Epameinondas Angelopoulos

Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit.

Objective –  To investigate risk factors of critical illness polyneuromyopathy (CIPM) in a general multidisciplinary intensive care unit (ICU).

Risk factors for tracheobronchial acquisition of resistant Gram-negative bacterial pathogens in mechanically ventilated ICU patients.

Abstract The aim of this study was to identify risk factors for tracheobronchial acquisition with the most common resistant Gram-negative bacteria in the intensive care unit (ICU) during the first week after intubation and mechanical ventilation. Tracheobronchial and oropharyngeal cultures were obtained at admission, after 48 hours, and after 7 days of mechanical ventilation. Patient characteristics, interventions, and antibiotic usage were recorded. Among 71 eligible patients with two negative bronchial cultures for resistant Gram-negative bacteria (at admission and within 48 hours), 41 (58%) acquired bronchial resistant Gram-negative bacteria by day 7. Acquisition strongly correlated with presence of the same pathogens in the oropharynx: Acinetobacter baumannii [odds ratio (OR) = 20·2, 95% confidence interval (CI): 5·5–73·6], Klebsiella pneumoniae (OR = 8·0, 95% CI: 1·9–33·6), and Pseudomonas aeruginosa (OR = 27, 95%: CI 2·7–273). Bronchial acquisition with resistant K. pneumoniae also was associated with chronic liver disease (OR = 3·9, 95% CI: 1·0–15·3), treatment with aminoglycosides (OR = 4·9, 95% CI: 1·4–18·2), tigecycline (OR = 4·9, 95% CI: 1·4–18·2), and linezolid (OR = 3·9, 95% CI: 1·1–15·0). In multivariate analysis, treatment with tigecycline and chronic liver disease were independently associated with bronchial resistant K. pneumoniae acquisition. Our results show a high incidence of tracheobronchial acquisition with resistant Gram-negative microorganisms in the bronchial tree of newly intubated patients. Oropharynx colonization with the same pathogens and specific antibiotics use were independent risk factors.

Determinants of prolonged intensive care unit stay in patients after cardiac surgery: a prospective observational study

BACKGROUND Prolonged intensive care unit (ICU) stay of patients after cardiac surgery has a major impact on overall cost and resource utilization. The aim of this study was to identify perioperative factors which prolong stay in ICU. METHODS All adult patients from a single, specialized cardiac center who were admitted to the ICU after cardiac surgery during a 2-month period were included. Demographic and clinical characteristics, comorbidities, preoperative use of drugs, intraoperative variables, and postoperative course were recorded. Hemodynamic and blood gas measurements were recorded at four time intervals during the first 24 postoperative hours. Routine hematologic and biochemical laboratory results were recorded preoperatively and in the first postoperative hours. RESULTS During the study period 145 adult patients underwent cardiac surgery: 65 (45%) underwent coronary artery bypass graft surgery, 38 (26%) valve surgery, 26 (18%) combined surgery and 16 (11%) other types of cardiac operation. Seventy nine (54%) patients had an ICU stay of less than 24 hours. Random forests analysis identified four variables that had a major impact on the length of stay (LOS) in ICU; these variables were subsequently entered in a logistic regression model: preoperative hemoglobin [odds ratio (OR) =0.68], duration of aortic clamping (OR =1.01) and ratio of arterial oxygen partial pressure to inspired oxygen fraction (PaO2/FiO2) (OR =0.99) and blood glucose during the first four postoperative hours (OR =1.02). ROC curve analysis showed an AUC =0.79, P<0.001, 95% CI: 0.71-0.86. CONCLUSIONS Low preoperative hemoglobin, prolonged aortic clamping time and low PaO2/FiO2 ratio and blood glucose measured within the first postoperative hours, were strongly related with prolonged LOS in ICU.

A Giant Intrathoracic Malignant Schwannoma Causing Respiratory Failure in a Patient without von Recklinghausen’s Disease

We report an unusual case of a thoracic opacity due to a huge mediastinal malignant schwannoma which compressed the whole left lung and the mediastinum causing respiratory failure in a 73-year-old woman without von Recklinghausens disease. Although the tumor was resected, the patient failed to wean from mechanical ventilation and died one month later because of multiple organ dysfunction syndrome.

Electrical muscle stimulation mobilizes endothelial progenitor cells in ICU patients.

Intr In the critically ill, the number of the bone marrowderived endothelial progenitor cells (EPCs) in peripheral blood constitutes a regeneration index of the endothelium of tissues that suffered the consequences of critical illness. Furthermore, electrical muscle stimulation (EMS) has been shown to induce beneficial effects in relation to prevention of acquired muscle weakness and atrophy, as well as weaning duration. The acute effects of EMS on EPCs have been scantily explored.