the paradox of ventilator-associated pneumonia prevention measures悖论与机械通气相关肺炎的预防措施.pdfVIP

Available online /content/13/5/315 Viewpoint The paradox of ventilator-associated pneumonia prevention measures Michael Klompas1,2 1Infection Control Department, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA 2Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Boston, MA 02215, USA Corresponding author: Michael Klompas, mklompas@ Published: 15 October 2009 Critical Care 2009, 13:315 (doi:10.1186/cc8036) This article is online at /content/13/5/315 © 2009 BioMed Central Ltd Abstract these strategies dramatically reduces VAP rates but almost There is a striking paradox in the literature supporting high-profile none has any impact on patients’ duration of mechanical measures to reduce ventilator-associated pneumonia (VAP): many ventilation, hospital length of stay, or mortality (Table 1). studies show significant reductions in VAP rates but almost none show any impact on patients’ duration of mechanical ventilation, Regular oral care with chlorhexidine, for example, reduces length of stay in the intensive care unit and hospital, or mortality. VAP rates by up to 37% to 66% but has no impact on The paradox is largely attributable to lack of specificity in the VAP duration of mechanical ventilation, intensive care unit (ICU) or definition. The clinical and microbiological criteria for VAP capture a population of patients with an array of conditions that range from hospital length of stay, or mortality [1-4]. Likewise, elevation serious to benign. Many of the benign ev