ICU 中肺炎的雾化治疗。

Aerosol Therapy for Pneumonia in the Intensive Care Unit.

机构信息

Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, Paris Cedex 13 75651, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.

出版信息

Clin Chest Med. 2018 Dec;39(4):823-836. doi: 10.1016/j.ccm.2018.08.005.

DOI:10.1016/j.ccm.2018.08.005

PMID:30390752

Abstract

Antibiotic aerosolization in patients with ventilator-associated pneumonia (VAP) allows very high concentrations of antimicrobial agents in the respiratory secretions, far more than those achievable using the intravenous route. However, data in critically ill patients with pneumonia are limited. Administration of aerosolized antibiotics might increase the likelihood of clinical resolution, but no significant improvements in important outcomes have been consistently documented. Thus, aerosolized antibiotics should be restricted to the treatment of extensively resistant gram-negative pneumonia. In these cases, the use of a vibrating-mesh nebulizer seems to be more efficient, but specific settings and conditions are required to improve lung delivery.

摘要

在呼吸机相关性肺炎（VAP）患者中进行抗生素雾化治疗可使呼吸道分泌物中的抗菌药物浓度非常高，远远超过静脉途径给药的水平。然而，在患有肺炎的重症患者中，相关数据有限。雾化抗生素给药可能会增加临床缓解的可能性，但在重要结局方面并未一致记录到显著改善。因此，抗生素雾化治疗应仅限于治疗广泛耐药的革兰氏阴性菌肺炎。在这些情况下，使用振动网式雾化器似乎更有效，但需要特定的设置和条件才能改善肺部输送。