Tag: pneumonia

Upvote Story 4
Researchers have assessed the impact antibiotic therapy on short (hospital) and long-term (6 months) outcomes of ICU patients with severe community-acquired pneumonia. Community-acquired pneumonia (CAP) remains one of the leading causes of hospital admission, with 5% to 15% of cases being admitted to an ICU, largely due to complications like shock and respiratory failure. Severe CAP has a mortality rate of about 30%. Yet, despite several... Read More | Comment
Upvote Story 6
Ventilator-associated pneumonia (VAP) remains a serious complication of mechanical ventilation (MV), and has an incidence between 2 and 16 episodes per 1000 ventilator-days, an attributable mortality of 5–13%, excess ICU length of stay (LOS) for survivors up to 9 days, and extra costs. Many studies have reported decreased VAP rates associated with the use of bundles of preventive measures. Fewer studies have reported compliance with... Read More | Comment
Upvote Story 6
Critical illness can disrupt local and systemic mechanisms that protect against upper gastrointestinal bleeding, a condition that may be associated with increased mortality, particularly among patients receiving extracorporeal life support. On the basis of randomized trials performed over a period of 40 years,3 most guidelines recommend preventive therapy with either histamine H2–receptor antagonists or proton-pump inhibitors (PPIs) for patients in the intensive care unit (ICU)... Read More | Comment
Upvote Story 13
Among patients with severe traumatic brain injury (TBI), early prophylactic hypothermia compared with normothermia did not improve neurologic outcomes at 6 months. These findings do not support the use of early prophylactic hypothermia for patients with severe traumatic brain injury. Among 511 patients who were randomized, 500 provided ongoing consent (mean age, 34.5 years [SD, 13.4]; 402 men [80.2%]) and 466 completed the primary outcome... Read More | Comment
Upvote Story 6
This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the noninferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in pregnant women and outside the operating room. Of 3472 patients randomized, mean (SD) age was 51 (19) years and 1777 (51%) were men. The primary end point, pulmonary aspiration, occurred in 10 patients (0.6%) in... Read More | Comment
Upvote Story 6
Intensive care is an interesting specialty. From all the early excitement in the 1970s, passing through two decades of intensive physiological use at the bedside, intensive care landed on the rough ground of modern randomized controlled trials (RCTs) in the late 1990s and early 2000s. The increasing number of critically ill patients coupled with new monitoring devices and important funding both from governmental and private... Read More | Comment
Upvote Story 7
Troponin assays are integral to the diagnosis of acute myocardial infarction (AMI), but there is concern that testing is over utilized and may not conform to published guidelines. We reviewed all testing performed at 14 hospitals over 12 months and associated troponin values with the primary and secondary diagnoses for each visit. Troponin was determined to be negative, indeterminate or elevated based on reference ranges.... Read More | Comment
Upvote Story 11
Among patients with E coli or K pneumoniae bloodstream infection and ceftriaxone resistance, definitive treatment with piperacillin-tazobactam compared with meropenem did not result in a noninferior 30-day mortality. These findings do not support use of piperacillin-tazobactam in this setting. Among 379 patients (mean age, 66.5 years; 47.8% women) who were randomized appropriately, received at least 1 dose of study drug, and were included in the... Read More | Comment
Upvote Story 5
A recently released report using data from the National Hospital Care Survey (NHCS) verifies existing data on the prevalence of pneumonia in hospitalizations and emergency department (ED) visits and provides the first-ever data collection on diagnostic testing, length of stay (LOS), intensive care unit (ICU) stays, and mortality. The report from the NHCS included only patients with first-listed diagnoses of pneumonia, meaning that pneumonia was... Read More | Comment
Upvote Story 7
Mr. Jackson is a 36-year-old man whom you are caring for in the intensive care unit (ICU). Before this hospitalization, he was healthy and took no medications. He has never smoked, and he drinks three or four beers every week. A week ago, a couple of coworkers in his office had respiratory illnesses, and a day later, he started having fever, chills, cough, and generalized... Read More | Comment
Upvote Story 16
Administration of corticosteroids in patients with severe influenza pneumonia is associated with increased ICU mortality, and these agents should not be used as co‑adjuvant therapy. A total of 1846 patients with primary influenza pneumonia were enrolled. Corticosteroids were administered in 604 (32.7%) patients, with methylprednisolone the most frequently used corticosteroid (578/604 [95.7%]). Secondary analysis of a prospective cohort study of critically ill patients with confirmed... Read More | Comment
Upvote Story 5
These findings support the use of the IDSA/ATS minor criteria to predict hospital mortality and guide ICU admission in inpatients with Community-Acquired Pneumonia (CAP) who do not require emergency mechanical ventilation or vasopressors. 1242 patients were studied (mean age 65.7 years, hospital mortality 14.7%). The areas under the receiver operating characteristic curves for the IDSA/ATS minor criteria were 0.88 (95% CI 0.86 to 0.91) and... Read More | Comment
Upvote Story 4
Time since symptom onset modifies the systemic inflammatory profile at Community-acquired Pneumonia (CAP) diagnosis. This information has relevant clinical implications for management, and it should be taken into account in the design of future clinical trials. In early presenters, CRP was significantly lower, whereas PCT, IL-6, and IL-8 were higher. Nonearly presenters showed significantly lower PCT, IL-6, and IL-8 levels. In the validation cohort, CRP... Read More | Comment
Upvote Story 6
Since the rate of gastrointestinal bleeding requiring endoscopic hemostasis is not different comparing patients with and without stress ulcer prophylaxis, and the increase in hospital-acquired pneumonia is significant, routine stress ulcer prophylaxis for patients with severe sepsis may be unnecessary. One-to-one propensity score matching created 15,651 pairs of patients who received stress ulcer prophylaxis within 2 days of admission and those who did not. Patient... Read More | Comment
Upvote Story 4
Chronic high alcohol consumption significantly increases the risk of ARDS. This finding suggests that patients admitted to hospital should be screened for chronic alcohol use. Seventeen observational studies (177,674 people) met the inclusion criteria. Meta-analysis of 13 studies showed that any measure of high relative to low alcohol consumption was associated with a significantly increased risk of ARDS. Read More | Comment
Upvote Story 8
The environment could be as important a battle ground as the clinic in the global fight against the spread of antibiotic resistance, new research has shown. A study conducted at the University of Exeter Medical School concluded that when bacteria are exposed to very low concentrations of antibiotics, numbers of antibiotic resistant bacteria increase just as much as at high clinical concentrations. Antimicrobial resistance (AMR)... Read More | Comment
Upvote Story 7
Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil. The main objective is to evaluate the incidence and risk factors of pressure ulcers (PU) in adult patients admitted to intensive care units (ICUs), as well as the outcome (including ICU and hospital mortality) of these patients. We evaluated 332 patients, 52.1% male, mean age 63.1 years. The... Read More | Comment
Upvote Story 5
Consequences of pulmonary aspiration can be biphasic with dissimilar sequelae. An early phase, coined pneumonitis, involves an inflammatory reaction to gastrointestinal contents with a pH typically less than 2.4 resulting in rapid clinical deterioration and recovery typically within 48 hours. Controversy in distinguishing pneumonia from pneumonitis in an effort to safely discontinue antibiotics may still remain as TPC is not routinely available in the United... Read More | Comment
Upvote Story 8
Immunosuppression is frequent in patients with acute respiratory distress syndrome (ARDS), and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures.... Read More | Comment
Upvote Story 8
Approximately 50 percent of all patients receiving mechanical ventilator support develop ventilator-associated pneumonia (VAP). Researchers at Massachusetts General Hospital (MGH) have developed an automated system for identifying patients at risk for complications associated with the use of mechanical ventilators. The new system uses an algorithm that has been shown to be 100 percent accurate in identifying at-risk patients when provided with necessary data, according to... Read More | Comment