摘要:

The incidence of invasive pulmonary aspergillosis (IPA) has increased in recent years because of the simultaneous increase of immunosuppressed patients. Reports of cases of patients with chronic obstructive pulmonary disease (COPD) with IPA have also increased. In the immunosuppressed population, a high index of clinical suspicion improves early diagnosis, allowing success rates of 30% to 50%. However, in patients with COPD, the mortality rate is close to 100%. Delay in treatment is related to a low index of clinical suspicion and could be the main factor leading to mortality. Moreover, the finding of other pathogenic microorganisms in respiratory samples could be another factor that delays treatment. It is important to bear in mind that patients with COPD are at a high risk of developing IPA, and persistence of pulmonary infiltrates or clinical deterioration should alert physicians to the possibility of IPA. In general, we agree with other authors that the guidelines set forth by the Centers for Disease Control should include patients with COPD in the list of high-risk patients.

ISSN:1068-0640    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Enteric and nonfermentative Gram-negative bacilli (GNB) are recognized causes of community-acquired pneumonia (CAP). Clinical presentation is usually severe, often justifying the admission of patients to an intensive care unit. The great majority of cases occur in persons who harbor GNB in the oropharynx, as a consequence of suffering from an underlying disease or taking antibiotics. Less frequently, the disease is the result of the hematogenous seeding of the lung from a distant septic focus. Clinical manifestations and radiologic features are nonspecific. However, the concurrence of a severe clinical picture and evidence of lung necrosis in a patient with comorbidity suggest the involvement of GNB. Etiologic diagnosis is difficult without resorting to invasive procedures aimed to obtain respiratory samples free of salivary contamination. Sputum Gram’s stain and culture are devoid of specificity, even if performed on a high-quality sample. CAP due to Enterobacteriaceae can usually be treated with a single &bgr;-lactam antibiotic. If signs of radiologic cavitation or shock are present, the addition of an aminoglycoside is advisable. To prevent the emergence of resistance, infections due toPseudomonas aeruginosaor other nonfermentative GNB require the combination of a &bgr;-lactam with an aminoglycoside or fluoroquinolone. Optimal duration of antibiotic therapy has not been well established, but 2 to 3 weeks are generally recommended.

ISSN:1068-0640    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Coal workers’ pneumoconiosis (CWP) and silicosis contribute substantially to the mortality rate in developed countries. Both diseases evolve after dust inhalation. Macrophage activation with an excessive inflammatory response triggers consecutive tissue fibrosis. Tumor necrosis factor-&agr; has been identified as one key mediator within the cytokine network. Genetic polymorphism of the promoter gene or a specific apoptosis pattern may contribute to susceptibility of the individual to develop disease. The diagnosis is based on nodules and opacities in the posteroanterior chest radiograph, which are scored according to the International Labour Office classification. The sensitivity of the chest radiograph to detect either lower-grade CWP or silicosis in subjects who have been exposed is poor, when compared with postmortem examinations. Computed tomography of the chest may be a complementary method for further clarification or detection of other parenchymal abnormalities in some individuals. The susceptibility to pulmonary infections withMycobacterium tuberculosisis not limited to patients with radiographic evidence of advanced pneumoconiosis but also includes subjects with early disease and those without radiographic evidence but with dust exposure. It is widely assumed that toxic dust inhalation induces defects in macrophage-mediated defense mechanisms, but very little convincing evidence exists to explain why dust exposure or pneumoconiosis is associated with mycobacterial infections.

ISSN:1068-0640    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Duke University’s (Durham, NC) Respiratory Care Department provides an airway management service that responds, on average, to 845 intubations per year. Airway procedures are performed by registered respiratory therapists who must complete a three-step training curriculum. This includes basic airway competencies, airway certification, and advanced standing. Requirements include advanced cardiac life support, written examination, laboratory demonstration, supervised clinical performance, and annual skills maintenance. The goals of our service are to provide (1) competent persons for performing the service, (2) a rapid response time, and (3) a cost-effective delivery. Results of an analysis of our service indicate that airways are successfully placed in less than 3 attempts in 93% of intubations performed. Additionally, recognized complication rates have dropped from 12% to 3% consecutively for the past 8 years. Response time has remained at less than 1 minute on average. Cost savings are realized by centralizing equipment and using nonphysician providers. By centralizing an airway management service in respiratory care departments, the following can be achieved: (1) response by a strategically located specialized team is ensured; (2) all necessary equipment arrives with the provider; (3) portable equipment is cost-effective, avoids loss, and ensures optimal function; (4) utilization of nonphysicians allows physicians to remain at their primary duties; and (5) a centralized airway service provides accurate records and data. Respiratory care departments can provide an effective and safe airway service.

ISSN:1068-0640    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A resurgence of interest in noninvasive mechanical ventilation to treat patients with acute or chronic respiratory failure is mainly an attempt to avoid complications commonly associated with the presence of an artificial airway when providing conventional positive-pressure ventilation. Although noninvasive ventilation via noninvasive positive-pressure ventilation has largely supplanted negative ventilation as a form of noninvasive ventilation, negative-pressure ventilation still has an active role in patients who require ventilatory assistance but who cannot tolerate noninvasive positive-pressure ventilation. In some centers throughout Europe, negative-pressure ventilation is used to treat acute respiratory decompensation due to chronic obstructive pulmonary disease, neurologic disorders, or neonates suffering with respiratory distress syndrome. In this review, we discuss the details of applying negative-pressure ventilation and explore the physiologic effects of negative-pressure ventilation on gas exchange, upper airway function, cardiovascular performance, and lower esophageal sphincter tone. Finally, we discuss the application of negative-pressure ventilation in specific disease states including neonatal respiratory distress syndrome, a variety of neuromuscular diseases, and in patients with chronic obstructive pulmonary disease.

ISSN:1068-0640    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Venous thromboembolism (VTE), although relatively easy to treat, can often be difficult to diagnose noninvasively. Many different noninvasive tests are currently available to diagnose VTE, including both pulmonary embolism and deep venous thrombosis. Choosing a sensible diagnostic strategy requires an understanding of the each test’s strengths and drawbacks, as well as its applicability to the particular clinical situation. In this article, the principles of each test are discussed, and the diagnostic criteria are explained and critiqued. Specific algorithms are suggested for common clinical situations. In addition, the areas in which noninvasive testing does not yield accurate diagnoses are described. In those circumstances, invasive contrast examinations (venography or pulmonary angiography) may still be necessary. Finally, promising newer strategies are described that may, in the future, enable VTE to be diagnosed faster, easier, and less expensively.

ISSN:1068-0640    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1068-0640    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1068-0640    

出版商:OVID    

年代:2001

数据来源: OVID