Anesthesiology and Intensive Care Department, AP-HP, Hôpital Cochin, 75014, Paris, France.
UMR1137 IAME, INSERM, Université de Paris, 75018, Paris, France.
Intensive Care Med. 2021 Mar;47(3):292-306. doi: 10.1007/s00134-020-06338-2. Epub 2021 Feb 9.
The respiratory microbiome has been less explored than the gut microbiome. Despite the speculated importance of dysbiosis of the microbiome in ventilator-associated pneumonia (VAP) and acute respiratory distress syndrome (ARDS), only few studies have been performed in invasively ventilated ICU patients. And only the results of small cohorts have been published. An overlap exists between bacterial populations observed in the lower respiratory tract and the oropharyngeal tract. The bacterial microbiota is characterized by relatively abundant bacteria difficult to cultivate by standard methods. Under mechanical ventilation, a dysbiosis occurs with a drop overtime in diversity. During VAP development, lung dysbiosis is characterized by a shift towards a dominant bacterial pathogen (mostly Proteobacteria) whereas enrichment of gut-associated bacteria mainly Enterobacteriaceae is the specific feature discriminating ARDS patients. However, the role of this dysbiosis in VAP and ARDS pathogenesis is not yet fully understood. A more in-depth analysis of the interplay between bacteria, virus and fungi and a better understanding of the host-microbiome interaction could provide a more comprehensive view of the role of the microbiome in VAP and ARDS pathogenesis. Priority should be given to validate a consensual and robust methodology for respiratory microbiome research and to conduct longitudinal studies. A deeper understanding of microbial interplay should be a valuable guide for care of ARDS and VAP preventive/therapeutic strategies. We present a review on the current knowledge and expose perspectives and potential clinical applications of respiratory microbiome research in mechanically ventilated patients.
与肠道微生物组相比，呼吸微生物组的研究较少。尽管有推测认为微生物组失调与呼吸机相关性肺炎（VAP）和急性呼吸窘迫综合征（ARDS）有关，但在接受有创机械通气的 ICU 患者中仅进行了少数研究。而且，只有小队列的研究结果已经发表。在下呼吸道和口咽tract 中观察到的细菌种群之间存在重叠。细菌微生物群的特征是相对丰富的细菌，难以通过标准方法培养。在机械通气下，随着时间的推移，会发生微生物失调，多样性逐渐下降。在 VAP 发展过程中，肺部微生物失调表现为优势细菌病原体（主要是 Proteobacteria）的转移，而肠道相关细菌（主要是肠杆菌科）的富集是区分 ARDS 患者的特征。然而，这种微生物失调在 VAP 和 ARDS 发病机制中的作用尚未完全阐明。更深入地分析细菌、病毒和真菌之间的相互作用，并更好地了解宿主-微生物组的相互作用，可以更全面地了解微生物组在 VAP 和 ARDS 发病机制中的作用。应优先验证呼吸微生物组研究的共识和稳健方法，并进行纵向研究。更深入地了解微生物相互作用应该是 ARDS 和 VAP 预防/治疗策略的宝贵指导。我们对当前的知识进行了综述，并介绍了机械通气患者呼吸微生物组研究的现状和潜在临床应用。
