Executive Summary Introduction Methodology Used to Prepare the Guideline Epidemiology Incidence Etiology Major Epidemiologic Points Pathogenesis Major Points for Pathogenesis Modifiable Risk Factors Intubation and Mechanical Ventilation Aspiration, Body Position, and Enteral Feeding Modulation of Colonization: Oral Antiseptics and Antibiotics Stress Bleeding Prophylaxis, Transfusion, and Glucose Control Major Points and Recommendations for Modifiable Risk Factors Diagnostic Testing Major Points and Recommendations for Diagnosis Diagnostic Strategies and Approaches Clinical Strategy Bacteriologic Strategy Recommended Diagnostic Strategy Major Points and Recommendations for Comparing Diagnostic Strategies Antibiotic Treatment of Hospital-acquired Pneumonia General Approach Initial Empiric Antibiotic Therapy Appropriate Antibiotic Selection and Adequate Dosing Local Instillation and Aerosolized Antibiotics Combination versus Monotherapy Duration of Therapy Major Points and Recommendations for Optimal Antibiotic Therapy Specific Antibiotic Regimens Antibiotic Heterogeneity and Antibiotic Cycling Response to Therapy Modification of Empiric Antibiotic Regimens Defining the Normal Pattern of Resolution Reasons for Deterioration or Nonresolution Evaluation of the Nonresponding Patient Major Points and Recommendations for Assessing Response to Therapy Suggested Performance Indicators

Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia the official statement of the American Thoracic Society and the Infectious Disease Society of America (特集 救急診療ガイドライン) -- (海外のガイドライン)

https://genoplivning.dk/wp-content/uploads/2013/07/european-resuscitation-council-guidelines-for-resuscitation-2010-section-4-adult-advanced-life-support.pdf

European Resuscitation Council Guidelines for Resuscitation 2010 Section 4 Adult advanced life support

http://drop-kicker.com/wp-content/uploads/2014/01/kyle-bia.pdf

Bioelectrical impedance analysis--part I: review of principles and methods.

It has become increasingly clear that life-history patterns among the vertebrates have been shaped by the plethora and variety of immunological risks associated with parasitic faunas in their environments. Immunological competence could very well be the most important determinant of life-time reproductive success and fitness for many species. It is generally assumed by evolutionary ecologists that providing immunological defences to minimise such risks to the host is costly in terms of necessitating trade-offs with other nutrient-demanding processes such as growth, reproduction, and thermoregulation. Studies devoted to providing assessments of such costs and how they may force evolutionary trade-offs among life-history characters are few, especially for wild vertebrate species, and their results are widely scattered throughout the literature. In this paper we attempt to review this literature to obtain a better understanding of energetic and nutritional costs for maintaining a normal immune system and examine how costly it might be for a host who is forced to up-regulate its immunological defence mechanisms. The significance of these various costs to ecology and life history trade-offs among the vertebrates is explored. It is concluded that sufficient evidence exists to support the primary assumption that immunological defences are costly to the vertebrate host.

https://www.jstor.org/stable/pdfplus/3546398.pdf

Trade‐offs in evolutionary immunology: just what is the cost of immunity?

Bioelectrical impedance analysis-part II: utilization in clinical practice.

Muscle wasting and energy balance in critical illness.

Background
Emergency intubation has been widely advocated as a life saving procedure in severe acute illness and injury associated with real or potential compromises to the patient's airway and ventilation. However, some initial data have suggested a lack of observed benefit.

Objectives
To determine in acutely ill and injured patients who have real or anticipated problems in maintaining an adequate airway whether emergency endotracheal intubation, as opposed to other airway management techniques, improves the outcome in terms of survival, degree of disability at discharge or length of stay and complications occurring in hospital.

Search methods
We searched the Cochrane Injuries Group Specialised Register (December 2006), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4), MEDLINE (1950 to November 2006), EMBASE (1980 to week 50, December 2006), National Research Register (Issue 4, 2006), CINAHL (1980 to December 2006), BIDS (to December 2006) and ICNARC (to December 2006). We also examined reference lists of articles for relevant material and contacted experts in the field. Non-English language publications were searched for and examined.

Selection criteria
All randomised (RCTs) or controlled clinical trials involving the emergency use of endotracheal intubation in the injured or acutely ill patient were examined.

Data collection and analysis
The full texts of 452 studies were reviewed independently by two authors using a standard form. Where the review authors felt a study may be relevant for inclusion in the final review or disagreed, the authors examined the study and a collective decision was made regarding its inclusion or exclusion from the review. The results were not combined in a meta-analysis due to the heterogeneity of patients, practitioners and alternatives to intubation that were used.

Main results
We identified three eligible RCTs carried out in urban environments. Two trials involved adults with non-traumatic out-of-hospital cardiac arrest. One of these trials found a non-significant survival disadvantage in patients randomised to receive a physician-operated intubation versus a combi-tube (RR 0.44, 95% CI 0.09 to 1.99). The second trial detected a non-significant survival disadvantage in patients randomised to paramedic intubation versus an oesophageal gastric airway (RR 0.86, 95% CI 0.39 to 1.90). The third included study was a trial of children requiring airway intervention in the prehospital environment. The results indicated no difference in survival (OR 0.82, 95% CI 0.61 to 1.11) or neurologic outcome (OR 0.87, 95% CI 0.62 to 1.22) between paramedic intubation versus bag-valve-mask ventilation and later hospital intubation by emergency physicians; however, only 42% of the children randomised to paramedic endotracheal intubation actually received it.

Authors' conclusions
The efficacy of emergency intubation as currently practised has not been rigorously studied. The skill level of the operator may be key in determining efficacy. 
In non-traumatic cardiac arrest, it is unlikely that intubation carries the same life saving benefit as early defibrillation and bystander cardiopulmonary resuscitation (CPR). 
In trauma and paediatric patients, the current evidence base provides no imperative to extend the practice of prehospital intubation in urban systems. 
It would be ethical and pertinent to initiate a large, high quality randomised trial comparing the efficacy of competently practised emergency intubation with basic bag-valve-mask manoeuvres (BVM) in urban adult out-of-hospital non-traumatic cardiac arrest.

/pdf/emergency-intubation-for-acutely-ill-and-injured-patients-4qj1dg3bh0.pdf

Emergency intubation for acutely ill and injured patients.

Objective
Evaluation of selective decontamination of the digestive tract (SDD) on late mortality in ventilated trauma patients in an intensive care unit (ICU).

https://link.springer.com/content/pdf/10.1007%2Fs00134-006-0455-4.pdf

The effect of selective decontamination of the digestive tract on mortality in multiple trauma patients: a multicenter randomized controlled trial

https://www.tarn.ac.uk/content/downloads/68/guly1.pdf

Testing the validity of the ATLS classification of hypovolaemic shock.

The concept of preventable deaths1 has stimulated debate about the identification and best ways oi avoiding such undesirable outcomes. A constant feature of the debate has been the finding of unsuspected and/or underestimated haemorrhage as a major contributor to such deaths.2Why is the presence of occult bleeding so difficult to diagnose? In many undergraduate text books of physiology it can be read that an increase in heart rate (HR) is almost invariably an accompaniment of severe haemorrhage and a tachycardia is one of the most valuable indicators of concealed bleeding. The widely acclaimed Advance Trauma Life Support (ATLS) courses emphasize the importance of progressive increases in HR and decreases in arterial blood pressure as the hallmarks of hypovolaemic shock.5 Also systolic blood pressure is included in the Revised Trauma Score (RTS),6 the basis of the physiological assessment of the injured patient incorporated into TRISS methodology.7 The continuing problem with the diagnosis of haemorrhage should lead to a questioning of the relationship between pulse rate and blood pressure and the magnitude of blood loss. Even during the First World War it was noted that traumatic shock was not always accompanied by a tachycardia8 and that 'blood pressure is of assistance in judging blood volume only when it is below a certain point, for there may be a considerable reduction of blood volume without any appreciable drop in the pressure'.9 When blood pressure was recorded at very short intervals after the patient had been wounded two groups could be identified; hypertensive and

https://emj.bmj.com/content/emermed/12/1/1.full.pdf

R. A. Little

Papers

Muscle wasting and energy balance in critical illness.

Emergency intubation for acutely ill and injured patients.

The effect of selective decontamination of the digestive tract on mortality in multiple trauma patients: a multicenter randomized controlled trial

Testing the validity of the ATLS classification of hypovolaemic shock.

Preventable deaths after injury: why are the traditional 'vital' signs poor indicators of blood loss?