Updates on community acquired pneumonia management in the ICU

Nair, Girish B.; Niederman, Michael S.

doi:10.1016/j.pharmthera.2020.107663

Cited by 89 publications

(71 citation statements)

References 103 publications

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“…Indicaţiile cateterismului cardiac la pacienţii cu hipertensiune pulmonară sunt [5,11]: 1 -confirmarea diagnosticului de HPI (presiunea capilarului pulmo-nar normală; creşterea PAP); 2 -estimarea severităţii hipertensiunii pulmonare; 3 -excluderea altor cauze; 4 -evaluarea rezervei vasodilatoare (vasodilatare acută indusă de substanţe vasoactive: NO, prostaciclină, adenozină); 5 -iniţierea terapiei parenterale cu substanţe vasoactive pulmonare (prostacicline).…”

Section: Summary Idiopathic Pulmonary Hypertension: Survival In Patients and Correlation Between Invasive And Non-invasive Indicesunclassified

“…În ceea ce priveşte corelaţia între parametrii neinvazivi şi cei invazivi, s-a constatat o corelaţie pozitivă şi semnificativă statistic între diametrul telediastilic VD, diametrul AP şi RVP după datele cateterismului cardiac drept (p <0,005). În rând cu această, valorile diametrului VD şi diametrului AP s-au corelat invers, semnificativ statistic cu valoare RVP şi nu cu valoarea presiunii medii în AP, faptul care este descris şi de alţi autori [5,16,18]. Nu a fost constatată o corelaţie semnificativă între valorile presiunilor medii în artera pulmonară şi HVD prezentă la 92,4 % (după datele electrocardiografice).…”

Section: Summary Idiopathic Pulmonary Hypertension: Survival In Patients and Correlation Between Invasive And Non-invasive Indicesunclassified

“…Rich S. consideră că la pacienţi cu HPP severă (în absenta rezervei vasodilatatoare) media duratei de viaţă după stabilirea diagnosticului este de 2,8 ani [5,17]. Tratamentul cu substanţe vasodilatatoare pulmonare poate prelungi durata de viaţă (aproximativ 10 ani).…”

Section: Summary Idiopathic Pulmonary Hypertension: Survival In Patients and Correlation Between Invasive And Non-invasive Indicesunclassified

“…Indicaţia transplantului cord-pulmon sau de transplant pulmonar este: HP severă asociată cu disfuncţie ventriculară severă şi clasa funcţională 3 -4 NYHA, în absenţa indicaţiei de tratament vasodilatator pulmonar [3,5].…”

Section: Summary Idiopathic Pulmonary Hypertension: Survival In Patients and Correlation Between Invasive And Non-invasive Indicesunclassified

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Idiopathic pulmonary hypertension: survival in patients and correlation between invasive and non-invasive indices

Martiniuc

2021

BulMed

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n this study performed during 10 years in 7 young patients (mean age 34,6±0,8 years) with severe idiopathic pulmonary hypertension we revealed a significant pozitive correlation between the values of right ventricle diastolic dimensions, diameter of the pulmonary artery and pulmonary artery vascular resistance. Late prognosis is unfavourable. During longterm impact the median survival was 4,4±1,1 years.

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Section: Summary Idiopathic Pulmonary Hypertension: Survival In Patients and Correlation Between Invasive And Non-invasive Indicesunclassified

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Idiopathic pulmonary hypertension: survival in patients and correlation between invasive and non-invasive indices

Martiniuc

2021

BulMed

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“…Such tests may be particularly useful in intensive care units (ICUs), where patients with pneumonia are frequent [ 2 , 3 ], there is an increase the risk of rapid deterioration and death [ 3 , 4 ], and thus there is a demand for urgent antimicrobial treatment [ 5 , 6 ]. Recommended practice for a suspected pneumonia include the prescription of empiric broad-spectrum antibiotics, with refinement once results of laboratory cultures become available (typically after 48–72 h) [ 5 ].…”

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confidence: 99%

Intensivists’ beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study

Pandolfo

Horne

Jani

et al. 2021

Antimicrob Resist Infect Control

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Background Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians’ endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians’ beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care. Methods We conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians’ beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically. Results Clinicians’ beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians’ prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device’s capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results. Conclusions Clinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests’ capabilities and integration into clinical practice. Implementation strategies should bolster users’ necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests’ purpose and benefits, identifying and addressing clinicians’ misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60–90 min) test, antibiotics can be started and refined after molecular diagnostic results become available.

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Prepandemic viral community‐acquired pneumonia: Diagnostic sensitivity and specificity of nasopharyngeal swabs and performance of clinical severity scores

Berastegui‐Cabrera

Aguilar‐Guisado

Crespo‐Rivas

et al. 2022

Journal of Medical Virology

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The objectives of this work were to assess the diagnostic sensitivity and specificity of nasopharyngeal (NP) swabs for viral community‐acquired pneumonia (CAP) and the performance of pneumonia severity index (PSI) and CURB‐65 severity scores in the viral CAP in adults. A prospective observational cohort study of consecutive 341 hospitalized adults with CAP was performed between January 2018 and March 2020. Demographics, comorbidities, symptoms/signs, analytical data, severity scores, antimicrobials, and outcomes were recorded. Blood, NP swabs, sputum, and urine samples were collected at admission and assayed by multiplex real time‐PCR, bacterial cultures, and Streptococcus pneumoniae and Legionella pneumophila antigens detection, to determine the etiologies and quantify the viral load. The etiology was identified in 174 (51.0%) patients, and in 85 (24.9%) it was viral, the most frequent rhinovirus and influenza virus. The sensitivity of viral detection in sputum (50.7%) was higher than in NP swabs (20.9%). Compared with sputum, the positive predictive value and specificity of NP swabs for viral diagnosis were 95.8% and 96.9%, respectively. Performance of PSI and CURB‐65 scores in all CAP with etiologic diagnosis were as expected, with mortality associated with higher values, but they were not associated with mortality in patients with viral pneumonia. NP swabs have lower sensitivity but high specificity for the diagnosis of viral CAP in adults compared with sputum, reinforcing the use NP swabs for the diagnostic etiology work‐up. The PSI and CURB‐65 scores did not predict mortality in the viral CAP, suggesting that they need to be updated scores based on the identification of the etiological agent.

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Updates on community acquired pneumonia management in the ICU

Cited by 89 publications

References 103 publications

Idiopathic pulmonary hypertension: survival in patients and correlation between invasive and non-invasive indices

Idiopathic pulmonary hypertension: survival in patients and correlation between invasive and non-invasive indices

Intensivists’ beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study

Prepandemic viral community‐acquired pneumonia: Diagnostic sensitivity and specificity of nasopharyngeal swabs and performance of clinical severity scores

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