新生儿和儿童呼吸机相关性肺炎：诊断方法和预防的系统分析。
Ventilator-associated pneumonia in neonates and children: a systematic analysis of diagnostic methods and prevention.
机构信息
Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki Greece.
出版信息
Future Microbiol. 2018 Sep;13:1431-1446. doi: 10.2217/fmb-2018-0108. Epub 2018 Sep 26.
AIM
While ventilator-associated pneumonia (VAP) remains frequent in Pediatric ICU, there is no gold standard for diagnosis.
METHODOLOGY
We conducted a systematic PUBMED analysis (January 1990-January 2017) searching original, full-length studies addressing only pediatric patients; for VAP diagnosis, only those comparing different diagnostic methods and for VAP prevention those implementing preventive measures.
RESULTS
Among 367 articles, 17 and 16 were analyzed for diagnosis and prevention, respectively. For diagnosis, 13 studies used CDC criteria; whereas, 14 assessed algorithms: clinical pulmonary index score, ventilator-associated events and biomarkers. Among five randomized trials assessing preventive strategies one found a role of probiotics. Ventilator-care bundles reduced VAP rates.
CONCLUSION
Absence of diagnostic gold standard impedes comparison of current approaches and preventive strategies.
目的
虽然呼吸机相关性肺炎（VAP）在儿科重症监护病房（PICU）仍然很常见，但目前还没有诊断的金标准。
方法
我们进行了系统的 PUBMED 分析（1990 年 1 月至 2017 年 1 月），仅检索了针对儿科患者的原创性、全文研究；对于 VAP 的诊断，仅比较了不同诊断方法的研究；对于 VAP 的预防，仅检索了实施预防措施的研究。
结果
在 367 篇文章中，有 17 篇和 16 篇分别用于分析诊断和预防。对于诊断，有 13 项研究使用了 CDC 标准；而有 14 项研究评估了算法：临床肺部指数评分、呼吸机相关事件和生物标志物。在五项评估预防策略的随机试验中，有一项发现了益生菌的作用。呼吸机护理包可降低 VAP 发生率。
结论
缺乏诊断的金标准阻碍了对当前方法和预防策略的比较。
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