Lows us to enlarge the program on other ailments.P44 Optimization of antibacterial therapy in pediatric

Lows us to enlarge the program on other ailments.P44 Optimization of antibacterial therapy in pediatric intensive care units working with procalcitoninN Beloborodova1, D Popov1, M Traube2, E Ochakovskaya1, E Chernevskaya1 1Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russian Federation; 2Filatov Children’s Hospital, Moscow, Russia Federation Vital Care 2007, 11(Suppl two):P44 (doi: 10.1186/cc5204) Introduction Neonates and infants within the ICU are at high risk of severe infections and sepsis. Usually it really is not uncomplicated to diagnose sepsis based only on clinical findings; reputable biomarkers are necessary to prove the diagnosis. Objective To study the worth of procalcitonin (PCT) as a marker, verifying the diagnosis, which enables the get started of de-escalating ABT in patients with clinical signs of sepsis. Procedures 3 hundred and seventy-four sufferers on artificial lung ventilation from two pediatric ICUs of two Russian hospitals had been enrolled. Blood samples for PCT testing (PCT LIA; BRAHMS AG, Germany) were taken below suspicion of sepsis or exacerbation of bacterial infection. Inside the very first stage (January ecember 2005), 50 neonates (age six (4?2) days) with many perinatal pathologies had been studied (Group A), and routine ABT was prescribed, with blood samples taken and stored for further PCT assessment. Within the second stage (January ovember 2006), 324 infants (age 6 (1.five?.4) months) after cardiac surgery were enrolled (Group B), and ABT was adjusted determined by PCT-testing outcomes. PCT > 2 ng/ml indicative of systemic bacterial inflammation along with clinical signs of sepsis was an indication for PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20801496 ABT with carbapenems. Information are shown as the median and interquartile variety. Outcomes Group A. Sepsis was diagnosed in 16/50 (32 ) sufferers. PCT > two ng/ml was observed in 23/50 (46 ) circumstances, such as 15/16 (94 ) sufferers with clinically diagnosed sepsis. In individuals with PCT > 2 ng/ml the mortality price was 7.7 if carbapenems (meropenem or imipenem/cilastatin) have been administered (n = 13), compared with 20 with diverse ABT (n = ten) ?even though in patients with PCT < 2 ng/ml (n = 27), ABT with carbapenems (n = 12) resulted in paradoxically higher mortality compared with other ABT schemes (n = 15): 17 vs 6.6 . Group B. Sepsis was defined in 24/324 (7.4 ) patients. PCT > two ng/ml was in 53/324 (16 ) situations, including all individuals with clinically diagnosed sepsis. Early ABT with meropenem, combined with vancomycin or linezolid, allowed 1 to decrease Nelotanserin sepsis-related mortality in these patients to 29 , which applied to become as higher as 74 prior to the introduction of this algorithm (P = 0.0028). Conclusion Early verification of sepsis working with PCT combined with carbapenems-based ABT enables decreasing sepsis-related mortality in critically ill infants and newborns staying inside the ICU.P43 Intensive care unit outcome versus haemodynamic status on arrival at a general intensive care unitT Reynolds, A Theodoraki, I Ketchley, A Tillyard, R Lawson, N Al-Subaie, M Cecconi, R Grounds, A Rhodes St George’s Hospital, London, UK Vital Care 2007, 11(Suppl 2):P43 (doi: 10.1186/cc5203) Introduction Goal-directed therapeutic protocols such as that described by Rivers and colleagues [1] have taken an essential location in efforts to enhance survival in septic patients. We looked at ICU outcomes for patients meeting the haemodynamic criteria from the Rivers trial on admission to our common ICU. Strategies We prospectively recorded haemodynamic parameters of 98 consecutive sufferers a.