Bellani S, Nesci M, Celotto S, Lampati L, Lucchini A
Servizio di Anestesia e Rianimazione, Azienda Ospedaliera San Gerardo, Monza, Italia.
Minerva Anestesiol. 2003 Apr;69(4):315-9.
Ventilator associated pneumonia (VAP) is a nosocomial lower respiratory tract infection that ensues in critically ill patients undergoing mechanical ventilation. The reported incidence of VAP varies between 9% and 68% with a mortality ranging between 33% and 71%. Two key factors are implicated in the pathogenesis of VAP: bacterial colonization of the upper digestive-respiratory tract and aspiration of oral secretions into the trachea. Preventive measurements are advocated to reduce the incidence of VAP, such as selective decontamination of the digestive tract (SDD), supraglottic aspiration and positioning. Prompt recognition and treatment of established VAP has also been demostrated to affect outcome. Therefore, the knowledge of risk factors associated with the development of VAP and the implementation of strategies to prevent, diagnose and treat VAP are mainstems in the nursing of mechanically ventilated patients.
呼吸机相关性肺炎(VAP)是一种医院获得性下呼吸道感染,发生在接受机械通气的重症患者中。报道的VAP发病率在9%至68%之间,死亡率在33%至71%之间。VAP发病机制涉及两个关键因素:上消化道-呼吸道的细菌定植和口腔分泌物误吸入气管。提倡采取预防措施以降低VAP的发病率,如消化道选择性去污(SDD)、声门上吸引和体位摆放。已证实及时识别和治疗已发生的VAP会影响预后。因此,了解与VAP发生相关的危险因素以及实施预防、诊断和治疗VAP的策略是机械通气患者护理的核心内容。