Abstract：
:VAP is clearly associated with an increased mortality, principally because of virulent pathogens such as P. aeruginosa. Part of the increased mortality may be due to inadequacies of antibiotic therapy. Apparent failure of antibiotic therapy has many causes; some are related to deficiencies of the antibiotic therapy, but others are unrelated. Antibiotic failure can be the result of persistence of the original causative organism because of resistance, inadequate local antibiotic levels, anatomic limitations, or to the development of superinfection, either pneumonia or extrapulmonary. Factors probably unrelated to the adequacy of antibiotic regimens include misdiagnosis of the source of infection or causative organism, SIRS associated with the VAP, and the immunocompetency of the host. The pattern of apparent failure can assist in determination of the cause. Four typical patterns are rapid early progression; persistent pneumonia; initial improvement followed by deterioration; and slow, progressive improvement. The deficiencies of tracheal aspirate cultures and portable chest radiographs make determination of the cause of apparent failure difficult by these methods. Therefore, more accurate but invasive or expensive tests are usually required to avoid spiraling empirical antibiotic therapy. Quantitative bronchoscopic cultures and chest CT scans are most likely to lead to an accurate evaluation and appropriate antibiotic changes.
journal_name
Clin Chest Medjournal_title
Clinics in chest medicineauthors
Wunderink RGsubject
Has Abstractpub_date
1995-03-01 00:00:00pages
173-93issue
1eissn
0272-5231issn
1557-8216journal_volume
16pub_type
杂志文章,评审abstract：:This article provides a systematic review of the literature on the application of noninvasive ventilation in various forms of hypercapnic and hypoxemic respiratory failures. A description of the underlying pathophysiology is followed by a review of physiologic data explaining the mechanisms of action of noninvasive ve...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70330-0
更新日期：1996-09-01 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
abstract：:Illicit drug users comprise a substantial and growing proportion of the HIV-infected population. Although they develop pulmonary complications common to all HIV transmission groups, they also have unique respiratory illnesses due to the direct effect of the illicit drugs on the lung. Bacterial infections, tuberculosis...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70348-8
更新日期：1996-12-01 00:00:00
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 overus...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2011.05.009
更新日期：2011-09-01 00:00:00
abstract：:Obesity hypoventilation syndrome has been noted for centuries, yet we still are trying to uncover the exact mechanisms behind the disease and best treatment modalities for patients afflicted by the condition. The syndrome, which results in symptoms based on a diverse spectrum of interactions between obesity, ventilato...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2018.01.006
更新日期：2018-06-01 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：:This article concentrates on those factors that are particularly important for performing and interpreting lung function tests in children. Specifically, technical considerations such as equipment, personnel, test performance, and bronchoprovocation procedures are discussed. Changes in lung function with growth and ap...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1987-12-01 00:00:00
abstract：:The adult respiratory distress syndrome is a reaction of the lung to a variety of severe direct or indirect pulmonary insults. It is characterized by acute respiratory distress, severe hypoxemia requiring high oxygen fractions, and "stiff lungs" requiring approaches to ventilatory management cited elsewhere in this is...
journal_title：Clinics in chest medicine
pub_type： 杂志文章
doi：
更新日期：1982-01-01 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：:Primary graft dysfunction (PGD) is the most important cause of early morbidity and mortality following lung transplantation. PGD affects up to 25% of all lung transplant procedures and currently has no proven preventive therapy. Lung transplant recipients who recover from PGD may have impaired long-term function and a...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2011.02.007
更新日期：2011-06-01 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：: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：:Since last reviewed in this forum, there have been remarkable advances in our understanding of the acute inflammatory process and how it contributes to the development of ALI. As stated in the beginning of this article, it is not possible to even begin to review all the specific advances that have been made. Instead, ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70159-3
更新日期：2000-09-01 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 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 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：:Pleural malignancies are ideal for novel therapeutic approaches because they are invariably fatal. Intrapleural (IP) chemotherapy has only marginal benefit in pleural malignancies, but may prove efficacious with hyperthermic chemotherapy administered in combination with maximal tumor debulking. IP immunotherapies may ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2013.04.007
更新日期：2013-09-01 00:00:00
abstract：:This article reviews the basic pathophysiologic mechanisms underlying the abnormal pulmonary gas exchange often seen in patients with cirrhosis. To summarize, the following keypoints seem appropriate: (1) Patients with cirrhosis have a low pulmonary vascular tone characterized by a poor or absent hypoxic pressor respo...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70298-7
更新日期：1996-03-01 00:00:00
abstract：:This article focuses on thoracoscopy for pleural procedures, both diagnostic and therapeutic, and discusses whether there is a difference between pleuroscopy and thoracoscopy or video-assisted thoracic surgery. How thinking should be structured regarding the management of pleural disease in the modern context of avail...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2012.12.002
更新日期：2013-03-01 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：:It has been proposed that invasive carcinoma of the bronchus develops through a transition from preinvasive lesions to overt malignancy. Newer diagnostic technologies have provided a more sensitive way to diagnose preinvasive lesions and a better understanding of the prevalence of such lesions. The natural history of ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2011.08.008
更新日期：2011-12-01 00:00:00
abstract：:Available data show that Africa, together with the Americas and western and central Europe, reported the lowest prevalence of multidrug-resistant tuberculosis (MDR-TB). However, sub-Saharan Africa has a high TB incidence and the highest human immunodeficiency virus (HIV) prevalence in the world, and because of the hig...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2009.08.019
更新日期：2009-12-01 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：:The term "steroid-resistant (SR) asthma" has been used to describe a group of asthmatics who demonstrate persistent airway obstruction and inflammation despite treatment with high doses of systemic glucocorticoids. There are at least two forms of SR asthma, that is, primary and acquired types. Type I SR asthma is acqu...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70405-6
更新日期：1997-09-01 00:00:00
abstract：:A variety of mechanical devices may be used to provide assistance when ventilation and cough are severely impaired by progressive respiratory weakness caused by neuromuscular disease. Traditionally, positive pressure ventilation via a tracheostomy has been used, but if upper airway function is adequate, a variety of n...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1994-12-01 00:00:00
abstract：:Endobronchial ablative therapies, such as mechanical debulking, laser therapy, electrocautery, argon plasma coagulation, cryotherapy, brachytherapy, photodynamic therapy, microdebrider bronchoscopy, resector balloon deobstruction, and intratumoral chemotherapy, are performed through a rigid or flexible bronchoscope in...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2017.11.008
更新日期：2018-03-01 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：:Chronic lung diseases, including chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH), are unusually prevalent among persons infected with human immunodeficiency virus (HIV). Often these disease states are identified at younger ages than would be expected in the general population. Recent epide...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2013.01.010
更新日期：2013-06-01 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
