Chastre J, Fagon J Y, Trouillet J L
Service de Réanimation Médicale, Hôpital Bichat, Paris, France.
Clin Infect Dis. 1995 Dec;21 Suppl 3:S226-37. doi: 10.1093/clind/21.supplement_3.s226.
The optimal management strategy for ventilator-dependent patients who develop symptoms suggestive of lung infection remains controversial. Our personal bias is that using bronchoscopic techniques to obtain protected-brush and bronchoalveolar lavage specimens from the affected area in the lung permits physicians to devise a therapeutic strategy that is superior to one based only on clinical evaluation. These bronchoscopic techniques, when they are performed before new antibiotics are administered, enable physicians to identify most patients who need immediate treatment and to select optimal therapy, in a form that is safe and well tolerated by patients. Furthermore, they frequently permit physicians to withhold antimicrobial treatment from patients without infection, thereby minimizing the risk of emergence of resistant microorganisms in the intensive care unit. Despite many advances in antimicrobial therapy, successful treatment of patients with nosocomial pneumonia remains a complex undertaking, and ultimately further trials will be needed to clarify the optimal duration of treatment and the circumstances in which monotherapy can be safely used.
对于出现肺部感染症状的呼吸机依赖患者，最佳管理策略仍存在争议。我们个人的观点是，使用支气管镜技术从肺部感染区域获取保护性毛刷和支气管肺泡灌洗标本，能让医生制定出比仅基于临床评估的策略更优的治疗方案。在使用新抗生素之前进行这些支气管镜技术操作，能使医生识别出大多数需要立即治疗的患者，并选择最佳治疗方法，且该方法对患者安全且耐受性良好。此外，它们常常能让医生不对未感染患者进行抗菌治疗，从而将重症监护病房中耐药微生物出现的风险降至最低。尽管抗菌治疗取得了许多进展，但医院获得性肺炎患者的成功治疗仍是一项复杂的任务，最终还需要进一步试验来明确最佳治疗时长以及能安全使用单一疗法的情况。
