No abstract

Summary Tuberous sclerosis is a congenital neurocutaneous complex resulting in the uncontrolled growth of hamartomas in the body. This report describes the anaesthetic management of a 17‐year‐old male with tuberous sclerosis complex who developed haemorrhage into angiomyolipomas of the kidney. The literature which is pertinent to the anaesthesiologist is reviewed.

Background. Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care unit (ICU) patients, encompassing up to 15% of all hospital acquired infections. Our hospital implemented a facility-wide conversion from a low-volume high-pressure polyvinyl cuffed endotracheal tube (PV-cuffed ETT) to a high-volume low-pressure (HVLP) polyurethane-cuffed endotracheal tube (PU-cuffed ETT) in an effort to reduce the incidence of VAP. Methods. We completed an IRB approved, retrospective chart review comparing the number of episodes of VAP 12 months preceding and following the introduction of a new ETT. A diagnosis of VAP was made based upon the guidelines of our institution, consistent with the Center of Disease Control and Prevention definition. Results. The number of patients developing VAP the year after the ETT conversion reduced to 32 (16.3%) from 68 (24.7%) the year before the conversion ( = 0.028). The rate of VAP was reduced by 56% per ventilator day after the implementation of the PU-cuffed ETT ( < 0.001). No significant differences were observed in length of hospital stay, length of mechanical ventilation, or mortality before or after the conversion. Conclusions. We found that HVLP PU-cuffed ETTs were associated with a statistically significant reduction of VAP in the adult ICUs.