摘要:

Lower respiratory tract infections due to anaerobic bacteria generally occur in children who are prone to aspirate. The origin of the anaerobic bacteria is usually the oropharyngeal bacterial flora, where anaerobic bacteria outnumber aerobic and facultative organisms 10 to 1. The lower respiratory tract infections where these organisms are found mixed with aerobic organisms are aspiration pneumonia, lung abscess, empyema, and tracheitis and pneumonia after intubation or installation of tracheostomy tubes. The predominant isolated anaerobic organisms arePeptostreptococcus, Fusobacterium,pigmentedPrevotellaandPorphyromonasspp, andBacteroides fragilisgroup. Management of these infections includes the administration of antimicrobials effective against these pathogens as well as their aerobic counterparts.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Health care and laboratory workers are exposed to a variety of respiratory infections in the workplace. Employee health programs have only recently addressed these hazards by applying the classical hierarchy of workplace controls, namely engineering, administrative, and work practice controls as well as personal protection. Historically, tuberculosis has been a significant risk to health care workers, and with its resurgence and the emergence of multiple-drug-resistant tuberculosis, these controls become an imperative. For other respiratory infections such as rubeola, varicella, and influenza, immunizations are an integral component of the primary prevention. Infection with respiratory syncytial virus imparts an incomplete immune response, and a significant percentage of hospital personnel become infected from the hospitalized infants in their care. The impact to the workforce and the risk of transmission to noninfected hospitalized infants are of concern. Although Legionnaires' disease is for the most part of little clinical significance to the health care worker, it can be deadly to the infected surgical transplant patient. This article explores the epidemiology, prevention, and regulatory issues of these infections in the health care setting.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Respiratory diseases in childhood can cause sequelae reaching far beyond childhood. The growing lung and airways are particularly sensitive to insults, including infection, inflammation, and allergic sensitization. There are many possible mechanisms that connect childhood respiratory illness to respiratory morbidity and mortality in the adult. The most important mechanisms are direct damage to the developing lung and airways, induction of bronchial hyperresponsiveness, chronic inflammation, and possibly chronic viral infections in the tissues of the respiratory system. The elucidation of childhood respiratory problems should be an integral part of the evaluation of adults with chronic respiratory disease.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The Internet is a global computer network that facilitates easy and rapid communication and information dissemination. Medical information, accessible both to the patient and the physician, has become more prevalent on the Internet. For the pulmonary medicine and critical care clinician, the Internet can be useful for obtaining professional educational and reference materials, pointing patients toward educational materials and support groups, participating in collegial discussions ranging from philosophies of medicine to advice regarding specific cases, and keeping abreast of the activities of professional organizations. As a consequence of its distributed structure, it can be difficult to quickly find information on the Internet, and one must be cautious in using the information found because it is generally not peer reviewed to guarantee accuracy. The future may lead to better organized and more reliable medical information. However, this will likely be at added expense to the user.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The potential for overdistended alveoli and/or elevated airway pressures to produce or potentiate lung injury has given increase to new ventilatory support strategies. Some of these new approaches incorporate lower tidal volumes and/or limit the peak inflation pressure. The technique termed “permissive hypercapnia” or “controlled hypoventilation” is a strategy that has the primary goals of providing adequate oxygenation and maintaining the end-inspiratory plateau pressure less than or equal to 35 cmH2O in an attempt to avoid the production of alveolar overdistension. Tidal volumes of 5 to 8 mL/kg may be required to achieve these ventilatory goals and may result in subsequent alveolar hypoventilation and respiratory acidosis. Permissive hypercapnia has been reported to be beneficial in the management of patients with acute lung injury and with severe airflow obstruction. This review discusses the potential consequences of hypercapnia and reviews the experimental evidence in support of this ventilatory strategy in the management of acutely ill patients with acute lung injury or severe airflow obstruction.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Pulmonary metastasis is common in the natural history of many malignancies. Although most metastases cause few symptoms, pulmonary tumor microembolism and lymphangitic carcinomatosis are exceptions. Both tumor microembolism and lymphangitic carcinomatosis are forms of microvascular metastasis involving the pulmonary blood vessels and lymphatic vessels, respectively that are pathologically distinct but closely related and often coexistent. These less common types of metastatic disease can dominate the clinical picture, causing profound respiratory impairment, potentially complicated by pulmonary hypertension and cor pulmonale, often in the absence of significant abnormalities on the chest radiograph. Antemortem diagnosis of both these disorders is frequently missed, usually because the diagnosis is not considered. Recognition of the characteristic perfusion scan pattern of “contour mapping” with both tumor microembolism and lymphangitic carcinomatosis, the distinctive high-resolution computed tomographic findings of lymphangitic carcinomatosis, and the advent of pulmonary microvascular cytology as a diagnostic modality are relatively recent advances that should lead to more frequent diagnosis, with the hope of improved outcome in selected patients. An illustrative case of tumor microembolism as the initial manifestation of cancer is presented, and the pathophysiology, clinical and imaging features, diagnosis, and treatment of tumor microembolism and lymphangitic carcinomatosis are reviewed.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Understanding the physiologic effects of changes in posture and position on normal respiratory function can facilitate their therapeutic application in the clinical setting. In healthy subjects, recumbency reduces lung volumes, increases the impedance to ventilation, and alters the regional distributions of ventilation and perfusion. Patients with airflow obstruction may experience orthopnea due to increases in airway resistance and regional gas trapping. Knowledge of the postural changes in pulmonary function and symptoms that occur in certain neuromuscular diseases may suggest a diagnosis (e.g., diaphragmatic paralysis) and allow for appropriate therapeutic intervention. Lateral decubitus positioning with “the good side down” can significantly improve oxygenation in many adult patients with unilateral parenchymal lung disease (e.g., lobar pneumonia). In the intensive care unit, continuous rotational therapy has been reported to reduce pulmonary complications. Because prone positioning can significantly improve pulmonary oxygen exchange, it often proves useful as a therapeutic adjunct to mechanical ventilation in patients with acute respiratory distress syndrome and refractory hypoxemia.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SYNOPSIS: Right heart catheterzation was associated with increase mortality, costs, and length of stay in an observational case control study of 5735 critically ill adult patients.SOURCE: Connors AF et al. The effectiveness of right heart catheterization in initial care of critically ill patients.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SYNOPSIS: Early extubation after coronary grafting is associated with improved intrapulmonary shunt and a reduction in intensive caer unit (ICU) and hospital length of stay without increasing perioperative morbidity.SOURCE: Cheng DC et al Morbidity outcome in early versus conventional tracheal extubation after coronary bypass grafting: a prospective randomized controlled trial.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SYNOPSIS: Patients with suspected acute thoracic aortic dissection should undergo at least one diagnostic test, even if the clinical suspicion is very low. A patient with a moderate to high clinical suspension for dissection should undergo a second diagnostic test if the first test is negative. When the prbability of dissection is high, the physician must consider delays in obtaining diagnostic tests and order the test that will be most quickly available and not necessarily the most sensitive.SOURCE: Sarasin FP et al. Detecting acute thoracic aortic dissection in the emergency department: time constraints and choice of the optional diagnostic test.

ISSN:1068-0640    

出版商:OVID    

年代:1997

数据来源: OVID