预防VAP ：Bundle 的作用-马朋林教授.pptVIP

预防VAP: Bundle 的作用 Clinical practice guidelines for HAP and VAP in adults (Canada). 时间1997-2003 数据分析 Incidence of VAP： 16.9% of Patients 15.9/1000 MV-days Outcomes Attributable to VAPCrit Care Med 2005; 33:2184–2193 病源微生物相关吗？ Impact of MRSA VAP on mortality : a systematic review Determinants and impact of MDR in pathogens causing VAP 高危因素：病人群体 病人性别 Ventilator-Associated PneumoniaInsights From Recent Clinical Trials 病人年龄是问题吗？ 多器官功能障碍综合征患者呼吸机相关性肺炎的危险因素分析 A Prospective Study of Ventilator-Associated Pneumonia in Children 机械通气时间 A prospective study in 23 Italian ICUs 724 critically ill patients (MV 24 hours) VAP: mean rate of 23%; 5% : MV for 1 day 69%: MV for 30 days Am Rev Respir Dis 1989;140:302–305. Epidemiology of VAP in a Long-Term Acute Care Hospital A total of 23 CDC-defined cases of VAP occurred in 19 patients during 13,746 ventilator days.The cumulative VAP incidence was 14.6% (23 of 157 admissions), and the incidence rate was 1.67 cases /1,000 ventilator-days, which was a 56% reduction from theVAP rate of 3.8 cases per 1,000 ventilator-days before the implementation of a VAP-bundle approach. MV 时间—VAP发生率并非线性相关 VAP 高危因素 Continuous Aspiration of Subglottic Secretions in the Prevention of VAP in the Postoperative Period of Major Heart Surgery CHEST 2008; 134:938–946 VAP 高危因素分析 Story from Current VAP Epidemiological Analysis 一双不干净的手，对一群缺乏抵抗能力的患者实施不规范的操作，导致呼吸机相关性肺炎的发生。 结果：花了大把的钱！增加了死亡风险！ IHI呼吸机Bundle内容 1、床头抬高 2、每日唤醒+脱机试验 3、消化性溃疡预防 4、深静脉血栓预防 Bundle 降低VAP的报道() Dominican Hospital： 97 days St. Vincent’s Hospital 255 days Virginia Mason Center 180 days University of Texas 50% reduction Naval Medical Center 150 days Our Lady of Lourdes 290 days University of Rochester 300 days VAP in a Military Deployed Setting: The Impact of an Aggressive Infection Control Program（ J Trauma. 2008;64:S123–S128） Implementing qualit