Canadian journal of anaesthesia = Journal canadien d'anesthésie
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In patients with ventilator-associated pneumonia (VAP), the isolation of Candida species (spp.) in respiratory secretions has been associated with worse outcomes. It is unclear whether Candida colonization is causally related or is a marker of disease severity. The objective of this study was to compare systemic inflammatory markers in patients with a clinical suspicion of VAP with Candida in respiratory tract (RT) cultures vs patients who have bacteria and those with no pathogens. ⋯ In patients with a clinical suspicion of VAP, the presence of Candida spp. only in the RT is associated with similar levels of inflammation and worse clinical outcomes compared with patients without Candida in RT secretions.
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Randomized Controlled Trial Comparative Study
A randomized comparison of the GlideRite(®) Rigid Stylet to a malleable stylet for orotracheal intubation by novices using the GlideScope(®).
A stylet is usually necessary when using the GlideScope(®) videolaryngoscope for orotracheal intubation. A special stylet, the GlideRite(®) Rigid Stylet (GRS), was designed for this purpose. A previous trial involving experienced operators showed that the GRS offered no performance improvement vs a standard malleable stylet (SMS). In our trial, we compared the performance of the GRS with that of the SMS in terms of time to intubation and ease of intubation when used by novice GlideScope(®) operators. ⋯ The GRS and the SMS have similar performance characteristics when used by novice operators for GlideScope(®)-assisted orotracheal intubation. (Registered at ClinicalTrials.gov: NCT00884754).
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Bivalirudin use for anticoagulating patients undergoing cardiac surgery, particularly those with or at risk for heparin-induced thrombocytopenia, has expanded over the past several years. The purpose of this review is to provide a summary of the following: the differences between indirect and direct thrombin inhibition, unfractionated heparin's limitations (i.e., heparin-induced thrombocytopenia), bivalirudin's pharmacology, recent cardiac surgery trials comparing bivalirudin and unfractionated heparin as anticoagulants, the growing role of bivalirudin-mediated anticoagulation for various surgical procedures, and the potential of bivalirudin-mediated vascular graft patency. ⋯ Although bivalirudin is not approved for cardiac surgery in the United States, it can be used in this setting in Canada as an anticoagulant in patients with heparin-induced thrombocytopenia provided the cardiac anesthesiologist is knowledgeable about potential complications from its use and knows how to manage or mitigate their incidence appropriately. During cardiopulmonary bypass, bivalirudin anticoagulation protocols must be thoroughly followed to attain optimal clinical outcomes. Additionally, further studies with bivalirudin are needed to determine the best monitoring modality and dosing regimen.