Progress of Ventilator Associated Pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHE Weiwei

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Keywords：

重症监护室; 呼吸机相关肺炎; 预防

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呼吸机相关肺炎( VAP) 是指应用机械通气治疗后48 h和停用机械通气拔除人工气道48 h 内发生的肺实质的感染性炎症。VAP 是机械通气治疗中常见的严重并发症。其发
生率为9% ～70% [ 1] , 病死率高达20% ～71% [ 2, 3 ] 。依据其发生的时间可分为早发性VAP 和晚发性VAP。早发性VAP: 即气管插管或人工气道建立 lt; 5 d 发生者, 约占VAP
的1/2, 主要由插管时即定植于呼吸道内的病原体如肺炎链球菌、甲氧西林敏感金黄色葡萄球菌、流感嗜血杆菌等引起。晚发性VAP: 即气管插管或人工气道建立 gt;5 d 发生者, 常
由肠道革兰阴性细菌如肠杆菌科、不动杆菌属和假单胞菌属细菌所致。采取有效措施预防VAP 的发生, 对于降低病死率, 减少住院时间和医疗费用, 节约医疗资源具有重要的意
义。按照随机对照临床试验中的预防措施可总分为非药物性措施与药物性措施。

Citation： SHE Weiwei. Progress of Ventilator Associated Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(1): 101-103. doi: Copy

1.	Bauer TT,Ferrer R,Angrill J,et al.Ventilator-associated pneumonia: incidence,risk factors,and microbiology.Semin Respir Infect,2000 Dec;15:272-279.
2.	Cook D.Ventilator associated pneumonia: Perspectiveson the burden of illness [J].Intensive Care Med ,2002,26 (Supp1):S31～S37.
3.	Morehead RS,Pinto SJ.Ventilator-associated pneumonia.Arch Intern Med,2000,160:1926-1936.
4.	Koeman M,van der Ven AJ,Hak E,Hak E,et al.Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia.Am J Respir Crit Care Med,2006,173:1348-1355.
5.	Vallés J,Artigas A,Rello J,et al.Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia.Ann Intern Med,1995,122:179-186.
6.	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.Chest,2002,121:858-862.
7.	刘淑红,阎锡新,曹双清,等.气囊上滞留物引流对呼吸机相关下呼吸道感染的影响.中华结核和呼吸杂志,2006,29:19～22.
8.	Heyland DK,Drover JW,Dhaliwal R,,et al.Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: role of small bowel feeding.JPEN J Parenter Enteral Nutr,2002,26:S51-S55.
9.	刘培荣,李秀敏,颜廷敏.呼吸机相关性肺炎的非药物性预防措施.齐鲁护理杂志,2006,12 :1094.
10.	Adair CG,Gorman SP,Byers LM,et al.Eradication of endotracheal tube biofilm by nebulised gentamicin.Intensive Care Med,2002,28:426-431.
11.	Kola A,Eckmanns T,Gastmeier P.Efficacy of heat and moisture exchangers in preventing ventilator-associated pneumonia: meta-analysis of randomized controlled trials.Intensive Care Med,2005,31:5-11.
12.	王辰,商鸣宇,黄克武,等.有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的研究.中华结核和呼吸杂志,2000,23:212-216.
13.	Orozco-Levi M,Torres A,Ferrer M,et al.Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients.Am J Respir Crit Care Med,1995,152:1387-1390.
14.	Drakulovic MB,Torres A,Bauer TT,et al.Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial.Lancet,1999,354:1851-1858.
15.	Cook D,Guyatt G,Marshall J,et al.A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation.Canadian Critical Care Trials Group.N Engl J Med,1998,338:791-797.
16.	Bergmans DC,Bonten MJ,Gaillard CA,et al.Prevention of ventilator-associated pneumonia by oral decontamination: a prospective,randomized,double-blind,placebo-controlled study.Am J Respir Crit Care Med,2001,164:382-388.
17.	Nichol KL,Nordin J,Mullooly J,et al.Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly.N Engl J Med,2003,348:1322-1332.

1. Bauer TT,Ferrer R,Angrill J,et al.Ventilator-associated pneumonia: incidence,risk factors,and microbiology.Semin Respir Infect,2000 Dec;15:272-279.
2. Cook D.Ventilator associated pneumonia: Perspectiveson the burden of illness [J].Intensive Care Med ,2002,26 (Supp1):S31～S37.
3. Morehead RS,Pinto SJ.Ventilator-associated pneumonia.Arch Intern Med,2000,160:1926-1936.
4. Koeman M,van der Ven AJ,Hak E,Hak E,et al.Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia.Am J Respir Crit Care Med,2006,173:1348-1355.
5. Vallés J,Artigas A,Rello J,et al.Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia.Ann Intern Med,1995,122:179-186.
6. 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.Chest,2002,121:858-862.
7. 刘淑红,阎锡新,曹双清,等.气囊上滞留物引流对呼吸机相关下呼吸道感染的影响.中华结核和呼吸杂志,2006,29:19～22.
8. Heyland DK,Drover JW,Dhaliwal R,,et al.Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: role of small bowel feeding.JPEN J Parenter Enteral Nutr,2002,26:S51-S55.
9. 刘培荣,李秀敏,颜廷敏.呼吸机相关性肺炎的非药物性预防措施.齐鲁护理杂志,2006,12 :1094.
10. Adair CG,Gorman SP,Byers LM,et al.Eradication of endotracheal tube biofilm by nebulised gentamicin.Intensive Care Med,2002,28:426-431.
11. Kola A,Eckmanns T,Gastmeier P.Efficacy of heat and moisture exchangers in preventing ventilator-associated pneumonia: meta-analysis of randomized controlled trials.Intensive Care Med,2005,31:5-11.
12. 王辰,商鸣宇,黄克武,等.有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的研究.中华结核和呼吸杂志,2000,23:212-216.
13. Orozco-Levi M,Torres A,Ferrer M,et al.Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients.Am J Respir Crit Care Med,1995,152:1387-1390.
14. Drakulovic MB,Torres A,Bauer TT,et al.Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial.Lancet,1999,354:1851-1858.
15. Cook D,Guyatt G,Marshall J,et al.A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation.Canadian Critical Care Trials Group.N Engl J Med,1998,338:791-797.
16. Bergmans DC,Bonten MJ,Gaillard CA,et al.Prevention of ventilator-associated pneumonia by oral decontamination: a prospective,randomized,double-blind,placebo-controlled study.Am J Respir Crit Care Med,2001,164:382-388.
17. Nichol KL,Nordin J,Mullooly J,et al.Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly.N Engl J Med,2003,348:1322-1332.

Chinese Journal of Respiratory and Critical Care Medicine

Progress of Ventilator Associated Pneumonia

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