Biomedical subjects
Frederick B Rogers
Publications and source records attributed to Frederick B Rogers.
Pulmonary embolism.
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Do proton pump inhibitors increase the incidence of nosocomial pneumonia and related infectious complications when compared with histamine-2 receptor antagonists in critically ill trauma patients?
BACKGROUND: Proton pump inhibitors (PPI) may increase the risk of nosocomial pneumonia caused by profound irreversible gastric acid suppression. The study purpose was to characterize differences in nosocomial pneumonia and related infections in trauma patients administered either histamine2-receptor antagonists (H2RA) or PPI. METHODS: Observational evaluation of consecutive critically ill adult trauma patients administered either omeprazole or famotidine during a 22-month period. Nosocomial infection was evaluated daily based on published CDC definitions. RESULTS: Eighty of 269 patients fulfilled study criteria. The PPI group (n = 40) exhibited increased baseline risk for infection, demonstrated by higher ISS (p = 0.020), more chest tube placements (p = 0.031), and increased chest trauma (p = 0.025). Overall number of patients infected per group included 33% and 40% of patients administered PPI and H2RA, respectively (p = 0.64). Despite baseline differences, the incidence of nosocomial infection was similar (p = 0.87), and extrapolation of pneumonia based on 1000 patient days revealed a ratio 51.7 vs 52.2 in the PPI vs H2RA groups, respectively, which was not significant (p = 0.99). CONCLUSIONS: Proton pump inhibitor administration does not increase risk of nosocomial pneumonia or other nosocomial infections compared with H2RA therapy in the critically ill trauma patient.
Daily evaluation of macroaspiration in the critically ill post-trauma patient.
BACKGROUND: Although critically ill trauma patients represent a high-risk population for macroaspiration, studies of trauma patients have not been explored. The study aims were to quantify rate and associated risks of macroaspiration and explore the pattern of antibiotic use and incidence of aspiration pneumonia within this patient group. METHODS: Consecutive trauma patients admitted to the intensive care unit (ICU) were prospectively observed for development of macroaspiration and subsequent aspiration pneumonia. Daily monitoring included chart review, laboratory and radiography results, and nurse inquiries for witnessed macroaspiration events. RESULTS: Seven of 60 patients included experienced a clinically confirmed macroaspiration event (11.7%). The incidence of pneumonia was similar, regardless of macroaspiration occurrence (28.6%: macroaspiration cases vs 17.0%: controls, p > or = 0.05). Patients with macroaspiration required a longer duration of mechanical ventilation (15 vs 9.5 days, p = 0.021) and intensive care unit stay (28 vs 7 days, p = 0.015). Paralytic agent utilization was associated with an increased risk for aspiration (p = 0.045). CONCLUSIONS: The incidence of macroaspiration within a critically ill trauma population may be less frequent compared with studies performed in other patient populations. Although macroaspiration was associated with a longer duration of mechanical ventilation and intensive care unit stay, this condition may not be associated with an increased rate of pulmonary infection.
Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference.
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