Pathologic Study
Specimens were processed according to standard methods. Evaluations were made by two observers, independently, without knowledge of bacteriologic data. The lesions were graded as previously described into six categories: no pneumonia, purulent mucous plugging, bronchiolitis, pneumonia, confluent pneumonia, and abscessed pneumonia. Classification of each specimen was based on the worst category observed. The diagnosis of pneumonia included only the pneumonia, confluent pneumonia, and abscessed pneumonia categories. For further analysis, each specimen was assigned a “histologic score” by grading no pneumonia, purulent mucous plugging, bronchiolitis, pneumonia, confluent pneumonia, and abscessed pneumonia as 0, 1, 2, 3, 4, and 5, respectively. Read the rest of this entry »

Characterization of an Animal Model of Ventilator-Acquired Pneumonia: Animal PreparationBacteriologic Samplings
On day 1, in both control and ATB groups, throat swabs were obtained for cultures and fiberoptic bronchoscopy-guided BAL was performed in the lingular bronchus (served as control). At completion of the study (day 4), blood was sampled for culture. An endotracheal aspirate was obtained by careful endotracheal suctioning using a sputum suction trap and processed for microscopic examination and bacterial cultures. Protected brush specimens and BAL were collected from the right middle lobe bronchus and the apical bronchus of the right lower lobe. Read the rest of this entry »

We then conducted a series of experiments in a third group of animals to investigate the consequences of intrabronchial inoculation of bacterial pathogens in the absence of MV (inoculated group). Clinical isolates of Pasteurella multocida and Klebsiella oxytoca were subcultured from positive blood cultures recovered from pigs that developed VAP in the control group. These organisms were considered as pathogens in the pigs since they were recovered both in lung and blood cultures in ventilated animals with pneumonia. Read the rest of this entry »

Characterization of an Animal Model of Ventilator-Acquired Pneumonia: Animal PreparationWith the pig in the supine position, intravascular catheters were inserted into the jugular vein and femoral artery under surgical conditions. A 7.5F Swan-Ganz catheter (Baxter Healthcare Corporation; Santa Ana, CA) was placed into the pulmonary artery via the external jugular vein through a right cervical cutdown and a 3F polyethylene catheter (Plastimed; St. Leu la Foret, France) was percutaneously inserted into the right or left femoral artery. These catheters were used for monitoring of hemodynamic and oxygenation parameters and for blood sampling. Finally, urinary drainage was obtained by vesical insertion of a 8F suprapubic catheter (Vesicoset; Angiomed; Karlsruhe, Germany) through surgical midline minipelvitomy. After this initial preparation, the animals were turned to the prone position with the snout positioned approximately 30° downwards from the neck axis to allow continuous drainage of oropharyngeal secretions onto an absorbent pad. Prone position was used since in pigs, as in sheep or cows, MV in the supine position results in lung atelectasis with severe ventilation/perfusion mismatch after a few hours. Read the rest of this entry »

Preliminary Study
Several pharmacologic and technical issues first had to be resolved to provide prolonged ventilatory support under general anesthesia in our animals. Indeed, to our knowledge, no data were available in the literature regarding prolonged anesthesia (> 12 h) in the pig. Attempts made with conventional drugs used for pigs’ anesthesia (pentobarbital, ketamine) failed because of the cardiovascular toxicity of these drugs as soon as they were administered for prolonged periods (> 24 h). We eventually succeeded in developing a well-tolerated drug regimen for obtaining anesthesia, analgesia, and muscle paralysis, combining midazolam, fentanyl, and pancuronium bromide. Read the rest of this entry »

Characterization of an Animal Model of Ventilator-Acquired PneumoniaVentilator-acquired pneumonia (VAP) and its se quelae are one of the leading causes of infectious deaths in the ICU. Several important issues regarding the pathophysiology, the diagnosis, the prevention, and the treatment of VAP are difficult to address in human due to the complexity of this multifactorial disease. Animal models could help to elucidate these issues. Unfortunately conventional models of pneumonia hardly approach the complex pathophysiology of human VAP. Indeed, in these models, pneumonia is usually produced by exogenous administration of a highly titrated bacterial inoculum sometimes combined with preceding or concomitant alteration of systemic or pulmonary antibacterial defences fully buy tavist online. In addition, they generally include a relatively short period of observation, Therefore, the applicability of such models to studies on VAP is limited. Read the rest of this entry »

First Month of Treatment in Patients With Severe Obstructive Sleep Apnea: ConclusionApplying this information and adjusting for pairwise comparisons, 10 complete data sets provided a statistical power of 95% (a=0.05) to detect a 2-cm H20 difference in CPAP requirement between T0 and T2/T4. Similarly, because the data spread among the patient and control groups for the other outcome variables were narrow, the study afforded satisfactory statistical power to detect clinically important change in these variables. Read the rest of this entry »

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