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Pneumonia associated with mechanical ventilation

Claire Dahyot-Fizelier, Denis Frasca, Sigismond Lasocki, Karim Asehnoune, Dorothée Balayn, Anne-Laure Guerin, Pierre-François Perrigault, Thomas Geeraerts, Philippe Seguin, Bertrand Rozec, Djilali Elaroussi, Vincent Cottenceau, Clément Guyonnaud, Olivier Mimoz
INTRODUCTION: Ventilator-associated pneumonia (VAP) is the first cause of healthcare-associated infections in intensive care units (ICUs) and brain injury is one of the main risk factors for early-onset VAP. Antibiotic prophylaxis has been reported to decrease their occurrence in brain-injured patients, but a lack of controlled randomised trials and the risk of induction of bacterial resistance explain the low level of recommendations. The goal of this study is to determine whether a single dose of ceftriaxone within the 12 hours postintubation after severe brain injury can decrease the risk of early-onset VAP...
October 18, 2018: BMJ Open
Ruohui Wang, Changkun Pan, Xiaokun Wang, Feng Xu, Shuang Jiang, Ming Li
BACKGROUND: The optimal timing of tracheotomy in critically ill ventilated patients remains controversial. OBJECTIVES: The objective of this meta-analysis was to assess tracheotomy timing for critically ill ventilated patients and determine the outcomes' reliability. METHODS: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials. RESULTS: Compared with late tracheotomy, early tracheotomy presented a lower incidence of ventilator-associated pneumonia (VAP), shorter duration of mechanical ventilation (MV), and shorter intensive care unit (ICU) stay...
October 15, 2018: Heart & Lung: the Journal of Critical Care
Laura Fuchs Bahlis, Luciano Passamani Diogo, Ricardo de Souza Kuchenbecker, Sandra Costa Fuchs
OBJECTIVE: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. METHODS: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality...
July 2018: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
Masayoshi Inoue
Mechanical ventilation is a useful treatment option for respiratory insufficiency following thoracic and cardiovascular surgery. Ventilation mode is classified as volume-controlled-ventilation(VCV) and pressure-controlled ventilation(PCV). Non-invasive ventilation(NIV) without tracheal intubation has been recently developed and is effective in patients with chronic obstructive pulmonary disease (COPD) exacerbation. Several pulmonary complications by mechanical ventilation such as ventilator-induced lung injury(VILI) or ventilator-associated pneumonia(VAP) could be avoided with NIV...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Luis Coelho, Ligia Rabello, Jorge Salluh, Ignacio Martin-Loeches, Alejandro Rodriguez, Saad Nseir, José Andrade Gomes, Pedro Povoa
PURPOSE: Ventilator-associated tracheobronchitis (VAT) has been suggested as an intermediate process between tracheobronchial colonization and ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation. The aim of this study was to evaluate the ability of C-reactive protein (CRP) and procalcitonin (PCT) to differentiate between VAT and VAP. METHODS: Pre-planned analysis of the prospective multinational TAVeM database, performed on 2960 patients receiving mechanical ventilation for >48 h, including 689 patients with VA-LRTI...
October 2, 2018: Journal of Critical Care
Peter M Mourani, Erica W Mandell, Maxene Meier, Adel Younoszai, John T Brinton, Brandie D Wagner, Sanne Arjaans, Brenda B Poindexter, Steven H Abman
RATIONALE: Early pulmonary vascular disease (PVD) after preterm birth is associated with a high risk for developing bronchopulmonary dysplasia (BPD), but its relationship with late respiratory outcomes during early childhood remains uncertain. OBJECTIVE: To determine whether PVD at 7 days after preterm birth is associated with late respiratory disease (LRD) during early childhood. METHODS: Prospective study of preterm infants born before 34 weeks postmenstrual age (PMA)...
October 10, 2018: American Journal of Respiratory and Critical Care Medicine
Mark Schieren, Andreas B Böhmer, Rolf Lefering, Thomas Paffrath, Frank Wappler, Jerome Defosse
INTRODUCTION: Chest trauma and obesity are both associated with increased risks for respiratory complications (e.g. hypoxia, hypercarbia, pneumonia), which are frequent causes of posttraumatic morbidity and mortality. However, as there is only limited and inconsistent evidence, the aim of our study was to analyse the effect of body mass index (BMI) on patient outcomes after thoracic trauma. PATIENTS AND METHODS: We screened 50.519 patients entered in TraumaRegister DGU® , between 2004-2009, when the BMI was part of the standardized dataset...
September 28, 2018: Injury
Alireza Dadashi, Nima Hosseinzadeh
Background: The pathogenesis of ventilator-associated pneumonia (VAP) is not clearly known. Recently, the role of gastric bacterial colonization has been proposed. The role of gastric colonization with Helicobacter pylori in pathogenesis of VAP was determined by comparing the prevalence of H. pylori in patients with VAP and control participants. Materials and Methods: One hundred and eighteen mechanically ventilated patients were divided into two groups; 59 participants with VAP and 59 without VAP...
2018: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
Luzzati Roberto, D'Agaro Pierlanfranco, Busca Annalisa, Maurel Cristina, Martellani Fulvia, Rosin Chiara, Segat Ludovica, Gatti Giuseppe, Mascarello Marta, Confalonieri Marco
OBJECTIVES: To evaluate burden and predictors of HSV pneumonia among immunocompromised patients not undergoing invasive mechanical ventilation according to a tailored diagnostic algorithm. METHODS: This prospective, observational study included immunocompromised adults with pneumonia non-responding to empirical antibiotic therapy. Bronchoalveolar lavage (BAL) specimens were cultured for bacteria, mycobacteria and fungi. Real-time PCR for Herpesviruses and other microorganisms were performed on BAL and other specimens...
September 26, 2018: Journal of Infection
Kentaro Shimizu, Tomoki Yamada, Hiroshi Ogura, Tomoyoshi Mohri, Takeyuki Kiguchi, Satoshi Fujimi, Takashi Asahara, Tomomi Yamada, Masahiro Ojima, Mitsunori Ikeda, Takeshi Shimazu
BACKGROUND: Commensal microbiota deteriorate in critically ill patients. The preventive effects of probiotic/synbiotic therapy on microbiota and septic complications have not been thoroughly clarified in patients with sepsis. The objective of this study was to evaluate whether synbiotics have effects on gut microbiota and reduce complications in mechanically ventilated patients with sepsis. METHODS: Sepsis patients who were mechanically ventilated in the intensive care unit (ICU) were included in this randomized controlled study...
September 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
Jaime Mei-Fong Chien, Seyed Ehsan Saffari, Ai-Ling Tan, Thuan-Tong Tan
BACKGROUND: Burkholderia pseudomallei is a gram negative bacteria that causes a spectrum of human diseases in the tropics. Although melioidosis is endemic in Southeast Asia, large clinical case series were rarely reported from metropolitan Singapore. METHODS: This is a retrospective study of 219 consecutive patients with culture proven infections due to Burkholderia pseudomallei between the years 2001 to 2016 managed in Singapore General Hospital (SGH). We aimed to review local patients' characteristics and identify clinical factors associated with mortality and recurrent melioidosis...
September 26, 2018: BMC Infectious Diseases
Yu-Shiuan Liang, Kai-Ching Yu, Chung-Shun Wong, Yuan Kao, Tung-Yu Tiong, Ka-Wai Tam
BACKGROUND: Multiple rib fractures are common in trauma patients, who are prone to trauma-associated complications. Surgical or nonsurgical interventions for the aforementioned conditions remain controversial. QUESTIONS/PURPOSES: The purpose of our study was to perform a meta-analysis to evaluate the clinical prognosis of surgical fixation of multiple rib fractures in terms of (1) hospital-related endpoints (including duration of mechanical ventilation, ICU length of stay [LOS] and hospital LOS), (2) complications, (3) pulmonary function, and (4) pain scores...
September 11, 2018: Clinical Orthopaedics and related Research
Béatrice La Combe, Anne-Claire Mahérault, Jonathan Messika, Typhaine Billard-Pomares, Catherine Branger, Luce Landraud, Didier Dreyfuss, Fadia Dib, Laurent Massias, Jean-Damien Ricard
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Oropharyngeal care with chlorhexidine to prevent ventilator-associated pneumonia is currently questioned, and exhaustive microbiologic data assessing its efficacy are lacking. The authors therefore aimed to study the effect of chlorhexidine mouthwash on oropharyngeal bacterial growth, to determine chlorhexidine susceptibility of these bacteria, and to measure chlorhexidine salivary concentration after an oropharyngeal care...
September 24, 2018: Anesthesiology
Pervin Korkmaz Ekren, Nur Zehra Töreyin, Payam Nahid, Mert Doskaya, Ayse Caner, Nevin Turgay, Aysin Zeytinoglu, Seray Toz, Feza Bacakoglu, Yuksel Guruz, Selda Erensoy
INTRODUCTION: Impact of Cytomegalovirus (CMV) co-infection pneumonia in non-HIV patients with Pneumocystis jirovecii pneumonia (PCP) is unclear. OBJECTIVES: The aim of our study was to determine whether CMV co-infection is associated with an increased risk of mortality. METHODS: Our study was conducted at Ege University Hospital, Turkey. We used molecular assays to diagnose Pneumocystis jirovecii in respiratory samples, and CMV in both respiratory and blood samples...
September 23, 2018: Clinical Respiratory Journal
Jie Li, Ping Zhang, Simiao Wu, Xingyang Yi, Chun Wang, Ming Liu
BACKGROUND: Large hemispheric infarction (LHI) is a devastating condition with high mortality and poor functional outcome in most conservatively treated patients. The purpose of this study was to explore factors associated with favorable outcome in patients with LHI. METHODS: We prospectively enrolled consecutive patients with LHI. Favorable outcome was defined as a modified Rankin Scale (mRS) score of 0 to 3 at 90 days. Multivariate logistic regression analysis was employed to identify the independent factors associated with favorable outcome...
September 20, 2018: BMC Neurology
Maryline Chomton, David Brossier, Michaël Sauthier, Emilie Vallières, Josée Dubois, Guillaume Emeriaud, Philippe Jouvet
OBJECTIVES: Ventilator-associated pneumonia is the second most common nosocomial infection in pediatric intensive care. The Centers for Disease Control and Prevention recently issued diagnosis criteria for pediatric ventilator-associated pneumonia and for ventilator-associated events in adults. The objectives of this pediatric study were to determine the prevalence of ventilator-associated pneumonia using these new Centers for Disease Control and Prevention criteria, to describe the risk factors and management of ventilator-associated pneumonia, and to assess a simpler method to detect ventilator-associated pneumonia with ventilator-associated event in critically ill children...
September 17, 2018: Pediatric Critical Care Medicine
Peter W Schreiber, Hugo Sax, Aline Wolfensberger, Lauren Clack, Stefan P Kuster
OBJECTIVE: The preventable proportion of healthcare-associated infections (HAIs) may decrease over time as standards of care improve. We aimed to assess the proportion of HAIs prevented by multifaceted infection control interventions in different economic settings. METHODS: In this systematic review and meta-analysis, we searched OVID Medline, EMBASE, CINAHL, PubMed, and The Cochrane Library for studies published between 2005 and 2016 assessing multifaceted interventions to reduce catheter-associated urinary tract infections (CAUTIs), central-line-associated bloodstream infections (CLABSIs), surgical site infections (SSIs), ventilator-associated pneumonia (VAP), and hospital-acquired pneumonia not associated with mechanical ventilation (HAP) in acute-care or long-term care settings...
September 20, 2018: Infection Control and Hospital Epidemiology
Kenneth E Remy, Irene Cortés-Puch, Steven B Solomon, Junfeng Sun, Benjamin M Pockros, Jing Feng, Juan J Lertora, Roy R Hantgan, Xiaohua Liu, Andreas Perlegas, H Shaw Warren, Mark T Gladwin, Daniel B Kim-Shapiro, Harvey G Klein, Charles Natanson
During the last half-century, numerous antiinflammatory agents were tested in dozens of clinical trials and have proven ineffective for treating septic shock. The observation in multiple studies that cell-free hemoglobin (CFH) levels are elevated during clinical sepsis and that the degree of increase correlates with higher mortality suggests an alternative approach. Human haptoglobin binds CFH with high affinity and, therefore, can potentially reduce iron availability and oxidative activity. CFH levels are elevated over approximately 24-48 hours in our antibiotic-treated canine model of S...
September 20, 2018: JCI Insight
V Rojo, P Vázquez, S Reyes, L Puente Fuertes, M Cervero
OBJECTIVE: Carbapenemase-producing Enterobacterias is a global health hazard due to their ease of transmission, difficulty of treatment, and their personal and economic impact. We analyze the factors associated with an increased risk of infection by Klebsiella pneumoniae carbapenemase-producing bacteria (KPC) and factors related to poor prognosis. METHODS: We designed a case-control study. KPC isolates were taken during an outbreak in a hospital in Madrid. A logistic regression was performed with the main variables...
September 18, 2018: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Diana P Pozuelo-Carrascosa, Ana Torres-Costoso, Celia Alvarez-Bueno, Iván Cavero-Redondo, Purificación López Muñoz, Vicente Martínez-Vizcaíno
QUESTION: In intubated adult patients receiving mechanical ventilation, does multimodality respiratory physiotherapy prevent ventilator-associated pneumonia, shorten length of intensive care unit (ICU) stay, and reduce mortality? DESIGN: A systematic review with meta-analysis of randomised controlled trials. PARTICIPANTS: Intubated adult patients undergoing mechanical ventilation who were admitted to an intensive care unit. INTERVENTION: More than two respiratory physiotherapy techniques such as positioning or postural drainage, manual hyperinflation, vibration, rib springing, and suctioning...
October 2018: Journal of Physiotherapy
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