Journal of critical care
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyPrevious cultures are not clinically useful for guiding empiric antibiotics in suspected ventilator-associated pneumonia: secondary analysis from a randomized trial.
To examine the predictive validity of prior cultures at predicting the microorganism isolated at the time of suspicion of ventilator-associated pneumonia (VAP). ⋯ There is poor agreement between prior cultures and cultures performed at time of suspicion of VAP. Prior cultures should not be used to narrow the spectrum of empiric antibiotics.
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Journal of critical care · Mar 2008
Meta AnalysisEfficacy of prone ventilation in adult patients with acute respiratory failure: a meta-analysis.
The use of prone ventilation in acute respiratory failure has been investigated by several randomized controlled trials in the recent past. To date, there has been no systematic review or meta-analysis of these trials. ⋯ The use of prone ventilation is associated with improved oxygenation. It is not associated with a reduction in mortality, pneumonia, or ICU stay and may be associated with an increased incidence of pressure sores.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyThe clinical significance of Candida colonization of respiratory tract secretions in critically ill patients.
Clinical uncertainty exists regarding the significance of colonization confined to respiratory tract secretions with Candida sp in critically ill patients. Our objectives were to describe such colonization, its associated risk factors, and to examine the clinical outcomes in patients with a clinical suspicion of ventilator-associated pneumonia with isolated Candida colonization compared to those without. ⋯ Respiratory tract Candida colonization is associated with worse clinical outcomes and is independently associated with increased hospital mortality. However, it is unclear whether Candida colonization is causally related to poor outcomes or whether it is a marker for increased morbidity and mortality.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyThe safety of targeted antibiotic therapy for ventilator-associated pneumonia: a multicenter observational study.
The aim of this study was to determine the safety of targeted antibiotic therapy (TT) in ventilator-associated pneumonia (VAP). ⋯ Targeted therapy is associated with less antibiotic use and no evidence of harm in the management of patients with VAP.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyUtility of Gram stain in the clinical management of suspected ventilator-associated pneumonia. Secondary analysis of a multicenter randomized trial.
Gram stains of endotracheal aspirates (EA) and bronchoalveolar lavages (BAL) may guide empiric antibiotic therapy in critically ill patients with suspected ventilator-associated pneumonia (VAP). Previous studies differ regarding the ability of the Gram stain to predict final culture results. The aim of the present study was to evaluate the relationship between EA or BAL Gram stains and final culture results in intensive care unit patients with a suspected VAP. ⋯ Gram stains performed for clinically suspected VAP poorly predict the final culture result and thus have a limited role in guiding initial empiric antibiotic therapy in such patients.