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Ventilator-associated Pneumonia (ventilator-associated + pneumonia)
Selected AbstractsEvidence-based algorithms for diagnosing and treating ventilator-associated pneumonia,JOURNAL OF HOSPITAL MEDICINE, Issue 5 2008Richard J. Wall MD Abstract BACKGROUND: Ventilator-associated pneumonia (VAP) is widely recognized as a serious and common complication associated with high morbidity and high costs. Given the complexity of caring for heterogeneous populations in the intensive care unit (ICU), however, there is still uncertainty regarding how to diagnose and manage VAP. OBJECTIVE: We recently conducted a national collaborative aimed at reducing health care,associated infections in ICUs of hospitals operated by the Hospital Corporation of America (HCA). As part of this collaborative, we developed algorithms for diagnosing and treating VAP in mechanically ventilated patients. In the current article, we (1) review the current evidence for diagnosing VAP, (2) describe our approach for developing these algorithms, and (3) illustrate the utility of the diagnostic algorithms using clinical teaching cases. DESIGN: This was a descriptive study, using data from a national collaborative focused on reducing VAP and catheter-related bloodstream infections. SETTING: The setting of the study was 110 ICUs at 61 HCA hospitals. INTERVENTION: None. MEASUREMENTS AND RESULTS: We assembled an interdisciplinary team that included infectious disease specialists, intensivists, hospitalists, statisticians, critical care nurses, and pharmacists. After reviewing published studies and the Centers for Disease Control and Prevention VAP guidelines, the team iteratively discussed the evidence, achieved consensus, and ultimately developed these practical algorithms. The diagnostic algorithms address infant, pediatric, immunocompromised, and adult ICU patients. CONCLUSIONS: We present practical algorithms for diagnosing and managing VAP in mechanically ventilated patients. These algorithms may provide evidence-based real-time guidance to clinicians seeking a standardized approach to diagnosing and managing this challenging problem. Journal of Hospital Medicine 2008;3:409,422. © 2008 Society of Hospital Medicine. [source] Decreased incidence of ventilator-associated pneumonia caused by Pseudomonas aeruginosa over 3 yearsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2000M. Fiore Background Ventilator-associated pneumonia (VAP) is a frequently occurring infection among critically ill patients. Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli are the most common micro-organisms causing VAP. The aim of this study was to ascertain the incidence of VAP diagnosed with bronchoalveolar lavage (BAL) by these possible pathogenic micro-organisms (PPMOs). Because VAP is often preceded by colonization of the oropharynx with the causative pathogen, sputum cultures were compared with the BAL cultures. Methods Over a 3-year period, all ventilated patients in two intensive care units (n = 1136) were reviewed for pneumonia. A VAP was present when the bacterial count of the BAL was more than 104 colony-forming units ml,1. The microbial results of all patients with a VAP (polymicrobial or monomicrobial) were recorded. Results The mean incidence of VAP was 8 per cent (n = 92), decreasing only slightly during the period (P > 0·05). The most frequent aetiological agents were P. aeruginosa (n = 34), S. aureus (n = 22), E. coli (n = 16) and K. pneumoniae (n = 10). The percentage of VAPs due to P. aeruginosa has declined progressively from 53 to 31 per cent. Concurrently, the incidence of Pseudomonas colonizing the sputum culture has declined (from 54 to 44 per cent). On the other hand, the incidence of VAP due to E. coli has increased from 13 (n = 2) to 36 per cent (n = 6). Colonization of the sputum with E. coli has similarly increased (from 13 to 27 per cent). Conclusion The incidence of VAP in the intensive care unit is in accordance with the literature, when diagnosed with strict criteria. No significant change in the incidence of VAP was noted during the 3-year period. Neither the decrease in incidence of VAP caused by P. aeruginosa nor the increase in E. coli pneumonia can be explained by a change in antibiotic regimens in the period studied. Hypothetically, cross-colonization of PPMOs by healthcare personnel can be influenced by hand-washing and wearing gloves. This can especially influence colonization by P. aeruginosa, thus explaining the decrease. © 2000 British Journal of Surgery Society Ltd [source] Closed suctioning system: Critical analysis for its useJAPAN JOURNAL OF NURSING SCIENCE, Issue 1 2010Nahoko HARADA Abstract Aim:, To determine the efficacy and effectiveness of the closed suctioning system. Method:, Literature review articles were accessed from the following databases: PubMed, EMBASE, CINAHL, and Cochrane Library. The literature review criteria included: all publication styles except meta-analysis, participants that were ,18 years, written in English, and published between 1973 and 2008. Results:, This literature review revealed that the efficacy and effectiveness of the closed suctioning system remains to be demonstrated. The device manufacturers' studies focused on cost reduction, cross-contamination, and preservation of the oxygen saturation of patients during endotracheal suctioning; however, the clinical studies focused on the use of closed suctioning systems to prevent ventilator-associated pneumonia. The reviewed studies had small sample sizes with heterogeneous demographics and non-randomized controls. Recent studies suggest that closed suctioning systems are no better than open suctioning systems in terms of mortality, morbidity, or the cost-benefit ratio. A few studies did indicate that the closed suctioning system might reduce the loss of lung volume and oxygen desaturation. Conclusion:, The studies reviewed in this article suggest that the evidence on the efficacy and effectiveness of closed suctioning systems is inconclusive. Only limited populations will benefit clinically from the use of this device. There is a need for further studies with randomized controlled trials to explore the use of closed suction systems and to update current clinical practise guidelines. [source] Pharmaceutical strategies to prevent ventilator-associated pneumoniaJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 4 2003Roisin McCrory ABSTRACT The increasing incidence of hospital-acquired (nosocomial) infection is a disturbing phenomenon resulting in significant patient mortality and putting considerable strain on healthcare budgets and personnel. One particularly serious aspect of nosocomial infection is that of ventilator-associated pneumonia (VAP). This arises in patients who receive mechanical ventilation within the intensive care unit. The quoted incidence of VAP varies widely (5,67%) and the reported mortality of patients with VAP is in the range of 24,71%. This review will examine the many factors that account for these wide ranges reported, including the patient population under investigation, the causative organism, the method of diagnosis, interventions employed and preventative strategies. The use of bioactive and drug-impregnated biomaterials for endotracheal tube construction is discussed as novel approaches to the prevention of VAP. [source] Mechanical Ventilation Exacerbates Alveolar Macrophage Dysfunction in the Lungs of Ethanol-Fed RatsALCOHOLISM, Issue 8 2005Pradip P. Kamat Background: Patients with alcohol abuse have a two- to three-fold increased risk of acute lung injury and respiratory failure after sepsis or trauma but are also at increased risk of nosocomial pneumonia. Mechanical ventilation exacerbates lung injury during critical illnesses. In this study we tested whether mechanical ventilation of the alcoholic lung promotes on balance a proinflammatory phenotype favoring ventilator-induced lung injury or an immunosuppressive phenotype favoring ventilator-associated pneumonia. Methods: Lungs from rats fed an isocaloric diet with or without ethanol (six weeks) were isolated and ventilated ex vivo with a low-volume (protective) or high-volume (injurious) strategy for two hours with or without prior endotoxemia (two hours). In other experiments, rats were subjected to high-volume ventilation in vivo. Airway levels of the proinflammatory cytokines tumor necrosis factor-,, macrophage inflammatory protein-2, and interleukin-1, were determined after mechanical ventilation ex vivo and compared with edematous lung injury after high-volume ventilation in vivo. In parallel, alveolar macrophage phagocytosis of bacteria and secretion of interleukin-12 during ventilation ex vivo and endotoxin-stimulated alveolar macrophage phagocytosis and tumor necrosis factor-, secretion in vitro were determined. Results: Ethanol ingestion suppressed the proinflammatory response to injurious mechanical ventilation and did not increase experimental ventilator-induced lung injury. In parallel, ethanol ingestion blunted the innate immune response of alveolar macrophages during injurious ventilation ex vivo and after endotoxin stimulation in vitro. Conclusions: Ethanol ingestion dampens ventilator-induced inflammation but exacerbates macrophage immune dysfunction. These findings could explain at least in part why alcoholic patients are at increased risk of ventilator-associated pneumonia. [source] Incidence and risk factors for the development of acute renal failure in patients with ventilator-associated pneumoniaNEPHROLOGY, Issue 3 2006GUL GURSEL SUMMARY: Aim: Infections are one of the most important risk factors for the development of acute renal failure (ARF) and ventilator-associated pneumonia (VAP) has been reported as one of the most frequent infection in intensive care units (ICU). Sepsis, shock, multiorgan dysfunction syndrome (MODS), use of nephrotoxic antibiotics and mechanical ventilation are potential risk factors for development of ARF during VAP. The objective of the study was to evaluate the incidence of ARF in patients with VAP and the role of VAP-related potential risk factors in the development of ARF. Methods: One hundred and eight patients who were admitted to the pulmonary ICU of a university hospital and developed VAP were included in this prospective observational cohort study. Only first episodes of VAP were studied. Diagnosis was based on microbiologically confirmed clinical findings. Potential outcome variables including responsible pathogens, recurrence, polymicrobial aetiology, bacteraemia, multidrug resistance of microorganisms, late/early VAP and sepsis and other known risk factors for development of ARF were evaluated. Risk factors were analysed by logistic regression analysis for significance. Results: Incidence of ARF was 38% (n = 41). Pneumonia with multidrug resistant pathogens (odds ratio, (OR) 5; 95% confidence interval (95%CI), 1.5,18; P = 0.011), sepsis (OR, 5.6; 95%CI, 1.7,18; P = 0.005) and severity of admission disease (Acute Physiology and Chronic Health Evaluation II score: OR, 1.1; 95%CI, 1.02,1.3; P = 0.017) were independent risk factors for the development of ARF during VAP episodes in multivariate analysis. Conclusion: These results showed that the incidence of ARF is high during the VAP episodes and that VAP developed with multidrug resistant pathogens and sepsis have an independent effect on the development of ARF. [source] Colistimethate sodium therapy for multidrug-resistant isolates in pediatric patientsPEDIATRICS INTERNATIONAL, Issue 3 2010Solmaz Celebi Abstract Aim:, The aim of the present study was to assess the efficacy and safety of colistimethate sodium therapy in multidrug-resistant nosocomial infections caused by Pseudomonas aeruginosa or Acinetobacter baumannii in neonates and children. Methods:, Pediatric patients hospitalized at the Uludag University Hospital who had nosocomial infections caused by multidrug-resistant P. aeruginosa or A. baumannii, were enrolled in the study. Colistimethate sodium at a dosage of 50,75 × 103 U/kg per day was given i.v. divided into three doses. Results:, Fifteen patients received 17 courses of colistimethate sodium for the following infections: ventilator-associated pneumonia (n= 14), catheter-related sepsis (n= 1) and skin and soft-tissue infection (n= 2). The mean age of patients was 53.2 + 74.7 months (range, 8 days,15 years) and 60% were male. Mortality was 26.6%. Conclusion:, Colistimethate sodium appears to be safe and effective for the treatment of severe infections caused by multidrug-resistant P. aeruginosa or A. baumannii in pediatric patients. [source] Consider position of patient to prevent ventilator-associated pneumoniaANAESTHESIA, Issue 5 2000T. Engelhardt [source] Analyzing Incomplete Data Subject to a Threshold using Empirical Likelihood Methods: An Application to a Pneumonia Risk Study in an ICU SettingBIOMETRICS, Issue 1 2010Jihnhee Yu Summary The initial detection of ventilator-associated pneumonia (VAP) for inpatients at an intensive care unit needs composite symptom evaluation using clinical criteria such as the clinical pulmonary infection score (CPIS). When CPIS is above a threshold value, bronchoalveolar lavage (BAL) is performed to confirm the diagnosis by counting actual bacterial pathogens. Thus, CPIS and BAL results are closely related and both are important indicators of pneumonia whereas BAL data are incomplete. To compare the pneumonia risks among treatment groups for such incomplete data, we derive a method that combines nonparametric empirical likelihood ratio techniques with classical testing for parametric models. This technique augments the study power by enabling us to use any observed data. The asymptotic property of the proposed method is investigated theoretically. Monte Carlo simulations confirm both the asymptotic results and good power properties of the proposed method. The method is applied to the actual data obtained in clinical practice settings and compares VAP risks among treatment groups. [source] Decreased incidence of ventilator-associated pneumonia caused by Pseudomonas aeruginosa over 3 yearsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2000M. Fiore Background Ventilator-associated pneumonia (VAP) is a frequently occurring infection among critically ill patients. Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli are the most common micro-organisms causing VAP. The aim of this study was to ascertain the incidence of VAP diagnosed with bronchoalveolar lavage (BAL) by these possible pathogenic micro-organisms (PPMOs). Because VAP is often preceded by colonization of the oropharynx with the causative pathogen, sputum cultures were compared with the BAL cultures. Methods Over a 3-year period, all ventilated patients in two intensive care units (n = 1136) were reviewed for pneumonia. A VAP was present when the bacterial count of the BAL was more than 104 colony-forming units ml,1. The microbial results of all patients with a VAP (polymicrobial or monomicrobial) were recorded. Results The mean incidence of VAP was 8 per cent (n = 92), decreasing only slightly during the period (P > 0·05). The most frequent aetiological agents were P. aeruginosa (n = 34), S. aureus (n = 22), E. coli (n = 16) and K. pneumoniae (n = 10). The percentage of VAPs due to P. aeruginosa has declined progressively from 53 to 31 per cent. Concurrently, the incidence of Pseudomonas colonizing the sputum culture has declined (from 54 to 44 per cent). On the other hand, the incidence of VAP due to E. coli has increased from 13 (n = 2) to 36 per cent (n = 6). Colonization of the sputum with E. coli has similarly increased (from 13 to 27 per cent). Conclusion The incidence of VAP in the intensive care unit is in accordance with the literature, when diagnosed with strict criteria. No significant change in the incidence of VAP was noted during the 3-year period. Neither the decrease in incidence of VAP caused by P. aeruginosa nor the increase in E. coli pneumonia can be explained by a change in antibiotic regimens in the period studied. Hypothetically, cross-colonization of PPMOs by healthcare personnel can be influenced by hand-washing and wearing gloves. This can especially influence colonization by P. aeruginosa, thus explaining the decrease. © 2000 British Journal of Surgery Society Ltd [source] Therapy of ventilator-associated pneumonia: the Tarragona StrategyCLINICAL MICROBIOLOGY AND INFECTION, Issue 1 2000M. Bodí No abstract is available for this article. [source] | ||||||||||