Hessen M T, Kaye D
Department of Medicine, Medical College of Pennsylvania, Philadelphia.
Crit Care Clin. 1988 Apr;4(2):245-57.
Nosocomial pneumonia remains a challenging problem in critically ill patients in terms of both diagnosis and therapy. The clinical picture is often confusing; confounding factors such as congestive heart failure, ARDS, and interstitial lung disease may obscure the presence of pneumonia. Previous antimicrobial therapy or the presence of large numbers of colonizing organisms contribute to the difficulty of diagnosis. The use of sheathed fiberoptic bronchoscopy with quantitative culture and biopsy is probably the best initial invasive test when routine diagnostic methods fail; open lung biopsy remains the ultimate standard for diagnosis. Empiric therapy is often necessary and should be designed to treat organisms suspected of being the etiologic pathogens either on the basis of preliminary laboratory results (gram and acid-fast stains) or the clinical setting.
医院获得性肺炎在重症患者的诊断和治疗方面仍然是一个具有挑战性的问题。临床表现往往令人困惑；诸如充血性心力衰竭、急性呼吸窘迫综合征和间质性肺病等混杂因素可能会掩盖肺炎的存在。先前的抗菌治疗或大量定植菌的存在增加了诊断的难度。当常规诊断方法失败时，使用带定量培养和活检的鞘式纤维支气管镜检查可能是最佳的初始侵入性检查；开胸肺活检仍然是诊断的最终标准。经验性治疗通常是必要的，应根据初步实验室结果（革兰氏染色和抗酸染色）或临床情况来设计，以治疗怀疑是致病病原体的微生物。
