Roux Damien, van Oort Pouline M, Ricard Jean-Damien, Bos Lieuwe D J
Inserm, IAME, UMR 1137, Paris Diderot University, Paris, France.
Department of Intensive Care, Academic Medical Center, Amsterdam, the Netherlands.
Ann Transl Med. 2017 Nov;5(22):445. doi: 10.21037/atm.2017.08.05.
The incidence of ventilator-associated pneumonia (VAP) is estimated to be around 10% in a high-risk population. Over the last decade, major improvements have been made in the prevention of VAP, with great cost-effectiveness. However, we still do not understand the exact pathogenesis of VAP. A better understanding might explain why some patients develop ventilator-associated tracheobronchitis, while others develop VAP even though they are infected with the same types of pathogens. Microbiome research has been a hot topic in translational medicine over the past decade. Slowly, microbiome research has also been introduced to the intensive care setting. One of the areas where it may influence our pathophysiological considerations is in VAP. The adapted island has been proposed for the colonization and infection of the respiratory tract. In this model, not only the immigration of bacteria into the lung is important, but elimination and regional growth factors are of equal significance. The importance of these factors can be supported by epidemiological studies. Several small observational studies on the development of the pulmonary microbiome during mechanical ventilation also support this theory. We speculate on the consequences of the newest insights in microbiome research on the prevention and targeted treatment of VAP. We conclude that there is still a strong need for more in-depth analyses of the changes in the microbial composition of the pulmonary microbiome during mechanical ventilation and with the development of VAP.
据估计，高危人群中呼吸机相关性肺炎（VAP）的发病率约为10%。在过去十年中，VAP的预防取得了重大进展，具有很高的成本效益。然而，我们仍然不清楚VAP的确切发病机制。更好地理解这一点或许可以解释为什么有些患者会发生呼吸机相关性气管支气管炎，而另一些患者即使感染了相同类型的病原体却会发生VAP。微生物组研究在过去十年一直是转化医学中的热门话题。慢慢地，微生物组研究也被引入到重症监护领域。它可能影响我们病理生理学思考的一个领域就是VAP。有人提出了适应性岛屿用于呼吸道的定植和感染。在这个模型中，不仅细菌向肺部的迁移很重要，清除和局部生长因子同样具有重要意义。这些因素的重要性得到了流行病学研究的支持。几项关于机械通气期间肺部微生物组发育的小型观察性研究也支持这一理论。我们推测微生物组研究的最新见解对VAP预防和靶向治疗的影响。我们得出结论，仍然非常需要对机械通气期间以及VAP发生过程中肺部微生物组的微生物组成变化进行更深入的分析。
