Antibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia From Pneumonitis*

Lascarrou, Jean Baptiste; Lissonde, Floriane; Thuaut, Aurélie Le; Bachoumas, Konstantinos; Colin, Gwenhaël; Lagarrigue, Matthieu Henry; Vinatier, Isabelle; Fiancette, Maud; Lachérade, Jean Claude; Yehia, Aihem; Joret, Aurélie; Lebert, Christine; Bourdon, Sandra; Lefèvre, Laurent Martin; Reignier, Jean

doi:10.1097/ccm.0000000000002525

Cited by 27 publications

(9 citation statements)

References 29 publications

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“…1,4,23,24 In human medicine, although the NLR has a good positive predictive value for bacteremia in patients with a variety of conditions presenting for emergency care, 25 routine WBC counts have not been shown to differ between ventilated patients with confirmed pneumonitis and those with bacterial pneumonia. 26 Whether the NLR may differ between canine patients with bacteremia or sepsis compared to those with nonseptic inflammation is unknown. A recent meta-analysis of mortality risk in human aspiration patients compared to other CAP patients found that those with a risk factor for aspiration and, therefore, presumed aspiration pneumonia, had a more than 3-fold increased risk of in-hospital and 30-day mortality.…”

Section: Discussionmentioning

confidence: 99%

Retrospective investigation of the neutrophil‐to‐lymphocyte ratio in dogs with pneumonia: 49 cases (2011–2016)

Conway

Valle

Waugh

et al. 2021

J Vet Emergen Crit Care

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Objective: To assess the utility of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcome in canine pneumonia compared with routine hematological parameters and systemic inflammatory response syndrome (SIRS) scores.Design: Retrospective study.Setting: University teaching hospital. Animals: Forty-nine client-owned dogs. Interventions: NoneMeasurements and Main Results: Medical records were reviewed to identify dogs with a diagnosis of pneumonia from July 2011 to December 2016. Signalment, clinical findings, laboratory characteristics, and outcome were recorded. Inclusion criteria were a clinical and radiographic diagnosis of pneumonia, plus reference laboratory hematology at diagnosis. Cases that received steroids were excluded. Euthanized dogs were only included in statistical analysis if euthanized solely due to pneumonia severity. The NLR, total WBC count, neutrophil count, lymphocyte count, band neutrophil percent of total WBC count (%-bands), and percentage of cases diagnosed with SIRS were compared between survivors and nonsurvivors. Receiver operating characteristic curves were generated to identify optimal sensitivity and specificity cutoffs for nonsurvival to discharge. Two hundred records were retrieved; 49 cases fulfilled the inclusion criteria. Of these, 33 (67%) survived to discharge.

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Section: Discussionmentioning

confidence: 99%

Retrospective investigation of the neutrophil‐to‐lymphocyte ratio in dogs with pneumonia: 49 cases (2011–2016)

Conway

Valle

Waugh

et al. 2021

J Vet Emergen Crit Care

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“…Our study lacked sufficient power to assess potential differences between enteral and parenteral nutrition, and we therefore pooled patients with these 2 nutrition modalities. The recent literature indicates that early nutrition is beneficial regardless of the route of delivery …”

Section: Discussionmentioning

confidence: 99%

“…Recovered microorganisms were routinely subjected to antibiotic susceptibility testing. Pneumonia was defined as early‐onset pneumonia if diagnosed within 48 hours after intubation and as ventilator‐associated pneumonia if diagnosed later …”

Section: Methodsmentioning

confidence: 99%

Nutrition During Targeted Temperature Management After Cardiac Arrest: Observational Study of Neurological Outcomes and Nutrition Tolerance

Martin

Reignier

Thuaut

et al. 2019

J Parenter Enteral Nutr

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Background: Whether providing nutrition support is beneficial or deleterious during targeted temperature management (TTM) after cardiac arrest is unclear. We therefore performed a retrospective observational study to determine whether early nutrition was beneficial or deleterious during TTM. Methods: We retrospectively studied patients admitted to our intensive care unit (ICU) between 2008 and 2014 after successfully resuscitated cardiac arrest. We compared the group given nutrition within 48 hours after ICU admission (E+ group) to the group given nutrition later on or not at all (E-group). Results: Of the 203 included patients, 143 were in the E+ group and 60 in the E-group. The E+ group had a significantly higher proportion of patients with a good 3-month neurological outcome (42.7% vs 16.7%, P < 0.001). The difference remained significant after adjustment on a propensity score (odds ratio, 3.47; 95% confidence interval, 1.48-8.14; P = 0.004). The cumulative energy deficit for an energy goal of 20 kcal/kg/d from admission to day 7 was significantly lower in the E+ group (3304 ± 2863 kcal vs 5017 ± 2655 kcal, P < 0.001). Within the E+ group, the subgroups with nutrition initiation when body temperature was <36°C vs ࣙ36°C were not significantly different regarding the frequencies of early-onset pneumonia, ventilator-associated pneumonia, vomiting, and prokinetic drug use (all P-values > 0.05). Conclusions: Early nutrition after cardiac arrest during TTM appears safe and may be associated with better neurological outcomes. These findings warrant a randomized controlled trial to resolve the remaining issues. (JPEN J Parenter Enteral Nutr. 2020;44:138-145) Keywords cardiac arrest; induced hypothermia; nutrition; pneumonia; targeted temperature management Clinical Relevancy StatementPatients comatose after cardiac arrest are admitted to the intensive care unit (ICU) for targeted temperature management and neurological prognostication. Whether providing From the

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“…As in all medical conditions possibly complicated by aspiration, history, physical examination, and laboratory and radiographic findings cannot reliably predict bacterial pneumonia or distinguish it from chemical pneumonitis [ 12 ]. Interestingly, a recent clinical investigation showed that only half the comatose patients receiving mechanical ventilation with suspected bacterial aspiration pneumonia had this diagnosis based on telescopic plugged catheter sampling [ 6 ]. The authors demonstrated that, in the absence of clinical, laboratory, or radiologic evidence of bacterial aspiration, pneumonia patients did not require antibiotics, and that in patients with suspected bacterial aspiration pneumonia, stopping empirical antibiotic therapy when routine telescopic plugged catheter sampling recovered no microorganisms was nearly always effective.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, only a minority may avoid aspiration and possibly be at lower risk of pneumonia [ 4 ]. In various acute pathologies involving aspiration as in drowning, bacterial pneumonia does not develop consistently following aspiration [ 5 , 6 ]. In addition, given the potential severity of aspiration and the absence of reliable clinical or laboratory markers separating non-infectious pneumonitis from bacterial aspiration pneumonia, patients routinely receive antibiotics without prior bacterial sampling to diagnose infection if suspected [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Consequences of Near-Drowning–Related Pneumonia—A Descriptive Series from Martinique, French West Indies

Cerland

Mégarbane

Kallel³

et al. 2017

IJERPH

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Drowning represents one major cause of accidental death. Near-drowning patients are exposed to aspiration that may result in pneumonia with life-threatening consequences. We designed this descriptive study to investigate the frequency, nature, and consequences of post-drowning pneumonia. One hundred and forty-four near-drowning patients (33 children and 111 adults) admitted during four years to the University Hospital of Martinique, French Indies, were included. Patients presented pre-hospital cardiac arrest (41%) and exhibited acute respiratory failure (54%), cardiovascular failure (27%), and lactic acidosis (75%) on admission. Empirical antibiotics, as decided by the physicians in charge, were administered in 85 patients (59%). Post-drowning early onset bacterial pneumonia was diagnosed as “possible” in 13 patients (9%) and “confirmed” in 22 patients (15%). Tracheal aspiration revealed the presence of polymorphous pharyngeal flora (59%) or one predominant bacteria species (41%) including Enterobacter aerogenes, Enterobacter cloacae, Staphylococcus aureus, Pseudomonas aeruginosa, Aeromonas hydrophilia, and Morganella morgani. Despite adequate supportive care, drowning resulted in 45 fatalities (31%). Early onset bacterial aspiration pneumonia (either possible or confirmed) did not significantly influence the risk of death. In conclusion, near-drowning–related bacterial aspiration pneumonia seems rare and does not influence the mortality rate. There is still a need for practice standardization to improve diagnosis of post-drowning pneumonia and near-drowning patient management.

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Antibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia From Pneumonitis*

Cited by 27 publications

References 29 publications

Retrospective investigation of the neutrophil‐to‐lymphocyte ratio in dogs with pneumonia: 49 cases (2011–2016)

Retrospective investigation of the neutrophil‐to‐lymphocyte ratio in dogs with pneumonia: 49 cases (2011–2016)

Nutrition During Targeted Temperature Management After Cardiac Arrest: Observational Study of Neurological Outcomes and Nutrition Tolerance

Incidence and Consequences of Near-Drowning–Related Pneumonia—A Descriptive Series from Martinique, French West Indies

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