[Recording of anesthesia and recovery phase with a new integrated anesthesia record]. / Protokollierung von Anaesthesie und Aufwachphase auf einem neuen integrierten Anaesthesie-Protokoll.

A new combined anaesthesia and recovery room record is presented, consisting of a treble sheet of self-copying paper two times prefolded to the standard chart size. It meets the increasing requirements of pre-, intra-, and postoperative anaesthesiological documentation.

[Tubal malpositioning as a cause of tubal cuff hernia]. / Tubusfehllage als Ursache einer Tubus-Cuffhernie.

Airway obstruction of endotracheal tubes may occur during general anaesthesia. A case is reported where endobronchial intubation and inflation of the cuff caused herniation into the left bronchus before the malpositioning had been corrected. This led to a cuff herniation that caused airway obstruction at the end of anaesthesia. The regional overinflation of the tubes cuff could be reproduced by a model by other tubes of the same type. Malpositioning of endotracheal tubes may cause cuff herniation that potentially leads to acute airway obstruction.

[Nosocomial infections in surgical intensive medicine. Results of a 5-year prospective study]. / Nosokomiale Infektionen in der operativen Intensivmedizin. Ergebnisse einer 5jährigen prospektiven Erhebung.

All the ICU patients were continuously studied during the first quarter of 5 consecutive years for infections according to a standard protocol. The investigators--the infection control officer and a well-trained infection control nurse--decided if the patient was infected by referring to medical and nursing record, temperature charts, laboratory and x-ray reports and, where necessary, by clinical examination. Definitions and criteria for infections comply with the CDC and the algorithms of the Senic Project. Only the first quarter of each year from 1980-1984 was analysed. The first quarter of 1980 was analysed retrospectively, the following years were examined prospectively. In 1984 a new ICU (ICU I) in addition to the old ICU (ICU II) was opened. The two ICUs differ in building construction but have similar patients, nursing staff and medical standards. The frequency of nosocomial infection was not affected by the different building constructions. The number of patients surveyed was 1009, 60% were males and 40% females. The average age was 45.5 years and the average period of stay about 4 days. 733 patients (72.6%) were intubated and artificially ventilated for 3 days. A fatal outcome resulted in 13.2% of all patients. 1129 nosocomial infections were registered in 311 patients, which means an infection rate of 32.8%. The most frequent nosocomial infections were those of the respiratory tract. Wound infections developed in 16.6%. The urinary tract was affected in 8.8%. Nosocomial septicaemias were observed in 8.7%. Catheter-associated infections were noticed in 6.7% of the patients. A fatal outcome resulted in 26% of the patients with nosocomial infections and in 6.9% of the non-infected patients, respectively.

Effect of selective flora suppression on colonization, infection, and mortality in critically ill patients: a one-year, prospective consecutive study.

OBJECTIVE: To study the effect of enterally administered polymyxin E, tobramycin, and amphotericin B (selective flora suppression) on bacterial colonization, infection, resistance, and mortality rate. DESIGN: Prospective, consecutive crossover controlled study. SETTING: Two surgical ICUs in a university hospital; ICU I with ten beds, ICU II with eight beds. PATIENTS: Two hundred patients entered the 1-yr trial. Fifty of 111 patients received selective flora suppression during the first 6 months in ICU I (test group), while 61 of 111 patients served as the control group in the following 6 months. In ICU II, 49 of 89 patients received no selective flora suppression in the first 6 months (control group), followed by 40 of 89 patients receiving selective flora suppression during the second 6-month period (test group). INTERVENTIONS: The test group got a mixture of nonabsorbable antibiotics (paste and suspension) in the digestive tract. The control group received paste and suspension without antimicrobial agents. All 200 patients received cefotaxime during the first 4 days. MEASUREMENTS AND MAIN RESULTS: With the use of selective flora suppression, colonization with aerobic Gram-negative bacilli was significantly (p less than .01) reduced. There was also a significant reduction in nosocomial bronchopulmonary (ICU I and II; p less than .001) and urinary tract (ICU II; p less than .001) infections. The difference in mortality was not significant. There was no development of resistance against the antibiotics used during the limited period evaluated. CONCLUSIONS: Selective flora suppression is effective in reducing secondary colonization by aerobic Gram-negative bacilli. Reduction of bronchopulmonary and urinary tract infections most likely occurs with colonization prevention.

[Selective flora suppression for control of infection in surgical intensive care medicine]. / Selektive Florasuppression zur Infektionskontrolle in der operativen Intensivmedizin.

The question to be answered in this study was: Is prophylactic selective florasuppression advantageous compared to conventional antibiotic policy as far as microbial colonisation, infection, mortality and development of resistance are concerned? A prospective, consecutive, placebo-controlled study in two ICU's was carried out during four 6-months periods. 200 patients who were intubated for at least 3 days, required intensive care for a minimum of 5 days, and belonged to either class III or IV according to the "Therapeutic Intervention Scoring System" were included in the study. They received either placebo or the prophylaxis regimen described by Stoutenbeek et al., consisting of polymyxin E, tobramycin and amphotericin B. Oropharyngeal, tracheobronchial and rectal colonisation with aerobic gram-negative bacilli markedly decreased in the test groups. The rates of nosocomial bronchopulmonary infections (ICU I and II) and urinary tract infections (ICU II) were significantly reduced. There was no significant reduction in wound infection, septicaemia and mortality rates. No development of resistance and no increase of multi-resistant strains occurred. Selective florasuppression is effective in reducing infection rates in critically ill patients without development of resistant strains.