Invasive and Noninvasive Strategies for Management of Suspected Ventilator-Associated Pneumonia

Article Abstract:

An invasive strategy for managing patients suspected of having ventilator-associated pneumonia can reduce mortality rates. The invasive strategy bases treatment decisions on an examination of tissue retrieved by a bronchoscope or bronchoalveolar lavage samples. The non-invasive method relies on clinical symptoms and isolation of microorganisms in sputum samples. When these two methods were compared in a study of 413 patients, those who received invasive monitoring had lower mortality rates, less severe symptoms, and required fewer antibiotics.

Care and treatment

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Bronchoalveolar lavage for rapid diagnosis of the fat embolism syndrome in trauma patients

Article Abstract:

One of the uncommon, but significant complications of serious trauma, particularly long bone fractures, is the development of the fat embolism syndrome. While the precise mechanism of the syndrome is not fully understood, the embolization of fat from the disrupted bone marrow to the lungs results in acute respiratory failure with a diffusely abnormal chest X-ray (known as the adult respiratory distress syndrome), global neurologic dysfunction, and petechiae (a pinpoint hemorrhagic rash). These symptoms appear 24 to 72 hours after the fracture, but the diagnosis is often confounded by the presence of other chest injuries, such as pulmonary contusion, and head injuries. While no definitive therapy currently exists for the fat embolism syndrome, its reliable diagnosis would facilitate studies of the efficacy of therapies. Bronchoalveolar lavage (BAL) is a technique by which the lungs are washed with saline solution, which is then suctioned and collected. The recovered saline contains the fluid and cells from the lungs' epithelium, which can then be examined microscopically. BAL was performed in 18 patients with long bone fractures; five had definite evidence of the fat embolism syndrome, in five others it was strongly suspected, and eight patients had no signs of the syndrome. These results were compared with nine patients with the adult respiratory distress syndrome but no history of trauma, and with 15 healthy volunteers. Cells obtained by BAL in all these patients were stained for fat droplets. In the five patients with known fat embolism syndrome, at least 30 percent of the cells obtained by BAL stained positively for fat droplets. In the five patients in whom the syndrome was only suspected, three had at least 40 percent of the cells stain for fat, while the other two had less than 2 percent. All of the controls had less than 2 percent fat-positive cells. Bronchoalveolar lavage, which is both simple and safe, appears to be an easy and reliable means of diagnosing the fat embolism syndrome in trauma patients. However, since fat embolism is so difficult to diagnose, no method yet exists to confirm BAL's true and false positive and negative predictive values. Nevertheless, BAL appears to both sensitive and specific for this condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Diagnosis, Causes of, Wounds and injuries, Injuries, Fractures (Injuries), Fractures, Acute respiratory distress syndrome, Adult respiratory distress syndrome, Bronchoalveolar lavage, Fat embolism

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Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial

Article Abstract:

Hospital patients who develop ventilator-associated pneumonia can be successfully treated with antibiotics for eight days instead of 15 days, according to a study of 401 patients. The only exception is patients who are infected with non-fermenting gram-negative bacteria, who may require treatment for 15 days. Shortening the treatment period can reduce the chances that the bacteria will become resistant to the antibiotic.

Antibiotics, Drug therapy, Dosage and administration, Bacterial pneumonia

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