Mar 16, 2015 - wards had higher utilisation and bundle completion rates. ... Introduction Severe sepsis results in ~36,800 UK deaths each year ... Methods We present an observational, consecutive study. .... Assessment of specific risk scores for patients admitted to the ICU ...... 0.79 (95% CI 0.47 to 1.35)) (see Figure 1).
Critical Care 2015, Volume 19 Suppl 1 http://ccforum.com/supplements/19/S1
M E E T I N G A B S T R AC T S
35th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 17-20 March 2015 Published: 16 March 2015 Publication charges for this supplement were funded by ISICEM.
P1 Cerebral autoregulation testing in a porcine model of intravenously administrated E. coli induced fulminant sepsis L Molnar1, M Berhes1, L Papp1, N Nemeth2, B Fulesdi1 1 Deoec Aneszteziologia, Debrecen, Hungary; 2University of Debrecen, Hungary Critical Care 2015, 19(Suppl 1):P1 (doi: 10.1186/cc14081) Introduction To assess cerebral hemodynamics in an experimental sepsis model. Methods Nineteen juvenile female Hungahib pigs were subjected into control group (n = 9) or septic group (n = 10). Under general anesthesia in animals of the sepsis group, Escherichia coli culture (2.5 × 105/ml; strain: ATCC 25922) was intravenously administrated in a continuously increasing manner as follows: 2 ml in the first 30 minutes, then 4 ml in 30 minutes and afterwards 16 ml/hour for 2 hours (so a total of 9.5 × 106 E. coli within 3 hours). In the control group the anesthesia was maintained for 8 hours, infusion was administered as a similar volume of isotonic saline solution and no other intervention was made. Hemodynamic monitoring of all animals was performed by PiCCo monitoring system. The middle cerebral artery of the pigs was insonated through the transorbital window and cerebral blood flow velocity (MCAV) and pulsatility index was registered. Results In the septic group, as expected, all animals developed fulminant sepsis and died within 3 to 7 hours two animals in 3 to 4 hours, and three in 6 to 7 hours). In the septic animals the heart rate rose and mean arterial pressure dropped, their ratio increased significantly compared with both the base values (at the 6th hour: P 75, female gender, diabetes mellitus (DM), insulin dependence, body mass index (BMI) >30, current smokers, COPD, cardiopulmonary bypass time (CBP) >120 minutes, use of steroids, emergency operation, prolonged mechanical ventilation (>48 hours), reintubation, transfusion with more than 3 units of red blood cells, and the postoperative use of non-invasive ventilation (NIV). The chi-square test was used for statistical analysis. Results A total of 35 patients (3.44%) were complicated by deep sternal wound infections. No statistical correlation was found with age >75, gender, DM, BMI >30, steroids, emergent operation, prolonged ventilation, CBP time >120 minutes, reintubation and NIV. Factors with statistical significant correlation are presented in Table 1. Table 1 (abstract P10)
Insulin
Sternal infection
P value
9/85
0.001
Current smoker
4/272
0.037
COPD
11/197
3
19/302
0.001
Conclusion Postoperative deep sternal wound infections have statistical significant correlation with the following parameters: transfusion with >3 red blood cell units, history of COPD, insulin dependence and when the patient is a current smoker. Also there is a tendency for correlation with CBP time >120 minutes (P = 0.056). References 1. 2.
Diez C, et al. Risk factors for mediastinitis after cardiac surgery – a retrospective analysis of 1700 patients J Cardiothor Surg. 2007;2:23. Schimmer C, et al. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial. Ann Thorac Surg. 2008;86:1897-904.
P11 Risk factors for bacteremia in adult febrile patients in emergency settings A Mikami1, Y Natori1, F Omata2, S Ishimatsu1 1 St Luke’s International Hospital, Tokyo, Japan; 2St Luke’s Life Science Institute, Tokyo, Japan Critical Care 2015, 19(Suppl 1):P11 (doi: 10.1186/cc14091) Introduction Blood culture is a critical procedure for detecting potentially life-threatening bloodstream infections (BSI). At the same time, early diagnosis and appropriate treatment of BSI are the key factors in order to improve prognosis. The purpose of the current analysis was to identify risk factors for bacteremia in adult febrile patients in emergency settings. Methods We conducted a retrospective case–control study within a population of adult patients visiting the emergency department at a community hospital (St Luke’s International Hospital, Tokyo, Japan) and who underwent two sets of blood culture testing between 2003 and 2012. Among a total of 13,582 patients, 1,322 (10%) were detected as bacteremia. We included in this study 179 randomly selected patients from the bacteremia group and 321 randomly selected patients from the negative blood culture group to serve as the comparison group. Multivariate logistic regression was used to evaluate the relationship between clinical characteristics factors and bacteremia. Results In a multivariate logistic regression model, a statistically significant independent effect was found for body temperature (BT) >38°C (OR = 2.58, 95% CI, 1.76 to 3.79, P
