6,931 results match your criteria Ventilator-Associated Pneumonia


Nursing issues in enteral nutrition during prone position in critically ill patients: A systematic review of the literature.

Intensive Crit Care Nurs 2020 Jul 5:102899. Epub 2020 Jul 5.

Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy. Electronic address:

Background: Early enteral nutrition (EN) and prone position may both improve the outcome of patients affected by moderate to severe Acute Respiratory Distress Syndrome. Recent guidelines suggest to administer early EN also during prone position. However, EN intolerance, such as high residual gastric volumes, regurgitation or vomiting, may occur during pronation. Read More

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http://dx.doi.org/10.1016/j.iccn.2020.102899DOI Listing

Alcohol Use Disorder Is Bad for Broken Ribs: A Nationwide Analysis of 19,638 Patients With Rib Fractures.

J Surg Res 2020 Jul 5;255:556-564. Epub 2020 Jul 5.

Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona. Electronic address:

Background: Alcohol use disorder (AUD) has deleterious effects on many organ systems. The aim of our study was to assess the impact of AUD on outcomes in patients with rib fractures. We hypothesized that AUD is associated with increased risk adverse outcomes. Read More

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http://dx.doi.org/10.1016/j.jss.2020.05.053DOI Listing

International Survey on Determinants of Antibiotic Duration and Discontinuation in Pediatric Critically Ill Patients.

Pediatr Crit Care Med 2020 Jun 29. Epub 2020 Jun 29.

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.

Objectives: We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries.

Design: Cross-sectional survey. Read More

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http://dx.doi.org/10.1097/PCC.0000000000002397DOI Listing

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients.

Antibiotics (Basel) 2020 Jul 5;9(7). Epub 2020 Jul 5.

Department of Anaesthesia and Critical Care Medicine, St James's Hospital, D08 X4RX Dublin, Ireland.

It is widely known that pneumonia (either community acquired or hospital acquired, as like ventilator associated pneumonia (VAP)), is the most frequent type of severe infection and continues to pose a significant burden on healthcare services worldwide. Despite new diagnostic developments, most pneumonia cases continue to be difficult to diagnose clinically, partly due to acquired antibiotic resistance and the lack of a 'gold standard' method of diagnosis. In other words, the lack of a rapid, accurate diagnostic test, as well as the uncertainty of the initial etiologic diagnosis and the risk stratification, results in empirical antibiotic treatments. Read More

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http://dx.doi.org/10.3390/antibiotics9070380DOI Listing

Stopping the Routine use of Contact Precautions for Management of MRSA and VRE at Three Academic Medical Centers: An Interrupted Time Series Analysis.

Am J Infect Control 2020 Jul 4. Epub 2020 Jul 4.

Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA.

Background:  Contact precautions (CP) are a widely adopted strategy to prevent cross-transmission of organisms, commonly methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Some hospitals have discontinued CP for patients with MRSA or VRE; however, the impact on hospital-acquired infection rates (HAI) has not been assessed systematically.

Methods:  Retrospective multicenter interrupted time series between 2002 and 2017 at three academic hospitals. Read More

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http://dx.doi.org/10.1016/j.ajic.2020.06.219DOI Listing

Incidence, risk factors, and effects on outcome of ventilator-associated pneumonia in patients with traumatic brain injury. Analysis of a large, multicenter, prospective, observational longitudinal study.

Chest 2020 Jul 4. Epub 2020 Jul 4.

School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy. Electronic address:

Background: No large prospective data are available on ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI).

Research Question: To evaluate the incidence, timing and risk factors of VAP after TBI and its effect on patients' outcome.

Study Design: and Methods: Analysis of the CENTER-TBI dataset, a large, multicenter, prospective, observational study including TBI patients admitted to European intensive care units (ICU), mechanically ventilated for ≥48 hours, and with an ICU length of stay (LOS) ≥72 hours. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.064DOI Listing

Development of an intensive care oral care frequency assessment scale.

Nurs Crit Care 2020 Jul 6. Epub 2020 Jul 6.

Faculty of Nursing, Fundamentals of Nursing Department, Akdeniz University, Antalya, Turkey.

Background: Oral care and frequency of oral care is important for intensive care patients in order to prevent the risk of ventilator-associated pneumonia. However, there are no scales to assess the frequency of oral care specific to intensive care units (ICUs).

Aims And Objectives: This study aimed to develop a valid and reliable tool, "Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS)", for assessing the frequency of nurses' oral care in critical ill patients. Read More

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http://dx.doi.org/10.1111/nicc.12529DOI Listing

COVID-19 Assessment with Bedside Lung Ultrasound in a Population of Intensive Care Patients Treated with Mechanical Ventilation and ECMO.

Diagnostics (Basel) 2020 Jul 2;10(7). Epub 2020 Jul 2.

Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark.

The COVID-19 pandemic has increased the need for an accessible, point-of-care and accurate imaging modality for pulmonary assessment. COVID-19 pneumonia is mainly monitored with chest X-ray, however, lung ultrasound (LUS) is an emerging tool for pulmonary evaluation. In this study, patients with verified COVID-19 disease hospitalized at the intensive care unit and treated with ventilator and extracorporal membrane oxygenation (ECMO) were evaluated with LUS for pulmonary changes. Read More

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http://dx.doi.org/10.3390/diagnostics10070447DOI Listing

Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach.

J Cardiothorac Vasc Anesth 2020 Jun 11. Epub 2020 Jun 11.

Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy.

Lung ultrasound (LU) has a multitude of features and capacities that make it a useful medical tool to assist physicians contending with the pandemic spread of novel coronavirus disease-2019 (COVID-19) caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, an LU approach to patients with suspected COVID-19 is being implemented worldwide. In noncritical COVID-19 patients, 2 new LU signs have been described and proposed, the "waterfall" and the "light beam" signs. Read More

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http://dx.doi.org/10.1053/j.jvca.2020.06.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289113PMC

Activity of ceftolozane-tazobactam and comparators when tested against bacterial surveillance isolates collected from patients at risk of infections caused by resistant gram-negative pathogens.

Diagn Microbiol Infect Dis 2020 Jun 6;98(1):115101. Epub 2020 Jun 6.

JMI Laboratories, North Liberty, Iowa, USA.

Ceftolozane-tazobactam is an antipseudomonal cephalosporin combined with a β-lactamase inhibitor. Ceftolozane-tazobactam has been approved for treatment of complicated urinary tract infections and acute pyelonephritis, for complicated intra-abdominal infections (with metronidazole) in adults, and for hospital-acquired bacterial pneumonia including ventilator-associated bacterial pneumonia. This study analyzed gram-negative pathogen susceptibility in US and European patients who are considered at risk for infections caused by pathogens resistant to commonly used antimicrobials: patients in the intensive care unit (ICU), patients on the hematology/oncology or transplant service who may be immunocompromised, and patients >65 years old (yo). Read More

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http://dx.doi.org/10.1016/j.diagmicrobio.2020.115101DOI Listing

Impact of Oral Care and Antisepsis on the Prevalence of Ventilator-Associated Pneumonia.

Oral Health Prev Dent 2020 Apr 1;18(2):331-336. Epub 2020 Apr 1.

Purpose: This study aimed to evaluate the impact of oral care and use of chlorhexidine gluconate on the prevention of ventilator-associated pneumonia (VAP) in patients admitted to an intensive care unit (ICU).

Materials And Methods: An evaluation was performed on 229 patients admitted to ICU in 2012 (before implementation of oral care protocol) and 329 in 2013 (after the protocol). Oral care was based on the removal of secretions from the oral cavity with 0. Read More

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http://dx.doi.org/10.3290/j.ohpd.a44443DOI Listing

Predicting ventilator-associated pneumonia.

Ann Transl Med 2020 Jun;8(11):670

Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland.

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http://dx.doi.org/10.21037/atm.2020.03.173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327331PMC

Hospital admissions for community-acquired, ventilator-associated and nonventilator hospital-acquired pneumonia in COPD patients in Spain (2016-2017).

Eur J Intern Med 2020 Jun 29. Epub 2020 Jun 29.

Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty. Rey Juan Carlos University. Alcorcón. Madrid, 28922, Spain.

Background: To examine the incidence, characteristics and outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and nonventilator hospital-acquired pneumonia (NV-HAP) in patients with or without COPD; compare in-hospital outcomes; and identify factors associated with in-hospital mortality (IHM) for pneumonia.

Methods: We carried out a retrospective observational study using the hospital discharge records from 2016-17 of the Spanish National Health System. Propensity score matching was used for data analysis. Read More

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http://dx.doi.org/10.1016/j.ejim.2020.06.028DOI Listing

Structure and process associated with the efficiency of intensive care units in low-resource settings: An analysis of the CHECKLIST-ICU trial database.

J Crit Care 2020 Jun 18;59:118-123. Epub 2020 Jun 18.

D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Brazilian Research in Intensive Care Network (BRICNet), Brazil; Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil. Electronic address:

Purpose: Characteristics of structure and process impact ICU performance and the outcomes of critically ill patients. We sought to identify organizational characteristics associated with efficient ICUs in low-resource settings.

Materials And Methods: This is a secondary analysis of a multicenter cluster-randomized clinical trial in Brazil (CHECKLIST-ICU). Read More

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http://dx.doi.org/10.1016/j.jcrc.2020.06.008DOI Listing

Pulmonary Aspergillosis in Patients with Suspected Ventilator-associated Pneumonia in UK Intensive Care Units.

Am J Respir Crit Care Med 2020 Jul 1. Epub 2020 Jul 1.

Queen's University Belfast, 1596, Belfast, United Kingdom of Great Britain and Northern Ireland;

Rationale: Aspergillus infection in patients with suspected ventilator-associated pneumonia remains uncharacterised due to absence of a disease definition and limited access to sensitive diagnostic tests.

Objectives: To estimate the prevalence and outcomes of Aspergillus infection in adults with suspected ventilator associated pneumonia.

Methods: Two prospective UK studies recruited 360 critically ill adults with new or worsening alveolar shadowing on chest X-ray and clinical/haematological parameters supporting suspected ventilator-associated pneumonia. Read More

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http://dx.doi.org/10.1164/rccm.202002-0355OCDOI Listing

The impact of antimicrobial stewardship program implementation at four tertiary private hospitals: results of a five-years pre-post analysis.

Antimicrob Resist Infect Control 2020 29;9:95. Epub 2020 Jun 29.

Research Center, Dr Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.

Background: Antimicrobial stewardship (AMS) programs have shown to reduce the emergence of antimicrobial resistance (AMR) and health-care-associated infections (HAIs), and save health-care costs associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the consumption and cost of antimicrobial agents using defined daily dose (DDD) and direct cost of antibiotics before and after the AMS program implementation. Secondary objective was to determine the rate of HAIs [ (), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infection (CLABSI) before and after the AMS program implementation. Read More

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http://dx.doi.org/10.1186/s13756-020-00751-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322716PMC

Bacterial and fungal coinfection among hospitalised patients with COVID-19: A retrospective cohort study in a UK secondary care setting.

Clin Microbiol Infect 2020 Jun 27. Epub 2020 Jun 27.

Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK; North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road. London. W6 8RF. UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London. W12 0NN. UK.

Objectives: We investigate the incidence of bacterial and fungal co-infection of hospitalised patients with confirmed SARS-CoV-2 in this retrospective observational study across two London hospitals during the first UK wave of COVID-19.

Methods: A retrospective case-series of hospitalised patients with confirmed SARS-CoV-2 by PCR was analysed across two acute NHS hospitals (February 20-April 20; each isolate reviewed independently in parallel). This was contrasted to a control group of influenza positive patients admitted during 2019/20 flu season. Read More

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http://dx.doi.org/10.1016/j.cmi.2020.06.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320692PMC

Safety Profile of Ceftazidime-Avibactam: Pooled Data from the Adult Phase II and Phase III Clinical Trial Programme.

Drug Saf 2020 Jun 29. Epub 2020 Jun 29.

AstraZeneca, Alderley Park, Macclesfield, UK.

Introduction: Ceftazidime-avibactam combines the established anti-pseudomonal cephalosporin, ceftazidime, with the novel non-β-lactam β-lactamase inhibitor, avibactam.

Objectives: The aim of this study was to evaluate the safety of ceftazidime-avibactam in adults using pooled data from two phase II (NCT00690378, NCT00752219) and five phase III (NCT01499290, NCT01726023, NCT01644643, NCT01808093 and NCT01595438/NCT01599806) clinical studies.

Methods: Safety data from seven multicentre, randomised, active-comparator studies were pooled by study group at the patient level for descriptive analyses, comprising patients with complicated urinary tract infection (cUTI), including pyelonephritis, complicated intra-abdominal infection (cIAI), or nosocomial pneumonia (NP), including ventilator-associated pneumonia (VAP), treated with ceftazidime-avibactam ± metronidazole or comparator. Read More

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http://dx.doi.org/10.1007/s40264-020-00934-3DOI Listing

A Structure-Function-Inhibition Analysis of the Type III Secretion Needle Protein PscF.

J Bacteriol 2020 Jun 29. Epub 2020 Jun 29.

Microbiotix, Inc., Worcester, MA, USA 01605.

The type III secretion system (T3SS) needle comprised of multiple PscF subunits is essential for the translocation of effector toxins into human cells, facilitating the establishment and dissemination of infection. Mutations in the gene provide resistance to the phenoxyacetamide (PhA) series of T3SS inhibitory chemical probes. To better understand PscF functions and interactions with PhA, alleles of with 71 single mutations altering 49 of the 85 residues of the encoded protein were evaluated for their effects on T3SS phenotypes. Read More

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http://dx.doi.org/10.1128/JB.00055-20DOI Listing

Associationbetween hyperoxia and mortality in severely burned patients.

Burns 2020 Jun 26. Epub 2020 Jun 26.

Arizona Burn Center 2601 E Roosevelt St, Phoenix, AZ 85008, United States.

Introduction: The use of oxygen is a key component of acute burn resuscitation, particularly when there is concern for carbon monoxide toxicity or inhalation injury. Prior studies of critically-ill patients have shown an association between early hyperoxia and increased mortality. There are no studies to date evaluating outcomes related to excessive oxygen administration in burn patients. Read More

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http://dx.doi.org/10.1016/j.burns.2019.12.002DOI Listing

The impact of antimicrobial stewardship program implementation at four tertiary private hospitals: results of a five-years pre-post analysis.

Antimicrob Resist Infect Control 2020 Jun 29;9(1):95. Epub 2020 Jun 29.

Research Center, Dr Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.

Background: Antimicrobial stewardship (AMS) programs have shown to reduce the emergence of antimicrobial resistance (AMR) and health-care-associated infections (HAIs), and save health-care costs associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the consumption and cost of antimicrobial agents using defined daily dose (DDD) and direct cost of antibiotics before and after the AMS program implementation. Secondary objective was to determine the rate of HAIs [Clostridium difficile (C. Read More

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http://dx.doi.org/10.1186/s13756-020-00751-4DOI Listing

Update of the treatment of nosocomial pneumonia in the ICU.

Crit Care 2020 Jun 29;24(1):383. Epub 2020 Jun 29.

ICU, Trinity Centre for Health Science HRB-Wellcome Trust, St James's Hospital, Dublin, Ireland.

In accordance with the recommendations of, amongst others, the Surviving Sepsis Campaign and the recently published European treatment guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), in the event of a patient with such infections, empirical antibiotic treatment must be appropriate and administered as early as possible. The aim of this manuscript is to update treatment protocols by reviewing recently published studies on the treatment of nosocomial pneumonia in the critically ill patients that require invasive respiratory support and patients with HAP from hospital wards that require invasive mechanical ventilation. An interdisciplinary group of experts, comprising specialists in anaesthesia and resuscitation and in intensive care medicine, updated the epidemiology and antimicrobial resistance and established clinical management priorities based on patients' risk factors. Read More

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http://dx.doi.org/10.1186/s13054-020-03091-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322703PMC

Biofilm formation on three different endotracheal tubes: a prospective clinical trial.

Crit Care 2020 Jun 29;24(1):382. Epub 2020 Jun 29.

Department of Clinical Sciences, Lund University, Lund, Sweden.

Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is believed to act as a reservoir for infecting microorganisms and thereby contribute to development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface, it is difficult to eradicate. Read More

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http://dx.doi.org/10.1186/s13054-020-03092-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322705PMC

Evaluation of the Etest and disk diffusion method for detection of the activity of ceftazidime-avibactam against Enterobacterales and Pseudomonas aeruginosa in China.

BMC Microbiol 2020 Jun 29;20(1):187. Epub 2020 Jun 29.

Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China.

Background: Ceftazidime-avibactam was approved in China in 2019 for treating complicated intra-abdominal infections, hospital-acquired pneumonia, ventilator-associated pneumonia, and infections caused by Enterobacterales and Pseudomonas aeruginosa for which treatment options are limited. However, no currently available commercial systems have been approved for antimicrobial susceptibility testing of ceftazidime-avibactam in China. Here, we evaluated the Etest and disk diffusion method for detecting the activity of ceftazidime-avibactam against Enterobacterales and P. Read More

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http://dx.doi.org/10.1186/s12866-020-01870-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325266PMC

Economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (E-PROSPECT): study protocol.

BMJ Open 2020 Jun 28;10(6):e036047. Epub 2020 Jun 28.

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.

Introduction: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the intensive care unit (ICU). Probiotics are defined as live microorganisms that may confer health benefits when ingested. Prior randomised trials suggest that probiotics may prevent infections such as VAP and -associated diarrhoea (CDAD). Read More

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http://dx.doi.org/10.1136/bmjopen-2019-036047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322334PMC

[Practice of nosocomial infection management in burn department based on the American hospital evaluation standard of the Joint Commission International].

Zhonghua Shao Shang Za Zhi 2020 Jun;36(6):488-492

Department of Burns, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.

To explore the role of continuous quality improvement measures based on the American hospital evaluation standard of the Joint Commission International (JCI) in prevention and control of nosocomial infection in Burn Department of the Second Affiliated Hospital of Zhejiang University School of Medicine (hereinafter referred to as the author' s department). From 2013 to 2018, based on 11 JCI standards related to infection prevention and control and the current situation of the author' s department, more than 50 doctors, nurses, and nursing assistants from the author' s department participated in continuous improvement of the three-level management system of nosocomial infection in the author' s department, focusing on implementing of management of patient with multidrug resistant bacteria infection, optimizing the infection control management of instrument and cloth, and implementing target management on 5 indicators such as hand hygiene implementation rate, and carrying out inspection, quality management, and improvement on 11 items of prevention and control of nosocomial infection. The implementation rate of hand hygiene from 2013 to 2018 and the accuracy rate of hand hygiene from 2016 to 2018 of medical staff in the author' s department, and incidences of catheter-related bloodstream infection (CRBSI) of central venous, catheter-associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP) of burn intensive care unit in the author's department from 2013 to 2018 were monitored. Read More

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http://dx.doi.org/10.3760/cma.j.cn501120-20190206-00020DOI Listing

Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients.

Clin Oral Investig 2020 Jun 27. Epub 2020 Jun 27.

Department of Clinical Medicine, Londrina State University, Londrina, Brazil.

Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU).

Material And Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Read More

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http://dx.doi.org/10.1007/s00784-020-03426-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320842PMC

A multicenter evaluation of outcomes following the use of nebulized heparin for inhalation injury (HIHI2 Study).

J Burn Care Res 2020 Jun 28. Epub 2020 Jun 28.

Department of Pharmacy, Eskenazi Health, Indianapolis, IN.

Inhalation injury causes significant morbidity and mortality secondary to compromise of the respiratory system as well as systemic effects limiting perfusion and oxygenation. Nebulized heparin reduces fibrin cast formation and duration of mechanical ventilation in patients with inhalation injury. To date, no study has compared both dosing strategies of 5,000 and 10,000 units to a matched control group. Read More

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http://dx.doi.org/10.1093/jbcr/iraa101DOI Listing

Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound.

Eur J Pediatr 2020 Jun 26. Epub 2020 Jun 26.

Neonatal Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, North Wing 6th floor, Westminster Bridge Road, London, SE1 0EH, UK.

No consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Read More

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http://dx.doi.org/10.1007/s00431-020-03710-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317892PMC

Usefulness of point-of-care multiplex PCR to rapidly identify pathogens responsible for ventilator-associated pneumonia and their resistance to antibiotics: an observational study.

Crit Care 2020 Jun 26;24(1):378. Epub 2020 Jun 26.

Service de Bactériologie-Hygiène, Hospital Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France.

Background: The use of multiplex PCR to shorten time to identification of pathogens and their resistance mechanisms for patients with ventilator-associated pneumonia (VAP) is attractive, but poorly studied. The multiplex PCR-based Unyvero pneumonia cartridge assay can directly identify 20 bacteria and one fungus, amongst the most frequently causing VAP, and 19 of their resistance markers in clinical specimens (bronchoalveolar lavage or tracheal aspirate), with a turnaround time of 4-5 h. We performed this study to evaluate the concordance between the multiplex PCR-based Unyvero pneumonia cartridge assay and conventional microbiological techniques to identify pathogens and their resistance mechanisms in patients with VAP. Read More

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http://dx.doi.org/10.1186/s13054-020-03102-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316635PMC

Prevention of Early Ventilator-Associated Pneumonia.

Authors:

N Engl J Med 2020 06;382(26):2582

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http://dx.doi.org/10.1056/NEJMx200010DOI Listing

Critical care practice in India: Results of the intensive care unit need assessment survey (ININ2018).

World J Crit Care Med 2020 Jun 5;9(2):31-42. Epub 2020 Jun 5.

Department of Critical Care, United Memorial Medical Center, Houston, TX 77091, United States.

Background: A diverse country like India may have variable intensive care units (ICUs) practices at state and city levels.

Aim: To gain insight into clinical services and processes of care in ICUs in India, this would help plan for potential educational and quality improvement interventions.

Methods: The Indian ICU needs assessment research group of diverse-skilled individuals was formed. Read More

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http://dx.doi.org/10.5492/wjccm.v9.i2.31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298589PMC

[Application of acute physiology and chronic health evaluation II score in the timing of noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2020 May;32(5):581-584

Department of Respiratory and Critical Care Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People's Hospital), Haikou 570208, Hainan, China. Corresponding author: Zeng Cimei, Email:

Objective: To explore the application of acute physiology and chronic health evaluation II (APACHE II) score in the timing and nursing of noninvasive ventilation for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods: 106 AECOPD patients admitted to Haikou People's Hospital from January 2018 to October 2019 were selected as the study objects. According to the method of random number table, the patients were divided into observation group and control group, with 53 patients in each group. Read More

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http://dx.doi.org/10.3760/cma.j.cn121430-20200106-00159DOI Listing

Healthcare-associated Infection in Intensive Care Units: Overall Analysis of Patient Criticality by Acute Physiology and Chronic Health Evaluation IV Scoring and Pathogenic Characteristics.

Indian J Crit Care Med 2020 Apr;24(4):252-257

Department of Microbiology, JSS Medical College, Mysuru, Karnataka, India.

Objectives: To compare the predicted vs observed mortality rate, criticality, and length of stay of the patients with healthcare-associated infections (HAIs) in intensive care units (ICUs) of a tertiary health center through acute physiology and chronic health evaluation (APACHE) IV scoring. To analyze the drug sensitivity pattern of the isolated pathogen.

Design: This is a prospective observational study involving the patients admitted to various ICUs of a tertiary care teaching hospital. Read More

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http://dx.doi.org/10.5005/jp-journals-10071-23384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297239PMC

Effects of Micronutrients or Conditional Amino Acids on COVID-19-Related Outcomes: An Evidence Analysis Center Scoping Review.

J Acad Nutr Diet 2020 May 20. Epub 2020 May 20.

Recent narrative reviews have described the potential efficacy of providing individuals infected with coronavirus disease 2019 (COVID-19) with additional micronutrients to reduce disease severity. Although there are compelling reasons why providing additional micronutrients or conditional amino acids may affect COVID-19-related outcomes, evidence is lacking. The objective of this scoping review is to explore and describe the literature examining the effect of providing additional micronutrients or conditional amino acids (glutamine, arginine) in adults with conditions or infections similar to COVID-19 infection on COVID-19-related health outcomes. Read More

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http://dx.doi.org/10.1016/j.jand.2020.05.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237946PMC
May 2020
2.444 Impact Factor

Incidence and outcomes of hospitalization for community-acquired, ventilator-associated and non-ventilator hospital-acquired pneumonias in patients with type 2 diabetes mellitus in Spain.

BMJ Open Diabetes Res Care 2020 Jun;8(1)

Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Madrid, Spain.

Introduction: To describe the incidence and compare in-hospital outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with or without type 2 diabetes mellitus (T2DM) using propensity score matching.

Research Design And Methods: This was a retrospective observational epidemiological study using the 2016-2017 Spanish Hospital Discharge Records.

Results: Of 245 221 admissions, CAP was identified in 227 524 (27. Read More

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http://dx.doi.org/10.1136/bmjdrc-2020-001447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304643PMC

Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia.

Crit Care 2020 06 19;24(1):366. Epub 2020 Jun 19.

Université de Paris, IAME, INSERM, Paris, F-75018, France.

Background: Early appropriate antibiotic therapy reduces morbidity and mortality of severe pneumonia. However, the emergence of bacterial resistance requires the earliest use of antibiotics with the narrowest possible spectrum. The Unyvero Hospitalized Pneumonia (HPN, Curetis) test is a multiplex PCR (M-PCR) system detecting 21 bacteria and 19 resistance genes on respiratory samples within 5 h. Read More

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http://dx.doi.org/10.1186/s13054-020-03067-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303941PMC

Ventilator management of adult patients in the emergency department.

Authors:
Ryan Pedigo

Emerg Med Pract 2020 07 1;22(7):1-20. Epub 2020 Jul 1.

Director, Medical Student Education, Harbor-UCLA Medical Center; Assistant Professor of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.

There are a variety of ventilator options available to the emergency clinician, and decisions on choosing optimal settings will depend on the clinical circumstances. Understanding the latest literature in ventilator management can improve patient outcomes by ensuring optimal oxygenation and ventilation and reducing the potential for ventilator-induced lung injury. This article reviews the most appropriate ventilator settings for a variety of conditions in intubated adult patients presenting to the emergency department, and gives recommendations on monitoring the ventilated patient and making ventilator adjustments. Read More

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Rapid and Point-of-Care Testing in Respiratory Tract Infections: An Antibiotic Guardian?

ACS Pharmacol Transl Sci 2020 Jun 12;3(3):401-417. Epub 2020 May 12.

University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.

This is a narrative review on the potential of rapid and point-of-care microbiological testing in pneumonia patients, focusing particularly on hospital-acquired and ventilator-associated pneumonia, which have substantial mortality and diverse microbiology. This work is written from a United Kingdom perspective, but much of it is generalizable internationally. In a world where antimicrobial resistance is a major international threat, the use of rapid molecular diagnostics has great potential to improve both the management of pneumonia patients and the stewardship of antibiotics. Read More

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http://dx.doi.org/10.1021/acsptsci.0c00027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233852PMC

High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant in Intensive Care Unit.

Infect Drug Resist 2020 18;13:1447-1454. Epub 2020 May 18.

Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China.

Purpose: The association between clinical and microbiological outcomes and high-dose tigecycline (TGC) was assessed in elderly (≥60 years old) patients with hospital-acquired and ventilator-associated pneumonia due to multidrug-resistant (). This study also assessed tigecycline combination with different antibiotics and its influence on the outcome.

Patients And Methods: An observational retrospective cohort study was conducted. Read More

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http://dx.doi.org/10.2147/IDR.S249352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244348PMC

Clinical Impact of Supplementation of Vitamins B1 and C on Patients with Sepsis-Related Acute Respiratory Distress Syndrome.

Tuberc Respir Dis (Seoul) 2020 Jul 16;83(3):248-254. Epub 2020 Jun 16.

Gyeongsang National University School of Medicine, Jinju, Korea.

Background: Although few studies have reported improved clinical outcomes with the administration of vitamin B1 and C in critically ill patients with septic shock or severe pneumonia, its clinical impact on patients with sepsis-related acute respiratory distress syndrome (ARDS) remains unclear. The purpose of this study was to evaluate the association with vitamin B and C supplementation and clinical outcomes in patients with ARDS.

Methods: Patients with ARDS requiring invasive mechanical ventilation, admitted to the medical intensive care unit (ICU) were included in this study. Read More

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http://dx.doi.org/10.4046/trd.2020.0008DOI Listing

Controlling nosocomial infection in adult intensive treatment unit: A quality improvement project.

Int J Risk Saf Med 2020 Jun 4. Epub 2020 Jun 4.

King Hamad University Hospital, Bahrain.

Background: Nosocomial infection is a significant burden on healthcare facilities. Its multifactorial nature renders it challenging to control. However, quality healthcare necessitates a safer service that poses no harm to the patient. Read More

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http://dx.doi.org/10.3233/JRS-190028DOI Listing

Acute Respiratory Distress Syndrome: Diagnosis and Management.

Am Fam Physician 2020 Jun;101(12):730-738

8th Theater Sustainment Command, Fort Shafter, HI, USA.

Acute respiratory distress syndrome (ARDS) is noncardiogenic pulmonary edema that manifests as rapidly progressive dyspnea, tachypnea, and hypoxemia. Diagnostic criteria include onset within one week of a known insult or new or worsening respiratory symptoms, profound hypoxemia, bilateral pulmonary opacities on radiography, and inability to explain respiratory failure by cardiac failure or fluid overload. ARDS is thought to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting inflammatory cell accumulation in the alveoli and microcirculation of the lung. Read More

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Assessment of the sedative effects of dexmedetomidine and propofol treatment in patients undergoing mechanical ventilation in the ICU and relationship between treatment and occurrence of ventilator-associated pneumonia and detection of pathogenic bacteria.

Exp Ther Med 2020 Jul 29;20(1):599-606. Epub 2020 Apr 29.

Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China.

The present study aimed to investigate the sedative effects of dexmedetomidine combined with propofol in patients undergoing mechanical ventilation in the intensive care unit (ICU), and to reveal the risk factors of ventilator-associated pneumonia (VAP). A retrospective analysis of 322 patients who had been subject to mechanical ventilation in the ICU ward was performed. Subjects were divided into two groups: A group treated with dexmedetomidine and propofol (combined group) and a group treated with dexmedetomidine alone (monotherapy group). Read More

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http://dx.doi.org/10.3892/etm.2020.8699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282099PMC

[A clinical study on the determination of cuff pressure in artificial airway by minimum air leakage method].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2020 Apr;32(4):439-442

Department of Critical Care Medicine, the Fifth Center Hospital in Tianjin, Tianjin 300457, China. Corresponding author: Cheng Xiuling, Email:

Objective: To compare the cuff pressure and leakage volume and the related complications of filling the tracheal tube cuff by minimum air leakage method and cuff pressure manometer method after endotracheal intubation, so as to provide theoretical basis for patients who was intubated to obtain appropriate cuff pressure.

Methods: A prospective randomized controlled study was conducted. 100 patients admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from December 2015 to June 2019 were enrolled. Read More

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http://dx.doi.org/10.3760/cma.j.cn121430-20200122-00143DOI Listing

Bundle of Coated Devices to Reduce Nosocomial Infections in the Intensive Care Unit: CRITIC Pilot Randomized Controlled Trial.

Ann Am Thorac Soc 2020 Jun 11. Epub 2020 Jun 11.

Instituto Latino-Americano de Sepsis, Sao Paulo, Brazil.

Rationale: Coated devices may reduce biofilm formation and reduce occurrence of device-related infections in critically ill patients. A bundle of coated devices (endotracheal tube - ETT, central venous catheter - CVC, urinary catheter - UC) simultaneously inserted may optimize benefits of coated devices in most severe patients.

Objectives: To assess feasibility of a randomized controlled trial on simultaneous insertion of gold-silver-palladium coated devices versus uncoated devices in severely ill patients required sequential insertion of all three devices (ETT, CVC and UC) for support in intensive care unit (ICU). Read More

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http://dx.doi.org/10.1513/AnnalsATS.202003-206OCDOI Listing

The Association of Antibiotic Duration With Successful Treatment of Community-Acquired Pneumonia in Children.

J Pediatric Infect Dis Soc 2020 Jun 11. Epub 2020 Jun 11.

Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Background: National guidelines recommend 10 days of antibiotics for children with community-acquired pneumonia (CAP), acknowledging that the outcomes of children hospitalized with CAP who receive shorter durations of therapy have not been evaluated.

Methods: We conducted a comparative effectiveness study of children aged ≥6 months hospitalized at The Johns Hopkins Hospital who received short-course (5-7 days) vs prolonged-course (8-14 days) antibiotic therapy for uncomplicated CAP between 2012 and 2018 using an inverse probability of treatment weighted propensity score analysis. Inclusion was limited to children with clinical and radiographic criteria consistent with CAP, as adjudicated by 2 infectious diseases physicians. Read More

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http://dx.doi.org/10.1093/jpids/piaa055DOI Listing

Microbiologic surveillance through subglottic secretion cultures during invasive mechanical ventilation: a prospective observational study.

J Crit Care 2020 May 26;59:42-48. Epub 2020 May 26.

Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Istituto di Anestesia e Rianimazione; Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address:

Purpose: Whether subglottic secretions (SS) culture during invasive mechanical ventilation may aid microbiological surveillance is unknown. We conducted a prospective study to assess SS cultures predictivity of endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) isolates.

Materials And Methods: 109 patients receiving mechanical ventilation for ≥48 hours underwent SS and ETA surveillance cultures twice weekly; blind BAL was performed in case of clinically suspected pneumonia. Read More

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http://dx.doi.org/10.1016/j.jcrc.2020.05.013DOI Listing
May 2020
2.191 Impact Factor

Multiple cross displacement amplification-a more applicable technique in detecting Pseudomonas aeruginosa of ventilator-associated pneumonia (VAP).

Crit Care 2020 06 8;24(1):306. Epub 2020 Jun 8.

Department of Healthcare, Xiamen Port Clinic of Xiamen Customs, Xiamen, Fujian, China.

Background: Early and rapid identification of Pseudomonas aeruginosa (P. aeruginosa) in patients with suspected ventilator-associated pneumonia (VAP) provides theoretical clinical advantages in therapeutic optimization strategies.

Methods: The P. Read More

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http://dx.doi.org/10.1186/s13054-020-03003-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276953PMC