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Hayajneh AA, Jaradat ZW, Alsatari ES, Alboom MH. Predictors of growth of Escherichia coli on lab coats as part of hospital-acquired infection transmission through healthcare personnel attire. Int J Clin Pract 2021; 75:e14815. [PMID: 34486786 DOI: 10.1111/ijcp.14815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 09/03/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Previous research has documented the presence of microbes on healthcare personnel (HCP) attire. This study aimed to explore the bacterial contamination and predictors of Escherichia coli (E coli) growth, as well as, hygiene and handling practices of HCP attire that could influence growth of E coli. METHODS Descriptive, cross-sectional study was used in this study. Convenience sampling of the 188 HCP was recruited from a main comprehensive hospital in the northern part of Jordan. Three swab samples were collected from three different parts of lab coats used by each participant. The generalised mixed linear model was used for the categorical variables and to identify the predictors of E coli growth on HCP attire. RESULTS Enterococcus faecalis was the most common species of bacteria found on lab coat. The HCP attire coming from the emergency department (ED) was highlighted with slightly higher contamination of E coli compared with other departments, such as critical care units. Factors associated with significant E coli growth on HCP attire were lab coat use over scrubs and borrowing of lab coats. The predictors of positive E coli growth were working in the ED, storing HCP attire in hospital lockers, believing the transmission of pathogens by HCP attire and carrying attire wrapped around arms. IMPLICATIONS Hygiene practices and policies, including a washing facility on the hospital premises, are a must to keep the lab coats clean. CONCLUSION HCP should be cautious about the method of use and storage of lab coats they wear.
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Affiliation(s)
- Audai A Hayajneh
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad W Jaradat
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Eman S Alsatari
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad H Alboom
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
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Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections - an overview. Infect Drug Resist 2018; 11:2321-2333. [PMID: 30532565 PMCID: PMC6245375 DOI: 10.2147/idr.s177247] [Citation(s) in RCA: 559] [Impact Index Per Article: 93.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. Multiple studies indicate that the common types of adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications. The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one in 17) die due to these. Several studies suggest that simple infection-control procedures such as cleaning hands with an alcohol-based hand rub can help prevent HCAIs and save lives, reduce morbidity, and minimize health care costs. Routine educational interventions for health care professionals can help change their hand-washing practices to prevent the spread of infection. In support of this, the WHO has produced guidelines to promote hand-washing practices among member countries.
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Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia,
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Muhamad Abu Bakar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia,
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Sepsis Survivors Admitted to Skilled Nursing Facilities: Cognitive Impairment, Activities of Daily Living Dependence, and Survival. Crit Care Med 2017; 46:37-44. [PMID: 28991827 DOI: 10.1097/ccm.0000000000002755] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Severe sepsis survivors frequently experience cognitive and physical functional impairment. The degree of impairment and its association with mortality is understudied, particularly among those discharged to a skilled nursing facility. Our objective was to quantify the cognitive and physical impairment among severe sepsis survivors discharged to a skilled nursing facility and to investigate the relationship between impairment and long-term mortality. DESIGN Retrospective cohort study. SETTING United States. SUBJECTS Random 5% sample of Medicare patients discharged following severe sepsis hospitalization, 2005-2009 (n = 135,370). MEASUREMENT AND MAIN RESULTS Medicare data were linked with the Minimum Data Set; Minimum Data Set-Cognition Scale was used to assess cognitive function, and the Minimum Data Set activities of daily living hierarchical scale was used to assess functional dependence. Associations were evaluated using multivariable logistic regression, Kaplan-Meier curves, and Cox proportional hazards regression. Of 66,540 beneficiaries admitted to a skilled nursing facility following severe sepsis, 34% had severe or very severe cognitive impairment, and 72.5% had maximal, dependence, or total dependence in activities of daily living. Median survival was 19.4 months for those discharged to a skilled nursing facility without having been in a skilled nursing facility in the preceding 1 year and 10.4 months for those discharged to a skilled nursing facility who had spent time in a skilled nursing facility in the prior year. The adjusted hazard ratio for death was 3.1 for those with very severe cognitive impairment relative to those who were cognitively intact (95% CI, 2.9-3.2; p < 0.001) and 4.3 for those with "total dependence" in activities of daily livings relative to those who were independent (95% CI, 3.8-5.0; p < 0.001). CONCLUSIONS Discharge to a skilled nursing facility following severe sepsis hospitalization among Medicare beneficiaries was associated with shorter survival, and cognitive impairment and activities of daily living dependence were each strongly associated with shortened survival. These findings can inform decision-making by patients and physicians and underscores high palliative care needs among sepsis survivors discharged to skilled nursing facility.
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Sex- and diagnosis-dependent differences in mortality and admission cytokine levels among patients admitted for intensive care. Crit Care Med 2014; 42:1110-20. [PMID: 24365862 DOI: 10.1097/ccm.0000000000000139] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the role of sex on cytokine expression and mortality in critically ill patients. DESIGN A cohort of patients admitted to were enrolled and followed over a 5-year period. SETTING Two university-affiliated hospital surgical and trauma ICUs. PATIENTS Patients 18 years old and older admitted for at least 48 hours to the surgical or trauma ICU. INTERVENTIONS Observation only. MEASUREMENTS AND MAIN RESULTS Major outcomes included admission cytokine levels, prevalence of ICU-acquired infection, and mortality during hospitalization conditioned on trauma status and sex. The final cohort included 2,291 patients (1,407 trauma and 884 nontrauma). The prevalence of ICU-acquired infection was similar for men (46.5%) and women (44.5%). All-cause in-hospital mortality was 12.7% for trauma male patient and 9.1% for trauma female patient (p = 0.065) and 22.9% for nontrauma male patients and 20.6% for nontrauma female patients (p = 0.40). Among trauma patients, logistic regression analysis identified female sex as protective for all-cause mortality (odds ratio, 0.57). Among trauma patients, men had significantly higher admission serum levels of interleukin-2, interleukin-12, interferon-γ, and tumor necrosis factor-α, and among nontrauma patients, men had higher admission levels of interleukin-8 and tumor necrosis factor-α. CONCLUSIONS The relationship between sex and outcomes in critically ill patients is complex and depends on underlying illness. Women appear to be better adapted to survive traumatic events, while sex may be less important in other forms of critical illness. The mechanisms accounting for this gender dimorphism may, in part, involve differential cytokine responses to injury, with men expressing a more robust proinflammatory profile.
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Zang Q, Wolf SE, Minei JP. Sepsis-induced Cardiac Mitochondrial Damage and Potential Therapeutic Interventions in the Elderly. Aging Dis 2014; 5:137-49. [PMID: 24729939 DOI: 10.14336/ad.2014.0500137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 12/13/2022] Open
Abstract
The incidence of sepsis and its attendant mortality risk are significantly increased with aging. Thus, severe sepsis in the elderly is likely to become an emerging concern in critical care units. Cardiac dysfunction is an important component of multi-organ failure after sepsis. In our laboratory, utilizing a pneumonia-related sepsis animal model, our research has been focused on the mechanisms underlying sepsis-induced cardiac failure. In this review, based on findings from others and ours, we discussed age-dependent decay in mitochondria and the role of mitochondrial reactive oxygen species (mtROS) in sepsis-induced cardiac inflammation and autophagy. Our recent discovery of a potential signal transduction pathway that triggers myocardial mitochondrial damage is also discussed. Because of the significance of mitochondria damage in the aging process and in sepsis pathogenesis, we hypothesize that specific enhancing mitochondrial antioxidant defense by mitochondria-targeted antioxidants (MTAs) may provide important therapeutic potential in treating elder sepsis patients. In this review, we summarized the categories of currently published MTA molecules and the results of preclinical evaluation of MTAs in sepsis and aging models.
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Affiliation(s)
| | - Steven E Wolf
- Departments of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Joseph P Minei
- Departments of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
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Kelly D, Kutney-Lee A, Lake ET, Aiken LH. The critical care work environment and nurse-reported health care-associated infections. Am J Crit Care 2013; 22:482-8. [PMID: 24186818 PMCID: PMC3996829 DOI: 10.4037/ajcc2013298] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Critically ill patients are susceptible to health care-associated infections because of their illnesses and the need for intravenous access and invasive monitoring. The critical care work environment may influence the likelihood of infection in these patients. OBJECTIVE To determine whether or not the critical care nurse work environment is predictive of nurse-reported health care-associated infections. METHODS A retrospective, cross-sectional design was used with linked nurse and hospital survey data. Nurses assessed the critical care work environment and provided the frequencies of ventilator-associated pneumonias, urinary tract infections, and infections associated with central catheters. Logistic regression models were used to determine if critical care work environments were predictive of nurse-reported frequent health care-associated infections, with controls for nurse and hospital characteristics. Results The final sample consisted of 3217 critical care nurses in 320 hospitals. Compared with nurses working in poor work environments, nurses working in better work environments were 36% to 41% less likely to report that health care-associated infections occurred frequently. CONCLUSION Health care-associated infections are less likely in favorable critical care work environments. These findings, based on the largest sample of critical care nurses to date, substantiate efforts to focus on the quality of the work environment as a way to minimize the frequency of health care-associated infections.
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Affiliation(s)
- Deena Kelly
- Deena Kelly is a postdoctoral research fellow in the Clinical Research, Investigation and Systems Modeling of Acute Illness
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Nasa P, Juneja D, Singh O. Severe sepsis and septic shock in the elderly: An overview. World J Crit Care Med 2012; 1:23-30. [PMID: 24701398 PMCID: PMC3956061 DOI: 10.5492/wjccm.v1.i1.23] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 10/20/2011] [Accepted: 12/30/2011] [Indexed: 02/06/2023] Open
Abstract
The incidence of severe sepsis and septic shock is increasing in the older population leading to increased admissions to the intensive care units (ICUs). The elderly are predisposed to sepsis due to co-existing co-morbidities, repeated and prolonged hospitalizations, reduced immunity, functional limitations and above all due to the effects of aging itself. A lower threshold and a higher index of suspicion is required to diagnose sepsis in this patient population because the initial clinical picture may be ambiguous, and aging increases the risk of a sudden deterioration in sepsis to severe sepsis and septic shock. Management is largely based on standard international guidelines with a few modifications. Age itself is an independent risk factor for death in patients with severe sepsis, however, many patients respond well to timely and appropriate interventions. The treatment should not be limited or deferred in elderly patients with severe sepsis only on the grounds of physician prejudice, but patient and family preferences should also be taken into account as the outcomes are not dismal. Future investigations in the management of sepsis should not only target good functional recovery but also ensure social independence and quality of life after ICU discharge.
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Affiliation(s)
- Prashant Nasa
- Prashant Nasa, Deven Juneja, Omender Singh, Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
| | - Deven Juneja
- Prashant Nasa, Deven Juneja, Omender Singh, Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
| | - Omender Singh
- Prashant Nasa, Deven Juneja, Omender Singh, Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
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Nasa P, Juneja D, Singh O. Severe sepsis and septic shock in the elderly: An overview. World J Crit Care Med 2012. [PMID: 24701398 DOI: 10.5492/wjccm.v1.i1.23.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The incidence of severe sepsis and septic shock is increasing in the older population leading to increased admissions to the intensive care units (ICUs). The elderly are predisposed to sepsis due to co-existing co-morbidities, repeated and prolonged hospitalizations, reduced immunity, functional limitations and above all due to the effects of aging itself. A lower threshold and a higher index of suspicion is required to diagnose sepsis in this patient population because the initial clinical picture may be ambiguous, and aging increases the risk of a sudden deterioration in sepsis to severe sepsis and septic shock. Management is largely based on standard international guidelines with a few modifications. Age itself is an independent risk factor for death in patients with severe sepsis, however, many patients respond well to timely and appropriate interventions. The treatment should not be limited or deferred in elderly patients with severe sepsis only on the grounds of physician prejudice, but patient and family preferences should also be taken into account as the outcomes are not dismal. Future investigations in the management of sepsis should not only target good functional recovery but also ensure social independence and quality of life after ICU discharge.
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Affiliation(s)
- Prashant Nasa
- Prashant Nasa, Deven Juneja, Omender Singh, Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
| | - Deven Juneja
- Prashant Nasa, Deven Juneja, Omender Singh, Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
| | - Omender Singh
- Prashant Nasa, Deven Juneja, Omender Singh, Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
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Vyroubal P, Chiarla C, Giovannini I, Hyspler R, Ticha A, Hrnciarikova D, Zadak Z. HYPOCHOLESTEROLEMIA IN CLINICALLY SERIOUS CONDITIONS - REVIEW. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 152:181-9. [DOI: 10.5507/bp.2008.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Myhre AE, Agren J, Dahle MK, Tamburstuen MV, Lyngstadaas SP, Collins AJL, Foster SJ, Thiemermann C, Aasen AO, Wang JE. Liver X receptor is a key regulator of cytokine release in human monocytes. Shock 2008; 29:468-74. [PMID: 17724434 DOI: 10.1097/shk.0b013e31815073cb] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Aberrant regulation of innate immune responses and uncontrolled cytokine bursts are hallmarks of sepsis and endotoxemia. Activation of the nuclear liver X receptor (LXR) was recently demonstrated to suppress inflammatory genes. Our aim was to investigate the expression of LXR in human monocytes under normal and endotoxemic conditions and to study the influence of LXR activation on endotoxin-induced cytokine synthesis and release. Adherent human monocytes or whole blood were pretreated with a synthetic LXR agonist (3-{3-[(2-chloro-3-trifluoromethyl-benzyl)-(2,2-diphenyl-ethyl)-amino]-propoxy}-phenyl)-acetic acid) and subsequently challenged with LPS (from Escherichia coli) or peptidoglycan (from Staphylococcus aureus). Cytokine release was assessed by a Multiplex antibody bead kit, and cytokine mRNA levels were measured by real-time reverse-transcriptase-polymerase chain reaction. We found that LXRalpha mRNA was up-regulated in CD14+ monocytes in LPS-challenged blood, whereas LXRbeta mRNA was not altered. Addition of 3-{3-[(2-chloro-3-trifluoromethyl-benzyl)-(2,2-diphenyl-ethyl)-amino]-propoxy}-phenyl)-acetic acid to monocytes suppressed the LPS-induced release of IL-1beta, IL-6, IL-8, IL-10, IL-12p40, TMF-alpha, macrophage inflammatory protein 1alpha, macrophage inflammatory protein 1beta, and monocyte chemoattractant protein 1 in a concentration-dependent manner. Surprisingly, an accompanying decrease in cytokine mRNA accumulation was not observed. The suppressed cytokine release could not be explained by a diminished transport of mRNA out of the nucleus or a decreased secretion of cytokines. We propose that LXR is a key regulator of cytokine release in LPS-challenged human monocytes, possibly by interfering with translational events.
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Affiliation(s)
- Anders E Myhre
- Institute for Surgical Research, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway
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Geropharmacology: a primer for advanced practice acute care and critical care nurses, part I. AACN Adv Crit Care 2008; 19:23-35; quiz 36-7. [PMID: 18418102 DOI: 10.1097/01.aacn.0000310748.00911.93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advanced practice nurses' challenge in managing older adults' medication regimens from an evidence base is difficult because older adults are vulnerable to medication errors and adverse drug reactions related to a number of factors. Predicting patients' responses to drugs is compounded during critical illness, adding to the heterogeneity and unpredictability of drug effects that are prevalent premorbidly. In the first part of this 2-part continuing education series, sources of medication errors and older adults' vulnerability are discussed, including normal changes of aging affecting pharmacokinetics and pharmacodynamics, polypharmacy, self-medicating, patient-family noncompliance, and inappropriately prescribed medications. In the second part, drug classes and drugs posing particular problems for older adults and cautions for acute care and critical care nurses who manage the medications of older adults are highlighted.
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Mortality and length-of-stay outcomes, 1993-2003, in the binational Australian and New Zealand intensive care adult patient database. Crit Care Med 2008; 36:46-61. [PMID: 18090383 DOI: 10.1097/01.ccm.0000295313.08084.58] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Intensive care unit (ICU) outcomes have been the subject of controversy. The objective was to model hospital mortality and ICU length-of-stay time-change of patients recorded in the Australian and New Zealand Intensive Care Society adult patient database. DESIGN Retrospective, cohort study of prospectively collected data on index patient admissions. SETTING Australian and New Zealand ICUs, 1993-2003. PATIENTS The Australian and New Zealand Intensive Care Society adult patient database, which contains data for 223,129 patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Hospital mortality and ICU length of stay were modeled using logistic and linear regression, respectively, with determination (80%) and validation (20%) data sets. Model adequacy was assessed by discrimination (receiver operating characteristic curve area, AZ) and calibration (Hosmer-Lemeshow C) for mortality and R2 for length of stay. Predictor variables included patient demographics, severity score, surgical and ventilation status, ICU categories, and geographical locality. The data set comprised 223,129 patients: Their mean (SD) age was 59.2 (18.9) yrs, 41.7% were female, their mean (SD) Acute Physiology and Chronic Health Evaluation (APACHE) III score was 53 (31), they had 16.1% overall mortality rate, and 45.7% were mechanically ventilated. ICU length of stay was 3.6 (5.6) days. A(Z), C statistic, and R2 for developmental and validation model data sets were 0.88, 17.64 (p = .02), and 0.18; and 0.88, 12.32 (p = .26), and 0.18, respectively. Variables with mortality impact (p < or = .001) were age (odds ratio [OR] 1.023), gender (OR 1.16; males vs. females), APACHE III score (OR 1.06), mechanical ventilation (OR 1.66), and surgical status (elective, OR 0.17; emergency, OR 0.47; compared with nonsurgical). ICU level and locality had significant mortality-time effects. Similar variables were found to predict length of stay. Risk-adjusted mortality declined, during 1993-2003, from 0.19 (95% confidence interval 0.17-0.21) to 0.15 (0.13-0.16) and similarly for ventilated patients: 0.26 (0.24-0.29) to 0.23 (0.21-0.25). Predicted mean ICU length of stay (days) demonstrated minimal overall time-change: 3.4 (2.2) in 1993 to 3.5 (2.7) in 2003, peaking at 3.7 (2.4) in 2000. CONCLUSIONS Overall hospital mortality rate in patients admitted to Australian and New Zealand ICUs decreased 4% over 11 yrs. A similar trend occurred for mechanically ventilated patients. Length of stay changed minimally over this period.
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Graf J, Janssens U. [Chronic critical disease--what does the long-term patient imply for intensive medicine]. Wien Klin Wochenschr 2006; 118:369-72. [PMID: 16865639 DOI: 10.1007/s00508-006-0628-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Fessler MB, Arndt PG, Frasch SC, Lieber JG, Johnson CA, Murphy RC, Nick JA, Bratton DL, Malcolm KC, Worthen GS. Lipid Rafts Regulate Lipopolysaccharide-induced Activation of Cdc42 and Inflammatory Functions of the Human Neutrophil. J Biol Chem 2004; 279:39989-98. [PMID: 15262974 DOI: 10.1074/jbc.m401080200] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lipid rafts are cholesterol-rich membrane microdomains that are thought to act as coordinated signaling platforms by regulating dynamic, agonist-induced translocation of signaling proteins. They have been described to play a role in multiple prototypical cascades, among them the lipopolysaccharide pathway, and to host multiple signaling proteins, including kinases and low molecular weight G-proteins. Here we report lipopolysaccharide-induced activation of the Rho family GTPase Cdc42, and we show its activation in the human neutrophil to be mediated by a p38 mitogen-activated protein kinase-dependent mechanism. Subcellular fractionation reveals that lipopolysaccharide induces translocation of Cdc42 to lipid rafts, where it and p38 are both found to be activated. By contrast, lipopolysaccharide causes translocation of Rac from the polymorphonuclear leukocyte (PMN) rafts and does not induce its activation. With the use of methyl-beta-cyclodextrin, a cholesterol-depleting agent that reversibly disrupts rafts, we confirm an important regulatory role for rafts in the activation state of p38 and Cdc42 and in the Rho GTPase-dependent functions superoxide anion production and actin polymerization. Methyl-beta-cyclodextrin induces activation of p38 and Cdc42, but not Rac, in the nonstimulated PMN, yet inhibits subsequent lipopolysaccharide-induced activation of p38 and Cdc42. In parallel, methyl-beta-cyclodextrin primes the human PMN for subsequent superoxide release triggered by the formylated bacterial tripeptide formyl-Met-Leu-Phe, and induces actin polymerization in a subcellular distribution distinct from that induced by lipopolysaccharide. In sum, these findings provide evidence for an important regulatory role of cholesterol in both transmission of the lipopolysaccharide signal and the inflammatory phenotype of the human neutrophil.
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Affiliation(s)
- Michael B Fessler
- Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado 80206, USA.
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Dünser MW, Hasibeder WR, Wenzel V, Schwarz S, Ulmer H, Knotzer H, Pajk W, Friesenecker BE, Mayr AJ. Endocrinologic response to vasopressin infusion in advanced vasodilatory shock. Crit Care Med 2004; 32:1266-71. [PMID: 15187504 DOI: 10.1097/01.ccm.0000127264.54807.b7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the endocrinologic response to a combined arginine vasopressin and norepinephrine (AVP/NE) infusion in advanced vasodilatory shock, and to examine the relationship between baseline plasma AVP concentrations and the hemodynamic response to AVP. DESIGN Preliminary, prospective, randomized, controlled clinical study. SETTING Twenty-three-bed general and surgical intensive care unit. PATIENTS Thirty-eight patients with advanced vasodilatory shock. Hemodynamic and laboratory data of 34 patients have already been presented in a recently published prospective, randomized, controlled study. INTERVENTIONS Continuous AVP (4 units/hr) and NE infusion in study patients; NE infusion only in control patients. MEASUREMENTS AND MAIN RESULTS At baseline, 24 hrs, and 48 hrs after randomization, plasma concentrations of AVP, adrenocorticotropic hormone, cortisol, renin, angiotensin II, aldosterone, prolactin, endothelin I, and atrial natriuretic factor were determined. Hemodynamic variables were recorded at baseline and 1, 12, and 24 hrs after randomization. Linear mixed effects models were used to test for differences between groups. The relationship between AVP plasma concentrations and hemodynamic response to AVP was analyzed using linear regression analyses. AVP/NE patients exhibited significantly higher AVP (p <.001) and prolactin (p <.001) plasma concentrations during the study period; there were no significant differences in plasma concentrations of other hormones. No significant correlation was detected between plasma AVP concentrations and the increase in mean arterial pressure after 1 hr (Pearson's correlation coefficient =.134, p =.584) and after 24 hrs (Pearson's correlation coefficient = -.198, p =.417). There were further no correlations between AVP plasma concentrations and the 24-hr response to AVP therapy in heart rate (Pearson's correlation coefficient = -.065, p =.791), stroke volume index (Pearson's correlation coefficient = -.106, p =.687), and NE requirements (Pearson's correlation coefficient =.04, p =.869). CONCLUSIONS The preliminary results of this study indicate that a combined AVP and NE infusion increases prolactin plasma concentrations in advanced vasodilatory shock. Hemodynamic effects of AVP infusion are independent of baseline plasma AVP concentrations.
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Affiliation(s)
- Martin W Dünser
- Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Leopold-Franzens-University of Innsbruck, Innsbruck, Austria
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Horwich TB, Hamilton MA, Maclellan WR, Fonarow GC. Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure. J Card Fail 2002; 8:216-24. [PMID: 12397569 DOI: 10.1054/jcaf.2002.0804216] [Citation(s) in RCA: 255] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although hypercholesterolemia is a well-defined risk factor for morbidity and mortality in coronary artery disease, the relationship between cholesterol and heart failure (HF) has rarely been investigated. METHODS Cholesterol and lipoproteins were measured in 1,134 patients with advanced HF who presented to a single center for HF management and transplant evaluation. Patients were stratified into five groups based on quintiles of total cholesterol (TC) level, and differences in patient characteristics and survival were evaluated. RESULTS Patients with low TC had significantly lower low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (TG), sodium, albumin, left ventricular ejection fraction, and cardiac output. The TC quintiles were similar in terms of HF etiology, hypertension, diabetes, and lipid-lowering therapy at time of referral. TC, LDL, HDL, and TG each predicted survival (P < or = .01) on univariate analysis, with improved survival at higher levels. After adjustment for risk factors using a Cox proportional hazards model, relative risks were 2.071, 1.369, 1.391, 1.006 for the first, second, third, and fourth TC quintiles, with quintile 5 as reference. CONCLUSIONS Serum TC represents a novel prognostic factor for patients with advanced HF. Further studies are necessary to investigate a potential role of low cholesterol and lipoproteins in the pathophysiology of HF progression.
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van Gorp ECM, Suharti C, Mairuhu ATA, Dolmans WMV, van Der Ven J, Demacker PNM, van Der Meer JWM. Changes in the plasma lipid profile as a potential predictor of clinical outcome in dengue hemorrhagic fever. Clin Infect Dis 2002; 34:1150-3. [PMID: 11915007 DOI: 10.1086/339539] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2001] [Revised: 11/19/2001] [Indexed: 11/03/2022] Open
Abstract
In 50 consecutive children admitted to the intensive care unit with the clinical diagnosis of dengue hemorrhagic fever (DHF)/dengue shock syndrome (grade III or IV), 20 patients with mild DHF (grade I or II), and 20 healthy control patients, the plasma lipid profile was measured. Levels of total plasma cholesterol, high-density lipoprotein, and low-density lipoprotein were significantly decreased in patients with the severest cases, compared with patients with mild DHF and healthy controls. Changes in the plasma lipid profile differentiate between patients with different stages of DHF disease severity and could be used as a potential predictor for clinical outcome.
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Affiliation(s)
- Eric C M van Gorp
- Department of Internal Medicine, Slotervaart Hospital, 1066 EC Amsterdam, The Netherlands.
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Gender and Cell-mediated Immunity Following Trauma, Shock, and Sepsis. Intensive Care Med 2002. [DOI: 10.1007/978-1-4757-5551-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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