytotoxic functions of highly purified blood lymphocytes from patients with breast cancer were studied before and after radiotherapy. Addition of PHA or of rabbit antibodies to target cells (chicken erythrocytes) were chosen as two means of inducing lymphocyte cytotoxicity in vitro. The proportion of T and non-T-lymphocytes was determined by means of E and EAC rosette tests. The antibody-induced cytotoxocity of lymphocytes decreased following radiotherapy while that mediated by PHA remained unchanged. There was some reduction in the percentage of EAC rosette-forming cells. These results, as well as our earlier observations, suggest that the decrease in the peripheral blood of the proportion of lymphocytes with receptors for activated complement is responsible for changes in the antibody-mediated lymphocyte cytotoxicity.