Objective: Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality( Chastre and Fagon, 2002; klompas, 2007) among mechanically venti- lated patients in the i...Objective: Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality( Chastre and Fagon, 2002; klompas, 2007) among mechanically venti- lated patients in the intensive care unit (ICU), with the incidence ranging from 9% to 27% ; crude mortality ranges from 25% to 50%.1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage (SSD) on the incidence of ventilated associated pneumonia in adult ICU patients. Methods: Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases (December 30, 2010). Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results: Ten RCTs with 2,314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk (RR) =0.52, 95% confidence interval (C/): 0.42-0.64, P〈0.000 01]. When SSD was compared with the control groups, the overall RR for ICU mortality was 1.00 (95% CI, 0.84-1.19) and for hospital mortality was 0.95 (95% CI, 0. 80-1.13). Overall, the subglottic drainage effect on the days of mechanical ventilation was -1.52 days (95% CI, -2.94 to -0.11) and on the ICU length of stay (LOS) was -0.81days (95% CI, -2.33 to -0.7). Conclusions: In this meta-analysis, when an endotracheal tube (ETT) with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi- mately 50%. Time on mechanical ventilation (MV) and the ICU LOS may be reduced, but no reduction in ICU or hospital mortality has been observed in published trials,展开更多
Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality...Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.展开更多
It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment....It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%;p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up.展开更多
目的系统评价中国新生儿呼吸机相关性肺炎(VAP)的危险因素,为临床制订预防策略提供依据。方法检索PubMed、Web of Science、中国知网(CNKI)、中国生物医学文摘数据库(CBM)、重庆维普(VIP)和万方数据库,收集研究中国新生儿VAP危险因素的...目的系统评价中国新生儿呼吸机相关性肺炎(VAP)的危险因素,为临床制订预防策略提供依据。方法检索PubMed、Web of Science、中国知网(CNKI)、中国生物医学文摘数据库(CBM)、重庆维普(VIP)和万方数据库,收集研究中国新生儿VAP危险因素的文献,按照纳入和排除标准筛选文献、提取数据并采用Revman5.1软件进行Meta分析。结果根据纳入排除标准,最终纳入20篇文献,病例1 145例,对照2 610例。影响新生儿发生VAP的危险因素包括机械通气(MV)≥3d、原发性肺部疾病、头部仰卧位、鼻胃管、早产、重插管、低体质量、血制品应用、剖宫产及肠外营养。结论临床上应针对中国新生儿VAP发病的相关危险因素采取针对性预防措施,从而降低VAP的发病率和病死率。展开更多
文摘Objective: Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality( Chastre and Fagon, 2002; klompas, 2007) among mechanically venti- lated patients in the intensive care unit (ICU), with the incidence ranging from 9% to 27% ; crude mortality ranges from 25% to 50%.1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage (SSD) on the incidence of ventilated associated pneumonia in adult ICU patients. Methods: Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases (December 30, 2010). Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results: Ten RCTs with 2,314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk (RR) =0.52, 95% confidence interval (C/): 0.42-0.64, P〈0.000 01]. When SSD was compared with the control groups, the overall RR for ICU mortality was 1.00 (95% CI, 0.84-1.19) and for hospital mortality was 0.95 (95% CI, 0. 80-1.13). Overall, the subglottic drainage effect on the days of mechanical ventilation was -1.52 days (95% CI, -2.94 to -0.11) and on the ICU length of stay (LOS) was -0.81days (95% CI, -2.33 to -0.7). Conclusions: In this meta-analysis, when an endotracheal tube (ETT) with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi- mately 50%. Time on mechanical ventilation (MV) and the ICU LOS may be reduced, but no reduction in ICU or hospital mortality has been observed in published trials,
文摘Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.
文摘It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%;p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up.
文摘目的系统评价中国新生儿呼吸机相关性肺炎(VAP)的危险因素,为临床制订预防策略提供依据。方法检索PubMed、Web of Science、中国知网(CNKI)、中国生物医学文摘数据库(CBM)、重庆维普(VIP)和万方数据库,收集研究中国新生儿VAP危险因素的文献,按照纳入和排除标准筛选文献、提取数据并采用Revman5.1软件进行Meta分析。结果根据纳入排除标准,最终纳入20篇文献,病例1 145例,对照2 610例。影响新生儿发生VAP的危险因素包括机械通气(MV)≥3d、原发性肺部疾病、头部仰卧位、鼻胃管、早产、重插管、低体质量、血制品应用、剖宫产及肠外营养。结论临床上应针对中国新生儿VAP发病的相关危险因素采取针对性预防措施,从而降低VAP的发病率和病死率。