Background
An endotracheal tube cuff pressure between 20 and 30 cmH2O is recommended to prevent ventilator-associated respiratory infection (VARI). We aimed to evaluate whether continuous cuff pressure control (CPC) was associated with reduced VARI incidence compared with intermittent CPC.
Methods
We conducted a multicenter open-label randomized controlled trial in intensive care unit (ICU) patients within 24 hours of intubation in Vietnam. Patients were randomly assigned 1:1 to receive either continuous CPC using an automated electronic device or intermittent CPC using a manually hand-held manometer. The primary endpoint was the occurrence of VARI, evaluated by an independent reviewer blinded to the CPC allocation.
Results
We randomized 600 patients; 597 received the intervention or control and were included in the intention to treat analysis. Compared with intermittent CPC, continuous CPC did not reduce the proportion of patients with at least one episode of VARI (74/296 [25%] vs 69/301 [23%]; odds ratio [OR] 1.13; 95% confidence interval [CI] .77–1.67]. There were no significant differences between continuous and intermittent CPC concerning the proportion of microbiologically confirmed VARI (OR 1.40; 95% CI .94–2.10), the proportion of intubated days without antimicrobials (relative proportion [RP] 0.99; 95% CI .87–1.12), rate of ICU discharge (cause-specific hazard ratio [HR] 0.95; 95% CI .78–1.16), cost of ICU stay (difference in transformed mean [DTM] 0.02; 95% CI −.05 to .08], cost of ICU antimicrobials (DTM 0.02; 95% CI −.25 to .28), cost of hospital stay (DTM 0.02; 95% CI −.04 to .08), and ICU mortality risk (OR 0.96; 95% CI .67–1.38).
Conclusions
Maintaining CPC through an automated electronic device did not reduce VARI incidence.
Clinical Trial Registration
NCT02966392.
Orange‐red‐emitting Eu3+‐doped Ca9Gd(PO4)7 phosphors have been obtained by a sol‐gel technique. These phosphors, excited by UV (270 nm) and near UV light (394 nm), emit orange‐red light in the range of 580–710 nm. The Ca9Gd(PO4)7:7 mol% Eu3+ phosphor annealed at 1100 °C shows the highest PL intensity. Judd‐Ofelt analysis reveals that the neighbor surroundings of Eu3+ ions are asymmetric, and the lowest asymmetry value is found at the dopant ratio of 7 mol%. The optimal phosphor excited by the wavelength of 394 nm displays an excellent thermal stability (∼76.4 % at 160 °C) with an activation energy of 0.163 eV. The corresponding CIE chromaticity coordinates (x; y) and color purity are calculated to be (0.5849; 0.3635) and 84.6 %, respectively. The quantum efficiency values of the Ca9Gd(PO4)7:Eu3+ phosphors coated on UV and near‐UV chips are 87.4 % and 5.1 %, respectively. It is the first time that the QE values of Ca9Gd(PO4)7:Eu3+‐based red and blue‐emitting LEDs are reported.
What Is Known and Objective
Allopurinol, the first‐line medication for hyperuricemia is well‐known for its association with severe cutaneous adverse reactions, especially Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). In the current study, we analysed the Vietnamese spontaneous reporting database to identify signals and preventability of allopurinol‐induced SJS/TEN in Vietnam from 2010 to 2019.
Methods
Signal generation was assessed using the case/non‐case method. Reporting odds ratios (RORs) and 95% confidence intervals (95% CI) were calculated.
Results
Among 72,822 spontaneous ADR reports submitted to the Vietnam National Drug Information and Adverse Drug Reaction Monitoring Centre, 392 reports were on SJS/TEN, of which, 65 cases (16.6%) were related to allopurinol. The signals of allopurinol‐induced SJS/TEN in Vietnam started in 2014 (ROR of 3.531, 95% CI: 1.830–6.810) and annually increased until 2019 (ROR of 11.923, 95% CI: 8.508–16.710). The preventability assessment showed that no allopurinol‐induced SJS/TEN case was definitely unpreventable. 61.6% of the SJS/TEN cases were avoidable because they were associated with inappropriate prescribing such as unapproved indications, too high initial dose and even rechallenging in patients with a history of allopurinol allergy.
What Is New and Conclusion
The signals of allopurinol‐induced SJS/TEN in Vietnam started in 2014 and annually increased until 2019. Our first report specifically focusing on the ADR preventability of allopurinol showed that correction of medical errors relating to prescription could prevent more than 60% of SJS/TEN cases in Vietnamese allopurinol users. This is a feasible and practical solution, provided that there would be a systematic change in both healthcare systems and public awareness.
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