Clinics in chest medicine
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Clinics in chest medicine · Sep 2011
ReviewDiagnosis of ventilator-associated respiratory infections (VARI): microbiologic clues for tracheobronchitis (VAT) and pneumonia (VAP).
Intubated patients are at risk of bacterial colonization and ventilator-associated respiratory infection (VARI). VARI includes tracheobronchitis (VAT) or pneumonia (VAP). ⋯ Extensive data indicate that early, appropriate antibiotic therapy improves outcomes for patients with VAP. Recognizing and treating VARI may allow earlier appropriate therapy and improved patient outcomes.
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This review summarizes recent clinical data examining the use of aerosolized antimicrobial therapy for the treatment of respiratory tract infections in mechanically ventilated patients in the intensive care unit. Aerosolized antibiotics provide high concentrations of drug in the lung without the systemic toxicity associated with the intravenous antibiotics. First introduced in the 1960s as a treatment of tracheobronchitis and bronchopneumonia caused by Pseudomonas aeruginosa, now, more than 40 years later, there is a resurgence of interest in using this mode of delivery as a primary therapy for ventilator-associated tracheobronchitis and an adjunctive therapy for ventilator-associated pneumonia.
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Clinics in chest medicine · Sep 2011
ReviewDe-escalation therapy: is it valuable for the management of ventilator-associated pneumonia?
In therapy for ventilator-associated pneumonia, it is essential to get initial empiric therapy correct; this is challenging because many patients are infected with multidrug-resistant pathogens. The need for achieving appropriate therapy can lead to broad-spectrum empiric therapy, which can represent antibiotic overuse and promote even more resistance. In an effort to combat this problem, de-escalation therapy has been proposed, with the goals of reducing the number of drugs, the spectrum of therapy, and the duration of therapy. This review examines the factors associated with an effective de-escalation strategy and ways to increase the rates of de-escalation in the future.