SummaryThe effect of two levels of humidification on the incidence of adverse airway events was studied in 58 adult female patients during deepening of anaesthesia using up to 12% desflurane. Humidification was provided by a breathing system filter with either low moisture-conserving performance (17.2 mg.l 21 at 0.5 l tidal volume, Group L) or high moisture-conserving performance (33.5 mg.l 21 at 0.5 l tidal volume, Group H). Forty-eight per cent of patients smoked and there were more smokers in Group L than in Group H. Adverse airway events consisted of coughing and laryngospasm. For coughing, the dominant explanator was smoking. When both humidity and age were included in the analysis, there was a significant smoking±humidity interaction (p , 0.05), such that high humidity decreased the incidence of coughing in nonsmokers but not in smokers. The incidence of laryngospasm was significantly lower in Group H than in Group L (p , 0.05). We conclude that when patients inspire high concentrations of desflurane during induction of anaesthesia, increasing humidification to the levels achieved in this study decreases the incidence of coughing among nonsmokers and of laryngospasm in both smokers and nonsmokers.

We describe the successful use of a general anesthetic for a thyroplasty, a procedure normally done under local anesthesia with or without sedation, in a patient who was keen to have surgery, but who refused local anesthesia with sedation.

Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ® . A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality. Objective It is known that the closed tracheal suction system (CTSS) produces less hemodynamic and gasometric deterioration than an open tracheal suction system (OTSS). Use is limited because no decrease in the incidence of ventilator-associated pneumonia (VAP) was found and also because it is more expensive. But, is daily periodic change of the CTSS necessary? The aim of this study was to analyze the incidence of VAP using a CTSS without periodic change versus an OTSS. Methods It is a prospective study of ICU patients from 1 January 2004 to 31 October 2004. Patients who required mechanical ventilation (MV) were randomized into two groups: one group was suctioned with CTSS without periodic change and another group with OTSS. An aspirate tracheal swab and a throat swab on admission and afterwards twice weekly were taken. VAP was classified based on throat flora in endogenous and exogenous samples. The statistical analysis was performed by chi-square test and Student's t test, and w...

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