Abstract:
UNLABELLED:Protected specimen brush (PSB) is considered to be one of the standard methods for the diagnosis of ventilator-associated pneumonia, but to our knowledge, intraindividual variability in results has not been reported previously. PURPOSE:To compare the results of two PSB performed in the same subsegment on patients with suspected ICU-acquired pneumonia (IAP). STUDY DESIGN:Between October 1991 and April 1992, each mechanically ventilated patient with suspected IAP underwent bronchoscopy with two successive PSB in the lung segment identified as abnormal on radiographs. Results of the two PSB cultures were compared using 10(3) cfu/ml cutoff for a positive result. Four definite diagnoses were established during the follow up: definite pneumonia, probable pneumonia, excluded pneumonia, and uncertain pneumonia. POPULATION:Forty-two episodes in 26 patients were studied; 60 percent of patients received prior antibiotic therapy. Thirty-two microorganisms were isolated from 24 pairs of PSB. Definite diagnosis was definite pneumonia in 7, probable pneumonia in 8, excluded pneumonia in 17, and uncertain pneumonia in 10 cases. RESULTS:The PSB recovered the same microorganisms and argued for a good qualitative reproducibility. The distinction of positive and negative results on the basis of the 10(3) cfu/ml classic threshold was less reproducible. For 24 percent of the microorganisms recovered and in 16.7 percent of episodes of suspected IAP, the two consecutive samples gave results spread out on each side of the 10(3) cfu/ml cutoff. Discordance was higher when definite diagnosis was certain or probable than when diagnosis was excluded (p = 0.015). There was no statistical effect of the order of samples between the two specimens for bacterial index and microorganism concentrations. CONCLUSION:These findings argue for the poor repeatability of PSB in suspected IAP and question the yield of the 10(3) cfu/ml threshold. In attempting to diagnose IAP, the results of PSB must be interpreted with caution considering the intraindividual variability.
journal_name
Chestjournal_title
Chestauthors
Timsit JF,Misset B,Francoual S,Goldstein FW,Vaury P,Carlet Jdoi
10.1378/chest.104.1.104subject
Has Abstractpub_date
1993-07-01 00:00:00pages
104-8issue
1eissn
0012-3692issn
1931-3543pii
S0012-3692(16)47482-9journal_volume
104pub_type
杂志文章相关文献
CHEST文献大全abstract:BACKGROUND:Architectural design of health-care facilities can influence patient safety; however, it is unknown whether patient outcomes are significantly affected by ICU design. METHODS:Six hundred sixty-four patients admitted to the medical ICU (MICU) of Columbia University Medical Center during 2008 were included in...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.09-1458
更新日期:2010-05-01 00:00:00
abstract:OBJECTIVE:This study applies a stochastic or probability search and display model to prospectively predict outcome and to evaluate therapeutic effects in a consecutively monitored series of 396 patients with severe thoracic and thoracoabdominal injuries. STUDY DESIGN:Prospective observational study of outcome predicti...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.128.4.2739
更新日期:2005-10-01 00:00:00
abstract::Thirty-eight high-risk patients (forced expiratory volume in one second [FEV1] less than 2.0L or maximum voluntary ventilation [MVV] less than 50 per cent of predicted) were observed for a minimum of one year after pneumonectomy for carcinoma of the lung. Operability was assessed by calculating a predicted postoperati...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.80.2.163
更新日期:1981-08-01 00:00:00
abstract:STUDY OBJECTIVE:To examine the hemodynamic and metabolic short-term effects of hypophosphatemia correction in patients with septic shock receiving catecholamine therapy. DESIGN:Prospective, single cohort study. SETTING:ICU, university hospital. PATIENTS:Ten patients with septic shock and hypophosphatemia below 2 mg/...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.107.6.1698
更新日期:1995-06-01 00:00:00
abstract::Continuous measurement of mixed venous oxygen saturation (SvO2) has been suggested as an adjunct in monitoring critically ill patients. We evaluated SvO2 monitoring in 24 patients suffering from complicated myocardial infarctions. Cardiac output and arterial lactate levels were measured when there were persistent 5 pe...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.95.3.607
更新日期:1989-03-01 00:00:00
abstract:BACKGROUND:Obesity hypoventilation syndrome (OHS) conventionally includes awake hypercapnia, but an isolated raised bicarbonate, even in the absence of awake hypercapnia, may represent evidence of "early" OHS. We investigated whether such individuals exhibit certain features characteristic of established OHS. METHODS:...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.14-1279
更新日期:2015-02-01 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::About one-third of the world population has latent TB infection (LTBI), the majority of which is distributed in 22 high-burden countries. Early diagnosis and treatment of active TB remains the top priority in resource-poor countries with high TB prevalence. Notwithstanding, because LTBI contributes significantly to th...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.12-0142
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:The accuracy of combined clinical examination (CE) and chest radiography (CXR) (CE + CXR) vs thoracic ultrasonography in the acute assessment of pneumothorax, hemothorax, and lung contusion in chest trauma patients is unknown. METHODS:We conducted a prospective, observational cohort study involving 119 adul...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.11-0208
更新日期:2012-05-01 00:00:00
abstract::A new bronchoscopic-protected catheter brush (BPCB), designed to obtain uncontaminated bronchial secretions, was studied in vitro and in vivo. The device was composed of a standard biopsy brush, protected by a single catheter and occluded with an agar plug. Ejection of the plug was obtained neither by advancing the br...
journal_title:Chest
pub_type: 临床试验,杂志文章
doi:10.1378/chest.93.4.746
更新日期:1988-04-01 00:00:00
abstract::A 60-year-old laboratory technician developed pulmonary infiltrates consistent with chemical pneumonitis following accidental exposure to a mixture of hydrogen bromide and phosphorus tribromide. A protracted clinical course ensued consistent with bronchiolitis obliterans. These problems may have been avoided if the po...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.94.1.208
更新日期:1988-07-01 00:00:00
abstract:BACKGROUND:Long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) combinations are a treatment option for patients with COPD who continue to have symptoms despite treatment with a LAMA or a LABA alone. The Efficacy and Safety of PT003, PT005, and PT001 in Subjects with Moderate-to-Very Severe COPD (PINN...
journal_title:Chest
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.chest.2016.11.028
更新日期:2017-02-01 00:00:00
abstract::In experimental animals, conditions which drastically decrease cardiac output may reduce the strength and endurance of respiratory muscles leading to hypercapnic respiratory failure. Because patients with chronic CHF have reduced cardiac output and vital capacity (FVC), we measured PImax and PEmax and maximal handgrip...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.98.5.1091
更新日期:1990-11-01 00:00:00
abstract::Two patients were treated for AIDS-associated bilateral pneumothoraces which persisted despite prolonged chest tube drainage. Heimlich flutter valves were used to facilitate the outpatient management of these patients. ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.100.1.281
更新日期:1991-07-01 00:00:00
abstract::Using recently published data, a nomogram was constructed to estimate the likelihood of asthma following methacholine challenge. Based on Bayes' theorem, the nomogram makes use of the sensitivity and specificity of methacholine challenge to calculate the post-test probability of asthma once the physician makes a deter...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.97.3.562
更新日期:1990-03-01 00:00:00
abstract::Collagenases in bronchoalveolar lavage fluid (BALF) of patients with bronchiectasis and healthy subjects were characterized using specific functional and immunologic assays. The BAL fluid contained interstitial collagenase and collagenolytic proteinases of bacterial origin. Collagenase activities, obtained after organ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.107.6.1641
更新日期:1995-06-01 00:00:00
abstract::Since first described in 1984, nontraumatic pneumothoraces in patients with AIDS has become more common. When compared with spontaneous pneumothorax in the general population, pneumothoraces in patients with AIDS are often complicated by prolonged air leaks as well as higher recurrence rates. Chemical pleurodesis has ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.105.3.823
更新日期:1994-03-01 00:00:00
abstract::To assess airway and lung parenchymal damage non-invasively in cystic fibrosis (CF), chest MRI has been historically out of the scope of routine clinical imaging due to technical difficulties such as the low proton density and respiratory and cardiac motion. However, technological breakthroughs have recently emerged t...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1016/j.chest.2020.12.008
更新日期:2020-12-17 00:00:00
abstract::We describe the Ca2+ movements in smooth muscle cells at rest and during activation and relaxation as deduced from transplasmalemmal Ca2+ fluxes and contractile respnses. The general picture which emerges is: the resting cell has a [Ca2+]cyt below 10(-7) M and large gradients are poised across both the cell membrane a...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.78.1_supplement.157
更新日期:1980-07-01 00:00:00
abstract::A 36-year-old man with a history of hypertrophic obstructive cardiomyopathy presented to the emergency room with "stabbing" chest pain. He had undergone dual-chamber pacemaker implantation in 1993 using an atrial lead (Accufix; Telectronics; Englewood, Colo) and a myomectomy in 1996 during which the distal portion of ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.114.2.637
更新日期:1998-08-01 00:00:00
abstract:BACKGROUND:Amphiregulin, a member of the epidermal growth factor family, has been shown to promote the growth of fibroblasts, to be associated with the T-helper type 2 cell adaptive immune response, and to up-regulate mucin gene expression. We aimed to determine whether sputum amphiregulin is expressed at elevated leve...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.08-2972
更新日期:2009-09-01 00:00:00
abstract::Hypothalamic-pituitary-adrenal function in a well-defined, carefully selected group of 25 patients with extrinsic asthma was assessed by measuring plasma levels of adrenocorticotropic hormone (ACTH) and of 11-deoxycorticol after administration of metyrapone and by measuring the level of cortisol following stimulation ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.75.2.161
更新日期:1979-02-01 00:00:00
abstract::Intravenous rtPA (total dose, 100 mg over 3 h) was compared with placebo in a prospective, randomized, double-blind trial in 5,011 patients with suspected AMI of less than 5 h duration. No ECG or enzymatic confirmation of the diagnosis was required for study entry. At 1 month 9.8% of patients given placebo had died co...
journal_title:Chest
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:
更新日期:1989-05-01 00:00:00
abstract:STUDY OBJECTIVES:The differential diagnosis of syndrome X and coronary artery disease (CAD) in patients with evidence of myocardial ischemia may be difficult. The possible difference in coronary calcium detected by electron-beam CT (EBCT) between syndrome X and CAD is rarely evaluated, especially in aged patients with ...
journal_title:Chest
pub_type: 临床试验,杂志文章
doi:10.1378/chest.120.5.1525
更新日期:2001-11-01 00:00:00
abstract:AIMS:This study investigated whether right ventricular (RV) diastolic function is impaired in pulmonary hypertension (PH) patients, and whether it is related to RV mass and afterload. In addition, the effects of an acute reduction of RV afterload by the oral intake of sildenafil were studied. Finally, we assessed wheth...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.06-1263
更新日期:2007-07-01 00:00:00
abstract::Primary neurogenic tumors of the lung are rare. Often, their histologic behavior presents a treatment dilemma. We present a case of benign endobronchial neurilemmoma managed by means of YAG laser resection together with a brief discussion of the management options available for these tumors. ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.95.2.461
更新日期:1989-02-01 00:00:00
abstract::The association between pulmonary impairment and all-cause mortality was investigated among white subjects in a follow-up study of a large national cohort. Pulmonary function was measured during the National Health and Nutrition Examination Survey (NHANESI) (1971 to 1975); subsequent mortality information was obtained...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.103.2.536
更新日期:1993-02-01 00:00:00
abstract::A 79-year-old woman in the course of a syncope evaluation is shown to have a trazodone-related cardiac arrhythmia confirmed by drug rechallenge. This nontricyclic antidepressant should be considered as potentially arrhythmogenic despite its generally favorable cardiovascular profile. ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.98.1.247
更新日期:1990-07-01 00:00:00
abstract::Endoscopic lung volume-reduction therapy for emphysema has been associated with therapeutic responses smaller in magnitude and less durable than surgical volume reduction (LVRS). Bronchoscopic emphysematous lung sealant (ELS) therapy has been shown to produce improvements in pulmonary function similar to surgery at 1 ...
journal_title:Chest
pub_type: 临床试验,杂志文章
doi:10.1378/chest.13-0446
更新日期:2013-11-01 00:00:00
abstract::Ten patients undergoing pneumonectomy were evaluated with the lateral position test (LPT) in addition to routine pulmonary function tests (PFTs). On the basis of the percentage of ventilation estimated to be contributed by each lung on LPT, predictions were made for expected values for each patient's post-pneumonectom...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.77.1.24
更新日期:1980-01-01 00:00:00