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  • 1
    Electronic Resource
    Electronic Resource
    Severe community-acquired pneumonia in ICUs: prospective validation of a prognostic score (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1307-1314 
    Details
    ISSN: 1432-1238
    Keywords: Key words Pneumonia ; Mortality ; Risk factors ; Intensive care units
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine predictors of intensive care unit (ICU) mortality in patients with community-acquired pneumonia (CAP), to develop a pneumonia-specific prognostic index, and to evaluate this index prospectively. Design: Combined retrospective and prospective clinical study over two periods: January 1987–December 1992 and January 1993–December 1994. Setting: Four medical ICUs in the north of France. Patients: Derivation cohort: 335 patients admitted to one ICU were retrospectively studied to determine prognosis factors and to develop a pneumonia-specific prognostic index. Validation cohort: 125 consecutive patients, admitted to four ICUs, were prospectively enrolled to evaluate this index. Results: In the derivation cohort, 16 predictors of mortality were identified and assigned a value directly proportional to their magnitude in the mortality model: aspiration pneumonia (–0.37), grading of sepsis ≥11 (–0.2), antimicrobial combination (–0.01), Glasgow score 〉12+mechanical ventilation (MV) (+0.09), serum creatinine ≥15 mg/l (+0.22), chest involvement shown by X-ray ≥3 lobes (+0.28), shock (+0.29), bacteremia (+0.29), initial MV (+0.29), underlying ultimately or rapidly fatal illness (+0.31), Simplified Acute Physiology Score ≥12 (+0.49), neutrophil count ≤3500/mm3 (+0.52), acute organ system failure score ≥2 (+0.64), delayed MV (+0.67), immunosuppression (+1.38), and ineffective initial antimicrobial therapy (+1.5). An index was obtained by adding each patient‘s points. According to a receiver operating characteristic curve, the cut-off value of this index was 2.5. In the validation cohort, an index of ≥2.5 could predict death with a positive predictive value of 0.92, sensitivity 0.61, and specificity 0.98. Conclusion: This index, which performs well in classifying patients at high-risk of death, may help physicians in initial patient care (appropriateness of the initial antimicrobial therapy) and guide future clinical research (analysis and design of therapeutic trials).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709543
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit (1995)
    Springer
    Intensive care medicine 21 (1995), S. 24-31 
    Details
    ISSN: 1432-1238
    Keywords: Community-acquired pneumonia ; Prognosis ; Epidemiology ; Critically ill patients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To characterize the epidemiology and to determine the prognosis factors in severe community-acquired pneumonia among patients admitted to an intensive care unit. Design Retrospective clinical study. Setting Intensive Care and Infectious Diseases Unit of a municipal general hospital of Lille University Medical School. Patients 299 consecutive patients exhibiting severe community-acquired pneumonia. Measurements and results On admission to ICU, 149 patients required mechanical ventilation for acute respiratory failure and 44 exhibited septic shock. Pulmonary involvement was bilateral in 71 patients. There were 260 organisms isolated from 197 patients (65.9%), the most frequent beingStreptococcus pneumoniae (n=80),Staphylococcus spp. (n=57) and Gram-negative bacilli (n=81). Overall mortality was 28.5% (85 patients). According to univariate analysis, mortality was associated with age over 60 years, anticipated death within 5 years, immunosuppression, shock, mechanical ventilation, bilateral pulmonary involvement, bacteremia, neutrophil count 〈3500/mm3, total serum protein level 〈45 g/l, serum creatinine 〉15 mg/l, non-aspiration pneumonia, ineffective initial therapy and complications. Multivariate analysis selected only 5 factors significantly associated with prognosis: anticipated death within 5 years, shock, bacteremia, non-pneumonia-related complications and ineffective initial therapy. Conclusion The effectiveness of the initial therapy appears to be the most significant prognosis factor and, as the one and only related to the initial medical intervention, suggests a need for permanent optimization of our antimicrobial strategies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02425150
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    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Pharmacokinetics of vancomycin during continuous hemodiafiltration (1993)
    Springer
    Intensive care medicine 19 (1993), S. 347-350 
    Details
    ISSN: 1432-1238
    Keywords: Vancomycin ; Pharmocokinetics ; Continuous hemodiafiltration ; Acute renal failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To study the pharmacokinetics of vancomycin in three patients with acute renal failure related to multi-organ failure during continous venovenous hemodiafiltration (CVVHD). Design: Prospective exploratory, open-labelled study. Setting Critical Care Unit in a University Medical Centre. Patients 3 patients exhibiting hemodynamic instability and oligo-anuric acute renal failure requiring extra-renal epuration were included in this study. Intervention Every patient received 7.5 mg/kg IV vancomycin over 1 h for a documented or suspected nosocomial staphylococcal infection. Serum and dialysate outlets samples were collected before infusion and 1, 3, 6, 12, 18, 24 after the end of infusion. Measurements and results Mean age was 58.7 years (range 41–79) and mean SAPS 15.7 (9–23). The mean peak concentrations were 27.3 mg/l (range 15.6–45.6) one hour after the end of infusion. The average remaining vancomycin concentration 24 h after the onset of infusion was 3.6 mg/I (range 2.6–4.5). The mean terminal disposition rate constant and elimination half-life were 0.05 h−1 and 13.9 h respectively. Mean total body clearance was 38.9±4.3 ml/min and dialysate outlet (DO) clearance 4.2±1.3 ml/min. The mean volume of distribution was 47.4±6.4 l. Conclusion CVVHD is effective for vancomycin elimination. In these patients, the elimination half-life is almost constant, involving a following injection of vancomycin 12 h later to achieve effective concentrations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01694710
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 4
    Electronic Resource
    Electronic Resource
    Nosocomial infections associated with long-term radial artery cannulation (1989)
    Springer
    Intensive care medicine 15 (1989), S. 241-246 
    Details
    ISSN: 1432-1238
    Keywords: Nosocomial infection ; Long-term cannulation ; Radial artery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From January 1987 to December 1987, 193 radial artery cannulations were performed in 112 patients (87 males, 25 females; mean age=57.5 years). The mean duration of cannulation was 6.45 days. After removal, the tip of the catheter was cultured using a semiquantitative culture technique: 164 catheters were cultured and positive results were seen in 37 cases (22.5%); 98 samples of infusate were cultured. Positive results were observed in 23 cases (23.5%). No bacteriological correlation was found between these two culture results. During the study, no catheter-related or infusate-related bacteraemia was detected. It is concluded that nosocomial infections associated with long-term radial artery cannulation are not commonly seen, in particular no catheter or infusate-related bacteraemia occurs even if the duration exceeds 4 days.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00271059
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 5
    Electronic Resource
    Electronic Resource
    Severe community-acquired pneumonia in ICUs: Prospective validation of a prognostic score (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1307-1314 
    Details
    ISSN: 1432-1238
    Keywords: Pneumonia ; Mortality ; Risk factors ; Intensive care units
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To determine predictors of intensive care unit (ICU) mortality in patients with community-acquired pneumonia (CAP), to develop a pneumonia-specific prognostic index, and to evaluate this index prospectively. Design Combined retrospective and prospective clinical study over two periods: January 1987–December 1992 and January 1993–December 1994. Setting Four medical ICUs in the north of France. Patients Derivation cohort: 335 patients admitted to one ICU were retrospectively studied to determine prognosis factors and to develop a pneumonia-specific prognostic index. Validation cohort: 125 consecutive patients, admitted to four ICUs, were prospectively enrolled to evaluate this index. Results In the derivation cohort, 16 predictors of mortality were identified and assigned a value directly proportional to their magnitude in the mortality model: aspiration pneumonia (−0.37), grading of sepsis ≥11 (−0.2), antimicrobial combination (−0.01), Glasgow score 〉12+mechanical ventilation (MV) (+0.09), serum creatinine ≥15 mg/l (+0.22), chest involvement shown by X-ray ≥3 lobes (+0.28), shock (+0.29), bacteremia (+0.29), initial MV (+0.29), underlying ultimately or rapidly fatal illness (+0.31), Simplified Acute Physiology Score ≥12 (+0.49), neutrophil count ≤3500/mm3 (+0.52), acute organ system failure score ≥2 (+0.64), delayed MV (+0.67), immunosuppression (+1.38), and ineffective initial antimicrobial therapy (+1.5). An index was obtained by adding each patient's points. According to a receiver operating characteristic curve, the cut-off value of this index was 2.5. In the validation cohort, an index of ≥2.5 could predict death with a positive predictive value of 0.92, sensitivity 0.61, and specificity 0.98. Conclusion This index, which performs well in classifying patients at high-risk of death, may help physicians in initial patient care (appropriateness of the initial antimicrobial therapy) and guide future clinical research (analysis and design of therapeutic trials).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709543
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 6
    Electronic Resource
    Electronic Resource
    Toxic epidermal necrolysis in a patient suffering from acquired immune deficiency syndrome (1994)
    Springer
    Infection 22 (1994), S. 365-365 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01715552
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
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