Mattner F, Gastmeier P
Medizinische Hochschule Hannover.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2005 Feb;40(2):79-84. doi: 10.1055/s-2004-825929.
Because of the high morbidity and mortality associated with health-care-associated pneumonia, it is important to implement evidence-based prevention measures. Recently by CDC published Guidelines for Preventing Health-Care-Associated Pneumonia describe prevention measures based on evaluated studies, randomized controlled trials or meta-analyses. In this paper the most important prevention measures are given, as well as the evidence classification. "Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of or tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions."
鉴于医疗保健相关肺炎的高发病率和高死亡率,实施循证预防措施非常重要。美国疾病控制与预防中心(CDC)近期发布的《预防医疗保健相关肺炎指南》描述了基于评估研究、随机对照试验或荟萃分析的预防措施。本文给出了最重要的预防措施以及证据分类。“在预防细菌性肺炎,尤其是呼吸机相关性肺炎的建议变化中,包括在接受机械辅助通气的患者中优先使用经气管插管而非鼻气管插管,使用无创通气以减少气管插管的需求和持续时间,在呼吸机出现故障或明显污染时更换呼吸回路,以及(在可行的情况下)使用带有背侧腔的气管插管以排出呼吸道分泌物。”