Recognition and prevention of nosocomial pneumonia in the intensive care unit and infection control in mechanical ventilation
Recognition and prevention of nosocomial pneumonia in the intensive care unit and infection control in mechanical ventilation
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DOI：
10.1097/ccm.0b013e3181e6cc98
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发表时间：
2010-08-01
影响因子：
8.8
通讯作者：
Kollef, Marin H.
中科院分区：
文献类型：
--
作者：
Morrow, Lee E.;Kollef, Marin H.
由于存在潜在的心肺疾病（例如，肺挫伤、急性呼吸窘迫综合征、肺不张）以及与该感染相关的非特异性放射学和临床体征。此外，重症监护室环境中NP的分类变得越来越复杂，因为发生NP的患者类型变得更加多样化。NP的发生尤其成问题，因为它与更大的住院死亡风险、更长的机械通气和重症监护室停留时间、更大的气管造口术需求以及显著增加的医疗护理成本相关。NP对医疗保健结果的不良影响增加了临床医生和医疗保健系统预防这种感染的压力，以及使呼吸衰竭患者住院过程复杂化的其他医院感染。本文将简要介绍目前诊断NP的方法，并重点介绍预防策略。最后，我们将提供一些关于机械通气患者的标准化或协议化护理如何减少并发症（如NP）的发生率和发病率的指导。(Crit Care Med 2010; 38[Suppl.]：S352-S362）
Nosocomial pneumonia (NP) is a difficult diagnosis to establish in the critically ill patient due to the presence of underlying cardiopulmonary disorders (e.g., pulmonary contusion, acute respiratory distress syndrome, atelectasis) and the nonspecific radiographic and clinical signs associated with this infection. Additionally, the classification of NP in the intensive care unit setting has become increasingly complex, as the types of patients who develop NP become more diverse. The occurrence of NP is especially problematic as it is associated with a greater risk of hospital mortality, longer lengths of stay on mechanical ventilation and in the intensive care unit, a greater need for tracheostomy, and significantly increased medical care costs. The adverse effects of NP on healthcare outcomes has increased pressure on clinicians and healthcare systems to prevent this infection, as well as other nosocomial infections that complicate the hospital course of patients with respiratory failure. This manuscript will provide a brief overview of the current approaches for the diagnosis of NP and focus on strategies for prevention. Finally, we will provide some guidance on how standardized or protocolized care of mechanically ventilated patients can reduce the occurrence of and morbidity associated with complications like NP. (Crit Care Med 2010; 38[Suppl.]:S352-S362)