Pneumonia in the intensive care unit:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1995
|
| Schriftenreihe: | Clinics in chest medicine
16,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII, 227 S. Ill., graph. Darst. |
Internformat
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| 245 | 1 | 0 | |a Pneumonia in the intensive care unit |c Richard G. Wunderink guest ed. |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 1995 | |
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| 650 | 7 | |a Intensive care |2 gtt | |
| 650 | 7 | |a Longontsteking |2 gtt | |
| 650 | 2 | |a Pneumopathie infectieuse | |
| 650 | 2 | |a Unité soins intensifs | |
| 650 | 4 | |a Intensive Care Units | |
| 650 | 4 | |a Intensive care units | |
| 650 | 4 | |a Pneumonia | |
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Datensatz im Suchindex
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| adam_text | I NFUMONJA IN THE INTENSIVE CARF UNIT
CONTENTS
, Preface xi
Richard G. Wunderink
Pathophysiology of Pneumonia 1
Steve Nelson, Carol M. Mason, Jay Kolls, and Warren R. Summer
The lung is continually exposed to infectious challenges requiring an
intricate system of defense mechanisms that facilitates the elimination of
pathogens and prevents the development of infection. Both the upper
airway and the lower respiratory tract have mechanical, humoral, and
cellular mechanisms in place to protect the airways from invading micro¬
organisms. Impairment in any arm of this system can result in a predispo¬
sition of the host to respiratory infections. Defects may be congenital,
acquired, or iatrogenic. Understanding how these defects lead to infection
may result in the development of innovative therapies, as well as preven¬
tive strategies.
The Pathology of Nosocomial Pneumonia 13
Jacqueline J. Coalson
Of patients who die in the intensive care unit (ICU), the mortality rate is
; significantly higher in those who develop nosocomial bacterial pneumo¬
nias. Pneumonia is difficult to diagnose clinically in patients with acute
lung injury, so the gold standard for a pneumonia diagnosis has been
its histopathologic presence in autopsy lung specimens. The potential
pitfalls in the proper sampling of the lung at autopsy and how the
histopathological appearance may be altered in a diffusely injured lung are
I discussed. Pathologists are encouraged to carefully analyze and evaluate
bronchoalveolar lavage (BAL) and protected specimen brush (PSB) speci¬
mens obtained from patients before death to help determine if pneumonia
is present.
Epidemiology of Nosocomial Pneumonia in the Intensive Care Unit 29
David L. George
Pneumonia is the most commonly reported nosocomial infection for ICU
patients, occurring predominantly in ventilated patients at a rate of 1% to
3% per day of mechanical ventilation. Substantial increased costs and
CLINICS IN CHEST MEDICINE VOLUME 16 • NUMBER 1 • MARCH 1995 vii
A
mortality have been attributed to nosocomial pneumonia. Our understand¬
ing of the epidemiology of nosocomial pneumonia in ICU populations has
been limited by the reliance of most published studies on clinical diagnos¬
tic criteria that are nonspecific. In addition to mechanical ventilation and
tracheal intubation, other suspected risk factors include chronic lung dis¬
ease, age, severity of illness, upper abdominal or thoracic surgery, head
trauma or depressed level of consciousness, and gastric acid inhibition.
Aspiration appears to be the primary mode of inoculation of microorgan¬
isms into the distal lung; however, the relative importance of different
sites as reservoirs for aspiration is controversial. It is hoped that studies
based on improved diagnostic techniques, such as quantitative cultures of
protected brush or bronchoalveolar lavage specimens, will provide the
basis for an improved understanding of the epidemiology and prevention
of this important infection of critically ill patients.
Diagnostic Imaging of Pneumonia and Its Complications in the
Critically 111 Patient 45
Sanford A. Rubin, Helen T. Winer Muram, and James V. Ellis
The interpretation of chest radiographs in an ICU setting poses numerous
problems. The radiographic patterns are often nonspecific, and several
different pathologic processes may be present in the lungs at the same
time. Clinical information can be both helpful and misleading in the
interpretation of these radiographs. This article focuses primarily on the
radiographic abnormalities caused by pneumonia and the adult respira¬
tory distress syndrome; however, other causes of lung disease in ICU
patients are also discussed.
Diagnosis and Differential Diagnosis of Ventilator Associated
Pneumonia 61
G. Umberto Meduri
Clinical criteria, radiographic findings, and analysis of a tracheal aspirate
are inaccurate for diagnosing ventilator associated pneumonia (VAP). This
article reviews both invasive and noninvasive diagnostic techniques, dis¬
cusses microbiologic and microscopic analysis of lower airway secretions,
and considers factors influencing the results of these tests. The differential
diagnosis of fever and pulmonary densities in ventilated patients is dis¬
cussed, and a systematic diagnostic approach for the evaluation of patients
with suspected VAP is presented.
Ventilator Associated Pneumonia Caused by Pseudomonas Infection 95
Marc Dunn and Richard G. Wunderink
Ventilator associated pneumonia due to Pseudomonas aeruginosa is one of
the most lethal forms of nosocomial pneumonia. Excessive mortality from
Pseudomonas pneumonia results from characteristics of the organism itself
and particular defects in host defense. An important factor in treatment is
recognition of the ability of P. aeruginosa to develop resistance to a wide
variety of antibiotics. Various bacterial products give Pseudomonas the
ability to cross anatomic barriers; subsequent tissue necrosis and vascular
invasion require drainage procedures for optimal therapy. Because the
mortality from Pseudomonas pneumonia remains high despite the availabil¬
ity of potent antibiotics, immunomodulation may be important in future
therapy.
Pneumonia Due to Staphylococcus Aureus Infection 111
Bishr Al Ujayli, Daniel A. Nafziger, and Louis Saravolatz
S. aureus has emerged as the second most common cause of nosocomial
pneumonias and is frequently associated with nonspecific signs and symp
viii contents
toms. The diagnosis of S. aureus pneumonias is associated with the same
difficulties that are associated with other intensive care pneumonias. This
article reviews the microbiology, epidemiology, clinical features, therapy,
and prevention of S. aureus pneumonia.
Nosocomial Viral Pneumonia in the Intensive Care Unit 121
Robert C. Holladay and G. Douglas Campbell, Jr
The role viruses play in nosocomial ICU pneumonias is not well docu¬
mented except for outbreaks of influenza and respiratory syncytial virus
(RSV) infections. Clinically, viral pneumonias are difficult to differentiate
from bacterial pneumonias, and most routine diagnostic tests are able to
diagnose viral pathogens. Therefore, the incidence of viral pneumonias is
almost certainly underestimated. The likelihood of a viral pneumonia is
increased if the patient is not responding to antimicrobial agents, if pneu¬
monia occurs during the winter months, or if there is evidence of viral
outbreaks in the hospital or community. In the past few years, new
diagnostic tests and a number of effective antiviral agents have been
introduced; this makes the rapid diagnosis and treatment of viral pneumo¬
nia possible.
Pneumonia in Patients with Multiple Trauma 135
Donna I. McRitchie, Joan Gumowitz Matthews, and Mitchell P. Fink
This article examines the features of nosocomial pneumonia in the subpop
ulation of patients with multiple trauma. Epidemiology, trauma associated
risk factors, diagnosis, microbiology, therapy, and prevention are re¬
viewed. While some issues may overlap with critically ill patients in
general, differences in approach and management will be discussed.
Pneumonia Complicating the Adult Respiratory Distress Syndrome 147
Lisa L. Dever and W. G. Johanson, Jr
Aspiration bronchopneumonia occurs in most patients undergoing pro¬
longed mechanical ventilation. These pneumonias adversely affect lung
function and release bacteria into the systemic circulation via the lungs
lymphatics. Through this mechanism, clinically occult pneumonias may
initiate activation of systemic inflammation, leading to the syndrome of
multiple organ failure.
Community Acquired Pneumonia in the Intensive Care Unit 155
Kenneth V. Leeper, Jr, and Antoni Torres
Patients with severe community acquired pneumonia (CAP) who require
ICU admission have unique features compared to those with CAP in
general. The spectrum of microbiologic etiologies for severe CAP is shifted
away from the pneumococcus and Haemophilus influenzae and toward
Legionella, Staphylococcus aureus, and gram negative enterics. Severe mortal¬
ity is influenced by appropriate antibiotic therapy. A reliable respiratory
sample is necessary for optimal antibiotic therapy, although empiric ther¬
apy remains the standard. Severe CAP frequently leads to respiratory
failure with special ventilatory needs, particularly if extensive unilateral
involvement is present. While ICU support has lowered the mortality rate
of severe CAP, further adjunctive therapies are needed to improve mortal¬
ity from severe CAP.
Ventilator Associated Pneumonia: Failure to Respond to
Antibiotic Therapy 173
Richard G. Wunderink
Ventilator associated pneumonia continues to have a significant attribut¬
able mortality despite the use of potent antibiotics. Apparent failure of
CONTENTS ix
antibiotic therapy is due to many causes. Some are due to deficiencies of
the antibiotic therapy, such as persistence of the original organism or
development of superinfection, while others, such as misdiagnosis, devel¬
opment of systemic inflammatory response (SIRS), or host defense deficits,
are probably unrelated. The pattern of apparent failure can assist in de¬
termining the cause. Four typical patterns are rapid early progression,
persistent pneumonia, initial improvement followed by deterioration, and
slow progressive improvement. Avoidance of spiralling empiric antibiotic
therapy usually requires special procedures such as quantitative broncho
scopic cultures and chest CT.
Prevention of Ventilator Associated Pneumonia:
An Attainable Goal? 195
Avtar S. Bassin and Michael S. Niederman
Nosocomial pneumonia is a common and serious problem among hospital¬
ized patients, particularly those treated with mechanical ventilation. This
article discusses infection control, the role of respiratory therapy equip¬
ment and endotracheal tubes, mobilization of tracheobronchial secretions,
the role of the gastrointestinal tract, nutritional support and the role of the
stomach, prophylactic antibiotics, and immunomodulation. Although there
are no proven modalities for immunoprophylaxis of nosocomial pneumo¬
nia, it is possible that early administration of a single agent or combination
of immune modulators may prove effective in reducing the mortality
associated with nosocomial pneumonia.
Epidemic Nosocomial Pneumonia in the Intensive Care Unit 209
Susan A. Maloney and William R. Jarvis
The changing and expanding spectrum of pathogens associated with noso¬
comial pneumonia (NP) will require modification in our approach to both
endemic and epidemic NP in the ICU. Knowledge of specific pathogens,
modes of transmission, and sources or reservoirs of epidemic NP is crucial
to the recognition, control, and prevention of these infections in ICU
patients. This article reviews the epidemiology of nosocomial NP out ,
breaks and outlines guidelines for investigating suspected epidemics of
NP within the ICU. Preventive strategies including appropriate surveil¬
lance for recognizing epidemic clusters, adherence to barrier isolation
precautions, proper disinfection and sterilization of respiratory care equip¬
ment, and judicious use of antimicrobial agents are also discussed.
Index 225
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| spelling | Pneumonia in the intensive care unit Richard G. Wunderink guest ed. Philadelphia [u.a.] Saunders 1995 XII, 227 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in chest medicine 16,1 Intensive care gtt Longontsteking gtt Pneumopathie infectieuse Unité soins intensifs Intensive Care Units Intensive care units Pneumonia Intensivtherapie (DE-588)4027258-8 gnd rswk-swf Lungenentzündung (DE-588)4036659-5 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Lungenentzündung (DE-588)4036659-5 s Intensivtherapie (DE-588)4027258-8 s DE-604 Wunderink, Richard G. Sonstige oth Clinics in chest medicine 16,1 (DE-604)BV000001084 16,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=006750165&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Pneumonia in the intensive care unit Clinics in chest medicine Intensive care gtt Longontsteking gtt Pneumopathie infectieuse Unité soins intensifs Intensive Care Units Intensive care units Pneumonia Intensivtherapie (DE-588)4027258-8 gnd Lungenentzündung (DE-588)4036659-5 gnd |
| subject_GND | (DE-588)4027258-8 (DE-588)4036659-5 (DE-588)4143413-4 |
| title | Pneumonia in the intensive care unit |
| title_auth | Pneumonia in the intensive care unit |
| title_exact_search | Pneumonia in the intensive care unit |
| title_full | Pneumonia in the intensive care unit Richard G. Wunderink guest ed. |
| title_fullStr | Pneumonia in the intensive care unit Richard G. Wunderink guest ed. |
| title_full_unstemmed | Pneumonia in the intensive care unit Richard G. Wunderink guest ed. |
| title_short | Pneumonia in the intensive care unit |
| title_sort | pneumonia in the intensive care unit |
| topic | Intensive care gtt Longontsteking gtt Pneumopathie infectieuse Unité soins intensifs Intensive Care Units Intensive care units Pneumonia Intensivtherapie (DE-588)4027258-8 gnd Lungenentzündung (DE-588)4036659-5 gnd |
| topic_facet | Intensive care Longontsteking Pneumopathie infectieuse Unité soins intensifs Intensive Care Units Intensive care units Pneumonia Intensivtherapie Lungenentzündung Aufsatzsammlung |
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