Comparison of semi-quantitative endotracheal aspirates to quantitative non-bronchoscopic bronchoalveolar lavage in diagnosing ventilator-associated pneumonia.

Background: Current strategies for diagnosing ventilator-associated pneumonia (VAP) favor the use of quantitative methods; however, semi-quantitative cultures of endotracheal aspirates are still commonly used.

Methods: The microbiological results of patients with suspected VAP who had both quantitative cultures with non-bronchoscopic bronchoalveolar lavage (BAL) and semi-quantitative cultures of endotracheal aspirate obtained within 24 hours of each other were retrospectively reviewed and compared, using a quantitative threshold of >or=10(4) colony-forming units/mL as a reference standard.

Results: 256 patients with paired cultures were identified.

Improved outcomes with routine respiratory therapist evaluation of non-intensive-care-unit surgery patients.

Background: Respiratory therapist (RT) driven protocols decrease ventilator days and resource utilization in the intensive care unit (ICU). Protocols have been studied in non-ICU settings, but their effect on mortality has been incompletely studied.

Methods: In our neurosurgery step-down, trauma/surgery step-down, and trauma/surgery general units we initiated an RT-driven evaluate-and-treat protocol that included a standardized, quantitative, RT-driven patient-assessment scale and protocolized interventions.

Effect of granulocyte-monocyte colony-stimulating factor therapy on leukocyte function and clearance of serious infection in nonneutropenic patients.

Study Objective: Impaired leukocyte function in patients with serious infections may increase mortality. Granulocyte-monocyte colony-stimulating factor (GM-CSF) broadly activates peripheral monocytes and neutrophils. We performed a clinical trial of GM-CSF in septic, hemodynamically stable patients to see whether GM-CSF treatment improved leukocyte function and mortality.