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Community-acquired pneumonia (CAP) is a common inflammatory process contained within the lungs in response to infection with non-hospital pathogens. Full resolution usually occurs with appropriate antimicrobial therapy. A significant proportion of patients develop severe CAP where there is failure to contain the local immune response and these patients may require admission to the intensive care unit (ICU). The CURB-65 severity score is a rapid, objective way of predicting mortality and can be used to guide site of care decisions in conjunction with clinical assessment. Microbiological investigations permit pathogen-specific antibiotic therapy and provide epidemiological data. Appropriate and timely administration of antibiotics is the mainstay of treatment. Complications include empyema, treatment failure, sepsis, respiratory failure and death. [ABSTRACT FROM AUTHOR]

Objective. To study the total amount of sedative drugs administered to patients in the intensive care unit (ICU) before and after tracheostomy. Design. Prospective observational study. Setting. Twelve-bedded general ICU that was expanded to an 18-bedded general ICU. Subjects. Twenty-two patients who had a tracheostomy inserted during their ICU stay. Interventions. None. End points. The total amount of sedative drugs administered to patients three days before and three days after insertion of tracheostomy. Measurements and main results. During the study period 447 patients were admitted to ICU, 27 (5.6%) had a tracheostomy. Four patients were excluded from the study because of the presence of hypoxic brain damage or a permanent tracheostomy prior to ICU admission. Twenty-three patients were studied. The median age was 65, median initial 24  h APACHE II score was 22, median length of stay was 36 days, and median time of performing the tracheostomy was 14 days. Twelve (52%) patients died and one patient was transferred to another centre the day after tracheostomy and was therefore not included in the comparison of sedation use before and after tracheostomy. Alfentanil, morphine, propofol and midazolam were used in 17 (77.3%), 8 (36.4%), 19 (86.4%) and 9 (40.9%) patients respectively. Overall, there was a significant reduction in the total amount of alfentanil ( p =0.01) and propofol ( p =0.01) administered before and after tracheostomy. One patient (4.5%) did not receive sedation before or after tracheostomy. Sedative drug use was reduced after tracheostomy in 13 (59%) patients and slightly increased in one (4.5%) patient. Sedative drugs were altered in 7 (31.8%) patients. Ten patients received only propofol and/or alfentanil for sedation. For these patients, there was a significant reduction in the use of both these agents after tracheostomy, p =0.02 and p [ABSTRACT FROM AUTHOR]

Abstract: Acute respiratory distress syndrome is a clinically and radiologically defined syndrome that is commonly diagnosed and managed in intensive care. It results in hypoxaemia and often requires mechanical ventilation. This article describes the most recent diagnostic classification and outlines the pathophysiology and current management of patients suffering from this syndrome. [Copyright &y& Elsevier]

Abstract: Community-acquired pneumonia (CAP) is a common inflammatory process contained within the lungs in response to infection with non-hospital pathogens. Full resolution usually occurs with appropriate antimicrobial therapy. A significant proportion of patients develop severe CAP where there is failure to contain the local immune response. These patients can develop septic shock requiring admission to the intensive care unit. The CURB65 severity score is a rapid, objective way of predicting mortality and can be used to guide site of care decisions in conjunction with clinical assessment. Microbiological investigation of severe CAP permits pathogen-specific antibiotic therapy and provides epidemiological data. Complications include parapneumonic effusions and empyema. Outcome from severe CAP can be improved by prompt antibiotic therapy. [Copyright &y& Elsevier]

Abstract: Community-acquired pneumonia (CAP) is a common inflammatory process contained within the lungs in response to infection with non-hospital pathogens. Full resolution usually occurs with appropriate antimicrobial therapy. A significant proportion of patients develop severe CAP where there is failure to contain the local immune response. These patients can develop septic shock requiring admission to the intensive care unit. The CURB65 severity score is a rapid, objective way of predicting mortality and can be used to guide site of care decisions in conjunction with clinical assessment. Microbiological investigation of severe CAP permits pathogen-specific antibiotic therapy and provides epidemiological data. Complications include parapneumonic effusions and empyema. Outcome from severe CAP can be improved by prompt antibiotic therapy. [ABSTRACT FROM AUTHOR]

Abstract: Acute lung injury is a clinically and radiologically defined syndrome which is commonly diagnosed in intensive care. This article describes the epidemiology, pathology and pathophysiology as well as current management strategies with supporting evidence where available. [ABSTRACT FROM AUTHOR]