Percutaneous tracheostomy in patients with disorders of the central nervous system.

BACKGROUND AND PURPOSE: Patients with disorders of the central nervous system frequently require maintenance of an artificial airway due to impairment of the cough reflex and swallowing, or due to the necessity to apply long-term mechanical ventilation. The technique of percutaneous tracheostomy, introduced in recent years to clinical practice globally, enables tracheostomy and establishment of an artificial airway in a bedside setting, in a quick, simple and minimally traumatic manner. It does not require the operating theatre environment and is associated with lower complication rates than the traditional surgical technique. MATERIAL AND METHODS: In the period from March 2003 till February 2007, we performed 75 procedures of Griggs mode percutaneous tracheostomy in intravenous anaesthesia, with use of a disposable Percutaneous Tracheostomy Kit (SIMS Portex, UK). The group of patients comprised 36 women and 39 men. Mean patient age was 57.4+/-17.9 years. RESULTS: On average, the procedure was performed on the 8th (7.8+/-2.6) day after intubation, and its average duration was 6.0+/-3.3 minutes. The most frequent complication was local bleeding from the site (13%), most of which, however, regressed spontaneously. Also observed were: puncture of the tracheal tube sealing cuff (7%), damage to the isthmus of the thyroid (3%), and extratracheal positioning of the tracheal tube (3%). In all the cases the procedure was concluded successfully. CONCLUSIONS: Griggs mode is a simple and safe technique enabling percutaneous tracheostomy in patients with pathology of the central nervous system. However, further research is needed to evaluate potential delayed complications of the procedure.

Comparative performance assessment of point-of-care testing devices for measuring glucose and ketones at the patient bedside.

Point-of-care (POC) testing devices for monitoring glucose and ketones can play a key role in the management of dysglycemia in hospitalized diabetes patients. The accuracy of glucose devices can be influenced by biochemical changes that commonly occur in critically ill hospital patients and by the medication prescribed. Little is known about the influence of these factors on ketone POC measurements. The aim of this study was to assess the analytical performance of POC hospital whole-blood glucose and ketone meters and the extent of glucose interference factors on the design and accuracy of ketone results. StatStrip glucose/ketone, Optium FreeStyle glucose/ketone, and Accu-Chek Performa glucose were also assessed and results compared to a central laboratory reference method. The analytical evaluation was performed according to Clinical and Laboratory Standards Institute (CLSI) protocols for precision, linearity, method comparison, and interference. The interferences assessed included acetoacetate, acetaminophen, ascorbic acid, galactose, maltose, uric acid, and sodium. The accuracies of both Optium ketone and glucose measurements were significantly influenced by varying levels of hematocrit and ascorbic acid. StatStrip ketone and glucose measurements were unaffected by the interferences tested with exception of ascorbic acid, which reduced the higher level ketone value. The accuracy of Accu-Chek glucose measurements was affected by hematocrit, by ascorbic acid, and significantly by galactose. The method correlation assessment indicated differences between the meters in compliance to ISO 15197 and CLSI 12-A3 performance criteria. Combined POC glucose/ketone methods are now available. The use of these devices in a hospital setting requires careful consideration with regard to the selection of instruments not sensitive to hematocrit variation and presence of interfering substances.

Two years on continuous ambulatory peritoneal dialysis--does it change peritoneal transport?

We investigated changes in peritoneal transport in patients treated at least 2 years with continuous ambulatory peritoneal dialysis (CAPD). The study included 28 patients (21 men, 7 women; CAPD duration: 24.0 - 28.3 months) who underwent peritoneal equilibration tests (PETs) at 3-month intervals for up to 24 months (group 24mPET). The PET results obtained at 24 months were compared to the results of the first PET taken in the same group (PET1, 0.03 - 15.86 months) and to the results of groups 1mPETand 6mPET. Group 1mPETconsisted of 41 patients--among them 14 patients (9 men, 5 women) from group 24mPET--who underwent a PET during the first month of CAPD. Group 6mPET consisted of 60 patients--among them 21 patients (15 men, 6 women) from group 24mPET--who underwent a PET at months 5 - 7 of CAPD. In analyzing paired data, we observed a significant reduction in vascular-to-mesothelial peritoneal transport (V --> M PT) in the entire group and in men. In analyzing unpaired data, we observed a reduction in V --> M PT between the 24mPET (n = 28) group and the 6mPET (n = 60) group [dialysate-to-plasma (D4/P2) creatinine: 0.54 +/- 0.18 vs. 0.65 +/- 0.19, p = 0.013]. Distribution of low, low-average, high-average, and high transporters did not vary among the groups, except in the case of low creatinine transporters, who represented 47% of the 24mPET group and 23% of the 6mPET group (p = 0.046). We conclude that in patients (men) treated with CAPD at least 2 years, V --> M PT decreases, increasing the percentage of low creatinine transporters and having no significant influence on dialysate drain volume. Peritoneal transport of glucose is stable over a 2-year period.

Siderophore-mediated strategies of iron acquisition by extraintestinal isolates of Enterobacter spp.

A total of 89 examined Enterobacter isolates belonging to three species: E. cloaceae, E. aerogenes and E. sakazakii, produced iron chelators detected in universal CAS assay. In chemical assays the strains were shown to excrete mostly catecholate (88 strains) and hydroxamate (42 strains) type of siderophores. Forty-one strains produced both catecholate and hydroxamate siderophores whereas one isolate produced only hydroxamate. Besides, the isolates were screened for genes coding for another siderophore: yersiniabactin. The genes for biosynthesis and uptake of yersiniabactin are located on the high-pathogenicity island (HPI) of Yersinia spp. The presence of three marker genes irp1, irp2 and fyuA was estimated by polymerase chain reaction. Two strains: E. aerogenes and E. cloaceae possessed irp1, irp2 and fyuA genes. PCR products of irp1, irp2 and fyuA were of 240, 280 and 780 bp, respectively.