呼吸机相关事件研究进展

Progress of ventilator-associated events

一直以来,对呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的监测始终存在诊断标准复杂、主观性大、可比性差、归因病死率低以及很难实现自动化监测等弊端,美国疾病预防控制中心于2013年1月开发出呼吸机相关事件(ventilator-associated event,VAE)这一新的监测定义以解决VAP的现存问题。VAE监测具备诸多优势:较好地预测患者的不良预后、采用客观的诊断标准、能够实现自动化监测等。与此同时,VAE监测也存在一些不足:对VAP患者的识别较差、目前为止依然缺乏足够的预防策略相关证据、在新生儿及儿童群体的应用尚无定论、和VAP一样容易被人为干涉等。VAE在我国的适用性及其危险因素和预防策略均有待进一步研究。

For a long time, the monitoring of ventilator-associated pneumonia(VAP) has many drawbacks, such as complex diagnostic criteria, high subjectivity, low comparability, low attributable mortality, and difficulty in automated monitoring. The U.S. Center for Disease Control and Prevention proposed a new monitoring definition of ventilatorassociated event(VAE) in January 2013 to address the existing problems of VAP. VAE monitoring can better predict the adverse prognosis of patients, adopt objective diagnostic criteria, and realize automatic monitoring. However, VAE surveillance also has some shortcomings: poor identification of VAP patients, lack of sufficient evidence of preventive strategies so far, inconclusive application in neonates and children groups, as easy to be interfered with as VAP. The applicability of VAE in China, its risk factors and preventive strategies need to be further studied.