呼吸机相关肺炎-英文版-课件

天津市第一中心医院 Diagnosis,Management and Prevention of Ventilator-Associated Pneumonia：An Update Diagnosis,Management Aetiology Aetiology Ventilator-associated pneumoniaVentilator-associated pneumonia ORORIntubation-associated pneumoniaIntubation-associated pneumonia?Ventilator-associated pneumonileading microorganisms in VAP:Gram-negative enteric bacilli Staphylococcus aureus（almost 50%were MRSA）Pseudomonas aeruginosa early-onset and late-onset VAPearly-onset and late-onset VAP leading microorganisms in VAP DiagnosisNoninvasive Diagnostic Strategies Invasive Diagnostic Strategies DiagnosisNoninvasive DiagnostNoninvasive Diagnostic Strategies new or changing pulmonary infiltrates on chest radiograph,fever,leukocytosis,raised inflammatory markers,such as C-reactive protein(CRP),and purulent tracheal secretions.none is specific for VAP!Noninvasive Diagnostic StrategCultures of endotracheal secretions Qualitative and Quantitative cultures serum biomarkers:CRP,PCT,sTREM-1Cultures of endotracheal secreInvasive Diagnostic Strategies bronchoalveolar lavage(BAL)plugged telescoping catheter(PTC)protected specimen brush(PSB)Blinded bronchial sampling obtaining quantitative cultures of pulmonary secretions high sensitivity and specificity Invasive Diagnostic Strategiesa culture threshold:distinguish infection from colonization quantitative culture threshold 105cfu/ml,104cfu/ml resulted in a false-positive rate of 42%accurate diagnosis,no differences in mortality rates a culture threshold:distingumanagementmanagementAntimicrobial Therapy the most likely causative organism be started as early as possible based on individual patient factors Antimicrobial Therapy the most Empirical Antimicrobial Therapy Single-Agent or Combination Therapy Duration of Therapy Nonresponse to Treatment Other Treatments Empirical Antimicrobial TheraPreventative Strategies Patient Position Heat and Humidification Suctioning of Secretions Selective Digestive Decontamination and Oral Decontamination Preventative Strategies PatienPreventive Bundles In patients admitted to the trauma ICU,a bundle of preventive strategies for VAP(daily evaluation for a spontaneous breathing trial,appropriate sedation level using the Richmond Agitation-Sedation Scale,head-of-bed elevation,and oral and hypopharyngeal hygiene)Preventive Bundles In patienFASTHUG concept(daily evaluation of patients feeding,analgesia,sedation,thromboembolic prophylaxis,elevation of the head of the bed,ulcer prophylaxis,and glucose control)FASTHUG concept ConclusionsConclusions