Davis Kimberly A
Department of Surgery, Division of Trauma, Surgical Critical Care and Burns, Loyola University Medical Center, Maywood, IL, USA.
J Intensive Care Med. 2006 Jul-Aug;21(4):211-26. doi: 10.1177/0885066606288837.
Ventilator-associated pneumonia is the most frequent intensive care unit (ICU)-related infection in patients requiring mechanical ventilation. In contrast to other ICU-related infections, which have a low mortality rate, the mortality rate for ventilator-associated pneumonia ranges from 20% to 50%. These clinically significant infections prolong duration of mechanical ventilation and ICU length of stay, underscoring the financial burden these infections impose on the health care system. The causes of ventilator-associated pneumonia are varied and differ across different patient populations and different types of ICUs. This varied presentation underscores the need for the intensivist treating the patient with ventilator-associated pneumonia to have a clear knowledge of the ambient microbiologic flora in their ICU. Prevention of this disease process is of paramount importance and requires a multifaceted approach. Once a diagnosis of ventilator-associated pneumonia is suspected, early broad-spectrum antibiotic administration decreases morbidity and mortality and should be based on knowledge of the sensitivities of common infecting organisms in the ICU. De-escalation of therapy, once final culture results are available, is necessary to minimize development of resistant pathogens. Duration of therapy should be based on the patient's clinical response, and every effort should be made to minimize duration of therapy, thus further minimizing the risk of resistance.
呼吸机相关性肺炎是需要机械通气的患者中最常见的重症监护病房（ICU）相关感染。与其他死亡率较低的ICU相关感染不同，呼吸机相关性肺炎的死亡率在20%至50%之间。这些具有临床意义的感染会延长机械通气时间和ICU住院时间，凸显了这些感染给医疗保健系统带来的经济负担。呼吸机相关性肺炎的病因多种多样，在不同患者群体和不同类型的ICU中有所不同。这种多样的表现突出了治疗呼吸机相关性肺炎患者的重症监护医生需要清楚了解其ICU中的环境微生物菌群。预防这一疾病过程至关重要，需要采取多方面的方法。一旦怀疑诊断为呼吸机相关性肺炎，早期给予广谱抗生素可降低发病率和死亡率，且应基于对ICU中常见感染病原体敏感性的了解。一旦获得最终培养结果，进行降阶梯治疗对于尽量减少耐药病原体的产生是必要的。治疗持续时间应基于患者的临床反应，应尽一切努力尽量缩短治疗持续时间，从而进一步降低耐药风险。
