Lower respiratory tract sampling from endotracheal aspirate (EA) and bronchoalveolar lavage (BAL) are both common methods to identify pathogens in severe pneumonia. However, the difference between these two methods in microbiota profiles remains unclear. We compared the microbiota profiles of pairwise EA and BAL samples in ICU patients with respiratory failure due to severe pneumonia. We prospectively enrolled 50 ICU patients with new onset of pneumonia requiring mechanical ventilation. EA and BAL were performed on the first ICU day, and samples were analyzed for microbial community composition via 16S rRNA metagenomic sequencing. Pathogens were identified in culture medium from BAL samples in 21 (42%) out of 50 patients. No difference was observed in the antibiotic prescription pattern, ICU mortality, or hospital mortality between BAL-positive and BAL-negative patients. The microbiota profiles in the EA and BAL samples are similar with respect to diversity, microbial composition, and microbial community correlations. The antibiotic treatment regimen was rarely changed based on the BAL findings. The samples from BAL did not provide more information than EA in the microbiota profiles. We suggest that EA is more useful than BAL for microbiome identification in mechanically ventilated patients.

Acute respiratory distress syndrome (ARDS) and hemophagocytic lymphohistiocytosis (HLH) are accompanied with poor outcome and high mortality when miliary tuberculosis is a causative pathogen for both of them. A patient complicated with ARDS and HLH is unusual in critical care, and few case reports are present in PudMed. Besides, the relationship between HLH and ARDS is still unknown and has not been reviewed in the literature. In this report, we present the case of a 74-year-old Taiwanese woman suffering from pulmonary tuberculosis and miliary tuberculosis, and she developed ARDS and HLH on the 3rd day after admission. We arranged serial laboratory examination, various serum markers, bone marrow aspiration, and bronchoscopy with alveolar lavage for survey; we prescribed empirical antibiotics and antituberculosis medication soon after alveolar lavage showing positive acid-fast stain. She was extubated on hospital day 31 and discharged on hospital day 73. In conclusion, early diagnosis and intervention for underlying disease and intensive bundle care for multiorgan failure are crucial for both ARDS and HLH.

Background/Objectives: Successfully weaning patients with prolonged mechanical ventilation (PMV: ≥21 days) from ventilators is a challenging process, and proper nutritional support is a crucial factor in this process. Previous studies have highlighted the significance of higher albumin levels and increased daily protein intake in predicting successful weaning among PMV patients. However, the importance of calorie intake in patients with PMV has remained unclear. Methods: This retrospective study included 1,038 adult patients (age >18 years) who underwent endotracheal intubation or tracheostomy and required mechanical ventilation for >21 days. Baseline characteristics, nutritional variables, disease severity, management factors and patient outcomes (hospital stay and duration of ventilator use) were analyzed between the weaning-failure and weaning-success sub-cohorts and factors associated with successful weaning were identified. Results: The participants had mean APACHE II score of 18 and a Day 1 SOFA score of 4.9 and the successful weaning rate was 70%. Multivariate logistic regression analysis revealed that higher albumin and hemoglobin levels, the absence of shock, less positive fluid status, and higher calorie intake were associated with a higher successful weaning rate; an average calorie intake higher than 25 kcal/kg/day during respiratory care center (RCC) stay predicted better successful ventilator weaning. Conclusions: Higher daily calorie intake in the RCC is associated with more successful ventilator weaning, and an average intake exceeding 25 kcal/kg/day is recommended for optimizing the weaning process.