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BackgroundIn acute respiratory distress syndrome (ARDS), pulmonary perfusion failure increases physiologic dead space ventilation (VD/VT), leading to a decline of the alveolar CO2 concentration [CO2]iA. Although it has been shown that alveolar hypocapnia contributes to formation of atelectasis and surfactant depletion, a typical complication in ARDS, the underlying mechanism has not been elucidated so far.MethodsIn isolated perfused rat lungs, cytosolic or mitochondrial Ca2+ concentrations ([Ca2+]cyt or [Ca2+]mito, respectively) of alveolar epithelial cells (AECs), surfactant secretion and the projected area of alveoli were quantified by real-time fluorescence or bright-field imaging (n=3–7 per group). In ventilated White New Zealand rabbits, the left pulmonary artery was ligated and the size of subpleural alveoli was measured by intravital microscopy (n=4 per group). Surfactant secretion was determined in the bronchoalveolar lavage (BAL) by western blot.ResultsLow [CO2]iA decreased [Ca2+]cyt and increased [Ca2+]mito in AECs, leading to reduction of Ca2+-dependent surfactant secretion, and alveolar ventilation in situ. Mitochondrial inhibition by ruthenium red or rotenone blocked these responses indicating that mitochondria are key players in CO2 sensing. Furthermore, ligature of the pulmonary artery of rabbits decreased alveolar ventilation, surfactant secretion and lung compliance in vivo. Addition of 5% CO2 to the inspiratory gas inhibited these responses.ConclusionsAccordingly, we provide evidence that alveolar hypocapnia leads to a Ca2+ shift from the cytosol into mitochondria. The subsequent decline of [Ca2+]cyt reduces surfactant secretion and thus regional ventilation in lung regions with high VD/VT. Additionally, the regional hypoventilation provoked by perfusion failure can be inhibited by inspiratory CO2 application.

Objetivo: identificar diagnosticos, intervencoes e resultados esperados de enfermagem a crianca com Doenca de Pompe, utilizando a Classificacao Internacional para a Pratica de Enfermagem® 2017. Metodo: estudo de caso realizado em dezembro de 2017, com uma mae de crianca com Doenca de Pompe. Resultados: elencaram-se dezessete diagnosticos de enfermagem, distribuidos entre as demandas de cuidados medicamentosos, tecnologicos, habituais modificados, de desenvolvimento e familiares. Discussao: os diagnosticos de enfermagem relacionaram-se ao tratamento e as complicacoes apresentadas pela crianca em decorrencia da Doenca de Pompe, acrescidas pelas necessidades familiares para desenvolver os cuidados no domicilio. Conclusao : verificou-se que a classificacao das praticas de enfermagem permitiu criar possibilidades mais especializadas para elaborar e executar um plano de cuidados com base nas reais necessidades desta crianca, podendo existir generalizacao para os portadores da mesma enfermidade. Descritores: Doenca de Deposito de Glicogenio Tipo II; Enfermagem Pediatrica; Atencao Primaria a Saude; Diagnostico de Enfermagem; Familia.

The risks and microbiology for peripherally inserted central catheters (PICCs) are less well described than those for traditional central catheters, particularly as they pertain to duration of catheterization. We compared patients with early- and late-onset PICC bloodstream infections at our institution and found significant differences in microbiologic etiologies.

Affiliations: 1. Department of Epidemiology, Beaumont Health System, Royal Oak, Michigan; 2. Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. Received April 26, 2012; accepted July 21, 2012; electronically published October 23, 2012. 2012 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2012/3312-0008$15.00. DOI: 10.1086/668430 Ultrasound transmission gel (USTG) is used in a variety of healthcare settings for both diagnostic and interventional procedures. Its potential role as a vehicle for spread of infections to patients is frequently overlooked. It has been shown on multiple occasions that USTG can become contaminated with bacteria, leading to significant outbreaks of infection among patients. It is incumbent upon all medical professionals to be aware of the potential risks these products pose to patients. Manufacturers of USTG should label products clearly as to their intended use. Producers of medical devices where USTG is likely to be used should provide explicit instructions on the type of USTG recommended and methods of use. Finally, standardized professional society guidelines would enhance patient safety and improve outcomes. On the basis of our recently described outbreak of infections associated with intrinsically contaminated ultrasound gel and a review of all other clusters, we would like to describe the differences between gels and propose guidelines for use of both nonsterile and sterile ultrasound gel. USTG is available from multiple manufacturers and comes in a variety of formulations and dispenser sizes, often without clearly defined differences between products or suggested uses. A review of one manufacturer’s website found 6 separate USTGs available for purchase, although it was not made clear what significant differences existed between products or if there were specific intended uses for them. Although these gels are often considered bacteriostatic because of components such as parabens or methyl benzoate, one study demonstrated that an ultrasound gel had no intrinsic antimicrobial properties and could function as a medium for bacterial growth. Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus were all demonstrated to survive in USTG in another in vitro study. The term “bacteriostatic” should not be used unless the product meets defined requirements to prove this. Contaminated USTG has been associated with outbreaks of infection due to a variety of procedures and microorganisms (Table 1). In all circumstances, the outbreaks were aborted after a switch to single-dose sterile gel. Our more recent report of cases of respiratory infections and colonizations with P. aeruginosa strongly suggested that gel contaminated at or around the time of manufacture was associated with infections. In this series, 16 patients were found to have P. aeruginosa in their respiratory tract after undergoing cardiovascular surgery. Laboratory isolates for 10 patients were saved, and all 10 proved to be more than 99% similar by molecular typing via repetitive extragenic palindromic polymerase chain reaction (rep-PCR). This surgery included the use of an intraoperative transesophageal echocardiogram (TEE) that utilized USTG as a conducting agent. The TEE probes were culture negative, but cultures of in-use multidose bottles of gel as well as sealed, unopened bottles of gel grew P. aeruginosa, which were also more than 99% similar to the outbreak strain by rep-PCR. Procedures utilizing USTG can range from noninvasive studies (such as transthoracic echocardiography, bladder scans, and vascular scans), to those with mucous membrane contact (such as TEE and transvaginal ultrasonography), to frankly invasive procedures (such as transrectal prostate biopsy [TRPB], thyroid biopsy, epiaortic ultrasonography [EAU], and stereotactic breast biopsies). As such, the Spaulding classification scheme can be applied to guide clinicians in making decisions regarding proper disinfection and sterilization of devices on the basis of the risk of infection involved with use of the item. By this scheme, scanning devices used for noninvasive procedures could be considered “noncritical devices” because of their contact with intact skin. Likewise, diagnostic studies using TEE or TRPB would require “semicritical” disinfection because of contact with mucous membranes. EAU transducers are required to be sterile, as they are introduced directly into the surgical field. On the basis of the Spaulding classification scheme, how does one define the appropriate use of USTG for procedures? Any procedure involving sterile skin preparation would likely also require sterile USTG. Sterility is not a necessary require

Objetivo: Identificar e caracterizar as revelações manifestas por crianças portadoras de doenças crônicas em tratamento ambulatorial. Métodos: Tratou-se de uma pesquisa qualitativa, norteada pelos referenciais do Interacionismo Simbólico e da análise de conteúdo temática de Bardin. A coleta dos dados foi desenvolvida por meio de sessões de brinquedo terapêutico com quatro crianças pré-escolares que convivem com a doença crônica. Resultados: Identificaram-se quatro categorias temáticas que marcam o cotidiano destas crianças: "Interações", "Luta", "Apoio" e "Dúvida". Conclusão: Estas crianças buscam transformar as interações de seu cotidiano com vistas a serem reconhecidas enquanto pessoas com voz, desejos, vontades, detentoras e formadoras de opinião. Objective: To identify and describe the revelations expressed by children with chronic diseases in outpatient treatment. Methods: This was a qualitative study guided by the theoretical framework of symbolic interactionism and Bardin's thematic content analysis. Data was collected through therapeutic play sessions with four preschool children who live with chronic illness. Results: Four thematic categories that characterize the daily life of these children were identified:"Interactions," "Fight," "Support" and "Doubt." Conclusion: The children in this study seek to transform their daily interactions with a view toward being recognized as individuals with voices, desires, wills and opinions.