老年病学英文课件：CAP in the elderly.ppt

Experi’ential * * * ?cubic?millimeter? neutrophil * 天然耐药Natural resistance * . Parox‘ysmal * Switch from Intravenous to Oral Therapy Patients should be switched from intravenous to oral therapy when they are hemodynamically stable and improving clinically, are able to ingest medications, and have a normally functioning gastrointestinal tract. (Strong ; level II) Patients should be discharged as soon as they are clinically stable, have no other active medical problems, and have a safe environment for continued care. Inpatient observation while receiving oral therapy is not necessary. (Moderate; level II) Criteria for Clinical Stability Temperature <37.8 degrees Heart rate <100 beats/min Respiratory rate <24 breaths/min Systolic blood pressure >90 mm Hg Arterial oxygen saturation >90% or pO2 >60 mm Hg on room air Ability to maintain oral intake Normal mental status Other TreatmentConsiderations Patients with hypoxemia or respiratory distress should receive a cautious trial of noninvasive ventilation (NIV) unless they require immediate intubation because of severe hypoxemia (arterial oxygen pressure/fraction of inspired oxygen [PaO2/FiO2] ratio <150) and bilateral alveolar infiltrates. (Moderate; level I ) Low-tidal-volume ventilation (6 ml/kg of ideal body weight) should be used for patients undergoing ventilation who have diffuse bilateral pneumonia or acute respiratory distress syndrome. (Strong ; level I ) Prevention All persons >50 years of age, others at risk for influenza complications, household contacts of high-risk persons, and health care workers should receive inactivated influenza vaccine (Strong ; I ) Health care workers in inpatient and outpatient settings and long-term care facilities should receive annual influenza immunization. (Strong; level I) Prevention Pneumococcal polysaccharide vaccine is recommended for persons >65 years of age and for those with selected high-risk concurrent diseases, (Strong ; level II ) Smoking cessa