Guidelines for Percutaneous Dilatational Tracheostomy (PDT) from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM).

Percutaneous dilatational tracheostomy is a common procedure in intensive care. This guideline from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM) describes indications and contraindications, timing, complications compared to surgical tracheostomy, anaesthesia and technique, decannulation strategy, as well as training and education.

Danish Guidelines 2015 for percutaneous dilatational tracheostomy in the intensive care unit.

Percutaneous dilatational tracheostomy is a common procedure in intensive care. This updated Danish national guideline describes indications, contraindications and complications, and gives recommendations for timing, anaesthesia, and technique, use of fibre bronchoscopy and ultrasound guidance, as well as decannulation strategy, training, and education.

[Bladder temperature versus tympanic membrane and forehead skin temperature]. / Blaere- versus øre- og pandetemperatur.

INTRODUCTION: The purpose of the study was to compare three different methods of assessing the core temperature: by measuring the bladder temperature, the tympanic temperature, (Braun Thermoscan 3000) and the forehead skin temperature (Philips SensorTouch). Measuring of the bladder temperature and the tympanic temperature are wellknown methods whereas measuring of the forehead skin temperature by the use of Sensor Touch is a fairly new method by which the temperature at the warmest area of the forehead is measured. MATERIAL AND METHODS: Forty-two randomly chosen adult patients who all had a bladder catheter with a thermometer and a normal urine output. The patients were admitted to an intensive care unit and none were intubated nasally. Otoscopy was performed prior to temperature measurement. The temperatures were measured almost simultaneously. At the same time a white blood cell count and the C-reactive-protein value was recorded. RESULTS: There was a good linear coherence between the bladder temperature and the tympanic temperature (r = 0.97). The linear coherence between the bladder temperature and the forehead skin temperature was poor (r = 0.59). We found a mean deviation of 0.07 degree C and a standard deviation of 0.3 degree C of the difference between the bladder temperature and the tympanic temperature (p = 0.19). The mean of the difference between the bladder temperature and the forehead skin temperature was 0.5 degree C and a standard deviation of 0.8 degree C (p = 0.0003). Furthermore the forehead skin thermometer was not able to measure temperatures < 35.0 degrees C. We found no statistically significant coherence between the core temperature and the white blood cell count or C-reactive-protein. DISCUSSION: Tympanic temperature was well coherent with bladder temperature--forehead skin temperature was poorly coherent with bladder temperature. By evaluating the core temperature in intensive care patients the tympanic temperature is a reliable alternative to the bladder temperature.

Non-invasive ventilation is less efficient in pneumonia than in chronic obstructive pulmonary disease exacerbation.

INTRODUCTION: Non-invasive ventilation (NIV) is especially valid for acute exacerbation in chronic obstructive pulmonary disease (COPD), but the trend has been to use it for all types of patients with acute respiratory failure (ARF). Recent data suggest that treatment failure occurs more often in patients with ARF from pneumonia than from COPD. MATERIAL AND METHODS: This was a retrospective study using data from patients with ARF admitted into the intensive care unit in a university-affiliated hospital in the period from 1 January 2009 to 31 December 2012 and treated with NIV. Patients with ARF due to acute exacerbation in COPD or ARF due to pneumonia were included. The primary end-point was treatment failure (intubation). The secondary end-point was in-hospital mortality. A total of 107 patients were included, 42 in the COPD group and 65 in the pneumonia group. RESULTS: We found no significant difference between the two groups with regard to age (mean 65 ± 8 years (COPD) versus mean 64 ± 16 years (pneumonia)), sex (male/female 23/19 (COPD) versus male/female 26/39 (pneumonia)) or New Simplified Acute Physiology Score (SAPS II) (mean 47 ± 11 (COPD) versus mean 51 ± 15 (pneumonia)). Treatment failure occurred in five patients in the COPD group (12%) and in 32 patients in the pneumonia group (49%), p < 0.00001. In-hospital mortality occurred in six patients in the COPD group (14%) and in 21 patients in the pneumonia group (32%), p = 0.01. CONCLUSION: NIV is less effective in the treatment of ARF due to pneumonia than in the treatment of ARF due to acute exacerbation in COPD. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Monitoring urinary orosomucoid in acute inflammation: observations on urinary excretion of orosomucoid, albumin, alpha1-microglobulin, and IgG.

BACKGROUND: Inflammation-associated proteinuria in acute, nonrenal disease is a common but poorly understood phenomenon. We performed an observational study of the urinary excretion of orosomucoid (alpha(1)-acid glycoprotein), albumin, alpha(1)-microglobulin (protein HC), and IgG to obtain quantitative and temporal data on these 4 proteins. METHODS: Urine samples were collected at daily intervals for up to 23 days from 6 patients with surgery-induced inflammation and at hourly intervals for a 24-h period from 7 sepsis patients. Urinary protein concentrations were assessed by immunoturbidimetry. RESULTS: During surgery-induced inflammation, the increase and decrease in orosomucoid excretion mirrored changes in plasma C-reactive protein. Values for all 4 urinary proteins were increased in sepsis patients. The observed maximum increases in urinary protein excretion relative to the upper reference values were 280-fold for orosomucoid, 98-fold for alpha(1)-microglobulin, 33-fold for albumin, and 26-fold for IgG. CONCLUSIONS: Orosomucoid, usually present in plasma and urine in much lower concentrations than albumin, is increased in urine to concentrations equal to or higher than albumin in proteinuria associated with acute inflammation. The pathophysiologic mechanisms responsible for this markedly increased excretion are unknown. Monitoring of urinary excretion of orosomucoid and other specific proteins, expressed as protein/creatinine ratios, may provide a window for clinically relevant real-time observation of changes in acute inflammatory processes. Orosomucoid in urine may be a more informative marker than albumin for inflammation.