在患有通风相关肺炎的重症患者中使用多素B与不同的施用方法:单中心经验
Rupeng Shi1, Yuanyuan Fu2, Yujing Gan1
1Department of Geriatric ICU, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Frontiers in pharmacology
|September 18, 2023
概括
雾化聚米辛B是一种可行的静脉注射替代品,用于呼吸机相关的肺炎,由广泛耐药的格拉姆阴性细菌引起,显示出类似的疗效,潜在的毒性较小.
科学领域:
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
背景情况:
- 由广泛耐药的格拉姆阴性细菌 (XDR-GNB) 引起的呼吸机相关肺炎 (VAP) 是一个重大的治疗挑战.
- 对于VAP中polymyxin B的最佳注射策略,无论是静脉注射 (IV),吸入 (IH) 或联合 (IV + IH),仍在争论中.
- 评估不同聚胺B药物注射途径的疗效和安全性,对于优化VAP治疗至关重要.
研究的目的:
- 为了比较静脉注射,吸入和综合静脉-吸入聚米辛B的疗效和安全性,用于治疗由XDR-GNB引起的VAP.
- 评估不同聚米辛B组的临床和微生物学结果,以及不良事件.
主要方法:
- 追溯队列研究包括111名VAP患者,XDR-GNB患者接受了polymyxin B.治疗.
- 患者被分为静脉注射 (IV),吸入 (IH) 和静脉注射加吸入 (IV + IH) 组.
- 分析的结果包括临床治愈/改善,微生物根除,细菌清除时间,28天死亡率和急性损伤.
主要成果:
- 临床治愈或改善率在所有组 (50-57.1%) 中都是可比的.
- 在所有组中都观察到高的微生物根除率;与IV相比,吸入的多素B显示细菌清除时间明显更快.
- 与静脉注射组相比,吸入组的急性损伤风险较低 (p=0.025).
结论:
- 作为静脉注射的替代品的 nebulized polymyxin B 是治疗 XDR-GNB.引起的 VAP 的一个可行的策略.
- 吸入的聚米辛B的疗效与静脉注射相比,具有潜在的全身毒性降低.
- 需要进一步的前性研究来证实这些发现,并确定吸入的多素B作为标准治疗选择.
相关概念视频
Pneumonia IV: Management
357
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
357
Pneumonia V: Nursing management and Prevention
2.2K
Nursing management of pneumonia involves promoting airway patency, facilitating rest and conserving energy, encouraging fluid intake, maintaining nutrition, and educating patients.
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
2.2K
Mechanical Ventilation III: Noninvasive Ventilation
149
Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation...
Noninvasive Positive-Pressure Ventilation...
149
Acute Respiratory Failure-V
159
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
159
Pneumonia III: Complications and Assessment
258
Pneumonia poses the potential for numerous complications that warrant consideration. These complications include the following:
258
Acute Pyelonephritis II: Diagnostic Studies and Management
15
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
15


