The ART of Antiretroviral Therapy in Critically Ill Patients With HIV.

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

Treatment of clinical aspiration: a reappraisal.

PURPOSE: The treatment of clinical aspiration is reviewed. SUMMARY: The common definition of aspiration is the inhalation of oropharyngeal or gastric contents into the larynx and lower respiratory tract. Pulmonary aspiration frequently occurs in both the hospital and community settings and can affect patients of all ages. Aspiration can often lead to pulmonary complications, which can be divided into two main pathophysiological processes: chemical pneumonitis and aspiration pneumonia. These processes differ based on the aspirate contents, which ultimately dictate the physiological pathway and enduring symptoms. While these processes are clearly divergent, the clinical presentation may be indistinguishable, often leading to inappropriate or unnecessary treatment. Despite the widespread use of antibiotic therapy for aspiration complications, the literature supporting this treatment is quite limited. A literature review of clinical trials was conducted to address core aspects of aspiration complications, including bacteriology and empirical antibiotic treatment. The findings reveal that many of the current antibiotic practices used to treat clinical aspiration stem from limited studies dating back to the 1970s or before. Newer data have begun to refute these standard antibiotic regimens and provide a case for tailored empirical treatment. The treatment of aspiration should be largely focused on the underlying etiology and tailored to individual patients and their symptoms. CONCLUSION: The management of aspiration should largely focus on whether the underlying problem is pneumonitis or pneumonia. Recent studies on aspiration pneumonia have begun to show a difference in culture-isolated bacteria and therefore optimal treatment regimens, compared with pivotal human trials completed more than 40 years ago.