- Department of General Intensive Care Unit, The First Affiliated Hospital, Dalian Medical University. Dalian, Liaoning,116011, ChinaCorresponding Author: HUANGWei, E-mail: wanxianyao@ gmail. com;
呼吸機相關性肺炎( VAP) 是指患者接受機械通氣治療48 h 后至停用機械通氣、拔除人工氣道后48 h 內發生的肺實質的感染性炎癥。為接受機械通氣患者最常見的院內感
染。VAP的發生率和病死率由于診斷手段不同, 報道不一。國外報道, VAP 發生率為9% ~70% [ 1] , 病死率高達20% ~71% [ 2, 3] ; 國內醫院調查, VAP發生率為48. 5% , 病死率為37. 5% [ 4] 。患者一旦發生VAP, 易造成撤機困難, 并可導致患者在ICU的停留時間及住院時間延長, 增加相關的醫療費用, 嚴重者可導致患者死亡。因此, VAP的早期預防、早期診斷和治療就顯得非常重要, 本文就近年來VAP 的診治現狀做一概述, 以供同道參考。
Citation: LUO Yunshan,WAN Xianyao. Ventilator-Associated Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(3): 335-340. doi: Copy
Copyright ? the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
| 1. | Bauer TT,Ferrer R,Angrill J,et al. Ventilator-associated pneumonia:incidence,risk factor and microbiology. Semin Respir Infect,2002,15:272-279. |
| 2. | Cook D. Ventilator-associated pneumonia:Perspectiveson the burden of illness. Intensive Care Med,2002,26(Supp1):S31-S37. |
| 3. | Morehead RS,Pinto SJ. Ventilator-associated pneumonia. Arch Intern Med,2000,160:1926-1936. |
| 4. | 楊秀芬,閻錫新. 氣囊上滯留物與呼吸機相關性肺炎的相關性研究. 中國呼吸與危重監護雜志,2005,4:271-274. |
| 5. | Marik PE,Varon J. Ventilator-associared pneumonia:science and hocus-pocus. Chest,2001,120:702-704. |
| 6. | Kollef MH,Fraser VJ. Antibiotic resistance in the intensive care unit. Ann Intern Med,2001,134:298-314. |
| 7. | 萬獻堯. 呼吸機相關性肺炎診治進展. 醫師進修雜志,2003,26(10):3-5. |
| 8. | Torres A,FàbregasN,Ew ig S,et al. Sampling methods for ventilator-associated pneumonia:validation using different histologic and microbiological references. Crit Care Med,2000,28:2799-2804. |
| 9. | 金浩承,何禮賢. 呼吸機相關性肺炎的病原學診斷技術與臨床意義. 中國呼吸與危重監護雜志,2004,3:329-331. |
| 10. | ATS/IDSA. Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcare pneumonia. Am J Respir Crit Care Med,2005,171:388-416. |
| 11. | Lisboa T,Rello J. Diagnosis of ventilator-associated pneumonia:Is there a gold standard and a simple approach?. Curr Opin Infect Dis,2008,21:174-178. |
| 12. | Ramirez P,Garcia MA,Ferrer M,et al. Sequential measurements of procalcitonin in diagnosing ventilator-associated pneumonia. Eur Respir J,2008,31:356-362. |
| 13. | Lisboa T,Seligman R,Diaz E,et al. C-reactive protein correlates with bacterial load and appropriate antibiotic therapy in suspected ventilator-associated pneumonia. Crit Care Med,2008,36:166-171. |
| 14. | Gibot S,Cravoisy A,Levy B,et al. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med,2004,350:451-458. |
| 15. | Nseir S,Ader F,Marquette CH. Nosocomial tracheobronchitis. Curr Opin Infect Dis,2009,22:148-153. |
| 16. | Nseir S. Aerosolized antibiotics for ventilator-associated tracheobronchitis:Let’s go with the flow!. Crit Care Med,2008,36:2191-2192. |
| 17. | Craven DE,Chroneou A,Zias NV,et al. Ventilator-associated tracheobronchitis:the impact of targeted antibiotic therapy on patient outcomes. Chest,2009,135:252-255. |
| 18. | 虞燕波,段美麗,李昂,等. 呼吸機相關性肺炎診療進展. 中國全科醫學,2007,10:72-74. |
| 19. | Marais BJ,Donald PR,Gie RP,et al. Diversity of disease manifesta-tions in childhood pulmonary tuberculosis. Ann Trop Paed,2005,25:79-86. |
| 20. | 印潔,施毅. 降階梯治療在重癥肺部感染治療中的地位. 中國呼吸與危重監護雜志,2008,7:9-12. |
| 21. | 王華靜,張琴,李艷,等. 呼吸機相關性肺炎的病因及防治對策. 中華醫院感染學雜志,2004,14:1232-1233. |
| 22. | Chastre J,Woff M,Fagon J Y,et al. Comparison of 8vs15 days of antibiotic therapy for ventilaror-associated pneumonia in adults. JAMA,2003,290:2588-2598. |
| 23. | Palmer LB,Smaldone GC,Simon SR,et al. Aerosolized antibiotics in mechanically ventilated patients:Delivery and response. Crit Care Med,1998,26:31-39. |
| 24. | Palmer LB,Smaldone GC,Chen JJ,et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med,2008,36:2008-2013. |
| 25. | 中華醫學會重癥醫學分會. 危重患者營養支持指導意見(草案). 中國危重病急救醫學,2006,18:582-590. |
| 26. | 梁志科,劉朝暉. 呼吸機相關性肺炎預防研究進展. 中華醫院感染學雜志,2008,18:148-150. |
| 27. | 黃偉,萬獻堯. 再論膿毒癥的集束化治療策略. 中國呼吸與危重監護雜志,2009,8:106-109. |
| 28. | Dodek P,Keenan S,Cook D,et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med,2004,141:305-313. |
| 29. | Bonten MJ,Weinstein RA. Infection control in intensive care units and prevention of ventilator-associated pneumonia. Semin Respir Infect,2000,15:327-335. |
| 30. | Fields LB. Oral care intervention to reduce incidence of ventilator-associared pneumonia in the neurologic intensive care unit. J Neurosci Nurs,2008,40:291-198. |
| 31. | Collard HR,Raint S,Matthay MA. Prevention of ventilator-associated pneumonia:an evidence-based systematic review. Ann Intern Med,2003,138:494-501. |
| 32. | 中華醫學會重癥醫學分會. 機械通氣臨床應用指南(2006). 中國危重病急救醫學,2007,19:65-72. |
| 33. | Wain JC. Postintubation tracheal stenosis. Chest Surg Clin N Am,2003,13:231-246. |
| 34. | 俞森洋. 有創機械通氣患者人工氣道的選擇:經鼻還是經口插管?是否要做早期氣管切開?. 中國呼吸與危重監護雜志,2009,1:3-5. |
| 35. | Leal-Noval SR,Marquez-Vácaro JA,García-Curiel A,et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med,2000,28:935-940. |
| 36. | Griffiths J,Barber VS,Morgan L,et al. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ,2005,330:1243-1246. |
| 37. | Zack JE,Garrison T,Trovillion E,et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med,2002,30:2407-2412. |
| 38. | Girou E,Schortgen F,Delclaux C,et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA,2000,284:2361-2367. |
| 39. | Carlucci A,Richard JC,Wysocki M,et al. Noninvasive versus conventional mechanical ventilation.An epidemiologic survey. Am J Respir Crit Care Med,2001,163:874-880. |
| 40. | Burns KE,Adhikari NK,Meade MO. A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anaesth,2006,53:305-315. |
| 41. | Nseir S,Favory R,Jozefowicz E,et al. Antimicrobial treatment for ventilator-associated tracheobronchitis:a randomized,controlled,multicenter study. Crit Care,2008,12:R62. |
| 42. | Palmer JB. Ventilator-associated infection. Curr Opin Pulm Med,2009,15:230-235. |
| 43. | Lakubtsevich RE,Spas VV,Dorokhin KM. Clinical course and intensive therapy of sepsis in geriatric patients. Klin Med(Mosk),2003,81:28-32. |
| 44. | De La Cal MA,Cerdá E,García-Hierro P,et al. Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract:a randomized,placebo-controlled,double-blind trial. Ann Surg,2005,241:424-430. |
| 45. | De Smet AM,Kluytmans JA,Cooper BS,et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med,2009,360:20-31. |
- 1. Bauer TT,Ferrer R,Angrill J,et al. Ventilator-associated pneumonia:incidence,risk factor and microbiology. Semin Respir Infect,2002,15:272-279.
- 2. Cook D. Ventilator-associated pneumonia:Perspectiveson the burden of illness. Intensive Care Med,2002,26(Supp1):S31-S37.
- 3. Morehead RS,Pinto SJ. Ventilator-associated pneumonia. Arch Intern Med,2000,160:1926-1936.
- 4. 楊秀芬,閻錫新. 氣囊上滯留物與呼吸機相關性肺炎的相關性研究. 中國呼吸與危重監護雜志,2005,4:271-274.
- 5. Marik PE,Varon J. Ventilator-associared pneumonia:science and hocus-pocus. Chest,2001,120:702-704.
- 6. Kollef MH,Fraser VJ. Antibiotic resistance in the intensive care unit. Ann Intern Med,2001,134:298-314.
- 7. 萬獻堯. 呼吸機相關性肺炎診治進展. 醫師進修雜志,2003,26(10):3-5.
- 8. Torres A,FàbregasN,Ew ig S,et al. Sampling methods for ventilator-associated pneumonia:validation using different histologic and microbiological references. Crit Care Med,2000,28:2799-2804.
- 9. 金浩承,何禮賢. 呼吸機相關性肺炎的病原學診斷技術與臨床意義. 中國呼吸與危重監護雜志,2004,3:329-331.
- 10. ATS/IDSA. Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcare pneumonia. Am J Respir Crit Care Med,2005,171:388-416.
- 11. Lisboa T,Rello J. Diagnosis of ventilator-associated pneumonia:Is there a gold standard and a simple approach?. Curr Opin Infect Dis,2008,21:174-178.
- 12. Ramirez P,Garcia MA,Ferrer M,et al. Sequential measurements of procalcitonin in diagnosing ventilator-associated pneumonia. Eur Respir J,2008,31:356-362.
- 13. Lisboa T,Seligman R,Diaz E,et al. C-reactive protein correlates with bacterial load and appropriate antibiotic therapy in suspected ventilator-associated pneumonia. Crit Care Med,2008,36:166-171.
- 14. Gibot S,Cravoisy A,Levy B,et al. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med,2004,350:451-458.
- 15. Nseir S,Ader F,Marquette CH. Nosocomial tracheobronchitis. Curr Opin Infect Dis,2009,22:148-153.
- 16. Nseir S. Aerosolized antibiotics for ventilator-associated tracheobronchitis:Let’s go with the flow!. Crit Care Med,2008,36:2191-2192.
- 17. Craven DE,Chroneou A,Zias NV,et al. Ventilator-associated tracheobronchitis:the impact of targeted antibiotic therapy on patient outcomes. Chest,2009,135:252-255.
- 18. 虞燕波,段美麗,李昂,等. 呼吸機相關性肺炎診療進展. 中國全科醫學,2007,10:72-74.
- 19. Marais BJ,Donald PR,Gie RP,et al. Diversity of disease manifesta-tions in childhood pulmonary tuberculosis. Ann Trop Paed,2005,25:79-86.
- 20. 印潔,施毅. 降階梯治療在重癥肺部感染治療中的地位. 中國呼吸與危重監護雜志,2008,7:9-12.
- 21. 王華靜,張琴,李艷,等. 呼吸機相關性肺炎的病因及防治對策. 中華醫院感染學雜志,2004,14:1232-1233.
- 22. Chastre J,Woff M,Fagon J Y,et al. Comparison of 8vs15 days of antibiotic therapy for ventilaror-associated pneumonia in adults. JAMA,2003,290:2588-2598.
- 23. Palmer LB,Smaldone GC,Simon SR,et al. Aerosolized antibiotics in mechanically ventilated patients:Delivery and response. Crit Care Med,1998,26:31-39.
- 24. Palmer LB,Smaldone GC,Chen JJ,et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med,2008,36:2008-2013.
- 25. 中華醫學會重癥醫學分會. 危重患者營養支持指導意見(草案). 中國危重病急救醫學,2006,18:582-590.
- 26. 梁志科,劉朝暉. 呼吸機相關性肺炎預防研究進展. 中華醫院感染學雜志,2008,18:148-150.
- 27. 黃偉,萬獻堯. 再論膿毒癥的集束化治療策略. 中國呼吸與危重監護雜志,2009,8:106-109.
- 28. Dodek P,Keenan S,Cook D,et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med,2004,141:305-313.
- 29. Bonten MJ,Weinstein RA. Infection control in intensive care units and prevention of ventilator-associated pneumonia. Semin Respir Infect,2000,15:327-335.
- 30. Fields LB. Oral care intervention to reduce incidence of ventilator-associared pneumonia in the neurologic intensive care unit. J Neurosci Nurs,2008,40:291-198.
- 31. Collard HR,Raint S,Matthay MA. Prevention of ventilator-associated pneumonia:an evidence-based systematic review. Ann Intern Med,2003,138:494-501.
- 32. 中華醫學會重癥醫學分會. 機械通氣臨床應用指南(2006). 中國危重病急救醫學,2007,19:65-72.
- 33. Wain JC. Postintubation tracheal stenosis. Chest Surg Clin N Am,2003,13:231-246.
- 34. 俞森洋. 有創機械通氣患者人工氣道的選擇:經鼻還是經口插管?是否要做早期氣管切開?. 中國呼吸與危重監護雜志,2009,1:3-5.
- 35. Leal-Noval SR,Marquez-Vácaro JA,García-Curiel A,et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med,2000,28:935-940.
- 36. Griffiths J,Barber VS,Morgan L,et al. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ,2005,330:1243-1246.
- 37. Zack JE,Garrison T,Trovillion E,et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med,2002,30:2407-2412.
- 38. Girou E,Schortgen F,Delclaux C,et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA,2000,284:2361-2367.
- 39. Carlucci A,Richard JC,Wysocki M,et al. Noninvasive versus conventional mechanical ventilation.An epidemiologic survey. Am J Respir Crit Care Med,2001,163:874-880.
- 40. Burns KE,Adhikari NK,Meade MO. A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anaesth,2006,53:305-315.
- 41. Nseir S,Favory R,Jozefowicz E,et al. Antimicrobial treatment for ventilator-associated tracheobronchitis:a randomized,controlled,multicenter study. Crit Care,2008,12:R62.
- 42. Palmer JB. Ventilator-associated infection. Curr Opin Pulm Med,2009,15:230-235.
- 43. Lakubtsevich RE,Spas VV,Dorokhin KM. Clinical course and intensive therapy of sepsis in geriatric patients. Klin Med(Mosk),2003,81:28-32.
- 44. De La Cal MA,Cerdá E,García-Hierro P,et al. Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract:a randomized,placebo-controlled,double-blind trial. Ann Surg,2005,241:424-430.
- 45. De Smet AM,Kluytmans JA,Cooper BS,et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med,2009,360:20-31.

