呼吸机相关肺炎——英文版课件精选.ppt

 Aetiology Diagnosis Noninvasive Diagnostic Strategies Invasive Diagnostic Strategies Noninvasive Diagnostic Strategies new or changing pulmonary infiltrates on chest radiograph, fever,leukocytosis, raised inflammatory markers, such as C-reactive protein (CRP), and purulent tracheal secretions. none is specific for VAP ! Cultures of endotracheal secretions Qualitative and Quantitative cultures serum biomarkers :CRP, PCT, sTREM-1… Invasive Diagnostic Strategies bronchoalveolar lavage (BAL) plugged telescoping catheter (PTC) protected specimen brush (PSB) Blinded bronchial sampling obtaining quantitative cultures of pulmonary secretions high sensitivity and specificity a culture threshold : distinguish infection from colonization quantitative culture threshold ≥105cfu/ml, ≥104cfu/ml resulted in a false-positive rate of 42% accurate diagnosis, no differences in mortality rates management Antimicrobial Therapy the most likely causative organism be started as early as possible based on individual patient factors Empirical Antimicrobial Therapy Single-Agent or Combination Therapy Duration of Therapy Nonresponse to Treatment Other Treatments Preventative Strategies Patient Position Heat and Humidification Suctioning of Secretions Selective Digestive Decontamination and Oral Decontamination Preventive ‘Bundles’ In patients admitted to the trauma ICU, a bundle of preventive strategies for VAP (daily evaluation for a spontaneous breathing trial, appropriate sedation level using the Richmond Agitation-Sedation Scale, head-of-bed elevation, and oral and hypopharyngeal hygiene) ‘FASTHUG’ concept (daily evaluation of patients’ feeding, analgesia, sedation, thromboembolic prophylaxis, elevation of the head of the bed, ulcer prophylaxis, and glucose control) Conclusions 天津市第一中心医院 天津市第一中心医院 天津市第一中心医院 Diagnosis, Management and Prevention of Ventilator-Associated Pneumonia ：An Update Intubation-associated pneumonia ?