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2.
Infect Control Hosp Epidemiol ; 38(2): 186-188, 2017 02.
Article in English | MEDLINE | ID: mdl-27852357

ABSTRACT

BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture. METHODS A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared. RESULTS The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014. CONCLUSIONS Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts. Infect Control Hosp Epidemiol 2017;38:186-188.


Subject(s)
Catheter-Related Infections/epidemiology , Cross Infection/prevention & control , Infection Control/methods , Intensive Care Units , Urinary Tract Infections/epidemiology , Antimicrobial Stewardship/statistics & numerical data , Humans , Ohio/epidemiology , Urine/microbiology
4.
J Clin Anesth ; 27(7): 602-5, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26260647

ABSTRACT

A 62-year-old woman with prosthetic mitral valve was admitted for explant of an infected prosthetic knee. Perioperatively, she was bridged with heparin and started on empiric vancomycin and piperacillin-tazobactam. Platelet counts dropped precipitously within 2 days reaching a nadir of 6000/µL, without any bleeding. Decline persisted despite substituting heparin with bivalirudin. Antiplatelet factor 4 and anti-PLA1 antigen were negative. Schistocytes were absent. Antibiotics were substituted with daptomycin for suspected drug-induced thrombocytopenia. Pulse dose of intravenous immunoglobulin was initiated with rapid normalization of platelet count. She tested positive for IgG antiplatelet antibodies to vancomycin and piperacillin-tazobactam thereby confirming the diagnosis. Drug-induced immune-mediated thrombocytopenia is an underrecognized cause of thrombocytopenia in the intensive care units. Clinicians should be cognizant of this entity, and a definitive diagnosis should be sought if feasible.


Subject(s)
Penicillanic Acid/analogs & derivatives , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Vancomycin/adverse effects , Device Removal , Female , Humans , Immunoglobulin G/immunology , Intensive Care Units , Middle Aged , Penicillanic Acid/administration & dosage , Penicillanic Acid/adverse effects , Piperacillin/administration & dosage , Piperacillin/adverse effects , Piperacillin, Tazobactam Drug Combination , Prosthesis-Related Infections/surgery , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/immunology , Vancomycin/administration & dosage
5.
J Bronchology Interv Pulmonol ; 22(3): 251-8, 2015 Jul.
Article in English | MEDLINE | ID: mdl-26165897

ABSTRACT

Pulmonary alveolar proteinosis is a disease caused by increased accumulation and impaired clearance of surfactant by alveolar macrophages. This narrative review summarizes the role of therapeutic whole-lung lavage in the management of pulmonary alveolar proteinosis. We describe the preprocedural evaluation, indications, and anesthetic considerations, along with step-by step technical aspects of the procedure, postoperative recovery, potential complications, and long-term outcomes.


Subject(s)
Bronchoalveolar Lavage/methods , Lung Diseases, Interstitial/therapy , Pulmonary Alveolar Proteinosis/therapy , Bronchoalveolar Lavage/adverse effects , Follow-Up Studies , Hospitalization , Humans , Lung Diseases, Interstitial/physiopathology , Operating Rooms , Pulmonary Alveolar Proteinosis/physiopathology
7.
J Clin Anesth ; 26(8): 693-6, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25439398

ABSTRACT

Routine chest roentgenogram to confirm catheter placement in a postsurgical patient showed a left-sided internal jugular central venous catheter that did not appear to cross the midline. Arterial blood gas samples showed greater oxygenation from the central catheter as compared with the peripheral arterial sample. However, a transduced waveform showed a venous tracing and pressure. Computed tomographic scan of the thorax without intravenous contrast showed a partial anomalous pulmonary venous connection with drainage of the left upper lobe pulmonary vein into the innominate vein.


Subject(s)
Catheterization, Central Venous , Pulmonary Veins/abnormalities , Vascular Malformations/diagnosis , Aged , Blood Gas Analysis , Critical Care , Humans , Incidental Findings , Male , Oxygen/metabolism , Tomography, X-Ray Computed , Vascular Malformations/pathology
8.
J Clin Anesth ; 26(3): 231-4, 2014 May.
Article in English | MEDLINE | ID: mdl-24793702

ABSTRACT

Patients receiving preoperative lithium therapy for bipolar disorder may present unique challenges in the perioperative period and during critical illness. Two cases of critically ill patients who developed lithium-induced adverse reactions in the perioperative period due to the low therapeutic index are reported.


Subject(s)
Antimanic Agents/adverse effects , Bipolar Disorder/drug therapy , Lithium Compounds/adverse effects , Antimanic Agents/administration & dosage , Critical Illness , Female , Humans , Lithium Compounds/administration & dosage , Middle Aged , Postoperative Period
16.
Liver Transpl ; 14(1): 46-52, 2008 Jan.
Article in English | MEDLINE | ID: mdl-18161838

ABSTRACT

Twenty adult patients undergoing orthotopic liver transplantation (OLT) were enrolled in this study, with the noninvasive indocyanine green plasma disappearance rate (ICG-PDR) measured both during and after OLT to assess the relationship between ICG-PDR and the ability of patients to achieve therapeutic postoperative tacrolimus immunosuppressant blood levels. Liver function was determined at both 2 and 18 hours post reperfusion with the ICG-PDR k value (1/min). Postoperative standard serum measures of liver function as well as liver biopsies were also collected and analyzed. The median ICG-PDR k value for the study group at 2 hours post reperfusion was 0.20 (0.16, 0.27), whereas at 18 hours post reperfusion, it was 0.22 (0.18, 0.35). The median change in the k value between the two ICG-PDR measurements was 0.05 (-0.02, 0.07) with P = 0.02. There was an interaction between the postoperative day 1 (18 hours post reperfusion) ICG-PDR k value and the linear increase in the tacrolimus blood level, such that the greater the k value was, the more gradual the observed rise was in tacrolimus over time [that is, the longer it took to achieve a therapeutic blood level (>12 ng/mL), P = 0.003]. Of the 16 patients that received tacrolimus, comparable dosing on a per kilogram body weight basis was observed. Also, no significant association between ICG-PDR k values and postoperative liver biopsy results was seen. This study demonstrates that the ICG-PDR measurement is a modality with the potential to assist in achieving adequate blood levels of tacrolimus following OLT.


Subject(s)
Coloring Agents/pharmacokinetics , Graft Rejection/drug therapy , Immunosuppressive Agents/administration & dosage , Indocyanine Green/pharmacokinetics , Liver Failure/surgery , Liver Transplantation , Tacrolimus/administration & dosage , Biopsy , Female , Follow-Up Studies , Graft Rejection/diagnosis , Graft Rejection/metabolism , Humans , Liver Failure/diagnosis , Liver Failure/metabolism , Male , Middle Aged , Predictive Value of Tests , Prognosis , Prospective Studies
17.
J Gastrointest Surg ; 8(4): 428-33, 2004.
Article in English | MEDLINE | ID: mdl-15120367

ABSTRACT

Complications following pancreaticoduodenectomy are common, partly because of nutritional debilitation. The aim of this study was to evaluate the impact of early postoperative tube feeding on outcome of pancreaticoduodenectomy and determine the best method for delivering enteral feeding. A retrospective review of 180 consecutive patients undergoing Whipple operations from 1994 to 2000 was performed. Two nonrandomized patient groups were retrospectively studied: those with early postoperative tube feeding vs. those with no planned feeding. Ninety-eight patients (54%) received postoperative jejunal feeding, whereas 82 patients (46%) did not. Jejunal feeding was delivered via a bridled nasojejunal tube in 55 patients (56%) and a gastrojejunal tube in 43 (44%). Vomiting (10% vs. 29%; P=0.002) and use of total parenteral nutrition (6% vs. 27%; P < 0.0001) were less in the jejunal feeding group as well as rates of readmission (12% vs. 27%; P=0.022), early (52% vs. 62%; P=0.223) and late (12% vs. 31%, P=0.005) complications, and infections (13% vs. 20%, P=0.014). Tube-related complications occurred in 6 of 98 patients, all of which were associated with gastrojejunal tubes (P=0.021). Early postoperative tube feeding after pancreaticoduodenectomy is associated with significantly less use of total parenteral nutrition and lower rates of readmission and complications. A bridled nasojejunal feeding tube appears to be a safe and reliable method of short-term enteral feeding.


Subject(s)
Enteral Nutrition , Pancreaticoduodenectomy , Postoperative Complications/therapy , Aged , Female , Humans , Jejunum , Male , Middle Aged , Pancreaticoduodenectomy/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Treatment Outcome
18.
Neurocrit Care ; 1(3): 367-9, 2004.
Article in English | MEDLINE | ID: mdl-16174936

ABSTRACT

The authors report the first case of propofol use for the control of non-epileptic involuntary movements in a patient with postviral encephalitis. The withdrawal from propofol was associated with re-emergence of involuntary movements. The patient was maintained on propofol infusion for 6 months while a series of medications were used in an attempt to control the movements. The movements were finally controlled with high doses of phenobarbital, diazepam, and olanzapine, and the propofol was slowly weaned.


Subject(s)
Anticonvulsants/therapeutic use , Dyskinesias/drug therapy , Propofol/therapeutic use , Adult , Dyskinesias/etiology , Encephalitis, Viral/complications , Female , Humans
19.
Infect Control Hosp Epidemiol ; 24(5): 347-50, 2003 May.
Article in English | MEDLINE | ID: mdl-12785408

ABSTRACT

BACKGROUND: Patients with penicillin allergy admitted to the intensive care unit (ICU) frequently receive non-beta-lactam antimicrobials for the treatment of infection. The use of these antimicrobials, more commonly vancomycin and fluoroquinolones, is associated with the emergence of multidrug-resistant infections. The penicillin skin test (PST) can help detect patients at risk of developing an immediate allergic reaction to penicillin and those patients with a negative PST may be able to use a penicillin antibiotic safely. METHODS: We determined the incidence of true penicillin allergy, the percentage of patients changed to a beta-lactam antimicrobial when the test was negative, the safety of the test, and the safety of administration of beta-lactam antimicrobials in patients with a negative test. Skin testing was performed using standard methodology. RESULTS: One hundred patients admitted to 4 ICUs were prospectively studied; 58 of them were male. The mean age was 63 years. Ninety-six patients had the PST: one was positive (1.04%), 10 (10.4%) were nondiagnostic, and 85 (88.5%) were negative. Of the 38 patients who received antimicrobials for therapeutic reasons, 31(81.5%) had the antibiotic changed to a beta-lactam antimicrobial after a negative reading versus 7 patients of the 57 (12%) who had received a prophylactic antimicrobial (P < .001). No adverse effects were reported after the PST or after antimicrobial administration. CONCLUSIONS: The PST is a safe, reliable, and effective strategy to reduce the use of non-beta-lactam antimicrobials in patients who are labeled as penicillin allergic and admitted to the ICU.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Hypersensitivity/diagnosis , Intensive Care Units , Penicillins/adverse effects , Skin Tests , Drug Resistance, Multiple , Humans , Lactams , Ohio , Prospective Studies
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