Background Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) ma... more Background Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59–78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57–77] vs 74 [64–80] years, p < 0.001) and had lower driving (12 [8–16] vs 15 [11–17] cmH2O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH2O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH2O, p < 0.001) pr...
Intermediate sendrom (IMS) proksimal ekstremite ve solunum kaslarinda, boyun fleksorlarinda ve kr... more Intermediate sendrom (IMS) proksimal ekstremite ve solunum kaslarinda, boyun fleksorlarinda ve kranial sinirlerde zayiflikla karakterizedir. Etyolojiyi aciklamak icin birkac hipotez gelistirilmistir (noromuskuler bileske disfonksiyonu, yetersiz veya gec oksim tedavisi, asetilkolinesterazin uzamis ve ciddi inhibisyonu). Klorprifos dusuk toksisiteyle iliskili organofosfattir. Klorprifosa sekonder IMS cok nadirdir. 56 yasinda erkek hastada klorprifos oral alimindan sonra gelisen IMS'u sunuyoruz. Baslangicta kolinerjik sendrom belirtileri gosteren hastada ikinci gunde mental ve respiratuar durumu kotulesip IMS'u dusunduren derin motor paralizi gelisti. Hastaya ventilator destegi gerekti. Pralidoksim gec (oral alimdan 52 saat sonra) ve 23 gunde aralikli olarak verilebildi. Hastanin takiplerinde ventilator iliskili pnomoni ve septik sok gelismesine ragmen 32. gununde taburcu edildi. Bu olgu klorprifos intoksikasyonlariyla gelen hastalarda IMS riski oldugunu gostermektedir.
Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New... more Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: “worsening” if moderate or severe acute respiratory distress syndrome cri...
Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2000
This study was planned to evaluate both the agents of hospital infections and antimicrobial treat... more This study was planned to evaluate both the agents of hospital infections and antimicrobial treatment observed in 100 (50 + 50) patients hospitalized at intensive care unit of Anesthesiology and Reanimation Department of Ankara University Medical Faculty during 1998 and 1999. Also the assessment of infection control measures and principles of rational antibiotic usage established at the beginning of 1998 was aimed. When hospital infection agents were analyzed, 7.6%, 5.2% and 3.7% increases were observed for Acinetobacter baumannii, methicillin resistant Staphylococcus aureus and Enterococcus spp. respectively in 1999 comparatively for 1998. Antimicrobial administration was evaluated in terms of DDD (defined daily dosages)/1000 hospitalization days suggested by WHO. 105 hospital infections in 1998 and 56 hospital infections in 1999 were observed. Antimicrobial usage was 260.2 DDD/1000 hospital days for 1998 and 243.6 DDD/1000 hospital days for 1999. The first three antibiotics prefer...
Table S4. Identification of clinical and microbiologic variables associated with 30-day mortality... more Table S4. Identification of clinical and microbiologic variables associated with 30-day mortality in patients infected with Acinetobacter, Klebsiella, or Pseudomonas spp. using univariate analysis. (DOCX 85 kb)
Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outco... more Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding No funding.
Background: To determine the frequency of, and factors associated with, death in hospital followi... more Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.Results: 2,186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in ...
1. Perner A, Hjortrup PB, Pettilä V. Focus on randomised clinical trials. Intensive Care Med 2018... more 1. Perner A, Hjortrup PB, Pettilä V. Focus on randomised clinical trials. Intensive Care Med 2018; 44: 2257-9. [CrossRef] 2. Ünal MN, Reinhart K. Understanding the Harms of HES: A Review of the Evidence to Date. Turk J Anaesthesiol Reanim 2019; 47: 81-91. [CrossRef] 3. Ertmer C, Zwißler B, Van Aken H, Christ M, Spöhr F, Schneider A, et al. Fluid therapy and outcome: a prospective observational study in 65 German intensive care units between 2010 and 2011. Ann Intensive Care 2018; 8: 27. [CrossRef] 4. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73: 712-6. [CrossRef] 5. Perner A, Bellomo R, Møller MH. Is research from databases reliable? No. Intensive Care Med 2019; 45: 115-7. [CrossRef]
Crimean-Congo hemorrhagic fever (CCHF), is a fatal viral infection transmitted to humans through ... more Crimean-Congo hemorrhagic fever (CCHF), is a fatal viral infection transmitted to humans through a tick bite or exposure to blood or tissues of viremic hosts. The clinical presentation is characterized by sudden onset high fever, headache, myalgia, abdominal pain and nausea-vomiting followed by gastrointestinal, urinary, respiratory tract and brain hemorrhage. Laboratory findings include leucopenia, thrombocytopenia, elevated liver enzymes, prolonged prothrombin time and activated partial thromboplastin time. We report a case of CCHF who was treated with a combination of DFPP and ribavirin therapy. As a result of this multimodal treatment, patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinical symptoms and laboratory findings improved gradually.
Postoperative pain management in pediatric strabismus patients is infrequently studied. Pediatric... more Postoperative pain management in pediatric strabismus patients is infrequently studied. Pediatric patients can be mobilized earlier if postoperative pain is minimized. In this study, two different regional anesthetic techniques, retrobulbar block and local infiltration, were compared with a &quot;no block&quot; control group for the postoperative management of pain in pediatric patients undergoing elective strabismus surgery. Thirty patients were randomly allocated to one of the study groups: group 1 (n=10) control, group 2 (n=10) retrobulbar block, and group 3 (n=10) subconjunctival bupivacaine infiltration. The parameters that were evaluated during the early postoperative period (6 hours) were circulatory, pain scores by Visual Analog Scale (VAS) and Modified Pediatric Objective Pain Scale (MPOPS), additional analgesic requirement, nausea, and vomiting. The parameters that were evaluated after discharge from the hospital (on postoperative days 1 and 2) through questionnaires were additional analgesic requirement, nausea, vomiting, sleep disturbances, activity, and appetite. Group 3 had significantly higher VAS and MPOPS scores at postoperative 120, 180, 240, 300, and 360 minutes than groups 1 and 2 (P &lt; .05). Patients in group 2 seemed to have a higher incidence of nausea and vomiting both in the early (6 hours) and late postoperative (postoperative days 1 and 2) periods; however, the difference was not statistically significant. Group 2 required less analgesic compared with groups 1 and 3 during the late postoperative period. Late postoperative activity and appetite were better in groups 2 and 3. Because there was no significant difference in terms of postoperative analgesia in the retrobulbar block or subconjunctival local anesthetic infiltration groups compared with the control group, we suggest that conventional methods of pain treatment are adequate for postoperative analgesia in strabismus surgery.
Objective.To assess the feasibility and effectiveness of the International Nosocomial Infection C... more Objective.To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multi-dimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance.Design.An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period.Setting.Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey.Participants.Healthcare workers at 99 ICU members of the INICC.Methods.A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (...
Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patien... more Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2
Background Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) ma... more Background Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59–78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57–77] vs 74 [64–80] years, p < 0.001) and had lower driving (12 [8–16] vs 15 [11–17] cmH2O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH2O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH2O, p < 0.001) pr...
Intermediate sendrom (IMS) proksimal ekstremite ve solunum kaslarinda, boyun fleksorlarinda ve kr... more Intermediate sendrom (IMS) proksimal ekstremite ve solunum kaslarinda, boyun fleksorlarinda ve kranial sinirlerde zayiflikla karakterizedir. Etyolojiyi aciklamak icin birkac hipotez gelistirilmistir (noromuskuler bileske disfonksiyonu, yetersiz veya gec oksim tedavisi, asetilkolinesterazin uzamis ve ciddi inhibisyonu). Klorprifos dusuk toksisiteyle iliskili organofosfattir. Klorprifosa sekonder IMS cok nadirdir. 56 yasinda erkek hastada klorprifos oral alimindan sonra gelisen IMS'u sunuyoruz. Baslangicta kolinerjik sendrom belirtileri gosteren hastada ikinci gunde mental ve respiratuar durumu kotulesip IMS'u dusunduren derin motor paralizi gelisti. Hastaya ventilator destegi gerekti. Pralidoksim gec (oral alimdan 52 saat sonra) ve 23 gunde aralikli olarak verilebildi. Hastanin takiplerinde ventilator iliskili pnomoni ve septik sok gelismesine ragmen 32. gununde taburcu edildi. Bu olgu klorprifos intoksikasyonlariyla gelen hastalarda IMS riski oldugunu gostermektedir.
Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New... more Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: “worsening” if moderate or severe acute respiratory distress syndrome cri...
Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2000
This study was planned to evaluate both the agents of hospital infections and antimicrobial treat... more This study was planned to evaluate both the agents of hospital infections and antimicrobial treatment observed in 100 (50 + 50) patients hospitalized at intensive care unit of Anesthesiology and Reanimation Department of Ankara University Medical Faculty during 1998 and 1999. Also the assessment of infection control measures and principles of rational antibiotic usage established at the beginning of 1998 was aimed. When hospital infection agents were analyzed, 7.6%, 5.2% and 3.7% increases were observed for Acinetobacter baumannii, methicillin resistant Staphylococcus aureus and Enterococcus spp. respectively in 1999 comparatively for 1998. Antimicrobial administration was evaluated in terms of DDD (defined daily dosages)/1000 hospitalization days suggested by WHO. 105 hospital infections in 1998 and 56 hospital infections in 1999 were observed. Antimicrobial usage was 260.2 DDD/1000 hospital days for 1998 and 243.6 DDD/1000 hospital days for 1999. The first three antibiotics prefer...
Table S4. Identification of clinical and microbiologic variables associated with 30-day mortality... more Table S4. Identification of clinical and microbiologic variables associated with 30-day mortality in patients infected with Acinetobacter, Klebsiella, or Pseudomonas spp. using univariate analysis. (DOCX 85 kb)
Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outco... more Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding No funding.
Background: To determine the frequency of, and factors associated with, death in hospital followi... more Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.Results: 2,186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in ...
1. Perner A, Hjortrup PB, Pettilä V. Focus on randomised clinical trials. Intensive Care Med 2018... more 1. Perner A, Hjortrup PB, Pettilä V. Focus on randomised clinical trials. Intensive Care Med 2018; 44: 2257-9. [CrossRef] 2. Ünal MN, Reinhart K. Understanding the Harms of HES: A Review of the Evidence to Date. Turk J Anaesthesiol Reanim 2019; 47: 81-91. [CrossRef] 3. Ertmer C, Zwißler B, Van Aken H, Christ M, Spöhr F, Schneider A, et al. Fluid therapy and outcome: a prospective observational study in 65 German intensive care units between 2010 and 2011. Ann Intensive Care 2018; 8: 27. [CrossRef] 4. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73: 712-6. [CrossRef] 5. Perner A, Bellomo R, Møller MH. Is research from databases reliable? No. Intensive Care Med 2019; 45: 115-7. [CrossRef]
Crimean-Congo hemorrhagic fever (CCHF), is a fatal viral infection transmitted to humans through ... more Crimean-Congo hemorrhagic fever (CCHF), is a fatal viral infection transmitted to humans through a tick bite or exposure to blood or tissues of viremic hosts. The clinical presentation is characterized by sudden onset high fever, headache, myalgia, abdominal pain and nausea-vomiting followed by gastrointestinal, urinary, respiratory tract and brain hemorrhage. Laboratory findings include leucopenia, thrombocytopenia, elevated liver enzymes, prolonged prothrombin time and activated partial thromboplastin time. We report a case of CCHF who was treated with a combination of DFPP and ribavirin therapy. As a result of this multimodal treatment, patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinical symptoms and laboratory findings improved gradually.
Postoperative pain management in pediatric strabismus patients is infrequently studied. Pediatric... more Postoperative pain management in pediatric strabismus patients is infrequently studied. Pediatric patients can be mobilized earlier if postoperative pain is minimized. In this study, two different regional anesthetic techniques, retrobulbar block and local infiltration, were compared with a &quot;no block&quot; control group for the postoperative management of pain in pediatric patients undergoing elective strabismus surgery. Thirty patients were randomly allocated to one of the study groups: group 1 (n=10) control, group 2 (n=10) retrobulbar block, and group 3 (n=10) subconjunctival bupivacaine infiltration. The parameters that were evaluated during the early postoperative period (6 hours) were circulatory, pain scores by Visual Analog Scale (VAS) and Modified Pediatric Objective Pain Scale (MPOPS), additional analgesic requirement, nausea, and vomiting. The parameters that were evaluated after discharge from the hospital (on postoperative days 1 and 2) through questionnaires were additional analgesic requirement, nausea, vomiting, sleep disturbances, activity, and appetite. Group 3 had significantly higher VAS and MPOPS scores at postoperative 120, 180, 240, 300, and 360 minutes than groups 1 and 2 (P &lt; .05). Patients in group 2 seemed to have a higher incidence of nausea and vomiting both in the early (6 hours) and late postoperative (postoperative days 1 and 2) periods; however, the difference was not statistically significant. Group 2 required less analgesic compared with groups 1 and 3 during the late postoperative period. Late postoperative activity and appetite were better in groups 2 and 3. Because there was no significant difference in terms of postoperative analgesia in the retrobulbar block or subconjunctival local anesthetic infiltration groups compared with the control group, we suggest that conventional methods of pain treatment are adequate for postoperative analgesia in strabismus surgery.
Objective.To assess the feasibility and effectiveness of the International Nosocomial Infection C... more Objective.To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multi-dimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance.Design.An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period.Setting.Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey.Participants.Healthcare workers at 99 ICU members of the INICC.Methods.A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (...
Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patien... more Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2
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