吸入的阿米卡可以预防与呼吸机相关的肺炎
Stephan Ehrmann1, François Barbier1, Julien Demiselle1
1From Centre Hospitalier Régional Universitaire (CHRU) de Tours, Médecine Intensive Réanimation, INSERM Centre d'Investigation Clinique (CIC) 1415, Clinical Research in Intensive Care and Sepsis-Trial Group for Global Evaluation and Research in Sepsis (CRICS_TRIGGERSep) French Clinical Research Infrastructure Network (F-CRIN) Research Network (S.E., E.M., D.G., C.S.G.), INSERM, Research Center for Respiratory Diseases (S.E., F.B., N.H.-V., R.R.), the University of Tours (S.E., N.H.-V., R.R.), CHRU de Tours, Réanimation Chirurgicale (M.F.), CHRU de Tours, Pharmacie (R.R.), and CHRU de Tours, INSERM CIC 1415 and Université de Tours et Nantes, Methods in Patient-Centered Outcomes and Health Research, INSERM 1246 (E.T.), Tours, Centre Hospitalier et Universitaire (CHU) d'Orléans, Médecine Intensive Réanimation, Orléans (F.B., M.-A.N., D.B.), Médecine Intensive-Réanimation, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil and INSERM, Unité Mixte de Recherche (UMR) 1260, Regenerative Nanomedicine, Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (J.D., F.M., H.M.), and Hôpitaux Universitaires de Strasbourg, Hôpital Hautepierre, Médecine Intensive Réanimation (J.-E.H., R.C.-J.), Strasbourg, the Department of Intensive Care, Burgundy University Hospital and Lipness Team, INSERM Research Center Lipids, Nutrition, Cancer (LNC)-UMR1231 and LabEx LipSTIC, University of Burgundy, and INSERM CIC 1432, Clinical Epidemiology, University of Burgundy (J.-P.Q.), and the Department of Intensive Care, Burgundy University Hospital (P.A.), Dijon, Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Louis Mourier, Départements Médico-Universitaires Enseignements et Soins de Proximité, Recherche, Innovation et Territoires (DMU ESPRIT), Service de Médecine Intensive Réanimation, Colombes (D.R., N.Z.), INSERM/French National Center for Scientific Research, Institut Necker Enfants Malades, Université Paris Cité (D.R.), and Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University (Q.L.), Paris, Centre Hospitalier Départemental Vendée, Médecine Intensive Réanimation, La Roche sur Yon (J.-C.L., M.-A.A.), Centre Hospitalier (CH) du Mans, Médecine Intensive Réanimation, Le Mans (M.L., M.S.-M.), CHU de Rennes, Réanimation Chirurgicale, Rennes (P.S.), CH Angoulême, Médecine Intensive Réanimation, Angoulême (D.S.), CHU de Poitiers, Médecine Intensive Réanimation (A.V.), Université de Poitiers, INSERM, Pharmacologie des Anti-Infectieux et Antibiorésistance (PHAR2), Unité 1070 and CHU de Poitiers, Anesthésie-Réanimation-Médecine Péri-Opératoire, F-86000 (C.D.-F.), Université de Poitiers, PHAR2 INSERM U1070 (N.G.), and CHU de Poitiers, Service de Toxicologie et Pharmacologie (N.G.). Poitiers, CHU de Rouen, Réanimation Chirurgicale (P.G.), University Rouen Normandie, Normandie University, Groupe de Recherche sur le Handicap Ventilatoire et Neurologique, Unité de recherche 3830 and Intensive Care Medicine, Rouen University Hospital (G.B.), Rouen, CHU Angers, Réanimation Chirurgicale, Angers (S.L.), CH d'Argenteuil, Réanimation Polyvalente, Argenteuil (G.P.), and Réanimation Médicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon (N.C.) - all in France; and the Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Q.L.).
吸入阿米卡显著减少了严重病情的成年人呼吸器相关的肺炎. 这种为期3天的治疗为预防机械通风患者这种严重感染提供了有希望的策略.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
背景情况:
- 呼吸机相关肺炎 (VAP) 是需要机械呼吸的危急病患者的一个重大问题.
- 预防性吸入抗生素在减少VAP发病率方面的有效性仍然不确定.
研究的目的:
- 评估吸入的阿米卡辛是否可以降低机械通风的成年人呼吸器相关肺炎的发病率.
- 在这个患者群体中评估吸入性阿米卡辛的安全性.
主要方法:
- 进行了一项多中心,双盲,随机,受控的优越性试验.
- 至少72小时接受机械通风治疗的重病成年人每天接受吸入的阿米卡辛 (20mg/kg理想体重) 或安慰剂,持续3天.
- 主要结局是28天内第一个VAP发作.
主要成果:
- 在阿米卡辛组15%的患者中出现了VAP,而在安慰剂组的患者中是22% (P=0.004).
- 与感染相关的呼吸器相关的并发症在阿米卡辛组也减少了 (18%对26%).
- 严重的不良反应很少发生,并且在不同组之间可比.
结论:
- 吸入性阿米卡辛3天疗程有效降低了机械通风患者呼吸器相关肺炎的发生率.
- 吸入的阿米卡是一种安全有效的预防策略,用于VAP在这个高风险群体.
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