Upper lobe relapse ofPneumocystis carinii Pneumonia during aerosolized pentamidine prophylaxis

Summary A patient with a history ofPneumocystis carinii pneumonia (PCP) inhaled aerosolized pentamidine (AP) for secondary prophylaxis of PCP. Nine months after the first PCP episode he presented with pulmonary upper-lobe infiltrations demonstrated by chest x-ray, and bronchoalveolar lavage confirmed the diagnosis of PCP. The clinical course and possible explanations for this unusual form of PCP are presented. The case emphasizes the importance of clinical controls for early diagnosis of relapse of PCP in patients inhaling aerosolized pentamidine. Monitoring of serum lactate dehydrogenase levels appeared to be important in the follow-up of the patient described.Abbreviations PCP Pneumocystis carinii pneumonia - AP aerosolized pentamidine - LDH lactate dehydrogenase - AIDS acquired immunodeficiency syndrome - HIV human immunodeficiency virus - BGA blood gas analysis - WBC white blood cell count - BAL bronchoalveolar lavage     

Aerosolized antibiotics in the intensive care unit

This review summarizes recent clinical data examining the use of aerosolized antimicrobial therapy for the treatment of respiratory tract infections in mechanically ventilated patients in the intensive care unit. Aerosolized antibiotics provide high concentrations of drug in the lung without the systemic toxicity associated with the intravenous antibiotics. First introduced in the 1960s as a treatment of tracheobronchitis and bronchopneumonia caused by Pseudomonas aeruginosa, now, more than 40 years later, there is a resurgence of interest in using this mode of delivery as a primary therapy for ventilator-associated tracheobronchitis and an adjunctive therapy for ventilator-associated pneumonia.     

PGI2雾化吸入在急性呼吸窘迫综合征中的治疗作用

目的观察雾化吸入前列腺I2（PGI2）对急性呼吸窘迫综合征（ARDS）患者血流动力学、动脉血气、氧合状况的影响，评价其治疗效果。方法2006年11月～2008年12月共救治ARDS患者55例，随机分为PGI2治疗组（28例）和对照组（27例）。治疗组在入院24h后雾化吸入PG1230ng／kg·min，每次25min，每天10次，连续使用7d。从血流动力学变化、动脉血氧分压（PaO2）、呼吸机通气时间及生存率等方面进行比较。结果治疗组Pa02、PaO2/FiO2恢复时间较对照组早（P〈0．01，P〈0．05），呼吸机支持时间显著短于对照组（P〈0．01），生存率显著高于对照组（P〈0．05）。结论PGI2能有效降低肺动脉压和肺血管阻力，增加心排量和氧供，提高其生存率，对ARDS有较好疗。     

Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis

PurposeNebulized colistin (NC) is a potential therapy for ventilator-associated pneumonia (VAP); however, the clinical efficacy and safety of NC remain unclear. This study investigated whether NC is an effective therapy for patients with VAP.Materials and methodsWe performed a search in Web of Science, PubMed, Embase, and the Cochrane Library to retrieve randomized controlled trials (RCTs) and observational studies published at any time until February 6, 2023. The primary outcome was clinical response. Secondary outcomes included microbiological eradication, overall mortality, length of mechanical ventilation (MV), length of intensive care unit stay (ICU-LOS), nephrotoxicity, neurotoxicity, and bronchospasm.ResultsSeven observational studies and three RCTs were included. Despite exhibiting a higher microbiological eradication rate (OR,2.21; 95%CI, 1.25–3.92) and the same nephrotoxicity risk (OR,0.86; 95%CI, 0.60–1.23), NC was not significantly different in clinical response (OR,1.39; 95%CI, 0.87–2.20), overall mortality (OR,0.74; 95%CI, 0.50–1.12), MV length (mean difference (MD),-2.5; 95%CI, −5.20–0.19), and the ICU-LOS (MD,-1.91; 95%CI, −6.66–2.84) than by the intravenous antibiotic. Besides, the risk of bronchospasm raised significantly (OR, 5.19; 95%CI, 1.05–25.52) among NC.ConclusionNC was associated with better microbiological outcomes but did not result in any remarkable changes in the prognosis of patients with VAP.