Crit Care Med:呼吸机械通气患者是否需要使用抗生素治疗?

2017-06-17 MedSci MedSci原创

近期,一项发表在杂志Crit Care Med上的研究旨在评估表现为吸入性细菌性肺炎或非细菌性吸入性肺炎症状的ICU昏迷患者中记录的细菌吸入性肺炎患者的比例。此项研究为前瞻性观察研究,选取250名昏迷(格拉斯哥昏迷量表评分≤8)并使用侵入性机械通气治疗的ICU患者。此项研究的主要结果是微生物学记录的细菌吸入性肺炎患者的比例。满足预期吸入综合征标准的患者在开始概率性抗生素治疗之前,常规地在支气管镜检

近期,一项发表在杂志Crit Care Med上的研究旨在评估表现为吸入性细菌性肺炎或非细菌性吸入性肺炎症状的ICU昏迷患者中记录的细菌吸入性肺炎患者的比例。


此项研究为前瞻性观察研究,选取250名昏迷(格拉斯哥昏迷量表评分≤8)并使用侵入性机械通气治疗的ICU患者。

此项研究的主要结果是微生物学记录的细菌吸入性肺炎患者的比例。满足预期吸入综合征标准的患者在开始概率性抗生素治疗之前,常规地在支气管镜检查期间进行伸缩插管导管取样。当培养物为阴性时,停止抗生素治疗。

在250例患者中,98例(39.2%)有吸入综合征,其中92例为机械通气停止之前。这92例患者的伸缩插管导管显示细菌性吸入性肺炎有43例(46.7%)。其余49例患者中,16例继续接受抗生素治疗,通常为肺炎以外的感染;在停用抗生素的33例患者中,仅有两例随后出现肺部感染迹象。有6例为机械通气后发生吸入综合征,因此未进行伸缩导管插入,抗生素治疗持续7天。43例细菌性吸入性肺炎患者和49例非细菌吸入性肺炎患者的机械通气时间、ICU住院时间和死亡率无差异。152例无吸入综合征患者未接受抗生素治疗。

此项研究表明:在接受机械通气的昏迷患者中,没有临床、实验室或放射学证据的细菌吸入性肺炎的患者不需要抗生素。在疑似细菌吸入性肺炎的患者中,当常规伸缩插管导管取样回收无微生物时,停止经验性抗生素治疗几乎总是有效。

原始出处:
Lascarrou JB, Lissonde F, et al. Antibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia From Pneumonitis. Crit Care Med. 2017 Jun 7. doi: 10.1097/CCM.0000000000002525.


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    2017-06-19 Boyinsh
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    2017-06-17 131****1460

    学习了,受益匪浅。

    0

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    2017-06-17 Y—xianghai

    学习了新知识

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    2017-06-17 有备才能无患

    在接受机械通气的昏迷患者中,没有临床、实验室或放射学证据的细菌吸入性肺炎的患者不需要抗生素。在疑似细菌吸入性肺炎的患者中,当常规伸缩插管导管取样回收无微生物时,停止经验性抗生素治疗几乎总是有效。

    0

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    2017-06-17 1e0f8808m18(暂无匿称)

    据其有无细菌感杂决定是否用抗生素。

    0

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