Clinical resolution in patients with suspicion of ventilator-associated pneumonia: A cohort study comparing patients with and without acute respiratory distress syndrome*

Vidaur, Loreto; Gualis, Belen; Rodríguez, Alejandro; Ramírez, Rafael; Sandiumenge, Alberto; Sirgo, G.; Dı́az, Emili; Rello, Jordi

doi:10.1097/01.ccm.0000165811.61232.d6

Cited by 68 publications

(48 citation statements)

References 22 publications

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“…Most of them were purportedly referred to ICUs as a result of car or motorbike accidents A significant correlation between normalization of the PaO2/FiO2 ratio and body temperature (fever) 72 Table 6. Cross-resistance of Acinetobacter baumannii to the tested antibiotics hours after the initiation of appropriate antibiotic therapy was observed, indicating the significance of appropriate treatment to the prognosis of the patients and consequently their survival and the cost effectiveness of the treatment [19][20][21]. This condition is more prominente when the patients are infected with antibiotic resistant bacteria such as A. baumannii, MRSA and P. aeruginosa (Table 2).…”

Section: Discussionmentioning

confidence: 96%

Ventilator-associated pneumonia in Iranian intensive care units

Japoni

Vazin

Davarpanah

et al. 2011

J Infect Dev Ctries

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Introduction: Nosocomial pneumonia (NP) and ventilator associated pneumonia (VAP) occur most frequently in intensive care units (ICU). This study seeks to determine the etiological agents of NP and VAP along with their antibacterial susceptibility patterns, and to evaluate the factors contributing to patient mortality. The impact of appropriate therapy in terms of three parameters (body temperature, PaO2/FiO2 ratio and leukocyte count) was also assessed. Methodology: This study involved 836 adult patients admitted to ICUs at the Nemazee Hospital, Shiraz, Iran, over nine months during 2008 and 2009. The inclusion criterion was the commencement of infection at least 48 hours following hospital admission. Clinical parameters including core temperature, leukocyte count. and PaO2/FiO2 ratio were evaluated. Antibiotic sensitivities of the isolated bacteria to a panel of antibiotics were determined using E-test. Results: Of 836 cases, only 58 (6.9 %) cases of NP were diagnosed, of which 42 (72 %) were VAP. A. baumannii, MRSA, P. aeruginosa and MSSA were the most prevalent bacteria. Significant correlations between previous antibiotic therapy (p = 0.04), use of corticosteroids (p = 0.02) and attributable mortality were found. A strong correlation between fever abatement and the ratio of PaO2/FiO2 with responses to treatment and outcomes was also evident. Conclusions: Combined treatment with meropenem/imipenem, ciprofloxacin and vancomycin seems to be appropriate and could cover all possible infective agents. To reduce mortality rate, reasonable prescription of antibiotics and corticosteroids could be effective. Furthermore, adopting a strategy to reduce body temperature and PaO2/FiO2 ratio could be beneficial in patients' outcomes.

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Section: Discussionmentioning

confidence: 96%

Ventilator-associated pneumonia in Iranian intensive care units

Japoni

Vazin

Davarpanah

et al. 2011

J Infect Dev Ctries

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“…The definitions for clinical progress of pneumonia (resolution, cure, or treatment failure) [24] and microbiological outcome (eradication, persistence, superinfection) [25] are summarized in the Supplementary Material (eTable 1).…”

mentioning

confidence: 99%

Is inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?

Bandeshe

Dulhunty

Dunlop

et al. 2016

Journal of Critical Care

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Word Length: 242Word length excluding abstract, tables and references: 2654 Keywords: nebulization, ventilator associated complication, ventilator associated pneumonia, unfractionated heparin, Corresponding Author:Associate Professor Rob Boots Department of Intensive Care Medicine Royal Brisbane and Women's HospitalButterfield Street, Herston.Queensland. AUSTRALIA. 4029Email: r.boots@uq.edu.au Udy, Andrew BHB MB ChB PGCert(AME) FCICM PhD 6 White, Hayden FCICM 7 A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPTA C C E P T E D M A N U S C R I P T Conclusion:Nebulized heparin cannot be recommended for prophylaxis against VAP or to hasten recovery from pneumonia in patients receiving MV.

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“…In most cases, the assessment of the infection response relies mostly on the course of the same criteria that were used for clinical diagnosis. [46][47][48] Bacterial eradication has been proposed as a criteria of improvement 49 ; however, these results have been challenged. 47 Chest x-rays are also of limited value as an initial deterioration is often expectable and there is commonly a delay in the radiologic improvement.…”

Section: Monitoring the Ventilator-associated Pneumonia Response To Amentioning

confidence: 98%

Biomarker Kinetics in VAP

Póvoa

Martín‐Loeches

Artigas

2015

Clinical Pulmonary Medicine

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Patients under mechanical ventilation are at risk for several problems and complications, in particular ventilator-associated pneumonia (VAP). The diagnosis of VAP results from a combination of radiologic findings, signs, and symptoms of lower-respiratory-tract infection, and microbiologic criteria. It is consensual that the definition of VAP is neither valid nor reliable. Several criteria are recognized as being inaccurate and subjective. With this scenario, there is need for improvement, and serum biomarkers, namely their, could bring additional information to improve the diagnosis and the management of VAP. Changes in biomarker concentrations over time, that is the kinetics, could be potentially useful in VAP prediction and diagnosis and in monitoring the response to antibiotic therapy.Patients under mechanical ventilation are at risk for several problems and complications, either noninfectious, namely, pulmonary edema and delirium, or infectious, in particular ventilator-associated pneumonia (VAP). 1,2 VAP is the second most frequent hospital-acquired infection (HAI), but is the most severe intensive care unit (ICU)-acquired infection. 2 Patients needing invasive mechanical ventilation are usually sicker and, in addition to the tracheal tube, they have other invasive devices, namely, a central venous catheter, an arterial line, a gastric tube, and a bladder catheter, which are readily colonized with several bacteria easily forming biofilms. 3 As a result, altogether, if these devices, on the one hand, are critical to organ and life support, on the other, they are super-highways for bacterial invasion. 3 It is hypothesized that HAI, namely VAP, that occur usually after >48 hours of ICU stay appear when the initial hyperinflammatory response to an insult, either infectious or not, has faded away, giving place to an impaired immunity and an antiinflammatory state. 4 There is accumulating evidence from research on this immunoparalysis state that, in addition, is complemented by the findings of the common pathogens involved in these HAI. 4 The bacteria involved in this second-hit insult (eg, Stenotrophomonas spp, Acinetobacter spp, Enterococus spp, Pseudomonas spp, and Candida spp) are usually weakly virulent and opportunistic microorganisms, and it is also common to observe viral reactivation (eg, cytomegalovirus). 5,6 This typically occurs in patients with a previously normal immunity that became markedly immunosuppressed after the onset of the critical illness.In addition, the development of VAP is associated with a worse outcome. Patients with this infectious complication have a longer duration of mechanical ventilation and longer ICU and hospital stay. In the 1990s, the attributable mortality was considered to be elevated, reaching >25% 7 ; however, recent carefully conducted analyses of large databases concluded that the attributable mortality seems to be much lower, between 4.4% and 13%. 2,8 As a consequence of a longer duration of mechanical ventilation and longer ICU and hospital stays as well as the need...

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Clinical resolution in patients with suspicion of ventilator-associated pneumonia: A cohort study comparing patients with and without acute respiratory distress syndrome*

Abstract: Measures of oxygenation and core temperature can help physicians to individualize and shorten the duration of antibiotic therapy in VAP episodes. ARDS patients with VAP take twice as long to resolve fever, whereas hypoxemia should be ignored in defining resolution in this subset.

Cited by 68 publications

References 22 publications

Ventilator-associated pneumonia in Iranian intensive care units

Ventilator-associated pneumonia in Iranian intensive care units

Is inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?

Biomarker Kinetics in VAP

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