Deng Jiayi, Li Fanglin, Zhang Ningjie, Zhong Yanjun
Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, China.
Front Pharmacol. 2022 Oct 19;13:945892. doi: 10.3389/fphar.2022.945892. eCollection 2022.
Ventilator-associated pneumonia (VAP) is the most common acquired infection in the intensive care unit. Recent studies showed that the critical COVID-19 patients with invasive mechanical ventilation have a high risk of developing VAP, which result in a worse outcome and an increasing economic burden. With the development of critical care medicine, the morbidity and mortality of VAP remains high. Especially since the outbreak of COVID-19, the healthcare system is facing unprecedented challenges. Therefore, many efforts have been made in effective prevention, early diagnosis, and early treatment of VAP. This review focuses on the treatment and prevention drugs of VAP in COVID-19 patients. In general, prevention is more important than treatment for VAP. Prevention of VAP is based on minimizing exposure to mechanical ventilation and encouraging early release. There is little difference in drug prophylaxis from non-COVID-19. In term of treatment of VAP, empirical antibiotics is the main treatment, special attention should be paid to the antimicrobial spectrum and duration of antibiotics because of the existence of drug-resistant bacteria. Further studies with well-designed and large sample size were needed to demonstrate the prevention and treatment of ventilator-associated pneumonia in COVID-19 based on the specificity of COVID-19.
呼吸机相关性肺炎（VAP）是重症监护病房中最常见的获得性感染。最近的研究表明，接受有创机械通气的危重型新冠患者发生VAP的风险很高，这会导致更差的预后和不断增加的经济负担。随着重症医学的发展，VAP的发病率和死亡率仍然很高。特别是自新冠疫情爆发以来，医疗系统面临着前所未有的挑战。因此，在VAP的有效预防、早期诊断和早期治疗方面已经做出了许多努力。这篇综述聚焦于新冠患者VAP的治疗和预防药物。一般来说，对于VAP预防比治疗更重要。VAP的预防基于尽量减少机械通气暴露并鼓励尽早脱机。药物预防与非新冠患者相比差异不大。在VAP的治疗方面，经验性使用抗生素是主要治疗方法，但由于存在耐药菌，应特别注意抗生素的抗菌谱和使用时长。基于新冠的特殊性，需要进一步开展设计良好且样本量较大的研究来论证新冠患者呼吸机相关性肺炎的防治。
