Respiration; international review of thoracic diseases
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To achieve bacteriologic and clinical success, sufficient concentrations of antimicrobial at the site of infection must be maintained for an adequate period of time. These dynamics are determined by combining drug pharmacokinetic and pharmacodynamic (PK/PD) data with minimum inhibitory concentrations. Bacteriologically confirmed failures have been reported in otitis media and, with a lesser degree of evidence, in pneumococcal pneumonia with a variety of agents that include beta-lactams, macrolides and fluoroquinolones. ⋯ However, no clinical failure has been reported during therapy for bacteremic pneumococcal pneumonia with adequate doses of beta-lactams. The failures reported with macrolides or fluoroquinolones have been due to either preexisting resistance to these agents that cannot be overcome by increasing the dose of the antimicrobial or, more rarely, the emergence of resistance during therapy. In this review, we offer an overview of the most important attributes of the main antimicrobials that are currently used in the treatment of community-acquired respiratory tract infections from a PK/PD perspective.
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There is a paucity of data comparing doses of sedative medication during bronchoscopy in immunosuppressed and non-immunosuppressed patients. ⋯ Stem cell transplant recipients and selected HIV patients with drug abuse need higher doses of midazolam for bronchoscopy.
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Noninvasive bilevel positive pressure ventilation (N-BiPAP) has an established role in providing respiratory support in patients with acute respiratory failure. The significant advantage of N-BiPAP is to avoid endotracheal intubation and its complications. Currently there are no data that support N-BiPAP as first-line treatment in patients with blunt thoracic trauma. ⋯ N-BiPAP administration could be a safe and effective method to improve the gas exchange in patients with acute respiratory failure due to blunt thoracic trauma.
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Guidelines and standards for diagnosis and management of chronic obstructive pulmonary disease (COPD) have been presented by different national and international societies, but the spirometric criteria for COPD differ between guidelines. ⋯ The main determinants for prevalent COPD were age, smoking habits and spirometric criteria of COPD. Though a majority reported airway symptoms and contact with health care providers due to respiratory complaints, only a minority was diagnosed as having COPD, indicating a large underdiagnosis.
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The lung is one of the most exposable organs to chemical warfare agents such as sulfur mustard gas. Pulmonary complications as a result of this gas range from severe bronchial stenosis to mild or no symptoms. Airway hyperresponsiveness (AHR) which is usually assessed as response to inhaled methacholine is the most characteristic feature of asthma. AHR is reported in chronic obstructive pulmonary disease patients and smokers, and may also show in chemical warfare victims. However, there are little reports regarding AHR in chemical warfare victims. ⋯ Results showed increased airway responsiveness of most chemical warfare victims to methacholine which correlated with the FEV1 value and which may be related to chronic airway inflammation or irreversible airway changes.