Rahat Hussain

Gram-Negative Intravascular Catheter-Related Bacteremia in Patients With Spinal Cord Injury

OBJECTIVE To determine whether the prevalence of gram-negative catheter-related bloodstream infection (CRBSI) is higher in patients with spinal cord injury (SCI) than in patients without SCI. DESIGN Retrospective chart review from August 1998 to August 2006. SETTING A Veterans Affairs medical center, which serves as a tertiary care medical center to over 500 veterans with SCI and is the primary source of health care for veterans in southeast Texas. PARTICIPANTS All hospitalized patients who had an International Classification of Diseases, Ninth Revision, code for bacteremia associated with their hospital stay. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The proportion of CRBSI caused by gram-negative organisms in the SCI patients to the proportion of CRBSI caused by gram-negative organisms in the non-SCI patients. RESULTS Eight (42%) of 19 episodes of CRBSI in the SCI were caused by a gram-negative organism as compared with 4 (11%) of 36 infections in the non-SCI group (P<.01). Factors associated with having a gram-negative organism rather than a gram-positive organism as the causative agent of CRBSI were SCI, femoral catheter site, prolonged hospitalization, decubitus ulcer, and urinary catheter. CONCLUSIONS In our medical center, patients with SCI who develop CRBSI are more likely to have an infection with a gram-negative organism than are patients without SCI. This knowledge may guide initial empirical therapy of suspected bloodstream infection.

Prolonged venovenous extracorporeal membrane oxygenation in a patient with acute respiratory distress syndrome

A 30 year-old Hispanic man with no significant previous medical history presented with refractory hypoxemia after flu-like symptoms. Because of progressive hypoxemia despite appropriate ventilator strategies, venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated for severe acute respiratory distress syndrome (ARDS). His course was complicated at our hospital by subarachnoid hemorrhage, right ventricular failure, multiple pneumothoraces, and significant deconditioning. He was able to be weaned off VV-ECMO after 193 days and was ambulatory at discharge from the hospital.

144: OBESITY PARADOX IN PATIENTS UNDERGOING VENOVENOUS EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT

Crit Care Med 2016 • Volume 44 • Number 12 (Suppl.) transplantation (HT). We sought to characterize outcomes for these children. Methods: Retrospective review of HT patients in our pediatric referral hospital between 1995 and 2015. Inclusion criteria were all patients cannulated to ECMO within the first 7 days after HT. Demographics and risk factors were compared between survivors and non-survivors. Standard statistical methods were applied. Results: There were 246 HT performed in the study period. Congenital heart disease (CHD) and cardiomyopathy (CM) patients were evenly represented (119, 48% vs 115, 47%). ECMO was instituted within 7 days of transplant for 28 patients (11%), 18 (64%) of whom survived to hospital discharge. CHD was the most common indication for HT in those managed with early ECMO (18, 64% vs 10, 36% CM). Median time to ECMO was 1 day (range 0-2 days), with 11 patients (61%) cannulated to ECMO from cardio-pulmonary bypass in the operating room. Survival to hospital discharge did not differ according to patient factors such as age, weight, gender, pre-transplant diagnosis, liver or renal function, panel reactive antibody level or pre-transplant pulmonary vascular resistance. Transplant factors such as donor:recipient weight ratio and organ ischemic time were not associated with survival, nor was indication for ECMO. Patients cannulated to ECMO in the operating room were less likely to survive to hospital discharge (4 of 11, 36%, p=0.02). Four patients treated with early ECMO received another ECMO run (4/28, 14%) at median time 55 days after decannulation (range 18 to 635 days). Conclusions: ECMO can be used to rescue children with early graft dysfunction after HT. It is associated with early mortality, with only 64% of supported patients surviving to hospital discharge. Cannulation to ECMO in the operating room may represent severe early graft failure and these patients were less likely to survive.