2010-危重患者的感染-麻醉本2课时_PPT课件.ppt

危重病人的感染;教学要求;;; ;;危重病人的感染因素;;危重病人感染的特点;;ICU常见的感染;;VAP的诊断标准; VAP的诊断标准;中华医学会呼吸病学分会重症肺炎的标准： 1、意识障碍 2、呼吸频率30次/分 3、PaO260mmHg，PaO2/FiO2300，需机械通气 4、血压： 90/60mmHg 5、胸片示双侧或多肺叶受累，或48小 时内病变扩大≧50% 6、少尿：尿量20ml/h，或80ml/4h， 或急性肾功能衰竭需透析治疗 ;重症社区肺炎诊断标准 ;CAP常见病原体;HAP常见病原体;腹部感染;;尿路感染;颅内感染;Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C. Impact of adequate antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003; 31:2742-2751. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999; 115:462-474. Rello J, Gallego M, Mariscal D, Sonora R, Valles J. The value of routine microbial investigation in ventilator-associated pneumonia. Am J Respir Crit Care Med 1997; 156:196-200. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest 2002;122:262-268. Luna CM, Vujacich P, Niederman MS, Vay C, Gherardi C, Matera J, Jolly EC. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 1997; 111:676-685. Leibovici L, Drucker M, Konigsberger H et al. Septic shock in bacteremic patients: risk factors, features and prognosis. Scand J Infect Dis 1997; 29:71-75. Valles J, Rello J, Ochagavia A, Garnacho J, Alcala MA. Community-acquired bloodstream infection in critically ill adult patients: impact of shock and inappropriate antibiotic therapy on survival. Chest 2003; 123:1615-1624. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118:146-155. Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit.