Abstract:
:Treatment failure (TF) is defined as a clinical condition with inadequate response to antimicrobial therapy. Clinical response should be evaluated within the first 72 h of treatment, whereas infiltrate images may take up to 6 weeks to resolve. Early failure is considered when ventilatory support and/or septic shock appear within the first 72 h. The incidence of treatment failure in community-acquired pneumonia is 10 to 15%, and the mortality is increased nearly fivefold. Resistant and unusual microorganisms and noninfectious causes are responsible for TF. Risk factors are related to the initial severity of the disease, the presence of comorbidity, the microorganism involved, and the antimicrobial treatment implemented. Characteristics of patients and factors related to inflammatory response have been associated with delayed resolution and poor prognosis. The diagnostic approach to TF depends on the degree of clinical impact, host factors, and the possible cause. Initial reevaluation should include a confirmation of the diagnosis of pneumonia, noninvasive microbiological samples, and new radiographic studies. A conservative approach of clinical monitoring and serial radiographs may be recommended in elderly patients with comorbid conditions that justify a delayed response. Invasive studies with bronchoscopy to obtain protected brush specimen and BAL are indicated in the presence of clinical deterioration or failure to stabilize. BAL processing should include the study of cell patterns to rule out other noninfectious diseases and complete microbiological studies. The diagnostic yield of imaging procedures with noninvasive and invasive samples is up to 70%. After obtaining microbiological samples, an empirical change in antibiotic therapy is required to cover a wider microbial spectrum.
journal_name
Chestjournal_title
Chestauthors
Menendez R,Torres Adoi
10.1378/chest.06-1995subject
Has Abstractpub_date
2007-10-01 00:00:00pages
1348-55issue
4eissn
0012-3692issn
1931-3543pii
S0012-3692(15)36732-5journal_volume
132pub_type
杂志文章,评审相关文献
CHEST文献大全abstract::A patient with systemic artery-to-pulmonary artery fistulae is described. Historically, all therapy of this type of lesion has been surgical. We describe a new mode of treatment, therapeutic embolization, which obviates surgical intervention and its attendant risks. Embolization is an alternative to surgery that shoul...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.82.6.791
更新日期:1982-12-01 00:00:00
abstract:STUDY OBJECTIVES:Solitary fibrous tumors of the pleura (SFTPs) are slow-growing neoplasms. Approximately 800 cases have been reported in the literature to date. The aim of this study was to address our experience with the management of SFTPs and to evaluate the advantage of video-assisted thoracoscopic surgery (VATS) i...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.125.3.1144
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND:Sarcoidosis is thought to be a T-helper type 1 cytokine-mediated disorder. Sputum induction has been proposed as a useful noninvasive method mainly for the assessment of airway diseases. However, it is unknown whether the balance of T-cytotoxic (Tc1) type 1 and Tc2 cells is altered in sarcoidosis. STUDY OBJ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.129.6.1592
更新日期:2006-06-01 00:00:00
abstract::Pneumocystis carinii pneumonia is a frequent manifestation of the acquired immune deficiency syndrome (AIDS). It usually presents radiologically as diffuse bilateral infiltrates and histologically as a foamy, eosinophilic intra-alveolar exudate containing the organisms' cysts. We recently studied two rare cases of P c...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.94.3.580
更新日期:1988-09-01 00:00:00
abstract:STUDY OBJECTIVES:To determine whether an association exists between aortic calcification viewed on plain chest radiography and coronary artery disease. METHODS:Retrospective review of all chest radiographs obtained from consecutive patients undergoing coronary angiography at a primary cardiac center during 1999. Plain...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.121.5.1468
更新日期:2002-05-01 00:00:00
abstract:STUDY OBJECTIVES:Evidence exists that HIV-seropositive individuals may be at increased risk for the development of precocious pulmonary emphysema. HIV infection is also associated with antioxidant deficiency in both the serum and lungs, and it is therefore possible that increased oxidant stress may contribute to parenc...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.126.5.1439
更新日期:2004-11-01 00:00:00
abstract::The clinical course of congestive heart failure (CHF) and mitral valve stenosis (MVS) is accompanied by episodes of dyspnea, wheezing, and cough, symptoms also observed in patients with bronchial hyperreactivity. However, it is still controversial whether bronchial hyperreactivity is demonstrable in patients with chro...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.103.5.1477
更新日期:1993-05-01 00:00:00
abstract:BACKGROUND:Severe pneumonia requiring ICU admission has not been well characterized with respect to long-term outcomes or predictors thereof. We examined the association between premorbid functional status and mortality in patients with severe pneumonia. METHODS:From 2000 to 2002, a population-based cohort of adults w...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.10-1054
更新日期:2011-01-01 00:00:00
abstract:STUDY OBJECTIVE:Data on the prevalence of myocarditis in children are limited. Autopsy studies have shown that myocarditis is often undiagnosed. We attempted to investigate the clinical features of asymptomatic myocarditis in four schoolchildren detected during a mass ECG screening in schoolchildren. DESIGN AND SETTIN...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.116.2.340
更新日期:1999-08-01 00:00:00
abstract::From 1982 to 1989, ECD was performed on 18 patients suffering from poorly-tolerated massive pulmonary embolism, for whom classic treatments (fibrinolytics and surgery) were impossible. Eleven of these 18 patients immediately improved (S group). This procedure was unsuccessful in other seven patients (F group). Thirtee...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.100.3.655
更新日期:1991-09-01 00:00:00
abstract:BACKGROUND:The prevalence of COPD is estimated to 4 to 14%. According to the Global Initiative for Chronic Obstructive Lung Disease guidelines, COPD is divided into four stages. Patients with stage IV disease (very severe) have FEV1 < 30% of predicted values and/or respiratory insufficiency. The few studies that exist ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.130.3.666
更新日期:2006-09-01 00:00:00
abstract::Aspiration of a foreign body into the lower airways is a common occurrence and can cause significant morbidity and mortality in humans. Most foreign bodies of the tracheobronchial tree are inanimate. However, the medical literature includes reports of live foreign bodies in the airways. Fish, leeches, and roundworms a...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1016/j.chest.2016.10.041
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Little is known about factors determining the pathogenesis and severity of asthma in Latin American countries. Costa Rica, one of the most prosperous Latin American nations, has a very high asthma prevalence. OBJECTIVE:To examine the relation between potential risk factors and childhood asthma in Costa Rica...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.120.3.785
更新日期:2001-09-01 00:00:00
abstract::The clinical, roentgenographic and laboratory findings, their relationship to each other and to the subsequent hospital course are reported for 14 victims of gaseous ammonia inhalation. Initial physical examination enabled differentiation of a mildly affected from a moderately affected group, but patients in both grou...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.77.4.496
更新日期:1980-04-01 00:00:00
abstract::The use of intermittent positive-pressure ventilation via nasal mask with a rocking bed provided the necessary ventilatory support for a person with quadriplegia living at home. This option was required to maintain an independent life-style of choice. The combination of techniques and the linkage of devices demonstrat...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.99.3.627
更新日期:1991-03-01 00:00:00
abstract::Epidemiologic research has revealed a substantial portion of the general population with abnormal spirometry results that are characterized by decreased FEV1 and FVC but a preserved FEV1/FVC ratio. This restrictive spirometry pattern (RSP) is inconsistently defined in the literature and not well addressed by current g...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.15-1045
更新日期:2016-01-01 00:00:00
abstract:STUDY OBJECTIVE:This study aimed to evaluate the effects of nasal continuous positive airway pressure (nCPAP) therapy on sleep and daytime symptoms of bed partners and patients with obstructive sleep apnea (OSA). DESIGN:A cross-sectional questionnaire survey. SETTING:The sleep laboratory of a university teaching hosp...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.111.5.1261
更新日期:1997-05-01 00:00:00
abstract:STUDY OBJECTIVES:To evaluate early and late lung function abnormalities and their predictors in a large sample of children who underwent bone marrow transplantation (BMT) for leukemias in the 1990s, highlighting changes with respect to the 1980s. DESIGNS:Prospective cohort. SETTING:A university department of pediatri...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.120.6.1900
更新日期:2001-12-01 00:00:00
abstract:CASE PRESENTATION:An 84-year-old man without a history of smoking presented with progressive dyspnea of 6 months' duration accompanied by fatigue and unintentional weight loss. He denied fever, chills, chest pain, hemoptysis, rash, joint pains, or muscle aches. He had multiple hospitalizations for similar presentations...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2017.03.013
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:A serum galactomannan (GM) assay has been approved for diagnosing invasive aspergillosis (IA). However, the role of the BAL-GM assay has not been well established. Therefore, we conducted a metaanalysis to determine the overall accuracy of BAL-GM in the diagnosis of IA. METHODS:After a systematic review of ...
journal_title:Chest
pub_type: 杂志文章,meta分析
doi:10.1378/chest.10-0488
更新日期:2010-10-01 00:00:00
abstract::Endogenously produced oxides of nitrogen appear to play important roles in tissue and organ homeostasis. Endogenous production of nitric oxide, which can be altered in response to various stimuli, can modulate vascular tone, oxyradical cascades, cell adhesion, and other aspects of inflammation. Because exogenously adm...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.113.5.1360
更新日期:1998-05-01 00:00:00
abstract::Imaging and Doppler echocardiography permits assessment of right ventricular size and systolic function and of pulmonary arterial pressures, and it may facilitate detection of thromboemboli within the heart or pulmonary artery. In patients with acute pulmonary embolism of sufficient severity to appreciably increase ri...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.101.4_supplement.151s
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:The study aimed to evaluate the effect of upper extremity resistance training for patients with COPD on dyspnea during activity of daily living (ADL), arm function, arm exercise capacity, muscle strength, and health-related quality of life (HRQL). METHODS:Patients were randomly assigned to an intervention o...
journal_title:Chest
pub_type: 杂志文章,随机对照试验
doi:10.1378/chest.10-1292
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:It would be valuable to have a noninvasive method of measuring impaired pulmonary gas exchange in patients with lung disease and thus reduce the need for repeated arterial punctures. This study reports the results of using a new test in a group of outpatients attending a pulmonary clinic. METHODS:Inspired a...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2018.02.001
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:International time trends in asthma mortality have played an important sentinel role in the identification of two epidemics of asthma mortality in some countries in the 1960s and the 1970s and 1980s. Since then, little attention has been paid to the ongoing international time trends. METHODS:Country-specifi...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.08-2082
更新日期:2009-04-01 00:00:00
abstract::Bronchopulmonary endometriosis is a rare cause of hemoptysis. We describe a woman with catamenial hemoptysis which was localized with chest CAT scanning and treated successfully with danazol. The proposed pathogenesis and manifestations of thoracic endometriosis are reviewed, and the use of new diagnostic and therapeu...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.87.5.687
更新日期:1985-05-01 00:00:00
abstract:STUDY OBJECTIVE:To assess whether myocardial contrast echocardiography (MCE) using harmonic power Doppler (HPD) in conjunction with the transvenous contrast agent SHU 563A would be useful in detecting stunned but viable myocardium. DESIGN:Acute coronary occlusion (2 to 3 h) followed by 1 h of reperfusion was created i...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.120.2.567
更新日期:2001-08-01 00:00:00
abstract::Prior antibiotic therapy, size of the infiltrate, and the person who performed the technique were the three factors that we studied to assess their influence on the effectiveness of transthoracic needle aspiration (TNA). Ninety-one patients with a diagnosis of severe bacterial pneumonia, who underwent TNA, have been i...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.107.1.96
更新日期:1995-01-01 00:00:00
abstract::The timing of surgical treatment of empyema remains controversial. Traditionally, thoracotomy is performed either within three weeks of diagnosis or delayed until presumed pleurodesis occurs. Often, these patients are moribund and the duration of illness impossible to determine. We report our surgical results in seven...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.90.4.511
更新日期:1986-10-01 00:00:00
abstract:BACKGROUND:The new GOLD (Global Initiative for Chronic Obstructive Lung Disease) strategy recommends use of the COPD Assessment Test (CAT) or modified Medical Research Council (mMRC) scale to assess symptoms in COPD against "risk" as assessed by spirometry or exacerbation frequency. We aimed to determine the concordanc...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.13-0161
更新日期:2013-10-01 00:00:00