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At least 919 records · Page 51Linked to original sources
PubMed2004

Aerosolized antibiotics in mechanically ventilated patients.

Aerosolized antibiotics are potentially useful in intensive care. At State University of New York at Stony Brook we developed a human model of tracheobronchitis in intubated patients. The model provides daily specimens of airway secretions, allowing serial studies of airway inflammation and testing of therapy modes. The presence of local infection is defined by a unique method of quantified sputum collection. Bench models have been developed that illustrate the factors that limit aerosol delivery to intubated patients. With those models clinical trials have defined possible indications for targeted aerosol therapy to patients at risk for deep lung infection. An efficient aerosolized-antibiotics method that delivers the aerosol past the endotracheal tube has been established, and with that method the drug levels in pulmonary secretions exceed by several orders of magnitude the levels expected with intravenous therapy. Potential end points of therapy are being evaluated, including the rate of bacterial resistance and the incidence and definition of deep lung infection.

Administration, Inhalation↗
PubMed2004

Granulomatous tracheo-bronchitis associated with Crohn's disease.

We report a rare case of diffuse tracheo-bronchitis as a complication of Crohn's disease. A young man with a long-standing history of Crohn's enterocolitis initially presented with epigastric pain and melena. Upper endoscopy revealed erythematous, edematous, and friable mucosa with erosions, particularly in the pyloric channel, causing gastric outlet obstruction, and a nonbleeding ulcer in the corpus of stomach. Biopsy of these lesions showed chronic gastritis and a noncaseating epithelioid granuloma, consistent with active Crohn's disease. The patient was treated with a course of corticosteroids and the gastric symptoms resolved. A few months later, he developed fever, cough, hemoptysis, and rash. Bronchoscopy demonstrated a markedly thickened and very inflamed trachea with extensive friable, whitish lesions and ulcerations. Histology showed severe noncaseating granulomatous inflammation. The patient improved with a 6-week oral, followed by an additional 4-week inhaled, corticosteroid treatment. Since then, he has been doing well without relapse of pulmonary symptoms for 2 years.

Adult↗
PubMed2004

[Diagnosis and management of necrotizing tracheobronchitis].

OBJECTIVE: Necrotizing tracheobronchitis has been described as a complication of mechanical ventilation of newborns with respiratory failure. Neonates with necrotizing tracheobronchitis present a diverse clinical spectrum from asymptomatic disease to severe airway obstruction that causes 45% of mortality. The objective of our study is to analyze our experience in the management of these patients. MATERIAL AND METHODS: In the last three years we have treated eight patients with necrotizing tracheobronchitis The mean age was 0.84 +/- 0.95 months, gestational age of 37.43 +/- 2.3 weeks. The mean weight was 3.07 +/- 1.04 kg. Five patients had a congenital heat disease (62.5%) and three have a respiratory failure (37.5%). We have analyzed the contributing factors, symptoms, diagnosis, treatment and results. RESULTS: All patients presented episodes of shock with treatment of drugs. Five patients have conventional ventilation (62.5%) while three have high frequency oscillatory ventilation (37.5%). There were not significant differences in the ventilator parameters of both groups (PMA, PIP, PEEP). Three patients were supported by ECMO when they developed necrotizing tracheobronchitis. The treatment was bronchoscopic removal of necrotic tissue. There was not any complication after the procedure. A patient suffered a stenosis in the left main bronchus. Three patients have died during follow-up for different causes. The time of pursuit is of 10.33 +/- 7.61 months. CONCLUSIONS: Necrotizing tracheobronchitis may be increasing in the Neonatal Intensive Care Units, due to a bigger survival of patient with serious respiratory failure and shock. Hypotension and shock seems to be a major contributing factor in the development of this lesion. Bronchoscopy is necessary for treatment and survival of the patients.

Bronchitis↗