Stepwise implementation of prevention strategies and their impact on ventilator-associated pneumonia incidence: A 13-Year observational surveillance study.

OBJECTIVE: To describe the practice of ventilator-associated pneumonia (VAP) prevention and control through the incremental introduction of prevention strategies and assess the effect on VAP incidence. DESIGN: Historical observational surveillance study conducted over 13 years. SETTING: A 12-bed adult intensive care unit (ICU) in a general hospital in Belgium. PARTICIPANTS: Patients admitted between 2007 and 2019, with ICU stays of ≥48 h. INTERVENTIONS: Incremental introduction of VAP preventive measures from 2008, including head-of-bed elevation, cuff pressure control, endotracheal tubes with tapered cuffs, subglottic secretion drainage, chlorhexidine oral care, and daily sedation assessment. MEASUREMENTS AND MAIN RESULTS: A significant decline in VAP incidence density rates was observed, from 18.3 to 2.6 cases per 1000 ventilator days from the baseline to the final period. CONCLUSIONS: Systematic implementation of VAP preventive measures significantly reduced VAP incidence. However, this reduction did not translate into decreased overall ICU mortality. IMPLICATIONS FOR PRACTICE: The study underscores the importance of continuous VAP surveillance and preventive measures in reducing VAP incidence.

For the love of muscles: a bodybuilder with complicated left ventricular heart failure.

Anabolic-androgenic steroid misuse is associated with cardiovascular toxicity. We report a unique case of a 46-year-old male bodybuilder with nonischemic systolic heart failure complicated with a large left ventricular thrombus and multiple emboli presumably caused by long-term abuse of anabolic steroids. The patient experienced almost full recovery after cessation of anabolic steroid use, initiation of oral anticoagulation and guideline-directed heart failure medical therapy. This case illustrates the importance of early recognition and appropriate medical management of anabolic-androgenic steroid induced cardiomyopathy.

Mitral annuloplasty for dilated cardiomyopathy with mitral regurgitation.

OBJECTIVES: This study reports survival, functional status, the change in post-operative left ventricular dimensions and function after'undersized mitral annuloplasty' in patients with non-ischaemic non-valvular dilated cardiomyopathy and secondary mitral regurgitation. PATIENTS AND METHODS: Between 2003 and 2009 10 patients (mean age 61.5 +/- 14 years) with non-ischaemic, non-valvular dilated cardiomyopathy with left ventricular ejection fraction (LV EF) <40% (mean +/- SD, 30.7 +/- 5.27) underwent isolated mitral repair and annuloplasty. All patients were receiving maximal drug therapy. Preoperatively 1 patient (10%) was functioning in New York Heart Association (NYHA) class II, 8 patients (80%) in class III and 1 patient (10%) in class IV. Transthoracic echocardiography was performed immediately before surgery and one year after surgery to assess valvular and ventricular function. For statistical analysis we have used paired t-tests and Wilcoxon's rank test. RESULTS: There were no hospital deaths. Duration of intubation and ICU stay was 1.8 +/- 1.3 and 3.8 +/- 1.8 days, respectively. Functional class after one year was significantly better than the preoperative value (from 3.00 +/- 0.47 to 1.40 +/- 0.52, P<0.001). One year post-operative data showed significant improvement of LV EF (from 30.70 +/- 5.27 to 46.60 +/- 14.47%) and a decrease of the left ventricular diastolic dimension (LVDd) (from 59.30 +/- 5.62 to 50.70 +/- 6.04 mm). CONCLUSION: Isolated undersized mitral annuloplasty in patients with non-ischaemic non-valvular dilated cardiomyopathy with associated mitral regurgitation, is a safe method with the potential of improving functional class, LV EF, and LVDd after one year.