この患者さんは,呼吸器関連肺炎を患っていますか?
1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. mklompas@partners.org
JAMA
|April 12, 2007
まとめ
呼吸器関連肺炎 (VAP) の正確な診断は極めて重要です. 2つの他の症状と組み合わせた新しい胸部X線発見は,VAPを強く示唆していますが,決定的な診断にはさらなる検査が必要です.
科学分野:
- 肺内医学は肺内医学である.
- 感染症 感染症は感染症です.
- クリティカルケア・メディシン
背景:
- 呼吸器関連肺炎 (VAP) は,病院で発症する重大な感染症です.
- VAPのタイムリーで正確な診断は,効果的な患者の治療と誤診の予防に不可欠です.
研究 の 目的:
- バクテリア性VAPの臨床,放射線,検査結果の診断精度を評価する.
- ヒストロジカル・ゴールドスタンダードと診断方法を比較する.
主な方法:
- MEDLINEとGoogle Scholarからの英語研究の体系的な文献レビュー.
- 14件の研究 (655人の患者) を含め,機械呼吸器と肺生検/検死データを含む.
- 診断記号と組み合わせの確率比 (LRs) の計算.
主要な成果:
- 発熱,異常な白血球数,またはの分泌物だけでは,VAPの診断価値は限られている.
- 新しい放射性浸透物と他の2つの徴候 (発熱,白血球症,性唾液) は,VAPの可能性を高めます (LR, 2.8).
- 新しい浸透物がないとVAPの可能性が低下する (LR,0.35);低中性粒子の分泌はVAPの可能性を低下させる (LR,0.05-0.10).
結論:
- ベッドサイドの評価とX線撮影は,VAPの示唆的ですが,決定的な証拠ではありません.
- 臨床医は,VAPの重症度および模倣性により,VAPの確認または代替診断を特定するために追加の検査を検討する必要があります.
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