刘洋;孟彦苓;杜斌;

• 1:中国医学科学院北京协和医学院北京协和医院内科重症监护病房

摘要(Abstract)：

<正>呼吸机相关性肺炎(ventilator-associated pneumo-nia,VAP)是机械通气患者最主要的医院获得性感染[1],其发生与人工气道(气管插管和气管切开管)更为相关,归因病死率约为30%[2]。VAP会延长患者的机械通气时间、重症监护病房(intensivecare unit,ICU)住院日及总住院日,增加医疗费用[2-3]。近年来有关VAP的研

关键词(KeyWords)： 呼吸机相关性肺炎;医院获得性感染

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 刘洋;孟彦苓;杜斌;

参考文献(References)：

• [1]Vincent JL,Bihari DJ,Suter PM,et al.The prevalence of nosocomial infection in intensive care units in Europe.Re-sults of the European Prevalence of Infection in Intensive Care(EPIC)Study.EPIC International Advisory Committee[J].JAMA,1995,274:639-644.
• [2]Heyland DK,Cook DJ,Griffith L,et al.The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient.The Canadian Critical Trials Group[J].Am J Respir Crit Care Med,1999,159:1249-1256.
• [3]Girou E,Stephan F,Novara A,et al.Risk factors and out-come of nosocomial infections:results of a matched case-control study of ICU patients[J].Am J Respir Crit Care Med,1998,157:1151-1158.
• [4]Fa`bregas N,Ewig S,Torres A,et al.Clinical diagnosis of ventilator associated pneumonia revisited:comparative vali-dation using immediate postmortem lung biopsies[J].Tho-rax,1999,54:867-873.
• [5]Heyland D,Ewig S,Torres A.Pro/con clinical debate:the use of a protected specimen brush in the diagnosis of ventila-tor associated pneumonia[J].Crit Care,2002,6:117-120.
• [6]Canadian Critical Care Trials Group.Arandomizedtrial of diag-nostic techniques for ventilator-associated pneumonia[J].N Engl J Med,2006,355:2619-2630.
• [7]Jackson SR,Ernst NE,Mueller EW,et al.Utility of bilat-eral bronchoalveolar lavage for the diagnosis of ventilator-as-sociated pneumonia in critically ill surgical patients[J].Am J Surg,2008,195:159-163.
• [8]Mentec H,May-Michelangeli L,RabbatA,etal.Blind and bronchoscopic sampling methods in suspected ventilator-as-sociated pneumonia.A multicentre prospective study[J].Intensive Care Med,2004,30:1319-1326.
• [9]Leo A,Galindo-Galindo J,Folch E,et al.Comparison of bronchoscopic bronchoalveolar lavage vs blind lavage with a modified nasogastric tube in the etiologic diagnosis of ventila-tor-associated pneumonia[J].Med Intensiva,2008,32:115-120.
• [10]Flanagan PG,Findlay GP,Magee JT,et al.The diagnosisof ventilator-associated pneumonia using nonbronchoscopic,nondirected lung lavages[J].Intensive Care Med,2000,26:20-30.
• [11]Lorente L,Lecuona M,Jime'nez A,etal.Ventilator-associ-ated pneumonia using a heated humidifier or a heat and moisture exchanger:a randomized controlled trial[J].Crit Care,2006,10:R116.
• [12]Siempos II,Vardakas KZ,Kopterides P,et al.Impact of passive humidification on clinical outcomes of mechanically ventilated patients:a metaanalysis of randomized controlled trials[J].Crit Care Med,2007,35:2843-2851.
• [13]Siempos II,Vardakas KZ,Falagas ME.Closed tracheal suction systems for prevention of ventilator-associated pneu-monia[J].Br J Anaesth,2008,100:299-306.
• [14]Subirana M,Sola I,Benito S.Closed tracheal suction sys-tems versus open tracheal suction systems for mechanically ventilated adult patients[J].Cochrane Database Syst Rev,2007:CD004581.
• [15]Lindgren S.Regional lung derecruitment after endotracheal suction during volume-or pressure-controlled ventilation:a study using electric impedance tomography[J].Intensive Care Med,2007,33:172-180.
• [16]Valle's J,Artigas A,Rello J,etal.Continuous aspiration of subglottic secretions in preventing ventilator-associated pneu-monia[J].Ann Intern Med,1995,122:179-186.
• [17]Dezfulian C,Shojania K,Collard HR,et al.Subglottic se-cretion drainage for preventing ventilator-associated pneumo-nia:a meta-analysis[J].Am J Med,2005,118:11-18.
• [18]Dullenkopf A,Gerber A,Weiss M.Fluid leakage past tra-cheal tube cuffs:evaluation of the newMicrocuff endotrache-al tube[J].Intens Care Med,2003,29:1849-1853.
• [19]Poelaert J,Depuydt P,De Wolf A,et al.Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery:a pilot study[J].J Tho-rac Cardiovasc Surg,2008,135:771-776.
• [20]Lorente L,Lecuona M,Jime'nez A,et al.Influence of an endotracheal tube with polyurethane cuff and subglottic se-cretion drainage on pneumonia[J].Am J Respir Crit Care Med,2007,176:1079-1083.
• [21]Smulders K,van der Hoeven H,Weers-Pothoff I,et al.A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation[J].Chest,2002,121:858-862.
• [22]Dragoumanis CK,Vretzakis GI,Papaioannou VE,etal.In-vestigating the failure to aspirate subglottic secretions with the Evac endotracheal tube[J].Anesth Analg,2007,105:1083-1085.
• [23]Inglis TJ,LimTM,Ng ML,et al.Structural features of tra-cheal tube biofilmformed during prolonged mechanical venti-lation[J].Chest,1995,108:1049-1052.
• [24]Kollef MH,Afessa B,Anzueto A,NASCENTInvestigation Group.Silvercoated endotracheal tubes and incidence of ventilator-associated pneumonia:the NASCENT randomized trial[J].JAMA,2008,300:805-813.
• [25]Raad I,Darouiche R,Hachem R,et al.The broad-spec-trum activity and efficacy of catheters coated with minocy-cline and rifampin[J].J Infect Dis,1996,173:418-424.
• [26]Iregui M,Ward S,Sherman G,etal.Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia[J].Chest,2002,122:262-268.
• [27]Alvarez-Lerma F.Modification of empiric antibiotic treat-ment in patients with pneumonia acquired in the intensive care unit.ICU-Acquired Pneumonia Study Group[J].In-tens Care Med,1996,22:387-394.
• [28]Kuti EL,Patel AA,Coleman CI.Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-as-sociated pneumonia and blood streaminfection:a meta-anal-ysis[J].Crit Care,2008,23:91-100.
• [29]Parker CM,Kutsogiannis J,Muscedere J,et al.Ventilator-associated pneumonia caused by multidrug-resistant organ-isms or Pseudomonas aeruginosa:prevalence,incidence,risk factors,and outcomes[J].J Crit Care,2008,23:18-26.
• [30]Sanders KM,Adhikari NK,Friedrich JO,et al.Previous cultures are not clinically useful for guiding empiric antibiot-ics in suspected ventilator-associated pneumonia:secondaryanalysis from a randomized trial[J].J Crit Care,2008,23:58-63.
• [31]Depuydt P,Benoit D,Vogelaers D,et al.Systematic sur-veillance cultures as a tool to predict involvement of multi-drug antibiotic resistant bacteria in ventilator-associated pneumonia[J].Intens Care Med,2008,34:675-682.
• [32]Joffe AR,Muscedere J,Marshall JC,et al.The safety of targeted antibiotic therapy for ventilator-associated pneumo-nia:a multicenter observational study[J].J Crit Care,2008,23:82-90.
• [33]Chastre J,Wolff M,Fagon JY,etal.Comparison of8vs15days of antibiotic therapy for ventilator-associated pneumonia in adults:a randomized trial[J].JAMA,2003,290:2588-2598.
• [34]Giantsou E,Liratzopoulos N,Efraimidou E,et al.De-esca-lation therapy rates are significantly higher by bronchoalveo-lar lavage than by tracheal aspirate[J].Intens Care Med,2007,33:1533-1540.
• [35]Garnacho-Montero J,Sa-Borges M,Sole-Violan J,et al.Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia:an observational,multi-center study comparing monotherapy with combination antibi-otic therapy[J].Crit Care Med,2007,35:1888-1895.
• [36]Heyland DK,Dodek P,Muscedere J,et al.Randomized trial of combination versus monotherapy for the empiric treat-ment of suspected ventilator-associated pneumonia[J].Crit Care Med,2008,36:737-744.