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1、预防VAP:Bundle的作用解放军309医院急救部马朋林内容提要VAP流行病学1VAP预防Bundle2研究结果的启示3AmJRespirCritCareMedVol165.pp867–903,2002确切的发生率尚未可知ClinicalpracticeguidelinesforHAPandVAPinadults(Canada).RotsteinC,CanJInfectDisMedMicrobiol2008;19(1):19-53.ICUVAP:32.3%时间1997-2003数据分析IncidenceofVAP:16.9%ofPatients15.9/1000MV-days法国
2、11个ICUVAP监测数据库CritCareMed2009;37:2545-2551Ventilator-associatedpneumoniainadultsindevelopingcountries:asystematicreview.InterJInfectDis(2008)12,505—512OutcomesAttributabletoVAPCritCareMed2005;33:2184–2193ClinicalandeconomicconsequencesofVAP:Asystematicreview.CCM2005PatientswhodevelopVAPincur>$
3、10,019inadditionalhospitalcosts.AmJRespirCritCareMed165.pp867–903,2002ICUventilatedpatientswithVAPhavea2-to10-foldhigherriskofdeathcomparedwithpatientswithoutpneumonia.Mortality:VAPChastreJandFagonJYCritCareMed2009;37:2709-291852项研究包含4882个VAP患者12465个非VAP对照者VAP导致死亡相对风险度(RR)1.27(95%CI:1.15-1.39,
4、P<0.01)PublicationBiasI2=69%研究的差异性分析FortraumapatientsN=9ForARDSpatientsN=4I2=1.3%I2=0%病源微生物相关吗?AmJRespirCritCareMed165.pp867–903,2002ImpactofMRSAVAPonmortality:asystematicreviewEurRespirJ2008;31:625–632CriticalCare2008,12:R142DeterminantsandimpactofMDRinpathogenscausingVAP高危因素:病人群体病人性别Gendera
5、ndsexhormonespecificriskofventilatorassociatedpneumoniaaftercriticalillnessorinjuryDossettLA,S42SurgicalForumAbstracts.JAmCollSurg718of2,290patientsdevelopedVAP(31%).MalesweremorelikelytodevelopVAP(34%vs25%,p<0.001),andthisassociationremainedafteradjustingforageandillnessseverity(OR1.5,95%CI1.
6、2-1.8,p<0.001).Ventilator-AssociatedPneumoniaInsightsFromRecentClinicalTrialsKollefMH,CHEST2005,128(5suppl2)583S-591SVariablesAdjOR(95%CI)pValueTraumaadmission1.68(1.15–2.47)0.0079Malegender1.54(1.15–2.07)0.0042DurationofMV.d1.50(1.33–1.70)<0.0001Continuoussedation1.43(1.07–1.92)0.0158ENwithin
7、48hofMV2.65(1.93–3.63)<0.0001Parenteralnutrition3.27(2.24–4.75)<0.0001病人年龄是问题吗?PostgradMedJ2006;82:172–178.多器官功能障碍综合征患者呼吸机相关性肺炎的危险因素分析ChinJEmergMed,November2006,l115(111):1010AProspectiveStudyofVentilator-AssociatedPneumoniainChildrenPe