Clinical efficacy and safety of linezolid in intensive care unit patients

Background:To characterize the population of critically ill patients and infections treated with linezolid in the intensive care unit(ICU),and to evaluate the clinical efficacy and safety of linezolid therapy.Methods::This multi-center,observational,real-world study was conducted across 52 hospitals between June 9,2018,and December 28,2019.Patients who met the following inclusion criteria were included:(1)admitted to the ICU,(2)of any age group,and(3)having a clinical or laboratory diagnosis of a Gram-positive bacterial infection.Clinical efficacy was categorized as success(cured or improved),failed,or non-evaluable.Adverse events and serious adverse events were recorded during treatment.Results::A total of 366 ICU patients who met the inclusion criteria were evaluated.Linezolid was used as second-and first-line treatment in 232(63.4%)and 134(36.6%)patients,respectively.The most common isolated strain was Staphylococcus aureus(methicillin-resistant Staphylococcus aureus:n=37/119,31.1%;methicillin-susceptible Staphylococcus aureus:n=15/119,12.6%);this was followed by Enterococci(vancomycin-resistant Enterococci:n=8/119,6.7%;vancomycin-susceptible Enterococci:n=11/119,9.2%)and Streptococcus pneumoniae(multidrug-resistant:n=4/119,3.4%;non-multidrug resistant:n=2/119,1.7%).The main infection sites where pathogens were detected included the lung(n=216/366,59.6%),skin and soft tissue(n=104/366,28.4%),and blood(n=50/366,13.7%).Clinical success was achieved in 301(82.2%)patients;34(9.3%)were cured and 267(73.0%)improved;treatment failure and non-evaluable outcomes were observed in 29(7.9%)in 36(9.8%)patients,respectively.Linezolid-related adverse events were reported in 8(2.2%)patients.No treatment-related serious adverse events were reported.Conclusions::Based on real-world results,linezolid was found to be effective and safe in the treatment of Gram-positive bacterial infections in critically ill patients.

Does airway pressure release ventilation offer new hope for treating acute respiratory distress syndrome?

Mechanical ventilation(MV)is an essential life support method for patients with acute respiratory distress syn-drome(ARDS),which is one of the most common critical illnesses with high mortality in the intensive care unit(ICU).A lung-protective ventilation strategy based on low tidal volume(LTV)has been recommended since a few years;however,as this did not result in a significant decrease of ARDS-related mortality,a more optimal venti-lation mode was required.Airway pressure release ventilation(APRV)is an old method defined as a continuous positive airway pressure(CPAP)with a brief intermittent release phase based on the open lung concept;it also perfectly fits the ARDS treatment principle.Despite this,APRV has not been widely used in the past,rather only as a rescue measure for ARDS patients who are difficult to oxygenate.Over recent years,with an increased under-standing of the pathophysiology of ARDS,APRV has been reproposed to improve patient prognosis.Nevertheless,this mode is still not routinely used in ARDS patients given its vague definition and complexity.Consequently,in this paper,we summarize the studies that used APRV in ARDS,including adults,children,and animals,to illustrate the settings of parameters,effectiveness in the population,safety(especially in children),incidence,and mechanism of ventilator-induced lung injury(VILI)and effects on extrapulmonary organs.Finally,we found that APRV is likely associated with improvement in ARDS outcomes,and does not increase injury to the lungs and other organs,thereby indicating that personalized APRV settings may be the new hope for ARDS treatment.