急性呼吸衰竭抗生素的使用（英文ppt）antibioticsin acute respiratory

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1、AntibioticsinAcuteRespiratoryFailureRobinJGreenPhDDivisionofPaediatricPulmonologyUniversityofPretoriaDefinitionsALI-acuteonsetofimpairedgasexchangePaO2/FIO2<300ARDS-PaO2/FIO2<200Oxygenationindex=(MAPxFI02/Pao2)x100AcuteLungInjuryCAPHIV-associatedpneumoniaHAP/VAPVirallungdiseaseDefin

2、itionCommunityAcquiredPneumoniaAcuteinfection(lessthan14days)acquiredinthecommunity,ofthelowerrespiratorytract,leadingtocoughordifficultybreathing,tachypnoeaorchest-wallindrawingAccountsfor30-40%ofallhospitaladmissionsCasefatalityrate15-28%ZarHJ,etalSAMJ2005CausesCommunityAcquiredPn

3、eumoniaBacterial:-StrepPneumoniae-Haemophilusinfluenzae-Staphaureus-MoraxellacatarrhalisAtypicalbacteria-Mycoplasmapneumoniae-Chlamydaphilapneumoniae/trachomatisViral-RSV-Humanmetapneumovirus-Parainfluenza-Adenovirus-Influenza-Rhinovirus-MeaslesvirusCausesofCommunityAcquiredPneumoni

4、aInadditioninHIV-infectedchildrenGram-negativebacteriaStaphaureus(includingCommunityAcquired-MRSA)TBFungiOrganismscultured–PaediatricWard–PretoriaAcademicHospitalTreatmentCommunityAcquiredPneumoniaAntibiotisforall–Amoxicillin(90mg/kg/daytds5days)–(IVAmpicillin)<2monthsaddaminoglycos

5、ide/cephalosporin>5yearsaddmacrolideHIV-infectionaddaminoglycosideHIV-exposed<6monthsaddcotrimoxazoleAIDSaddcotrimoxazoleZarHJ,etalSAMJ2005HIV-infectedchildrenNoevidencethatPK/PDprinciplesaredifferenttohealthychildrenAllspecimensshowedresistancetoco-trimoxazole.SavitreeChaloryooInte

6、rnationalJournalofPediatricOtorhinolaryngology1998;44:103-107BrinkA.PersonnelcommunicationPCPPneumoniaDiagnosis:-Immunecompromised-Respiratorydistressandfewcrepitations-InterstitialpatternonCXR-LDH>500-PCR3.FluidsinAcuteRespiratoryDistressSyndrome/AcuteLungInjuryNHLBIandARDSnet-FACT

7、TtrialConservativefluidmanagementstrategyfavouredIncreaseinventilatorfreedaysandreductioninICUstay,lowerOI,plateaupressure,PEEP,higherPaO2/FIO2NoincreaseratesofshockorrenalfailureNeedtocloselymonitorelectrolytesCalfeeCS,MatthayMA.Chest2007;131:913-19ManagingSeverePCPPneumoniaLungpro

8、tectivestrategies(l