- Poster presentation
- Open access
- Published:
Incidence of lower respiratory tract infections in patients treated with post-cardiac arrest mild therapeutic hypothermia and selective digestive tract decontamination
Critical Care volume 15, Article number: P302 (2011)
Introduction
Mild therapeutic hypothermia (MTH) is known to have a neuroprotective effect after cardiac arrest (CA). Among the well-recognized side effects is an increased incidence of infections. A useful strategy in preventing lower respiratory tract infections (LRIs) during MTH is selective digestive tract decontamination (SDD). To this purpose, we examined the use of antibiotics and microbial flora in sputum in post-CA patients treated with MTH and SDD and compared this with the infection rate during MTH that has been reported in literature.
Methods
We examined sputum (endotracheal aspirate) of all post-CA patients who were treated with MTH (32 to 34°C) during 24 hours after ICU admission and SDD/cefotaxim (SDD/CFT) in our 16-bed mixed ICU in a teaching hospital in the Netherlands in the period January 2007 to December 2008 (n = 55; male = 44, female = 11). Sputum was collected at ICU admission and several days later as part of our SDD/CFT routine. Between 24 and 48 hours after admission, body temperature was actively held below 37°C. LRI was defined as the presence of a potentially pathogenic microorganism (PPM) and the use of antibiotics other than SDD/CFT. The presence of Candida albicans/Candida spp. was considered colonisation and was treated with aerosol antifungal medication.
Results
The in-hospital mortality in our cohort was 30.9%. As can be concluded from our results, in 59.5% of cases a PPM was present in the first sputum during SDD/CFT treatment after admission, with C. albicans being the most prevalent (23.6%). As compared with the sputum on admission, the cultures of the first sputum with SDD/CFT more often showed a monomicrobial isolate (25.5 vs. 40.5%). In sputum of 9/37 (24%) of our patients, a PPM (other than C. albicans/C. spp.) that justifies the use of antibiotics was present, with S. aureus being the most prevalent PPM (13.5%); 5/9 patients were treated with antibiotics, 1/9 received no additional antibiotics, 3/9 were lost to follow-up. Our results point towards a lower incidence of LRI in SDD/CFT-treated patients as compared with non-SDD/CFT-treated patients (88%) who were treated with MTH post-CA [1]. The incidence of LRI in our small cohort (24%) was also considerably lower as compared with a recent study by Nielsen and colleagues (48%) [2].
Conclusions
Our results might point towards a beneficial role of SDD/CFT in preventing LRI during treatment with MTH.
References
Nieuwendijk R, et al.: Intensive Care Med. 2008, 34: S211. 10.1007/s00134-007-0810-0
Nielsen N, et al.: Crit Care Med. 2010, in press.
Author information
Authors and Affiliations
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Vellinga, N., Boerma, E. & Kuiper, M. Incidence of lower respiratory tract infections in patients treated with post-cardiac arrest mild therapeutic hypothermia and selective digestive tract decontamination. Crit Care 15 (Suppl 1), P302 (2011). https://doi.org/10.1186/cc9722
Published:
DOI: https://doi.org/10.1186/cc9722