Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control.
Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control.
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DOI：
10.1007/s00134-009-1742-7
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发表时间：
2010-02
影响因子：
38.9
通讯作者：
Zhang, Haibo
中科院分区：
文献类型：
--
作者：
Antonelli, Massimo;Azoulay, Elie;Bonten, Marc;Chastre, Jean;Citerio, Giuseppe;Conti, Giorgio;De Backer, Daniel;Lemaire, Francois;Gerlach, Herwig;Hedenstierna, Goran;Joannidis, Michael;Macrae, Duncan;Mancebo, Jordi;Maggiore, Salvatore M.;Mebazaa, Alexandre;Preiser, Jean-Charles;Pugin, Jerome;Wernerman, Jan;Zhang, Haibo
任何延迟适当的抗生素治疗可能危及呼吸机相关性肺炎（VAP）的结果。然而，VAP的诊断和最佳治疗仍然是重症医师面临的挑战。Jung等人在一项113例经支气管肺泡灌洗证实的VAP的研究中，评估了使用每周一次常规定量气管内抽吸（EA）培养结果指导初始抗生素治疗的潜在影响。在EA指导下，初始抗生素方案在85%的情况下是适当的，这一比例明显优于应用ATS指南（73%）。当临床医生没有VAP前EA来指导他们的治疗时（EA未执行组），只有61%的治疗是适当的，这证实了常规监测培养可能有助于提高VAP经验性抗生素治疗的充分性。呼吸物理治疗和早期活动被建议预防和治疗VAP。Patman等人对144例获得性脑损伤（ABI）患者进行了一项前瞻性、随机对照试验，研究物理治疗的效果。本研究发现，常规的呼吸物理治疗方案，包括体位、手动过度充气和每天重复6次的吸痰，在常规的医疗/护理之外，并没有显著降低成人ABI的VAP发生率、MV或ICU/住院时间。由于诊断为VAP的患者数量较少，因此无法就呼吸物理治疗是否在MV持续时间、ICU/住院时间或每日CPIS评分等临床变量方面加速VAP的恢复得出任何结论。先前的研究已经确定，铜绿假单胞菌的获得与缺乏抗假单胞菌活性的抗菌药物的施用有关。然而，在这方面，抗假单胞菌药物的作用尚不清楚。在一项旨在比较重症监护环境中抗生素混合使用与循环使用策略的干预研究中，马丁内斯等人能够收集有关抗生素暴露和铜绿假单胞菌定植的详细纵向数据。他们的数据表明，喹诺酮类药物和抗假单胞菌头孢菌素实际上可能阻止铜绿假单胞菌的获得，而哌西林-他唑巴坦和阿米卡星可能会增强这种获得。关于耐药性的获得，他们发现喹诺酮类药物和头孢菌素是相当中性的，而所有其他药物也与其他抗生素的耐药性获得有关。有趣的是，在连续治疗3天之前，耐药性的出现从未达到可检测的水平，联合治疗对预防无效。
Any delay in adequate antibiotic treatment may compromise the outcome of ventilator-associated pneumonia (VAP). However, the diagnosis and optimal treatment of VAP remain a challenge for intensivists. Jung et al.[1] assessed the potential impact of using results of once-aweek routine quantitative endotracheal aspirate (EA) cultures to guide initial antibiotic treatment in a study of 113 episodes of bronchoalveolar lavage-confirmed VAP. When guided by EA, the initial antibiotic regimen was adequate in 85% of situations, a proportion significantly superior to that resulting from application of the ATS guidelines (73%). When clinicians did not have a pre-VAP EA to guide their treatment (EA not performed group), only 61% of treatments were adequate, confirming that routine surveillance cultures may help to improve the adequacy of empiric antibiotic therapy for VAP. Respiratory physiotherapy and early mobilisation have been suggested to both prevent and treat VAP. Patman et al.[2] performed a prospective, randomised controlled trial in 144 patients with acquired brain injury (ABI) on the effect of physiotherapy. This study found that a regular respiratory physiotherapy regimen including positioning, manual hyperinflation and suctioning repeated six times per day, when provided in addition to routine medical/nursing care, did not significantly reduce the incidence of VAP, length of MV or ICU/hospital stay for adults with ABI. Due to the small number of patients diagnosed with VAP, it was not possible to draw any conclusions as to whether respiratory physiotherapy hastens the recovery from VAP in terms of duration of MV, length of ICU/hospital stay or clinical variables such as the daily CPIS score.Previous studies have established that acquisition of P. aeruginosa is associated with the administration of antimicrobial agents devoid of antipseudomonal activity. In this regard, however, the role of antipseudomonal agents is less clear. During an intervention study aimed to compare a mixing versus a cycling strategy of antibiotics use in the critical care setting, Martinez et al.[3] were able to gather detailed longitudinal data about exposure to antibiotics and colonisation by P. aeruginosa. Their data suggest that quinolones and antipseudomonal cephalosporins may actually prevent the acquisition of P. aeruginosa, whereas piperacillin-tazobactam and amikacin may enhance it. With respect to the acquisition of resistance, they found that quinolones and cephalosporins were rather neutral, whereas all the other agents were associated with the acquisition of resistance also to other antibiotics. Interestingly, emergence of resistance never arose to detectable levels before 3 days of continuous therapy and combination treatment was not useful for prevention.
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影响因子：
38.9
作者：
Baldesi, Olivier;Michel, Fabrice;Papazian, Laurent
通讯作者：
Papazian, Laurent
DOI：
10.1164/ajrccm.162.6.9904099
发表时间：
2000-12-01
影响因子：
24.7
作者：
Fencl, V;Jabor, A;Figge, J
通讯作者：
Figge, J
影响因子：
38.9
作者：
Cordingley, Jeremy J.;Vlasselaers, Dirk;Van den Berghe, Greet
通讯作者：
Van den Berghe, Greet
影响因子：
38.9
作者：
Darmon, Michael;Schortgen, Frederique;Brochard, Laurent
通讯作者：
Brochard, Laurent
影响因子：
38.9
作者：
Berg, Ronan M. G.;Strauss, Gitte Irene;Moller, Kirsten
通讯作者：
Moller, Kirsten