Anesthesiology Department, Harborview Medical Center, University of Washington, Box 359724, 325 Ninth Avenue, Seattle, WA 98104, USA.
Respir Care. 2010 Aug;55(8):1046-55.
Ventilator-associated pneumonia (VAP) is a pervasive and expensive nosocomial infection that is largely related to instrumentation of the airway with an endotracheal tube (ETT), followed by microaspiration of contaminated secretions. VAP prevention will probably be most effective via a multifaceted approach, which includes meticulous attention to basic infection-control methods during patient care, proper patient positioning, oral hygiene, and removal of the ETT as soon as indicated. Modification of the ETT to reduce microaspiration and/or biofilm formation may also play an important role in VAP prevention. However, despite numerous studies of various such interventions, there is insufficient evidence upon which to base strong recommendations, and important safety concerns remain regarding the use of some devices. Most importantly, cost-effectiveness data are lacking for modified ETTs designed to prevent VAP. It is critical that future studies of ETTs designed to prevent VAP be adequately powered to demonstrate efficacy on important patient outcomes and safety, in addition to cost-effectiveness.
呼吸机相关性肺炎（VAP）是一种普遍且昂贵的医院获得性感染，主要与使用气管内插管（ETT）进行气道器械操作有关，随后是受污染的分泌物的微吸入。通过多方面的方法，VAP 的预防可能是最有效的，其中包括在患者护理过程中对基本感染控制方法的细致关注、正确的患者体位、口腔卫生以及一旦出现指征就尽快去除 ETT。对 ETT 进行改造以减少微吸入和/或生物膜形成也可能在 VAP 预防中发挥重要作用。然而，尽管对各种干预措施进行了大量研究，但仍缺乏有力推荐的充分证据，并且一些设备的使用仍存在重要的安全问题。最重要的是，用于预防 VAP 的改良 ETT 的成本效益数据尚缺乏。未来旨在预防 VAP 的 ETT 研究必须具有足够的效力，以证明在重要的患者结局和安全性方面的有效性，以及成本效益。
