Expert review of respiratory medicine
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Expert Rev Respir Med · Apr 2012
ReviewFluid administration limited by lung sonography: the place of lung ultrasound in assessment of acute circulatory failure (the FALLS-protocol).
The FALLS-protocol is included in a limited investigation to diagnose the cause of shock. After simple echocardiography has ruled out obstructive shock (tamponade, pulmonary embolism), the lung is investigated. ⋯ Hypovolemic shock will eventually improve - septic shock will not, and the slight excess fluid creates an early, silent stage of interstitial edema, demonstrated by B-lines, demanding interruption of fluid therapy. This sequential approach, combined with the usual, clinical, biochemical and echocardiographic parameters, must be evaluated in multicenter studies.
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A relevant problem in the management of pulmonary infections is the low specificity of clinical symptoms for the exact diagnosis and the need of antibiotic therapy. An ideal biomarker for bacterial pulmonary infections should allow a rapid diagnosis, have a prognostic value and facilitate therapeutic decision making. The two biomarkers currently needed in clinical use are C-reactive protein and procalcitonin. ⋯ In several interventional studies procalcitonin-guided therapy has proven to allow a significant reduction of duration and frequency of antibiotic therapy. However, for the evaluation of prognosis in community-acquired pneumonia, new cardiovascular biomarkers are superior compared with inflammatory markers, especially for the determination of long-term mortality. The combination of several biomarkers reflecting different pathophysiological pathways has the potential to improve the management of community-acquired pneumonia in the future.