Current opinion in infectious diseases
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Curr. Opin. Infect. Dis. · Apr 2011
ReviewModifying endotracheal tubes to prevent ventilator-associated pneumonia.
The endotracheal tube (ETT) is the main avenue leading to airway contamination and subsequent ventilator-associated pneumonia (VAP) during mechanical ventilation. A number of modifications to the ETT are available, aimed at reducing the incidence of VAP. We review here available systems and devices, and clinical data regarding their efficacy. ⋯ Modifications of ETTs aimed at decreasing the onset of VAP show promising results. However, the lack of a significant effect on outcomes prompts us to use caution before recommending their widespread use.
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The frequency and impact of viruses among intensive care unit (ICU) nonimmunocompromised patients remains controversial. This review analyzes their place as causal pathogens in ventilator-associated pneumonia, as well as their effects on ICU patients' outcomes. ⋯ Using efficient and rapid virologic diagnostic tests (antigenemia or PCR), the identification of viruses in ICU patients is frequent. Their role in the occurrence of ventilator-acquired pneumonia and their impact on patient outcome depend on the virus. There is sufficient evidence suggesting CMV pathogenicity to conduct an interventional randomized trial using anti-CMV drugs.
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Due to their different virulence and infectivity, both severe acute respiratory syndrome (SARS) and H1N1 09 revealed different strengths and weaknesses in our ability to contain new viral threats over the past decade. This review focuses on recent literature around attempts to contain the impact of these two viral epidemics that have refined our approach for the future. ⋯ The experience with H1N1 09 and SARS has been very useful in informing us of the strengths and weaknesses of our current approach to emerging epidemics. Key messages are a need for improved surveillance, more flexible planning, improved diagnostic testing and retaining a focus on basic hygiene measures.