infections in the critically ill principles and management

... simple and quick method at the internal jugular vein: make a skin landmark at the area of the vein, switch off the ultrasound Fig 12.16 The operator's hand holding the probe ex-poses the vein in ... axis and remains strictly motionless over the thorax The operator's hand holding the needle is firmly positioned in front of the probe's landmark The needle is then easily inserted toward the vein ... was obtained in the syringe in less than 20 s, in 16% of cases in less than 1 min In 12% of cases that were considered laborious, success was nonetheless obtained in less than 5 min In other words,

Ngày tải lên: 09/08/2014, 15:20

... analysis, including analysis of the posterior zones after positioning the patient in the lateral decubitus An analysis of the apex will be added, by apply-ing the probe at the supraclavicular fossa in ... dissecting the wall, preparing the pouch with skin materials and other additional procedures Since there is no lateral hole, the catheter should be with-drawn little by little during the procedure ... effusion collects in dependent areas Any free pleural effusion will therefore be in contact with the bed in a supine patient This zone will not be easy to approach Rotating the patient in the later-al

Ngày tải lên: 09/08/2014, 15:20

... may indicate a certain diagnostic uncertainty »Hepatization« is an interesting word in the ultra-sound field, since the lung and the liver have a sim-ilar pattern The term »alveolar filling« ... next [14] The Ultrasound Signs Elementary sign, the comet-tail artifact arising from the pleural line, well defined, erasing A lines, in rhythm with lung sliding and spreading up to the lower ... edge of the screen without fading, i.e., the ultrasound B line (Fig 17.6) This description dis-tinguishes the B line from the Z line (Fig 17.7) and the E line (see Fig 16.11, p 113) The elaborated

Ngày tải lên: 09/08/2014, 15:20

... a critical issue, an intensivist trained in emergency ultrasound should clearly be trained in applying the probe on the heart The reader is therefore invited to acquire the basic knowledge necessary ... examination, including the heart but also the lungs and veins, can be compared with these complex approaches when only the medical prescription changes are taken into account In terms of therapeutic ... scan in a patient in shock with thoracic pain Note the substan-tial thrombosis, with regular layers A, circulating lumen of the aorta back to the periphery a few millimeters in each systole In the

Ngày tải lên: 09/08/2014, 15:20

... fibroscopy will remain the reference test for tra-cheal disorders, but the principle remains the same: give the patient a first noninvasive, rapid approach that can alter the usual management, depending ... setting, and vigilance regarding crossed infections must be reinforced The Abdomen Dressings sometimes cover the entire abdominal wall, but these limitations can be bypassed The dressings can ... Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill Am } Respir Grit Care Med 150:776-783 2 Landmann MD (1986) Ultrasound screening for sinus disease Otolaryngol

Ngày tải lên: 09/08/2014, 15:20

... com-bined The Ultrasound Unit from the beginning, basic steps can be acquired one after the other To begin with, training can be limited to a single application, for instance lung sliding in the ... equipment and long training for staff), resulting in a still mar-ginal penetration In addition, the information obtained does not answer all questions [4] Even if the answer is binary at the end ... half will be achieved if one looks into the meaning of the word »stethoscope«, which comes from the Greek and was created by a French physi-cian at the beginning of the nineteenth century This instrument,

Ngày tải lên: 09/08/2014, 15:20

... baseline and ACTH-induced increases in cortisol/albumin and SAPS II score Relation between baseline and ACTH-induced increases in cortisol/albumin and SAPS II score (a) Association between baseline ... (n = 23), there were no differences in baseline cor-tisol values and increases Moreover, our findings with high baseline levels and low increases in cortisol associated with increasing severity ... corticos-teroid-binding globulin in serum in septic shock Clin Chem 1989, 35:1675-1679. 28 Beishuizen A, Thijs LG, Vermes I: Patterns of corticosteroid-binding globulin and the free cortisol index during

Ngày tải lên: 13/08/2014, 03:21

... gastrointestinal function and glucose metabolism that occur in the critically ill, focuses on current understanding of the eff ects of gastro-intestinal hormones in health and critical illness, and ... establish the eff ects on gastric emptying and/or appetite in the critically ill is indicated Th e motilin receptor also represents a target for therapy in the critically ill Concerns of erythromycin-associated ... promise in accelerating gastric empty ing in healthy individuals and ambulant patients [6] Incretin-based therapies are likely to fi nd a place in the management of hyperglycaemia in the intensive

Ngày tải lên: 13/08/2014, 20:22

... allows shorter training for the interested teams By the Way, Why “BLUE”-Protocol? The blue is the dominant tone of these patients The blue is the color of the veins, pointing that the venous analysis ... probes), since the B-lines come and go through the shooting line of the M-mode Abolished lung sliding generates a neous MM-space in M-mode: hyperechoic if the shooting line strings a B-line (like ... by the anatomy and physiology of the lung, then the clinical approach, then the mastery of reading a radiograph, interpreting blood gases or ECG, etc., up to the understanding of the pathophysiology

Ngày tải lên: 21/01/2020, 07:20

... BLUE-Point 54 The PLAPS-Point 54 Location of the Lung in Challenging Patients 56 Other Points? The Case of the Patient in the Prone Position 56 BLUE-Points and Clinical Information ... 22 Video 10.1 The A-profi le A standard lung sliding See the ribs, the bat sign, and the pleural line, and note the sparkling at the pleural line, spreading below Note also the A-line Example of ... Respecting the Sky- Earth Axis 46 The Third Principle: Locating the Lung and Defi ning Areas of Investigation 47 The Fourth Principle: Defi ning the Pleural Line 47 The Fifth Principle:

Ngày tải lên: 21/01/2020, 11:52

... allows shorter training for the interested teams By the Way, Why “BLUE”-Protocol? The blue is the dominant tone of these patients The blue is the color of the veins, pointing that the venous analysis ... probes), since the B-lines come and go through the shooting line of the M-mode Abolished lung sliding generates a neous MM-space in M-mode: hyperechoic if the shooting line strings a B-line (like ... by the anatomy and physiology of the lung, then the clinical approach, then the mastery of reading a radiograph, interpreting blood gases or ECG, etc., up to the understanding of the pathophysiology

Ngày tải lên: 22/01/2020, 08:32

... to inflam-mation, infections, or malignant diseases Taking into account these characteristics, in critically ill patients, the increased syn-thesis of this protein due to sepsis, infections, inflammatory ... among critically ill patients admitted to the Intensive Care Unit (ICU) Indeed, roughly 70 % of them are anemic since the beginning and almost 100 % develop anemia during the first week after the ... when there are dis-crepancies between the clinical situation and the main hemato-logical parameters: for example, sepsis is improving and leukocyte level is still increasing or there is a worsening

Ngày tải lên: 23/01/2020, 00:03

... thrombocytopenia and thrombocytosis in critically ill patients will be illustrated, and their implications on morbidity and mortality will be discussed Due to its importance in the ICU setting, a section in ... glycoproteins (IIb/IIIa, or IbIX) Abs bind to glycoproteins and sensitized platelets are eliminated by the reticuloendothelial system, resulting in seTrang 13require the presence of the drug to bind ... heparin flushes or lines washing procedure) must be discontinued and replaced with another anticoagulant, for example, direct thrombin or activated FX inhibitors [ 37 ] In a 6 The Critically Ill

Ngày tải lên: 23/01/2020, 01:02

... includingours,havereportedpromisingresultsinthe treat-mentofadvancedNPCusingEBV-specificCTLtherapy.Chia etal.evaluatedthesafetyandefficacyofchemotherapyin combinationwithLMP-2specificEBV-CTLsinaPhaseII clin-icaltrialincluding38patients.Afteramedianfollowupof ... secreting the most IFN-␥ in responseto antigen stimulation.33Usingeitherofthesemanufacturetechniques yieldedpromisingresults,with8/10patientsachieving viro-logical and clinical responses in the ... AlthoughtheincidenceofPTLDafterHSCTvariesinthe lit-erature,itcanincreasefrom∼2%upto10 -20%inpatients withtheaforementionedriskfactors.6,10,11,15 In contrast to the post-HSCT setting, the overall inci-denceofPTLDpost-SOThasdeclinedlikelyduetoenhanced

Ngày tải lên: 04/12/2022, 16:12

... M.Sc 87 Management and Treatment Amar Safdar, M.D and Issam I Raad, M.D 99 Catheter-Related Infections in the Critically Ill vi The Management and Treatment of Intravascular Catheter-Related Infections ... CATHETER-RELATED INFECTIONS IN THE CRITICALLY ILL CATHETER-RELATED INFECTIONS IN THE CRITICALLY ILL Edited by Naomi P O’Grady, M.D Critical Care Medicine Department Warren Grant Magnuson Clinical ... regarding biofilms and the role they play in catheter infections take on added significance when coupled with the extended dwell times of catheters xii Catheter-Related Infections in the Critically...

Ngày tải lên: 10/08/2014, 16:22

... remain on the insertion site and to dry before inserting the catheter Allow povidone-iodine to remain on the skin for at least minutes, or longer if it is not yet dry before inserting the catheter ... Catheter-Related Infections in the Critically Ill Site Dressings The importance of the cutaneous microflora in the pathogenesis of CVCrelated infection suggests that the dressing applied to the ... technique during catheter insertion and in 14 Catheter-Related Infections in the Critically Ill follow-up care of the catheter, have been associated with substantially lower rates of catheter-related...

Ngày tải lên: 10/08/2014, 16:22

... facilitated by the biofilm 34 Catheter-Related Infections in the Critically Ill generated by the host and also by the production of adhesins and mucoid substances by the bacteria and fungi themselves ... controlled by inserting the subclavian catheters in the operating room, by tunnelizing the subclavian lines, nor by improving skin antisepsis We then started a series of studies that included separate ... (14) Furthermore, the 28 Catheter-Related Infections in the Critically Ill mechanisms and speed of S aureus migration along the subcutaneous tract have been investigated and clarified in an animal...

Ngày tải lên: 10/08/2014, 16:22

... PATHOGENESIS The two major pathways (extraluminal and intraluminal routes) involved in the colonization of the catheter occur at different times during 60 Catheter-Related Infections in the Critically Ill ... sterilely and placed in a sterile container with ml of phosphate buffered saline (PBS) The 52 Catheter-Related Infections in the Critically Ill container is sonicated and vortexed The PBS is inoculated ... advances in the diagnosis of catheter-related infection with the catheter in situ, confirmation of the diagnosis still requires either the removal of the catheter and clinical improvement of the patient...

Ngày tải lên: 10/08/2014, 16:22

... out the diagnosis of CRI, and surveillance skin cultures are not recommended 66 Catheter-Related Infections in the Critically Ill Cultures of the catheter hub (Table 2), which explore mainly the ... catheters (44) Specific studies are needed to evaluate the validity of the technique in critically ill patients with short-term catheters 70 Catheter-Related Infections in the Critically Ill The ... 64 Catheter-Related Infections in the Critically Ill Comparison of Catheter Culture Techniques The different mechanisms of colonization of the intravascular part of the catheter may explain some...

Ngày tải lên: 10/08/2014, 16:22

... underlying illness (5-7,25) 94 Catheter-Related Infections in the Critically Ill Relationship to Therapy The bulk of the studies reporting on use of antimicrobial therapy inappropriate for the ... rates and have thus been thought to be less deadly than secondary BSIs arising from a serious infection in another organ such as the lung The case report at the beginning of the chapter convincingly ... catheter (IV) was inserted into a vein in his hand while out in the field This IV was left in place upon arrival to the hospital where he was found to have several broken ribs on the left and...

Ngày tải lên: 10/08/2014, 16:22