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Care of Intubated Patients in Triage
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Shalvi Mahajan, Komal A Gandhi
Ventilator associated pneumonia (VAP). It is defined as pneumonia following endotracheal intubation and mechanical ventilation of at least 48 hours. Since patients can spend many hours in triage, implementation of a VAP prevention bundle is important.
Treatment of Ventilator-Associated Pneumonia
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Modern use of positive pressure ventilation originated in the early 1950s, when it was recognized that supportive care with endotracheal tubes and manual ventilation with an inflated rubber bag could dramatically reduce the mortality of polio-induced respiratory failure [1]. These patients were ultimately clustered together to facilitate the around-the clock ventilatory support, thus representing the birth of the intensive care unit as we know it today. Even at this time, it was acknowledged that the endotracheal tube represented a novel means of introducing potentially noxious material into the lower respiratory tract, but it wasn't until a decade later that mechanical ventilation was understood to be a substantial risk factor for hospital acquired pneumonia [2]. The following 60 years have seen a tremendous advancement in our understanding of ventilator-associated pneumonia (VAP) with the development of numerous prevention strategies and treatment guidelines. Despite this progress, the diagnosis of VAP is still imperfect and optimal treatment remains unclear, further confounding progress on this deadly infection.
Nosocomial Infections Caused by Acinetobacter spp. — Therapeutic Problems
Published in E. Bergogne-Bénézin, M.L. Joly-Guillou, K.J. Towner, Acinetobacter, 2020
Early appropriate antibiotic treatment is able to reduce the fatality rate of Gram-negative bacteraemia by approximately 50%. In addition, the frequency with which shock develops is reduced, and even after the development of shock, patients with adequate antibiotic therapy have a better prognosis (Kreger et al., 1980). Since Acinetobacter is considered to be an organism of relatively low virulence, the role of early appropriate therapy has been a matter for debate. Tilley and Roberts (1994) studied the outcome of bacteraemia caused by Acinetobacter in 52 pa-tients. The prognosis appeared to correlate more closely with the type of underlying disease and its severity than with other factors, including the appropriateness of the initial therapy. In another study of 27 patients with nosocomial Acinetobacter bacteraemia, 6 had polymicrobial sepsis that carried a higher mortality than ‘pure’Acinetobacter bacteraemia (50% vs. 0%) (Smego, 1985). In contrast, in a case-control study, Fagon et al. (1993) found that ventilator-associated pneumonia caused by Pseudomonas aeruginosa or Acinetobacter spp. was responsible for an attributable mortality of 42.8%, compared to 27% in the overall population of patients with ventilator-associated pneumonia. In another control study performed during an outbreak of A. baumannii infections, the mortality attributable to respiratory tract infections was 50% (Kaul et al., 1994).
Bacterial and fungal infections: a frequent and deadly complication among critically ill acute liver failure patients
Published in Infectious Diseases, 2023
Félicie Belicard, Kieran Pinceaux, Estelle Le Pabic, Valentin Coirier, Flora Delamaire, Benoît Painvin, Mathieu Lesouhaitier, Adel Maamar, Pauline Guillot, Quentin Quelven, Pauline Houssel, Karim Boudjema, Florian Reizine, Christophe Camus
The overall incidence rate of ICU-acquired infections was 14.2‰ (57 of 4020 ICU-days, 95% CI 10.7–18.4‰). The incidence rate according to three consecutive periods was 17.4‰ (11.2–25.6‰, 2000–2007), 9.8‰ (5.2–16.8‰, 2008–2015) and 15.1‰ (9.1–23.6‰, 2016–2021) (p = .24). The acquisition delay was 5 [3–10] days for infections acquired before/without LTx and 9 [9–14] days for those acquired after LTx. The incidence rate of ventilator-associated pneumonia was 11.8 per 1000 ventilator-days and the incidence rate of bloodstream infection was 5.5‰. Compared with the pre-decontamination period, the incidence rate of all-site acquired infections did not change significantly with the use of the decontamination regimen (12.2‰ versus 18.4‰, incidence rate ratio 0.65 [0.38–1.13], p = .10).
Strategies for implementation of a multidisciplinary approach to the treatment of nosocomial infections in critically ill patients
Published in Expert Review of Anti-infective Therapy, 2021
Ignacio Martin-Loeches, Mark Metersky, Andre Kalil, Maria Diletta Pezzani, Antoni Torres
Historically, hospital-acquired and ventilator-associated pneumonia were treated with 14 or more days of antibiotics. Then, the 2005 American Thoracic Society Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia recommended 7 days of therapy for most patients with HAP and VAP [54]. The recommendation was based on several studies that demonstrated clinical improvement prior to 7 days in most VAP patients and on a large randomized trial showing similar overall outcomes between patients who received 8 days of therapy compared to patients who received 15 days of therapy [55]. While outcomes were equivalent in the two groups, a higher rate of recurrent VAP was diagnosed at 28 days in the subgroup of patients who had VAP caused by non-fermenting Gram negative bacilli (NF-GNB), including Pseudomonas spp. (the majority), Acinetobacter spp. and Stenotrophomonas maltophila.
Procalcitonin kinetics to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: procalcitonin’s adjunct role
Published in Libyan Journal of Medicine, 2021
Shao-Hua Lin, Ying-ping He, Jun-Jie Lian, Cun-Kun Chu
Comparisons were made between the two groups of patients in terms of the time of invasive ventilation support, total mechanical ventilation support time, the incidence of ventilator-associated pneumonia, 48-hour reintubation rate, the incidence of upper gastrointestinal bleeding, respiratory critical illness hospitalization time, total hospitalization time, RICU treatment cost, total treatment cost, and clinical mortality. The 48-hour reintubation rate refers to the proportion in which the patients were given endotracheal intubation mechanical ventilation support again within 48 hours due to the fact that their conditions had deteriorated to the extent that ARF occurred after the first invasive ventilation support treatment. The diagnosis of ventilator-associated pneumonia follows the guidelines for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia [20]. Moreover, the invasive ventilation support time refers to the total days during which endotracheal intubation was performed, further invasive ventilator support treatment elapsed, and intubation was standby (d). And upper gastrointestinal bleeding refers to the indwelling gastric tube and extraction of gastric juice. The gastric juice is generally tested positive for occult blood.