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  • 1
    Language: English
    In: Scientific reports, 2021-11-15, Vol.11 (1), p.22264-22264
    Description: AbstractVentilator-associated pneumonia (VAP) is a frequent complication of mechanical ventilation and is associated with substantial morbidity and mortality. Accurate diagnosis of VAP relies in part on subjective diagnostic criteria. Surveillance according to ventilator-associated event (VAE) criteria may allow quick and objective benchmarking. Our objective was to create an automated surveillance tool for VAE tiers I and II on a large data collection, evaluate its diagnostic accuracy and retrospectively determine the yearly baseline VAE incidence. We included all consecutive intensive care unit admissions of patients with mechanical ventilation at Bern University Hospital, a tertiary referral center, from January 2008 to July 2016. Data was automatically extracted from the patient data management system and automatically processed. We created and implemented an application able to automatically analyze respiratory and relevant medication data according to the Centers for Disease Control protocol for VAE-surveillance. In a subset of patients, we compared the accuracy of automated VAE surveillance according to CDC criteria to a gold standard (a composite of automated and manual evaluation with mediation for discrepancies) and evaluated the evolution of the baseline incidence. The study included 22′442 ventilated admissions with a total of 37′221 ventilator days. 592 ventilator-associated events (tier I) occurred; of these 194 (34%) were of potentially infectious origin (tier II). In our validation sample, automated surveillance had a sensitivity of 98% and specificity of 100% in detecting VAE compared to the gold standard. The yearly VAE incidence rate ranged from 10.1–22.1 per 1000 device days and trend showed a decrease in the yearly incidence rate ratio of 0.96 (95% CI, 0.93–1.00, p = 0.03). This study demonstrated that automated VAE detection is feasible, accurate and reliable and may be applied on a large, retrospective sample and provided insight into long-term institutional VAE incidences. The surveillance tool can be extended to other centres and provides VAE incidences for performing quality control and intervention studies.
    Subject(s): Automation ; Data collection ; Morbidity ; Patients ; Quality control ; Surveillance ; Ventilation ; Ventilator-associated pneumonia ; Ventilators
    ISSN: 2045-2322
    E-ISSN: 2045-2322
    Source: Nature Open Access
    Source: Academic Search Ultimate
    Source: PubMed Central
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  • 2
    Language: English
    In: Antimicrobial resistance & infection control, 2019-05-22, Vol.8 (1), p.81-81
    Description: Background: The aim of the study was to evaluate the composition and the temporal evolution of the oropharyngeal microbiome in antibiotic-naive patients requiring mechanical ventilation and to gain new insights into the pathogenesis of ventilator-associated pneumonia (VAP). Methods: Prospective, observational single-center nested case-control study. Patients with acute critical illness and anticipated duration of mechanical ventilation 〉 4 days were eligible. We took oropharyngeal swabs (and if available, tracheal secretions) daily, starting at the day of intubation. The microbiota was characterized by 16S rRNA high-throughput sequencing and compared between patients developing VAP versus controls. Results: Five patients developed VAP. In three patient the causative pathogens were Enterobacteriaceae and in two Haemophilus influenzae. Locally weighted polynomial regression suggested that the within diversity (=alpha) was lower in Enterobacteriaceae VAP patients between days two to five of mechanical ventilation when compared to controls. Detection of Enterobacteriaceae in the oropharynx occurred on day two of follow-up and consisted of a single operational taxonomic unit in 2/3 patients with enterobacterial VAP. Conclusions: In acutely-ill patients who developed enterobacterial VAP the causative pathogen gained access to the oropharynx early after starting mechanical ventilation and outgrew the commensal members of the microbiome. Whether a specific pattern of the oropharyngeal microbiome between days three to five of mechanical ventilation may predict VAP enterobacterial VAP has to be evaluated in further studies.
    Subject(s): Adolescent ; Adult ; Aged ; Antibiotics ; Artificial respiration ; Case-Control Studies ; Clinical outcomes ; Complications and side effects ; Cystic fibrosis ; Development and progression ; Enterobacteriaceae - classification ; Enterobacteriaceae - isolation & purification ; Enterobacteriaceae Infections - microbiology ; Female ; Haemophilus influenzae - classification ; Haemophilus influenzae - isolation & purification ; Health aspects ; High-Throughput Nucleotide Sequencing ; Hospitals ; Humans ; Infection prevention ; Infectious Diseases ; Intensive care ; Intensive Care Units ; Life Sciences & Biomedicine ; Longitudinal Studies ; Male ; Microbiology ; Microbiota ; Microbiota (Symbiotic organisms) ; Middle Aged ; Mortality ; Multiculturalism & pluralism ; Nosocomial infections ; Nosocomial pneumonia ; Oropharyngeal and tracheal microbiome ; Oropharynx ; Oropharynx - microbiology ; Patients ; Pharmacology & Pharmacy ; Pneumonia ; Pneumonia, Ventilator-Associated - microbiology ; Prospective Studies ; Public, Environmental & Occupational Health ; Research ; Respiration, Artificial - adverse effects ; RNA, Ribosomal, 16S - genetics ; Science & Technology ; Streptococcus infections ; Surveillance ; Thorax ; Trachea - microbiology ; Usage ; Ventilator-associated pneumonia ; Ventilators ; Young Adult
    ISSN: 2047-2994
    E-ISSN: 2047-2994
    Source: BioMedCentral Open Access
    Source: Academic Search Ultimate
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
    Source: PubMed Central
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
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  • 3
    Language: English
    In: Intensive care medicine, 2017-02-17, Vol.43 (7), p.1048-1051
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00134-017-4716-1
    Subject(s): Anesthesiology ; Critical Care - methods ; Critical Care Medicine ; Echocardiography ; Echocardiography, Transesophageal - economics ; Echocardiography, Transesophageal - standards ; Emergency Medicine ; Extracorporeal Membrane Oxygenation - methods ; Hemodynamic Monitoring - methods ; Human health and pathology ; Humans ; Intensive ; Intensive Care Units ; Life Sciences ; Medicine ; Medicine & Public Health ; Miniaturization ; Pain Medicine ; Patient monitoring equipment ; Pediatrics ; Pneumology/Respiratory System ; Reproducibility of Results ; Septic shock ; What's New in Intensive Care
    ISSN: 0342-4642
    E-ISSN: 1432-1238
    Source: Alma/SFX Local Collection
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  • 4
    Language: English
    In: PloS one, 2017, Vol.12 (6), p.e0178946-e0178946
    Description: Reduced cellular ATP synthesis due to impaired mitochondrial function of immune cells may be a factor influencing the immune response in septic shock. We investigate changes in mitochondrial function and bioenergetics of human monocytes and lymphocyte subsets. Thirty patients with septic shock were studied at ICU admission, after 24 and 48 hours, and after resolution of shock. Enzymatic activities of citrate synthase and mitochondrial complexes I, IV, and ATP synthase and ATP content of monocytes, T-cells and B-cells and pro-inflammatory (IL-1β and IL-6) and anti-inflammatory (IL-10) cytokine plasma concentrations were compared to samples from 20 healthy volunteers. Large variations in mitochondrial enzymatic activities of immune cells of septic patients were detected. In monocytes, maximum levels of citrate synthase activity in sepsis were significantly lower when compared to controls (p = 0.021). Maximum relative enzymatic activity (ratio relative to citrate synthase activity) of complex I (p〈0.001), complex IV (p = 0.017) and ATP synthase (p〈0.001) were significantly higher. In T-cells, maximum levels of citrate synthase (p = 0.583) and relative complex IV (p = 0.602) activity did not differ between patients and controls, whereas levels of relative complex I (p = 0.006) and ATP synthase (p = 0.032) were significantly higher in septic patients. In B-cells of patients, maximum levels of citrate synthase activity (p = 0.004) and relative complex I (p〈0.001) were significantly higher, and mean levels of relative complex IV (p = 0.042) lower than the control values, whereas relative ATP synthase activity did not differ (p = 1.0). No significant difference in cellular ATP content was detected in any cell line (p = 0.142-0.519). No significant correlations between specific cytokines and parameters of mitochondrial enzymatic activities or ATP content were observed. Significant changes of mitochondrial enzymatic activities occur in human peripheral blood immune cells in septic shock when compared to healthy controls. Assessed sub-types of immune cells showed differing patterns of regulation. Total ATP-content of human immune cells did not differ between patients in septic shock and healthy volunteers.
    Subject(s): Adenosine ; Adenosine Triphosphate - biosynthesis ; Aged ; ATP ; ATP synthase ; ATP Synthetase Complexes - biosynthesis ; ATP Synthetase Complexes - immunology ; B-Lymphocytes - immunology ; B-Lymphocytes - metabolism ; B-Lymphocytes - pathology ; Bioenergetics ; Biology and Life Sciences ; Blood ; Citrate (si)-Synthase - genetics ; Control ; Correlation ; Cytochrome-c oxidase ; Cytokines ; Development and progression ; Enzymatic activity ; Enzymes ; Female ; Genetic aspects ; Health care ; Healthy Volunteers ; Hospitals ; Humans ; Immune response ; Immune system ; Inflammation ; Intensive care ; Interleukin 1 ; Interleukin 10 ; Interleukin 6 ; Interleukin-10 - genetics ; Interleukin-10 - immunology ; Interleukin-1beta - genetics ; Interleukin-1beta - immunology ; Interleukin-6 - genetics ; Interleukin-6 - immunology ; Lymphocytes ; Lymphocytes B ; Lymphocytes T ; Male ; Medicine ; Medicine and Health Sciences ; Metabolism ; Middle Aged ; Mitochondria ; Mitochondria - genetics ; Mitochondria - immunology ; Mitochondria - pathology ; Mitochondrial DNA ; Monocytes ; Monocytes - immunology ; Monocytes - metabolism ; Patients ; Peripheral blood ; Phosphorylation ; Physiological aspects ; Physiology ; Research ; Research and Analysis Methods ; Sepsis ; Septic shock ; Shock ; Shock, Septic - genetics ; Shock, Septic - immunology ; Shock, Septic - pathology ; Synthesis ; T-Lymphocytes - immunology ; T-Lymphocytes - metabolism ; T-Lymphocytes - pathology
    ISSN: 1932-6203
    E-ISSN: 1932-6203
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
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  • 5
    Language: English
    In: Intensive care medicine, 2019-07-04, Vol.45 (8), p.1093-1102
    Description: Purpose Mortality in circulatory shock is high. Enhanced resolution of shock may improve outcomes. We aim to determine whether adding hemodynamic monitoring with continual transesophageal echocardiography (hTEE) to usual care accelerates resolution of hemodynamic instability. Methods 550 patients with circulatory shock were randomly assigned to four groups stratified using hTEE (hTEE vs usual care) and assessment frequency (minimum every 4 h vs 8 h). Primary outcome was time to resolution of hemodynamic instability, analyzed as intention-to-treat (ITT) analysis at day 6 and in a predefined secondary analysis at days 3 and 28. Results Of 550 randomized patients, 271 with hTEE and 274 patients with usual care were eligible and included in the ITT analysis. Time to resolution of hemodynamic instability did not differ within the first 6 days [hTEE vs usual care adjusted sub-hazard ratio (SHR) 1.20, 95% confidence interval (CI) 0.98–1.46, p  = 0.067]. Time to resolution of hemodynamic instability during the 72 h of hTEE monitoring was shorter in patients with TEE (hTEE vs usual care SHR 1.26, 95% CI 1.02–1.55, p  = 0.034). Assessment frequency had no influence. Time to resolution of clinical signs of hypoperfusion, duration of organ support, length of stay and mortality in the intensive care unit and hospital, and mortality at 28 days did not differ between groups. Conclusions In critically ill patients with shock, hTEE monitoring or hemodynamic assessment frequency did not influence resolution of hemodynamic instability or mortality within the first 6 days. Trial registration and statistical analysis plan ClinicalTrials.gov Identifier: NCT02048566.
    Subject(s): Aged ; Anesthesiology ; Care and treatment ; Circulatory shock ; Critical Care Medicine ; Critical Illness - therapy ; Critically ill ; Echocardiography, Transesophageal - instrumentation ; Echocardiography, Transesophageal - methods ; Emergency Medicine ; Female ; General & Internal Medicine ; Hemodynamic monitoring ; Hemodynamic Monitoring - instrumentation ; Hemodynamic Monitoring - methods ; Hemodynamic transesophageal echocardiography (hTEE) ; Humans ; Intensive ; Intensive / Critical Care Medicine ; Intensive Care Units - organization & administration ; Intensive Care Units - statistics & numerical data ; Life Sciences & Biomedicine ; Logistic Models ; Male ; Medical examination ; Medicine ; Medicine & Public Health ; Middle Aged ; Original ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System ; Proportional Hazards Models ; Randomized controlled trial ; Research ; Science & Technology ; Shock - physiopathology ; Switzerland ; Transesophageal echocardiography ; Usage
    ISSN: 0342-4642
    E-ISSN: 1432-1238
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
    Source: Alma/SFX Local Collection
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  • 6
    Language: English
    In: European journal of applied physiology, 2013-04-06, Vol.113 (8), p.2025-2037
    Description: Impairment of cognitive performance during and after high-altitude climbing has been described in numerous studies and has mostly been attributed to cerebral hypoxia and resulting functional and structural cerebral alterations. To investigate the hypothesis that high-altitude climbing leads to cognitive impairment, we used of neuropsychological tests and measurements of eye movement (EM) performance during different stimulus conditions. The study was conducted in 32 mountaineers participating in an expedition to Muztagh Ata (7,546 m). Neuropsychological tests comprised figural fluency, line bisection, letter and number cancellation, and a modified pegboard task. Saccadic performance was evaluated under three stimulus conditions with varying degrees of cortical involvement: visually guided pro- and anti-saccades, and visuo-visual interaction. Typical saccade parameters (latency, mean sequence, post-saccadic stability, and error rate) were computed off-line. Measurements were taken at a baseline level of 440 m and at altitudes of 4,497, 5,533, 6,265, and again at 440 m. All subjects reached 5,533 m, and 28 reached 6,265 m. The neuropsychological test results did not reveal any cognitive impairment. Complete eye movement recordings for all stimulus conditions were obtained in 24 subjects at baseline and at least two altitudes and in 10 subjects at baseline and all altitudes. Measurements of saccade performances showed no dependence on any altitude-related parameter and were well within normal limits. Our data indicates that acclimatized climbers do not seem to suffer from significant cognitive deficits during or after climbs to altitudes above 7,500 m. We demonstrated that investigation of EMs is feasible during high-altitude expeditions.
    Subject(s): Adult ; Altitude ; Biomedical and Life Sciences ; Biomedicine ; Cognition ; Cognitive function ; Female ; High altitude ; Human Physiology ; Humans ; Hypoxia ; Male ; Middle Aged ; Mountaineering - physiology ; Neuropsychological testing ; Neuropsychological Tests ; Occupational Medicine/Industrial Medicine ; Original Article ; Saccades ; Saccadic eye movement ; Sports Medicine
    ISSN: 1439-6319
    E-ISSN: 1439-6327
    Source: Alma/SFX Local Collection
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  • 7
    Language: English
    In: Acta neurochirurgica, 2016-01-25, Vol.158 (3), p.595-601
    Description: Background External ventricular drainage (EVD) is frequently used in different groups of patients in neurocritical care. Despite the frequent use of EVD, no consensus regarding the diagnosis of EVD-related infection currently exists, and diagnosis is commonly based on criteria for the diagnosis of non-EVD-related CNS infections. This study evaluates the diagnostic accuracy of clinical and laboratory parameters for the prediction of EVD-related infection in patients with proven EVD-related infection. Methods In two tertiary care centers, data on EVD insertions were matched with a microbiologic database of cultured microorganisms and positive Gram stains of cerebrospinal fluid (CSF) to identify patients with EVD-related infections. Available clinical data and results of blood tests and CSF analysis were retrospectively collected. Predefined potential clinical and laboratory predictors of EVD-related infection were compared between three time points: at the time EVD insertion and 48 h before and at the time of occurrence of EVD-related infection. Results Thirty-nine patients with EVD-associated infection defined by positive CSF culture or positive CSF Gram stains and concomitant clinical signs of infection were identified. At the time of infection, a significantly higher incidence of abnormal temperature, high respiratory rate, and a slightly but significantly higher incidence of decreased mental state were observed. The assessed blood and CSF parameters did not significantly differ between the different assessment time points. Conclusions Our analysis of 39 patients with culture positive EVD-related infection showed that commonly used clinical and laboratory parameters are not reliable infection predictors.
    Subject(s): Adult ; Aged ; Biomarkers - cerebrospinal fluid ; Central Nervous System Infections - cerebrospinal fluid ; Central Nervous System Infections - etiology ; CSF analysis ; Diagnostic parameters ; Drainage - adverse effects ; EVD infection ; Experimental Research - Neurosurgical Techniques ; Female ; Humans ; Interventional Radiology ; Male ; Markers of inflammation ; Medicine ; Medicine & Public Health ; Middle Aged ; Minimally Invasive Surgery ; Neurology ; Neuroradiology ; Neurosurgery ; Neurosurgical Procedures - adverse effects ; Surgical Orthopedics
    ISSN: 0001-6268
    E-ISSN: 0942-0940
    Source: Alma/SFX Local Collection
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  • 8
    Language: English
    In: Intensive care medicine, 2015-03-20, Vol.41 (6), p.1029-1036
    Description: Purpose Rapid assessment and intervention is important for the prognosis of acutely ill patients admitted to the emergency department (ED). The aim of this study was to prospectively develop and validate a model predicting the risk of in-hospital death based on all available information available at the time of ED admission and to compare its discriminative performance with a non-systematic risk estimate by the triaging first health-care provider. Methods Prospective cohort analysis based on a multivariable logistic regression for the probability of death. Results A total of 8,607 consecutive admissions of 7,680 patients admitted to the ED of a tertiary care hospital were analysed. Most frequent APACHE II diagnostic categories at the time of admission were neurological (2,052, 24 %), trauma (1,522, 18 %), infection categories [1,328, 15 %; including sepsis (357, 4.1 %), severe sepsis (249, 2.9 %), septic shock (27, 0.3 %)], cardiovascular (1,022, 12 %), gastrointestinal (848, 10 %) and respiratory (449, 5 %). The predictors of the final model were age, prolonged capillary refill time, blood pressure, mechanical ventilation, oxygen saturation index, Glasgow coma score and APACHE II diagnostic category. The model showed good discriminative ability, with an area under the receiver operating characteristic curve of 0.92 and good internal validity. The model performed significantly better than non-systematic triaging of the patient. Conclusions The use of the prediction model can facilitate the identification of ED patients with higher mortality risk. The model performs better than a non-systematic assessment and may facilitate more rapid identification and commencement of treatment of patients at risk of an unfavourable outcome.
    Subject(s): Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anesthesiology ; Care and treatment ; Critical Care Medicine ; Critical Illness - mortality ; Critically ill ; Decision Support Techniques ; Emergency department ; Emergency Medicine ; Emergency Service, Hospital - statistics & numerical data ; Female ; Health risk assessment ; Hospital Mortality ; Humans ; Intensive ; Intensive / Critical Care Medicine ; Logistic Models ; Male ; Medicine ; Medicine & Public Health ; Methods ; Middle Aged ; Mortality ; Original ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Prognostic model ; Prospective Studies ; Risk ; Risk factors ; Triage ; Triage - methods ; Vital sign instability ; Vital Signs - physiology ; Young Adult
    ISSN: 0342-4642
    E-ISSN: 1432-1238
    Source: Alma/SFX Local Collection
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  • 9
    Language: English
    In: Acta neurochirurgica, 2018-07-31, Vol.160 (10), p.2039-2047
    Description: Background Device infection is a major complication of placement external ventricular drains (EVD). Diagnostic features are often masked by underlying disease or cerebrospinal fluid (CSF) contamination by blood. We aim to assess which diagnostic modalities are applied for EVD-related infection (ERI) diagnosis and evaluate their accuracy. Methods This observational prospective study included 187 adult patients with an EVD. Modalities of clinical diagnosis of ERI diagnosed by treating physicians on clinical grounds and blood and CSF analysis (clinically diagnosed ERI (CD-ERI)) were assessed prospectively. Additionally, the diagnostic accuracy of clinical and laboratory parameters for the diagnosis of culture proven ERI (CP-ERI) was evaluated, using data of the study patients and including a retrospective cohort of 39 patients with CP-ERI. Results Thirty-one CD-ERIs were diagnosed in the prospective cohort. Most physicians used CSF analysis to establish the diagnosis. ROC analysis revealed an AUC of 0.575 ( p  = 0.0047) for the number of positive SIRS criteria and AUC of 0.5420 ( p  = 0.11) for the number of pathological neurological signs for diagnosis of CP-ERI. Diagnostic accuracy of laboratory values was AUC 0.596 ( p  = 0.0006) for serum white blood cell count (WBCC), AUC 0.550 ( p  = 0.2489) for serum C-reactive protein, AUC 0.644 ( p  〈 0.0001) for CSF WBCC and AUC 0.690 for CSF WBC/red blood cell count ratio (both p  〈 0.0001). Neither a temporal trend in potential predictors of CP-ERI nor a correlation between clinical diagnosis and proven CSF infection was found. Conclusions Clinicians base their diagnosis of ERI mostly on CSF analysis and occurrence of fever, leading to over-diagnosis. The accuracy of the clinical diagnosis is low. Commonly used clinical and laboratory diagnostic criteria have a low sensitivity and specificity for ERI.
    Subject(s): CSF changes ; Diagnosis ; EVD-related infection ; External ventricular device ; Interventional Radiology ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Neurology ; Neuroradiology ; Neurosurgery ; Neurosurgical intensive care ; Original Article - Neurosurgical intensive care ; Surgical Orthopedics
    ISSN: 0001-6268
    E-ISSN: 0942-0940
    Source: Alma/SFX Local Collection
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  • 10
    Language: English
    In: Intensive care medicine, 2019-07-22, Vol.45 (9), p.1330-1330
    Description: The original version of this article unfortunately contained a mistake.
    Subject(s): Anesthesiology ; Correction ; Critical Care Medicine ; Emergency Medicine ; Intensive ; Intensive / Critical Care Medicine ; Medicine ; Medicine & Public Health ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System
    ISSN: 0342-4642
    E-ISSN: 1432-1238
    Source: Alma/SFX Local Collection
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