Leeper K V
Department of Medicine, University of Tennessee-Memphis 35153.
New Horiz. 1993 Nov;1(4):550-62.
Nosocomial bacterial pneumonia, or the recently introduced term, "ventilator-associated pneumonia," is a common cause of infection in adult respiratory distress syndrome (ARDS). The presence of ventilator-associated pneumonia in ARDS patients is associated with prolonged ventilatory support and increased mortality rates. Unfortunately, clinical and radiographic diagnoses of pneumonia are sensitive but nonspecific and, at best, select a patient population for which further diagnostic evaluation is warranted. The empiric use of broad-spectrum antibiotics in mechanically ventilated patients without pneumonia may be harmful by facilitating colonization and superinfection with virulent organisms. Recent techniques for sampling lower respiratory tract secretions (protected specimen brushing, bronchoalveolar lavage), via fiberoptic bronchoscopic and nonbronchoscopic guidance have been used to establish improved accuracy in the diagnosis of pneumonia. Although these methodologies are not in widespread use in the ICU setting, the results obtained, when properly performed and with carefully processed specimens, may direct the clinician to the appropriate antibiotic therapy and provide a method of assessing its effectiveness. Moreover, if pneumonia is not confirmed, then an aggressive reevaluation of fever and pulmonary infiltrates in the patient with ARDS is indicated.
医院获得性细菌性肺炎，或最近提出的术语“呼吸机相关性肺炎”，是成人呼吸窘迫综合征（ARDS）中常见的感染原因。ARDS患者中呼吸机相关性肺炎的存在与通气支持时间延长和死亡率增加有关。不幸的是，肺炎的临床和影像学诊断敏感但不特异，充其量只是选择出需要进一步诊断评估的患者群体。在没有肺炎的机械通气患者中经验性使用广谱抗生素可能会因促进毒性微生物的定植和二重感染而有害。最近通过纤维支气管镜和非支气管镜引导对下呼吸道分泌物进行采样的技术（保护性标本刷检、支气管肺泡灌洗）已被用于提高肺炎诊断的准确性。尽管这些方法在重症监护病房环境中尚未广泛使用，但如果操作得当且标本处理仔细，所获得的结果可能会指导临床医生选择合适的抗生素治疗并提供评估其疗效的方法。此外，如果未确诊肺炎，则表明需要对ARDS患者的发热和肺部浸润进行积极的重新评估。
