Venovenous extracorporeal membrane oxygenation (ECMO) is increasingly used in patients with respiratory failure who fail conventional treatment. Postoperative pneumonia is the most common infection ...after lung transplantation (40%). Imipenem is frequently used for empirical treatment of nosocomial pneumonia in the intensive care unit. Nevertheless, few data are available on the impact of ECMO on pharmacokinetics, and no data on imipenem dosing during ECMO. Currently, no guidelines exist for antibiotic dosing during ECMO support.
We report the cases of 2 patients supported with venovenous ECMO for refractory acute respiratory distress syndrome following single lung transplantation for pulmonary fibrosis, treated empirically with 1 g of imipenem intravenously every 6 h. Enterobacter cloacae was isolated from the respiratory sample of Patient 1 and Klebsiella pneumoniae was isolated from the respiratory sample of Patient 2. Minimum inhibitory concentrations of the 2 isolated strains were 0.125 and 0.25 mg/L, respectively. Both patients were still alive on day 28. This is the first report, to our knowledge, of imipenem concentrations in lung transplantation patients supported with ECMO. This study confirms high variability in imipenem trough concentrations in patients on ECMO and with preserved renal function. An elevated dosing regimen (4 g/24 h) is more likely to optimize drug exposure, and therapeutic drug monitoring is recommended, where available. Population pharmacokinetic studies are indicated to develop evidence‐based dosing guidelines for ECMO patients.
Previous studies have shown that the high dose of gentamicin (8 mg/kg) rarely achieves the desired peak plasma concentration (Cmax) of ≥30 mg/l in patients with severe sepsis or septic shock. The aim ...of this study was to determine the first dose of gentamicin needed to achieve a Cmax ≥ 30 mg/l. We conducted a prospective observational cohort study in one intensive care unit. All consecutive patients hospitalized for severe sepsis or septic shock and treated with a first dose of gentamicin >6 mg/kg were evaluated. During the study period, 15 of the 57 patients (26.3 %) treated with gentamicin had a Cmax ≥ 30 mg/l. The median dose of gentamicin administered was 8.9 7.8–9.9 mg/kg. Independent factors in the multivariate analysis associated with a Cmax ≥ 30 mg/l were higher body mass index (per kg/m
2
increment) (OR: 1.173, 95%CI: 1.015–1.356,
P
= 0.03) and higher first dose of gentamicin (per mg/kg increment) (OR: 2.343, 95%CI: 1.346–4.08,
P
= 0.003). The optimal first dose to achieve a Cmax ≥ 30 mg/l was 11 mg/kg, with a specificity and a sensitivity of 100 % and 53.3 % respectively. These results suggest that a first dose of gentamicin >11 mg/kg is needed to achieve a Cmax ≥ 30 mg/l in most patients.
Laparoscopic Roux-en-Y gastric bypass is one of the most commonly performed bariatric procedures and most patients are women of reproductive age. Consequently, general surgeons and obstetricians need ...to be aware that these patients are at risk of bariatric specific surgical complications during their pregnancy. We report a case involving a 32-year-old woman who had undergone Roux-en-Y gastric bypass surgery 2 years previously. She presented at 25 weeks of gestation with a closed loop obstruction due to a retrograde jejunojejunal intussusception that was initially misdiagnosed as acute pancreatitis.
The desorption of moisture from wool Popescu, C.; Augustin, P.; Wortmann, F. J.
Journal of thermal analysis and calorimetry,
04/2015, Letnik:
120, Številka:
1
Journal Article
Recenzirano
We have carried out a DSC investigation under nitrogen flow of moisture desorption from wool equilibrated with various amounts of water. The recorded data have been used to calculate the kinetic ...parameters of the desorption process assuming a single process and within the framework of the reaction order. We found that while the reaction order and the peak temperature change with the equilibrium water content (
e.w.c.
) which wool fibre had at the beginning of the desorption experiment, the activation energy and the pre-exponential factor remain fairly constant. The overall reaction rate shows that, due to the change of the kinetics of wool-water system with the change of the initial moisture content, higher the initial water content of the fibre is, faster the desorption occurs. The results point out clearly that any study of moisture desorption from keratins should specify the initial value of the equilibrium water content.
The Pic 2005 field campaign took place from 13 June to 7 July 2005 close to the high-altitude permanent atmospheric observatory Pic-du-Midi (PDM), situated at 2875
m
asl in the French Pyrenees. The ...experimental set-up combined in situ ground-based observations at PDM with ozone lidar measurements at two lower sites in close vicinity (600
m
asl/28
km away, and 2380
m
asl/500
m away). Such an experimental configuration is appropriate to address the question of the vertical layering of the chemical atmosphere in a mountain area and above the plain nearby, and how this influences measurements conducted on a mountain summit under the influence of horizontal transport at regional scale, and vertical transport at local scale. Forecast tools made it possible to plan and carry out 6 one-day Intensive Observation Periods (IOPs), mostly in anticyclonic conditions favoring local thermally induced circulations, with and without local pollution in the lower troposphere.
It was thus possible to document i) ozone diurnal variations at PDM; ii) correlation between ozone measurements at PDM and their counterparts at the same altitude in the free troposphere; iii) ozone variability in the vicinity of PDM.
The field campaign provided direct experimental evidence that at daytime in the encountered conditions (mostly anticyclonic), PDM failed in a large extent to be representative of the troposphere above the surrounding flat areas at similar altitude. First, ozone daily averages at PDM were found lower than their free-tropospheric counterpart. Thermally induced circulations and convection pumping clean air from the rural boundary layer can account qualitatively for ozone depletion observed at PDM during daytime. However the surface measurements do not support the hypothesis of direct lifting of near-surface air masses up to PDM. Thus, mixing with free-tropospheric air, photochemistry and surface deposition in the valleys appear to be needed ingredients to account quantitatively for the observed variations (in proportions that further studies should determine). Second, ozone variability was found to be much lower at PDM than in the free troposphere—again an indication of atmospheric mixing. In particular at daytime, the PDM observatory did not allow for detection of ozone-rich layers simultaneously visible above the plain. Beyond these first results, the data set presented here paves way to detailed studies of the IOPs.
► Surface monitors and profilers deployed around a mountain-top station (2.9
km
asl). ► Ozone very stratified in the area due to deposition and complex transport patterns. ► Evidence of daytime transport of ozone-depleted air from the valleys to the station. ► Station representative at daytime of lower layers above the plain (1–2
km
asl). ► Mixing made ozone less variable at the station than in the regional free troposphere.
No recommendations are currently available to help the clinician with the pharmacological management of intensive care unit (ICU) patients with elevated cardiac troponin (cTn) not linked to type 1 ...AMI. The aim of this study was to evaluate the pattern of cardiologic medications for patients with elevated cTnI in ICU not link to type 1 AMI and their effects on in-hospital mortality.
A prospective observational cohort study conducted in two ICU units. Patients with increased plasma concentration of cTnI at admission not linked to type 1 AMI were consecutively included.
One hundred and ninety of the 835 patients admitted (23%) had an increased plasma concentration of cTnI not related to type 1 AMI. Antiplatelet therapy (AT) and statin were prescribed in 56 (29.5%) and 50 (26.3%) of patients, respectively. Others cardiologic medications were prescribed in less than 5% of all cases and were considered as contraindicated in more than 50% of cases. Antiplatelet therapy was the only cardiologic treatment associated with reduction of in-hospital mortality following uni- and multivariate analysis. The death rate was 23% and 40% in these patients treated with and without AT, respectively (aOR=0.39 95% CI: 0.15-0.97).
Statin and AT were frequently prescribed to patients with a cTnI elevation not linked to type 1 AMI. This study suggests that AT in patients with an increased plasma concentration of cTnI, not related to type 1 AMI in ICU, could reduce in-hospital mortality.
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