Hot topics on the diagnosis and antimicrobial therapy of ventilator-associated pneumonia, including clinical diagnostic criteria, evaluation of biomarkers, ventilator associated events, clinical pulmonary infection score, ventilator-associated tracheobronchitis, microbiological diagnosis and duration of therapy were discussed. The viewpoints in the guidelines of America, Europe and Japan were also reviewed.
Objective To study the clinical characteristics, diagnosis and treatment of primary pulmonary lymphoma. Methods A retrospective review of primary pulmonary lymphoma cases at a single institution from 2006 to 2008 was performed, and relevant literature was reviewed. Results Primary pulmonary lymphoma is a rare disease. The diagnosis was difficult because of the lack of specific characteristics. The most common symptoms were cough and fever. X-ray feature included solitary or multiple nodules and consolidation. Definite diagnosis was made by pathologic and immunohistchemical examinations. The recommended first-line therapy is chemotherapy. Conclusion Appropriate invasive biopsy is necessary for early diagnosis of primary pulmonary lymphoma
Objective To assess the risk factors associated with extubation failure in patients who had successfully passed a spontaneous breathing trial.Methods Patients receiving invasive mechanical ventilation for over 48 h were enrolled in the study，they were admitted into Emergency ICU of Zhongshan Hospital during May 2006 and Oct.2007.A spontaneous breathing trial was conducted by a pressure support of 7 cm H2O for 30 min.Clinical data were prospectively recorded for the patient receiving full ventilatory support before and after the spontaneous breathing trial.Regarding the extubation outcome，patients were divived into extubation success group and extubation failure group.Results A total of 58 patients with a mean（±SD） age of 69.4±12.7 years passed spontaneous breathing trial and were extubated.Extubation failure occurred in 11 patients（19%）.The univariate analysis indicated the following associations with extubation failure：elderly patients（78.1±7.9 years vs 67.4±15.1years，Plt;0.05），higher rapid shallow breathing index（RSBI） value（83±12 breaths·min-1·L-1 vs 68±19 breaths·min-1·L-1，Plt;0.05）and excessive respiratory tract secretions（54.5％ vs 21.3％，Plt;0.05）.Conclusion Among routinely measured clinical variables，elderly patients，higher RSBI value and amount of respiratory tract secretions were the valuable index for predicting extubation failure despite a successful spontaneous breathing trial.
