Severe pneumonia in intensive care: Cause, diagnosis, treatment and management: A review of the literature

Current Opinion in Pulmonary Medicine

Volumn 18, Issue 3, 2012, Pages

  De Pascale, Gennaro ^a   Bello, Giuseppe ^a   Tumbarello, Mario ^a   Antonelli, Massimo ^a  

^a FONDAZIONE POLICLINICO UNIVERSITARIO A GEMELLI IRCCS   (Italy)

Author keywords

acute respiratory failure; antimicrobial treatment; life supportive strategies; molecular diagnostic techniques

Indexed keywords

AMIKACIN; AMINOGLYCOSIDE ANTIBIOTIC AGENT; AMOXICILLIN PLUS CLAVULANIC ACID; AMPICILLIN; AZITHROMYCIN; CEFEPIME; CEFOTAXIME; CEFTRIAXONE; CEFUROXIME; CIPROFLOXACIN; ERTAPENEM; GENTAMICIN; IMIPENEM; LEVOFLOXACIN; LINEZOLID; MACROLIDE; MEROPENEM; MOXIFLOXACIN; PIPERACILLIN PLUS TAZOBACTAM; PROCALCITONIN; SULBACTAM; TOBRAMYCIN; VANCOMYCIN; VIRULENCE FACTOR;

ADENOVIRUS; ANTIBIOTIC THERAPY; ARTIFICIAL VENTILATION; COMMUNITY ACQUIRED PNEUMONIA; CONSERVATIVE TREATMENT; CRITICALLY ILL PATIENT; CRYPTOCOCCUS NEOFORMANS; DISEASE SEVERITY; ENDOTRACHEAL INTUBATION; EXTRACORPOREAL OXYGENATION; FIBEROPTIC BRONCHOSCOPY; FLUID THERAPY; HERPES VIRUS; HIGH FREQUENCY VENTILATION; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS; IMMUNOASSAY; INFLUENZA VIRUS A H1N1; INTENSIVE CARE; LEGIONELLA; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS; MYCOBACTERIUM; OBESITY; PARAINFLUENZA VIRUS; PATIENT POSITIONING; PNEUMONIA; PREGNANCY; PSEUDOMONAS AERUGINOSA; REAL TIME POLYMERASE CHAIN REACTION; RESPIRATORY FAILURE; RESPIRATORY SYNCYTIAL PNEUMOVIRUS; REVIEW; SEASONAL INFLUENZA; SEPTIC SHOCK; SPUTUM ANALYSIS; STAPHYLOCOCCUS AUREUS; STREPTOCOCCUS PNEUMONIAE;

ANTI-INFECTIVE AGENTS; HUMANS; INTENSIVE CARE; PNEUMONIA; RESPIRATORY INSUFFICIENCY;

EID: 84859213574     PISSN: 10705287     EISSN: 15316971     Source Type: Journal    
DOI: 10.1097/MCP.0b013e328351f9bd     Document Type: Review

References (144)

1. Restrepo MI, Mortensen EM, Velez JA, et al. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU. Chest 2008; 133:610-617. (Pubitemid 351367367)
2. Kollef KE, Schramm GE, Wills AR, et al. Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant Gram-negative bacteria. Chest 2008; 134:281-287.
3. Restrepo MI, Anzueto A. Severe community-acquired pneumonia. Infect Dis Clin North Am 2009; 23:503-520.
4. Brown SM, Dean NC. Defining and predicting severe community-acquired pneumonia. Curr Opin Infect Dis 2010; 23:158-164. In this review new predictive models and approaches aimed to describe pneumonia severity are discussed.
5. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (2 Suppl):27-72.
6. Chalmers JD, Taylor JK, Mandal P, et al. Validation of the Infectious Diseases Society of America/American Thoracic Society minor criteria for intensive care unit admission in community-acquired pneumonia patients without major criteria or contraindications to intensive care unit care. Clin Infect Dis 2011; 53:503-511. A prospective observational study upon the predictive role of IDSA/ATS minor criteria for ICU admission.
7. Restrepo MI, Jorgensen JH, Mortensen EM, Anzueto A. Severe community-acquired pneumonia: current outcomes, epidemiology, etiology, and therapy. Curr Opin Infect Dis 2001; 14:703-709. (Pubitemid 33141191)
8. Zilberberg MD, Shorr AF. Healthcare-associated pneumonia: the state of evidence to date. Curr Opin Pulm Med 2011; 17:142-147. A comprehensive review on ongoing concerns regarding the management of HCAP.
9. Muscedere JG, Day A, Heyland DK. Mortality, attributable mortality, and clinical events as end points for clinical trials of ventilator-associated pneumonia and hospital-acquired pneumonia. Clin Infect Dis 2010; 51 (1 Suppl):120-125.
10. Wheeler AP, Bernard GR. Acute lung injury and the acute respiratory distress syndrome: a clinical review. Lancet 2007; 369:1553-1564. (Pubitemid 46670280)
11. Torres A, Ewig S, Lode H, Carlet J. European HAP working group. Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 2009; 35:9-29.
12. Masterton RG, Galloway A, French G, et al. Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2008; 62:5-34. (Pubitemid 351865870)
13. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171:388-416.
14. Niederman MS. Recent advances in community-acquired pneumonia: in patient and outpatient. Chest 2007; 131:1205-1215. (Pubitemid 46608726)
15. Paganin F, Lilienthal F, Bourdin A, et al. Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor. Eur Respir J 2004; 24:779-785. (Pubitemid 39504431)
16. Yoshimoto A, Nakamura H, Fujimura M, Nakao S. Severe community-acquired pneumonia in an intensive care unit: risk factors for mortality. Intern Med 2005; 44:710-716. (Pubitemid 41093823)
17. Osler W. The principles and practice of medicine. 4th ed. New York: Appleton; 1901. p. 108.
18. Calbo E, Garau J. Factors affecting the development of systemic inflammatory response syndrome in pneumococcal infections. Curr Opin Infect Dis 2011; 24:241-247. This recent review analyzes those factors influencing the severity of systemic inflammatory response syndrome during pneumococcal infection.
19. Carratalà J, Garcia-Vidal C. An update on Legionella. Curr Opin Infect Dis 2010; 23:152-157.
20. Rello J, Rodriguez A, Torres A, et al. Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia. Eur Respir J 2006; 27:1210-1216. (Pubitemid 44914306)
21. Garau J, Bouza E, Chastre J, et al. Management of methicillin-resistant Staphylococcus aureus infections. Clin Microbiol Infect 2009; 15:125-136.
22. Taneja C, Haque N, Oster G, et al. Clinical and economic outcomes in patients with community-acquired Staphylococcus aureus pneumonia. J Hosp Med 2010; 5:528-534.
23. Ramsey C, Kumar A. H1N1: viral pneumonia as a cause of acute respiratory distress syndrome. Curr Opin Crit Care 2011; 17:64-71. The authors review the literature on novel H1N1 viral pneumonia causing ARDS.
24. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007; 357:2601-2614.
25. Labelle AJ, Arnold H, Reichley RM, et al. A comparison of culture-positive and culture-negative health-care-associated pneumonia. Chest 2010; 137:1130-1137. This retrospective cohort study highlights clinical differences between culture-negative and culture-positive HCAP.
26. Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Prediction of infection due to antibiotic-resistant bacteria by select risk factors for healthcare-associated pneumonia. Arch Intern Med 2008; 168:2205-2210.
27. Micek ST, Kollef KE, Reichley RM, et al. Healthcare-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother 2007; 51:3568-3573. (Pubitemid 47519345)
28. Venditti M, Falcone M, Corrao, et al. Study Group of the Italian Society of Internal Medicine. Outcomes of patients hospitalized with community-acquired, healthcare-associated, and hospital-acquired pneumonia. Ann Intern Med 2009; 150:19-26.
29. Schreiber MP, Chan CM, Shorr AF. Resistant pathogens in nonnosocomial pneumonia and respiratory failure: is it time to refine the definition of healthcare-associated pneumonia? Chest 2010; 137:1283-1288. In this retrospective study the authors evaluate the correlation degree of current HCAP definition with the presence of respiratory infection due to a resistant pathogen. A new interesting clinical score aimed to identify potentially multidrug-resistant respiratory infections is proposed.
30. Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 2010; 51 (1 Suppl):81-87.
31. Esperatti M, Ferrer M, Theessen A, et al. Nosocomial pneumonia in the intensive care unit acquired by mechanically ventilated versus nonventilated patients. Am J Respir Crit Care Med 2010; 182:1533-1539. A well structured prospective study in which clinical and microbiological differences between mechanically ventilated and nonventilated patients with ICU-acquired pneumonia are described. The type of isolates and outcomes were similar between the two groups.
32. Woodhead M, Blasi F, Ewig S, et al. Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections: full version. Clin Microbiol Infect 2011; 176:E1-E59. Most recent guidelines for the management of pneumonia in adult patients.
33. Falguera M, Trujillano J, Caro S, et al. NAC-CALIDAD (Proyecto Integrado deInvestigación de la Sociedad Española de Patología del Aparato Respiratorio sobre Infecciones Respiratorias de Vías Bajas) Study Group. A prediction rule for estimating the risk of bacteremia in patients with community-acquired pneumonia. Clin Infect Dis 2009; 49:409-416.
34. Shimada T, Noguchi Y, Jackson JL, et al. Systematic review and meta-analysis: urinary antigen tests for legionellosis. Chest 2009; 136:1576-1585.
35. Sordé R, Falcó V, Lowak M, et al. Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients with community- acquired pneumonia to guide antimicrobial therapy. Arch Intern Med 2011; 171:166-172. A prospective study in which the role of pneumococcal antigen detection in the management of patients hospitalized with CAP is investigated.
36. Bartlett JG. Diagnostic tests for agents of community-acquired pneumonia. Clin Infect Dis 2011; 52 (4 Suppl):296-304.
37. Antonelli M, Conti G, Rocco M, et al. Noninvasive positive-pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy. Chest 2002; 121:1149-1154. (Pubitemid 34280435)
38. Azoulay E, Mokart D, Lambert J, et al. Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 2010; 182:1038-1046. In this trial, the authors randomized 219 nonintubated patients with cancer and acute respiratory failure to early bronchoscopic bronchoalveolar lavage and noninvasive tests vs. noninvasive tests only, finding similar results in the two groups in regard to either the need for intubation or the proportion of patients with no diagnosis.
39. Chastre J, Trouillet JL, Combes A, Luyt CE. Diagnostic techniques and procedures for establishing the microbial etiology of ventilator-associated pneumonia for clinical trials: the pros for quantitative cultures. Clin Infect Dis 2010; 51 (1 Suppl):88-92.
40. Caliendo AM. Multiplex PCR and emerging technologies for the detection of respiratory pathogens. Clin Infect Dis 2011; 52 (4 Suppl):326-330. In this recent and comprehensive review the author describes multiplex PCR technologies, focusing on their role in the early diagnosis of respiratory pathogens.
41. Tenover FC. Developing molecular amplification methods for rapid diagnosis of respiratory tract infections caused by bacterial pathogens. Clin Infect Dis 2011; 52 (4 Suppl):338-345.
42. Johansson N, Kalin M, Tiveljung-Lindell A, et al. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis 2010; 50:202-209.
43. Sethi S. Molecular diagnosis of respiratory tract infection in acute exacerbations of chronic obstructive pulmonary disease. Clin Infect Dis 2011; 52 (4 Suppl):290-295.
44. Matsumura Y, Ito Y, Iinuma Y, et al. Quantitative real-time PCR and the (1→3)-β-d-glucan assay for differentiation between Pneumocystis jirovecii pneumonia and colonization. Clin Microbiol Infect 2011. [Epub ahead of print]
45. Hage CA, Knox KS, Davis TE, Wheat LJ. Antigen detection in bronchoalveolar lavage fluid for diagnosis of fungal pneumonia. Curr Opin Pulm Med 2011; 17:167-171. In this recent review the authors summarize the current evidence upon the importance of bronchoalveolar lavage fluid fungal antigen detection in patients at risk for fungal pneumonia.
46. Torelli R, Sanguinetti M, Moody A, et al. Aspergillus DNA in bronchoalveolar lavage fluid samples from high-risk patients using a commercial real-time PCR assay: a comparison with galactomannan enzyme immunoassay for the diagnosis of invasive aspergillosis. J Clin Microbiol 2011. [Epub ahead of print] A recent prospective study aimed to investigate the performance of a molecular Aspergillus detection test in a cohort of high-risk patients.
47. Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006; 174:84-93. (Pubitemid 43955248)
48. Gilbert DN. Procalcitonin as abiomarker in respiratory tract infection. Clin Infect Dis 2011; 52 (4 Suppl):346-350.
49. Ramírez P, Ferrer M, Martí V, et al. Inflammatory biomarkers and prediction for intensive care unit admission in severe community-acquired pneumonia. Crit Care Med 2011; 39:2211-2217. In this multicenter prospective trial the authors analyze the relationship between inflammatory biomarkers and prediction of ICU admission in a large cohort of patients with CAP.
50. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 20#08. Intensive Care Med 2008; 34:17-60.
51. Martin-Loeches I, Lisboa T, Rodriguez A, et al. Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia. Intensive Care Med 2010; 36:612-620. This is an interesting prospective observational multicenter study in which the use of macrolides in patients with SCAP, including those ones complicated by severe sepsis and septic shock, was associated with lower ICU mortality.
52. Kett DH, Cano E, Quartin AA, et al. Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis 2011; 11:181-189. In this recent article the authors investigated the relationship between guideline compliance and outcomes for patients in intensive care with multidrug-resistant pneumonia. Among 303 patients, 129 were treated according to current guidelines. Survival rate was significantly lower in the compliance group. The main reason for compliance failure was nonuse of dual treatment for Gram-negative pathogens.
53. Niederman MS, Craven DE, Chastre J, et al. Treatment of hospital-acquired pneumonia. Lancet Infect Dis 2011; 11:728.
54. Pea F, Viale P. The antimicrobial therapy puzzle: could pharmacokinetic-pharmacodynamic relationships be helpful in addressing the issue of appropriate pneumonia treatment in critically ill patients? Clin Infect Dis 2006; 42:1764-1771. (Pubitemid 43839445)
55. Roberts JA, Lipman J. Pharmacokinetic issues for antibiotics in the critically ill patient. Crit Care Med 2009; 37:840-851.
56. Taccone FS, Laterre PF, Spapen H, et al. Revisiting the loading dose of amikacin for patients with severe sepsis and septic shock. Crit Care 2010; 14:R53.
57. Gonçalves-Pereira J, Póvoa P. Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of β-lactams. Crit Care 2011. [Epub ahead of print] This recent systematic review analyzes those studies performed upon beta-lactam antibiotic pharmacokinetics in critically ill patients. Given the significant heterogeneity and unpredictability of their plasmatic and tissue concentrations, beta-lactam continuous infusion and therapeutic drug monitoring are suggested.
58. Wunderink RG. Surrogate markers and microbiologic end points. Clin Infect Dis 2010; 51 (1 Suppl):126-130.
59. Sibila O, Luna CM, Agustí C, et al. Effects of glucocorticoids in ventilated piglets with severe pneumonia. Eur Respir J 2008; 32:1037-1046.
60. Confalonieri M, Urbino R, Potena A, et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med 2005; 171:242-248.
61. Chen Y, Li K, Pu H, Wu T. Corticosteroids for pneumonia. Cochrane Database Syst Rev 2011; 3:CD007720.
62. De Pascale G, Bello G, Antonelli M. Steroids in severe pneumonia: a literature review. Minerva Anestesiol 2011; 77:902-910. A recent review upon the use of steroids in severe pneumonia.
63. Bernard GR, Vincent JL, Laterre PF, et al. Recombinant human protein CWorldwide Evaluation in Severe Sepsis (PROWESS) study group. Efficacy and safety of recombinant human activated protein Cfor severe sepsis. N Engl J Med 2001; 344:699-709.
64. Wunderink RG. Adjunctive therapy in community-acquired pneumonia. Semin Respir Crit Care Med 2009; 30:146-153.
65. Rello J. Demographics, guidelines, and clinical experience in severe community- acquired pneumonia. Crit Care 2008; 12 (6 Suppl):S2.
66. Barochia AV, Cui X, Vitberg D, et al. Bundled care for septic shock: an analysis of clinical trials. Crit Care Med 2010; 38:668-678. A meta-analysis to evaluate the impact of septic shock bundle use on patients'outcome.
67. Ferrer R, Artigas A. Effectiveness of treatments for severe sepsis: data from the bundle implementation programs. Minerva Anestesiol 2011; 77:360-365. A comprehensive review on the effectiveness of bundle implementation programs.
68. Nava S, Hill N. Noninvasive ventilation in acute respiratory failure. Lancet 2009; 374:250-259.
69. Gristina GR, Antonelli M, Conti G, et al. GiViTI (Italian Group for the Evaluation of Interventions in Intensive Care Medicine). Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. Crit Care Med 2011; 39:2232-2239. A retrospective analysis on NIV use in Italian ICUs for the management of ARF in hematological malignancies.
70. Antonelli M, Conti G, Esquinas A, et al. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med 2007; 35:18-25. (Pubitemid 46035672)
71. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149:818-824. (Pubitemid 24082248)
72. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000; 342:1301-1308.
73. Briel M, Meade M, Mercat A, et al. Higher vs.lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. J Am Med Assoc 2010; 303:865-8673.
74. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006; 354:2564-2575.
75. Papazian L, Forel JM, Gacouin A, et al. ACURASYS Study Investigators. neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010; 363:1107-1116. In this multicienter, double-blind trial, the authors observed that early neuromuscular blocking use in patients with severe ARDS was associated with improved 90-day survival rate and increased ventilator-free days.
76. Gattinoni L, Carlesso E, Taccone P, et al. Prone positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis. Minerva Anestesiol 2010; 76:448-454. The role of prone positioning in patients with severe ARDS is analyzed in this article.
77. Sud S, Friedrich JO, Taccone P, et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med 2010; 36:585-599. The study analyzes 10 most recent RCTs evaluating the effects of prone positioning in patients with ALI/ARDS.
78. Esan A, Hess DR, Raoof S, et al. Severe hypoxemic respiratory failure: part 1-ventilatory strategies. Chest 2010; 137:1203-1216. A comprehensive review on conventional and unconventional ventilator strategies for the management of severe ARF.
79. Sokol J, Jacobs SE, Bohn D. Inhaled nitric oxide for acute hypoxemic respiratory failure in children and adults. Cochrane Database Syst Rev 2003; 1:CD002787.
80. Adhikari NK, Burns KE, Friedrich JO, et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. Br Med J 2007; 334:779.
81. Patroniti N, Zangrillo A, Pappalardo F, et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med 2011; 37:1447-1457. Description of an Italian network organization (ECMOnet) aimed to centralize patients with suspected H1N1 ARDS when they might be treated with ECMO.
82. Peek GJ, Mugford M, Tiruvoipati R, et al.CESAR trial collaboration. Efficacy and economic assessment of conventional ventilator support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374:1351-1363.
83. Noah MA, Peek GJ, Finney SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). J Am Med Assoc 2011; 306:1659-1668. In this well matched cohort study it was observed that patients with H1N1-related severe ARDS who were referred and transferred to an ECMO center presented a lower hospital mortality rate than non-ECMO-referred patients. This article reinforces the usefulness of ECMO technology in severe ARDS patients.
84. Aquino-Esperanza J, Rodriguez PO, Boughen S, Raimondi A, et al. Severe respiratory disease in an intensive care unit during influenza A(H1N1) 2009 pandemia. Med-Buenos Aires 2010; 70:401-407.
85. Attridge RT, Frei CR. Health Care-associated Pneumonia: An Evidence-based Review. Am J Med 2011; 124:689-697.
86. Attridge RT, Frei CR, Restrepo MI, Lawson KA, et al. Guideline-concordant therapy and outcomes in healthcare-associated pneumonia. Eur Resp J 2011; 38:878-887.
87. Azoulay E, Mokart D, Lambert J, et al. Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 2010; 182:1038-1046. [38]
88. Barochia AV, Cui X, Vitberg D, et al. Bundled care for septic shock: an analysis of clinical trials. Crit Care Med 2010; 38:668-678. [66]
89. Becher RD, Hoth JJ, Neff LP, Rebo JJ, et al. Multidrug-Resistant Pathogens and Pneumonia: Comparing the Trauma and Surgical Intensive Care Units. Surg Infect 2011; 12:267-272.
90. Bloos F, Marshall JC, Dellinger RP, Vincent JL, et al. Multinational, observational study of procalcitonin in ICU patients with pneumonia requiring mechanical ventilation: a multicenter observational study - art. no. R88. Crit Care 2011; 15:R88.
91. Brown SM, Dean NC. Defining and predicting severe community-acquired pneumonia. Curr Opin Infect Dis 2010; 23:158-164. [04]
92. Butt S, Swiatlo E. Treatment of community-Acquired Pneumonia in an Ambulatory Setting. Am J Med 2011; 124:297-300.
93. Calbo E, Garau J. Factors affecting the development of systemic inflammatory response syndrome in pneumococcal infections. Curr Opin Infect Dis 2011; 24:241-247. [18]
94. Caliendo AM. Multiplex PCR and emerging technologies for the detection of respiratory pathogens. Clin Infect Dis 52(4 Suppl)2011:326-330. [40]
95. Chalmers JD, Mandal P, Singanayagam A, Akram AR, et al. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med 2011; 37:1409-1420.
96. Chalmers JD, Taylor JK, Mandal P, Choudhury G, et al. Validation of the Infectious Diseases Society of America/American Thoratic Society Minor Criteria for Intensive Care Unit Admission in Community-Acquired Pneumonia Patients Without Major Criteria or Contraindications to Intensive Care Unit Care. Clin Infect Dis 2011; 53:503-511.
97. Chalmers JD, Taylor JK, Mandal P, et al. Validation of the Infectious Diseases Society of America/American Thoracic Society minor criteria for intensive care unit admission in community-acquired pneumonia patients without major criteria or contraindications to intensive care unit care. Clin Infect Dis 2011; 53:503-511. [06]
98. Correia MA, Mello MJG, Petribu NC, Silva EJC, et al. Agreement on Radiological Diagnosis of Acute Lower Respiratory Tract Infection in Children. J Trop Pediatr 2011; 57:204-207.
99. De Pascale G, Bello G, Antonelli M. Steroids in severe pneumonia: a literature review. Minerva Anestesiol 2011; 77:902-910. [62]
100. Dodek PM, Norena M, Keenan SP, Teja A, et al. Intensive care unit admissions for community-acquired pneumonia are seasonal but are not associated with weather or reports of influenza-like illness in the community. J Crit Care 2011; 26:228-233.
101. Dubnov-Raz G, Somech R, Warschawski Y, Eisenberg G, et al. Clinical characteristics of children with 2009 pandemic H1N1 influenza virus infections. Pediatr Int 2011; 53:426-430.
102. Eckmann C, Heizmann WR, Leitner E, von Eiff C, et al. Prospective, Non-Interventional, Multi-Centre Trial of Tigecycline in the Treatment of Severely Ill Patients with Complicated Infections - New Insights into Clinical Results and Treatment Practice. Chemotherapy 2011; 57:275-284.
103. Esan A, Hess DR, Raoof S, et al. Severe hypoxemic respiratory failure: part 1-ventilatory strategies. Chest 2010; 137:1203-1216. [78]
104. Esperatti M, Ferrer M, Theessen A, et al. Nosocomial pneumonia in the intensive care unit acquired by mechanically ventilated versus nonventilated patients. Am J Respir Crit Care Med 2010; 182:1533-1539. [31]
105. Esperatti M, Ferrer M, Theessen A, Liapikou A, et al. Nosocomial Pneumonia in the Intensive Care Unit Acquired by Mechanically Ventilated versus Nonventilated Patients. Am J Respir Crit Care Med 2010; 182:1533-1539.
106. Falcone M, Venditti M, Shindo Y, Kollef MH. Healthcare-associated pneumonia: Diagnostic criteria and distinction from community-acquired pneumonia. Int J Infect Dis 2011; 15:E545-E550.
107. Ferrer R, Artigas A. Effectiveness of treatments for severe sepsis: data from the bundle implementation programs. Minerva Anestesiol 2011; 77:360-365. [67]
108. Fraimow HS, Tsigrelis C. Antimicrobial Resistance in the Intensive Care Unit: Mechanisms, Epidemiology, and Management of Specific Resistant Pathogens. Crit Care Clin 2011; 27:163-205.
109. Franzetti F, Antonelli M, Bassetti M, Blasi F, et al. Consensus document oncontroversial issues for the treatment of hospital-associated pneumonia. Int J Infect Dis 2010; 14:S55-S65.
110. Gattinoni L, Carlesso E, Taccone P, et al. Prone positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis. Minerva Anestesiol 2010; 76:448-454. [76]
111. Gonçalves-Pereira J, Póvoa P. Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of b-lactams. Crit Care 2011. [Epub ahead of print] [57]
112. Gristina GR, Antonelli M, Conti G, et al. GiViTI (Italian Group for the Evaluation of Interventions in Intensive Care Medicine). Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. Crit Care Med 2011; 39:2232-2239. [69]
113. Hage CA, Knox KS, Davis TE, Wheat LJ. Antigen detection in bronchoalveolar lavage fluid for diagnosis of fungal pneumonia. Curr Opin Pulm Med 2011; 17:167-171. [45]
114. Hartung TK, Chimbayo D, van Oosterhout JJG, Chikaonda T, et al. Etiology of suspected Pneumonia in Adults Admitted to a High-Dependency Unit in Blantyre, Malawi. Am J Trop Med Hyg 2011; 85:105-112.
115. Hemila H. Vitamin Cand Community-acquired Pneumonia. Am J Respir Crit Care Med 2011; 184:621-622.
116. Jean SS, Hsueh PR. Current review of antimicrobial treatment of nosocomial pneumonia caused by multidrug-resistant pathogens. Expert Opin Pharmacother 2011; 12:2145-2148.
117. Joung MK, Lee JA, Moon SY, Cheong HS, et al. Impact of deescalation therapy on clinical outcomes for intensive care unit-acquired pneumonia - art. no. R79. Crit Care 2011; 15:R79.
118. Kett DH, Cano E, Quartin AA, et al. Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis 2011; 11:181-189. [52]
119. Kett DH, Cano E, Quartin AA, Mangino JE, et al. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis 2011; 11:181-189.
120. Labelle AJ, Arnold H, Reichley RM, et al. A comparison of culture-positive and culture-negative health-care-associated pneumonia. Chest 2010; 137:1130-1137. [25]
121. Lin SH, Lai CC, Tan CK, Liao WH, et al. Outcomes of hospitalized patients with bacteraemic and non-bacteraemic community-acquired pneumonia caused by Streptococcus pneumoniae. Epidemiol Infect 2011; 139:1307-1316.
122. Makris D, Desrousseaux B, Zakynthinos E, Durocher A, et al. The impact of cOPD on ICU mortality in patients with ventilator-associated pneumonia. Respir Med 2011; 105:1022-1029.
123. Mangino JE, Peyrani P, Ford KD, Kett DH, et al. Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study - art. no. R38. Crit Care 2011; 15:R38.
124. Martin-Loeches I, Lisboa T, Rodriguez A, et al. Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia. Intensive Care Med 2010; 36:612-620. [51]
125. McGrath EJ, Asmar BI. Nosocomial Infections and Multidrug-Resistant Bacterial Organisms in the Pediatric Intensive Care Unit. Indian J Pediatr 2011; 78:176-184.
126. Noah MA, Peek GJ, Finney SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). J Am Med Assoc 2011; 306:1659-1668. [83]
127. Papazian L, Forel JM, Gacouin A, et al. ACURASYS Study Investigators. neuromuscular blockers inearly acute respiratory distress syndrome. N Engl J Med 2010; 363:1107-1116. [75]
128. Patroniti N, Zangrillo A, Pappalardo F, et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med 2011; 37:1447-1457. [81]
129. Ramírez P, Ferrer M, Marti V, et al. Inflammatory biomarkers and prediction for intensive care unit admission in severe community-acquired pneumonia. Crit Care Med 2011; 39:2211-2217. [49]
130. Ramsey C, Kumar A. H1N1: viral pneumonia as a cause of acute respiratory distress syndrome. Curr Opin Crit Care 2011; 17:64-71. [23]
131. Riou M, Carbonnelle S, Avrain L, Mesaros N, et al. In vivo development of antimicrobial resistance in Pseudomonas aeruginosa strains isolated from the lower respiratory tract of Intensive Care Unit patients with nosocomial pneumonia and receiving antipseudomonal therapy. Int J Antimicrob Agents 2010; 36:513-522.
132. Ruiz LA, Gomez A, Jaca C, Martinez L, et al. Bacteraemic community-acquired pneumonia due to Gram-negative bacteria: incidence, clinical presentation and factors associated with severity during hospital stay. Infection 2010; 38:453-458.
133. Sasbon JS, Centeno MA, Garcia MD, Boada NB, et al. Influenza A(pH1N1) infection in children admitted to a pediatric intensive care unit: Differences with other respiratory viruses. Pediatr Crit Care Med 2011; 12:E136-E140.
134. Schreiber MP, Chan CM, Shorr AF. Resistant pathogens in nonnosocomial pneumonia and respiratory failure: is it time to refine the definition of health-care-associated pneumonia? Chest 2010; 137:1283-1288. [29]
135. Sordé R, Falcó V, Lowak M, et al. Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients
136. Sud S, Friedrich JO, Taccone P, et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med 2010; 36:585-599. [77]
137. Textoris J, Wiramus S, Martin C, Leone M. Overview of antimicrobial therapy in intensive care units. Expert Rev Anti-Infect Ther 2011; 9:97-109.
138. Torelli R, Sanguinetti M, Moody A, et al. Aspergillus DNA in bronchoalveolar lavage fluid samples from high-risk patients using a commercial real-time PCR assay: a comparison with galactomannan enzyme immunoassay for the diagnosis of invasive aspergillosis. J Clin Microbiol 2011. [Epub ahead of print] [46]
139. Vojtova V, Kolar M, Hricova K, Uvizl R, et al. Antibiotic utilization and Pseudomonas aeruginosa resistance in intensive care units. New Microbiol 2011; 34:291-298.
140. Walkey AJ, O'Donnell MR, Wiener RS. Linezolid vsGlycopeptide Antibiotics for the Treatment of Suspected Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia A Meta-analysis of Randomized Controlled Trials. Chest 2011; 139:1148-1155.
141. Wolfler A, Calderoni E, Ottonello G, Conti G, et al. Daily practice of mechanical ventilation in Italian pediatric intensive care units: A prospective survey. Pediatr Crit Care Med 2011; 12:141-146.
142. Woodhead M, Blasi F, Ewig S, et al. Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections: full version. Clin Microbiol Infect 2011; 176:E1-E59. [32]
143. Yung M, Slater A, Festa M, Williams G, et al. Pandemic H1N1 in Children Requiring Intensive Care in Australia and New Zealand During Winter 2009. Pediatrics 2011; 127:E156-E163.
144. Zilberberg MD, Shorr AF. Healthcare-associated pneumonia: the state of evidence to date. Curr Opin Pulm Med 2011; 17:142-147. [08]