ABSTRACT
BACKGROUND: High-frequency oscillatory ventilation (HFOV) may be used as a rescue therapy for adults with acute respiratory distress syndrome who have failed conventional ventilation (CV). We undertook a prospective study to investigate the determinants of mortality and the sequential evolution of organ failures in HFOV-treated adult acute respiratory distress syndrome patients. METHODS: The indication for HFOV was severe oxygenation failure (PaO2/FiO2 <120 mm Hg) while receiving aggressive CV support (defined by either PaO2 ≤65 mm Hg with FiO2 ≥0.6 when positive end-expiratory pressures >10 cmH2O or plateau airway pressure ≥35 cm H2O). Demographic, clinical, and physiologic data were collected prospectively (May 2007-July 2009). Organ System Failure (OSF), Sequential Organ Failure Assessment (SOFA), and Multiple Organ Dysfunction (MOD) scores were recorded during and after HFOV application. Additional outcome measures included HFOV successful weaning rate, cause of failure, complications, survival rate, and cause of death. RESULTS: The intensive care unit mortality rate was 62% (21 of 34). Survivors had a significantly shorter CV time before HFOV than nonsurvivors (32.8 hours ± 16.7 hours vs. 47.9 hours ± 26.2 hours, p = 0.049). Survivors had significantly lower baseline lung injury scores, OSF, SOFA, and MOD scores than nonsurvivors. After HFOV, the OSF, SOFA, and MOD scores were significantly decreased for survivors, particularly from day 3 onward. CONCLUSIONS: Survivors had early improvements in OSF scores after HFOV application. Organ failure system scoring may be used for deciding on HFOV initiation and for evaluating the effects of HFOV.
Subject(s)
High-Frequency Ventilation/methods , Hospital Mortality/trends , Multiple Organ Failure/mortality , Respiratory Distress Syndrome/mortality , Respiratory Distress Syndrome/therapy , Adult , Aged , Blood Gas Analysis , Cohort Studies , Critical Care/methods , Female , Follow-Up Studies , High-Frequency Ventilation/adverse effects , Humans , Intensive Care Units , Male , Middle Aged , Multiple Organ Failure/diagnosis , Multiple Organ Failure/therapy , Oxygen Consumption/physiology , Positive-Pressure Respiration/adverse effects , Positive-Pressure Respiration/methods , Prospective Studies , Respiratory Distress Syndrome/diagnosis , Risk Assessment , Survival Analysis , Taiwan , Treatment Outcome , Ventilator WeaningABSTRACT
Pneumococcal (Pnc) carriage is associated with pneumococcal diseases. Breast feeding and maternal vaccinationmay be a useful approach to prevent pneumococcal infection in young infants. We examined the risk of Pnc carriageby infants at six months of age after pneumococcal polysaccharide vaccination of pregnant women. We selected 139pregnant woman. The woman were randomly allocated to receive 23-valent polysaccharide vaccines during pregnancy(Group 1) after pregnancy (Group 2) or not receive any vaccine (Group 3). Nasopharyngeal swabs were collectedfrom the infants at three and six months of age. The infants were evaluated monthly during the first six months. Weincluded 47 mothers in Group 1, 45 mothers in Group 2 and 47 mothers in Group 3. Forty-seven percent of the babieswere exclusively breast fed until six months, 26% received both breast feeding and artificial feeding and 13%received only artificial feeding. Among those patients, 26% were colonized by Pnc at six months (12 from group 1,13 from group 2, and 12 from group 3). There was no significant difference in colonization between the three groups.Thirty percent of the children were colonized by a non-susceptible strain. We concluded that young infants (threemonths old) are already susceptible to pneumococcal carriage. Vaccination during pregnancy with a polysaccharidevaccine did not decrease Pnc colonization.
Subject(s)
Humans , Pregnancy , Pneumonia, Pneumococcal/immunology , Pneumococcal VaccinesABSTRACT
Pneumococcal (Pnc) carriage is associated with pneumococcal diseases. Breast feeding and maternal vaccinationmay be a useful approach to prevent pneumococcal infection in young infants. We examined the risk of Pnc carriageby infants at six months of age after pneumococcal polysaccharide vaccination of pregnant women. We selected 139 pregnant woman. The woman were randomly allocated to receive 23-valent polysaccharide vaccines during pregnancy(Group 1) after pregnancy (Group 2) or not receive any vaccine (Group 3). Nasopharyngeal swabs were collectedfrom the infants at three and six months of age. The infants were evaluated monthly during the first six months. Weincluded 47 mothers in Group 1, 45 mothers in Group 2 and 47 mothers in Group 3. Forty-seven percent of the babieswere exclusively breast fed until six months, 26% received both breast feeding and artificial feeding and 13%received only artificial feeding. Among those patients, 26% were colonized by Pnc at six months (12 from group 1,13 from group 2, and 12 from group 3). There was no significant difference in colonization between the three groups.Thirty percent of the children were colonized by a non-susceptible strain. We concluded that young infants (threemonths old) are already susceptible to pneumococcal carriage. Vaccination during pregnancy with a polysaccharidevaccine did not decrease Pnc colonization.(AU)
