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Noninvasive ventilation is recommended for immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure.
Noninvasive ventilation is recommended for immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure.
True
The study by Parke et al. in 2011 was a preliminary randomized controlled trial to evaluate the effectiveness of nasal high-flow oxygen in intensive care patients.
The study by Parke et al. in 2011 was a preliminary randomized controlled trial to evaluate the effectiveness of nasal high-flow oxygen in intensive care patients.
True
Helmet CPAP has been proven more effective than oxygen therapy alone in improving oxygenation in community-acquired pneumonia.
Helmet CPAP has been proven more effective than oxygen therapy alone in improving oxygenation in community-acquired pneumonia.
True
P-SILI justifies the intubation of COVID-19 patients according to a study published in Annals of Intensive Care in 2020.
P-SILI justifies the intubation of COVID-19 patients according to a study published in Annals of Intensive Care in 2020.
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A study in Anaesthesia in 2008 evaluated the performance of oxygen delivery devices when simulating the breathing pattern of respiratory failure.
A study in Anaesthesia in 2008 evaluated the performance of oxygen delivery devices when simulating the breathing pattern of respiratory failure.
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High-flow oxygen therapy was more efficient than helmet NIV in reducing patients' respiratory effort.
High-flow oxygen therapy was more efficient than helmet NIV in reducing patients' respiratory effort.
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Patients with intense baseline inspiratory effort and severe oxygenation impairment benefited more from helmet NIV.
Patients with intense baseline inspiratory effort and severe oxygenation impairment benefited more from helmet NIV.
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There was a significant reduction in mortality with corticosteroid therapy.
There was a significant reduction in mortality with corticosteroid therapy.
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Hyperglycaemia occurred in 18% of patients receiving corticosteroids and 12% of patients with placebo.
Hyperglycaemia occurred in 18% of patients receiving corticosteroids and 12% of patients with placebo.
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All older RCTs comparing hydrocortisone to placebo were multicentre studies.
All older RCTs comparing hydrocortisone to placebo were multicentre studies.
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High-flow nasal oxygen (HFNO) is always superior to standard oxygen therapy for patients with sCAP and acute hypoxaemic respiratory failure.
High-flow nasal oxygen (HFNO) is always superior to standard oxygen therapy for patients with sCAP and acute hypoxaemic respiratory failure.
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Non-invasive mechanical ventilation (NIV) is not recommended for patients with persistent hypoxaemic respiratory failure who do not need immediate intubation.
Non-invasive mechanical ventilation (NIV) is not recommended for patients with persistent hypoxaemic respiratory failure who do not need immediate intubation.
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HFNO has been shown to provide better oxygenation, more comfort, and lower respiratory rate when compared to standard oxygen therapy in patients with acute respiratory failure.
HFNO has been shown to provide better oxygenation, more comfort, and lower respiratory rate when compared to standard oxygen therapy in patients with acute respiratory failure.
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Breathing efforts during spontaneous ventilation can have no impact on lung injury in patients with acute respiratory failure.
Breathing efforts during spontaneous ventilation can have no impact on lung injury in patients with acute respiratory failure.
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The ability of HFNO to deliver high fractions of inspired oxygen generates a mild negative end-expiratory pressure effect in the airways.
The ability of HFNO to deliver high fractions of inspired oxygen generates a mild negative end-expiratory pressure effect in the airways.
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Noninvasive ventilation is not recommended in patients with the most severe spectrum of community-acquired pneumonia (CAP).
Noninvasive ventilation is not recommended in patients with the most severe spectrum of community-acquired pneumonia (CAP).
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The guidelines aim to standardize the treatment and management of patients with severe CAP.
The guidelines aim to standardize the treatment and management of patients with severe CAP.
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The guidelines for critically ill patients with CAP are easy to implement regardless of healthcare system variations.
The guidelines for critically ill patients with CAP are easy to implement regardless of healthcare system variations.
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The recommendations for severely ill CAP patients have been developed solely by specialists in the field of respiratory medicine.
The recommendations for severely ill CAP patients have been developed solely by specialists in the field of respiratory medicine.
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The guidelines highlight existing knowledge gaps and provide suggestions for future research in the field of CAP.
The guidelines highlight existing knowledge gaps and provide suggestions for future research in the field of CAP.
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In patients with severe community-acquired pneumonia (sCAP) due to influenza, it is recommended to use oseltamivir without confirming the diagnosis with PCR.
In patients with severe community-acquired pneumonia (sCAP) due to influenza, it is recommended to use oseltamivir without confirming the diagnosis with PCR.
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For patients with sCAP and shock, corticosteroids are not recommended based on the guidelines.
For patients with sCAP and shock, corticosteroids are not recommended based on the guidelines.
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Empirical oseltamivir is recommended for patients with sCAP when PCR confirmation of influenza is available.
Empirical oseltamivir is recommended for patients with sCAP when PCR confirmation of influenza is available.
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Patients with sCAP and aspiration risk factors should receive specific therapy targeting anaerobic bacteria according to the guidelines.
Patients with sCAP and aspiration risk factors should receive specific therapy targeting anaerobic bacteria according to the guidelines.
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Immunocompromised patients are excluded from the recommendation to integrate specific risk factors for guiding antibiotic prescription in sCAP patients.
Immunocompromised patients are excluded from the recommendation to integrate specific risk factors for guiding antibiotic prescription in sCAP patients.
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In patients with severe community-acquired pneumonia, rapid microbiological techniques are recommended to be added to current testing of blood and respiratory tract samples.
In patients with severe community-acquired pneumonia, rapid microbiological techniques are recommended to be added to current testing of blood and respiratory tract samples.
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High-Flow Nasal Oxygen (HFNO) is suggested over standard oxygen for patients with sCAP and acute hypoxaemic respiratory failure not requiring immediate intubation.
High-Flow Nasal Oxygen (HFNO) is suggested over standard oxygen for patients with sCAP and acute hypoxaemic respiratory failure not requiring immediate intubation.
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For hospitalized patients with severe community-acquired pneumonia, the addition of fluoroquinolones to beta-lactams is suggested as empirical antibiotic therapy.
For hospitalized patients with severe community-acquired pneumonia, the addition of fluoroquinolones to beta-lactams is suggested as empirical antibiotic therapy.
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Procalcitonin (PCT) is suggested to reduce the duration of antibiotic treatment in patients with sCAP.
Procalcitonin (PCT) is suggested to reduce the duration of antibiotic treatment in patients with sCAP.
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Helmet CPAP has been proven less effective than oxygen therapy alone in improving oxygenation in community-acquired pneumonia.
Helmet CPAP has been proven less effective than oxygen therapy alone in improving oxygenation in community-acquired pneumonia.
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Helmet NIV is more efficient than high-flow oxygen therapy in reducing patients' respiratory effort.
Helmet NIV is more efficient than high-flow oxygen therapy in reducing patients' respiratory effort.
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Hyperglycaemia occurred in 18% of patients receiving helmet CPAP and 12% of patients with placebo.
Hyperglycaemia occurred in 18% of patients receiving helmet CPAP and 12% of patients with placebo.
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Noninvasive ventilation is not recommended for immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure.
Noninvasive ventilation is not recommended for immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure.
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Patients with intense baseline expiratory effort and severe oxygenation impairment benefit more from helmet CPAP.
Patients with intense baseline expiratory effort and severe oxygenation impairment benefit more from helmet CPAP.
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High-flow oxygen therapy has been proven more effective than helmet NIV in improving oxygenation in community-acquired pneumonia.
High-flow oxygen therapy has been proven more effective than helmet NIV in improving oxygenation in community-acquired pneumonia.
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The study by Parke et al. in 2011 was a preliminary randomized controlled trial to evaluate the effectiveness of helmet CPAP in intensive care patients.
The study by Parke et al. in 2011 was a preliminary randomized controlled trial to evaluate the effectiveness of helmet CPAP in intensive care patients.
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There was a significant reduction in mortality with noninvasive ventilation therapy.
There was a significant reduction in mortality with noninvasive ventilation therapy.
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$18 ext{%}$ of patients receiving corticosteroids had hyperglycaemia, while $12 ext{%}$ of patients receiving chemotherapy had hyperglycaemia.
$18 ext{%}$ of patients receiving corticosteroids had hyperglycaemia, while $12 ext{%}$ of patients receiving chemotherapy had hyperglycaemia.
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Patients undergoing transplantation with a CD4 count lower than 200 are included in the scope for sCAP management guidance.
Patients undergoing transplantation with a CD4 count lower than 200 are included in the scope for sCAP management guidance.
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The guidelines were developed by an ERS, ESICM, ESCMID and ALAT task force, with no involvement of methodologists.
The guidelines were developed by an ERS, ESICM, ESCMID and ALAT task force, with no involvement of methodologists.
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The risk prediction methods for DRP mentioned in the review are characterised by high specificity and generally low sensitivity.
The risk prediction methods for DRP mentioned in the review are characterised by high specificity and generally low sensitivity.
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Most of the risk prediction scores mentioned have high positive predictive values.
Most of the risk prediction scores mentioned have high positive predictive values.
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MARUYAMA et al. conducted a retrospective cohort study to evaluate the risk prediction algorithm from NIEDERMAN and BRITO.
MARUYAMA et al. conducted a retrospective cohort study to evaluate the risk prediction algorithm from NIEDERMAN and BRITO.
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In the prospective implementation study by WEBB et al., the electronic CAP clinical decision support included the DRIP score.
In the prospective implementation study by WEBB et al., the electronic CAP clinical decision support included the DRIP score.
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The algorithm recommended broad-spectrum antibiotics in more cases than they were actually received.
The algorithm recommended broad-spectrum antibiotics in more cases than they were actually received.
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Excessively broad antibiotic therapy has been shown to be associated with positive outcomes for patients with CAP.
Excessively broad antibiotic therapy has been shown to be associated with positive outcomes for patients with CAP.
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The use of multiplex PCR assays can lead to inappropriate escalation of antibiotics based on false-positive results.
The use of multiplex PCR assays can lead to inappropriate escalation of antibiotics based on false-positive results.
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In most cases of positive PCR, negative culture cases are usually false-negative.
In most cases of positive PCR, negative culture cases are usually false-negative.
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The culture/PCR discordance is more likely to occur with antibiotic-resistant pathogens that require the same antibiotics as usual CAP therapy.
The culture/PCR discordance is more likely to occur with antibiotic-resistant pathogens that require the same antibiotics as usual CAP therapy.
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A cost–benefit analysis is available for multiplex PCR testing, considering potential benefits and testing costs.
A cost–benefit analysis is available for multiplex PCR testing, considering potential benefits and testing costs.
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Empirical antibiotic selection in community-acquired pneumonia (CAP) is solely based on clinical judgment.
Empirical antibiotic selection in community-acquired pneumonia (CAP) is solely based on clinical judgment.
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Risk prediction algorithms for drug-resistant pathogens have no impact on initial empiric antibiotic therapy in pneumonia patients.
Risk prediction algorithms for drug-resistant pathogens have no impact on initial empiric antibiotic therapy in pneumonia patients.
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Strategies for predicting drug-resistant pathogens in community-acquired pneumonia are irrelevant for hospitalized patients.
Strategies for predicting drug-resistant pathogens in community-acquired pneumonia are irrelevant for hospitalized patients.
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Risk factors for multidrug-resistant pathogens play a significant role in guiding empiric antibiotic therapy for pneumonia patients.
Risk factors for multidrug-resistant pathogens play a significant role in guiding empiric antibiotic therapy for pneumonia patients.
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Using risk factors to predict drug-resistant pathogens has no impact on the selection of initial empiric therapy in pneumonia patients.
Using risk factors to predict drug-resistant pathogens has no impact on the selection of initial empiric therapy in pneumonia patients.
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The use of the DRIP score was associated with a reduction in narrow-spectrum antibiotic use.
The use of the DRIP score was associated with a reduction in narrow-spectrum antibiotic use.
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Failure to initiate appropriate empirical therapy in patients with sepsis and septic shock has been linked to decreased morbidity and mortality.
Failure to initiate appropriate empirical therapy in patients with sepsis and septic shock has been linked to decreased morbidity and mortality.
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The unnecessary use of broad-spectrum antibiotics in community-acquired pneumonia (CAP) is associated with shorter hospital stays.
The unnecessary use of broad-spectrum antibiotics in community-acquired pneumonia (CAP) is associated with shorter hospital stays.
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Accurately predicting which patients require DRP coverage is not considered an important clinical objective.
Accurately predicting which patients require DRP coverage is not considered an important clinical objective.
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Early administration of broad-spectrum antimicrobial regimens is associated with increased mortality.
Early administration of broad-spectrum antimicrobial regimens is associated with increased mortality.
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Risk factors for drug resistance in pneumonia can be categorized into pathogen acquisition, colonisation persistence, selective pressure from antibiotics, and host physiology alteration.
Risk factors for drug resistance in pneumonia can be categorized into pathogen acquisition, colonisation persistence, selective pressure from antibiotics, and host physiology alteration.
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According to the guidelines, it is recommended to avoid using the healthcare-associated pneumonia (HCAP) definition when treating patients with empirical therapy directed at drug-resistant pathogens.
According to the guidelines, it is recommended to avoid using the healthcare-associated pneumonia (HCAP) definition when treating patients with empirical therapy directed at drug-resistant pathogens.
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Risk prediction models based on reproducible risk factors have been shown to accurately estimate the risk of drug-resistant pathogens in pneumonia.
Risk prediction models based on reproducible risk factors have been shown to accurately estimate the risk of drug-resistant pathogens in pneumonia.
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Patients with a history of colonisation or infection with drug-resistant pathogens are not considered at risk for drug resistance according to the guidelines.
Patients with a history of colonisation or infection with drug-resistant pathogens are not considered at risk for drug resistance according to the guidelines.
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Selecting empirical antibiotics based on specific risk factors is only recommended for immunocompromised sCAP patients according to the guidelines.
Selecting empirical antibiotics based on specific risk factors is only recommended for immunocompromised sCAP patients according to the guidelines.
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The global prevalence of MRSA in patients with CAP was 5% in the GLIMP cohort study.
The global prevalence of MRSA in patients with CAP was 5% in the GLIMP cohort study.
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Patients with low risk scores according to DRP prediction models may benefit from narrow-spectrum treatment, reducing costs associated with drug acquisition.
Patients with low risk scores according to DRP prediction models may benefit from narrow-spectrum treatment, reducing costs associated with drug acquisition.
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The prevalence of P.aeruginosa was 2% in patients with confirmed diagnosis of CAP in a point prevalence study that included 3193 patients.
The prevalence of P.aeruginosa was 2% in patients with confirmed diagnosis of CAP in a point prevalence study that included 3193 patients.
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The use of broad-spectrum antibiotics for CAP has decreased over time to cover DRP such as MRSA, P.aeruginosa, and ESBL-producing Enterobacterales.
The use of broad-spectrum antibiotics for CAP has decreased over time to cover DRP such as MRSA, P.aeruginosa, and ESBL-producing Enterobacterales.
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The cost–benefit of using narrow-spectrum antimicrobials has been clearly demonstrated in patients with sCAP.
The cost–benefit of using narrow-spectrum antimicrobials has been clearly demonstrated in patients with sCAP.
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Adding fluoroquinolones to beta-lactams is suggested as empirical antibiotic therapy for hospitalized patients with severe community-acquired pneumonia.
Adding fluoroquinolones to beta-lactams is suggested as empirical antibiotic therapy for hospitalized patients with severe community-acquired pneumonia.
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High-Flow Nasal Oxygen (HFNO) is recommended for patients with severe community-acquired pneumonia (sCAP) and acute hypoxaemic respiratory failure not requiring immediate intubation.
High-Flow Nasal Oxygen (HFNO) is recommended for patients with severe community-acquired pneumonia (sCAP) and acute hypoxaemic respiratory failure not requiring immediate intubation.
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Immunocompromised patients are included in the recommendation to integrate specific risk factors for guiding antibiotic prescription in sCAP patients.
Immunocompromised patients are included in the recommendation to integrate specific risk factors for guiding antibiotic prescription in sCAP patients.
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Procalcitonin (PCT) is not suggested to reduce the duration of antibiotic treatment in patients with sCAP.
Procalcitonin (PCT) is not suggested to reduce the duration of antibiotic treatment in patients with sCAP.
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Helmet CPAP has been proven more effective than oxygen therapy alone in improving oxygenation in community-acquired pneumonia.
Helmet CPAP has been proven more effective than oxygen therapy alone in improving oxygenation in community-acquired pneumonia.
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The ability of High-Flow Nasal Oxygen (HFNO) to deliver high fractions of inspired oxygen generates a mild positive end-expiratory pressure effect in the airways.
The ability of High-Flow Nasal Oxygen (HFNO) to deliver high fractions of inspired oxygen generates a mild positive end-expiratory pressure effect in the airways.
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Most of the risk prediction scores mentioned have low positive predictive values.
Most of the risk prediction scores mentioned have low positive predictive values.
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Adding rapid microbiological techniques to current testing of blood and respiratory tract samples is not recommended for patients with severe community-acquired pneumonia.
Adding rapid microbiological techniques to current testing of blood and respiratory tract samples is not recommended for patients with severe community-acquired pneumonia.
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The guidelines for critically ill patients with CAP are difficult to implement regardless of healthcare system variations.
The guidelines for critically ill patients with CAP are difficult to implement regardless of healthcare system variations.
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$18 ext{%}$ of patients receiving corticosteroids had hyperglycaemia, while $12 ext{%}$ of patients receiving chemotherapy had hyperglycaemia.
$18 ext{%}$ of patients receiving corticosteroids had hyperglycaemia, while $12 ext{%}$ of patients receiving chemotherapy had hyperglycaemia.
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Study Notes
Beneficial Effects of Humidified High Flow Nasal Oxygen in Critical Care Patients
- A prospective pilot study published in Intensive Care Medicine (2011) found beneficial effects of humidified high flow nasal oxygen in critical care patients.
- Another study published in Respir Care (2011) found that nasal high-flow oxygen improved oxygenation in intensive care patients.
Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation
- A study published in Am J Respir Crit Care Med (2020) compared high-flow nasal cannula and helmet noninvasive ventilation in acute hypoxemic respiratory failure and found that high-flow nasal oxygen was more effective.
Recommendations for Severe Community-Acquired Pneumonia (sCAP)
- In patients with sCAP and acute hypoxaemic respiratory failure not needing immediate intubation, high-flow nasal oxygen (HFNO) is suggested instead of standard oxygen (conditional recommendation, very low quality of evidence).
- Non-invasive mechanical ventilation (NIV) might be an option in certain patients with persistent hypoxaemic respiratory failure not needing immediate intubation, irrespective of HFNO (conditional recommendation, low quality of evidence).
- The use of PCT to reduce the duration of antibiotic treatment in patients with sCAP is suggested (conditional recommendation, low quality of evidence).
- The addition of macrolides, not fluoroquinolones, to beta-lactams as empirical antibiotic therapy in hospitalised patients with sCAP is suggested (conditional recommendation, very low quality of evidence).
- The use of oseltamivir for patients with sCAP due to influenza confirmed by PCR is suggested (conditional recommendation, very low quality of evidence).
Corticosteroids in sCAP
- A significant reduction in ICU mortality was found with the use of corticosteroids in patients with sCAP (risk ratio of 0.36, 95% CI 0.16–0.82).
- The use of corticosteroids in patients with sCAP is suggested if shock is present (conditional recommendation, low quality of evidence).
Risk Factors for Drug-Resistant Pathogens (DRP) in sCAP
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Specific risk factors, such as local epidemiology and previous colonisation, can be used to guide decisions regarding DRP and empirical antibiotic prescription in sCAP patients (conditional recommendation, moderate quality of evidence).
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The use of DRP prediction models can reduce costs and improve patient outcomes.
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The prevalence of DRP, such as MRSA, P.aeruginosa, and ESBL-producing Enterobacterales, is increasing in sCAP patients.### Empiric Antibiotic Therapy and Mortality
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A study published in Chest 2001 analyzed empiric antibiotic therapy and mortality among Medicare pneumonia inpatients in 10 Western States.
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The study found that severe community-acquired pneumonia treated with β-lactam-respiratory quinolone vs. β-lactam-macrolide combination had different outcomes.
Association of Antibiotics with Mortality and Cardiovascular Events
- A 2014 study published in JAMA found an association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia.
- The study highlighted the importance of considering the potential risks and benefits of antibiotic therapy in this patient population.
Optimal Antibiotic Treatment for Pneumococcal Pneumonia
- A study published in Arch Intern Med 2001 suggested that monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia.
- The study emphasized the importance of considering the severity of illness and the potential need for combination therapy.
Host, Bacterial, and Antibiotic Factors in Pneumococcal Pneumonia
- A 2013 study published in Thorax found that host, bacterial, and antibiotic treatment factors contribute to mortality in adult patients with bacteraemic pneumococcal pneumonia.
- The study highlighted the importance of considering the complex interplay of these factors in determining treatment outcomes.
Epidemiology and Outcome of Severe Pneumococcal Pneumonia
- A 2012 multicenter study published in Crit Care found that severe pneumococcal pneumonia admitted to intensive care units had a high mortality rate.
- The study emphasized the importance of early recognition and aggressive treatment of severe pneumococcal pneumonia.
Procalcitonin-Guided Antibiotic Treatment
- A 2017 Cochrane review found that procalcitonin-guided antibiotic treatment can reduce mortality in acute respiratory tract infections.
- A 2018 patient-level meta-analysis published in Lancet Infect Dis found that procalcitonin-guided antibiotic treatment can reduce mortality in acute respiratory infections.
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Test your knowledge on the benefits of humidified high flow nasal oxygen in critical care patients based on research studies. Explore the effectiveness of nasal high-flow oxygen delivery devices in intensive care settings.
