ABSTRACT
OBJECTIVE: To determine the optimal moment to perform tracheostomy in a patient requiring anterior cervical fixation. METHODS: A retrospective observational study conducted over an 18-year period included 56 patients who had been admitted to the intensive care unit with acute spinal cord injury and underwent tracheostomy and surgical fixation. The sample was divided into 2 groups: at-risk group (31 patients who had undergone tracheostomy before cervical surgery or <4 days after surgery) and not-at-risk group (25 patients who had undergone tracheostomy >4 days after fixation surgery). Descriptive and comparative studies were carried out. Overall trend of the collected data was analyzed using cubic splines (graphic methods). RESULTS: The only infectious complications diagnosed as related to the surgical procedure were infection of the surgical wound in 2 patients in the not-at-risk group (12%) and deep tissue infection in 1 patient in the at-risk group (3.2%). During the study period, we identified a tendency toward performance of early tracheostomies. CONCLUSIONS: Our results suggest that the presence of a tracheostomy stoma before or immediately after surgery is associated with a low risk of infection of the cervical surgical wound in instrumented spinal fusion.
Subject(s)
Spinal Cord Injuries/surgery , Spinal Fusion/methods , Tracheostomy/methods , Adolescent , Adrenal Cortex Hormones/metabolism , Adult , Aged , Aged, 80 and over , Cervical Vertebrae/surgery , Chi-Square Distribution , Critical Care/methods , Female , Humans , Male , Middle Aged , Risk Factors , Spinal Cord Injuries/mortality , Time Factors , Young AdultABSTRACT
OBJECTIVE: To determine the usefulness of procalcitonin (PCT) in decision-making when faced with suspected infection in patients with extensive burns. STUDY: Retrospective, observational follow-up study. INSTITUTION: Burn Unit of the Complexo Hospitalario Universitario A Coruña (CHUAC), Spain. PATIENTS AND METHOD: We included all patients admitted to the Unit from June 2011 to March 2012 with ≥20% total body surface area burned or ≥10% full-thickness body surface area burned with suspected infection (17 patients with 34 events of suspected infection). RESULTS: The infections were confirmed in 16/34 episodes (47.1%), and documented in 44.1% (n=15). There were no statistically significant differences in the PCT figures at the time the infection was suspected between the cases with confirmed and unconfirmed infection (p=0.682). The PCT values showed no discriminative value for differentiating patients with SIRS from those with sepsis, severe sepsis and septic shock (area under ROC curve (AUC)=0.546; 95% CI: 0.326-0.766). No significant correlation was found between SOFA and PCT, although there were differences in the PCT values in the patients who had tissue hypoperfusion. CONCLUSION: Results show that PCT is not a precise indicator of sepsis at the time of diagnosis. A correlation between PCT levels and hypoperfusion was observed.
Subject(s)
Burns/blood , Calcitonin/blood , Protein Precursors/blood , Sepsis/blood , Systemic Inflammatory Response Syndrome/blood , Adult , Aged , Area Under Curve , Biomarkers/blood , Burn Units , Burns/complications , Calcitonin Gene-Related Peptide , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , ROC Curve , Retrospective Studies , Sepsis/complications , Sepsis/diagnosis , Shock, Septic/blood , Shock, Septic/diagnosis , Smoke Inhalation Injury/complications , Systemic Inflammatory Response Syndrome/diagnosis , Young AdultABSTRACT
Clostridium difficile is the most common cause of infectious diarrhea in adults healthcare institutions. Recent studies have shown an increase in the incidence, severity and recurrence of C. difficile infection (CDI). Factors associated with the patient and medical care provided contribute to establishing colonization and, in some cases, subsequent progression to symptomatic disease. The availability of new microbiological techniques has contributed greatly to improving care for these patients. A diagnostic algorithm is provided for cases in which CDI is suspected based on current evidence regarding the effectiveness of microbiological and radiological methods. In cases in which CDI is confirmed, the first and most effective measure is the withdrawal of any antibiotic treatment the patient is receiving, if possible. The antimicrobial treatment of CDI is based on three classic agents: metronidazole, vancomycin and teicoplanin, along with the recent addition of fidaxomicin. Patients presenting serious symptoms, in addition to appropriate support and monitoring measures, may require surgical treatment. Infection prevention and control strategies can interrupt the transmission mechanism. This manuscript reviews current evidence on the approach of this entity from a multidisciplinary point of view.