Association of hypoglycemia with mortality for subjects hospitalized with pneumonia.

Background: Previous research has shown that hypoglycemia is associated with worse outcomes for the elderly, in sepsis, and in children with pneumonia. The purpose of this study was to examine whether hypoglycemia (<70 mg/dL) is associated with increased 30-day mortality, after adjusting for potential confounders, for adults hospitalized with pneumonia.

Methods: A retrospective cohort study conducted at 2 tertiary teaching hospitals.

Diagnosis of pulmonary malignancy after hospitalization for pneumonia.

Background: Many physicians recommend that patients receive follow-up chest imaging after the diagnosis of pneumonia to ensure that a pulmonary malignancy is not missed. However, there is little research evidence to support this practice. Our aims were to assess the frequency of the diagnosis of pulmonary malignancy, and to identify risk factors for pulmonary malignancy following hospitalization for pneumonia.

Activity of a silver-coated endotracheal tube in preclinical models of ventilator-associated pneumonia and a study after extubation.

Objective: To elucidate the mechanism of action of the silver-coated endotracheal tube in models of the early pathogenesis of ventilator-associated pneumonia.

Design: Open-labeled, prospective, controlled, sequentially conducted, preclinical studies, and in vitro assessment of tubes from patients.

Setting: Microbiology laboratory of a device manufacturer, animal research facility of a university, and a tertiary medical center.

Common medications that increase the risk for developing community-acquired pneumonia.

Purpose Of Review: Community-acquired pneumonia (CAP) is a common problem with significant morbidity, mortality and costs. Recent reports link several medications and the development of CAP and associated poor outcomes. Our aim was to review the most relevant data regarding the possible association of the use of inhaled corticosteroids for patients with chronic obstructive lung disease and the risk of development of CAP.

Association between a silver-coated endotracheal tube and reduced mortality in patients with ventilator-associated pneumonia.

Background: A silver-coated endotracheal tube (ETT) reduced the incidence of ventilator-associated pneumonia (VAP) compared with an uncoated ETT in the North American Silver-Coated Endotracheal Tube (NASCENT) study.

Methods: To evaluate the effect of an ETT and risk factors on mortality, we performed a retrospective cohort analysis in patients who developed VAP in the NASCENT study. We determined causes of death and VAP due to potentially multidrug-resistant bacteria (eg, Pseudomonas, Acinetobacter) and performed stepwise multivariate logistic regression with the following predefined variables: treatment group, Acute Physiology and Chronic Health Evaluation (APACHE) II score, continuous sedation, coma, COPD, emergency surgery/trauma, immunodeficiency, potentially multidrug-resistant bacteria, and inappropriate initial antibiotics.

Outcomes of patients ventilated with synchronized intermittent mandatory ventilation with pressure support: a comparative propensity score study.

Background: Few data are available regarding the benefits of one mode over another for ventilatory support. We set out to compare clinical outcomes of patients receiving synchronized intermittent mandatory ventilation with pressure support (SIMV-PS) compared with assist-control (A/C) ventilation as their primary mode of ventilatory support.

Methods: This was a secondary analysis of an observational study conducted in 349 ICUs from 23 countries.

International study of the prevalence and outcomes of infection in intensive care units.

Context: Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections.

Objective: To provide an up-to-date, international picture of the extent and patterns of infection in ICUs.

Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality.

Background: Limited data are available on the impact of time to ICU admission and outcomes for patients with severe community acquired pneumonia (CAP). Our objective was to examine the association of time to ICU admission and 30-day mortality in patients with severe CAP.

Methods: A retrospective cohort study of 161 ICU subjects with CAP (by International Classification of Diseases, 9th edition, codes) was conducted over a 3-year period at two tertiary teaching hospitals.

Characterisation of exacerbations of chronic bronchitis and COPD in Europe: the GIANT study.

Objective: The GIANT study collected information on patients with acute exacerbations of chronic bronchitis (AECB) and chronic obstructive pulmonary disease (COPD) and the effect of treatment with moxifloxacin.

Methods: AECB history, concomitant diseases, moxifloxacin treatment, concomitant medication, clinical symptoms and adverse events were recorded. A questionnaire at the end of treatment recorded the impact on patients' daily lives.

Effect of fluticasone propionate/salmeterol (250/50) on COPD exacerbations and impact on patient outcomes.

Prevention and treatment of COPD exacerbations are recognized as key goals in disease management. This randomized, double-blind, parallel-group, multicenter study evaluated the effect of fluticasone propionate/salmeterol 250 mcg/50 mcg (FSC 250/50) and salmeterol 50 mcg (SAL) twice-daily on moderate/severe exacerbations. Subjects received treatment with FSC 250/50 during a one month run-in, followed by randomization to FSC 250/50 or SAL for 52 weeks.

Answers to 5 common questions about acute exacerbations of COPD.

Because acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are major causes of morbidity and mortality in COPD, they must be prevented when possible and when they occur, treated aggressively. This article answers 5 of the most common questions I receive about AECOPDs: 1) Are worsening respiratory symptoms an acute exacerbation or disease progression? 2) What is the best first-line treatment for an AECOPD? 3) Would systemic steroids be an effective treatment? 4) When should antibiotics be considered? 5) Is it possible to prevent an AECOPD? The physician should not assume that exacerbations are part of the disease process; they can be treated and their frequency can be reduced with appropriate preventive measures. Treatment needs to be tailored to disease severity and patient risk factors, including bacterial resistance, which significantly affects patient outcomes.

Severe community-acquired pneumonia.

Community-acquired pneumonia (CAP) is the leading cause of death from infectious diseases in the United States. It accounts for 500,000 hospitalizations and 45,000 deaths each year, and it represents one of the most common causes of ICU admission. The mortality rate due to severe CAP has shown little improvement over the past few years, with rates as high as 58% when patients were admitted to the ICU.

Impact of frequency of COPD exacerbations on pulmonary function, health status and clinical outcomes.

Background: COPD exacerbations are responsible for the morbidity and mortality of this disease. The relationship between exacerbations and patient-related clinical outcomes is not clearly understood.

Methods: A retrospective analysis of two 1-year, placebo-controlled clinical trials with tiotropium 18 microg daily was conducted to examine relationships between exacerbations and other clinical outcomes.

Efficacy of tiotropium in the prevention of exacerbations of COPD.

Exacerbations are the most frequent cause of medical visits, hospital admissions and death among patients with chronic obstructive pulmonary disease (COPD). Tiotropium bromide is a long-acting bronchodilator that has demonstrated clinical efficacy in significantly improving the FEV(1) and health-related quality of life (HRQL) in patients with COPD. The prolonged and persistent bronchodilation achieved with tiotropium may reduce the exacerbation and COPD-related hospitalisation rates.

Evaluation of withdrawal of maintenance tiotropium in COPD.

Introduction: In chronic diseases such as chronic obstructive pulmonary disease (COPD), patients may not perceive all of the benefits of drug therapy until withdrawal. Thus, we evaluated the effect of tiotropium withdrawal on clinical variables.

Methods: COPD subjects who participated in two identical 1-year, prospective, double-blind, placebo-controlled studies of tiotropium 18 microg once daily who completed a 3-week visit following discontinuation of therapy were included in this analysis.

Insights into interventions in managing COPD patients: lessons from the TORCH and UPLIFT studies.

Influencing the progression of COPD has long been an elusive goal of drug therapy. Directly or indirectly, this has again been investigated in two of the largest, long-term drug trials in COPD: Towards a Revolution in COPD Health (TORCH) and Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT). Neither trial achieved statistical significance in their respective primary outcomes; however, both make considerable contributions to understanding of how the progression of COPD may be influenced.

Impact of statins and ACE inhibitors on mortality after COPD exacerbations.

Background: The purpose of our study was to examine the association of prior outpatient use of statins and angiotensin converting enzyme (ACE) inhibitors on mortality for subjects >or= 65 years of age hospitalized with acute COPD exacerbations.

Methods: We conducted a retrospective national cohort study using Veterans Affairs administrative data including subjects >or=65 years of age hospitalized with a COPD exacerbation. Our primary analysis was a multilevel model with the dependent variable of 90-day mortality and hospital as a random effect, controlling for preexisting comorbid conditions, demographics, and other medications prescribed.

The role of gram-negative bacteria in healthcare-associated pneumonia.

Healthcare-associated pneumonia (HCAP) is a unique entity that differs from community-acquired pneumonia in both bacteriology and outcomes and has similarities to hospital-acquired pneumonia and ventilator-associated pneumonia. HCAP patients are at higher risk of potential multidrug-resistant pathogens, including resistant gram-negative organisms, especially Pseudomonas aeruginosa and acinetobacter spp., but also extended-spectrum beta-lactamases (ESBLs).

Novel targets in the management of pneumonia.

Community-acquired pneumonia (CAP) is the leading cause of death from infectious diseases in the US. It accounts each year for 500,000 hospitalizations and 45,000 deaths and represents one of the most common causes of intensive care unit (ICU) admission. The mortality rate due to severe CAP has shown little improvement in the past three decades, remaining between 21% and 58% in patients admitted to the intensive care unit.

Community-acquired pneumonia in elderly patients.

Community-acquired pneumonia continues to have a significant impact on elderly individuals, who are affected more frequently and with more severe consequences than younger populations. As the population ages it is expected that the medical and economic impact of this disease will increase. Despite these concerns, little progress has been made in research specifically focusing on community-acquired pneumonia in the elderly.

Association of hydrophilic versus lipophilic angiotensin-converting enzyme inhibitor use on pneumonia-related mortality.

Background: Recent studies suggest that angiotensin-converting enzyme (ACE) inhibitors may have beneficial effects for patients with or at risk for pneumonia. However, other studies have not found a survival benefit. Other research suggests that ACE inhibitors that are lipophilic may be superior to hydrophilic ACE inhibitors in terms of tissue penetration and inhibition of ACE.

Impact of prior outpatient antibiotic use on mortality for community acquired pneumonia: a retrospective cohort study.

Background: The purpose of this study was to examine whether prior outpatient antibiotic use is associated with increased 30-day mortality, after adjusting for potential confounders, for those subsequently hospitalized with pneumonia.

Methods: A retrospective cohort study conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of, and had a chest x-ray consistent with, community-acquired pneumonia.

Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia.

Recent studies suggest that macrolides may have beneficial effects for patients at risk for certain infections. The current authors examined the effect of macrolide therapy on 30- and 90-day mortality for patients with severe sepsis caused by pneumonia. A retrospective cohort study was conducted at two tertiary teaching hospitals.