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Presence of cardiac activity on ultrasound is a weak predictor of return of spontaneous circulation. We are aware of a large multicenter prospective study currently examining the same question as we have attempted to answer. It is hoped that the REASON study will answer definitively which components of cardiac activity seen on echo during cardiac arrest might predict outcome including return of spontaneous circulation and survival to hospital discharge.

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If the address matches an existing account you will receive an email with instructions to retrieve your username. Academic Emergency Medicine Volume 19, Issue Progressive Clinical Practice Free Access. Search for more papers by this author. Tools Request permission Export citation Add to favorites Track citation.

Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Objectives: The objective was to determine if focused transthoracic echocardiography echo can be used during resuscitation to predict the outcome of cardiac arrest. Study Selection To ensure that all relevant articles were identified by the literature search and that those returned were unbiased and relevant, we developed strict inclusion and exclusion criteria. Figure 1 Open in figure viewer PowerPoint.

Figure 2 Open in figure viewer PowerPoint. Summary and Forest plot of individual and pooled negative LRs. Figure 3 Open in figure viewer PowerPoint. Summary and Forest plot of individual and pooled positive LRs.

Extracorporeal Resuscitation of Cardiac Arrest

Figure 4 Open in figure viewer PowerPoint. Supporting Information Data Supplement S1. Search strategy. Accessed Jul 18, Google Scholar. Crossref PubMed Google Scholar. PubMed Google Scholar. Crossref Google Scholar. Citing Literature. Volume 19 , Issue 10 October Pages Figures References Related Information.

Close Figure Viewer. Browse All Figures Return to Figure. Previous Figure Next Figure. Email or Customer ID. Forgot password? For SAEM members, you must be signed into saem. Go to saem. Old Password. New Password. The concordance at the clinical cut-off 0. No significant bias was observed compared to the reference method.

Introduction: Procalcitonin PCT is a serum biomarker suggested by the Surviving Sepsis Campaign to aid in determination of the appropriate duration of therapy in septic patients. Trauma patients have a high prevalence of septic complications, often difficult to distinguish from inflammatory response. PCT values typically declined after 72h from trauma and increased only during secondary systemic bacterial infections.

The aims of the study are to evaluate reliability and usefulness of PCT serum concentration in trauma. Plasma PCT concentration was measured using an automate analyzer Modular E-Brahms on 1st day of antimicrobial therapy and every 48h hours. Antimicrobial therapy was stopped according to a local protocol; however medical judgment was considered the overriding point for therapeutic decision.

Results: Median ISS of patients was PCT mean concentration at the starting of antimicrobial treatment was Daily course of PCT was not related to distance from trauma Rho In 21 of 40 patients Conclusions: Our experience suggests that PCT could help physician to optimize duration of antimicrobial therapy in trauma patients. No standard approach can be recommended at present. Introduction: Long duration of antimicrobial treatment may predispose to colonization and subsequent infections by multidrug-resistant organisms MDRO and Clostridium difficile.

Methods: Adult patients with sepsis by the Sepsis-3 classification and any of five infections pneumonia community-acquired; hospital- acquired or ventilator-associated; acute pyelonephritis; primary bacteremia are randomized to PCT-guided treatment or standard of care SOC treatment. Patients are followed for six months. Serial stool samples are cultured for MDRO and screened for glutamate dehydrogenase antigen and toxins of C. Results: patients have been enrolled so far. Most common diagnoses are community-acquired pneumonia At baseline, Residency in health-care facilities was the only variable associated with C.

MDRO colonization was associated with residency in health-care facilities odds ratio 6. Introduction: Influenza causes deaths per year globally. It caused 80 deaths in the US in There are no blood-based diagnostics able to identify influenza infection and distinguish it from other infections.

We have previously described a blood-based gene influenza meta-signature IMS score to differentiate influenza from bacterial and other viral respiratory infections. Methods: We prospectively validated the IMS in a multi-site validation study by recruiting individuals patients with suspected influenza, 46 healthy controls in 10 community or hospital clinics across Australia.

Conclusions: Collectively, our prospective multi-center validation of the IMS demonstrates its potential in diagnosis of influenza infections. Summary of outcomes for patients. Introduction: Previous findings of our group suggest that patients with Gram-negative hospital-acquired severe sepsis have better prognosis when sepsis is developing after recent multiple trauma through stimulation of favorable interleukin IL responses [1].

Under a similar rationale, we investigated if preceding osteomyelitis may affect experimental osteomyelitis. Methods: Sham or experimental osteomyelitis was induced in 32 male New Zealand white rabbits after drilling a hole at the upper metaphysis of the left tibia and implementing diluent or 5log10 of Staphylococcus aureus using foreign body. After three weeks, the foreign body was removed and experimental pyelonephritis or sham surgery was induced after ligation of the right pelvo-ureteral junction and instillation of 6log10 of Escherichia coli in the renal pelvis. Survival was recorded and circulating mononuclear cells were isolated and stimulated for the production of tumour necrosis factor-alpha TNFa and IL At death or sacrifice, tissue outgrowth and myeloperoxidase MPO were measured.

Results: Four sham-operated rabbits S , 16 rabbits subject to sham surgery and then pyelonephritis SP and 12 rabbits subject to osteomyelitis and then pyelonephritis OP were studied. Survival after 14 days of group SP was Lab findings are shown in Figure 1. Il production was blunted. Negative correlation between E. Conclusions: Preceding staphylococcal osteomyelitis provides survival benefit to subsequent experimental osteomyelitis through down-regulation of innate immune responses leading to efficient phagocytosis. Introduction: Activation of neutrophils is a mandatory step and a sensitive marker of a systemic inflammatory response syndrome SIRS which is closely related to development of multiple organ failure.

The search for drugs that can prevent SIRS and reduce mortality in critically ill patients remains significant. The aim of this study was to study the anti-inflammatory effect of the synthetic analogue of leu-enkephalin Dalargin on human neutrophils. Methods: The study was conducted on isolated from the blood of healthy donors neutrophils. The statistical significance was estimated using Mann-Whitney test.

Results: Synthetic analogue of leu-enkephalin in various concentrations has an anti-inflammatory effect on both intact and pre-activated with bacterial components neutrophils, reducing their activation and degranulation in a dose-dependent manner Figs. Conclusions: Synthetic analogue of leu-enkephalin prevents neutrophil activation by bacterial compounds. This has a potential of translation into clinical practice for sepsis treatment. Tissue hypoxia during the progression of sepsis is associated with microcirculatory and mitochondrial disturbances.

Our aim was to investigate the possible influence of ETAr antagonist, ETBr agonist or combined treatments on oxygen dynamics, microcirculatory and mitochondrial respiration parameters in experimental sepsis. Invasive hemodynamic monitoring and blood gas analyses were performed during a min observational window. Intestinal microcirculation perfusion rate, red blood cell velocity - RBCV was investigated by intravital videomicroscopy.

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Results: The septic reaction was characterized by significant hypotension and decreased microperfusion, oxygen extraction and CI - CII-linked OxPhos values. The ETBr agonist treatment prevented the sepsis-induced hypotension, decrease in oxygen extraction, and significantly increased the perfusion rate. The combined therapy amplified the beneficial mitochondrial and microcirculation effects of selective ETAr antagonist and ETBr agonist compounds.

Conclusions: The combination of ETAr antagonism and ETBr agonism may offer a novel tool for a simultaneous microcirculatory and mitochondrial resuscitation strategy in sepsis. Introduction: Sepsis often induces immunosuppression, which is associated with high mortality rates. Nivolumab is a human IgG-4 antibody directed against the programmed cell death 1 PD-1 immune-checkpoint inhibitor, which disrupts PDmediated signaling and restores antitumor immunity. Nivolumab is an approved anti-cancer drug that may have the potential to improve sepsis-induced immunosuppression.

Results: Five and eight patients were assigned to the and mg groups, respectively. Lymphocyte counts and monocytic human leukocyte antigen DR-1 appeared to increase over time in both groups Figures 1 and 2. Adverse events AEs were observed in four patients in each group. Drug related-AEs were observed in only one patient in the mg group Table 2. No deaths related to nivolumab occurred. Conclusions: A single dose of mg nivolumab appeared to be well tolerated and sufficient to maintain nivolumab blood concentration in patients with sepsis.

Results suggest both and mg nivolumab therapy could improve relevant immune indices. C28d, serum drug concentration on Day 28; Ceoi, end of infusion drug concentration; Cmax, maximum peak serum drug concentration; Cmin, minimum trough serum drug concentration; SD, standard deviation; Q2W, every two weeks. Introduction: The systemic inflammatory response syndrome SIRS accompanies tissue trauma and infection and, when severe or dysregulated, contributes to multiple organ failure and critical illness.

Observational studies in man and animal have shown that low-dose acetyl-salicylic acid promotes resolution of inflammation and might attenuate excessive inflammation by increasing the synthesis of specialised pro-resolving lipid mediators SPMs. Methods: We randomly assigned patients with SIRS who were expected to stay in ICU for more than 48 hours to receive enteral aspirin mg per day or placebo for 7 days or until death or discharge from the ICU, whichever came first.

The primary outcome was IL-6 serum concentration at 48h after randomisation. The secondary outcomes included safety and feasibility outcomes. There were no significant differences for control vs. There were no between-group differences with respect to ICU or hospital mortality, number of bleeding episodes or requirements for red cell transfusions Table 2.

Conclusions: In patients admitted to the ICU with SIRS, low-dose aspirin did not result in a decreased concentration of inflammatory biomarkers compared with placebo. Introduction: Debilitating muscle weakness and impaired muscle regeneration is prevalent in ICU patients. Remarkably, premorbid obesity has been shown to protect against this weakness in both ICU patients and septic mice, which coincided with markers of elevated ketogenesis [1]. We here assessed whether ketone body supplementation could directly protect the muscle during sepsis.

Methods: In a resuscitated, antibiotic-treated mouse model of prolonged 5 days abdominal sepsis cecal ligation and puncture , lean ill mice received standard parenteral nutrition 5. Markers of muscle weakness and regeneration were assessed. These data identify nutritional 3HB supplementation as a potential preventive therapy for muscle weakness, requiring further investigation.

Vitamin C is a cellular antioxidant, it increases eNOS and decreases NF-kB; it has several immune-enhancing effects and is crucial for endogenous vasopressors synthesis. Vitamin C reserves in sepsis are often as poor as in scurvy [1]. In recent studies, intravenous high Vitamin C dose seems to reduce organ failure and improve outcome in septic shock. We enrolled 24 patients: 13 received Vitamins supplementation, 11 standard of care. Patients with end stage kidney disease were ruled out.

We analysed data with Mann-Whitney and Wilcoxon tests. Mean vasoactive therapy length was quite similar. DAF was No Vit C patient developed oxalate nephropathy nor worsened renal function. Introduction: In the light of new insight on pathogenesis of sepsis and after inconclusive randomized clinical trials RCTs , the benefit of macrolides as adjunctive, low-cost and promising molecules in sepsis, remains to be assessed. Patients are blindly randomized to receive either 1gr of intravenous clarithromycin or placebo once daily for four consecutive days.

The primary endpoint is survival at 28 days. The study is powered for patients. Results: Sixty-nine patients have been enrolled so far. SOFA score on enrollment is Introduction: Toxin-producing gram-positive organisms cause some of the most severe forms of septic shock [1,2]. Adjunctive therapies such as intravenous immunoglobulins IVIG have been proposed for these patients [3,4]. However, at patient presentation, the presence of a toxin-producing organism is most often unknown. IVIG use in these patients was generally safe, with only 1 possible transfusion reaction.

Conclusions: IVIG administration can be considered in a selected group of patients presenting with acute and very severe septic shock, as part of a multimodal approach [5]. Introduction: Extra corporeal treatments are used in septic patients to decrease the inflammatory mediators, but definitive conclusions are lacking. The aim of this study is to evaluate in septic patients with AKI: 1- the effect of the adsorbing membrane Oxiris on the immunological response 2- the different response in survivors and non survivors.

Student T test or Mann- Whitney was used to compare values changes. At Table 1 are shown the main results of this study in all the patients.

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This must be confirmed in a RCT. Introduction: Sepsis is common and often fatal, representing a major public health problem. Hemoadsorption CytoSorb therapy aims to reduce cytokines and stabilise the overall immune response in septic shock patients. All centres followed a common protocol and received ethics committee approval.

Results: A total of 45 patients were administered CytoSorb in addition to standard of care. Also there was reduction in inflammatory markers like Cytokines IL6 in most of the patients. All patients in survivor group showed a significant improvement in MAP No device related adverse effect was observed in any of the patients. Conclusions: In this multi-centered prospective IIS study, we could observe clinical benefits of Hemoadsorption CytoSorb therapy in Septic shock patients if the therapy was initiated early.

Larger randomised study are required to establish the above clinical benefits in larger patient population.

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Introduction: Sepsis and the multiorgan failure is a leading cause of mortality in the intensive care unit. Promising new therapies continue to be investigated for the management of septic shock. We used it as an adjuvant therapy in our patients with Sepsis due to varied causes. Institutional ethics committee approval was taken before initiating the study. Results: A total of patients 77 Male and 23 Females with a mean age of A total of 40 patients survived out of patients.

All the survivors showed a significant improvement in MAP Conclusions: Retrospective analysis showed significant reduction of vasopressors, Sepsis Score and improvement in MAP in survived group versus non-survived group. Looking into the positive outcome of this case series, randomized controlled studies are required to define the potential benefits of this new treatment option. Introduction: Septic shock is a life-threatening multiple organ dysfunction that has high morbidity and mortality in critically ill patients, due to a dysregulated host response to infection.

Treatment was combined with ECMO in 8 patients. Procalcitonin Conclusions: Therapeutic cytokine removal applied with CVVHDF in septic shock patients have positive contributions to biochemical parameters and provide survival advantage. Introduction: Recent studies have focused on demonstrating the potential benefits of immunomodulation in the management of septic patients.

Methods: After ethical approval was obtained, we prospectively included 39 patients admitted to the general ICU of Fundeni Clinical Institute. Clinical heart rate, arterial pressure, temperature, Glasgow coma scale and paraclinical data PaO2, serum bilirubin and creatinine, platelet count, white blood cell count, pH, C-reactive protein and procalcitonine , vasopressor support and need for mechanical ventilation were recorded before and after the three sessions.

Mean SOFA score decreased non-significantly from Conclusions: The use of CytoSorb was associated with a slight non-significant improvement in organ function and a decrease of procalcitonine levels. Thrombocytopenia remains one of the most important complications of renal replacement therapy. Introduction: Circulating cell-free neutrophil extracellular traps NETs would induce a microcirculatory disturbance of sepsis.

To address this issue, we evaluated the effect of hemoperfusion with a polymyxin B cartridge PMX-DHP; Toray, Japan , which was originally developed for the treatment in patients with Gram-negative bacterial infection, on circulating cell-free NETs in patients with septic shock and in phorbol myristate acetate PMA -stimulated neutrophils obtained from healthy volunteer. Methods: Ex vivo closed loop hemoperfusion was performed through a circuit formed by connecting the small PMX module to a tube and a peristalsis pump. Whole blood from healthy volunteers incubated with or without PMA or from septic shock patients were applied to circuit and perfused.

Blood was collected at 0, 1 and 2 hr after perfusion. Selective removal of circulating components of NETs may improve the remote organ damage in patients with septic shock.

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Each values were also compared to EAA levels. EAA levels were significantly increased in gram-negative bacteremia patients compared to the patients with gram-positive bacteremia or fungemia. Introduction: Numerous inconclusive randomized clinical trials RCTs in sepsis in the past years suggest a need to re-think trial design to improve resource allocation and facilitate policy adoption decisions.

We aim to compare the original one-shot trial with an alternative sequential design that balances trial costs and value of information. Methods: Adult patients with sepsis, respiratory failure and total SOFA score of at least 7, are randomized to receive intravenous clarithromycin or placebo adjunctive to standard-of-care therapy. Fixed and variable costs of trial execution including administrative, insurance, supplies, tests are calculated; hospitalization cost is extracted from patient records; medical care beyond day 28 is recorded; cost of adoption in the general population is estimated.

Known incidence of sepsis with respiratory failure allows estimation of the population to benefit from trial decision. A Bayesian model is used to determine the sequential design that maximizes trial value. Results: We will compare the performance of the sequential trial design with the one-shot design of INCLASS trial in terms of sample size, cost, social-welfare, and probability of correctly identifying the best treatment. Conclusions: In this protocol we validate a Bayesian model for sequential clinical trials and assess the benefits for the patient population and health care system.

Introduction: CytoSorb-Adsorption has been described as an effective way for hemodynamic stabilisation in septic shock [1]. Aim of this study was to examine whether the adsorption-therapy could influence patient-outcome with catecholamine resistant septic shock CRSS and acute renal failure ARV. Furhtermore we tried to identify clinical constellations that would predict an effective use of adsorbers. The efficacy was assesed by means of laboratory tests, catecholamine dependency and outcome.

Calculations were done with non-parametric-tests depicted as median values [Q25, Q75]. Length of intensive care unit stay LOS did differ significantly 13 days [4,24] vs 22 days [19,29]. Conclusions: IL-6 can be reduced with adsorption. Patients with catecholamine-reduction did not differ in regard to their initial IL LOS was shorter for patients treated with adsorption. According to our experience adsorption can be taken into consideration when CRSS is beginning. The aim of this study was to determine the adequate starting period of expanded application to the contact precautions in the scheduled surgical patients in the mixed ICU.

Methods: We performed retrospective observational study on patients who were admitted to our ICU after planed surgery from May to Dec. We detected the patients who acquired BD newly and investigated the relation to the length of ICU stay. Finally, we made the logistic regression model of each cutoff day day1 to 7 and compared Odds Ratio OR and AUC of each models using stata. Results: Category day 2 or more, especially day 4 or more had significantly higher detection rate of DB compared to day 1 Table 1.

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Similar results were observed in OR according to logistic regression. According to each cutoff day models of logistic regression, the day 4 model had the highest OR Relationship between duration of ICU stay and detection of bacteria and toxin that required contact precautions. Introduction: The objective of this study was to evaluate the incidence density of urinary tract infection associated with bladder catheter in neurological intensive care unit and identification of actions that were related to low prevalence.

Methods: A retrospective analysis of the hospitalized patients from December to January was carried out, considering the patients who used the bladder catheter and the cases of urinary tract infection, correlating with improvement actions implemented in the period. Results: In the analyzed period, patients were hospitalized in the unit, with mean age of Of these, 27 had a urinary tract infection, which represented 1. During the analyzed period, urological physiotherapy was monitored, daily check of the urinary tract infection prevention bundle, analysis of all cases of infection with search of barriers breaking through Ishikawa methodology, feedback to the multiprofessional team of indicators related to the presence of invasive device, monthly monitoring of the mean time of bladder catheter with established goals.

Conclusions: It is possible to guarantee low prevalence of urinary tract infection, in a complex profile of patients, through a multiprofessional approach, accompanied by structured management of data analysis and monitoring. Introduction: Surgical site infection SSI is a risk in every operation wound, as it negatively impacts patient morbidity and mortality, and also increases financial demands, such as prolonged hospital stay, further antibiotics and surgical procedures.

The aim of this study was to analyse SSI and its risk factors after thoracic and lumbar surgery.

Methods: A six-year monocentric observation prospective cohort study monitored the incidence of SSI, wound complications and further risk factors in consecutive patients after planned thoracic and lumbar surgery for degenerative disease, trauma and tumour. All patients received short antibiotic prophylaxis before and during long operations. All wound complications and SSI were monitored up to 30 days and 1 year after operations.

We searched for risk factors for SSI in multivariate logistic regression analysis. Results: We recorded 22 incidences of SSI 8. Predictor of SSI in multivariate logistic regression analysis was hospital wound complications OR Conclusions: Contrary to the prevailing literature, our study did not identify corticoids, diabetes mellitus or transfusions as risk factors for the development of SSI, but only wound complications and warm seasons. There are different education measures written material with reminders, continuous feedback, interventions involving novel equipment on performance of hand hygiene.

In the present study, we assessed the impact of immediate verbal feedback on performance of hand hygiene by health care workers using a new Continuous Closed-circuit Television Monitoring CCTV method and direct, overt analog observation method. Methods: This is an interventional study. We conducted overt — direct observations and covert - CCTV observational sessions to measure hand hygiene compliance before and after interventional measures of health care workers HCWs in our ICU.

As interventional measures, we used personal verbal immediate feedback at the end of the overt observational session, performed by infection control nurse. Results: Overall, opportunities to perform hand hygiene. We believe that it needs additional scrutiny and combining additional intervention strategies to improve hand hygiene compliance. Introduction: Cytomegalovirus CMV has been recognized as an important pathogen in immunocompromised individuals for as long time.

In recent years, some studies have focused on CMV infection among immunocompetent intensive care patients. The results are inconsistent and the impact of this virus on the prognosis of these patients is not solved. Our purpose were to determine the prevalence, the risk factors and the consequence of CMV infection in immunocompetent intensive care unit patients. Methods: Observational retrospective case-control study comparing two groups of intensive care patients: CMV-positive and CMV-negative. Patients suspected of developing CMV infection were included.

CMV impact on prognosis was judged by the complications developed and mortality. Another comparison among infected patients between the deceased and the living was carried out in order to determine CMV morbidity and mortality factors. No significant differences in age, sex, comorbidities, severity, ventilation, use of amines and corticosteroids were found. CMV was not associated with significant morbidity and mortality. Conclusions: CMV infection is common in immunocompetent intensive care patients. Transfusion history is a risk factor of infection. CMV is a marker of the severity of the underlying disease of patients rather than a cause of morbidity and mortality.

Introduction: Necrotizing soft tissue infections NSTI are characterised by extensive tissue necrosis, triggering an overwhelming inflammatory response like sepsis or septic shock [1]. The mortality rate is high and the search for predicting factors has brought conflicting results. We hypothesized that inflammation parameters and organ dysfunctions in the first 24h may correlate with mortality on the intensive care unit ICU. Methods: We analysed retrospectively electronic data from patients who were admitted to our University Hospital during For the statistical analysis we used SPSS, version Results: 59 patients with NSTI were admitted during the study period.

There were 41 males Plotting a receiver operator characteristic curve for the SOFA score against mortality, we obtained an area under the curve of 0. Both kidney and liver dysfunction were significantly linked to a higher risk of mortality. An association of four or more organ dysfunctions increased the risk of death by a factor of 8. Conclusions: SOFA score and presence of liver or kidney dysfunction respectively in the first 24h correlated well with an increased risk of death.

The different inflammatory markers showed no predicting value towards the risk of mortality. Introduction: Ventilator-associated pneumonia VAP is one of the leading infection in critically ill patients. The study was approved by the Ethics Committee of our institution. Patients next of kin provided written informed consent. Introduction: Immunological dysfunction is common in critically ill patients but the optimal method to measure it and its clinical significance are unknown. Methods: A secondary analysis of a phase 2 randomized, multi-centre, double-blinded placebo controlled trial [1].

There were no differences in allocation groups; all the patients were analyzed as one cohort. The primary outcome was the development of NIs; secondary outcomes included day mortality. Results: Data was available for patients. Baseline characteristics and outcomes are reported in Tables 1 and 2. Both comparisons showed no difference between NIs and clinical outcomes between tertiles. Conclusions: Admission ex-vivo stimulated TNF-a level is not associated with the occurrence of NIs or clinical outcomes.

Further study is required to evaluate the ability of this assay to quantify immune function over the course of critical illness. Introduction: We believe traditional ventilator associated pneumonia VAP is limited by its complexity, subjectivity and marginal attributable mortality. It generates debate but not a matrix. Methods: Inclusion Criteria: All patients intubated for at least 48 hours. Exclusion Criteria: All elective post-cardiac surgery. Follow Up: Extubation or death. Results: A total of patients were enrolled between 3rd September to 20th October in The major reason for this reduction is decrease in percentage of ventilated patients 45 vs 40 as well as slight reduction in length of stay on ventilator 3 vs 2.

Introduction: There is limited information about sepsis in very old patients hospitalized with community-acquired pneumonia CAP. Methods: We conducted a retrospective study using data that were prospectively collected at the Hospital Clinic of Barcelona. We aimed to investigate the prevalence, etiology, risk factors and clinical outcomes of this population, comparing patients with and without sepsis defined according to SEPSIS-3 criteria. Written informed consent was waived because of the non-interventional study design.

There was no significant difference in the distribution of pathogens in patients with and without sepsis Figure 1. Male sex OR 1. One-year mortality was higher in very old patients with sepsis compared with those without sepsis Table 1. A propensity-adjusted multivariable analysis showed that risk factors for day mortality in septic patients were chronic renal disease OR 2. Conclusions: In very old patients hospitalized with CAP, antibiotic therapy before admission was associated with a decreased risk of sepsis, whereas diabetes mellitus was associated with a decreased risk of day mortality.

Introduction: Legionella species may cause life-threatening pneumonia and thus need early treatment. Differentiating Legionella pneumoniae LP from other types of pneumonia including Mycoplasma pneumoniae MP , Steptococcus pneumoniae SP and viral types of community-acquired pneumonia CAP has important implications regarding antibiotic therapy. Current testing options for LP infection have limited sensitivity leading to time delays in treatment and to usage of empirical broad-spectrum antibiotics.

Recently, a Legionella Scoring system based on six parameters has been proposed. We aimed to independently validate this score and investigate whether additional clinical and laboratory parameters would further improve its accuracy. Methods: We analyzed patients hospitalized in a tertiary care hospital between and with CAP and a defined etiology. Association and discrimination were assessed using logistic regression analysis and area under the receiver operator characteristic curve ROC AUC. Results were similar for subgroups based on each of the different CAP types.

Additionally, we found that a history of nausea further improves the diagnostic accuracy of the legionella score to an AUC of 0. Conclusions: In patients hospitalized with CAP, a high Legionella score on admission strongly predicts LP infection and thereby can optimize the empiric antibiotic management. A clinical history of nausea further improves diagnosis. Systematic use of this scoring system in conjunction with other diagnostic tests may improve the diagnostic and therapeutic management of patients presenting with CAP.

Introduction: Acinetobacter baumannii AcB remains one of the most prevalent ventilator-associate pneumonia VAP causing pathogen. In recent years, share of drug resistant AcB strains across Europe was found to be steadily increasing. Consequently, in , AcB was included in the WHO global priority list of drug-resistant bacteria to highlight the need for the research development. The aim of this study was to identify the relation of risk factors for ventilator-associated pneumonia VAP and mortality with drug resistance profiles of AcB. Methods: A retrospective cohort study of patients treated in medical-surgical ICUs with drug-resistant strains of AcB as pathogens of VAPover a 2-year period was carried out.

The overall in-hospital mortality rate was Thus, timely mechanical ventilation and ICU treatment may reduce the risk of VAP due to higher drug-resistant AcB, especially in more severely ill patients. Introduction: sepsis following traumatic and surgical intervention increases morbidity, mortality, cost and length of patient stay in hospital. The aim of this study was to identify the major pathogens associated with wounds infection and to review their antimicrobial reactions.

Methods: A 5-year review of nosocomial wound infection and colonization in patients admitted to the intensive care unit of tertiary care Hospital southern region of Saudi Arabia from Jan. Patients of all ages and gender who required ICU attention at some point and defined as nosocomial infection using standard CDC criteria and presented with various degrees of wound and bed sore infections were included in the study. Results: There were episodes of wound and episodes of bedsore infections. The most common organisms Klebsiella pneumoniae The percentage sensitivity of the organisms to the 51 antimicrobial agents was Conclusions: Data from this and other studies supports the hypothesis that high incidence of gram negative bacilli This requires strong infection control actions to enhance patient care.

We aimed to assess the predictive performance of these risk factors. Adult patients with no severe immunosuppression and a diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia with confirmed microbiology were enrolled. Patients or their next of kin provided written informed consent.

Introduction: Growing antimicrobial resistance among Gram-negative rod GNR strains is a worldwide issue. Flora monitoring is associated with right first choice of antimicrobial treatment. Among Acinetobacter spp. In multi-variate analysis lethal outcome Conclusions: 7yrs study revealed Acinetobacter spp. High sensitivity of GNR to carbapenems was found. Introduction: Of great concern is the dissemination in health care environments of multi-drug resistant MDR bacteria, especially Klebsiella pneumoniae carbapenemase KPC -producing enterobactereaceae.

Methods: Our objective is to identify the differences in risk factors and outcomes between patients who did and did not acquire KPC- producing bacteria during their stay in the ICU of an university hospital in Rio de Janeiro, Brazil. We designed a nested case — control study of a retrospective cohort from May to June Three hundred and thirty nine patients were admitted to the ICU.

The two groups were compared according to demographic clinical and microbiological data. Results: There was no significant differences in gender, age, severity scores between the two groups. J Am Coll Cardiol ; Bedside echocardiography by emergency physicians. Ann Emerg Med ; Emerg Med Clin N Am ; Blaivas M. Incidence of pericardial effusion in patients presenting to emergency department with unexplained dyspnea. Acad Emerg Med ; Nagdev A, Stone M. Point-of-care ultrasound evaluation of pericardial effusions; Does this patient have cardiac tamponade?

Resuscitation ; Kircher B, Himmelman R. Non invasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol ; Sonospirometry: A new method for non-invasive measurement of mean right atrial pressure based on two-dimensional echocardiographic measurements of the inferior vena cava during measured inspiration. Feigenbaum's Echocardiography. Philadelphia: Lippincott, Williams and Wilkins; Consecutive therapeutic echocardiographically guided pericardiocenteses: Clinical profile, practice patterns and outcomes spanning 21 years.

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