医院内肺炎和呼吸机相关肺炎诊断、严重程度评估和抗感染治疗.ppt

文档介绍：2017/11/14
Bijie
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HAP and VAP: diagnosis, severity assessment and antimicrobial therapy医院内肺炎和呼吸机相关肺炎诊断、严重程度评估和抗感染治疗
复旦大学附属中山医院
Zhongshan Hospital of Fudan University
胡必杰 Bijie HU
Hospital-Acquired Pneumonia (HAP): Definitions
HAP:
Arises 48 hours or more after hospital admission
Is not incubating at the time of admission
Ventilator-associated pneumonia (VAP):
Arises 48-72 hours or more after endotracheal intubation
Healthcare-associated pneumonia (HCAP):
Arises within 90 days of having been admitted to an acute care facility & pt. has resided in a nursing home or LTCF
(American Thoracic Society/IDSA. Am J Respir Crit Care Med 2005;171:388-416)
ical pneumonia这个词
使用“医疗相关感染”(health care–associated infection)或缩写为HAI,ial(医院内的)一词
医院获得性肺炎也改用医疗相关肺炎(health care–associated pneumonia),英文缩写仍为HAP,ical pneumonia一词
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Hospital Location & Relative Frequency of HAP & VAP
HAP
14%
ICU
HAP
%
Non-ICU
HAP
%
VAP
86%
Non-ICU HAP
ICU HAP
VAP
ICU HAP
HAP
ICU
(Kumpf G et al. J Clin Epidemiol 1998;54:495-502)
(Lizioli A et al. J Hosp Infect 2003;54:141-148)
(Richards MJ et al. Crit Care Med 1999;27:887-892)
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Diagnosis 诊断
Non-invasive Strategy for Diagnosing HAP/VAP
Clinical approach
New lung infiltrate
new onset fever, leukocytosis or purulent sputum
non-quantitative bacterial analysis of endotracheal aspirate
Drawback – relatively non-specific for HAP
Heyland et al. demonstrated adequacy of clinical criteria for VAP diagnosis in RCT (BAL with quantitation vs. non-quantitative endotracheal aspirate): no difference in 28 d mortality or LOS in ICU or hospital
(ATS, Am J Respir Crit Care Med 1996;153:1711-1725)
(Helling TS, Van Way C, Krantz S, et al. Am J Surg 1996;171:570-575)
(Hubmayr RD et al ATS Consensus Statement Intensive Care Med 2002;28:1521-1536)
(Canadian Critical Care Trials Group. NEJM 2006;355:2619-2630)
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肺部感染临床诊断困难:“类肺炎”
充血性心衰,肺栓塞
急性肺损伤与ARDS
过敏性肺炎,嗜酸细胞浸润性肺炎