RESUMO
The diagnosis, prognostication, and differentiation of phenotypes of COPD can be facilitated by CT scan imaging of the chest. CT scan imaging of the chest is a prerequisite for lung volume reduction surgery and lung transplantation. Quantitative analysis can be used to evaluate extent of disease progression. Evolving imaging techniques include micro-CT scan, ultra-high-resolution and photon-counting CT scan imaging, and MRI. Potential advantages of these newer techniques include improved resolution, prediction of reversibility, and obviation of radiation exposure. This article discusses important emerging techniques in imaging patients with COPD. The clinical usefulness of these emerging techniques as they stand today are tabulated for the benefit of the practicing pulmonologist.
Assuntos
Pulmão , Doença Pulmonar Obstrutiva Crônica , Humanos , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Pneumonectomia , Imageamento por Ressonância Magnética , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagemRESUMO
Pneumonia that fails to resolve after 10 to 14 days of antibiotic therapy can lead physicians to call for consultation or unnecessary invasive diagnostic procedures. Understanding the infectious and noninfectious causes of pneumonia and their normal times to resolution is enormously helpful in the judicious evaluation of and timely intervention in this very challenging condition.
Assuntos
Resistência Microbiana a Medicamentos , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Pneumonia/diagnóstico , Pneumonia/microbiologia , Fatores Etários , Idoso , Infecções Comunitárias Adquiridas/microbiologia , Árvores de Decisões , Humanos , Pneumopatias/diagnóstico por imagem , Infecções Oportunistas/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Radiografia , Fatores de Tempo , Procedimentos DesnecessáriosRESUMO
Resistance of microbes to antibiotics is an increasing problem in intensive care units (ICUs) with a prevalence of 86% in some isolates. Resistance results in increased morbidity, mortality, and increased costs. Risk factors associated with the development of resistance and strategies to combat resistance are discussed. Risk factors include increased antibiotic use, host factors including severity of illness and length of stay, and lack of adherence to infection control practices. Multiple strategies to decrease resistance have been studied. Changing antimicrobial practices via guideline development, antibiotic restriction, use of information systems technology, crop rotation, narrowing spectrum of empiric antibiotics, multidisciplinary approaches, and selective decontamination have had variable results. Prevention of horizontal transmission via handwashing, glove and gown use, alternatives to soap, and improving the workload and facilities for health care workers is discussed. Primary prevention via decreased length of stay, selective digestive decontamination, vaccine development, and decreased use of invasive devices also plays a role.