这位患者是否患有呼吸机相关的肺炎?
1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. mklompas@partners.org
JAMA
|April 12, 2007
概括
精确诊断呼吸机相关肺炎 (VAP) 是至关重要的. 一个新的胸部X射线发现结合其他两个症状强烈表明VAP,但确定的诊断需要进一步测试.
科学领域:
- 肺部医学 肺部医学
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
背景情况:
- 呼吸机相关性肺炎 (VAP) 是一种严重的医院感染.
- 及时和准确的VAP诊断对于有效的患者治疗和预防误诊至关重要.
研究的目的:
- 评估细菌VAP的临床,放射和实验室发现的诊断准确性.
- 将诊断方法与组织学黄金标准进行比较.
主要方法:
- 来自MEDLINE和谷歌学者的英语语言研究的系统文献综述.
- 包括14项研究 (655名患者) 的机械呼吸和肺活检/尸检数据.
- 对诊断症状和组合的概率比率 (LRs) 的计算.
主要成果:
- 发烧,异常白细胞计数或性分泌物本身对VAP具有有限的诊断价值.
- 一个新的放射性透物加上另外两个迹象 (发烧,白细胞病,性) 会增加VAP的可能性 (LR, 2.8).
- 缺少新的透物会降低VAP的可能性 (LR,0.35);分泌中的低中性粒细胞使VAP不太可能 (LR,0.05-0.10).
结论:
- 床边评估和X射线图提供了暗示性的,但不是最终的证据,为VAP.
- 临床医生应考虑进行额外的测试以确认VAP或鉴定由于VAP的严重程度和模仿性而导致的替代诊断.
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