Abstract：
:The long-term ventilated patient is at high risk for developing nosocomial pneumonia or tracheobronchitis. In general, the frequency of infection increases with the duration of mechanical ventilation, but the risk appears to be greatest in the first week of intubation. Although these types of infection are common and may have morbidity and mortality impact, the daily risk is less in the long-term ventilated patient than in the acutely ill intubated patient. This reduced daily risk may reflect a "survivor effect," with less healthy patients dying early in the hospital stay and not surviving long enough to undergo tracheostomy and long-term ventilation. A number of factors predispose these patients to infection, including host defense impairment and exposure to large numbers of bacteria. This exposure can occur through the airway, and proper care of respiratory therapy devices is essential to minimize the risk for infection. Most infections of the lower respiratory tract are preceded by airway colonization with EGN bacteria and, with improvement in host defenses and nutrition, infection in the face of colonization is less likely. In some patients, colonization can be eliminated. When the long-term ventilated patient does develop infection, it generally involves highly resistant gram-negative or gram-positive organisms and therapy should be prompt and appropriate. Not all such patients respond to systemic antibiotics, and the use of adjunctive aerosol therapy may have benefit for those with either tracheobronchitis or pneumonia, especially if highly resistant pathogens are present.
journal_name
Clin Chest Medjournal_title
Clinics in chest medicineauthors
Ahmed QA,Niederman MSdoi
10.1016/s0272-5231(05)70026-5subject
Has Abstractpub_date
2001-03-01 00:00:00pages
71-85issue
1eissn
0272-5231issn
1557-8216pii
S0272-5231(05)70026-5journal_volume
22pub_type
杂志文章,评审abstract：:This article review available strategies for mechanically ventilating patients with the adult respiratory distress syndrome. The authors first present the conventional strategies of mechanical ventilation: volume-limited mechanical ventilation with positive end-expiratory pressure (PEEP) at normal inspiratory-expirato...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1990-12-01 00:00:00
abstract：:Tobacco dependency syndrome is an organic disease caused by chronic use of inhaled tobacco smoke. It is occasionally controlled by willpower alone, but often requires pharmacotherapy in conjunction with various techniques to manage the psychological manifestations. The two effective drugs are bupropion, which is an or...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70018-6
更新日期：2000-03-01 00:00:00
abstract：:Management of acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) is largely supportive, with the use of mechanical ventilation being a central feature. Recent advances in the understanding of ALI/ARDS and mechanical ventilation have revealed that lung-protective ventilation strategies may atten...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2006.06.008
更新日期：2006-12-01 00:00:00
abstract：:Studies suggest clinically manifest cardiac involvement occurs in 5% of patients with pulmonary/systemic sarcoidosis. The principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. Data indicate that an 20% to 25% of patients with pulmonary/systemic s...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2015.08.008
更新日期：2015-12-01 00:00:00
abstract：:A multitude of overlapping defenses has evolved to help combat the inventiveness of pathogens seeking to invade us, and because the lung is the most common primary route of infection, it is in the lung that the most varied responses are seen. This article focuses on recent research, particularly in innate immunity, an...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2012.03.003
更新日期：2012-06-01 00:00:00
abstract：:The synthesis of nitric oxide (NO) and its targets are reviewed physiologically during sepsis and wound healing, a self-limiting process in which mechanisms are still identified incompletely. NO also plays an active and direct role during infection, aimed at protecting the host and destroying the microbe. During septi...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70318-x
更新日期：1996-06-01 00:00:00
abstract：:The most common causes for undiagnosed transudative effusions are congestive heart failure and hepatic hydrothorax. Pleural fluid N terminal pro-brain natriuretic peptide levels higher than 1500 pg/mL are virtually diagnostic of congestive heart failure. The most common causes for undiagnosed exudative pleural effusio...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2005.12.002
更新日期：2006-06-01 00:00:00
abstract：:Bacterial pneumonias occur with increased frequency and can be associated with increased morbidity in the HIV-infected population compared with normals. The pathogens that most frequently cause community-acquired pneumonias are S. pneumoniae, H. influenzae, and occasionally S. aureus. These pneumonias usually respond ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1988-09-01 00:00:00
abstract：:Pulmonary embolism remains a leading cause of morbidity and mortality in the United States. However, with improved recognition and diagnosis, the risk of death diminishes. The diagnosis depends on the clinician's suspicion. Pulmonary emboli are categorized into low, intermediate, or high risk based on the scoring scal...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2018.04.013
更新日期：2018-09-01 00:00:00
abstract：:Occupational and environmental exposures contribute to the development and progression of most lung diseases, yet their impact is greatly under-recognized in clinical practice. Clinicians caring for patients with respiratory diseases should maintain a high index of suspicion for occupational and environmental contribu...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2020.08.019
更新日期：2020-12-01 00:00:00
abstract：:Elevated serum IgE has many etiologies including parasitic infection, allergy and asthma, malignancy, and immune dysregulation. The hyper-IgE syndromes caused by mutations in STAT3, DOCK8, and PGM3 are monogenic primary immunodeficiencies associated with high IgE, eczema, and recurrent infections. These primary immuno...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2016.04.016
更新日期：2016-09-01 00:00:00
abstract：:Stents are used for palliation of symptoms of central airway obstruction caused by either malignant or benign conditions. Stents may be applied for maintaining airway patency after dilatation of postinflammatory and infectious strictures, for airway dehiscence after lung transplantation, and for the management of trac...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2009.08.002
更新日期：2010-03-01 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：:This article reviews aspects of mechanical ventilation in patients without lung injury, patients in the perioperative period, and those with neurologic injury or disease including spinal cord injury. Specific emphasis is placed on ventilator strategies, including timing and indications for tracheostomy. Lung protectiv...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2016.07.010
更新日期：2016-12-01 00:00:00
abstract：:The pharmacologic treatment of chronic obstructive pulmonary disease (COPD) differs from that of asthma in several respects. Oral therapy should be the keystone, using a long-acting theophylline or a beta 2-sympathomimetic agent. The addition of a metered dose inhalant aerosol provides additive benefit with low toxici...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1990-09-01 00:00:00
abstract：:In summary, the evaluation of the tired patient requires an awareness of the various meanings of tiredness. Furthermore, it is important to differentiate normal sleepiness that is a product of circadian rhythm variation in vigilance from pathologic sleepiness. Sleepiness that results from faulty habits, e.g., altered ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1992-09-01 00:00:00
abstract：:This article describes the pathophysiology of the respiratory system after upper abdominal surgery, emphasizing the role of respiratory muscle dysfunction. The history of current techniques to measure respiratory muscle function are reviewed. The authors describe the postoperative pattern of breathing, speculate on th...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1993-06-01 00:00:00
abstract：:The authors attempt to demonstrate those circumstances for which perfusion scintigraphy, by itself, or in combination with ventilation scintiscanning, offers the best adjunctive information in excluding or confirming the presence of pulmonary embolism. They then identify those circumstances in which scintiscanning doe...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1984-09-01 00:00:00
abstract：:After half a century of clinical experience and research, management of pulmonary arterial hypertension remains a challenge. Currently, data to support the use of standard therapies for pulmonary arterial hypertension (oxygen supplementation, diuretics, digoxin, anticoagulation, and calcium channel blockers) are mostl...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2006.12.003
更新日期：2007-03-01 00:00:00
abstract：:Fungal pneumonias cause unacceptable morbidity among patients with hematologic malignancies (HM) and recipients of hematopoietic stem cell transplantation (HSCT). The high incidence of fungal pneumonias in HM/HSCT populations arises from their frequently severe, complex, and persistent immune dysfunction caused by the...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2017.04.009
更新日期：2017-09-01 00:00:00
abstract：:Severe asthma remains poorly understood and frustrating to treat, partly because it is a heterogeneous disease. Recent improvements in the definition of severe asthma have allowed better characterization of the phenotypes of severe asthma and the related physiologic and pathologic abnormalities. Early-onset severe ast...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2005.10.002
更新日期：2006-03-01 00:00:00
abstract：:The pharmacologic treatment of the reversible elements of chronic obstructive pulmonary disease is discussed in this article. Discussion focuses on three classes of bronchodilator drugs--the sympathomimetic agents, the methylxanthines, and the anticholinergic agents. A section on corticosteroid use in patients with ch...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1986-12-01 00:00:00
abstract：:Pseudomonas aeruginosa remains an important cause of pulmonary disease in patients who have cystic fibrosis. The development of antimicrobial therapy directed against this organism has resulted in the preservation of lung function and improved longevity. Efficacy has been demonstrated with agents administered via pare...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2007.02.003
更新日期：2007-06-01 00:00:00
abstract：:In summary, long-term complications of artificial airways are rare but important sequelae of artificial airways. Many of the potential long-term complications of translaryngeal intubation and tracheotomy are similar and overlapping. Although most patients who undergo these procedures tend to tolerate them without diff...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(03)00048-0
更新日期：2003-09-01 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：:Inhaled corticosteroids (ICS) have led to improved asthma control and reduced asthma mortality in the Western world. ICS are effective in combating T-helper type 2-driven inflammation featuring mast cell and eosinophilic airway infiltration. Their effect on innate immunity-driven neutrophilic inflammation is poor and ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2012.05.004
更新日期：2012-09-01 00:00:00
abstract：:This article reviews several important noninfectious pulmonary complications that threaten survival, pulmonary function, and quality of life after lung transplantation. Topics reviewed include primary graft dysfunction (PGD), native lung hyperinflation, anastomotic complications, phrenic nerve injury, pleural complica...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2005.06.006
更新日期：2005-12-01 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：:Nonresolving pneumonia is a common and frequently misunderstood problem faced by the practicing pulmonologist. While radiographic resolution of most infections is relatively long and lags behind clinical signs of recovery, data suggest that a variety of host defense problems are a consequence of systemic illness and a...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1987-09-01 00:00:00
abstract：:Respiratory viruses are common in solid organ and hematopoietic stem cell transplant recipients and a recognized cause of significant morbidity and mortality. Epidemiology, risk factors, and attributable mortality in both populations are reviewed. In addition, virus-specific prevention and treatment options, including...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2017.07.012
更新日期：2017-12-01 00:00:00
