To update the state-of-the-art on pneumonia in adult patients in the intensive care unit (ICU), with special emphasis on new developments in management.
We searched MEDLINE, using the following keywords: hospital-acquired pneumonia, ventilator-associated pneumonia and healthcare-associated pneumonia, diagnosis, therapy, prevention.
Interventions to prevent pneumonia in the ICU should combine multiple measures targeting the invasive devices, microorganisms, and protection of the patient. Once pneumonia develops, the appropriateness of the initial antibiotic regimen is a vital determinant of outcome. Three questions should be formulated: a) Is the patient at risk of methicillin-resistant Staphylococcus aureus?; b) Is Acinetobacter baumannii a problem in the institution?; and c) is the patient at risk of Pseudomonas aeruginosa? Antibiotic therapy should be started immediately and must circumvent pathogen-resistance mechanisms developed after previous antibiotic exposure. Therefore, antibiotic choice should be institution specific and patient oriented. Microbiologic investigation is useful on evaluating the quality of the respiratory sample and permits early modification of the regimen in light of the microbiologic findings.
A decision tree outlining an approach to the evaluation and management of ventilator-associated pneumonia is provided.
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"Increased gastric residual volume related to enteral feeding can result in pulmonary aspiration which is one of the most serious mechanical complications (Memis¸et al., 2007). This fact indicates that aspiration is one of the main factors causing the development of VAP (Cook, 2000; Rello and Diaz, 2003). Aspiration in intensive care units was seen at a rate between 0.8% and 95%. "
[Show abstract][Hide abstract] ABSTRACT: Enteral nutrition is one of the major risk factors for ventilator-associated pneumonia. Abdominal massage is assumed to prevent the development of ventilator-associated pneumonia by reducing residual gastric volume.Objectives
To identify the effect of abdominal massage administered to critically ill patients with mechanical ventilation and continuous enteral feeding on the development of ventilator-associated pneumonia.DesignA randomized controlled design was used in this study.SettingThis study was performed in a critical care unit of a university hospital in Turkey.Participants: The sample of the study consisted of a total of 32 patients, selected randomly to receive abdominal massage (n = 16) and a control group (n = 16). The stratified randomization was used in this study. Patients were stratified according to age and gender.MethodsA fifteen-minute abdominal massage was administered to the patients in the intervention group twice daily. No intervention was administered to the patients in the control group.ResultsAt the end of monitoring days a reduction, compared to the control patients, was identified. The amount of gastric residual volume and abdominal circumference measurement of the patients in the intervention group had decreased. This reduction was found to be significant in the statistical analysis (p < 0.05). Also, although not reaching the statistical significance level, ventilator-associated pneumonia decreased in the intervention group with a ratio of 6.3% compared to the control group (31.3%) (p > 0.05).Conclusion
This study revealed that abdominal massage administered to intubated and enterally-fed patients reduced gastric residual volume and abdominal distention. In addition, a decrease in the ratio of ventilator-associated pneumonia was determined.
International Journal of Nursing Studies 11/2014; 52(2). DOI:10.1016/j.ijnurstu.2014.11.001 · 2.90 Impact Factor
"Treatment of P. aeruginosa infections is still a challenge due to its biochemical attributes (Rello and Diaz, 2003), including poor outer membrane permeability and increased membrane efflux pumps. Furthermore, P. aeruginosa harbors an intrinsic resistance to almost every class of antimicrobial agents (El Solh and Alhajhusain, 2009). "
[Show abstract][Hide abstract] ABSTRACT: Blocking PcrV, an essential component of the Type III secretion system (TTSS), has demonstrated efficacy against Pseudomonas aeruginosa infections. However, most of the results came from laboratory strains. Whether it is applicable to clinically isolated multi-drug resistant (MDR) strains is unknown. In this study we investigated the expression level of TTSS in clinically isolated MDR P. aeruginosa strains and the effects of anti-PcrV antibody on MDR isolate induced acute lung injury (ALI). The expression level of TTSS was quantified in 53 isolates including 25 MDR strains and 28 susceptible strains. We investigated the effect of anti-PcrV antibody through a murine model induced by instillation of a MDR strain into the left lung through trachea. Our results showed that the expression level of TTSS in MDR strains is comparable to susceptible strains. Anti-PcrV ensured the survival of challenged mice, reduced the bacteria numbers and attenuated lung inflammation and injury. This study proved that anti-PcrV may be a potentially effective strategy against MDR P. aeruginosa induced ALI.
"Pseudomonas aeruginosa is an opportunistic pathogen that infects immune-compromised individuals and cause cystic fibrosis and nosocomial infections  . P. aeruginosa produces various quorum sensing molecules to communicate each other in a population. "
[Show abstract][Hide abstract] ABSTRACT: We have previously shown that PQS and HHQ, two quorum sensing molecules, can down-regulate host the innate immune responses and that this is mediated through the NF-kappaB pathway. In this study, to search for a comprehensive set of genes regulated by these quorum sensing molecules, we performed a global gene expression analysis using DNA microarray in J774A.1 monocyte/macrophage cells line. The expression of these genes was confirmed by RT-PCR. We found that PQS and HHQ down-regulated the expression of genes involved in immune responses and transcription as well as other functions, some of which are downstream of NF-kappaB pathway consistent with our previous results. PQS and HHQ inhibited LPS-induced morphological change and nitric oxide production, suggesting that they inhibit macrophage activation. However, PQS and HHQ did not affect apoptosis, suggesting that their effects on immune system are not from general alteration of cell function. This study provides insight how the quorum sensing molecules influence host cells.