Severe Pneumonia
http://www.100md.com
《新英格兰医药杂志》
What is severe pneumonia? A number of scenarios immediately spring to mind, including pneumonia due to hantavirus, severe acute respiratory syndrome (SARS), or severe influenza in previously well young people that leads to death within a day or so of onset. But it is not that simple. In Severe Pneumonia two chapters by different authors discuss the definition of severe pneumonia, but ultimately the reader realizes that, despite multiple definitions, none is completely satisfactory. Both chapters concern severe community-acquired pneumonia, whereas 9 of the 15 chapters in the book deal with ventilator-associated pneumonia. Interestingly, severe ventilator-associated pneumonia is not defined.
The chapter on pulmonary host defenses (which is the last chapter in the book when, logically, it should be first) and the chapter on why some patients get severe pneumonia are excellent. The latter is a good review of the influence of genetic factors on the host response to pneumonia. The authors of this chapter, Waterer and Wunderink, state that "although often underrecognized or underestimated, a strong inheritable risk for death from infection clearly exists."
The chapters on ventilator-associated pneumonia are a good review of a complex topic. They justify the purchase of the book. Several topics are not covered, including SARS, which is the epitome of severe pneumonia. It is surprising that the management of severe pneumonia in an intensive care unit is also not addressed. I expected a discussion of the merits of low-dose corticosteroid therapy, the use of activated protein C, and the benefits of controlling hyperglycemia. The underpinning of proper management of severe pneumonia is an understanding of disordered respiratory physiology. A chapter on this topic would have been worthwhile. Despite these shortcomings, the book is a useful addition to the libraries of readers with a great interest in pneumonia.
Thomas J. Marrie, M.D.
University of Alberta
Edmonton, AB T6G 2R7, Canada
tom.marrie@ualberta.ca((Lung Biology in Health a)
The chapter on pulmonary host defenses (which is the last chapter in the book when, logically, it should be first) and the chapter on why some patients get severe pneumonia are excellent. The latter is a good review of the influence of genetic factors on the host response to pneumonia. The authors of this chapter, Waterer and Wunderink, state that "although often underrecognized or underestimated, a strong inheritable risk for death from infection clearly exists."
The chapters on ventilator-associated pneumonia are a good review of a complex topic. They justify the purchase of the book. Several topics are not covered, including SARS, which is the epitome of severe pneumonia. It is surprising that the management of severe pneumonia in an intensive care unit is also not addressed. I expected a discussion of the merits of low-dose corticosteroid therapy, the use of activated protein C, and the benefits of controlling hyperglycemia. The underpinning of proper management of severe pneumonia is an understanding of disordered respiratory physiology. A chapter on this topic would have been worthwhile. Despite these shortcomings, the book is a useful addition to the libraries of readers with a great interest in pneumonia.
Thomas J. Marrie, M.D.
University of Alberta
Edmonton, AB T6G 2R7, Canada
tom.marrie@ualberta.ca((Lung Biology in Health a)