Prevention and diagnosis of ventilator-associated pneumonia: a survey on current practices in Southern Spanish ICUs

STUDY OBJECTIVES: To assess the implementation of selected ventilator-associated pneumonia (VAP) prevention strategies, and to learn how VAP is diagnosed in the ICUs of Southern Spain. DESIGN: Multicentric survey. SETTING: The ICUs of 32 hospitals of the public health-care system of Southern Spain. PATIENTS OR PARTICIPANTS: Directors of ICUs. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Twenty-eight ICUs (87.5%) returned completed questionnaires. Ventilator circuits were changed every 72 h or longer in 75% of ICUs. Use of heat and moisture exchangers and open endotracheal suction systems were reported in 96% of ICUs. Subglottic secretion drainage was never used, and 57% of ICUs checked endotracheal tube cuff pressure at least daily. Semi-recumbent position was common (93%), and 67.5% of ICUs used frequently noninvasive ventilation. Continuous enteral feeding was reported in all ICUs. Sedative infusions were usually interrupted every day in 11% of ICUs. Seventy-five percent of ICUs had specific guidelines for antibiotic therapy of VAP, but rotation of antibiotics was uncommon (11%). Twenty-nine percent of ICUs diagnosed VAP without microbiological confirmation. The most used technique for microbiologic diagnosis was qualitative culture of endotracheal aspirates (42.8%). The centers with a larger structural complexity reported using VAP therapy guidelines more frequently than the smaller centers, but they did not utilized bronchoscopic techniques for diagnosing VAP. CONCLUSIONS: Common prevention and diagnostic procedures in clinical practice, including large teaching institutions, significantly differed from evidence-based recommendations and reports by research groups of excellence. In addition, our study suggests that clinical practice for preventing and diagnosing VAP is variable and many opportunities exist to improve the care of patients receiving mechanical ventilation.     

Obstruction in patients with colorectal cancer increases morbidity and mortality in association with altered nutritional status

Intestinal obstruction aggravates the prognosis of colorectal cancer (CRC) patients. The aim of this study was to carry out a comparative analysis of nutritional status and inflammatory response in CRC patients with or without intestinal obstruction. The study was carried out on 43 patients with CRC. Twenty-three of these patients had intestinal obstruction. Anthropometric measurements, serum protein content, acute phase reactants, and diagnostic and risk nutritional indices were analyzed. The presence of intestinal obstruction reduced albumin (31 +/- 5.2 vs. 36 +/- 4.2 g/l; P = 0.0025) and prealbumin (0.13 +/- 0.047 vs. 0.21 +/- 0.042 g/l; P = 0.0001) and increased C-reactive protein (49 +/- 43.8 vs. 14 +/- 16.7 mg/l; P = 0.006) and alpha1-antitrypsin (189 +/- 34.7 vs. 148 +/- 35.4 mg/dl; P = 0.0011). Intestinal obstruction was related to malnutrition (86% vs. 33%; P = 0.019) and Mullen's prognostic nutritional index (48 +/- 21.7 vs. 31 +/- 17.9; P = 0.038) in CRC patients. Mullen's nutritional risk index was inversely correlated to total cholesterol (r = -0.51; P = 0.0002) and albumin (r = -0.81; P = 0.0001). No correlation was found between Duke's tumor stages and acute phase response, inflammatory parameters, and malnutrition. In conclusion, intestinal obstruction occurred more frequently in CRC patients with malnutrition. The increased morbidity and mortality of CRC patients was also associated with acute phase response, inflammation, and low serum cholesterol and triglyceride concentration.     

Physical and mental component summaries score of the SF-36 in coronary patients

Background: The aim of the study was to determine the clinical and sociodemographic factors related to the physical and mental components of the health-related quality of life (HRQL) in coronary patients. Methods: We studied 132 patients diagnosed with Acute Myocardial Infarction (AMI) and unstable angina admitted to a cardiology unit over a period of 18 months. The HRQL was assessed with the Short Form 36 Health Questionnaire (SF-36) and the presence of possible mental disorders was measured using the General Health Questionnaire (GHQ-28). In order to study the variables related to both physical and mental summary components of the SF-36, two multiple linear regression models were constructed with the physical (PCS) and the mental component summary (MCS) as outcome variables. Results: The GHQ-28 score 6 was the variable most associated with the lowest PCS in the patients studied. Moreover in the patients with a personal history of coronary heart disease (CHD), age tended to increase the PCS of the HRQL, whereas in those with no such history, age diminished the PCS score. For the MCS, not being married, being of female sex, having GHQ-28 scores 6 and being of younger age were the four variables most related to the lowest MCS score in the patients studied. Conclusion: Age, sex, marital status, personal history of CHD and the presence of a possible mental disorder were the factors most related to HRQL in the coronary patients studied. Focusing medical attention on these groups could contribute to improving their quality of life.     

Kynurenamines as neural nitric oxide synthase inhibitors

To find new compounds with potential neuroprotective activity, we have designed, synthesized, and characterized a series of neural nitric oxide synthase (nNOS) inhibitors with a kynurenamine structure. Among them, N-[3-(2-amino-5-methoxyphenyl)-3-oxopropyl]acetamide is the main melatonin metabolite in the brain and shows the highest activity in the series, with an inhibition percentage of 65% at a 1 mM concentration. The structure-activity relationship of the new series partially reflects that of the previously reported 2-acylamido-4-(2-amino-5-methoxyphenyl)-4-oxobutyric acids, endowed with a kynurenine-like structure. Structural comparisons between these new kinurenamine derivatives, kynurenines, and 1-acyl-3-(2-amino-5-methoxyphenyl)-4,5-dihydro-1H-pyrazole derivatives also reported confirm our previous model for the nNOS inhibition.     

The VAMP device. Benefits for the critical patient

Taking blood samples by means of conventional intravascular devices requires throwing away an initial volume of mixed blood and serum which comprises between 24-26% of the volume of blood extracted from the patient admitted into an intensive care ward. At present time there exists a device with a reservoir, VAMP, which permits one to obtain blood samples without having to waste this initial volume. The working hypothesis poses that the use of the VAMP device decreases the risk of transfusion. This study has a random prospective design. This study subjects are 58 patients admitted in the intensive care ward at the Parc Taulí Corporation distributed in a control group which made use of a conventional device and a VAMP group which made use of the device having a reservoir. The study used a data recordsheet. Statistical calculations were carried out on the SPSS program.     

Influence of changes in dietary fatty acids during pregnancy on placental and fetal fatty acid profile in the rat

To determine whether the composition of long-chain polyunsaturated fatty acids (PUFA) could be modified in the fetus by maternal dietary fatty acids, pregnant Sprague-Dawley rats were fed semipurified diets that differed only in the non-vitamin lipid component. The diets contained either 10 g palm, sunflower, olive or fish oil (FOD)/100 g diet. A total of 5-6 rats were studied in each group. At day 20 of gestation, corresponding to 1.5 days prior parturition, the fatty acids in maternal adipose tissue were closely related to the fatty acid composition in the corresponding diet. An important proportion of arachidonic acid (AA) appeared in maternal liver and plasma, although it was lower in the FOD than in the other groups. Except for saturated fatty acids, the proportion of individual fatty acids in the placenta correlated linearly with that in maternal plasma. Also, PUFA in fetal plasma and liver showed significant correlations with PUFA in maternal plasma. Again, AA showed the lowest proportion in the plasma and liver of the FOD group. Therefore, the maternal dietary fatty acid composition influences maternal and fetal plasma and tissue composition, and an increase in dietary omega-3 fatty acids decreases the amount of AA in maternal and fetal tissues.