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Clinics in Chest Medicine

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https://www.readbyqxmd.com/read/30390756/respiratory-infections-an-ongoing-challenge-with-a-promising-future
#1
EDITORIAL
Michael S Niederman
No abstract text is available yet for this article.
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390755/personalizing-the-management-of-pneumonia
#2
REVIEW
Samir Gautam, Lokesh Sharma, Charles S Dela Cruz
Pneumonia is a highly prevalent disease with considerable morbidity and mortality. However, diagnosis and therapy still rely on antiquated methods, leading to the vast overuse of antimicrobials, which carries risks for both society and the individual. Furthermore, outcomes in severe pneumonia remain poor. Genomic techniques have the potential to transform the management of pneumonia through deep characterization of pathogens as well as the host response to infection. This characterization will enable the delivery of selective antimicrobials and immunomodulatory therapy that will help to offset the disorder associated with overexuberant immune responses...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390754/new-antibiotics-for-pneumonia
#3
REVIEW
Matteo Bassetti, Elda Righi, Alessandro Russo, Alessia Carnelutti
Delayed antimicrobial prescriptions and inappropriate treatment can lead to poor outcomes in pneumonia. In nosocomial infections, especially in countries reporting high rates of antimicrobial resistance, the presence of multidrug-resistant gram-negative and gam-positive bacteria can limit options for adequate antimicrobial treatment. New antibiotics, belonging to known classes of antimicrobials or characterized by novel mechanisms of actions, have recently been approved or are under development. Advantages of the new compounds include enhanced spectrum of activity against resistant bacteria, high lung penetration, good tolerability, and possibility for intravenous to oral sequential therapy...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390753/optimizing-antibiotic-administration-for-pneumonia
#4
REVIEW
Ana Motos, James M Kidd, David P Nicolau
Pneumonia, including community-acquired bacterial pneumonia, hospital-acquired bacterial pneumonia, and ventilator-acquired bacterial pneumonia, carries unacceptably high morbidity and mortality. Despite advances in antimicrobial therapy, emergence of multidrug resistance and high rates of treatment failure have made optimization of antibiotic efficacy a priority. This review focuses on pharmacokinetic and pharmacodynamic approaches to antibacterial optimization within the lung environment and in the setting of critical illness...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390752/aerosol-therapy-for-pneumonia-in-the-intensive-care-unit
#5
REVIEW
Charles-Edouard Luyt, Guillaume Hékimian, Nicolas Bréchot, Jean Chastre
Antibiotic aerosolization in patients with ventilator-associated pneumonia (VAP) allows very high concentrations of antimicrobial agents in the respiratory secretions, far more than those achievable using the intravenous route. However, data in critically ill patients with pneumonia are limited. Administration of aerosolized antibiotics might increase the likelihood of clinical resolution, but no significant improvements in important outcomes have been consistently documented. Thus, aerosolized antibiotics should be restricted to the treatment of extensively resistant gram-negative pneumonia...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390751/is-zero-ventilator-associated-pneumonia-achievable-practical-approaches-to-ventilator-associated-pneumonia-prevention
#6
REVIEW
Cristina Vazquez Guillamet, Marin H Kollef
Ventilator-associated pneumonia (VAP) remains a significant clinical entity with reported incidence rates of 7% to 15%. Given the considerable adverse consequences associated with this infection, VAP prevention became a core measure required in most US hospitals. Many institutions implemented effective VAP prevention bundles that combined head of bed elevation, hand hygiene, chlorhexidine oral care, and subglottic drainage. More recently, spontaneous breathing and awakening trials have consistently been shown to shorten the duration of mechanical ventilation and secondarily reduce the occurrence of VAP...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390750/management-of-ventilator-associated-pneumonia-guidelines
#7
REVIEW
Mark L Metersky, Andre C Kalil
Two recent major guidelines on diagnosis and treatment of ventilator-associated pneumonia (VAP) recommend consideration of local antibiotic resistance patterns and individual patient risks for resistant pathogens when formulating an initial empiric antibiotic regimen. One recommends against invasive diagnostic techniques with quantitative cultures to determine the cause of VAP; the other recommends either invasive or noninvasive techniques. Both guidelines recommend short-course therapy be used for most patients with VAP...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390749/how-can-we-distinguish-ventilator-associated-tracheobronchitis-from-pneumonia
#8
REVIEW
Sean Keane, Maria Sole Vallecoccia, Saad Nseir, Ignacio Martin-Loeches
Ventilator-associated tracheobronchitis (VAT) might represent an intermediate process between lower respiratory tract colonization and ventilator-associated pneumonia (VAP), or even a less severe spectrum of VAP. There is an urgent need for new concepts in the arena of ventilator-associated lower respiratory tract infections. Ideally, the gold standard of care is based on prevention rather than treatment of respiratory infection. However, despite numerous and sometimes imaginative efforts to validate the benefit of these measures, most clinicians now accept that currently available measures have failed to eradicate VAP...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390748/airway-devices-in-ventilator-associated-pneumonia-pathogenesis-and-prevention
#9
REVIEW
Anahita Rouzé, Ignacio Martin-Loeches, Saad Nseir
Airway devices play a major role in the pathogenesis of microaspiration of contaminated oropharyngeal and gastric secretions, tracheobronchial colonization, and ventilator-associated pneumonia (VAP) occurrence. Subglottic secretion drainage is an effective measure for VAP prevention, and no routine change of ventilator circuit. Continuous control of cuff pressure, silver-coated tracheal tubes, low-volume low-pressure tracheal tubes, and the mucus shaver are promising devices that should be further evaluated by large randomized controlled trials...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390747/health-care-associated-pneumonia-is-it-still-a-useful-concept
#10
REVIEW
Grant W Waterer
"Health care-associated pneumonia (HCAP) was introduced into guidelines because of concerns about the increasing prevalence of drug-resistant pathogens (DRPs) not covered by standard empirical therapy. We now know that DRPs are very localized phenomena with low rates in most sites. Although HCAP risk factors are associated with a higher mortality, this is driven by comorbidities rather than the pathogens. Empirical coverage of DRPs has generally not resulted in better patient outcomes. A far more nuanced approach must be taken for patients with risk factors for DRPs taking into account the local cause and severity of disease...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390746/adjunctive-therapies-for-community-acquired-pneumonia
#11
REVIEW
Adrian Ceccato, Miquel Ferrer, Enric Barbeta, Antoni Torres
The use of adjuvant therapies for community-acquired pneumonia is still in development. Combinations of antibiotics with macrolides seem to be the best option when there is no risk of resistance. The use of corticosteroids is the treatment of choice in patients with severe pneumonia and a high inflammatory response who do not present contraindications for these drugs. Other drugs await confirmation of their benefit and should be used only on exceptional occasions at this time.
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390745/vaccines-to-prevent-pneumococcal-community-acquired-pneumonia
#12
REVIEW
Cornelis H van Werkhoven, Susanne M Huijts
Streptococcus pneumoniae is the most frequent pathogen in community-acquired pneumonia and also causes invasive diseases like bacteremia and meningitis. Young children and elderly are especially at risk for pneumococcal diseases and are, therefore, eligible for pneumococcal vaccination in most countries. This reviews provides an overview of the current epidemiology of pneumococcal infections, history and evidence of available pneumococcal polysaccharide and conjugate vaccines, and current recommendations.
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390744/guidelines-to-manage-community-acquired-pneumonia
#13
REVIEW
Richard G Wunderink
Few guidelines have greater acceptance than that for management of community-acquired pneumonia (CAP). Despite this, areas remain controversial, and new challenges continue to emerge. Current guidelines differ from those of northern European countries predominantly in need for macrolide combination with β-lactams for hospitalized, non-intensive care unit patients. A preponderance of evidence favors combination therapy. Challenges for current and future CAP guidelines include new antibiotic classes, emergence of viruses as major causes for CAP, new diagnostic modalities, alternative risk stratification for pathogens resistant to usual CAP antibiotics, and evidence-based management of severe CAP, including immunomodulatory therapy such as corticosteroids...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390743/influenza-and-viral-pneumonia
#14
REVIEW
Rodrigo Cavallazzi, Julio A Ramirez
Influenza and other respiratory viruses are commonly identified in patients with community-acquired pneumonia, hospital-acquired pneumonia, and in immunocompromised patients with pneumonia. Clinically, it is difficult to differentiate viral from bacterial pneumonia. Similarly, the radiological findings of viral infection are nonspecific. The advent of polymerase chain reaction testing has enormously facilitated the identification of respiratory viruses, which has important implications for infection control measures and treatment...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390742/the-role-of-biomarkers-in-the-diagnosis-and-management-of-pneumonia
#15
REVIEW
Sarah Sungurlu, Robert A Balk
Biomarkers are used in the diagnosis, severity determination, and prognosis for patients with community-acquired pneumonia (CAP). Selected biomarkers may indicate a bacterial infection and need for antibiotic therapy (C-reactive protein, procalcitonin, soluble triggering receptor expressed on myeloid cells). Biomarkers can differentiate CAP patients who require hospital admission and severe CAP requiring intensive care unit admission. Biomarker-guided antibiotic therapy may limit antibiotic exposure without compromising outcome and thus improve antibiotic stewardship...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390741/the-lung-microbiome-and-its-role-in-pneumonia
#16
REVIEW
Benjamin G Wu, Leopoldo N Segal
The use of next-generation sequencing and multiomic analysis reveals new insights on the identity of microbes in the lower airways blurring the lines between commensals and pathogens. Microbes are not found in isolation; rather they form complex metacommunities where microbe-host and microbe-microbe interactions play important roles on the host susceptibility to pathogens. In addition, the lower airway microbiota exert significant effects on host immune tone. Thus, this review highlights the roles that microbes in the respiratory tract play in the development of pneumonia...
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30390740/inflammation-and-pneumonia-why-are-some-more-susceptible-than-others
#17
REVIEW
Joseph P Mizgerd
Pneumonia is an important cause of morbidity and mortality. However, pneumonia is an unusual outcome of respiratory infection. Most of the time, microbes in the lung can be controlled by a combination of constitutive and recruited defense mechanisms. Inflammation is a key component of recruited defenses. Variations in inflammation that influence pneumonia susceptibility and severity are considered here.
December 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122190/venous-thromboembolism-an-evolving-entity
#18
EDITORIAL
Peter S Marshall, Wassim H Fares
No abstract text is available yet for this article.
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122189/surgical-management-of-acute-and-chronic-pulmonary-embolism
#19
REVIEW
Barbara L LeVarge, Cameron D Wright, Josanna M Rodriguez-Lopez
Surgical pulmonary embolectomy and pulmonary thromboendarterectomy are well-established treatment strategies for patients with acute and chronic pulmonary embolism, respectively. For both procedures, techniques and outcomes have evolved considerably over the past decades. Patients with massive and submassive acute pulmonary embolism are at risk for rapid decline owing to right ventricular failure and shock. When thrombus is proximal, embolectomy can rapidly restore cardiac function. Chronic thromboembolic pulmonary hypertension is a more complex disease that requires skilled, careful dissection of the arterial wall, including vascular intima...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122188/catheter-based-therapies-for-pulmonary-emboli
#20
REVIEW
Jeffrey S Pollak
More aggressive therapy for acute pulmonary embolism beyond anticoagulation is indicated in patients at higher risk for mortality and morbidity, namely those suffering from massive and possibly submassive disease. Catheter-based thrombolysis, catheter-based mechanical thrombus debulking, or combinations of these offer opportunities for rapid clot reduction and clinical improvement with a lower bleeding risk than systemic thrombolysis and perhaps greater efficacy. Optimal low-dose regimens for direct thrombolysis have not been defined just as optimal techniques and devices for mechanical therapy have not been developed, underscoring the need for further work...
September 2018: Clinics in Chest Medicine
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