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Clinical Outcomes of Early Vancomycin Administration before Identification of Methicillin-resistant Staphylococcus aureus in Patients with Nosocomial Pneumonia
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Yong Woo Seo, Jung Eun Lee, Bo Ram Min, Jae Seok Park, Jeong Eun Kim, Young Yun Jang, Hun Pyo Park, Nam Hee Ryoo, Won Il Choi
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Korean J Crit Care Med. 2007;22(1):1-6.
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 Abstract
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- BACKGROUND
The aim of this study is to determine the clinical outcomes of early vancomycin administration before identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients with nosocomial pneumonia on a ventilator. METHODS: We retrospectively reviewed patients with nosocomial pneumonia in a 20-bed medical ICU during a period of 2 years and 2 months. This study included 52 inpatients, who were admitted for more than 72 hr and had a new or progressive lung infiltrate plus at least two of the following three criteria for pneumonia: abnormal body temperature (>38oC or <35oC), abnormal leukocyte count (>10,000/mm3 or <3,000/mm3), and purulent bronchial secretions. All of the MRSA were identified in tracheal aspirates during mechanical ventilation. RESULTS: A total of 23 patients who received vancomycin prior to identification of MRSA exhibited a 28-day mortality rate of 60%, while 29 patients who received vancomycin after identification of MRSA showed a 28-day mortality rate of 40% (p=0.17). There was no statistically significant difference in severity index and routine laboratory findings between the two groups. CONCLUSIONS: Early vancomycin administration before identification of MRSA does not appear to affect the mortality rate for patients with nosocomial pneumonia.
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Collagen Synthesis in an in Vivo Rat Model of Ventilator-induced Lung Injury
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Won Il Choi
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Korean J Crit Care Med. 2006;21(2):109-115.
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Abstract
PDF
- BACKGROUND
Experimentally, maintaining high pressure or high volume ventilation in animal models produces an acute lung injury, however, there was little information on remodeling. We investigated the collagen synthesis in a rat model of ventilator-induced lung injury.
METHODS
Rats were ventilated with room air at 85 breaths/minute for 2 hours either tidal volume 7 ml/kg or 20 ml/kg (V(T)7 or V(T)20, respectively). After 2 hours of ventilation, rats were placed in the chamber for 24 hours.
Lung collagen was evaluated by immunohistochemistry (n=5) and collagen was quantitated by collagen assay (n=5). Static compliance (Csta) of the whole lung as obtained from the pressure volume curves.
RESULTS
Type I collagen was an increase in expression in the interstitium with large V(T) (20 ml/ kg) ventilation after 2 hours of mechanical ventilation (MV), and further increased expression after 24 hours of recovery period.
Static lung compliance was significantly (p<0.05) decreased in the V(T)20 compared with V(T)7 (0.221+/-0.05 vs 0.305+/-0.06 ml/cm H2O) after 2 hours of MV. There was a further decrease in lung compliance after 24 hours of recovery period (0.144+/-0.07 vs 0.221+/-0.05, p<0.05) in the V(T)20.
CONCLUSIONS
Large tidal volume ventilation causes an increase in type 1 collagen expression with reduction of lung compliance.
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