Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients

Background

Ventilator-associated pneumonia (VAP) is an important complication of mechanical ventilation and is particularly common in trauma, burn, and surgical patients. Interventions that kill bacteria in the oropharynx reduce the pool of viable organisms available for translocation to the lung and thereby lessen the likelihood of developing VAP. Repeated administration of chlorhexidine (CHX) to the mouth and oropharynx has been shown to reduce the incidence of VAP, but use of a single dose has not been studied. This randomized, controlled clinical trial tested an early (within 12 hours of intubation) application of CHX by swab versus control (no swab) on oral microbial flora and VAP.

Methods

A total of 145 trauma patients requiring endotracheal intubation were randomly assigned to the intervention (5 mL CHX) or control group. VAP (Clinical Pulmonary Infection Score [CPIS] ≥ 6) was evaluated on study admission and at 48 and 72 hours after intubation.

Results

A total of 145 patients were enrolled; 71 and 74 patients were randomized to intervention and control groups, respectively. Seventy percent of the patients were male, and 60% were white; their mean age was 42.4 years (±18.2). A significant treatment effect was found on CPIS both from admission to 48 hours (P = .020) and to 72 hours (P = .027). In those subjects without pneumonia at baseline (CPIS < 6), 55.6% of the control patients (10/18) had developed VAP by 48 or 72 hours versus only 33.3% of the intervention patients (7/21).

Conclusion

an early, single application of CHX to the oral cavity significantly reduces CPIS and thus VAP in trauma patients.     

呼吸机相关性肺炎的病原学调查

目的通过分析重症监护病房呼吸机相关性肺炎的病原学特点,对临床治疗提供依据。方法分析我院2003年9月~2004年8月重症监护病房收治的53例VAP患者的91株致病菌及其药物敏感情况。结果G-菌65例,占71.43%,以鲍曼不动杆菌,铜绿假单孢菌,阴沟肠杆菌为主,各占21.98%,17.58%,15.38%;G 菌22例,占24.18%,其中金黄色葡萄球菌占12.09%;真菌4例,占4.40%。多数细菌对抗生素耐药率较高。结论呼吸机相关性肺炎病原菌以G-菌为主且耐药率高,合理使用抗生素有助于预防和治疗VAP。     

Aerosolized antibiotics in the intensive care unit

This review summarizes recent clinical data examining the use of aerosolized antimicrobial therapy for the treatment of respiratory tract infections in mechanically ventilated patients in the intensive care unit. Aerosolized antibiotics provide high concentrations of drug in the lung without the systemic toxicity associated with the intravenous antibiotics. First introduced in the 1960s as a treatment of tracheobronchitis and bronchopneumonia caused by Pseudomonas aeruginosa, now, more than 40 years later, there is a resurgence of interest in using this mode of delivery as a primary therapy for ventilator-associated tracheobronchitis and an adjunctive therapy for ventilator-associated pneumonia.     

医院获得性肺炎、呼吸机相关性肺炎、卫生保健相关性肺炎的最新治疗进展

尽管目前有很好的抗生素治疗,对症支持治疗和预防,但是医院获得性肺炎(HAP)、呼吸机相关性肺炎(VAP)和卫生保健相关性肺炎(HCAP)仍是导致患者发病和死亡的重要原因,本文对 HAP,VAP 和 HCAP 的最新治疗进展将在此作一综述。     

呼吸机相关性肺炎的预防研究进展

呼吸机相关性肺炎是机械通气患者常见并发症,是重症监护病房院内感染主要原因.目前,该病发病率、病死率高,预防可能是控制该病流行和发病的最佳策略.该文将近年来有关呼吸机相关性肺炎预防措施的研究进展作一综述,旨在寻找有效的预防措施,以降低呼吸机相关性肺炎的发病率和病死率.     

呼吸机相关性气管支气管炎研究进展

在重症监护室机械通气的患者中,下呼吸道感染有很高的发病率,并且也是死亡的重要原因.对于呼吸机相关性肺炎(VAP)的治疗和预防已有很多认识,但是对于呼吸机相关性气管支气管炎(VAT)的研究却很少.VAT是一种相对局限性的疾病,由于目前还没有对VAT明确的统一定义,所以很难对VAT和VAP进行鉴别.如果患者出现下呼吸道感染,微生物检查阳性,胸片没有新的或进行性加重的浸润影,就应该考虑到VAT,如果进一步发展就可能转化成VAP,故对VAT有针对性的抗生素治疗可能是预防VAP和改善患者治疗效果的新策略.     

Diagnosis of ventilator-associated respiratory infections (VARI): microbiologic clues for tracheobronchitis (VAT) and pneumonia (VAP)

Intubated patients are at risk of bacterial colonization and ventilator-associated respiratory infection (VARI). VARI includes tracheobronchitis (VAT) or pneumonia (VAP). VAT and VAP caused by multidrug-resistant (MDR) pathogens are increasing in the United States and Europe. In patients with risk factors for MDR pathogens, empiric antibiotics are often initiated for 48 to 72 hours pending the availability of pathogen identification and antibiotic sensitivity data. Extensive data indicate that early, appropriate antibiotic therapy improves outcomes for patients with VAP. Recognizing and treating VARI may allow earlier appropriate therapy and improved patient outcomes.     

呼吸机相关性气管-支气管炎

机械通气患者的下呼吸道感染包括呼吸机相关性气管-支气管炎和呼吸机相关性肺炎.下呼吸道细菌定植的数量、类型和毒力与宿主免疫力之间的关系决定着患者感染的部位和范围.目前两者在诊断上的区别只是影像学上有无肺部新发或是进展性浸润影,致使临床上许多气管-支气管感染患者被忽视;而度时治疗呼吸机相关性气管-支气管感染可以增加撤机后生存时间、降低继发呼吸机相关性肺炎发病率和重症监护病房病死率;同时抗生素雾化疗法是否对早期呼吸道细菌定植甚至感染控制有益需要进一步评估.本文就呼吸机相关性气管-支气管感染诊疗研究进行文献复习.     

Can endocan be a new biomarker in ventilator-associated pneumonia?

Ventilator-Associated Pneumonia (VAP) is a hospital-acquired bacterial infection with high incidence and mortality rate. The aim of this study is to investigate the correlation between the Endocan level and development of VAP and whether or not this correlation was correlated with the clinical findings. Demographic data, white blood cell (WBC) count, procalcitonin (PCT), c-reactive protein (CRP), and fever levels of 60 patients were recorded in serial measurements for 5 days. When there was the presence of fever or elevated Endocan, alveolar lavage culture was taken and chest radiographies were taken. Correlations of the Endocan levels with the culture results and laboratory values were examined. The rate of VAP was found as 10.4/1000 mechanical ventilator days. Endocan levels were significantly higher in patients with VAP (p < 0.05). However, there was no significant difference among PCT, WBC, CRP measurements (p > 0.05). No correlation was found between Endocan levels and PCT, WBC and CRP levels in those with VAP (p > 0.05). A significant correlation was found between the Endocan level and the elevated fever 24 h later (p:0.001). The serum Endocan level on the day 3 had a specificity of 73.3%, a sensitivity of 68.9%, positive predictive value of 44%, and negative predictive value of 88.5% at the cut off level of 9.17 ng/mL. In this study, it was determined that high Endocan levels were associated with the development of VAP. The present study suggested that Endocan can be used as a screening tool for the development of VAP.

呼吸机相关性肺炎诊断、预防和治疗指南的质量评价

目的 评价国内2013年颁布的呼吸机相关性肺炎诊断、预防和治疗指南(VAP指南)的质量,了解当前指南存在的问题,为今后更新该指南和开发其他循证指南提供方法学参考.方法 利用指南质量评价工具AGRE EⅡ评价指南质量.结果 VAP指南六个领域得分情况为:范围和目的79％,参与人员68％,制定的严谨性70％,表达的明晰性81％,应用性40％,编辑独立性0％.结论 国内2013年颁布的呼吸机相关性肺炎循证指南质量中等,仍需在指南报告规范和应用性、编辑独立性方面进一步加强.     

联合纤维支气管镜灌洗治疗呼吸机相关性肺炎疗效观察

目的 观察联合纤维支气管镜灌洗治疗呼吸机相关性肺炎的临床效果.方法 将我院自2008年8月至2011年4月间40例呼吸机相关性肺炎患者随机分成两组,每组20例,两组均给予常规抗炎、支持治疗,治疗组给予联合纤维支气管镜灌洗治疗.结果 治疗组在控制炎症时间、出现严重并发症、缩短住院时间、降低住院成本方面优于对照组.结论 联...     

呼吸机相关性肺炎的发病因素及相关的预防措施

呼吸机相关性肺炎（ventilator associated pneumonia，VAP）为重症病房最常见的医院内获得性感染，具有较高的发病率和死亡率。只有对其发病机制和流行病学有较全面了解，才可能提出合理的预防措施。     

呼吸机相关性肺炎病原学特点及耐药性分析

目的 分析我院呼吸机相关性肺炎(VAP)的病原学特点及耐药情况.方法 对我院综合重症监护室和呼吸重症监护室2011年1月至2012年8月诊断为VAP的44例患者病原学资料进行回顾性分析.结果 44例患者支气管分泌物培养获得致病菌83株,其中革兰阴性杆菌63株,占75.9％;革兰阳性球菌14株,占16.9％;真菌6株,占7.2％.革兰阴性杆菌中占前6位的分别是鲍曼不动杆菌、嗜麦芽窄食单胞菌、铜绿假单胞菌、肺炎克雷伯菌、产吲哚黄杆菌、阴沟肠杆菌;革兰阳性球菌主要是金黄色葡萄球菌.所分离菌株均不同程度表现多重耐药.结论 VAP的主要病原菌为革兰阴性杆菌,常为多重耐药的致病菌,临床医师应根据病原菌学及抗菌药物敏感性资料,及时选择合理的抗生素控制感染,延缓耐药菌株的产生.     

气管导管生物膜与呼吸机相关性肺炎

呼吸机相关性肺炎在机械通气患者中非常常见,因其高发病率、病死率及高医疗费用,使其成为ICU工作者不得不面临的难题之一.本文就呼吸机相关性肺炎的发病机制及其预防措施作一概述.     

急性肺损伤大鼠肺Ⅰ型和Ⅲ型胶原合成的变化

目的:探讨急性肺损伤大鼠肺Ⅰ型和Ⅲ型胶原合成的变化.方法:SD大鼠24只,随机分为正常对照组、潮气量(VT)8 ml/kg组(A组)和16ml/kg组(B组),每组8只.A、B两组分别机械通气4 h,通气结束后测定肺组织湿/干重(W/D)、肺泡灌洗液与血浆蛋白比值、Ⅰ型和Ⅲ型前胶原mRNA表达及其比值、Ⅰ型和Ⅲ型前胶原肽(PINP和PⅢNP)浓度.结果:①与正常对照组肺组织W/D比较,A组和B组均显著增加(P均＜0.05),B组又明显高于A组(P＜0.05);②正常对照组和A组肺泡灌洗液与血浆蛋白比值无显著差异,而B组显著高于前两组(P＜0.05);③Ⅰ型前胶原mRNA表达在正常对照组与A组之间无显著差异,而B组显著高于前两组(P均＜0.05);④Ⅲ型前胶原mRNA表达在正常对照组与A组之间无显著差异,B组显著高于前两组(P均＜0.05);⑤Ⅰ型前胶原与Ⅲ型前胶原mRNA比值3组间比较均无显著差异(P＞0.05);⑥PⅠ NP、PⅢNP表达3组间比较均无显著差异(P＞0.05).结论:高潮气量通气导致正常大鼠出现肺损伤,Ⅰ型和Ⅲ型前胶原mRNA表达增加,但4 h内并未出现Ⅰ型和Ⅲ型前胶原比值增加,胶原蛋白尚未增加.