Ventilator-associated pneumonia and its prevention

被引:107
作者
Bouadma, Lila [1 ]
Wolff, Michel [1 ,2 ,3 ]
Lucet, Jean-Christophe [2 ,3 ]
机构
[1] Hop Bichat Claude Bernard, Assistance Publ Hop Paris, Serv Reanimat Med & Malad Infect, F-75877 Paris 18, France
[2] Hop Bichat Claude Bernard, Assistance Publ Hop Paris, Unite Hyg & Lutte Infect Nosocomiale, F-75877 Paris 18, France
[3] Univ Paris Diderot, Paris, France
关键词
intensive care unit; mechanical ventilation; prevention; ventilator-associated pneumonia; CRITICALLY-ILL PATIENTS; SUBGLOTTIC SECRETION DRAINAGE; RANDOMIZED CONTROLLED-TRIALS; COATED ENDOTRACHEAL-TUBES; EVIDENCE-BASED GUIDELINES; INTENSIVE-CARE-UNIT; MECHANICAL VENTILATION; SEMIRECUMBENT POSITION; NOSOCOMIAL PNEUMONIA; ATTRIBUTABLE MORTALITY;
D O I
10.1097/QCO.0b013e328355a835
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Purpose of review Given that ventilator-associated pneumonia (VAP) causes substantial morbidity, mortality and costs, prevention of this infectious process is a major challenge. Recent findings This study provides an update on the prevention of VAP, focusing on the ability of preventive measures to improve patient outcomes and concentrating wherever possible on the data published within the past 5 years. Particular attention is being paid to the latest approach to facilitate the implementation of those prevention measures known as 'care bundles'. Summary Several preventive measures have been shown to reduce the rate of VAP but many less have demonstrated an impact on patient outcomes (noninvasive positive pressure ventilation, sedation and weaning protocols, selective digestive and oral decontamination and endotracheal tube with drainage of subglottic secretions). Patients at risk must be approached with a bundle of preventive measures. Beyond the theoretical frame, a great deal of attention must be given to the factors that might improve adherence to those preventive measures. Future clinical trials testing new strategies in preventing VAP should have patient outcomes (i.e. a reduction in the length under mechanical ventilation, in the duration of stay in healthcare settings or in antibiotic consumption) as primary end-points rather than VAP rates.
引用
收藏
页码:395 / 404
页数:10
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