预防VAP ：Bundle 的作用-马朋林教授PPT.pptVIP

预防VAP: Bundle 的作用;内容提要;Am J Respir Crit Care Med Vol 165. pp 867–903, 2002;;Clinical practice guidelines for HAP and VAP in adults (Canada).;Outcomes Attributable to VAPCrit Care Med 2005; 33:2184–2193;Clinical and economic consequences of VAP: A systematic review. CCM 2005;Am J Respir Crit Care Med 165. pp 867–903, 2002;Crit Care Med 2009; 37: 2709-2918;Publication Bias;研究的差异性分析;For trauma patients N=9;病源微生物相关吗？;Impact of MRSA VAP on mortality : a systematic review;Critical Care 2008, 12:R142;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.;Respiratory Medicine (2007) 101, 762–767;Epidemiology of VAP in a Long-Term Acute Care Hospital;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;医源性因素;Story from Current VAP Epidemiological Analysis;内容提要;Prevention measures of VAP;IHI呼吸机Bundle内容;捆绑是 ’有” 或 ’无”的策略, 要麽不用, 要麽全部应用以取得治疗的成功。 每个病人, 每项措施均要落实;Reports from Lady of Lourdes Hospital, Binghampton, New York, USA ;Bundle 降低VAP的报道();VAP in a Military Deployed Setting: The Impact of an Aggressive Infection Control Program（ J Trauma. 2008;64:S123–S128）;Shorr A F, Kollef M H Chest 2005;128:583S-591S;Implementing quality improvements in the intensive care unit:Ventilator bundle as an example. ;Potential for publication bias;Conclusion:;呼吸机 Bundle临床依从性分析（N=166）2005.6-2008.6 ;Bundle 应用前后对照研究;内容提要;Bundle 内容的间的逻辑联系;Bundle内容中确切有效措施;1、床头抬高问题;原因：不能保持30-45度位置;Factors impacting on patient position;2. 每日唤醒-脱机;仅强调Wake-up不够;Depth of Sedation assessed by Motor Activity Level;计划镇静内容;缩短机械通气天