[Administration of tobramycin aerosols in patients with nosocomial pneumonia: a preliminary study].
ABSTRACT The aim of this study was to assess renal and respiratory tolerance of aerosolized tobramycin in intubated and mechanically ventilated patients with nosocomial pneumonia.
This was a multicenter, randomized, double-blind, placebo controlled study. Thirty-eight mechanically ventilated patients with documented nosocomial pneumonia were included. Patients treated with intravenous betalactam and tobramycin were randomly allocated to receive aerosolized tobramycin (6 mg/kg/day, n = 21) or placebo (n = 17). The aerosol was administered via a pneumatic nebulizer once a day for 5 days.
Respiratory tolerance was good in all but two patients. No acute renal failure occurred. By day 10, 7 patients in the tobramycin group (35%) had been extubated versus 3 in the placebo group (18.5%, p = 0.18). By day 28, 6 patients had died (2 in the tobramycin group and 4 in the placebo group, p = 0.23).
Aerosolized tobramycin was well tolerated in ventilated patients with documented nosocomial pneumonia.
Article: Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit.[show abstract] [hide abstract]
ABSTRACT: In critically ill intubated patients, signs of respiratory infection often persist despite treatment with potent systemic antibiotics. The purpose of this study was to determine whether aerosolized antibiotics, which achieve high drug concentrations in the target organ, would more effectively treat respiratory infection and decrease the need for systemic antibiotics. Double-blind, randomized, placebo-controlled study performed from 2003 through 2004. The medical and surgical intensive care units of a university hospital. Critically ill intubated patients were randomized if: 1) > or = 18 yrs of age, intubated for a minimum of 3 days, and expected to survive at least 14 days; and 2) had ventilator-associated tracheobronchitis defined as the production of purulent secretions (> or = 2 mL during 4 hrs) with organism(s) on Gram stain. Of 104 patients monitored, 43 consented for treatment and completed the study. No patients were withdrawn from the study for adverse events. Aerosol antibiotic (AA) or aerosol saline placebo was given for 14 days or until extubation. The responsible clinician determined the administration of systemic antibiotics (SA). Patients were followed for 28 days. Primary: Centers for Disease Control National Nosocomial Infection Survey diagnostic criteria for ventilator-associated pneumonia (VAP) and clinical pulmonary infection score. Secondary: white blood cell count, SA use, acquired antibiotic resistance, and weaning from mechanical ventilation. Most patients had VAP at randomization. With treatment, the AA group had reduced signs of respiratory infection: reduced Centers for Disease Control National Nosocomial Infection Survey VAP (14/19; 73.6%) to (5/14; 35.7%) vs. placebo (18/24; 75%) to (11/14; 78.6%), reduction in clinical pulmonary infection score, lower white blood cell count at day 14, reduced bacterial resistance, reduced use of SA, and increased weaning (all p < or = .05). In critically ill patients with ventilator-associated tracheobronchitis, AA decrease VAP and other signs and symptoms of respiratory infection, facilitate weaning, and reduce bacterial resistance and use of systemic antibiotics.Critical care medicine 07/2008; 36(7):2008-13. · 6.37 Impact Factor
Article: The role of aerosolized antimicrobials in the treatment of ventilator-associated pneumonia.[show abstract] [hide abstract]
ABSTRACT: The ability to deliver high concentrations of antimicrobial agents directly to the site of pneumonia is attractive, especially with the availability of high-efficiency nebulizers. A major focus of inhaled antimicrobial therapy has been to prevent and treat ventilator-associated pneumonia (VAP). VAP occurs commonly in mechanically ventilated patients and is associated with significant morbidity and high mortality. Moreover, the emergence of VAP due to multiple-drug-resistant Gram-negative organisms that are resistant to any form of systemic antimicrobial therapy has provided an impetus to explore inhaled antimicrobial treatment as an adjunct to systemic therapy. Tobramycin solution for inhalation and colistimethate sodium have been formulated for delivery via inhalation. Although these agents are being increasingly employed in intensive care units, the intricacies involved in their use are not appreciated by many clinicians. This review discusses the role of these agents in the prevention and treatment of VAP, with an emphasis on some of the problems associated with their use. Further research is needed to support the use of inhaled antimicrobial therapy in patients with VAP.Respiratory care 08/2007; 52(7):866-84. · 2.01 Impact Factor
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ABSTRACT: The respiratory care profession is over 60 years old. Throughout its short history, change and innovation have been the terms that best describe the development of the profession. The respiratory therapist (RT) of today barely resembles the clinicians of 60 years ago, and the future role of the RT is clearly open to debate. Medicine is continually changing, with new approaches to disease management emerging almost daily. Third-party payers are challenging payment for iatrogenic injury, manpower issues are affecting all disciplines in medicine, and the nonphysician and physician work force is aging. These factors make us question what the respiratory care profession will look like in the year 2015. To address this issue the American Association for Respiratory Care established a task force to envision the RT of the future. The goal is to identify potential new roles and responsibilities of RTs in 2015 and beyond, and to suggest the elements of education, training, and competency-documentation needed to assure safe and effective execution of those roles and responsibilities. We present the initial findings of that task force.Respiratory care 04/2009; 54(3):375-89. · 2.01 Impact Factor