RESUMEN
We reviewed medical records of patients without known HIV and with positive cultures for nontuberculous mycobacteria (NTM) isolated during 2000-2003 from 1 large hospital in New York, New York. Overall, 505 patients had positive NTM cultures; 119 (24%) met the criteria for NTM disease. The difference between demographic characteristics of case-patients in our study (66% female, 61% white, and 59% > 60 years of age) and those of the base population as determined by regional census data was statistically significant. Estimated incidences for positive cultures, all disease, and respiratory tract disease were 17.7, 2.7, and 2.0 per 100,000 persons, respectively. More patients with rapidly growing mycobacteria (61%), Mycobacterium kansasii (70%), or M. marinum (100%) met criteria for disease than did patients with M. avium complex (MAC) (27%, (p < 0.01). NTM disease in patients without HIV is increasing. Laboratory-based surveillance may be useful for detecting non-MAC and non-respiratory tract disease.
Asunto(s)
Infecciones por VIH , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Mycobacterium/aislamiento & purificación , Adolescente , Adulto , Anciano , Bacteriemia/epidemiología , Bacteriemia/microbiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/microbiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Enfermedades Cutáneas Bacterianas/epidemiología , Enfermedades Cutáneas Bacterianas/microbiología , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/microbiología , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/microbiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiologíaRESUMEN
Maintenance of airway secretion clearance, or airway hygiene, is important for the preservation of airway patency and the prevention of respiratory tract infection. Impaired airway clearance often prompts admission to the intensive care unit (ICU) and can be a cause and/or contributor to acute respiratory failure. Physical methods to augment airway clearance are often used in the ICU but few are substantiated by clinical data. This review focuses on the impact of oral hygiene, tracheal suctioning, bronchoscopy, mucus-controlling agents, and kinetic therapy on the incidence of hospital-acquired respiratory infections, length of stay in the hospital and the ICU, and mortality in critically ill patients. Available data are distilled into recommendations for the maintenance of airway hygiene in ICU patients.
Asunto(s)
Infección Hospitalaria/prevención & control , Higiene/normas , Unidades de Cuidados Intensivos , Mucosa Respiratoria/metabolismo , Infecciones del Sistema Respiratorio/prevención & control , Antiinfecciosos/uso terapéutico , Broncoscopía , Descontaminación/métodos , Expectorantes/uso terapéutico , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Factores de Riesgo , SucciónRESUMEN
BACKGROUND: Safety and efficacy of extracorporeal membrane oxygenation (ECMO) in pregnancy is unknown. CASE: A 33-year-old pregnant woman at 23 weeks of gestation presented with acute respiratory distress syndrome unresponsive to conventional mechanical ventilation. Early initiation of ECMO therapy along with protective mechanical ventilation strategy resulted in an excellent maternal and fetal outcome. CONCLUSION: Extracorporeal membrane oxygenation can be life saving when initiated early in pregnant patients with severe acute respiratory insufficiency unresponsive to conventional mechanical ventilation.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Complicaciones del Embarazo/terapia , Síndrome de Dificultad Respiratoria/terapia , Dolor Abdominal , Adulto , Femenino , Rotura Prematura de Membranas Fetales , Edad Gestacional , Síndrome HELLP , Humanos , Recién Nacido , Recien Nacido Prematuro , Embarazo , Resultado del Embarazo , Radiografía , Respiración Artificial , Síndrome de Dificultad Respiratoria/diagnóstico por imagenRESUMEN
HELLP syndrome (hemolysis, elevation of liver enzymes, and low platelet count) occurs during pregnancy. Intrahepatic hemorrhage and subcapsular liver hematoma with or without rupture are reported complications of this syndrome. The patient described in this report developed HELLP syndrome associated with a subcapsular liver hematoma and pulmonary artery thrombus, complications that created a therapeutic conundrum.