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201. Protein Metabolism

Author

Cedric W. Lefebvre, Jay P. Babich, James H. Grendell, John E. Heffner, Ronan Thibault, Claude Pichard, Xavier Monnet, Jean-Louis Teboul, Christer A. Sinderby, Jennifer Beck, Osita I. Onugha, David A. Spain, Denis D. Bensard, David A. Partrick, Juan A. Asensio, Juan M. Verde, D. Dante Yeh, Mitch Cohen, A. L. Hoefnagel, Peter J. Papadakos, Matthew Kutcher, M. Margaret Knudson, Robert A. Izenberg, Rochelle Dicker, Ana Cristina Diogo, Charles E. Lucas, Anna M. Ledgerwood, Jan J. De Waele, Inneke E. De laet, Tjasa Hranjec, Christopher M. Watson, Robert G. Sawyer, Matthijs Van Wissen, Victor E. A. Gerdes, Eric C. M. Van Gorp, Dees P. M. Brandjes, Marcel Soesan, Neeta Kannan, John A. Kellum, Azriel Perel, Samir G. Sakka, Kai Singbartl, Ulf Hemprich, Kenton L. Anderson, Anthony J. Dean, Chuin Siau, Paul E. Marik, Itzhak Brook, Lionel A. Mandell, Christopher Fee, Jordi Carratalà, Carolina Garcia-Vidal, Gianluigi Li Bassi, Lina Maria Saucedo, Antoni Torres, Oliver L. Gunter, Raeanna C. Adams, John A. Morris, Dominique Vandijck, Stijn Blot, Sonia Labeau, Cesare Gregoretti, Paolo Pelosi, Giacomo Bellani, Antonio Pesenti, Jeffrey Johnson, Sonja Hansen, Elisabeth Meyer, Hrishikesh S. Kulkarni, Kalpalatha K. Guntupalli, Behrouz Zand, Olan A. Soremekun, Ashley Mull, Christopher B. Colwell, Gage M. Ochsner, Norman E. McSwain, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Eric A. J. Hoste, Kathleen M. Vollman, Mustafa Hussain, H. Leon Pachter, Dietrich Henzler, Elaine Chiew-Lin Liew, Aaron M. Joffe, Douglas B. Coursin, Florian M. E. Wagenlehner, Kurt G. Naber, Arny A. Ferrando, Robert R. Wolfe, Scott E. Bell, Kathryn M. Beauchamp, José Garnacho-Montero, Dushyant Maharaj, Dominic W. K. Spray, Charles S. Brudney, Srini Pyati, Gorazd Voga, Umberto Lucangelo, Massimo Ferluga, Francesca Bernabè, Lluis Blanch, Giorgio Della Rocca, C. Coccia, Jonathan R. Egan, Marino S. Festa, Mehul Patel, Coleman Rotstein, Luigi Barberis, Vito Fanelli, Lorenzo Del Sorbo, Prasanna Simha Mohan Rao, Matthew J. Wall, Peter I. Tsai, Kenneth L. Mattox, Jay L. Koyner, Patrick T. Murray, Jaume Canet, Clara Llubià, Kiarash Shahlaie, and J. Paul Muizelaar

Published
2012
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202. Pelvic Binders

Author

Cedric W. Lefebvre, Jay P. Babich, James H. Grendell, John E. Heffner, Ronan Thibault, Claude Pichard, Xavier Monnet, Jean-Louis Teboul, Christer A. Sinderby, Jennifer Beck, Osita I. Onugha, David A. Spain, Denis D. Bensard, David A. Partrick, Juan A. Asensio, Juan M. Verde, D. Dante Yeh, Mitch Cohen, A. L. Hoefnagel, Peter J. Papadakos, Matthew Kutcher, M. Margaret Knudson, Robert A. Izenberg, Rochelle Dicker, Ana Cristina Diogo, Charles E. Lucas, Anna M. Ledgerwood, Jan J. De Waele, Inneke E. De laet, Tjasa Hranjec, Christopher M. Watson, Robert G. Sawyer, Matthijs Van Wissen, Victor E. A. Gerdes, Eric C. M. Van Gorp, Dees P. M. Brandjes, Marcel Soesan, Neeta Kannan, John A. Kellum, Azriel Perel, Samir G. Sakka, Kai Singbartl, Ulf Hemprich, Kenton L. Anderson, Anthony J. Dean, Chuin Siau, Paul E. Marik, Itzhak Brook, Lionel A. Mandell, Christopher Fee, Jordi Carratalà, Carolina Garcia-Vidal, Gianluigi Li Bassi, Lina Maria Saucedo, Antoni Torres, Oliver L. Gunter, Raeanna C. Adams, John A. Morris, Dominique Vandijck, Stijn Blot, Sonia Labeau, Cesare Gregoretti, Paolo Pelosi, Giacomo Bellani, Antonio Pesenti, Jeffrey Johnson, Sonja Hansen, Elisabeth Meyer, Hrishikesh S. Kulkarni, Kalpalatha K. Guntupalli, Behrouz Zand, Olan A. Soremekun, Ashley Mull, Christopher B. Colwell, Gage M. Ochsner, Norman E. McSwain, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Eric A. J. Hoste, Kathleen M. Vollman, Mustafa Hussain, H. Leon Pachter, Dietrich Henzler, Elaine Chiew-Lin Liew, Aaron M. Joffe, Douglas B. Coursin, Florian M. E. Wagenlehner, Kurt G. Naber, Arny A. Ferrando, Robert R. Wolfe, Scott E. Bell, Kathryn M. Beauchamp, José Garnacho-Montero, Dushyant Maharaj, Dominic W. K. Spray, Charles S. Brudney, Srini Pyati, Gorazd Voga, Umberto Lucangelo, Massimo Ferluga, Francesca Bernabè, Lluis Blanch, Giorgio Della Rocca, C. Coccia, Jonathan R. Egan, Marino S. Festa, Mehul Patel, Coleman Rotstein, Luigi Barberis, Vito Fanelli, Lorenzo Del Sorbo, Prasanna Simha Mohan Rao, Matthew J. Wall, Peter I. Tsai, Kenneth L. Mattox, Jay L. Koyner, Patrick T. Murray, Jaume Canet, Clara Llubià, Kiarash Shahlaie, and J. Paul Muizelaar

Published
2012
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203. Pericardiocentesis

Author

Cedric W. Lefebvre, Jay P. Babich, James H. Grendell, John E. Heffner, Ronan Thibault, Claude Pichard, Xavier Monnet, Jean-Louis Teboul, Christer A. Sinderby, Jennifer Beck, Osita I. Onugha, David A. Spain, Denis D. Bensard, David A. Partrick, Juan A. Asensio, Juan M. Verde, D. Dante Yeh, Mitch Cohen, A. L. Hoefnagel, Peter J. Papadakos, Matthew Kutcher, M. Margaret Knudson, Robert A. Izenberg, Rochelle Dicker, Ana Cristina Diogo, Charles E. Lucas, Anna M. Ledgerwood, Jan J. De Waele, Inneke E. De laet, Tjasa Hranjec, Christopher M. Watson, Robert G. Sawyer, Matthijs Van Wissen, Victor E. A. Gerdes, Eric C. M. Van Gorp, Dees P. M. Brandjes, Marcel Soesan, Neeta Kannan, John A. Kellum, Azriel Perel, Samir G. Sakka, Kai Singbartl, Ulf Hemprich, Kenton L. Anderson, Anthony J. Dean, Chuin Siau, Paul E. Marik, Itzhak Brook, Lionel A. Mandell, Christopher Fee, Jordi Carratalà, Carolina Garcia-Vidal, Gianluigi Li Bassi, Lina Maria Saucedo, Antoni Torres, Oliver L. Gunter, Raeanna C. Adams, John A. Morris, Dominique Vandijck, Stijn Blot, Sonia Labeau, Cesare Gregoretti, Paolo Pelosi, Giacomo Bellani, Antonio Pesenti, Jeffrey Johnson, Sonja Hansen, Elisabeth Meyer, Hrishikesh S. Kulkarni, Kalpalatha K. Guntupalli, Behrouz Zand, Olan A. Soremekun, Ashley Mull, Christopher B. Colwell, Gage M. Ochsner, Norman E. McSwain, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Eric A. J. Hoste, Kathleen M. Vollman, Mustafa Hussain, H. Leon Pachter, Dietrich Henzler, Elaine Chiew-Lin Liew, Aaron M. Joffe, Douglas B. Coursin, Florian M. E. Wagenlehner, Kurt G. Naber, Arny A. Ferrando, Robert R. Wolfe, Scott E. Bell, Kathryn M. Beauchamp, José Garnacho-Montero, Dushyant Maharaj, Dominic W. K. Spray, Charles S. Brudney, Srini Pyati, Gorazd Voga, Umberto Lucangelo, Massimo Ferluga, Francesca Bernabè, Lluis Blanch, Giorgio Della Rocca, C. Coccia, Jonathan R. Egan, Marino S. Festa, Mehul Patel, Coleman Rotstein, Luigi Barberis, Vito Fanelli, Lorenzo Del Sorbo, Prasanna Simha Mohan Rao, Matthew J. Wall, Peter I. Tsai, Kenneth L. Mattox, Jay L. Koyner, Patrick T. Murray, Jaume Canet, Clara Llubià, Kiarash Shahlaie, and J. Paul Muizelaar

Published
2012
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204. PiCCO Monitor

Author

Cedric W. Lefebvre, Jay P. Babich, James H. Grendell, John E. Heffner, Ronan Thibault, Claude Pichard, Xavier Monnet, Jean-Louis Teboul, Christer A. Sinderby, Jennifer Beck, Osita I. Onugha, David A. Spain, Denis D. Bensard, David A. Partrick, Juan A. Asensio, Juan M. Verde, D. Dante Yeh, Mitch Cohen, A. L. Hoefnagel, Peter J. Papadakos, Matthew Kutcher, M. Margaret Knudson, Robert A. Izenberg, Rochelle Dicker, Ana Cristina Diogo, Charles E. Lucas, Anna M. Ledgerwood, Jan J. De Waele, Inneke E. De laet, Tjasa Hranjec, Christopher M. Watson, Robert G. Sawyer, Matthijs Van Wissen, Victor E. A. Gerdes, Eric C. M. Van Gorp, Dees P. M. Brandjes, Marcel Soesan, Neeta Kannan, John A. Kellum, Azriel Perel, Samir G. Sakka, Kai Singbartl, Ulf Hemprich, Kenton L. Anderson, Anthony J. Dean, Chuin Siau, Paul E. Marik, Itzhak Brook, Lionel A. Mandell, Christopher Fee, Jordi Carratalà, Carolina Garcia-Vidal, Gianluigi Li Bassi, Lina Maria Saucedo, Antoni Torres, Oliver L. Gunter, Raeanna C. Adams, John A. Morris, Dominique Vandijck, Stijn Blot, Sonia Labeau, Cesare Gregoretti, Paolo Pelosi, Giacomo Bellani, Antonio Pesenti, Jeffrey Johnson, Sonja Hansen, Elisabeth Meyer, Hrishikesh S. Kulkarni, Kalpalatha K. Guntupalli, Behrouz Zand, Olan A. Soremekun, Ashley Mull, Christopher B. Colwell, Gage M. Ochsner, Norman E. McSwain, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Eric A. J. Hoste, Kathleen M. Vollman, Mustafa Hussain, H. Leon Pachter, Dietrich Henzler, Elaine Chiew-Lin Liew, Aaron M. Joffe, Douglas B. Coursin, Florian M. E. Wagenlehner, Kurt G. Naber, Arny A. Ferrando, Robert R. Wolfe, Scott E. Bell, Kathryn M. Beauchamp, José Garnacho-Montero, Dushyant Maharaj, Dominic W. K. Spray, Charles S. Brudney, Srini Pyati, Gorazd Voga, Umberto Lucangelo, Massimo Ferluga, Francesca Bernabè, Lluis Blanch, Giorgio Della Rocca, C. Coccia, Jonathan R. Egan, Marino S. Festa, Mehul Patel, Coleman Rotstein, Luigi Barberis, Vito Fanelli, Lorenzo Del Sorbo, Prasanna Simha Mohan Rao, Matthew J. Wall, Peter I. Tsai, Kenneth L. Mattox, Jay L. Koyner, Patrick T. Murray, Jaume Canet, Clara Llubià, Kiarash Shahlaie, and J. Paul Muizelaar

Published
2012
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205. Pelvic Packing

Author

Cedric W. Lefebvre, Jay P. Babich, James H. Grendell, John E. Heffner, Ronan Thibault, Claude Pichard, Xavier Monnet, Jean-Louis Teboul, Christer A. Sinderby, Jennifer Beck, Osita I. Onugha, David A. Spain, Denis D. Bensard, David A. Partrick, Juan A. Asensio, Juan M. Verde, D. Dante Yeh, Mitch Cohen, A. L. Hoefnagel, Peter J. Papadakos, Matthew Kutcher, M. Margaret Knudson, Robert A. Izenberg, Rochelle Dicker, Ana Cristina Diogo, Charles E. Lucas, Anna M. Ledgerwood, Jan J. De Waele, Inneke E. De laet, Tjasa Hranjec, Christopher M. Watson, Robert G. Sawyer, Matthijs Van Wissen, Victor E. A. Gerdes, Eric C. M. Van Gorp, Dees P. M. Brandjes, Marcel Soesan, Neeta Kannan, John A. Kellum, Azriel Perel, Samir G. Sakka, Kai Singbartl, Ulf Hemprich, Kenton L. Anderson, Anthony J. Dean, Chuin Siau, Paul E. Marik, Itzhak Brook, Lionel A. Mandell, Christopher Fee, Jordi Carratalà, Carolina Garcia-Vidal, Gianluigi Li Bassi, Lina Maria Saucedo, Antoni Torres, Oliver L. Gunter, Raeanna C. Adams, John A. Morris, Dominique Vandijck, Stijn Blot, Sonia Labeau, Cesare Gregoretti, Paolo Pelosi, Giacomo Bellani, Antonio Pesenti, Jeffrey Johnson, Sonja Hansen, Elisabeth Meyer, Hrishikesh S. Kulkarni, Kalpalatha K. Guntupalli, Behrouz Zand, Olan A. Soremekun, Ashley Mull, Christopher B. Colwell, Gage M. Ochsner, Norman E. McSwain, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Eric A. J. Hoste, Kathleen M. Vollman, Mustafa Hussain, H. Leon Pachter, Dietrich Henzler, Elaine Chiew-Lin Liew, Aaron M. Joffe, Douglas B. Coursin, Florian M. E. Wagenlehner, Kurt G. Naber, Arny A. Ferrando, Robert R. Wolfe, Scott E. Bell, Kathryn M. Beauchamp, José Garnacho-Montero, Dushyant Maharaj, Dominic W. K. Spray, Charles S. Brudney, Srini Pyati, Gorazd Voga, Umberto Lucangelo, Massimo Ferluga, Francesca Bernabè, Lluis Blanch, Giorgio Della Rocca, C. Coccia, Jonathan R. Egan, Marino S. Festa, Mehul Patel, Coleman Rotstein, Luigi Barberis, Vito Fanelli, Lorenzo Del Sorbo, Prasanna Simha Mohan Rao, Matthew J. Wall, Peter I. Tsai, Kenneth L. Mattox, Jay L. Koyner, Patrick T. Murray, Jaume Canet, Clara Llubià, Kiarash Shahlaie, and J. Paul Muizelaar

Published
2012
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206. Pulmonary Artery Occlusion Pressure

Author

Cedric W. Lefebvre, Jay P. Babich, James H. Grendell, John E. Heffner, Ronan Thibault, Claude Pichard, Xavier Monnet, Jean-Louis Teboul, Christer A. Sinderby, Jennifer Beck, Osita I. Onugha, David A. Spain, Denis D. Bensard, David A. Partrick, Juan A. Asensio, Juan M. Verde, D. Dante Yeh, Mitch Cohen, A. L. Hoefnagel, Peter J. Papadakos, Matthew Kutcher, M. Margaret Knudson, Robert A. Izenberg, Rochelle Dicker, Ana Cristina Diogo, Charles E. Lucas, Anna M. Ledgerwood, Jan J. De Waele, Inneke E. De laet, Tjasa Hranjec, Christopher M. Watson, Robert G. Sawyer, Matthijs Van Wissen, Victor E. A. Gerdes, Eric C. M. Van Gorp, Dees P. M. Brandjes, Marcel Soesan, Neeta Kannan, John A. Kellum, Azriel Perel, Samir G. Sakka, Kai Singbartl, Ulf Hemprich, Kenton L. Anderson, Anthony J. Dean, Chuin Siau, Paul E. Marik, Itzhak Brook, Lionel A. Mandell, Christopher Fee, Jordi Carratalà, Carolina Garcia-Vidal, Gianluigi Li Bassi, Lina Maria Saucedo, Antoni Torres, Oliver L. Gunter, Raeanna C. Adams, John A. Morris, Dominique Vandijck, Stijn Blot, Sonia Labeau, Cesare Gregoretti, Paolo Pelosi, Giacomo Bellani, Antonio Pesenti, Jeffrey Johnson, Sonja Hansen, Elisabeth Meyer, Hrishikesh S. Kulkarni, Kalpalatha K. Guntupalli, Behrouz Zand, Olan A. Soremekun, Ashley Mull, Christopher B. Colwell, Gage M. Ochsner, Norman E. McSwain, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Eric A. J. Hoste, Kathleen M. Vollman, Mustafa Hussain, H. Leon Pachter, Dietrich Henzler, Elaine Chiew-Lin Liew, Aaron M. Joffe, Douglas B. Coursin, Florian M. E. Wagenlehner, Kurt G. Naber, Arny A. Ferrando, Robert R. Wolfe, Scott E. Bell, Kathryn M. Beauchamp, José Garnacho-Montero, Dushyant Maharaj, Dominic W. K. Spray, Charles S. Brudney, Srini Pyati, Gorazd Voga, Umberto Lucangelo, Massimo Ferluga, Francesca Bernabè, Lluis Blanch, Giorgio Della Rocca, C. Coccia, Jonathan R. Egan, Marino S. Festa, Mehul Patel, Coleman Rotstein, Luigi Barberis, Vito Fanelli, Lorenzo Del Sorbo, Prasanna Simha Mohan Rao, Matthew J. Wall, Peter I. Tsai, Kenneth L. Mattox, Jay L. Koyner, Patrick T. Murray, Jaume Canet, Clara Llubià, Kiarash Shahlaie, and J. Paul Muizelaar

Published
2012
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207. Effects of duty cycle and positive end-expiratory pressure on mucus clearance during mechanical ventilation*

Author

Montserrat Rigol, Albert Gabarrus, Lina Maria Saucedo, Theodor Kolobow, Mariano Esperatti, Laia Fernandez, Joan-Daniel Martí, Gianluigi Li Bassi, Nestor Luque, Antoni Torres, and Miquel Ferrer

Subjects
Mechanical ventilation, Glottis, business.industry, Swine, medicine.medical_treatment, Hemodynamics, Critical Care and Intensive Care Medicine, Mucus, Positive-Pressure Respiration, medicine.anatomical_structure, Duty cycle, Mucociliary Clearance, Anesthesia, medicine, Breathing, Animals, Female, Respiratory system, business, Pulmonary Ventilation, Positive end-expiratory pressure
Abstract

Objectives: During mechanical ventilation, air flows may play a role in mucus transport via two-phase gas liquid flow. The aim of this study was to evaluate effects of duty cycles and positive end-expiratory pressure on mucus clearance in pigs using mechanical ventilation, and to assess their safety. Design: Prospective randomized animal study. Setting: Animal research facility, University of Barcelona, Spain. Subjects: Eight healthy pigs. Interventions: Pigs were intubated and on volume-control mechanical ventilation for up to 84 hrs. After 4, 24, 48, and 72 hrs of mechanical ventilation, six levels of duty cycle (0.26, 0.33, 0.41, 0.50, 0.60, and 0.75) with no associated positive end-expiratory pressure or 5 cm H2O of positive end-expiratory pressure were randomly applied. Surgical bed was oriented 30 degrees in the reverse Trendelenburg position, as in the semirecumbent position. Measurement and Main Results: Inspiratory and expiratory flows and hemodynamics were measured after each 30-min ventilation period. Mucus movement was assessed through fluoroscopy tracking of radio-opaque markers. Mucus velocity was described by a positive vector (toward the glottis) or negative vector (toward the lungs). No effect of positive end-expiratory pressure was found; however, as duty cycle was increasingly prolonged, a trend toward reduced velocity of mucus moving toward the lungs and increased outward mucus velocity was found (p .064). Two clusters of mucus velocities were identified as duty cycle was prolonged beyond 0.41. Thus, duty cycle >0.41 increased mean expiratory‐inspiratory flow bias from 4.1 4.6 to 7.9 5.9 L/min (p < .0001) and promoted outward mucus velocity from 0.22 1.71 mm/min (range, 5.78 to 2.42) to 0.53 1.06 mm/min (1.91 to 3.88; p .0048). Duty cycle of 0.75 resulted in intrinsic positive end-expiratory pressure (2.1 1.1 cm H2O [p < .0001] vs. duty cycle 0.26‐0.5), with no hemodynamic compromise. Conclusions: In the semirecumbent position, mucus clearance is improved with prolongation of the duty cycle. However, in clinical practice, positive findings must be balanced against the potentially adverse hemodynamic and respiratory effects. (Crit Care Med 2012; 40:895‐902)

Published
2011

208. A Novel Ventilatory Strategy To Prevent Bacterial Translocation From The Oropharynx And Lung Colonization Following Tracheal Intubation

Author

Montserrat Rigol, Mariano Esperatti, Gianluigi Li Bassi, Miquel Ferrer, Antoni Torres, Nestor Luque, Jordi Vila, Joan Martí, Isabel Martin, Lina Maria Saucedo, Laia Fernandez, and Ignasi Roca

Subjects
medicine.medical_specialty, Lung, medicine.anatomical_structure, business.industry, Anesthesia, medicine.medical_treatment, Tracheal intubation, medicine, Colonization, Bacterial translocation, business, Surgery
Published
2011
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209. Effects Of Positive End Expiratory Pressure On Expiratory Flow Bias And Mucus Clearance In Mechanically Ventilated Piglets

Author

Montserrat Rigol, Mariano Esperatti, Antoni Torres, Gianluigi Li Bassi, Joan Daniel Martí, Nestor Luque, Cristina Esquinas, Lina Maria Saucedo, Miquel Ferrer, Joan Ramon Badia, and Carmen Alicia San José

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Flow (psychology), Cardiology, medicine, business, Mucus clearance, Positive end-expiratory pressure
Published
2010
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210. Validation Of The ATS/IDSA Guidelines For ICU-acquired Pneumonia

Author

Adamantia Liapikou, Miquel Ferrer, Mauricio Valencia, Anna Theessen, Josep Mensa, Mariano Esperatti, A. Torres, A San Jose, J A Martínez, and Lina Maria Saucedo

Subjects
Pneumonia, medicine.medical_specialty, business.industry, Emergency medicine, medicine, medicine.disease, business
Published
2010
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211. Effects of Manual Rib Cage Compression On Peak Expiratory Flow And Mucus Clearance In Mechanically Ventilated Piglets

Author

Cristina Esquinas, Joan Daniel Martí, Mariano Esperatti, Antoni Torres, Lina Maria Saucedo, Carmen Alicia San José, Gianluigi Li Bassi, Nestor Luque, Montserrat Rigol, and Miquel Ferrer

Subjects
Rib cage, medicine.medical_specialty, business.industry, Anesthesia, medicine, Compression (physics), business, Mucus clearance, Surgery
Published
2010
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212. Effects Of Expiratory-Inspiratory Flow Bias On Prevention Of Mucus Retention During Mechanical Ventilation In The Semi-Recumbent Position

Author

Joan Ramon Badia, Cristina Esquinas, Gianluigi Li Bassi, Nestor Luque, Carmen Alicia San José, Lina Maria Saucedo, Antoni Torres, Mariano Esperatti, Miquel Ferrer, Joan Daniel Martí, and Montserrat Rigol

Subjects
Mechanical ventilation, Inspiratory flow, business.industry, medicine.medical_treatment, Anesthesia, Semi-recumbent position, medicine, business, Mucus retention
Published
2010
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213. Do guidelines change outcomes in ventilator-associated pneumonia?

Author

Miguel Ferrer, Gianluigi Li Bassi, Antoni Torres, and Lina Maria Saucedo

Subjects
Microbiology (medical), Antiinfective agent, medicine.medical_specialty, business.industry, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, Guidelines as Topic, bacterial infections and mycoses, medicine.disease, respiratory tract diseases, Anti-Bacterial Agents, Pneumonia, Infectious Diseases, Pharmacotherapy, Treatment Outcome, Intensive care, Drug Resistance, Multiple, Bacterial, Health care, Etiology, Pneumonia, Bacterial, Medicine, Humans, business, Intensive care medicine
Abstract

The purpose of the study is to summarize effects of implementation of current and past guidelines for management and treatment of ventilator-associated pneumonia (VAP) on outcome of intensive care patients, with particular focus on etiology of VAP, pathogens prediction, appropriate empiric antibiotic therapy and mortality.Several studies have shown that in patients with clinical suspicion of VAP, appropriate antibiotic therapy administered in a timely manner can improve survival. Guidelines for management and treatment of VAP have been developed to help physicians to achieve those goals. Implementation of guidelines into clinical practice is difficult to achieve and requires extensive education for healthcare personnel and translation of recommendations into local protocols. Studies have shown that guidelines implementation is associated with better outcome. However, extensive research needs to be undertaken in order to validate efficacy of guidelines in predicting etiology of pneumonia, in particular, to promptly identify multidrug-resistant pathogens. Only one recent report has validated the latest guidelines and called attention for further research to improve microbial prediction.Guidelines implementation can improve outcomes. To achieve this goal, guidelines should be adapted to local microbiology, accurately predict VAP pathogens and help physicians to administer the most appropriate empirical antimicrobial therapy.

Published
2010

214. Endotracheal tube biofilm translocation in the lateral Trendelenburg position

Author

Miguel Ferrer, José Ramírez, Eli Aguilera Xiol, Nestor Luque, Lina Maria Saucedo, Maria Adela Saco, Gianluigi Li Bassi, Ignasi Roca, Otavio T. Ranzani, Jordi Vila, Joan Martí, Valeria Giunta, Laura Muñoz, Montserrat Rigol, Mariano Esperatti, Laia Fernández-Barat, and Antoni Torres

Subjects
Pathology, medicine.medical_specialty, Swine, medicine.medical_treatment, Trendelenburg position, Lumen (anatomy), Lung injury, medicine.disease_cause, Critical Care and Intensive Care Medicine, Bacterial Adhesion, Patient Positioning, Microbiology, Intubation, Intratracheal, Medicine, Animals, Respiratory system, Bronchitis, Lung, Microscopy, Confocal, business.industry, Pseudomonas aeruginosa, Research, Pneumonia, Ventilator-Associated, medicine.disease, respiratory tract diseases, Pneumonia, medicine.anatomical_structure, Biofilms, Models, Animal, Microscopy, Electron, Scanning, Tracheitis, business, Respiratory tract
Abstract

Introduction Laboratory studies demonstrated that the lateral Trendelenburg position (LTP) is superior to the semirecumbent position (SRP) in the prevention of ventilator-associated pulmonary infections. We assessed whether the LTP could also prevent pulmonary colonization and infections caused by an endotracheal tube (ETT) biofilm. Methods Eighteen pigs were intubated with ETTs colonized by Pseudomonas aeruginosa biofilm. Pigs were positioned in LTP and randomized to be on mechanical ventilatin (MV) up to 24 hour, 48 hour, 48 hour with acute lung injury (ALI) by oleic acid and 72 hour. Bacteriologic and microscopy studies confirmed presence of biofilm within the ETT. Upon autopsy, samples from the proximal and distal airways were excised for P.aeruginosa quantification. Ventilator-associated tracheobronchitis (VAT) was confirmed by bronchial tissue culture ≥3 log colony forming units per gram (cfu/g). In pulmonary lobes with gross findings of pneumonia, ventilator-associated pneumonia (VAP) was confirmed by lung tissue culture ≥3 log cfu/g. Results P.aeruginosa colonized the internal lumen of 16 out of 18 ETTs (88.89%), and a mature biofilm was consistently present. P.aeruginosa colonization did not differ among groups, and was found in 23.6% of samples from the proximal airways, and in 7.1% from the distal bronchi (P = 0.001). Animals of the 24 hour group never developed respiratory infections, whereas 20%, 60% and 25% of the animals in group 48 hour, 48 hour-ALI and 72 hour developed P.aeruginosa VAT, respectively (P = 0.327). Nevertheless, VAP never developed. Conclusions Our findings imply that during the course of invasive MV up to 72 hour, an ETT P.aeruginosa biofilm hastily colonizes the respiratory tract. Yet, the LTP compartmentalizes colonization and infection within the proximal airways and VAP never develops.

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