诊断VAP:文献分析

David

Crit Care. 2008 Apr 21;12(2):R56. [Epub ahead of print] Links
Diagnosis of ventilator-associated pneumonia: a systematic review of the literature.
诊断VAP:文献分析
Rea-Neto A, Youssef NC, Tuche F, Brunkhorst F, Ranieri VM, Reinhart K, Sakr Y.
Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University Hospital, 07743 Jena, Germany. yasser.sakr@med.uni-jena.de.

Abstract
Introduction
Early, accurate diagnosis is fundamental in the management of patients with ventilator-associated pneumonia (VAP). The aim of this qualitative review was to compare various criteria of diagnosing VAP in the intensive care unit (ICU) with a special emphasis on the value of clinical diagnosis, microbiological culture techniques, and biomarkers of host response.

Methods
A MEDLINE search was performed using the keyword 'ventilator associated pneumonia' AND 'diagnosis'. Our search was limited to human studies published between January 1966 and June 2007. Only studies of at least 25 adult patients were included. Predefined variables were collected, including year of publication, study design (prospective/retrospective), number of patients included, and disease group.

Results
Of 572 articles fulfilling the initial search criteria, 159 articles were chosen for detailed review of the full text. A total of 64 articles fulfilled the inclusion criteria and were included in our review. Clinical criteria, used in combination, may be helpful in diagnosing VAP, however, the considerable inter-observer variability and the moderate performance should be taken in account. Bacteriologic data do not increase the accuracy of diagnosis as compared to clinical diagnosis. Quantitative cultures obtained by different methods seem to be rather equivalent in diagnosing VAP. Blood cultures are relatively insensitive to diagnose pneumonia. The rapid availability of cytological data, including inflammatory cells and Gram stains, may be useful in initial therapeutic decisions in patients with suspected VAP. C-reactive protein, procalcitonin, and soluble triggering receptor expressed on myeloid cells are promising biomarkers in diagnosing VAP.

Conclusion
An integrated approach should be followed in diagnosing and treating patients with VAP, including early antibiotic therapy and subsequent rectification according to clinical response and results of bacteriologic cultures.

harmoni

要
简介
早期，准确的诊断是呼吸机相关肺炎（VAP）病人管理的基础工作。本研究定性地回顾评价各种ICU的VAP诊断标准在临床诊断、微生物培养技术和生物标志宿主反应过程中的价值。
方法
以“呼吸机相关性肺炎”和“诊断”为关键词在MEDLINE中进行搜索。搜索范围限定在1966年1月到2007年6月出版的人体研究，且研究的样本不应少于25个成年患者。预变量为出版时间、研究设计（前瞻性或回顾性研究）、患者人数和疾病种类。
结果
有572篇文章符合搜索标准，其中159篇文章用来全文回顾。共有64篇包含有诊断标准的文章纳入我们的回顾性研究。临床标准的混合性使用可能有助于诊断VAP，但必须充分考虑到测量数据的变异和一般表现。临床观察较细菌学数据更能增加诊断的准确性。通过不同方法获得的定量培养可能对诊断VAP作用相当。相对其他方法，血培养对肺炎诊断缺乏敏感性。细胞学资料及时且有效，其中包括炎细胞和戈蓝染色都会对可疑的VAP患者的首次治疗的选定发挥一定作用。C反应蛋白、降钙素和可溶性髓系细胞表达的触发受体在诊断VAP的诊断方面前途广阔。
结论
在诊断和治疗VAP患者全过程中，我们应整合各种诊断方法，来指导早期抗生素化疗和后期基于临床效果观察和细菌培养结果上的治疗方案调整。
（译的不好，敬请指正。）

David

迎您常来！

harmoni

专家交流是我的荣幸.
如果时间充裕,还想译一点<isolation 2007>,众人拾柴火焰高．