Xie Xinming, Lyu Jun, Hussain Tafseel, Li Manxiang
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
Clinical Research Center, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
Front Pharmacol. 2019 Mar 28;10:298. doi: 10.3389/fphar.2019.00298. eCollection 2019.
Ventilator-associated pneumonia (VAP) is one of the most prevalent and serious complications of mechanical ventilation, which is considered a common nosocomial infection in critically ill patients. There are some great options for the prevention of VAP: (i) minimize ventilator exposure; (ii) intensive oral care; (iii) aspiration of subglottic secretions; (iv) maintain optimal positioning and encourage mobility; and (v) prophylactic probiotics. Furthermore, clinical management of VAP depends on appropriate antimicrobial therapy, which needs to be selected based on individual patient factors, such as previous antibacterial therapy, history of hospitalization or mechanical ventilation, and bacterial pathogens and antibiotic resistance patterns. In fact, antibiotic resistance has exponentially increased over the last decade, and the isolation of a multidrug-resistant (MDR) pathogen has been identified as an independent predictor of inadequate initial antibiotic therapy and which is significantly associated with increased mortality. Multiple attempts were used in the treatment of VAP, such as novel antibacterial agents, inhaled antibiotics and monoclonal antibodies. In this review, we summarize the current therapeutic options for the prevention and treatment of VAP, aiming to better management of VAP in clinical practice.
呼吸机相关性肺炎(VAP)是机械通气最常见且严重的并发症之一,被认为是重症患者常见的医院感染。预防VAP有一些很好的方法:(i)尽量减少呼吸机使用时间;(ii)加强口腔护理;(iii)吸引声门下分泌物;(iv)保持最佳体位并鼓励活动;(v)预防性使用益生菌。此外,VAP的临床管理取决于适当的抗菌治疗,这需要根据个体患者因素来选择,如先前的抗菌治疗、住院或机械通气史,以及细菌病原体和抗生素耐药模式。事实上,在过去十年中抗生素耐药性呈指数级增长,多重耐药(MDR)病原体的分离已被确定为初始抗生素治疗不足的独立预测因素,且与死亡率增加显著相关。治疗VAP采用了多种方法,如新型抗菌药物、吸入性抗生素和单克隆抗体。在本综述中,我们总结了目前预防和治疗VAP的治疗选择,旨在更好地在临床实践中管理VAP。