A care bundle approach for prevention of ventilator-associated pneumonia.

Implementation of care bundles for prevention of ventilator-associated pneumonia (VAP) and its impact on patient outcomes requires validation with long-term follow-up. A collaborative multi-centre cohort study was conducted in five Spanish adult intensive-care units. A care bundle approach based on five measures was implemented after a 3-month baseline period, and compliance, VAP rates, intensive-care unit length of stay (ICU LOS) and duration of mechanical ventilation were prospectively recorded for 16 months. There were 149 patients in the baseline period and 885 after the intervention. Compliance with all measures after intervention was <30% (264/885). In spite of this, VAP incidence decreased from 15.5% (23/149) to 11.7% (104/885), after the intervention (p <0.05). This reduction was significantly associated with hand hygiene (OR = 0.35), intra-cuff pressure control (OR = 0.21), oral hygiene (OR = 0.23) and sedation control (OR = 0.51). Use of the care bundle was associated with an incidence risk ratio of VAP of 0.78 (95% CI 0.15-0.99). We documented a reduction of median ICU LOS (from 10 to 6 days) and duration of mechanical ventilation (from 8 to 4 days) for patients with full bundle compliance (intervention period). Efforts on VAP prevention and outcome improvement should focus on achieving higher compliance in hand and oral hygiene, sedation protocols and intracuff pressure control.

Lesión postraumática de la arteria carótida.Valoración del diagnóstico clinicorradiológico / Posttraumatic lesion of the carotid artery. Evaluation of the clinico-radiological diagnosis

Introducción. Las lesiones vasculares postraumáticas de la arteria carótida (LPAC) son poco frecuentes pero tienen una elevada morbimortalidad por lo cual es importante su diagnóstico y tratamiento precoz. Objetivo. Revisar los hallazgos clínicos y radiológicos de la LPAC con la hipótesis de que existen signos que permiten su diagnóstico precoz. Pacientes y métodos. Estudio retrospectivo de 9 pacientes (p) con LPAC. Resultados. La causa fue un accidente de tráfico (4 p), precipitación (1p) o un movimiento brusco cervical aislado (4 p). La clínica inicial era de dolor cervical (1 p), hipoacusia (1p), síndrome de Claude-Bernard-Horner (4 p) o síntomas de un ataque vascular cerebral (6 p). La TC craneal mostraba un infarto cerebral de arteria cerebral media (6 p), una hemorragia subaracnoidea (1 p) o era normal (3 p). El diagnóstico de la lesión vascular se realizó mediante resonancia magnética (9 p), arteriografía (5 p) y ecografía-Doppler (4 p). Las lesiones vasculares fueron: estenosis grave por trombosis mural (3 p), oclusión por trombosis completa (4 p) y pseudoaneurisma (2p).Conclusiones. La LPAC se debe sospechar tras un traumatismo craneofacial-cervical cuando ha habido un movimiento cervical brusco, cuando existe un síndrome de Claude-Bernard-Horner o cuando se demuestra un infarto cerebral de arteria cerebral media (AU)

[Post-traumatic lesion of the carotid artery. Evaluation of the clinico-radiological diagnosis]. / Lesión postraumática de la arteria carótida. Valoración del diagnóstico clinicorradiológico.

INTRODUCTION: Posttraumatic vascular lesions of the carotid artery (PLCA) are infrequent but have a high morbid-mortality, so early diagnosis and treatment is important. OBJECTIVE: To review the clinical and radiological findings of the PLCA with the hypothesis that there are signs which permit early diagnosis. PATIENTS AND METHODS: A retrospective study of 9 patients (p) with PLCA. RESULTS: The cause was road traffic accident (4p), fall (1p) or a single abrupt cervical movement (4p). The initial clinical feature was cervical pain (1p), deafness (1p), Claude-Bernard-Horner syndrome (4p) or symptoms of a cerebral vascular accident (6p). Cranial CT showed a cerebral infarct in the territory of the middle cerebral artery (6p), subarachnoid hemorrhage (1p) or normal (3p). Diagnosis of the vascular lesion was made using magnetic resonance (9p), arteriography (5p) and echo-Doppler (4p). The vascular lesions were: severe stenosis due to a mural thrombosis (3p), complete obstruction due to thrombosis (4p) and pseudoaneurysm (2p). CONCLUSIONS: PLCA should be suspected following craniofacial-cervical trauma when there was an abrupt neck movement, a Claude-Bernard-Horner syndrome is present or a cerebral infarct in the territory of the middle cerebral artery is shown.

Simulation of the variable compliance of living systems.

The purpose of this study was to differentiate between the terms generation and simulation which are normally used in the construction of electronic models of biological systems. A technique was adopted based on Miller's theorem to obtain time variable impedances and it was applied to the ventricular compliance simulation. In order to prove experimentally the proposed method, an electronic model of the cardiovascular system using half a heart was designed in which the ventricle is represented by a single time-varying compliance. The voltages which represent the atrial ventricular and aortic pressures and the ventricular volume are provided by the model as outputs.

Electronic trace of the mean axis of the heart.

A technique is described for tracing the mean electrical axis of the heart from an ECG waveform generator on a general purpose CRT, which could be used to teach medical students and might also be useful as an auxillary unit to investigate the possible applications of the mean electrical axis to the diagnosis of cardiac disorders.