Use of linezolid in critically ill patients admitted to intensive care units.

All indications of linezolid (LZD) in Intensive Care Units (ICU) were included as cases in an observational, prospective and multicentre study. One hundred thirty-nine indications were analyzed. In most cases (92.7%), treatment for nosocomial infections was indicated. The most frequent infection was pneumonia (42.7%), followed by catheter-related bacteraemias (CRB). A total of 58.7% of the indications were empirical and in 45.7% of the cases the cultures confirmed infection by gram-positive cocci (GPC). In 43 cases (31.2%), the indication was made as a rescue measure (mainly due to clinical failure) in patients previously treated with glycopeptides. Of isolated GPC, 70.2% were methicillin-resistant. The cure rate of the population per intent-to-treat was 73.2%. Only one case of thrombocytopenia was recorded. Conclusions. LZD is used with a high degree of diagnostic safety. In the ICU, it is primarily indicated to treat pneumonias and CRB with good clinical and microbiological response. This antibiotic has acted as a good therapeutic resource against clinical failure in infections treated with glycopeptides.

Use of linezolid in critically ill patients admitted to Intensive Care Units / Uso del linezolid en pacientes enfermos admitidos en las Unidades de Cuidados Intensivos

All indications of linezolid (LZD) in Intensive Care Units (ICU) were included as cases in an observational, prospective and multicentre study. One hundred thirty-nine indications were analyzed. In most cases (92.7%), treatment for nosocomial infections was indicated. The most frequent infection was pneumonia (42.7%), followed by catheter-related bacteraemias (CRB). A total of 58.7% of the indications were empirical and in 45.7% of the cases the cultures confirmed infection by gram- positive cocci (GPC). In 43 cases (31.2%), the indication was made as a rescue measure (mainly due to clinical failure) in patients previously treated with glycopeptides. Of isolated GPC, 70.2% were methicillin-resistant. The cure rate of the population per intent-to-treat was 73.2%. Only one case of thrombocytopenia was recorded. Conclusions. LZD is used with a high degree of diagnostic safety. In the ICU, it is primarily indicated to treat pneumonias and CRB with good clinical and microbiological response. This antibiotic has acted as a good therapeutic resource against clinical failure in infections treated with glycopeptides (AU)

En un estudio observacional, prospectivo y multicéntrico, los casos incluidos fueron todas las indicaciones de linezolid en las Unidades de Cuidados Intensivos (UCI). Se analizaron 139 indicaciones. En la mayoría de los casos (92,7%), había indicación para un tratamiento de infecciones nosocomiales. La infección más frecuente fue la neumonía (42,7%), seguida de bacteriemias relacionadas con catéteres. Un total del 58,7% de las indicaciones fue empírico, mientras que, en el 45,7% de los casos, los cultivos confirmaron una infección por cocos grampositivos. En 43 casos (31,2%), la indicación se estableció como medida de rescate (principalmente por fracaso clínico) en pacientes tratados previamente con glucopéptidos. El 70,2% de los cocos grampositivos aislados fue meticilina resistente. La tasa de curación de la población de intención de tratar fue del 73,2%. Únicamente se registró un caso de trombocitopenia. Conclusiones. El uso de linezolid demostró un elevado grado de seguridad diagnóstica. Su indicación principal en la UCI es el tratamiento de neumonías y bacteriemias relacionados con catéteres obteniéndose una buena respuesta clínica y microbiológica. Este antibiótico ha actuado como un buen recurso terapéutico frente al fracaso clínico en las infecciones tratadas con glucopéptidos (AU)

Early vs conventional extubation after cardiac surgery with cardiopulmonary bypass.

OBJECTIVES: Sedation and ventilation overnight after cardiac surgery is common practice. However, early extubation may be feasible with no increase in postoperative complications. This study examines (1) if early extubation is possible in a significant number of patients, (2) if it reduces ICU stay, and (3) if this practice increases postoperative complications. DESIGN: Prospective, controlled, randomized clinical trial. PATIENTS AND METHODS: We randomized 404 consecutive patients to early extubation (7 to 11 h postoperatively) (group A, 201 patients) or conventional extubation (between 8 and 12 AM the following day) (group B, 203 patients). Variables included type and severity of the disease, surgical risk, type of operation, operative incidences, postoperative complications, duration of mechanical ventilation, intubation and ICU stay, bleeding, reoperation, vasoactive drugs, and mortality. RESULTS: Groups were comparable. Extubation within the preestablished time was successful in 60.2% of patients in group A and 74.4% in group B. Median ICU stay was 27 h in group A and 44 h in group B (p=0.008). Discharge from ICU within the first 24 h postoperatively was 44.3% in group A and 30.5% in group B (p=0.006). There was no significant difference in complications between groups. Successfully extubated patients in group A had more reintubation and prolonged ventilation than in group B. CONCLUSIONS: (1) Sixty percent of our patients were extubated within 11 h of operation. (2) As a result, the length of stay in ICU was reduced and the percentage of patients discharged within 24 h was increased. (3) There was no increase in clinically important postoperative complications.

Computer assisted management of information in an intensive care unit.

In order to use the capability of computers for handling large amounts of information, we developed a program for the acquisition, handling, storage and retrieval of administrative and clinical information generated in the 20 bedded multidisciplinary critical care unit of a University Hospital. At an initial phase a personal computer (PC) was used to collect information from 4362 patients, that included registration data, coded admission problems, techniques and special treatments, and final diagnosis. This information combined with free text provided a discharge report. Complementary programs allowed calculation and storage of hemodynamic and gas exchange parameters. This experience led to a second phase in which a computer with microprocessor Intel 80386 at 25 MHz, 8 MB RAM, 310 MB hard disk and a streamer for 150 MB cartridge tape back up, using UNIX operating system, permitted multiple users working simultaneously through 1 central console and 7 ASCII terminals. Data input included demographic data, previous and admission problems in coded form, present history and physical examination in free text, list of present problems in coded form, comments on evolution, record of special techniques and treatments, laboratory data, treatment, final diagnosis and facility for using all the information to elaborate the final report. Side modules provide help for drugs dosing, protocols for specific conditions and clerical routines. The system is open for connection to other areas of the Hospital. Data from more than 2000 patients have been included so far.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-base derangements during sorbent regenerative hemodialysis in mechanically ventilated patients.

OBJECTIVE: To assess acid-base derangements during sorbent regenerative hemodialysis in mechanically ventilated patients. DESIGN: Consecutive case series; prospective study. SETTING: An ICU in a university hospital. PATIENTS: Seven patients undergoing hemodialysis for acute renal failure who required mechanical ventilation for acute respiratory failure. INTERVENTIONS: Pulmonary and systemic hemodynamics, pH, and gas tensions in dialysate, arterial and mixed venous blood, and blood entering and leaving the dialyzer, were measured before, during, and after hemodialysis. MEASUREMENTS AND MAIN RESULTS: During the first 2 hrs of hemodialysis, dialysate pH decreased from 6.91 +/- 0.14 to 6.06 +/- 0.37 and PCO2 increased to 437 +/- 111 torr (58.2 +/- 14.8 kPa). Simultaneously, the patients lost bicarbonate into the bath. As a result, pHa decreased from 7.38 +/- 0.02 to 7.31 +/- 0.02. At the end of dialysis, pHa returned to normal. CONCLUSION: Sorbent hemodialysis in mechanically ventilated patients is accompanied by acidosis that may contribute to hemodynamic instability.