Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780. Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=−0.59, 95% CI: −1.03, −0.15) and hospital length of stay (MD=−1.24, 95% CI: −2.30, −0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive. The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.

Mechanical ventilation (MV) is a life-support therapy that may predispose to morbid and lethal complications, with ventilator-associated pneumonia (VAP) being the most prevalent. In 2013, the Center for Disease Control (CDC) defined criteria for ventilator-associated events (VAE). Ten years later, a growing number of studies assessing or validating its clinical applicability and the potential benefits of its inclusion have been published. Surveillance with VAE criteria is retrospective and the focus is often on a subset of patients with higher than lower severity. To date, it is estimated that around 30% of ventilated patients in the intensive care unit (ICU) develop VAE. While surveillance enhances the detection of infectious and non-infectious MV-related complications that are severe enough to impact the patient's outcomes, there are still many gaps in its classification and management. In this review, we provide an update by discussing VAE etiologies, epidemiology, and classification. Preventive strategies on optimizing ventilation, sedative and neuromuscular blockade therapy, and restrictive fluid management are warranted. An ideal VAE bundle is likely to minimize the period of intubation. We believe that it is time to progress from just surveillance to clinical care. Therefore, with this review, we have aimed to provide a roadmap for future research on the subject.

Histoplasmosis has traditionally been described as having discrete geographic areas of endemicity. Over the last few decades, it has become more and more clear that these areas are not accurate depictions of where histoplasmosis can occur. Our understanding of where histoplasmosis occurs has improved in recent years due to improving access to diagnostic testing and increased reporting as well as larger at-risk populations (HIV and non-HIV immune suppression) resulting in more cases. Although areas of relatively higher risk and case numbers certainly still exist, histoplasmosis has been observed in much of the world at this point. Our knowledge of the geographic distribution of histoplasmosis, though improving, remains incomplete. While diagnostic testing has traditionally been confined to visualization and/or culture in much of the world, antigen testing has emerged as an excellent tool. Unfortunately access to antigen testing has been inadequate for much of the world, but this has started to change in recent years and will likely change more dramatically in the near future, assuming ongoing positive developments in the area of lateral flow tests for antigen testing. In this review, we describe the current understanding of the geographic distribution of histoplasmosis, the current landscape of diagnostic testing, and the evolution of both areas with an eye towards the future.

Differential diagnosis of COVID-19 includes a broad range of conditions. Prioritizing containment efforts, protective personal equipment and testing can be challenging. Our aim was to develop a tool to identify patients with higher probability of COVID-19 diagnosis at admission. This cross-sectional study analyzed data from 100 patients admitted with suspected COVID-19. Predictive models of COVID-19 diagnosis were performed based on radiology, clinical and laboratory findings; bootstrapping was performed in order to account for overfitting. A total of 29% of patients tested positive for SARS-CoV-2. Variables associated with COVID-19 diagnosis in multivariate analysis were leukocyte count ≤7.7 × 103 mm–3, LDH >273 U/L, and chest radiographic abnormality. A predictive score was built for COVID-19 diagnosis, with an area under ROC curve of 0.847 (95% CI 0.77–0.92), 96% sensitivity and 73.5% specificity. After bootstrapping, the corrected AUC for this model was 0.827 (95% CI 0.75–0.90). Considering unavailability of RT-PCR at some centers, as well as its questionable early sensitivity, other tools might be used in order to identify patients who should be prioritized for testing, re-testing and admission to isolated wards. We propose a predictive score that can be easily applied in clinical practice. This score is yet to be validated in larger populations.