Pneumonia in the intensive care unit
ABSTRACT 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.
Full-textDOI: · Available from: Emili Diaz, Jul 16, 2015
- SourceAvailable from: Leyla Ozdemir
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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%. "
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 · 2.25 Impact Factor
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- "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). "
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.Respiratory Physiology & Neurobiology 01/2014; DOI:10.1016/j.resp.2014.01.001 · 1.97 Impact Factor
Article: Nosocomial pneumonia.[Show abstract] [Hide abstract]
ABSTRACT: Nosocomial pneumonia (NP) is defined as pneumonia that develops within 48 hours or more of hospital admission and which was not developing at the time of admission. Nosocomial pneumonia, also known as hospital-acquired pneumonia (HAP), is the second most common hospital infection, while ventilator-associated pneumonia represents the most common intensive care unit (ICU) infection. Nosocomial pneumonia significantly contributes to morbidity, mortality, and escalating healthcare costs because of increases in antibiotic prescription and administration, length of ICU stay, and length of hospital stay. Aspiration and colonization of the upper respiratory tract seem to be the major pathogenetic mechanisms for the development of NP, either in intubated or spontaneously breathing patients. The microbiology of NP depends on the timing of onset. In early-onset NP, the responsible pathogens are generally endogenous community-acquired pathogens. In late-onset NP, the responsible microbes include potentially multi-drug-resistant nosocomial organisms residing in oropharyngeal or gastric contents. Important risk factors for development of NP include coma, intubation, prolonged mechanical ventilation, repeated intubations, supine positioning, and long-term antibiotic use. The most significant preventive measures include routine hand washing and avoidance of (1) the supine position, (2) inappropriate antibiotics, and (3) overuse of H2-antagonists for stress ulcer prophylaxis. Accurate diagnosis of NP is difficult and controversial, warranting consideration for the application of invasive quantitative culture techniques over tracheal aspirates. Empiric antibiotic treatment should be prompt, starting on clinical suspicion, and based on local ICU pathogen epidemiology and antibiotic resistance patterns and on a deescalating antibiotic strategy. Innovative antibiotic strategies, such as antibiotic rotation, to help prevent the emergence of multi-drug-resistant pathogens and improve survival should be considered.Critical care nursing quarterly 01/2004; 27(3):241-57. DOI:10.1097/00002727-200407000-00005