Abstract：
UNLABELLED:VAP is a complex nosocomial infection, the disease expression and resulting patient outcome of which is dependent on host factors, the causative organism, the timing and adequacy of treatment, and the presence of intrinsic or inducible antibiotic resistance. Significant improvements have been achieved in our ability to reduce the occurrence of VAP in the hospital setting. Clinicians caring for mechanically ventilated patients should strive to develop focused programs for the prevention of VAP, other nosocomial infections, and the occurrence of antibiotic-resistant infections at their institutions. The benefits of such programs are well demonstrated. The components of a PDSA (Plan-Do-STUDY-Act) model that can be simply employed to develop a VAP prevention program are as follows: Stages Plan: 1. Identify potentially modifiable risk factors for VAP at the institutional level. 2. Develop a strategy to modify or prevent the occurrence of these risk factors. [figure: see text] Do: 1. Carry out the planned intervention strategy. 2. Identify problems in the implementation of the designed intervention. 3. Update the intervention with solutions for the identified problems. 4. Collect basic data (e.g., VAP rates, severity of illness). STUDY:1. Analyze data. 2. Summarize the results. Act: 1. Determine the overall success or failure of the intervention. 2. Identify potential modifications to improve the intervention strategy. 3. Prepare for next PDSA cycle. Inherent in the development and application of such programs is the concept that they are continuous processes striving to improve clinical performance over time (Fig. 3). At any given institution, the most likely approach to the prevention of NP and VAP will be a multifaceted one, employing interventions aimed at reducing the occurrence of aerodigestive tract colonization with pathogenic bacteria and aspiration. To be successful, such quality improvement programs must be embraced at the institutional level. Only in this way can hospitals hope to successfully reduce their rates of VAP and sustain or improve upon those efforts over time.
journal_name
Clin Chest Medjournal_title
Clinics in chest medicineauthors
Kollef MHdoi
10.1016/s0272-5231(05)70242-2subject
Has Abstractpub_date
1999-09-01 00:00:00pages
653-70issue
3eissn
0272-5231issn
1557-8216pii
S0272-5231(05)70242-2journal_volume
20pub_type
杂志文章,评审abstract：:Our understanding of chronic bronchitis has been hampered by the fact that the diagnosis is based upon historical evidence of recurrent cough and sputum without any requirement that certain physiologic or microscopic criteria be met. Despite the fact that epidemiological studies have implicated viruses, bacteria, and ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1981-01-01 00:00:00
abstract：:Recent progress in medical therapies has diminished the role of transplantation in the management of PPH during the past decade. Drug therapy is not effective in some patients, responses to therapy are not sustained over time in others, and drug side effects eventually limit the benefits of treatment in a few more. Lu...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70293-8
更新日期：2001-09-01 00:00:00
abstract：:Biologic drugs have revolutionized the treatment of certain hematologic, autoimmune, and malignant diseases, but they may place patients at risk for reactivation or acquisition of tuberculosis. This risk is highest with the tumor necrosis factor-alpha (TNF-α) inhibitors. Amongst this class of drugs, the monoclonal ant...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2019.07.003
更新日期：2019-12-01 00:00:00
abstract：:Continuous mechanical ventilation used for life support is accepted as standard practice in nearly every hospital in the United States today. The history of the evolution of techniques that we take virtually for granted today is fascinating. This article recounts some of the highlights in the development of modern-day...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1988-03-01 00:00:00
abstract：:Lung transplantation is an accepted treatment for a large number of end-stage pulmonary diseases. There are several complications that pertain specifically to lung transplant recipients, including airway ischemia, reperfusion edema, infections, acute rejection, obliterative bronchiolitis, and other postoperative probl...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70257-4
更新日期：1999-12-01 00:00:00
abstract：:Several medications have been associated with the development of the BOOP lesion. Often, symptoms include nonproductive cough and shortness of breath with bilateral crackles by examination. Occasionally, there is fever and rash, and, rarely, eosinophilia. The chest radiograph usually shows bilateral patchy infiltrates...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/S0272-5231(03)00140-0
更新日期：2004-03-01 00:00:00
abstract：:Many different therapeutic compounds are associated with pulmonary toxicity. Although the mechanism of injury for many of these compounds is poorly defined, several compounds are believed to produce alterations in normal lung biochemistry. These mechanisms of injury in both clinical and experimental models are discuss...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1989-03-01 00:00:00
abstract：:Clinically apparent involvement of the heart and nervous system occurs in a relatively small number of patients with sarcoidosis. The diagnosis of myocardial and neurological sarcoidosis is difficult because anatomic presence of granulomas without clinical dysfunction is an important feature of sarcoidosis. The chest ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70420-2
更新日期：1997-12-01 00:00:00
abstract：:Thoracic imaging is widely used to detect lower respiratory tract infections, identify their complications, and aid in differentiating infectious from noninfectious thoracic disease. Less commonly, the combination of imaging findings and a clinical setting can favor infection with a specific organism. This confluence ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2015.02.005
更新日期：2015-06-01 00:00:00
abstract：:As recently as the 1992 Report of the American Thoracic Society Workshop on Lung Transplantation, no QOL facts were given and no knowledge gaps related to QOL outcomes were cited. Even at the present time, the information in that area is based on a relatively small set of preliminary reports. Current information indic...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70387-7
更新日期：1997-06-01 00:00:00
abstract：:The description of organized thrombus in major pulmonary arteries can be found in autopsy reports dating back to the late nineteenth and early twentieth centuries. Not until the 1950s was the antemortem diagnosis and clinical syndrome of chronic thrombotic obstruction of the major pulmonary arteries better characteriz...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2006.11.009
更新日期：2007-03-01 00:00:00
abstract：:The treatment of idiopathic pulmonary fibrosis (IPF) remains controversial. The benefits of conventional treatment with corticosteroids plus either azathioprine or cyclophosphamide have not been established in randomized, controlled trials. Other treatment strategies have been suggested as understanding of the pathoge...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2005.08.004
更新日期：2006-03-01 00:00:00
abstract：:The process of smoking cessation involves progression through five stages of change: precontemplation, contemplation, preparation, action, and maintenance. Most patients are not prepared to take action on their smoking, yet most smoking cessation programs are designed for smokers who are so prepared. Small percentages...
journal_title：Clinics in chest medicine
pub_type： 杂志文章
doi：
更新日期：1991-12-01 00:00:00
abstract：:Bronchodilator therapy with adrenergic agonists in asthma is discussed and the therapeutic efficacy and side effects of various routes of administration of beta agonists are compared. The aerosol administration, the most effective route, is described in detail as to the optimal technique of administration, to the vari...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1984-12-01 00:00:00
abstract：:This article discusses refeeding in relation to respiratory skeletal muscle function and the subsequent function of the respiratory system as a whole. The characteristic alterations in malnourished skeletal muscle and the response to refeeding are outlined. Following this, a simple energetic model is used to explore f...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1986-03-01 00:00:00
abstract：:The recent advances in our understanding of breathing in sleep include an evolution in the selection and surgical therapy of patients with the sleep apnea syndrome. Recent work suggests that shorter polysomnographic studies may be adequate for diagnostic purposes in many sleep apnea patients. It is now clear that cent...
journal_title：Clinics in chest medicine
pub_type： 杂志文章
doi：
更新日期：1985-12-01 00:00:00
abstract：:Despite complete resection of what seems to be all evident tumor, one third to three quarters of patients with stages I and II NSCLC ultimately succumb to this neoplasm. Patients who are cured of an original NSCLC or small cell cancer remain at risk for a new primary lung cancer. Although the importance of lifelong su...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(03)00067-4
更新日期：2002-03-01 00:00:00
abstract：:The use of nuclear magnetic resonance to produce diagnostic images of the human chest has just become possible. These images are computer-reconstructed maps of the distribution in tissue of protons and of some of their magnetic characteristics. The images are high resolution and anatomically accurate, are capable of d...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1984-06-01 00:00:00
abstract：:The pathogenesis of O2 toxicity involves intracellular production of partially reduced O2 metabolites, which increases with O2 partial pressure. Cytotoxic O2 metabolites impair enzyme function and inhibit DNA, protein, and surfactant lipid biosynthesis. Compounds used clinically that increase O2 metabolism or that are...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1990-03-01 00:00:00
abstract：:Blood gas analyses are an essential part of modern patient care. Although all blood gas instruments have pH, PCO2, and PO2 electrodes based on the same principles, instruments in current use vary greatly in design, operator dependence, and accuracy. For the clinician to obtain accurate and timely results there must be...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1989-06-01 00:00:00
abstract：:Although a biopsy may need to be performed in complicated patients, bronchoalveolar lavage (BAL) is an important adjunct to the diagnosis of pulmonary and disseminated fungal infections. Culture is the gold standard for diagnosis in many instances, but cytologic and morphologic analysis is often diagnostic. Although n...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2009.02.010
更新日期：2009-06-01 00:00:00
abstract：:Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. The main areas within pulmonary medicine for whic...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2010.10.007
更新日期：2011-03-01 00:00:00
abstract：:The basic science and clinical understanding of infection with Blastomyces dermatitidis has been a field of constant evolution and continued revision of hypotheses. This article highlights some areas in which recent progress has the potential for significant impact on the clinical care of patients. Specifically, this ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2009.02.003
更新日期：2009-06-01 00:00:00
abstract：:An older smoker tends to be asked less often to quit although he or she has much to gain from achieving a nonsmoking status. Multiple barriers may interfere with attempting to quit including nicotine withdrawal, doubted self-efficacy, other smokers in one's environment, or misperceptions of little gain from quitting. ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1993-09-01 00:00:00
abstract：:Gas exchange between the atmosphere and the human body depends on the lungs and the function of the respiratory pump. The respiratory pump consists of the respiratory control center located in the brain, bony rib cage, diaphragm, and intercostal, accessory, and abdominal muscles. A variety of muscles serve to fine-tun...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2018.01.011
更新日期：2018-06-01 00:00:00
abstract：:Non-small cell lung cancer with very limited extent of metastatic spread commonly is termed, oligometastatic disease (OMD), and typically described as no more than 3 to 5 lesions. Definitive local therapy potentially leads to significant improvement in progression-free survival and overall survival. OMD may occur de n...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2020.02.004
更新日期：2020-06-01 00:00:00
abstract：:Because of physiologic changes associated with aging and the development of chronic illness, the elderly will continue to be at risk for catastrophic illnesses including adult respiratory distress syndrome (ARDS). Current management of elderly patients with ARDS is only supportive and focused on avoiding complications...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1993-09-01 00:00:00
abstract：:Current advances in guided bronchoscopy methods permit minimally invasive access to essentially any area of the lungs. This provides a potential means to treat patients with localized lung malignancies who might not otherwise tolerate conventional treatment, which commonly relies on surgical resection. Ablation method...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2017.11.014
更新日期：2018-03-01 00:00:00
abstract：:Quantitative assessment of pulmonary metabolic function has been shown to be a novel and important approach to obtaining specific and subtle biochemical information regarding endothelial cell function in the normal and diseased lung. A primary consideration in this measurement of whole organ metabolism, whether it be ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1989-03-01 00:00:00
abstract：:This article focuses primarily on the recent literature on abdominal compartment syndrome (ACS) and the definitions and recommendations published by the World Society for the Abdominal Compartment Syndrome. The definitions regarding increased intra-abdominal pressure (IAP) are listed and are followed by an overview of...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2008.09.003
更新日期：2009-03-01 00:00:00
