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Pneumonia associated with mechanical ventilation

Marion Houard, Anahita Rouzé, Geoffrey Ledoux, Sophie Six, Emmanuelle Jaillette, Julien Poissy, Sébastien Préau, Frédéric Wallet, Julien Labreuche, Saad Nseir, Benoit Voisin
BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common ICU-acquired infection. Recently, the incidence of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBLE) has substantially increased in critically ill patients. Identifying patients at risk for VAP related to ESBLE could be helpful to improve the rate of appropriate initial antibiotic treatment, and to reduce unnecessary exposure to carbapenems. The primary objective was to identify risk factors for VAP related to ESBLE...
2018: PloS One
Ata Mahmoodpoor, Hadi Hamishehkar, Roghaieh Asghari, Ramin Abri, Kamran Shadvar, Sarvin Sanaie
BACKGROUND: Ventilator-associated pneumonia (VAP) occurs as a life-threatening complication in critically ill mechanically ventilated patients. Probiotic administration may modify the gut microbiota; however, whether this modification could decrease VAP occurrence is not known. METHODS: In this study, 100 adult critically ill patients undergoing mechanical ventilation for >48 hours were randomly assigned to either the probiotic or the control group. The patients in the probiotic group received 2 capsules of probiotic preparation containing Lactobacillus, Bifidobacterium, and Streptococcus spp...
August 8, 2018: Nutrition in Clinical Practice
Wen-Cheng Chao, Wei-Lun Chang, Chieh-Liang Wu, Ming-Cheng Chan
BACKGROUND: A ventilator-associated events (VAEs) algorithm was developed to detect events in mechanically ventilated subjects using objective parameters, and we aimed to use objective data of fluid balance to identify pulmonary edema-associated VAEs. METHODS: This single-center retrospective cohort study was conducted in a medical ICU and enrolled all mechanically ventilated patients between July 2016 and June 2017. Electronic medical records were reviewed to obtain data regarding ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), possible ventilator-associated pneumonia (VAP), and traditionally defined VAP...
August 7, 2018: Respiratory Care
Zhihao Qiao, Jianghong Yu, Kai Yu, Mengya Zhang
BACKGROUND: To compare the clinical values of bronchoscopic sputum suction and general sputum suction in respiratory failure patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with sequential invasive-noninvasive mechanical ventilation at the pulmonary infection control (PIC) window (period of lower sputum production, with thinner viscosity and lighter color, and alleviated clinical signs of infection). METHODS: Patients with AECOPD-induced respiratory failure received orotracheal intubation mechanical ventilation and were randomly divided into bronchoscopic sputum suction group or general sputum suction group, and who were then treated with sequential invasive-noninvasive mechanical ventilation at PIC window (both groups)...
August 2018: Medicine (Baltimore)
Gerard Moreno, Alejandro Rodríguez, Luis F Reyes, Josep Gomez, Jordi Sole-Violan, Emili Díaz, María Bodí, Sandra Trefler, Juan Guardiola, Juan C Yébenes, Alex Soriano, José Garnacho-Montero, Lorenzo Socias, María Del Valle Ortíz, Eudald Correig, Judith Marín-Corral, Montserrat Vallverdú-Vidal, Marcos I Restrepo, Antoni Torres, Ignacio Martín-Loeches
PURPOSE: To determine clinical predictors associated with corticosteroid administration and its association with ICU mortality in critically ill patients with severe influenza pneumonia. METHODS: Secondary analysis of a prospective cohort study of critically ill patients with confirmed influenza pneumonia admitted to 148 ICUs in Spain between June 2009 and April 2014. Patients who received corticosteroid treatment for causes other than viral pneumonia (e.g., refractory septic shock and asthma or chronic obstructive pulmonary disease [COPD] exacerbation) were excluded...
August 3, 2018: Intensive Care Medicine
Antoine Gros, Claire Dupuis, Stéphane Ruckly, Alexandre Lautrette, Maité Garrouste-Orgeas, Marc Gainnier, Jean-Marie Forel, Guillaume Marcotte, Elie Azoulay, Yves Cohen, Carole Schwebel, Laurent Argaud, Etienne de Montmollin, Shidasp Siami, Dany Goldgran-Toledano, Michael Darmon, Jean-Francois Timsit
OBJECTIVES: This study in critically ill patients with shock assessed the prognostic value of body weight variations occurring each day from day 3 to day 7 on the 30-day outcome in terms of mortality, occurrence of ventilator-associated pneumonia and of bedsore, and occurrence of length of stay . DESIGN: Retrospective analysis of data. Multivariate subdistribution survival models were used at each day, from day 3 to day 7. The impact of body weight variations on length of stay was estimated through a multivariate negative binomial regression model...
July 27, 2018: Critical Care Medicine
Josefina López-Aguilar, Gianluigi Li Bassi, María Elisa Quilez, Joan Daniel Martí, Otavio Ranzani Tavares, Eli Aguilera Xiol, Montserrat Rigol, Nestor Luque, Raquel Guillamat, Isidre Ferrer, Antoni Torres, Lluís Blanch
We previously corroborated benefits of the Trendelenburg position in the prevention of ventilator-associated pneumonia (VAP). We now investigate its potential effects on the brain versus the semirecumbent position. We studied seventeen anesthetized pigs and randomized to be ventilated and positioned as follows: duty cycle (TI/TTOT) of 0.33, without positive end-expiratory pressure (PEEP), placed with the bed oriented 30° in anti-Trendelenburg (control group); positioned as in the control group, with TI/TTOT adjusted to achieve an expiratory flow bias, PEEP of 5 cm H2O (IRV-PEEP); positioned in 5° TP and ventilated as in the control group (TP)...
July 25, 2018: Shock
Kentaro Shimizu, Hiroshi Ogura, Daijiro Kabata, Ayumi Shintani, Osamu Tasaki, Masahiro Ojima, Mitsunori Ikeda, Takeshi Shimazu
INTRODUCTION: The preventive association of synbiotics therapy has not been thoroughly clarified in mechanically ventilated patients. The purpose of this study was to evaluate whether synbiotics therapy has preventive association against septic complications in ventilated critically ill patients. METHODS: Critically ill patients who were mechanically ventilated were included in this retrospective observational study. Patients who received synbiotics (Bifidobacterium breve, Lactobacillus casei, and galactooligosaccharides) within 3 days after admission (denoted as synbiotics group) were compared with patients who did not receive synbiotics...
July 20, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Chin Seng Gan, Judith Ju-Ming Wong, Rujipat Samransamruajkit, Soo Lin Chuah, Yek Kee Chor, Suyun Qian, Nattachai Anantasit, Xu Feng, Jacqueline Soo May Ong, Phan Huu Phuc, Suwannee Phumeetham, Rehena Sultana, Tsee Foong Loh, Lucy Chai See Lum, Jan Hau Lee
OBJECTIVES: Extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome are poorly described in the literature. We aimed to describe and compare the epidemiology, risk factors for mortality, and outcomes in extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome. DESIGN: This is a secondary analysis of a multicenter, retrospective, cohort study...
July 20, 2018: Pediatric Critical Care Medicine
Kimberly Keefer, Regis Bender, Jason Liao, Jeffrey Sivik, Andry Van de Louw
Patients with non-Hodgkin's lymphoma (NHL) receiving rituximab-containing chemotherapy are at risk of developing respiratory complications, but comprehensive information on these complications and their impact on survival is lacking. We performed a retrospective cohort analysis on 123 NHL patients who received rituximab-containing chemotherapy between 2009 and 2016 in order to describe the incidence, etiologies and effect on survival of respiratory complications defined by new or worsening respiratory symptoms requiring diagnostic work-up or hospitalization...
July 21, 2018: Annals of Hematology
Michael S Niederman
PURPOSE OF REVIEW: Hospital-acquired pneumonia (HAP) is a form of nosocomial pneumonia, distinct from ventilator-associated pneumonia (VAP). This review compares HAP and VAP, highlighting differences in natural history, risk factors, and bacteriology that necessitate a different approach to the therapy of HAP, compared with VAP. RECENT FINDINGS: HAP can arise out of the ICU, or in the ICU, and can lead to severe illness, including the need for intubation and mechanical ventilation...
July 19, 2018: Current Opinion in Critical Care
Chantelle Chapman, Prue Morgan, Dominique A Cadilhac, Tara Purvis, Nadine E Andrew
BACKGROUND: Chest infections occur in approximately one-third of patients following acute stroke, and are associated with poor outcomes. Limitations in previous reviews restricted the accuracy of results. OBJECTIVES: To perform a systematic review to reliably identify modifiable risk factors for chest infections following acute stroke. METHODS: Ovid Medline, CINAHL, Cochrane, EMBASE and AMED were searched from 1946 to April 2017 for observational studies where risk factors for chest infections in patients hospitalized with acute stroke were reported...
July 20, 2018: Topics in Stroke Rehabilitation
Benoit Jacques Bibas, Paulo Francisco Guerreiro Cardoso, Helio Minamoto, Paulo Manoel Pêgo-Fernandes
Benign tracheoesophageal fistula (TEF) results from an abnormal communication between the posterior wall of the trachea or bronchi and the adjacent anterior wall of the esophagus. It can be acquired or congenital. The onset of the TEF has a negative impact on the patient's health status and quality of life because of swallowing difficulties, recurrent aspiration pneumonia, and severe weight loss. Several acquired conditions may cause TEF. The most frequent is prolonged orotracheal intubation (75% of the cases)...
June 2018: Annals of Translational Medicine
Eirini Tsakiridou, Anna-Maria Mega, Epameinondas Zakynthinos, Theodora Melissopoulou, George Stamos, Konstantinos Argyriou, Stamatoula Pangrati, Ioannis Deliolanis, Ioannis Floros
INTRODUCTION: Critically ill intubated patients are at risk for ventilator-associated pneumonia. However, intubation may not occur in intensive care unit (ICU) and subsequent ICU admission may be delayed. OBJECTIVES: To evaluate whether intubation >24 hours prior ICU admission and delay in ICU admission is associated with ventilator-associated pneumonia (VAP) in non-trauma critically ill patients. MATERIALS AND METHODS: Prospective observational study conducted in a medical-surgical ICU of a tertiary hospital...
July 17, 2018: Clinical Respiratory Journal
Haifaa Hassan Al-Mousa, Abeer Aly Omar, Víctor Daniel Rosenthal, Mona Foda Salama, Nasser Yehia Aly, Mohammad El-Dossoky Noweir, Flavie Maria Rebello, Dennis Malungcot Narciso, Amani Fouad Sayed, Anu Kurian, Sneha Mary George, Amna Mostafa Mohamed, Ruby Jose Ramapurath, Suga Thomas Varghese, Pablo Wenceslao Orellano
Objective: To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in three intensive care units (ICUs) from two hospitals in Kuwait City from January 2014 to March 2015. Design: A prospective, before-after study on 2507 adult ICU patients. During baseline, we performed outcome surveillance of VAP applying CDC/NHSN definitions. During intervention, we implemented the IMA through the INICC Surveillance Online System (ISOS), which included: (1) a bundle of infection prevention interventions; (2) education; (3) outcome surveillance; and (4) feedback on VAP rates and consequences...
July 2018: Journal of Infection Prevention
Sergio Ramírez-Estrada, Leonel Lagunes, Yolanda Peña-López, Amir Vahedian-Azimi, Saad Nseir, Kostoula Arvaniti, Aliye Bastug, Izarne Totorika, Nefise Oztoprak, Lilla Bouadma, Despoina Koulenti, Jordi Rello
PURPOSE: To analyze the impact on patient outcome of ventilator-associated events (VAEs) as defined by the Centers for Disease Control and Prevention (CDC) in 2008, 2013, and the correlation with ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT). METHODS: This was a prospective, observational, multicenter, international study conducted at 13 intensive care units (ICUs); thirty consecutive adults mechanically ventilated for ≥ 48 h per site were eligible, with daily follow-up being recorded in a collaborative web database; VAEs were assessed using the 2013 CDC classification and its 2015 update...
July 12, 2018: Intensive Care Medicine
Jayesh A Dhanani, Jeremy Cohen, Suzanne L Parker, Hak-Kim Chan, Patricia Tang, Benjamin J Ahern, Adeel Khan, Manoj Bhatt, Steven Goodman, Sara Diab, Jivesh Chaudhary, Jeffrey Lipman, Steven C Wallis, Adrian Barnett, Michelle Chew, John F Fraser, Jason A Roberts
BACKGROUND: Nebulised antibiotics are frequently used for the prevention or treatment of ventilator-associated pneumonia. Many factors may influence pulmonary drug concentrations with inaccurate dosing schedules potentially leading to therapeutic failure and/or the emergence of antibiotic resistance. We describe a research pathway for studying the pharmacokinetics of a nebulised antibiotic during mechanical ventilation using in vitro methods and ovine models, using tobramycin as the study antibiotic...
July 11, 2018: Intensive Care Medicine Experimental
Xiaoqing Hu, Ying-Ying Huang, Yuguang Wang, Xiaoyuan Wang, Michael R Hamblin
Biofilm describes a microbially-derived sessile community in which microbial cells are firmly attached to the substratum and embedded in extracellular polymeric matrix. Microbial biofilms account for up to 80% of all bacterial and fungal infections in humans. Biofilm-associated pathogens are particularly resistant to antibiotic treatment, and thus novel antibiofilm approaches needed to be developed. Antimicrobial Photodynamic therapy (aPDT) had been recently proposed to combat clinically relevant biofilms such as dental biofilms, ventilator associated pneumonia, chronic wound infections, oral candidiasis, and chronic rhinosinusitis...
2018: Frontiers in Microbiology
Xu An Huang, Yan Ping Du, Bin Bin Fu, Liu Xia Li
BACKGROUND: The influence of the subglottic secretion drainage (SSD) on the microorganisms of ventilator associated pneumonia (VAP) is still unclear.A meta-analysis focusing on the influence of the SSD on the microorganisms of VAP. METHODS: A comprehensive search was conducted through the online studies of PubMed, Embase, Cochrane Library, Google scholar, CNKI (China National Knowledge Infrastructure), and VIPI (Database for Chinese Technical Periodicals) using specific search terms...
July 2018: Medicine (Baltimore)
Andrew J Kerwin, Brian K Yorkgitis, David J Ebler, Firas G Madbak, Albert T Hsu, Marie L Crandall
BACKGROUND: Cervical spinal cord injury (CSCI) is devastating. Respiratory failure, ventilator associated pneumonia (VAP), sepsis, and death frequently occur. Case reports of diaphragm pacing (DPS) have suggested earlier liberation from mechanical ventilation in acute CSCI patients. We hypothesized DPS implantation would decrease VAP and facilitate liberation from ventilation. METHODS: We performed a retrospective review of acute CSCI patients managed at a single level 1 trauma center between 1/2005-5/2017...
July 5, 2018: Journal of Trauma and Acute Care Surgery
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