Nosocomial pneumonia: emerging concepts in diagnosis, management, and prophylaxis.

Abstract:

:Nosocomial pneumonia is a dynamic disease with multiple etiologic agents and a changing natural history. The highest attack rates and mortality occur in patients with ventilator-associated pneumonia. Diagnosis of nosocomial pneumonia is often made by clinical criteria that are sensitive but lack specificity. The use of quantitative endotracheal aspirates or bronchoscopy with bronchoalveolar lavage and protected specimen brush clearly improve diagnostic specificity and outcome in patients who are mechanically ventilated. The rapid spread of multidrug-resistant, spp, and has made initial empiric therapy more difficult. Management principles include the use of techniques for more accurate diagnosis and early antimicrobial therapy with appropriate agents along with careful analysis of culture results, clinical response, and potential complications of pneumonia and therapy. Strategies for prophylaxis are of critical importance for risk reduction, improvement in patient outcome, and reduction of hospital costs.

journal_name

Curr Opin Crit Care

authors

Craven DE,De Rosa FG,Thornton D

doi

10.1097/00075198-200210000-00009

keywords:

subject

Has Abstract

pub_date

2002-10-01 00:00:00

pages

421-9

issue

5

eissn

1070-5295

issn

1531-7072

journal_volume

8

pub_type

杂志文章,评审
  • Interventions to decrease the morbidity and mortality associated with implantable cardioverter-defibrillator shocks.

    abstract:PURPOSE OF REVIEW:Implantable cardioverter-defibrillator (ICD) implantation is the standard of care for secondary prevention in patients with previous cardiac arrest and for primary prevention in appropriately selected patients with cardiomyopathy. However, ICD therapies and the arrhythmias that trigger these therapies...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e328357ae68

    authors: Bradfield JS,Buch E,Shivkumar K

    更新日期:2012-10-01 00:00:00

  • Update on the management of acute liver failure.

    abstract:PURPOSE OF REVIEW:This review describes the current intensive care management of acute liver failure (ALF) and the latest evidence for emerging therapies. RECENT FINDINGS:Mortality from ALF continues to improve and in some cases, medical therapy can negate the need for liver transplantation because of protocolized man...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000583

    authors: Trovato FM,Rabinowich L,McPhail MJW

    更新日期:2019-04-01 00:00:00

  • Should we use driving pressure to set tidal volume?

    abstract:PURPOSE OF REVIEW:Ventilator-induced lung injury (VILI) can occur despite use of tidal volume (VT) limited to 6 ml/kg of predicted body weight, especially in patients with a smaller aerated compartment (i.e. the baby lung) in which, indeed, tidal ventilation takes place. Because respiratory system static compliance (CR...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000377

    authors: Grieco DL,Chen L,Dres M,Brochard L

    更新日期:2017-02-01 00:00:00

  • Refractory status epilepticus.

    abstract:PURPOSE OF REVIEW:Although conventional anticonvulsant agents can terminate status epilepticus in most cases, a substantial minority of patients develops medically refractory status and requires more aggressive care. This review explores the options available. RECENT FINDINGS:Increasing numbers of previously unexpecte...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccx.0000157079.72999.87

    authors: Bleck TP

    更新日期:2005-04-01 00:00:00

  • Perioperative haemodynamic therapy.

    abstract:PURPOSE OF REVIEW:To discuss the perioperative monitoring tools and targets for haemodynamic optimization and to assess the influence of goal-directed therapy (GDT) on organ function, complications and outcome in different categories of surgical patients. RECENT FINDINGS:The choice of perioperative haemodynamic monito...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32833ab81e

    authors: Kirov MY,Kuzkov VV,Molnar Z

    更新日期:2010-08-01 00:00:00

  • The timing of spinal stabilization in polytrauma and in patients with spinal cord injury.

    abstract:PURPOSE OF REVIEW:Despite improved care of multiple injured patients, controversial data about the best time point for decompression and stabilization of spine fractures and spinal cord injuries are published. Some studies even question the value of surgical management. RECENT FINDINGS:In several mostly retrospective ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e328319650b

    authors: Schinkel C,Anastasiadis AP

    更新日期:2008-12-01 00:00:00

  • Paralytics in critical care: not always the bad guy.

    abstract:PURPOSE OF REVIEW:The use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) and acute lung injury remains controversial, although frequent. This review analyzes the effects of NMBAs on thoracopulmonary mechanics, gas exchange, patient outcome and their potential advers...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/mcc.0b013e3283220e60

    authors: Forel JM,Roch A,Papazian L

    更新日期:2009-02-01 00:00:00

  • Role of intestinal epithelial apoptosis in survival.

    abstract:PURPOSE OF REVIEW:To outline evidence that suggests increased intestinal epithelial apoptosis (programmed cell death) plays an important role in critical illness of infectious and noninfectious origin. RECENT FINDINGS:Both human and animal studies demonstrate that the gut epithelium has increased levels of cellular de...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200304000-00013

    authors: Husain KD,Coopersmith CM

    更新日期:2003-04-01 00:00:00

  • The science and art of pediatric critical care nutrition.

    abstract:PURPOSE OF REVIEW:Nutritional status and nutrient delivery during critical illness impact clinical outcomes. We have reviewed recent studies that may guide best practices regarding nutrition therapy in critically ill children. RECENT FINDINGS:Malnutrition is prevalent in the pediatric ICU population, and is associated...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000316

    authors: Martinez EE,Mehta NM

    更新日期:2016-08-01 00:00:00

  • Neurocritical care: a distinct discipline?

    abstract:PURPOSE OF REVIEW:We sought to review the evidence supporting neurocritical care as a distinct specialty of medicine. RECENT FINDINGS:Over the past 20 years, neuro-intensive care units have evolved from neurosurgical units focused primarily on postoperative monitoring to units that provide comprehensive medical and sp...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32808255c6

    authors: Rincon F,Mayer SA

    更新日期:2007-04-01 00:00:00

  • Airway and ventilator management in trauma patients.

    abstract:PURPOSE OF REVIEW:Securing the airway to provide sufficient oxygenation and ventilation is of paramount importance in the management of all types of emergency patients. Particularly in severely injured patients, strategies should be adapted according to useful recent literature findings. RECENT FINDINGS:The role of ou...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000160

    authors: Beckers SK,Brokmann JC,Rossaint R

    更新日期:2014-12-01 00:00:00

  • Esophageal pressure monitoring: why, when and how?

    abstract:PURPOSE OF REVIEW:Esophageal manometry has shown its usefulness to estimate transpulmonary pressure, that is lung stress, and the intensity of spontaneous effort in patients with acute respiratory distress syndrome. However, clinical uptake of esophageal manometry in ICU is still low. Thus, the purpose of review is to ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000494

    authors: Yoshida T,Brochard L

    更新日期:2018-06-01 00:00:00

  • Update on progress in the international, multicenter, randomized, controlled trial of corticosteroids after significant head injury (Medical Research Council CRASH Trial).

    abstract:PURPOSE OF REVIEW:To provide an update on the progress of the multicenter, randomized, controlled trial of corticosteroids after significant head injury (CRASH). RECENT FINDINGS:After a successful pilot phase, the main phase of the CRASH Trial began in March 2001. By June 2002, 107 hospitals from 31 countries were par...

    journal_title:Current opinion in critical care

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00075198-200304000-00003

    authors: MRC CRASH Trial National Coordinators.

    更新日期:2003-04-01 00:00:00

  • Improving outcomes in the early phases after major trauma.

    abstract:PURPOSE OF REVIEW:The scope of this review is to describe what is known about injury outcomes and the principles by which they can be improved by acute phase interventions. Assessing which outcomes matter to trauma patients is important both for the evaluation of existing and novel acute interventions and to assess the...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32834a9353

    authors: Brohi K,Cole E,Hoffman K

    更新日期:2011-10-01 00:00:00

  • The epithelium in acute lung injury/acute respiratory distress syndrome.

    abstract:PURPOSE OF REVIEW:The mechanisms of epithelial injury in acute lung injury/acute respiratory distress syndrome have been of interest since the syndrome was first described. Cell therapies to replace injured epithelium are a futuristic dream; however, there is ongoing research to achieve this goal. We review research re...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3282f417a0

    authors: Gropper MA,Wiener-Kronish J

    更新日期:2008-02-01 00:00:00

  • Pharmacokinetic/pharmacodynamic considerations for the optimization of antimicrobial delivery in the critically ill.

    abstract:PURPOSE OF REVIEW:Antimicrobials are very commonly used drugs in the intensive care setting. Extensive research has been conducted in recent years to describe their pharmacokinetics/pharmacodynamics in order to maximize the pharmacological benefit and patient outcome. Translating these new findings into clinical practi...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000229

    authors: Tsai D,Lipman J,Roberts JA

    更新日期:2015-10-01 00:00:00

  • Myocardial protection during resuscitation from cardiac arrest.

    abstract:PURPOSE OF REVIEW:Successful treatment of cardiac arrest requires that an electrically stable and mechanically competent cardiac activity be promptly reestablished. However, many interventions used to attempt to reestablish cardiac activity may also inflict additional myocardial injury and, in turn, compromise resuscit...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200306000-00005

    authors: Gazmuri RJ,Ayoub IM,Kolarova J

    更新日期:2003-06-01 00:00:00

  • Fluid choices impact outcome in septic shock.

    abstract:PURPOSE OF REVIEW:We discuss the goals of resuscitation, in both the early and the later phases, measures of organ perfusion, fluid responsiveness and the consequences of tissue edema. RECENT FINDINGS:The cost of over-aggressive fluid resuscitation is increased organ failure and mortality. In anticipation of the upcom...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000116

    authors: Douglas JJ,Walley KR

    更新日期:2014-08-01 00:00:00

  • Advanced extracorporeal therapy in trauma.

    abstract:PURPOSE OF REVIEW:The purpose is to review the current application of extracorporeal life support (ECLS) in trauma patients. In addition, programmatic development is described. RECENT FINDINGS:ECLS use is increasing among trauma patients. Several recent studies among trauma patients report survival rates of 65-79%. De...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000366

    authors: Zonies D,Merkel M

    更新日期:2016-12-01 00:00:00

  • Extracorporeal life support for severe acute respiratory distress syndrome.

    abstract:PURPOSE OF REVIEW:To provide a summary of the recent literature on extracorporeal membrane oxygenation (ECMO) in adults with severe acute respiratory distress syndrome (ARDS), focusing on advances in equipment, current conventional and unconventional indications, complications, and future applications. RECENT FINDINGS...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000170

    authors: Leligdowicz A,Fan E

    更新日期:2015-02-01 00:00:00

  • When and how should we do a tracheostomy?

    abstract::Tracheostomy is one of the most common surgical procedures in the intensive care unit. Since the introduction of percutaneous techniques, tracheostomy has become increasingly popular. The technique is relatively easy, and the early and late complication rates are relatively low.It is unknown at which moment tracheosto...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章

    doi:10.1097/00075198-200008000-00005

    authors: van Heurn LW

    更新日期:2000-08-01 00:00:00

  • Antimicrobial resistance in ICUs: an update in the light of the COVID-19 pandemic.

    abstract:PURPOSE OF REVIEW:To describe current antimicrobial resistance in ESKAPE Gram-negative microorganisms and their situation in the ICUs, the implication of the so-called high-risk clones (HiRCs) involved in the spread of antimicrobial resistance as well as relevance of the COVID-19 pandemic in the potential increase of r...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000755

    authors: Cantón R,Gijón D,Ruiz-Garbajosa P

    更新日期:2020-10-01 00:00:00

  • Nutritional assessment and support of the patient with acute heart failure.

    abstract:PURPOSE OF REVIEW:A significant number of patients hospitalized with heart failure are malnourished. Depletion of micronutrients, which is known to occur in heart failure for a variety of reasons, may contribute to myocardial abnormalities noted in heart failure. In this review, we focus on nutritional supplementation ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32833e10d4

    authors: Sarma S,Gheorghiade M

    更新日期:2010-10-01 00:00:00

  • Microcirculatory disorders in sepsis and transplantation: therapy with natural coagulatory inhibitors antithrombin and activated protein C.

    abstract:PURPOSE OF REVIEW:Modern technologies allow visualization of microcirculatory disorders. This review describes how the coagulatory inhibitors antithrombin and activated protein C (APC) can improve microcirculation in sepsis and transplantation. RECENT FINDINGS:The effects of antithrombin and APC on microcirculatory di...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccx.0000244121.54495.f7

    authors: Hoffmann JN,Fertmann JM,Jauch KW

    更新日期:2006-10-01 00:00:00

  • Critical illness polyneuropathy.

    abstract::Critical illness polyneuropathy (CIP) is a syndrome that was first extensively described in the early 1980s, mainly in patients with failure to wean from mechanical ventilation. The syndrome is further characterized by limb muscle weakness, usually more pronounced distally than proximally, and is often accompanied by ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200208000-00006

    authors: van Mook WN,Hulsewé-Evers RP

    更新日期:2002-08-01 00:00:00

  • Renal dysfunction and fluid and electrolyte disturbances.

    abstract:PURPOSE OF REVIEW:To examine recent developments in preventing and treating postoperative acute renal dysfunction. To review contemporary issues concerning perioperative fluid and electrolyte management. RECENT FINDINGS:Renal dysfunction remains a major postoperative morbidity despite the advent of intermittent and co...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e328348bef5

    authors: Hashem R,Weissman C

    更新日期:2011-08-01 00:00:00

  • New ways to reduce unnecessary variation and improve outcomes in the intensive care unit.

    abstract::The care of critically ill patients and the advent of the modern day intensive care unit (ICU) present a large person power and cost burden to society. The high cost of critical care is attributed to high overhead expenses (eg, experienced staff and equipment), high resource utilization (eg, pharmaceutical resources, ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200108000-00015

    authors: Holcomb BW,Wheeler AP,Ely EW

    更新日期:2001-08-01 00:00:00

  • Pulmonary and extrapulmonary acute respiratory distress syndrome: are they different?

    abstract:PURPOSE OF REVIEW:Acute respiratory distress syndrome has been considered a morphologic and functional expression of lung injury caused by a variety of insults. Two distinct forms of acute respiratory distress syndrome/acute lung injury are described, because there are differences between pulmonary acute respiratory di...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200502000-00003

    authors: Rocco PR,Zin WA

    更新日期:2005-02-01 00:00:00

  • Recent developments in percutaneous tracheostomy: improving techniques and expanding roles.

    abstract:PURPOSE OF REVIEW:The purpose of this review is to provide an update of recent developments pertaining to the use of percutaneous tracheostomy. Percutaneous tracheostomy has been established as an alternative to open surgical tracheostomy, but many key questions about the optimal use of this procedure remain unanswered...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccx.0000170680.09759.f2

    authors: Bardell T,Drover JW

    更新日期:2005-08-01 00:00:00

  • Integrating palliative care in the ICU.

    abstract:PURPOSE OF REVIEW:Although providing palliative care in the ICU has become a priority, the success of different methods to integrate palliative care into the ICU has varied. This review examines the current evidence supporting the different models of palliative care delivery and highlights areas for future study. RECE...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000149

    authors: Hua M,Wunsch H

    更新日期:2014-12-01 00:00:00