管理与呼吸机相关的肺炎:指南
Mark L Metersky1, Andre C Kalil2
1Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030-1321, USA.
Infectious disease clinics of North America
|January 27, 2024
概括
两项主要指导方针对诊断呼吸机相关肺炎 (VAP) 提出了不同的观点,但同意在大多数患者中使用局部耐药性数据和短期抗生素. 对于诊断和治疗持续时间的用法在指导方针之间有所不同.
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) 在重症监护机构中带来了重大挑战.
- 最近的主要指导方针涉及VAP诊断和治疗,强调不断变化的临床建议.
研究的目的:
- 为了比较和对比最近两份关于VAP诊断和治疗的主要指南的建议.
- 在VAP管理策略中确定协议和分歧的关键领域.
主要方法:
- 对VAP的两个突出的临床实践指南进行比较分析.
- 审查有关诊断技术,经验抗生素选择和治疗持续时间的建议.
主要成果:
- 这两份指导方针都强调将经验性抗生素定制为局部耐药性模式和患者特异性风险因素.
- 关于侵入性诊断技术对VAP因果关系的有用性,指导方针存在分歧.
- 两人都主张对大多数VAP病例进行短期抗生素治疗.
结论:
- 虽然在抗生素管理和短期治疗疗程等核心原则上存在共识,但特定的诊断方法和诸如prokalcitonin等生物标志物的作用仍然是指导方针变化的领域.
- 在管理VAP时,临床医生必须仔细考虑指南细微差别和当地流行病学.
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