Medicina intensiva
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Blood cultures are the gold standard for the etiological diagnosis of bacteremia, though false-positive results are relatively frequent primarily due to contamination from skin flora during sample extraction. Correct skin antisepsis is important for reducing the bacterial load and opportunities for contamination. ⋯ Some authors even suggest that the chosen antiseptic is irrelevant to the contamination rate, provided the blood culture extraction method is adequate and is performed by a trained professional. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Several measures related to asepsis for preventing catheter-related bloodstream infection have been proposed. The aseptic measures recommended by scientific societies include hand hygiene of the person who is inserting or manipulating the catheter; maximum sterile barrier precautions during catheter insertion; disinfection of catheter hubs; the use of needle-less connectors and injection ports; the avoidance of antibiotic ointments (except in hemodialysis catheters); change the dressing if it is soiled, loose or damp; and aseptic technique during dressing changes. Other measures only recommended by the most recently published guides (possibly due to the publication of recent studies reporting their beneficial effects) are the use of antimicrobial-impregnated dressings, changing transparent dressings every 7 days, and bathing of the patient with chlorhexidine. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Skin antisepsis in invasive procedures aims to reduce the bacterial load at the site of incision or puncture. Alcohol solutions seem to be more effective in preventing surgical site infection. ⋯ Given the potential neurotoxicity of alcohol and chlorhexidine gluconate, contact of antiseptic solutions with the central nervous system should be avoided. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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To determine the risk of microbiological contamination with hospital use high- and low-flow bubbling humidifiers. ⋯ On one hand, there seems to be a low risk of contamination during the first weeks of use of prefilled humidifiers, which allows multiple use in different patients, without a risk of cross-contamination. On the other hand, it should be underscored that handling reusable humidifiers without correct aseptic measures can increase the risk of contamination; replacing reusable humidifiers with prefilled models therefore could be the safest option.
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Paroxysmal sympathetic hyperactivity (PSH) is a potentially life-threatening neurological emergency secondary to multiple acute acquired brain injuries. It is clinically characterized by the cyclic and simultaneous appearance of signs and symptoms secondary to exacerbated sympathetic discharge. The diagnosis is based on the clinical findings, and high alert rates are required. ⋯ However, the excitation-inhibition model is the theory that best explains the different aspects of this condition, including the response to treatment with the available drugs. The key therapeutic references are the early recognition of the disorder, avoiding secondary injuries and the triggering of paroxysms. Once sympathetic crises occur, they must peremptorily aborted and prevented. of the later the syndrome is recognized, the poorer the patient outcome.