Palmer Lucy B
Pulmonary Critical Care Division, State University of New York, Department of Medicine, Stony Brook, New York 11794-8172, USA.
Curr Opin Crit Care. 2009 Oct;15(5):413-8. doi: 10.1097/MCC.0b013e328330abcf.
This review will summarize recent clinical data examining the efficacy of aerosolized antimicrobial therapy in treating respiratory tract infections in mechanically ventilated patients in the ICU.
Aerosolized antibiotics provide high levels of drug in the lung and reduce the systemic toxicity associated with intravenous antibiotics. First introduced in the 1970s as a form of prophylaxis for ventilator-associated pneumonia (VAP), now, more than 30 years later, there is a resurgence of interest in using this mode of delivery as primary or adjunctive treatment for ventilator-associated tracheobronchitis (VAT) or VAP. Increasingly resistant organisms are colonizing and infecting critically ill patients, and direct delivery of antibiotic to the lung is being re-evaluated as a means to treat these highly resistant organisms that may not respond to systemic therapy. There are new data emerging that suggest these agents may effectively treat these pathogens when used in targeted, time limited protocols.
Aerosolized antibiotic therapy may provide an efficacious means of treating respiratory tract infection when targeted at mechanically ventilated patients with proximal airway infection, VAT (with or without VAP) and with highly resistant organisms.
本综述将总结近期关于雾化抗菌治疗在重症监护病房机械通气患者呼吸道感染治疗中疗效的临床数据。
雾化抗生素可在肺部提供高浓度药物，并降低与静脉使用抗生素相关的全身毒性。雾化抗生素于20世纪70年代首次作为预防呼吸机相关性肺炎（VAP）的一种形式被引入，如今，30多年后，人们对将这种给药方式用作呼吸机相关性气管支气管炎（VAT）或VAP的主要或辅助治疗重新产生了兴趣。越来越多的耐药菌正在定植并感染重症患者，将抗生素直接输送至肺部正作为一种治疗可能对全身治疗无反应的高度耐药菌的手段而被重新评估。新出现的数据表明，当按照有针对性的、限时方案使用这些药物时，可能有效治疗这些病原体。
当针对患有近端气道感染、VAT（无论有无VAP）且感染高度耐药菌的机械通气患者时，雾化抗生素治疗可能是一种有效的呼吸道感染治疗手段。
