Current opinion in infectious diseases
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Curr. Opin. Infect. Dis. · Jun 2009
ReviewOptimizing intensive care management in paediatric sepsis.
Paediatric sepsis continues to be a disease with unacceptably high morbidity and mortality, despite huge advances in paediatric intensive care organization and technology. This review examines the epidemiology, pathophysiology and advances in the treatment of paediatric sepsis. ⋯ This review aims to evaluate the recent therapeutic advances and potential for further developments in the management of paediatric sepsis in the ICU.
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Curr. Opin. Infect. Dis. · Apr 2009
ReviewBundles to prevent ventilator-associated pneumonia: how valuable are they?
To review the value of care bundles to prevent ventilator-associated pneumonia (VAP). ⋯ The Ventilator Bundle is an effective method to reduce VAP rates in ICUs. The ventilator bundle should be modified and expanded to include specific processes of care that have been definitively demonstrated to be effective in VAP reduction or a specific VAP bundle created to focus on VAP prevention.
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This review summarizes recent developments in the diagnosis and treatment of fungal pneumonia, with an emphasis on invasive pulmonary aspergillosis. ⋯ Galactomannan antigen detection is a valuable tool for evaluating patients at risk for invasive aspergillosis (as a screening assay on serum samples from neutropenic patients or as a confirmatory assay on bronchoalveolar lavage fluid samples, in general), but should be used in conjunction with modern imaging techniques. beta-D-Glucan and PCR assays are still investigational. Voriconazole is the drug of choice for invasive aspergillosis, whereas liposomal amphotericin B at 3 mg/kg per day is the preferred alternative in case of contraindication, drug-related side-effects, or intolerance. Whenever possible, optimal antifungal therapy should be complemented by surgical debridement of necrotic tissue. The added value of combination therapy is still unproven. Therapeutic drug monitoring of mold-active azoles should be implemented in order to minimize toxicity and maximize efficacy. Lipid-based formulations of amphotericin B, and to a lesser extent voriconazole, are the drugs of choice for non-Aspergillus related fungal pneumonia. Although active in prophylaxis, the efficacy of posaconazole in confirmed infections remains controversial.
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Nosocomial tracheobronchitis is common among intubated critically ill patients. Ventilator-associated tracheobronchitis (VAT) represents an intermediate process between lower respiratory tract colonization and ventilator-associated pneumonia. The aim of this review is to discuss recent findings on VAT. ⋯ Antibiotic treatment is beneficial in VAT patients. Future studies should confirm these promising results and determine the best duration of antimicrobial therapy in these patients.