1、天津市第一中心医院 Diagnosis, Management and Prevention of Ventilator-Associated Pneumonia：An UpdateAetiology ?leading microorganisms in VAP : Gram-negative enteric bacilli Staphylococcus aureus（almost 50% were MRSA ） Pseudomonas aeruginosa DiagnosisNoninvasive Diagnostic Strategies Invasive Diagnostic Strat
2、egies Noninvasive Diagnostic Strategies new or changing pulmonary infiltrates on chest radiograph, fever,leukocytosis, raised inflammatory markers, such as C-reactive protein (CRP), and purulent tracheal secretions. none is specific for VAP !Cultures of endotracheal secretions Qualitative and Quanti
3、tative cultures serum biomarkers :CRP, PCT, sTREM-1Invasive Diagnostic Strategies bronchoalveolar lavage (BAL) plugged telescoping catheter (PTC) protected specimen brush (PSB)Blinded bronchial sampling obtaining quantitative cultures of pulmonary secretions high sensitivity and specificity a cultur
4、e threshold : distinguish infection from colonization quantitative culture threshold 105cfu/ml, 104cfu/ml resulted in a false-positive rate of 42%accurate diagnosis, no differences in mortality rates managementAntimicrobial Therapy the most likely causative organism be started as early as possible b
5、ased on individual patient factors Empirical Antimicrobial Therapy Single-Agent or Combination Therapy Duration of Therapy Nonresponse to Treatment Other Treatments Preventative Strategies Patient Position Heat and Humidification Suctioning of Secretions Selective Digestive Decontamination and Oral
6、Decontamination Preventive Bundles In patients admitted to the trauma ICU, a bundle of preventive strategies for VAP(daily evaluation for a spontaneous breathing trial, appropriate sedation level using the Richmond Agitation-Sedation Scale, head-of-bed elevation, and oral and hypopharyngeal hygiene) FASTHUG concept (daily evaluation of patients feeding, analgesia, sedation, thromboembolic prophylaxis, elevation of the head of the bed, ulcer prophylaxis, and glucose control) Conclusions
