登山者 发表于 2013-12-20 15:31

Diagnosis of ventilator-associated pneumonia



Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard



Philip E. Grguricha,b,c, Jana Hudcovab,d,e, Yuxiu Leib,f,g, Akmal Sarwarb,e,f,
and Donald E. Cravenb,e,g

Purpose of review
The aim is to discuss the clinical, microbiologic, and radiological criteria used in the diagnosis of ventilatorassociated pneumonia (VAP), distinguish between ventilator-associated tracheobronchitis (VAT) and VAP, and reconcile the proposed Centers for Disease Control surveillance criteria with clinical practice.
Recent findings
Numerous ventilator-associated complications (VACs), including VAP and VAT, may occur in critically ill, intubated patients. A variety of definitions for identifying VAP have been proposed, but there is no diagnostic gold standard. The proposed surveillance definition will identify infectious and noninfectious VAC, including VAP and VAT, but this definition may be inadequate for clinical practice.
Summary
The clinical characteristics of VAP and VAT are similar and include fever, leukocytosis, and purulent sputum. An infiltrate on chest radiograph is consistent with VAP but lacks diagnostic precision, so it is not a criterion in the proposed surveillance definition and should be interpreted cautiously by clinicians. Microbiologically, quantitative and semiquantitative endotracheal aspirate cultures may be employed to diagnose VAP and VAT. Positive bronchoalveolar lavage and protected specimen brush cultures are useful only for the diagnosis of VAP. Experts should collaborate to evelop consensus definitions for VAP and VAT that can be applied in practice.
Keywords
Centers for Disease Control surveillance definition, clinical diagnosis, multidrug resistant bacteria, ventilator-associated pneumonia, ventilator-associated tracheobronchitis







登山者 发表于 2013-12-20 15:32

目前，VAP最新的变化。

田田~ 发表于 2013-12-20 15:43

赞一个，咱们感控非常需要这种循证的更新

登山者 发表于 2013-12-20 17:16

iamliujy 发表于 2013-12-20 15:43 static/image/common/back.gif
赞一个，咱们感控非常需要这种循证的更新

这是篇review，不能完成算循证研究。仅仅是个综述而已。

不过，通过它的总结，我们了解了目前VAP诊断和监测中存在的问题和挑战。

牛牛2013 发表于 2013-12-20 17:32

已经下载学习，谢谢您的分享

鬼才 发表于 2013-12-21 00:31

这是一篇非常好的VAP诊断综述文献，反映了最新的动态。值得学习参考。

姬如意 发表于 2014-8-15 12:35

谢谢分享，正好需要这方面的知识和资料！
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