Abstract:
:In therapy for ventilator-associated pneumonia, it is essential to get initial empiric therapy correct; this is challenging because many patients are infected with multidrug-resistant pathogens. The need for achieving appropriate therapy can lead to broad-spectrum empiric therapy, which can represent antibiotic overuse and promote even more resistance. In an effort to combat this problem, de-escalation therapy has been proposed, with the goals of reducing the number of drugs, the spectrum of therapy, and the duration of therapy. This review examines the factors associated with an effective de-escalation strategy and ways to increase the rates of de-escalation in the future.
journal_name
Clin Chest Medjournal_title
Clinics in chest medicineauthors
Niederman MS,Soulountsi Vdoi
10.1016/j.ccm.2011.05.009subject
Has Abstractpub_date
2011-09-01 00:00:00pages
517-34issue
3eissn
0272-5231issn
1557-8216pii
S0272-5231(11)00057-8journal_volume
32pub_type
杂志文章,评审abstract::Pulmonary hypertension is a frequently encountered problem in older patients. True idiopathic pulmonary arterial hypertension can also be seen and requires careful exclusion in older patients. Institution of therapies must be tempered with an appreciation of individual comorbidities and functional limitations that may...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2007.08.006
更新日期:2007-12-01 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::The combination of the unique pathologic features of usual interstitial pneumonia (UIP) on biopsy, the progressive clinical course, and resistance to anti-inflammatory therapy constitutes the cardinal manifestations of what is termed idiopathic pulmonary fibrosis (IFP)/usual interstitial pneumonia, and it has led to r...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2004.04.003
更新日期:2004-12-01 00:00:00
abstract::Systemic lupus erythematosus (SLE) is a potentially severe, frequently disabling autoimmune disease with multiorgan involvement and a typically waxing and waning course. SLE is often considered the prototypical autoimmune disease. Although SLE has the potential to affect any organ, the lungs are commonly involved late...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2010.05.001
更新日期:2010-09-01 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::Infections due to the rapidly growing mycobacteria are being identified with increasing frequency, especially in the southern coastal United States. Cutaneous disease, including both community-acquired infections and nosocomial diseases such as augmentation mammaplasty wound infections and sternal wound infections, ar...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1989-09-01 00:00:00
abstract::Many pathologists and pulmonologists have trained and practiced in an era during which therapeutic options for patients have increased manyfold with regard to pharmacologic agents. Toxicity to the lung may be recognized as data accumulate in the form of case reports and clinical reviews to document the clinical and pa...
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::This article gives a broad overview of the increasingly important applications of bronchoscopy, flexible (FOB) and rigid (RB), in a modern medical intensive care unit. Special emphasis is made to bronchoscopy use in mechanically ventilated patients. Therapies such as endobronchial stenting and Nd:YAG laser are being u...
journal_title:Clinics in chest medicine
pub_type: 杂志文章
doi:10.1016/s0272-5231(05)70041-1
更新日期:2001-06-01 00:00:00
abstract::Pulmonary rehabilitation is an art of medical practice incorporating many therapeutic modalities with the goal of improving the patient's functional ability. The gains to be realized and the basis for improvement following pulmonary rehabilitation are detailed in this article. ...
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::Leptospirosis is a worldwide disease. In this time of globalization knowledge about leptospirosis is important. Although pulmonary involvement has an incidence varying from 20% to 70% and its exteriorization may vary from mild to severe, The severe form appears to be becoming more prevalent (at least in Brazil) and ma...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(01)00010-7
更新日期:2002-06-01 00:00:00
abstract::Early detection and surgical resection are essential for the treatment of lung cancer. It would be ideal to be able to detect and treat preinvasive bronchial lesions, defined as dysplasia and carcinoma in situ before progressing to invasive cancer. Advanced airway-assessment techniques have opened an avenue for early ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2013.04.005
更新日期:2013-09-01 00:00:00
abstract::In general, lung involvement in connective tissue disorders has not been as well defined as has isolated interstitial lung disease; this applies particularly to bronchiolitis, which occurs infrequently. The low prevalence of bronchiolitis may reflect difficulties in making the diagnosis in mild to moderate disease; at...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-12-01 00:00:00
abstract::Although primarily a lung disease, chronic obstructive pulmonary disease (COPD) is now recognized to have extrapulmonary effects on distal organs, the so-called systemic effects and comorbidities of COPD. Skeletal muscle dysfunction, nutritional abnormalities including weight loss, cardiovascular complications, metabo...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2013.10.007
更新日期:2014-03-01 00:00:00
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journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2020.08.016
更新日期:2020-12-01 00:00:00
abstract::Mechanical ventilation has become a very common and well-accepted practice in modern intensive care units. The use of the mechanical ventilator has progressed from being a support system during surgery and for acutely ill patients to being used in both moderate and long-term life support in patients with inadequate ve...
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::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::The features of cardiovascular and pulmonary disease in exercise testing are described. In general, ventilatory limitation is the most common factor in lung disease. An early anaerobic threshold and a decreased VO2 mix in the absence of ventilatory limitation is the usual feature of severe heart disease. ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章
doi:
更新日期:1984-03-01 00:00:00
abstract::Each year, a vast number of individuals are infected with the endemic fungi. An expanding population, along with further land development in endemic areas, will likely continue to place individuals at risk for exposure to these organisms. A high index of suspicion may be required to diagnose histoplasmosis, blastomyco...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70232-x
更新日期:1999-09-01 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 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::There will be many changes in the sleep field in the next 5 to 10 years. These will include increments in our knowledge of the basic neurobiologic mechanisms driving sleep and the impact of sleep loss on general health. The technology used in the sleep laboratory will likely change as well, leading to a larger range o...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70444-5
更新日期:1998-03-01 00:00:00
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journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2013.08.002
更新日期:2013-12-01 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::CT is a useful tool for identification of small airways diseases, and it can be used to classify these entities into inflammatory and constrictive bronchiolitis. Inflammatory forms of bronchiolitis include cellular bronchiolitis (usually caused by infection or aspiration), respiratory bronchiolitis, panbronchiolitis, ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2007.11.008
更新日期:2008-03-01 00:00:00
abstract::Patient adherence to prescribed tuberculosis regimens must be assured to prevent relapse, acquired resistance, and transmission. Directly observed therapy (DOT), an outpatient management strategy designed to ensure adherence, is not widely used because it is perceived to be inordinately expensive. The primary focus of...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70365-8
更新日期:1997-03-01 00:00:00
abstract::Because there is insufficient cellular energy for organisms to perform their functions at the same constant rate and at the same time, all biologic processes show rhythmicity, each with its own unique frequency, amplitude, and phase. Optimal sleep and wakefulness requires proper timing and alignment of desired sleep-w...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2010.02.009
更新日期:2010-06-01 00:00:00
abstract::To conclude, impairment ratings differ among various diseases and compensation programs. It therefore is important to note, at the outset, which compensation program the patient is eligible for because the requirements of the different programs may vary. The physician report must clearly state an opinion using termino...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70395-6
更新日期:1997-09-01 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::Complications of tracheotomy are largely preventable. Although some authors cite these complications as indications for prolonged endotracheal intubation to avoid tracheotomy, others believe that the laryngotracheal complications of prolonged endotracheal intubation warrant early tracheotomy. Obviously, unnecessary tr...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1991-09-01 00:00:00
abstract::Most gravidas with asthma can be managed with an inhaled beta-adrenergic agonist (terbutaline or epinephrine) and beclomethasone dipropionate. The administration of prednisone to control exacerbation of asthma is appropriate and should not be withheld if current medications are inadequate. The outcome of pregnancy in ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1992-12-01 00:00:00