Mehmet Sezai Tasbakan

Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: a randomized clinical trial.

BACKGROUND AND OBJECTIVE The aim was to evaluate whether oral swabbing with 0.2% chlorhexidine gluconate (CHX) decreases the risk of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients. MATERIAL AND METHODS Sixty-one dentate patients scheduled for invasive mechanical ventilation for at least 48 h were included in this randomized, double-blind, controlled study. As these patients were variably incapacitated, oral care was provided by swabbing the oral mucosa four times/d with CHX in the CHX group (29 patients) and with saline in the control group (32 patients). Clinical periodontal measurements were recorded, and lower-respiratory-tract specimens were obtained for microbiological analysis on admission and when VAP was suspected. Pathogens were identified by quantifying colonies using standard culture techniques. RESULTS Ventilator-associated pneumonia developed in 34/61 patients (55.7%) within 6.8 d. The VAP development rate was significantly higher in the control group than in the CHX group (68.8% vs. 41.4%, respectively; p = 0.03) with an odds ratio of 3.12 (95% confidence interval = 1.09-8.91). Acinetobacter baumannii was the most common pathogen (64.7%) of all species identified. There were no significant differences between the two groups in clinical periodontal measurements, VAP development time, pathogens detected or mortality rate. CONCLUSION The finding of the present study, that oral care with CHX swabbing reduces the risk of VAP development in mechanically ventilated patients, strongly supports its use in ICUs and indeed the importance of adequate oral hygiene in preventing medical complications.

Comparison of clinical characteristics in patients with obesity hypoventilation syndrome and obese obstructive sleep apnea syndrome: a case-control study.

Obesity hypoventilation syndrome (OHS) can be overlooked unless clinicians have a high index of suspicion. The present case‐control study aimed to compare characteristics of patients with OHS and obese obstructive sleep apnea syndrome (OSAS), and to identify determinants of hypercapnia in OSAS patients.

Elevated Risk of Sleepiness-Related Motor Vehicle Accidents in Patients with Obstructive Sleep Apnea Syndrome: A Case-Control Study

Objectives: The present case-control study aimed to determine whether obstructive sleep apnea syndrome (OSAS) patients are at an increased risk for sleepiness-related motor vehicle accidents (MVAs) than controls and to identify disease-related factors associated with accident risk. Methods: Demographic, anthropometric, clinical, and polysomnographic parameters of 312 OSAS patients were compared with 156 age- and sex-matched primary snoring subjects. Results: The rate of OSAS patients reporting accident was higher than snoring subjects (21.2% vs. 11.5%, P = .011), and OSAS was associated with an increase in accident risk (odds ratio = 2.06, 95% confidence interval [CI], 1.17 to 3.61, P = .012). Younger OSAS patients (P = .001) and those who were male (P = .001), had greater neck circumference (P = .002), had a higher Epworth sleepiness score (ESS; P < .0001), and had a higher apnea–hypopnea index (AHI; p = .039) had more MVAs than OSAS patients. Daytime sleepiness was associated with a 2.74-fold increase (95% CI, 1.54 to 4.87, P = .001) in accident risk. In multiple logistic regression analysis, accident risk was associated with neck circumference (P < .031) and ESS (P < .0001). In addition, accident risk could be excluded in OSAS patients with neck circumference < 43 cm and ESS < 11 (sensitivity 33.3%, specificity 85.8%). Conclusions: The present results show that OSAS patients have a twofold higher risk of traffic accidents than control subjects, and increased neck circumference and excessive daytime sleepiness are useful in predicting OSAS patients at higher risk of having accidents.

Change in weight and central obesity by positive airway pressure treatment in obstructive sleep apnea patients: longitudinal data from the ESADA cohort

The effect of positive airway pressure treatment on weight and markers of central obesity in patients with obstructive sleep apnea remains unclear. We studied the change in body weight and anthropometric measures following positive airway pressure treatment in a large clinical cohort. Patients with obstructive sleep apnea with positive airway pressure treatment from the European Sleep Apnea Database registry (n = 1,415, 77% male, age 54 ± 11 [mean ± SD] years, body mass index 31.7 ± 6.4 kg/m2, apnea–hypopnea index 37 ± 24 n per hr, Epworth Sleepiness Scale 10.2 ± 5.0) were selected. Changes in body mass index and neck/waist/hip circumferences at baseline and at follow‐up visit were analysed. Overall, body mass index (0.0 [95% confidence interval, −0.1 to 0.2] kg/m2) and neck circumference (0.0 (95% confidence interval, −0.1 to 0.1] cm) were unchanged after positive airway pressure treatment compared with baseline (follow‐up duration 1.1 ± 1.0 years and compliance 5.2 ± 2.1 hr per day). However, in non‐obese (body mass index <30 kg/m2) patients, positive airway pressure treatment was associated with an increased body mass index and waist circumference (0.4 [0.3–0.5] kg/m2 and 0.8 [0.4–1.2] cm, respectively, all p < 0.05), and weight gain was significantly associated with higher positive airway pressure compliance and longer positive airway pressure treatment duration. In the obese subgroup, body mass index was reduced after positive airway pressure treatment (−0.3 [−0.5 to −0.1] kg/m2, p < 0.05) mainly in patients with a strong reduction in Epworth Sleepiness Scale. In conclusion, positive airway pressure therapy was not found to systematically change body mass index in the European Sleep Apnea Database cohort, but the response was heterogeneous. Our findings suggest that weight gain may be restricted to an obstructive sleep apnea phenotype without established obesity. Lifestyle intervention needs to be considered in both lean and obese patients with obstructive sleep apnea receiving positive airway pressure treatment.

Prevalence of overlap syndrome in chronic obstructive pulmonary disease patients without sleep apnea symptoms

The co‐existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is a common phenomenon referred to as overlap syndrome (OS). In this study, we evaluated the prevalence of OS in mild hypoxemic COPD patients without OSA symptoms and compared characteristics of OS and COPD patients.

The comparison of microscopy and real time polymerase chain reaction methods for the diagnosis of Pneumocystis Jirovecii pneumonia: evaluation of clinical parameters

Introduction Pneumocystis jirovecii pneumonia (PCP) causes serious infections, especially in patients with immunosuppressive diseases. In this study, it was aimed to evaluate the results of samples obtained from PCP suspected patients using two different methods together with clinical data. Materials and Methods Microscopy and real time polymerase chain reaction (real time PCR) methods were performed with bronchoalveolar lavage (BAL) samples sended to Ege University Medical Faculty Direct Parasitology Diagnostic Laboratory between March 2009 and June 2010. Demographic characteristics, clinical and laboratory data were also recorded retrospectively. The data were evaluated using the SPSS 16.0 program. Result A total of 42 BAL samples collected from patients (24 males, mean age: 31.49 ± 26.14) were included. There were totally 16 P. jirovecii positives either one of the tests. Sixteen and three samples were detected positive by real time PCR and microscopy, respectively. Trimethoprim-sulfamethoxazole was prescribed in 11 PCP diagnosed cases and 6 of them died. Conclusions Today, despite the growing opportunities in diagnosis and treatment, PCP pneumonia is associated with high mortality. Careful examination of clinical data and immune status of the patients are important. Multidisciplinary approach is required for early PCP diagnosis.

Effect of Isolation of Candida Species from Respiratory Specimens on Prognosis

Objective: Candida species are often isolated from respiratory specimens of patients with a history of long duration of hospitalization, immunosuppression, diabetes, alcoholism, history of wide spectrum antibiotic or corticosteroid usage. The aim of this retrospective study is to investigate the effect of isolation of Candida species from respiratory specimens on prognosis. Material and Method: Patients in the Department of Chest Disease in whom Candida species had been grown in ≥2 respiratory specimens obtained at the same or at different time periods within the last two years were enrolled in the study. Demographic features of the patients, risk factors for fungal infection, and the effect of this infection on prognosis were evaluated. Results: Out of 47 cases (mean age 67.6±14.6 yrs, 33 males) enrolled in the study, 29 were diagnosed as pneumonia at admission. The most frequent species isolated was C. albicans (68.1%). Fifty bacterial agents were isolated from respiratory specimens of 29 patients (61.7%) initially or on follow-up along with Candida species. Immunosuppression was detected in 28 patients (59.6%). Mean duration of hospitalization was 22.3±15.2 days and 26 patients (55.3%) died. Radiologically, multiple-zone involvement, C. tropicalis isolation, high APACHE II score, co-existing bacterial infection, low PaO 2 /FiO 2 ratio, and low albumin levels were found to be associated with mortality. Conclusion: This study showed that Candida species could also be isolated in respiratory specimens of non-immunosuppressed patients and mortality was high. It was concluded that bacterial co-infection and C. tropicalis isolation affected the prognosis negatively. (Tur Toraks Der 2011; 12: 153-7)