- Department of General Intensive Care Unit, The First Affiliated Hospital, Dalian Medical University. Dalian, Liaoning,116011, ChinaCorresponding Author: HUANGWei, E-mail: wanxianyao@ gmail. com;
呼吸机相关性肺炎( VAP) 是指患者接受机械通气治疗48 h 后至停用机械通气、拔除人工气道后48 h 内发生的肺实质的感染性炎症。为接受机械通气患者最常见的院内感
染。VAP的发生率和病死率由于诊断手段不同, 报道不一。国外报道, VAP 发生率为9% ～70% [ 1] , 病死率高达20% ～71% [ 2, 3] ; 国内医院调查, VAP发生率为48. 5% , 病死率为37. 5% [ 4] 。患者一旦发生VAP, 易造成撤机困难, 并可导致患者在ICU的停留时间及住院时间延长, 增加相关的医疗费用, 严重者可导致患者死亡。因此, VAP的早期预防、早期诊断和治疗就显得非常重要, 本文就近年来VAP 的诊治现状做一概述, 以供同道参考。
Citation： LUO Yunshan,WAN Xianyao. Ventilator-Associated Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(3): 335-340. doi: Copy
Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
| 1. | Bauer TT，Ferrer R，Angrill J，et al. Ventilator-associated pneumonia：incidence，risk factor and microbiology. Semin Respir Infect，2002，15：272-279. |
| 2. | Cook D. Ventilator-associated pneumonia：Perspectiveson the burden of illness. Intensive Care Med，2002，26(Supp1)：S31-S37. |
| 3. | Morehead RS，Pinto SJ. Ventilator-associated pneumonia. Arch Intern Med，2000，160：1926-1936. |
| 4. | 杨秀芬，阎锡新. 气囊上滞留物与呼吸机相关性肺炎的相关性研究. 中国呼吸与危重监护杂志，2005，4：271-274. |
| 5. | Marik PE，Varon J. Ventilator-associared pneumonia：science and hocus-pocus. Chest，2001，120：702-704. |
| 6. | Kollef MH，Fraser VJ. Antibiotic resistance in the intensive care unit. Ann Intern Med，2001，134：298-314. |
| 7. | 万献尧. 呼吸机相关性肺炎诊治进展. 医师进修杂志，2003，26（10）：3-5. |
| 8. | Torres A，FàbregasN，Ew ig S，et al. Sampling methods for ventilator-associated pneumonia：validation using different histologic and microbiological references. Crit Care Med，2000，28：2799-2804. |
| 9. | 金浩承，何礼贤. 呼吸机相关性肺炎的病原学诊断技术与临床意义. 中国呼吸与危重监护杂志，2004，3：329-331. |
| 10. | ATS/IDSA. Guidelines for the management of adults with hospital-acquired，ventilator-associated，and healthcare pneumonia. Am J Respir Crit Care Med，2005，171：388-416. |
| 11. | Lisboa T，Rello J. Diagnosis of ventilator-associated pneumonia：Is there a gold standard and a simple approach?. Curr Opin Infect Dis，2008，21：174-178. |
| 12. | Ramirez P，Garcia MA，Ferrer M，et al. Sequential measurements of procalcitonin in diagnosing ventilator-associated pneumonia. Eur Respir J，2008，31：356-362. |
| 13. | Lisboa T，Seligman R，Diaz E，et al. C-reactive protein correlates with bacterial load and appropriate antibiotic therapy in suspected ventilator-associated pneumonia. Crit Care Med，2008，36：166-171. |
| 14. | Gibot S，Cravoisy A，Levy B，et al. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med，2004，350：451-458. |
| 15. | Nseir S，Ader F，Marquette CH. Nosocomial tracheobronchitis. Curr Opin Infect Dis，2009，22：148-153. |
| 16. | Nseir S. Aerosolized antibiotics for ventilator-associated tracheobronchitis：Let’s go with the flow!. Crit Care Med，2008，36：2191-2192. |
| 17. | Craven DE，Chroneou A，Zias NV，et al. Ventilator-associated tracheobronchitis：the impact of targeted antibiotic therapy on patient outcomes. Chest，2009，135：252-255. |
| 18. | 虞燕波，段美丽，李昂，等. 呼吸机相关性肺炎诊疗进展. 中国全科医学，2007，10：72-74. |
| 19. | Marais BJ，Donald PR，Gie RP，et al. Diversity of disease manifesta-tions in childhood pulmonary tuberculosis. Ann Trop Paed，2005，25：79-86. |
| 20. | 印洁，施毅. 降阶梯治疗在重症肺部感染治疗中的地位. 中国呼吸与危重监护杂志，2008，7：9-12. |
| 21. | 王华静，张琴，李艳，等. 呼吸机相关性肺炎的病因及防治对策. 中华医院感染学杂志，2004，14：1232-1233. |
| 22. | Chastre J，Woff M，Fagon J Y，et al. Comparison of 8vs15 days of antibiotic therapy for ventilaror-associated pneumonia in adults. JAMA，2003，290：2588-2598. |
| 23. | Palmer LB，Smaldone GC，Simon SR，et al. Aerosolized antibiotics in mechanically ventilated patients：Delivery and response. Crit Care Med，1998，26：31-39. |
| 24. | Palmer LB，Smaldone GC，Chen JJ，et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med，2008，36：2008-2013. |
| 25. | 中华医学会重症医学分会. 危重患者营养支持指导意见（草案）. 中国危重病急救医学，2006，18：582-590. |
| 26. | 梁志科，刘朝晖. 呼吸机相关性肺炎预防研究进展. 中华医院感染学杂志，2008，18：148-150. |
| 27. | 黄伟，万献尧. 再论脓毒症的集束化治疗策略. 中国呼吸与危重监护杂志，2009，8：106-109. |
| 28. | Dodek P，Keenan S，Cook D，et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med，2004，141：305-313. |
| 29. | Bonten MJ，Weinstein RA. Infection control in intensive care units and prevention of ventilator-associated pneumonia. Semin Respir Infect，2000，15：327-335. |
| 30. | Fields LB. Oral care intervention to reduce incidence of ventilator-associared pneumonia in the neurologic intensive care unit. J Neurosci Nurs，2008，40：291-198. |
| 31. | Collard HR，Raint S，Matthay MA. Prevention of ventilator-associated pneumonia：an evidence-based systematic review. Ann Intern Med，2003，138：494-501. |
| 32. | 中华医学会重症医学分会. 机械通气临床应用指南（2006）. 中国危重病急救医学，2007，19：65-72. |
| 33. | Wain JC. Postintubation tracheal stenosis. Chest Surg Clin N Am，2003，13：231-246. |
| 34. | 俞森洋. 有创机械通气患者人工气道的选择：经鼻还是经口插管？是否要做早期气管切开？. 中国呼吸与危重监护杂志，2009，1：3-5. |
| 35. | Leal-Noval SR，Marquez-Vácaro JA，García-Curiel A，et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med，2000，28：935-940. |
| 36. | Griffiths J，Barber VS，Morgan L，et al. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ，2005，330：1243-1246. |
| 37. | Zack JE，Garrison T，Trovillion E，et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med，2002，30：2407-2412. |
| 38. | Girou E，Schortgen F，Delclaux C，et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA，2000，284：2361-2367. |
| 39. | Carlucci A，Richard JC，Wysocki M，et al. Noninvasive versus conventional mechanical ventilation.An epidemiologic survey. Am J Respir Crit Care Med，2001，163：874-880. |
| 40. | Burns KE，Adhikari NK，Meade MO. A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anaesth，2006，53：305-315. |
| 41. | Nseir S，Favory R，Jozefowicz E，et al. Antimicrobial treatment for ventilator-associated tracheobronchitis：a randomized，controlled，multicenter study. Crit Care，2008，12：R62. |
| 42. | Palmer JB. Ventilator-associated infection. Curr Opin Pulm Med，2009，15：230-235. |
| 43. | Lakubtsevich RE，Spas VV，Dorokhin KM. Clinical course and intensive therapy of sepsis in geriatric patients. Klin Med(Mosk)，2003，81：28-32. |
| 44. | De La Cal MA，Cerdá E，García-Hierro P，et al. Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract：a randomized，placebo-controlled，double-blind trial. Ann Surg，2005，241：424-430. |
| 45. | De Smet AM，Kluytmans JA，Cooper BS，et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med，2009，360：20-31. |
- 1. Bauer TT，Ferrer R，Angrill J，et al. Ventilator-associated pneumonia：incidence，risk factor and microbiology. Semin Respir Infect，2002，15：272-279.
- 2. Cook D. Ventilator-associated pneumonia：Perspectiveson the burden of illness. Intensive Care Med，2002，26(Supp1)：S31-S37.
- 3. Morehead RS，Pinto SJ. Ventilator-associated pneumonia. Arch Intern Med，2000，160：1926-1936.
- 4. 杨秀芬，阎锡新. 气囊上滞留物与呼吸机相关性肺炎的相关性研究. 中国呼吸与危重监护杂志，2005，4：271-274.
- 5. Marik PE，Varon J. Ventilator-associared pneumonia：science and hocus-pocus. Chest，2001，120：702-704.
- 6. Kollef MH，Fraser VJ. Antibiotic resistance in the intensive care unit. Ann Intern Med，2001，134：298-314.
- 7. 万献尧. 呼吸机相关性肺炎诊治进展. 医师进修杂志，2003，26（10）：3-5.
- 8. Torres A，FàbregasN，Ew ig S，et al. Sampling methods for ventilator-associated pneumonia：validation using different histologic and microbiological references. Crit Care Med，2000，28：2799-2804.
- 9. 金浩承，何礼贤. 呼吸机相关性肺炎的病原学诊断技术与临床意义. 中国呼吸与危重监护杂志，2004，3：329-331.
- 10. ATS/IDSA. Guidelines for the management of adults with hospital-acquired，ventilator-associated，and healthcare pneumonia. Am J Respir Crit Care Med，2005，171：388-416.
- 11. Lisboa T，Rello J. Diagnosis of ventilator-associated pneumonia：Is there a gold standard and a simple approach?. Curr Opin Infect Dis，2008，21：174-178.
- 12. Ramirez P，Garcia MA，Ferrer M，et al. Sequential measurements of procalcitonin in diagnosing ventilator-associated pneumonia. Eur Respir J，2008，31：356-362.
- 13. Lisboa T，Seligman R，Diaz E，et al. C-reactive protein correlates with bacterial load and appropriate antibiotic therapy in suspected ventilator-associated pneumonia. Crit Care Med，2008，36：166-171.
- 14. Gibot S，Cravoisy A，Levy B，et al. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med，2004，350：451-458.
- 15. Nseir S，Ader F，Marquette CH. Nosocomial tracheobronchitis. Curr Opin Infect Dis，2009，22：148-153.
- 16. Nseir S. Aerosolized antibiotics for ventilator-associated tracheobronchitis：Let’s go with the flow!. Crit Care Med，2008，36：2191-2192.
- 17. Craven DE，Chroneou A，Zias NV，et al. Ventilator-associated tracheobronchitis：the impact of targeted antibiotic therapy on patient outcomes. Chest，2009，135：252-255.
- 18. 虞燕波，段美丽，李昂，等. 呼吸机相关性肺炎诊疗进展. 中国全科医学，2007，10：72-74.
- 19. Marais BJ，Donald PR，Gie RP，et al. Diversity of disease manifesta-tions in childhood pulmonary tuberculosis. Ann Trop Paed，2005，25：79-86.
- 20. 印洁，施毅. 降阶梯治疗在重症肺部感染治疗中的地位. 中国呼吸与危重监护杂志，2008，7：9-12.
- 21. 王华静，张琴，李艳，等. 呼吸机相关性肺炎的病因及防治对策. 中华医院感染学杂志，2004，14：1232-1233.
- 22. Chastre J，Woff M，Fagon J Y，et al. Comparison of 8vs15 days of antibiotic therapy for ventilaror-associated pneumonia in adults. JAMA，2003，290：2588-2598.
- 23. Palmer LB，Smaldone GC，Simon SR，et al. Aerosolized antibiotics in mechanically ventilated patients：Delivery and response. Crit Care Med，1998，26：31-39.
- 24. Palmer LB，Smaldone GC，Chen JJ，et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med，2008，36：2008-2013.
- 25. 中华医学会重症医学分会. 危重患者营养支持指导意见（草案）. 中国危重病急救医学，2006，18：582-590.
- 26. 梁志科，刘朝晖. 呼吸机相关性肺炎预防研究进展. 中华医院感染学杂志，2008，18：148-150.
- 27. 黄伟，万献尧. 再论脓毒症的集束化治疗策略. 中国呼吸与危重监护杂志，2009，8：106-109.
- 28. Dodek P，Keenan S，Cook D，et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med，2004，141：305-313.
- 29. Bonten MJ，Weinstein RA. Infection control in intensive care units and prevention of ventilator-associated pneumonia. Semin Respir Infect，2000，15：327-335.
- 30. Fields LB. Oral care intervention to reduce incidence of ventilator-associared pneumonia in the neurologic intensive care unit. J Neurosci Nurs，2008，40：291-198.
- 31. Collard HR，Raint S，Matthay MA. Prevention of ventilator-associated pneumonia：an evidence-based systematic review. Ann Intern Med，2003，138：494-501.
- 32. 中华医学会重症医学分会. 机械通气临床应用指南（2006）. 中国危重病急救医学，2007，19：65-72.
- 33. Wain JC. Postintubation tracheal stenosis. Chest Surg Clin N Am，2003，13：231-246.
- 34. 俞森洋. 有创机械通气患者人工气道的选择：经鼻还是经口插管？是否要做早期气管切开？. 中国呼吸与危重监护杂志，2009，1：3-5.
- 35. Leal-Noval SR，Marquez-Vácaro JA，García-Curiel A，et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med，2000，28：935-940.
- 36. Griffiths J，Barber VS，Morgan L，et al. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ，2005，330：1243-1246.
- 37. Zack JE，Garrison T，Trovillion E，et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med，2002，30：2407-2412.
- 38. Girou E，Schortgen F，Delclaux C，et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA，2000，284：2361-2367.
- 39. Carlucci A，Richard JC，Wysocki M，et al. Noninvasive versus conventional mechanical ventilation.An epidemiologic survey. Am J Respir Crit Care Med，2001，163：874-880.
- 40. Burns KE，Adhikari NK，Meade MO. A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anaesth，2006，53：305-315.
- 41. Nseir S，Favory R，Jozefowicz E，et al. Antimicrobial treatment for ventilator-associated tracheobronchitis：a randomized，controlled，multicenter study. Crit Care，2008，12：R62.
- 42. Palmer JB. Ventilator-associated infection. Curr Opin Pulm Med，2009，15：230-235.
- 43. Lakubtsevich RE，Spas VV，Dorokhin KM. Clinical course and intensive therapy of sepsis in geriatric patients. Klin Med(Mosk)，2003，81：28-32.
- 44. De La Cal MA，Cerdá E，García-Hierro P，et al. Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract：a randomized，placebo-controlled，double-blind trial. Ann Surg，2005，241：424-430.
- 45. De Smet AM，Kluytmans JA，Cooper BS，et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med，2009，360：20-31.