呼吸器関連肺炎に対する呼吸道管理の影響:ランダム化試験からの証拠
D Cook1, B De Jonghe, L Brochard
1Department of Medicine, St Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada. debcook@fhs.csu.mcmaster.ca
JAMA
|March 21, 1998
まとめ
特定の呼吸道管理戦略は,重症患者の呼吸器関連肺炎 (VAP) の発生率を低下させる可能性があります. 加湿器の使用,挿管部位,分泌排水などの要因は,VAPリスクに影響します.
科学分野:
- クリティカルケア・メディシン
- 肺内科 肺内科 肺内科
- 感染症 感染症は感染症です.
背景:
- 呼吸器関連肺炎 (VAP) は,重症患者の罹病率と死亡率の重要な原因です.
- 多くの介入は,VAPのリスクを軽減することを目的としており,エビデンスに基づいた呼吸道管理の必要性を強調しています.
研究 の 目的:
- VAP率に対するエアウェイ・マネジメント戦略の影響を体系的に検討する.
- 機械呼吸器を使用する患者のVAP発生率を減らすことができる特定の介入を特定する.
主な方法:
- 1980年から1997年7月に発表されたランダム化試験の体系的レビュー.
- 含有基準は,VAP率に影響を与える換気器回路と分泌物管理戦略に焦点を当てました.
- 2人の独立した研究者によるデータ抽象化.
主要な成果:
- 換気器回路の変更や吸い込みシステムのタイプは,VAP率を大幅に変更しませんでした.
- VAP率の低下は,加熱加湿器を避ける,熱と水分交換器を使用する,口腔インチューブ,下分泌液の排水,運動ベッドを使用することと潜在的に関連していました.
結論:
- 特定の呼吸道および分泌管理技術は,重症病院でのVAP率に影響を与える可能性があります.
- これらの戦略の臨床採用は,証拠,コスト,およびアクセシビリティに依存します.
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